23D-012 (11) BP-2009-0403
GIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2009-0403
Project# JS-2009-000543
Est.Cost: $15600.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sq.ft.): 12588.84 Owner: FREEMAN OTIS STANTON
Zoning:URB(100)/ Applicant: RCI ROOFING
AT: 8 NONOTUCK ST
Applicant Address: Phone: Insurance:
P 0 BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTONMAO1027-0309 ISSUED ON:10/9/2008 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP, PLY & SHINGLE ROOF
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 10/9/2008 0:00:00 $35.0012984
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
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Department use only
City of Northampton Status of Permit:
- 'Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
1Dh� 413=587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
'APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
Map Lot Unit
Yonoriac,K s tree
Zone Overlay District
Elm St.District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Stan Fre_e.m a n g . ■ona cK St. /F'l orlerue.
Name(Print) Curre t a ing SS:
attae heCi � � - 58
Telephone
Signature
2.2 Authorized Agent:
' - f,.C.z. Roofin P.o.Box 309 - F2st}-�arnpton, ,Ma, -
Name(Print) J Current Mailing Address: 01027
t'.13) 521- 4115
Signature Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1 Building Roof., :3 t�4 1 5 )_0o� (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5 Fire Protection
6. Total = (1 +2 + 3 +4+5) 4 L,1 L0_0, 00 Check Number date( 0'35---
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
w
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Lxisting Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side I.: R: I,: R:
Rear
Bgilding I'eight
Hidg. Square Footage
Onen Space Footage %
t o area minus bide&paved
pa:-king)
31-Parking Spaces
Fill:
(volume&I_peation)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DON'T KNOW O YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW O YES Q
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained Q , Date Issued:
C. Do any signs exist on the property? YES (.2) NO Q
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO Q
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading, excavation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable)
New House I I Addition Replacement Windows Alteration(s) F-1 Roofing
Or Doors CI
Accessory Bldg. I I Demolition I I New Signs [O] Decks [E ] Siding [0] Other[D]
Brief Description of Proposed
Work: attaeh P11 -
Rip/ Re-dec new ;t./3 les
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing, complete the following:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will bui ding conform to the Building and Zoning regulations? Yes No .
I. Septic`ank City Sewer Private well City water Supply
SECTION 7a -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Stan Fre em an , as Owner of the subject
property
hereby authorize V M ar h --Del(S, Q€ Pt.C. I. Roo f∎■na
to act on my behalf, in all matters relative to work authorized by thislouilding permit application.
attaelled olg/Qg
Signature of Owner Date
I, Y 1Z -Deh Sk. as aL1t i Y I1ezi acie.tit , as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing Rep lication are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
aY1� I i s 1 e,
Print Name
Oig/0
Signature of Owner/Agent Date
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SECTION 8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
•
Name of License Holder: M aY 1 t el i s l e, '7'741334
License Number
51Bl Ho yoke St.- Easthampton, Ma. o toa.f/ 5 - 03 - 10
Address Expiration Date
Signature p
Tele hone
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9. Registered Home Improvement Contractor: Not Applicable ❑
• 126235
Company Name Registration Number
5( B Nolyoke Street - P 0• 'Box 301 5-Oh- I D
Address L� t1�f Expiration Date
th
Easampton/ Ma. o102.(1 Telephoncen 31521-4175
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the buildin permit.
Signed Affidavit Attached Yes No ❑
11. - Home Owner Exemption
T;ie current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner: Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is. or is intended to he.a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner.
Such"homeowner''shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will he required from time to time,during and upon
completion of the work,for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General laws Annotated,you may be liable for person(s)
you hire to perform work for you under this permit. •
I'he undersigned "homeowner-certifies and assumes responsibility 1or compliance with the State Building Code,City of
Northampton Ordinances.State and Local Zoning laws and State of Massachusetts General Laws Annotated.
Homeowner Signature at-4a oc �__-- • - —___-_-
wsk^.� - - Crrt of ki i iliainptnii 1 =*
y .
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-- DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal I3uilding
Northampton, Mass. 01060 toe''
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, L.Mar . Deli sle _of f.n.I. 'toilful
Nccnsedperm uec)
v.i:ii a principal place of business/residence at:
5J a }4o1.nkr St./Eastharn 1`ovi Pia. O.iOai (phone#�1113)5at7-X1'775
f strcct/c?ty/ statehip)
cc/hereby certify, under the pains and penalties of perjury, that:
(\. I am an employer providing the following worker's compensation coverage for my
ea:olovees working on this job:
National Union F`iYe.
Ins. Co offittshix PA VVtC3631?6 005/09
r (Policy Number)
(Expiration Date)
I am a sole proprietor, general contractor or homeowner (circle one) and have hired
he contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(:.:t ch slitimil s xct if necessary to include infortnatioc pertaining to all contra ton)
( ) I gun a sole proprietor and have no one working for me.
) I am a home owner performing all the work myself.
NOTE:plc:ac be aware that while hom era who employ pins to do muntro� ,construction or repair work on a dwelling of 7
r.nt rccc than three units in which the bomootvncr raider or oa the grounds appurtenant thereto are not generally 000ai•cred to be
rrp toyer-a under the worker's ration Act(GL152.ss 1(5)),application by a homeowner for a liana or permit may evidence the
etiM.I rtatue of an employee under the Works 'a Compomation Act.
I ua5crstand that a copy of this ctatcm at may be forwarded to the De artnrar of Induntriel Amide/di Office of lrouraooe for the
•x)Vsc verification and that failure to ccaur covcrugo undo'sociioa 15A of MCI 152 esa lead to lbw impositio i of Maki'peualda
'g of a.Ene'of up to S I,SOO.00 and/or itnprisonnnent of up to one year and civil penalties in the form of a Stop Work order and a '
...W of:;100.00 a day against inc.
For&p ut:menW rase Doty .
'°NO8 Permit Number
Signature of L / Map+t Lot#
iccnser/Permittcc a: - ':
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11.C. I. Roofing ,.
51B Holyoke Street
P.O. Box 309 Esti m ate
Easthampton, MA 01027 Date
Phone (413) 527-4775 9/8/2008
Fax (413) 527-8469
Name/Address Job Location
Stan Freeman 8 Nonotuck Street
8 Nonotuck Street Florence, MA
Florence, MA 01062 586-8958
Terms Rep
Estimate valid for 20 days Rich
Job Description Total
Remove existing roofs. 15,600.00
Furnish & install 1/2" plywood over existing decking.
Furnish & install aluminum drip edge, pipe flashings, chimney flashings and step flashings.
Furnish & install new lead counter flashings.
Furnish & install CertainTeed Winterguard ice & water barrier along eaves and valleys.
Furnish and install 15 lb. felt.
Furnish and install 30 year CertainTeed Woodscape Series shingle.
Furnish and install CertainTeed approved ridge vent.
All exterior roofing related debris to be removed by R.C.I. Roofing.
All work will be performed according to manufacturers' specifications.
5-Star CertainTeed Surestart Plus extended material and workmanship warranty included.
30 year CertainTeed material warranty included.
All related permits will be obtained by R.C.I. Roofing.
SPECIAL ITEMS NEEDED
THE OWNER HAS THE RIGHT TO CANCEL THE CONTRACT WITHIN (3)
THREE BUSINESS DAYS OF DATE OF SIGNING. Total $15.600.00
TERMS OF PAY MEN f
5%Deposit t
Balance upon completion Customer Signature C�Y " c .
Registration# 126235
Construction License#074334 Date ��
insured by Reynolds,Barnes&Hebb,Inc.413-447-7376