29-226 RC.I. RoOfMg, LLP
51B Holyoke Street
P.O.Box 309 Estimate
Date
Easthampton, MA 01027
Phone(413)527-4775 8/31/2006
Fax(413)527-8469
Name/Address Job Location
Kenneth Culver Garage Roof Only
152 Acrebrook Drive 152 Acrebrook Drive
Florence, MA 01062 Florence, MA
584-7092
Terms Rep
Estimate valid for 60 days Chris
Job Description Total
Remove existing roofs. 3,000.00
Furnish&install aluminum drip edge,pipe flashings and chimney flashings.
Furnish&install new lead counter flashings.
Furnish&install ice&water barrier along eaves and valleys.
Furnish and install 15 lb.felt over existing deck.
Furnish and install 30 year Tamko Heritage Series shingle.
Furnish and install Cor-A-Vent 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 year R.C.I.workmanship warranty included.
30 year Tamko material warranty included.
All related permits will be obtained by R.C.I. Roofing.
SPECIAL ITEMS NEEDED
Add$2.50 per sq. ft. for wood replacement if needed.
WE LOOK FORWARD TO DOING BUSINESS WITH YOU THIS WINTER.
Total $3,000.00
TERMS OF PAYMENT
30%Upon delivery of materials
70%Upon completion Customer Signature /L T—
Registration# 126235
Construction License#074334 Date
Insured by Reynolds,Barnes&Hebb,Inc.413-447-7376
4tttniaPft R
�a�l RChttLtCCi
DEPARTMENT OP BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFMI A.VIT
1fd1silp., of R- 0-1 - Roofin�-
(licenser/permitter)
-.;nth a principal place of business/residence at:
-5_ (phone#X1 -2--.qt7#75
street/ ty/statdzip)
10 hereby certify, under the pains and penalties of perjury, that:
V) I am an employer providing the following worker's compensation coverage for my
��11
�mployces woridng on this job:
AmeYican AomeASsuyanC WC$9bbgiS 0
(Insurance Company) (Policy Number) ira on Date)
; ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
she contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Coruparry/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additiocal greet if nea nary to inc}ude information pertaining to all coatraetors)
O I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:pica"be awvc that whila homwv naa who employ persom to do maint�omswietion or rcqaiir work oo a dwelling of
riot mac than throe units in Which the homoownac resides a oa the grounds appurtenant tbacto art:not goo airy 000ndered to be
cmploym undo the workce,ration Act(GL152,,=1(5)),application by a homeowner for a fictwe a permit may evidence the
legil rtauu of an employor under the wort &Compomation ACL
I uadast=d tlut a copy of this ant=**wAy bo fart/Wr W to the DtpartmQA of ludu+drid Aaidett&0IDa of lmtunoa rot dW
coverage vcrificatioa ttad that failure to roa,tre eovetngo trudsr section 23 A of MoL 152 can Itxd>4 the'imposit'soo of ecimioel peaeltia
ooasi ring of a fine of UP to S 1,500.00 md/or isz pr6oamcnt of up to ooe year and pvt7 pemlties I i the form of a Stop Wottt Ordet and a
rind of s 100.00 a nay agsi�tnc
For use only
Permit Number
W Map4
J� iy Signahtrc of Licensce/permitice �-.;
SECTION 5 'DESCRIPTION'OF'PROPOSED WORKI- chedkall applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ) Siding[ ] Other [ ]
Brief Description of Proposed Work: f
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative [I Renovating unfinished basement Yes No
Plans Attached Roll ❑ • Sheet O
sa°If New Flo exandtor addition'to.eXi`sting<Mu'ging, `complete tth f6110 �'I :
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 Ccnservation Compliance. Mascheck Energy Compliance form attached?
In. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
I. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a -OWNER AUTHORIZATION -.TO BE COMPLETED WHEN
OWNERS AGENT'OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, _ KermA 11 ex as Owner of the subject property
hereby authorize •M 2rk Defi s-At of R- • to act on
my behalf, in all matters relative to work authorized by this building permit application.
34o
Signature of Owner Dale
My k D isle- CIS cLl zPA as ent- as Owner/Authorized Agent
hereby declare that the statements and information on the foregoin application are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
Print Name
eJ'1 sl e-
31Q11oq
Signature of Owner/Agent Date
SECTION 8—CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :sJJdy 1)P1;51 t T74,334
4,33 4
— License Number
.51 T 027 5 -03 - 08
Address Expiration Date
Signature Telephone
- Not Applicable ❑
m r v men n r r
) It 235
Com any Name Registration Number
51 B 0 kjo re At - .Q x 3bl 5- ob - OS
Address J Expiration Date
-Ma. 01bag Telephon 175
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 building permit.
Signed Affidavit Attached Yes....... ❑ No...... ❑
The 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, cr is intended to be, 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 be 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.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature a,tt,dChe�
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Date Issued:
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property?YES_
No
IF YES, describe size, type and location:
a.
City of Northampton
Building Department
212 Main Street
Room 100
Northampton, MA 01060
pone 413.587.1240 Fax 413.587.1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: Th�ssecti°�" Ali `0"`�
15a-Here Yoph lY e, q
Zone ` w 0 rla is
Elm St. District - ,CBDPis"tact
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
icn h 0u)veir i5a AerebrooK -Nye, / F1oY�rx
Name(Print) Cursky il"¢ ss:
A ta6eA Telephone
Signature
2.2 Authorized Agent:
May hl)el i 51t - R. C.I. Rods no P. . ' OX 30q - East amotw Kai
Name(Print) Current Mailing Address: T 0102.7
C11 5�7- jig75
Sig ature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars) to be Official Use Only
completed by ermit applicant
1. Building Roof i n 3000 .00 (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) 000.00 Check Number
This Section for Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
BP-2007-0930
GIs#: COMMONWEALTH OF MASSACHUSETTS
�..
9 426 3;, 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-2007-0930
Project# JS-2007-001516
Est. Cost: $3000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sq. ft.): 14984.64 Owner: CULVER KENNETH R&
Zoning: URA Applicant: RCI ROOFING
AT. 152 ACREBROOK DR
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775
EASTHAMPTONMA01027-0309 ISSUED ON:41412007 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & 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 4/4/2007 0:00:00 $25.0010100
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo