24D-323 RC.1:0 oormg, LLP
51B Holyoke Street
P.O. Box 309 ■
Easthampton, MA 01027 Estimate Date
Phone (413) 527-4775 11/30/2006
Fax (413) 527-3469
Name/Address Job Location
Donna Riley 155 Prospect Street
155 Prospect Street Northampton, MA
Northampton. MA 01060 584-7935
Terms Rep
Estimate valid for 60 days Chris
Job Description Total
Remove existing roofs. 7,800.00
Furnish& install aluminum drip edge,pipe flashing and chimney flashing.
Furnish&install new lead counter flashings.
Furnish& install ice&water barrier along eaves and valleys.
Furnish& install 15 lb. felt over existing deck.
Furnish&install 30 year Tamko Heritage Series shingle.
Furnish& install Cor-A-Vent ridge vent.
Furnish& install Versico rubber roof system on flat roof section.
All exterior roofing related debris to be removed by R.C.I. Roofing.
All work to 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 square foot for wood replacement if needed.
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total $7,800.00
TERMS OF PAYMENT
30%Upon delivery of materials
70%Upon completion Customer Signature
Registration# 126235
Construction License#074334 Date
Insured by Reynolds,Barnes&Hebb,Inc.413-447-7376
Gzf� oaf 'Nartiiauip#ult
¢lasaachnactts'
o DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street a Municipal Building
Northampton, Macs. 01060
W ORICEIR'S COMPENSATION INSURANCE A.FF EDAVTT
15 1 le Of a. 0..T - Roofi n�-
0icacnsedpermittcc)
«ntta principal place of bus' ess/residence at:
(phone# -q?#75
street/ ty/statr/rip)
do 'hereby certuy, under the pains and penalties of perjury, that.
( , ? am an employer providing the following worker's compensation coverage for my
emDio%'ees woFEDg on this job:
atrne l anlnt l G011.0 681bb)0 10/5 /07
( ��1r anec Company) (Policy Number) (Expiration Dale)
a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below„vho have the following worker's compensation policies:
sNcum of Contractor) (Insurance Company/Policy Number) (Expiration Date)
Name of Contractor} (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) Gnsurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance CompanyNolicy Numbcr) (Expiration Date)
(Aaacti a6l ccu.l 6-1 if nec-2ary to tnc}tKra information pertaining to all oc radors)
( ) I am a sole proprietor and have no one worEng for me.
( ) Y am a home owner performing all the work myself.
?TOTE:plcsae be aw2re that whilo homcowners wbo=ploy pasom w do mainte awc,wn*uctioo or repair work on a dwelling of
rot:,"c thsn throe units in wbich the homeowner reside oc on the grounds V"tenud thactn are not gaxr2ny woAdend to be
c--np',oyc:-s under the%orkct'z ouxVxusutioa Act(GL152,ss 1(5)),aMlicxboa by a homeowner for a rupee cc permit may evidence the
,tom:cU tun of an employee under the workce,Compensation Act.
i un-icr:und thst a copy of this rtat«nmt may be foaworded to the Dopastmmt of Ioduutrial Aocideastr Office of ta—Um for the
o0vc-a6e verific mlioo and that fa ure to enure oovctity under section 25A of MOIL 152 can lad to tba imposition of csim w pwalties
Boa•4tirsg of a fmc'of up to S 1,500,00 alwor iarprboemcat of up to ox year and dvil panWes in the form of a Stop Work O tW aM a
rice of S(00.00 a day tpinsi ttx
For.4-t-�U”ooh'
Permit Ntvaber
Map# Lot# t.
Sipnaturc of Licrosec/Permittee
� �,4a�AUi�•G _ __ ��
SECTION 8-.CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : a ,e ;S e, - r77433 ,4
License Number
5 - T 0a? 5 - 03 - 08
Address Expiration Date
(j413) 523
Signature Telephone
Not Applicable ❑
C'. I. Roofi� 1 2,6 2.35
Com any Name Registration Number
o ko 5• ®b - 08
Address J Expiration Date
Telephon 75
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, or 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 persons)
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
r
SECTION 5- DESCRIPTIONsOF"PROPOSED WORF("(ch ck all applicable)
New House ❑ Addition ❑ Replacement Windows [Alteration(s) ❑ Roofing
Or Doors
El
Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other[ ]
Brief Description of Proposed Work: s h/aq k,,S
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet❑
sa: Ifi New Fio"use 'nd or tldttion9to exi`sti k� us ing,.cottiplefie h f tl it'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 Conservation Compliance. Mascheck 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 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 AGENTbR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, 1JU�lYIa Ill/�V as Owner of the subject property
hereby authorize .MaYk De-Visle. o(+ R-0-1- RoofinQ to act on
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, Mary `)1'i le- Q5___ �bj liciYi agent as Owner/Authorized Agent
hereby declare that the statements and information on the foregoinWapplication are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
Print Name
Signature of Owner/Agent Date
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:
City of Northampton
Building Department
212 Main Street
Room 100
Northampton, MA 01060
phone 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
This sec b co"
1.1 Property Address: 4
Zoriie 0►e�Ya Est
Elm St. District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
'Donna New t Me. l N`ton
Name(Print) Cx t,t1(I iili4-ec
rQss:
2i-acC P-A TelephoJnne 5
Sig nature
2.2 Authorized Agent:
mark-�)el WE
L E
- RT�._I_— R00f ono PU.C3lZX-.A i -Em6amotw- Ma
Name(Print) --�+7 Current Mailing Address: I O�Q^�il'1f
(�W) 527- IT75
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 '7800.06 (a) Building Permit Fee'
Electrical (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanica' (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 +4 + 5) 1 7900-00 Check Number S'�
This Section For Official Use Only
Building Permit Number: Date issued:
Signature:
Building Commissioner/Inspector of Buildings Date
BP-2007-0773
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-2007-0773
Project# JS-2007-001242
Est. Cost: $7800.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group_ RCI ROOFING 126235
Lot Size(sq. ft.): 4443.12 Owner: RILEY DONNA M
Zoning. URC Applicant: RCI ROOFING
AT. 155 PROSPECT ST
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTONMA01027-0309 ISSUED ON:21712007 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
I.Jnderground: 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 2/7/2007 0:00:00 $25.009916
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo