29-019 R.C.I ROOFING
40 MAINE AVE.
P.O. BOX 309
EASTHAMPTON, MA 01027-0309 FCESIMATE
PHONE (413')527- 4775
FAX (413)527-8469
Date: MARCH 5, 2002
Estimate To:
DONALD DADMUN Estimated By: CHRIS THOMPSON
30 BIRCH HILL RD. Start Date:
FLORENCE, MA. 01062 Job Location: 30 BIRCH HILL RD.
FLORENCE, MA. 01062
Job Phone: (413)584-0803
JOB DESCRIPTION
FURNISH INSTALL AIJ)MINUM DRfPFL)GE AND ALL OTHER RELATED FLASHTNGS.
INSTALL T(-F & WATER BARRIER 6, f1p ALONG F
7R 1 S H j INSTAr.L 7.51b.FELT
FURNTSH & INSTALL 30 YEAR TAMKn SHINGLE.
ALL ROOFING RELATED DEBRIS TO BE REMOVED RY RCI ROOFTNG.
ALL WOPK WILL PERFORMED ACcogr)TlVG To MANUpACTUgEg,� SPECIFICATIONS.
10 YEAR R.C.I. WORKMANSHTP WARRANTY TNCLUDED.
ALL RELATED PERMITS WILL BE QUTAINFD RY R-C.I. ROOFING,
SPECIAL ITEMS NEEDED
ADD $2.00 PER SQ. FT. FOR WOOD REPLACEMENT IF NEEDED.
CHIMNEY AND SKYLIGHTS WILL BE WRAPPED WITH ICE AND WATER BARRIER.
Additional information pertaining to this Job Estimate
TERMS OF PAYMENT
30%PRIOR TO START Total Estimated _
70%UPON COMPLETION Job Cosf�$10,200.00
REGISTRATION#126235
FEDERAL I.D.#04 3418839 Authorized, ) �?
CONSTRUCTION LICENSE#074334 Signature -3 j
INSURED BY HACKWORTH INSURANCE(413)527-9907 - /
ORIGINAL-ESTIMATOR COPY
L
p o Cr of twInt amptntt
z ,
.1�l:ssacftascttt'
r
DEPARTMENT OF BUIIDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFMAVrr
(lioansedpermittee)
with a principal place of business/residence at:
oL'-hone#) W3-627-Lo%7_7
(stncdci ty/staidzip)
do hereby certify, under the pains and penalties of perjury, that:
aln,an employer providing the following worker's compensation coverage for my
employees working on this job:
WU-3(5-311l 4.0 1 10- 5-07, -
ansuraace Compmy) (Policy Number) (Expiration Dare)
( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hired
the contractors listed below who have the following workers compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance a Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Comparty/Policy Number) (Expiration Date)
(ruin addidonsr Sheet if acc=ury to iac3ode kfoem ion pataiaiag to all ooatrsctm)
O I am a sole proprietor and have no one work-hg for me.
( ) I am a home owner performing all the work myself.
NOTE:please be award that whir*homcovraeta who emptoy pasom to do tnximl�coamictica or r cpair work oo a d—Ilieg of ,
one mote thsa throe units is which the homoowocr raids or oa the ground,apptu mwA tberdo are Dot CC000 Y 000skkmd to be
emploYas ucda the wacttees warp—am Act(G-1.152.-1(5)).appUmdoo by a bocuowaa for a Game a permit may evidence tho
legal AM—of as employee under the Wod wee CompeDSation Ad.
I understand that a copy oftaw rtaiemew may be forwarded to the Dcput=oa of LDdustrid Aceidm&OfSoe of Imurwoe roe 1110
covrsage verification sad thu fs3lure to$erne covmp under soWoa 25A of MOL 152 c=tad to tbs imposition of ai-;"1 pe &Wes
oomistm5 of a•fine ofup to 31,5W.00 and/or impsisoos>�of tip to one year and civil pm%Wcs in the form of a Stop Walk Order and a .
fms of 5100.00 a day SPICA tae.
For dcp rW=O l wo cdy
Permit Number
2viap# I.ot# .
•Szgnahuu of Liccoswipermiace
1•�iffa•f::.).�. .Ja.
••••�+eae.eeAe.TiueJ:.,.., e.:..rwFiM...•. n,_•a ., ..... +
' �Yn
8 1 Licensed Construction Sup r„ a visor: Not Applicable O �
Name of Llcense Holder Mar -il")dkSA O`1 ( 33
` Ucense Number
Address Expiration Date
Ll 13 670 441?�
Signature Telephone
FROM,RMWE Not Applicable O
Company Registration Number
Address Expiration Date
/
"1 d MQ1 A t C LV L C t VIQYl Telephone
Im
SCIJ,Mi? ISArT�1�0`111i `. ,�r FFDIVI1'�11 �GLt e': t5z, «rc6
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....... O No...... D
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 buildine 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'lidvised 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
.f
{ 1
4.
'Wn
New House O Addition O Replacement Windows Alteration(s)❑ Roofing J1(
Or Doors ❑
Accessory Bldg. O DemolltionO New Signs [ ] Decks [ J Siding[ ] Other'[
Brief Description of Proposed Work: ���"�`��- ��t.S\1 S�rrw�`� — �Qa��, 30 uc • `� .\L-S
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attached Roll 0•Sheet 0
r .
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
OWN RS E 0 , . C�1'.C? .", ' �D N �PER iT * ka
.. ..
I, \ ilC�` 'y �1 , as Owner of the subject property
hereby authorize F—V" a-C., L'� T 1`� � to act on
my behalf, in all matters relative to work authorized by,this building.permit application.
Signature of Owner Date
I, 6tA Z_ f\ C-L 9-\nc 7k Y , as Omer/Authorized Agent
hereby declare that the statements and information on the foregoing app&tion are true and accurate,to the-best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
t' Z_ at
Print Name
Signature of G?weer/Agent Date
...': .. ;
Section4. � r:
,A,LL'DWQR.A.TION MUST BE COMPLETED, or PERMIT CAN-BE
xw:
DENIED DUE TO LACKOF INFORMATION
Existing Proposed Required by Zoning' '
This colutnu tp,be filled in by ._.
Building De�mea�,` �
Lot Size
Frontage
Setbacks F "•
L: R. L: R.
Building Height -
Bldg.Square Footage %
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
volume&L.ocation
A. Hasa.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 contam'a brook, body of water or wetlands? NO ON'T,KNOW
YES _.,.. . .
1F'YE9, has a`permit been or need to be obtained from the Conservatlommission?
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
- "di Department
Main Street
... .,�.. , Room 100
Northampton, MA 01060
MAR pAlAe243.58T4240 Fax 413.587.1272
APP46J ii4oh�'C dflIS7RUCTJALTER, REPAIR, RENOVA�E OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SE010N.1-;SI EI • Y ;
1.1 Property Address:
4� Y
�Et St PJ , r
wl ,
SECTION`2.- Pi�OP R�+1f��Q171fN $ +I<'%AUTHQ,& EDe.J�,QtENT
2.1 Owner of Record:
O
Name(Print) --� Current Mailin Address:
03
- Telephone
Signature
2.2 Authorized Agent:
Name(Print) Qurrerit Mailing Address:
Signature Telephone
• �d' iro 4°c��. . 9d� 6 s'4
EC :I
Item Estimated Cost(Dollars)to be Qffie�a Use'Ofay.
completed by ermit applicant
1. Building / U a�Q . 00 '(a) Buil:ding`Perr l.j gee
2. Electrical (b) Estimated Total Cost of
Construction from:'6.
3. Plumbing Building-P.ermit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total =(1 + 2-+ 3 +4+ 5) Check Number
This Sectionfor.Official Use+Onl
Building Permit Number• ` Date Issued *r r
n f :
Signature D,i' 4, "a
'1 J 4L I': • 4
7 • ; r
6uiltli�gCoinrtissian`eCl1sR ..g. Ildings,,,.., :: ..,. A :^ .. .... _, a
BP-2003-0823
GIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot:-001
Permit: BuUft
Category: BUILDING PERMIT
Permit# BP-2003-0823
Project# JS-2003-1347
Est.Cost: $10000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sq. ft.): 17816.04 Owner: DADMUN DONALD C&BARBARA K
Zoning:URA Applicant: RCI ROOFING
AT. 30 BIRCH HILL RD
Applicant Address: Phone: Insurance:
P 0 BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTONMA01027-0309 ISSUED ON:413103 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 Sienature:
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 4/3/03 0:00:00 3776 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo