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36-162 (3) �� .I. RoOf�M LLP g� 51B Holyoke Street P.O.Box 309 Easthampton, MA 01027 Estimate Date Phone(413)527-4775 6/24/2005 Fax (413)527-8469 Name/Address Job Location Darren Desmarais 1086 Burts Pit Road 1086 Burts Pit Road Florence, MA Florence, MA 01062 586-8558 Terms Rep Estimate valid for 60 days Mike Job Description Total Remove existing roofs. 3,950.00 Furnish&install aluminum drip edge,pipe flashings and chimney flashings. Fumish& 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 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. Note: Solar panel removal and re-installation to be provided by owner. WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total $3,950.00 TERMS OF PAYMENT 30%Upon delivery of materials 70%Upon completion Customer Signature Registration# 126235 Construction License#074334 Date P, 6 Insured by Hackworth Insurance(413)527-9907 COs Nar#fjttllip foil y aSf RChttfrtlf m DEPARTMENT OF BUILDING; INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AF17,UJA.VTT (licensedpermittec) with a principal place of business/residence at: 5 (phone# 13).527- T75 tC ty/�ap) do he:eby certify, under the pains and penalties of perjury, that: (�I am an employer providing the following worker's compensation coverage for my employees working on this job: M gal 1�tC231s-31?ta •oy� 10/5/05 C-mattUce Comfy) (Policy Number) (Expiry on Date) O I a-m a sole proprietor, general contractor or homeowner (circle one) and have hired the co:atractors listed below who have the following worker's compensation policies: (Name of Contractor) (L=uancc Company/Poticy Number) (F-cpimtioa Date) (N�me of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Dame of Contractor) (Insurance Company/Policy Number) (Expiration Date) (&Matt:a3ditioa:d if necc=u y to include infocmi ion pertaining to all 000traaors) ( ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:please be aware that whilo homcowmrs who cmplay pers.=to do mxinicasnc.construction or repair work on a dwelling of not mote than thtroo units in winch the homoovrncr resider oc on the grounds appurtenant iberdD arc not many comidaed to be employ-31-6cr the worker's.coatpcns-4ca Act(G1,152,ss l(5)),application by s homoowncr for a license or permit may evidcom tho lcgl ct�of an oaployor under tho Worker's C.ompeoulion Ad I undcn d that a copy of this ctatcmmt may be forwarded to tbo DVwt=o!of ln&tWial Ac6don&Office of Imruwoe for the -vcr agc verification and tbat failure to&==cov=V Undcr section 23A of MOIL 152 oaa lead to tbs WVosition of criminal pta Wc$ oocni-%i of a fmo of up to s 1,300.00 and/or impsisotu>x�of up to one year end civt7 pcmttics in the form of a stop wA Order and a firm of L'100.00 a day tgninst ma For dcpctwead ueo only Permit Number Nfap# Lot# ,.�:-„� � Signature of LiccnseelPermittee �. Q'.11Lryil•�i_' 'ri3�'v� SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder :� aY—� e s e. License Number 5 - r oa7 5 - 03 - Ob Address Expiration Date - Signature Telephone Not Applicable ❑ la.b 235 Com any Name Registration Number 51 B Ke. Street - En. &A. 301 5- Ob - 0�_ 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 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�tta�:he� SECTION 5= DESCRIPTIONmOPPROPOSED-WORK(ch6 call applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll D - Sheet 6a If Newhouse and or addition'to existin housing C I e--b, (.I"o" 1- : 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-OWNERA .UTHORIZATION'-TO BE COMPLETED WHEN OWNERS AGENT ORtONTRACTOR APPLIES FOR BUILDING PERMIT I, �arYn 17esrnaY�i s as Owner of the subject property her authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, Mary 1 1W '' as 2t'hail Q,C(] a4 —nt 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 91 Q0 Signature of Owner/Agent Date D f 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 puking) #of Parking Spaces Fill: v volume&Location l 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: t City of Northampton Building Department 212 Main Street Room 100 Northampton, MA 01060 one 41-3.587-1240 Fax 413-587.1272 p . ,�SS 1 APP_LI ?IQN 'O:,CONST UCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING r SECTION 1 -SITE INFORMATION This sec i orb `6 vmp et, 1.1 Property Address: � � k . sz r � b Buys �t fi"Ro Map. x� Zone OVe`rrr ay his r ct Elm St. District CB District ' r- SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: arren I)csmaYaiS it) L BuAs 9 t,nnc1 F Name(Print) Curren I'ng A r ache� � b - �t 5 Telephone Signature 2.2 Authorized Agent: . 96. x o9 - Easthamotw- Ma Name(Print) Current Mailing Address: 01027 3 5247- Sig ature Telephone SECTION 3 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars) to be Official Use Only completed by ermit applicant 1. Building Roof>Ih 39 5oxo (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) 9 5D Q Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building'Comm issioner/Inspector of Buildings Date; 1086 BURTS PIT RD BP-2006-0348 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:36- 162 CITY OF NORTHAMPTON Lot: -001 Permit: Building Categor: BUILDING PERMIT Permit# BP-2006-0348 Protect# JS-2006-0511 Est.Cost: $3950.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: RCI ROOFING 126235 Lot Size(sq. ft.): 11543.40 Owner: DESMARAIS MEGAN C&DARREN C zoning: SR Applicant: RCI ROOFING AT: 1086 BURTS PIT RD Applicant Address: Phone: Insurance: P O BOX 309 (413) 527-4775 Workers Compensation EASTHAMPTONMA01027-0309 ISSUED ON:912912005 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 9/29/2005 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo