13-085 Roofing LLP
51B Holyoke Street
P.O. Box 309 Date
Easthampton, MA 01027
Phone (413) 527-4775 4/24/2008
Fax (413) 527-8469
Name/Address Job Location
Richard Wynne 68 Coles Meadow Road
68 Coles Meadow Road Northampton, MA
Northampton, MA 01060 584-7930
Terms Rep
Estimate valid for 60 days Rich
Job Description Total
Remove existing roofs. 9,600.00
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 over existing deck.
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 CerainTeed 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
Add $2.50 per sq. ft. for wood decking replacement if needed.
THE OWNER HAS THE RIGHT TO CANCEL THE CONTRACT WITHIN (3)
THREE BUSINESS DAYS OF DATE OF SIGNING. Total $9,600.00
TERMS OF PAYMENT
5%Deposit
Balance upon completion Customer Signature
Registration# 126235 (�}
Construction License#074334 Date �-I C
Insured by Reynolds,Barnes&Hebb, Inc. 413-447-7376
.r
4�tiA�lP�.O
� ��
9 6 �asaatllnattta'
d, DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFII)AVTr
f, t Mar ,ldt-51e- of R. C.).1. Roofina
(i /ltt=)
with a principal place of business/residence at:
,51 B Ho��`� (phone#
tY/sYatelap)
do hereby certify, under the pains and penalties of perjury, that.
WI am as employer providing the following worker's compensation coverage for my
employees workan on this job:
Thy=nsurance, ;211 d
-):heSk&of Pennsylvania V�L' 688'13x5 0 05 0
(I»nce Company) (Policy Number) irahon Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
�r
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Numhe.r) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additioml shoot if neccasry to wfvrtuafioa pauiming to all oodm'ctvra)
( ) 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 awzrc that while homcowncn who employ pc==w do=hAc tike,construction or repair work on a dwelling of
not mote than throe units is which the homoowncr tcsidd a oa the grounds apµutenamth=w an ad gc ocrally considatd to be
employas under the wocicces ration Act(GL152.ss 1(5)),application by a homeowner for a lion w cc permd may evidence the
10621 data Of=omployec under the WocicoC19 C,oaVemation Act.
I uadei a d that a copy of this datcmcat may be forwarded to the Dcpwuocnt of lndnstrial Axadmmf Office of I--for the
covaxge vaificatioa and that failure;to sox=coverage under section 25A of MCIL 152 an Iced to the imposition of aiminsl pmawes
oomLiting of a rme of up to S 1,300.00 an&oe impzisoaux� of up to one Yea and eivt7 permutes is the form of a stop Work Order and a
fma of 5 1 oo.00 a day against tnf—�
For&PrWxat d tuo-1Y
Permit Number
Mao —Lot#
i�..` Si of Liccnsedpermittee
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder: May h Mp e�1 S e 1 (P4 ,3 3•I j�
License Number
.1Ud1jo_he- St.- EasthZTnD1 t 5 - 03 - ,10
Address —� Expiration Date
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
8-e. I. �Rofi- nQ 126235
Company Name J Registration Number
5 J.9JJol� Street - P t� x 309 5-101,- / 0
Address Expiration Date
Eas .darn
M.J. 0182. !R Telephon 7
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...... ❑
11. - Home Owner Exemption
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.
A� acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion of the work.tor 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 2�.ta��ee�
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks Siding[❑] Other[❑]
Brief Description of Proposed }.} ,,, , .\) I ra 1
Work: a L LC7���1� — 1 I� ILkiI {es
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 constriction 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 AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, 1 nne as Owner of the subject
property
hereby authorize
to act on my oehalf, in all matters relative to work authorized by thislouillding permit application.
;AU A d 7liqlQ9
Signature of Owner Date
I, LuaYk –T)A i S'e- aS aU Y 7.�� aQ l , as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing aZblication are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
I)Aisle,
Print Name
Signature of Owner/Agent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete 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
arking)
#of Parking Spaces
Fi'L
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Page and/or Document#°
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained I Obtained 0 , Date Issued
C. Do any signs exist on the property? YES t NO
IF YES, describe size, type and location: j
D. Are there any proposed changes to or additions of signs intended for the property? YES Q 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 0 NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
A,
Department use only
City of Northampton Status of Permit:
Building Department 9 p Curb Gut/Driveway Permit �. _ �
212Main Street SeweNSepti�Availabilit
Room 100 Water/Well Availability
,fit"hainpton, MA 01060 Two Sets of Structural Plans
p'k 6ne 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPObATiON TO CONSTRUCT,*LEER, 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
68 Coles Meadow Road Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
�i ch ard�n n e, b8 Odes
Name(Print) Current I)Ga� ddre�;,
attached '- r('�
Telephone
Signature
2.2 Authorized Agent:
• PA&X 309
Name(Print) Current Mailing Address: �— 7 OIOA^
(q 13 5.1'7- J4 775 iL-I
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by erMMmit applicant
1. Building 0()f q b oo.W (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) . Check Number This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
BP-2009-0047
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: roofing BUILDING PERMIT
Permit# BP-2009-0047
Project# JS-2008-001747
Est. Cost: $9600.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sq. ft.): 56628.00 Owner: WYNNE RICHARD H
Zoning: SR Applicant: RCI ROOFING
AT. 68 COLES MEADOW RD
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTONMA01027-0309 ISSUED ON.711512008 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 7/15/2008 0:00:00 $25.0012455
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
LICENSED REGISTERED INSURED
A. .MASONS .&I
V US i r-R-N- MASS
'1"0W101WM�
383 COLLEGE HWY, SOUTHAMPTON, MA 01073 • (413) 527-1800,540-1959
WWW.WESTERNMASSMASONS.COM
QUOTE
To: DICK WYNNE Date: 4-28-2008
68 COLES MEADOW RD. Quote# 78598
NORTHAMPTON MA Project: CHIMNEY
Phone: 584-7930
Description of Work To Be Done:
CHIMNEY WILL BE TAKEN DOWN TO THE ROOFLINE AND REBUILT WITH NEW BRICKS, FLUE
AND LEAD FLASHING
SLOPE CONCRETE CAP.
WE HEREBY PROPOSE TO FURNISH MATERIALS AND LABOR- $ 1950.00
IN ACCORDANCE WITH THE ABOVE SPECIFICATIONS,FOR THE SUM OF:
This quote may be withdrawn from us if not accepted within 30 days.
Quote Prepared By: David Osiecki
TERMS:Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an
extra charge over and above the estimate.By signing this quote you agree and understand all the above terms and conditions that apply to this job. ®'
Any changes that are to be made,must be discussed prior to construction and agreed upon by contractor and may also effect to the final price. V/S4
PAYMENT TO BE MADE AS FOLLOWS:One half of quoted amount is due when job construction has begun.Remaining balance of bill will be paid
in full when job is complete.A Finance Charge of 1-101(18%annual rate)per month will be added to any unpaid balance over 30 days.
ACCEPTANCE OF PROPOSAL:The Above Prices,Specifications And Conditions Are Satisfactory And Hereby Accepted.You Are Authorized To Do '
The Work As Specified.Payment Will Be Made As Outlined Above.
Signature: ---> 1 hate: Signature:
f,� _ Date:
x
Thank You For Choosing Western Mass Masonsl
' r
HOME OWNER EXERTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CiVR 108.3.4 to
act as his/her construction supervisor. The state defines"Homeowner" as, "Person(s)
who owns a parcel on which he/she resides or intends 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
home owner."
The building department for the City of Northampton wants person(s) who seek to use
the home owner exemption, to act as their own construction supervisor, to be aware that
by doing so you become responsible for compliance with state building codes and
regulations. The inspection process requires that the building department be called to
inspect work at various stages, which include foundation/footings (before backfill).
sonotube holes (before hour) a rough building inspection (before work is
concealed) insulation inspection (if required) and a final building inspection. The
building department requires these inspections before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occupancv
until the work can be insaected.
If the homeowner hires other trades to perform work(electrical, plumbing& gas) the
homeowner will be responsible to make sure that the trades hired secure their proper
permits in conjunction to the building permit issued, and that they get their required
inspections. Failure of the individual trades to secure the permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
I, understand the above.
(Home owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date
Address of work
location
1ize Coin inon yeah o_f_A1.ssacnKseirs
Dep aI r31 ent of I.,Z�iiCSr la�,4 4CCidenrS
ice of I72veSZiz a£io?2S
_ 600 Y"T%ashing ton Srreer
Boston, 31_-? 02111
h 'rc.rnass.�of dia
Workers' Compensation Insurance -Affidavit: Builder si ContractorslEIectrieians,'Plr�r_:bers
r alicant information Please Print LeQibly
_:unle iBusiness'Or�anizanoaTndiv/idualis t��e.l. J � 9q
Ad(freSJ:
v
ClV,,/State%Zip: C.0 6- Phone-
Are you an employer? Check the ppropriate bog: Type of project(required):
4. I am a general contractor and I
1.�am a employer with (� ❑ 6. ❑New construction
employees (full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g_ ❑Demolitionv I
workma for me in any capacity. employees and have workers' 9 ❑Building addition
(No workers' comp. insurance comp. insurance.+
required-) �. ❑ We are a corporation and its 10-❑Electrical repairs or additions
:.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. o workers' comp. right of exemption per\YIGL
1_ ❑Roof repairs
insurance required.] T e. 152, §1(4),and we have no
employees. [N o workers' 1 Other
comp. insurance required.]
`Any applicant that checks box=i must aiso fill out the section below showing their workers'compensatjon policy information.
Homeowne.who submit this aiitdavit indicating they are doing all wort:and then hire=outside contractors must subrtit a new affidavit indicating such.
Contractors that check this box must attached an additional sheet showing the name of the sub-contactors and state whether or not those entities have
employees. If the sub-contactors have employees,they must provide their workers'comp.policy number_
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
irfon;zaticn. 1
I.,urar_ce Cc..pany 7 N zile
Policv:�or Self-ins. Lic. ' Expiration Date:
Job Site Address: (P 4:a S� ��C'e-z _ c?/K City/State/Zip: w
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 2fA of 1VIGL c. 152 can lead to the imposition of criminal penalties of a
fire up to S 1.500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of ap to S250M a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DLA for insurance coverage verification.
I do hereby certify i er t e n nd penalties ofperjury Char the information provided above is true and correct.
Cimattyre: Date:
Phone 1:
i
UU.1cial cis,oizly. Do not write in this area, to be completed by city•or town of iciaL
Cin or Town: Per mit'License
Issuing Authority (circle one):
1.Beard of Health 2.Building Department 5. City/Town CIerk 4.Electrical Inspector . Plumbing Inspector
6. Other
it Contact Person: Ph ore.
SECTION 2-CONSTRUCTION SERVICES
E.1 Licensed Construction Sioer,/iscr. NotAppiicable ❑
Name of License Holder; 1 U S/C�i�/` z-5z/
License Number
S� f �/0
address Expiration Date
k121 ll�e-t
3icnafta Telephone
I.Registered Home lmDrovement Contractor_ w,_ Not Applicable ❑
/3,5 cP-3
:omoanv Name Registration Number
ddress Expiration Date
� Telephone
ECTION 10-WORKERS'CCOMPEMSAT10N INSURANCE AFFIDAVIT 4M.G L.c.152,§25C(&)
Porkers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
the denial of the issuance of the buiidin ermit.
oned Affidavit Attached Yes....... No...... ❑
The current exemption for"homeowners"was extended to include Owner-occupied Dwellines of one(1) or two(2)families
and to allow such homeowner to engage an indi'viiduai for hire'wuo does not possess a license. provided that the owner acts
as supervisor.CIMR 780. Sixth Edition Section 1083.5.1.
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 Derson 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 shah be
responsible for all such work performed under the building Dermit
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 ofEmployers 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
I
i
S-C710N b-CESCPIPT10N 0;=P=;OPOSED WORK(check all aooiicabie�
I
New house ❑ Addition �I Replacement Windows Alteration(s) � I Roofing � I
Or Doors I
I
Accessory Bldg. Demolition New Signs [=J Decks [L---j Siding [p' Other[pl
I
Brae=Description of proposed ,� ® Zia, ti 111/mot
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovatine unfinished basement Yes No
Plans Attached Roll -S heet
I
sa. If Neal house and oe addition td existing h6using. comDfete thefot[aWind:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. is there a caraee attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
c. Energy Ccnser✓atcn Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
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, .gamic Tank City Sewer - Private well City eater Supply
ISECTION 7a-OWNER:AUTHORIZATION. BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING P1=i
i, as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
I
Signature of Owner Date
/< as Owner/Authcrzed
Agent hereby declare that the St2tementS and information on the foregcirg application are true and accurate, to the best cf my knowledge
and belief-
Signed under the pains and penalties of perjury.
L,/5% ��----—
Print dame
Scrai,,_re of-wrier 'gem -
1 All information Must Be Completed. Permit Car.Be Denied Due To incomplete Information
Exisr;na Proposed Required by Zoning
This coiumn to be'Ilec In by
Front
Re
Building Height
Blda
Square Footage
Open Space Footage %
(Lot area minus bidg&paved
parldruz
ofParkiniz Spaces
(volume&Location)
A. Has a Special Permit/Variarce/Finding ever been issued for/on the site?
�~\ x~��� �~\
NO �� DONTKNO� YES k_�
IF YES, date bsue
IF YES: Was the permit recorded at the Registry ufDeeds?
��
NO �� DONTKNOYY 0 YES
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water orwetlands? NO 0 DONTKNOYY 0 YES 0
IF YES, has permit been or need to be obtained from the Conservation Commission? '
Needs to be obtained »r-) Obtained v=� Date ,
`�� ' L_/ . . �______._____
C. Do any signs exist on the propert �� ��y7 YES v~/ NO \_�
IF YES, describe �ypeandiocation' `
' '
D. Are there any proposed changes tonr additions of signs intended for the property 7 YES NO 0
IF YES, describe size' type and (ocation:
E. Will the construcdon activity disturb(clearing,gradingexcavation, orfiUing)over 1 acre oris it part ofa common p-lsn
that will dioturb over Iacre? YEB � ) NO � )
�� ��
IF YES, then a Nort6i�m-TtohS5orT-n-0it-e—r M�����ent-pennit from the DPW is required.
Department use only
City of Northampton ( I� �o
Building Departrnentl .���o rb ut/ Wav Permit
212 Main Street Sewen-lSe c wailability I
Room 100 r1weall 'rlabilrty
Northampton, MA 01)06,C) JUN 2 6 ets ctural Plans
phone 413-587-1240 Fax 113-5 7-1272 _ Ptat/Site farts
APPLICATION TO CONSTRUCT,ALTER,RE S OVATE-UR1 D�O H A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE.INFORMATION
1.1 PrODerty Address: This section to be completed by office
Map Lot Unit
Zone Overlay District
Eirri St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
D - -CX W tAl Ala CS
Name(Printl Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
Name(Pri Current Mailing Address:
nt)
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS'
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit aoolicant
1. Building I (a)Building'Perrrrit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) I
5. Fire Protection _
6. Total=(1 +2+3+4+5) 1 a (/ G Ctieck Number
This Section For Official Use Only
- Date-
Building Permit Number. Issued:
Signature:
j,- - -------- ---- ---------_—_
I_ Building Gemmissione�/lnspecforor uumngs- � Gate
1
..„ BP-2008-1185
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
Pen-nit# BP-2008-1185
Project# JS-2008-001747
Est. Cost: $1950.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: WESTERN MASS MASONS 133234
Lot Size(sq. ft.): 56628.00 Owner: WYNNE RICHARD H
Zoning: SR Applicant: WESTERN MASS MASONS
AT. 68 COLES MEADOW RD
Applicant Address: Phone: Insurance:
147 MIDDLE RD (413) 540-1959 WC
SOUTHAMPTONMA01073 ISSUED ON.612712008 0:00:00
TO PERFORM THE FOLLOWING WORK.-REBUILD CHIMNEY FROM ROOFLINE
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 6/27/2008 0:00:00 $25.003219
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo