17C-096 (2) C.I. RoOfing, LLP
51B Holyoke Street
P.O.Box 309
Easthampton, MA 01027 Estimate Date
Phone (413)527-4775 10/14/2004
Fax (413)527-8469
Name/Address Job Location
Bob Whitman 140 Chestnut Street
140 Chestnut Street Florence, MA
Florence, MA 01062 586-1537
Terms Rep
Estimate valid for 60 days Mike
Job Description Total
Estimate is for back side of house only. I �" 5,350.00
�c ,d;, fio•ti� w `J W ,rlr loyv"" Ko tuvoH S ►nfK t
Remove existing roofs. (-{'r ' ��' r"f '4 ndVVAft ,�/n �t_ t 0 /ear art 7p
Furnish& install 1/2" plywood over the existing decking. yG �'�
Furnish& install aluminum drip edge,pipe flashing and chimney flashing. faY ► ?,,�
Furnish& install ice and water barrier along eaves and valleys.
Furnish& install 15 lb.felt.
Furnish& install 30 year Tamko shingle.
Furnish& install ridge vent. C 6P
Furnish&install V ersico rubber roof system on flat section. 3• = • 'r''
All roofing related debris to be removed by R.C.I. Roofing.
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 _ // /
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See c. ie ptoh$'-P, ��, Parity kclaIf
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total $5,350.00
TERMS OF PAYMENT
30%Upon delivery of materials Xe 70%Upon completion Customer Signature
Registration# 126235
Construction License#074334 Date
Insured by Hackworth Insurance(413)527-9907 ,��
A E (riif_�) Cf �,Trj f!}Urlt}lfoll - =
31 a=•itch narfIs* -
i --
DEPAR i MENT OP nUILDD\10 rNSPPCT)01.'s
212 Main Strcct ' Municipal Building
Northampton, Mass. 01060 •
«'OMCER'S CONQ'ENSA`ITON L`tSURA_NCE AFFMAN11-l'
(liccvscrJpermittcc) 9
With a principal place of business/residence at:
5113 HDIIJ 10 3t-It �fon MA
(s��tyfsZatcla p)
do hereby certifjr, under tlic puns anti penalties of perjury:, that
(�) I am an employer providing the foilowine worker's comocnsadon covem�e for my
e1up10yces NvorUng On'tllis job:
va� 3�S=.3i�ia�-o4 10 05
m=Comm.,) (Polio:NU--,Lb,-r) i zbor Du.. —
a sole proprietor, general contractor or homeowner (ci:cie one) and have hired
the contactors listed below rYbo have the following worker's cocpen-salon policies:
(Name of Conc c.o-) (InRranc Cornpan)-fpciic; ?duulbc:) (YXpIrujon Datc)
(Name of Contractor) (1ns.Irancc ComoanwPolim, \tlmccr) (i=xpir,.6on Date)
(Name of Conrraetd,) (Insurance. Companyipoke}• N:Lmt�r) (E\aimuon Dalc)
(Name of Coaaaetor) anszuancc Comp_n Rollcy Numbu) (Expiration Dkc).
(►trzeb zddr oezl t3ea ifnoomlry to a�etude iafixma�oo pczta;ain�to.J1 coohc.on
( ) I am a sole proprietor and 'have no one working for me.
( ) I am..a home owner performing all the work myself.
NOTE:pl=4 be aw2re Lt=MtiJe bomco.+xn%kto employ pesovs w -- c croo c repair w=rit on.d.•clL;of
not mote tbro 'Toe t?a is u'bicb the bomoovwocr raid=or oo the pcu .&z�ptutcn_r1 tbeeo c e oa�o,—fly oevid-rci is be
employe tzn�c the- k=Az o—s_rion A=(GLI52J=1(5)).appliapoo by a boa=w=for a Gc=.c or prrtntt rzy--;dmoc the
Ic J n.n,,of as.aploy.r uodar tho Worlcdc Coc V*=mjioa AcL
I undcrwAnd that a copy of thin mla may b.foe—:6d to tb.Dey.rtmm¢of lemasricl Aecdowy oT, .of trwr.00v ror tb.
oo�z�tr�O°"�lhzt f�tie t4 saQUe fo`eTZbt order soetioe 2S w of biQL 1 S2 m lead to the i�eaitioa of trimias!peaaLi=
000searag of a Gae of to S 1.500.00 artNor�Priyoameai or up to ooc year end ei,il prnahio in 6c form of a Slop Wort:order.rid.
rmo 0(5100.00 a day eptia=t tae
For u•e only
permit Numbar
Map.� Lot K
Sttn4ur of Lio=xscc1permiuca Ste A ::
?Yt.,.rv"° %! s $ r.4K *
fSw, 01
R1,MOR( R1 ?TKON S�R VI G.
:r. s
8.1 Licensed Construction Supervisor: _ Not Applicable ❑
Name of License Holder :_{oM�le-l/5lf— q7' 33J4
License Number
7 5 , 3 - 04
Address Expiration Date
X775
Signature Telephon
Not Applicable ❑
R. C • 2. Rrnf� no 1 �b � 3,�
Company Name Registration Number
J4 o Mai n Agmue-, 0% .3o i 5 - b - O to
Address Expiration Date
Telephone /3 522-J P775 ,
0S' COMPENSA710N IIN RANGEAFFIDAVIT(MSG L c 1.52, § 2506))
F , .a.;.., ..,....
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...... ❑
> i
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 acccptable 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_� d QLP-64
R ECX�K .
c"ec1cG �1�
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ } Other [ ]
Brief Description of Proposed Work: a, ,aL'hec.
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attached Roll D- Sheet 0
6� #' ew ou e.a:7 0 '°�'�,itrontoei�sting�ho°���ngco�pflrfh`efolllow�rnf7:
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. bimensions
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
gym :
SEO ��OBEQMPLETED 1QI�HEN
O1NEfq. E Q CTOR PUES�EO 611LDING PERMIT
..
I, pml hJtM-A'V1- as Owner of the subject property
hereby authorize S ma1(j, Belisle, 0-- + It e e• T • Ro n 7 1 na to act on
my behalf, in all matters relative to work authorized by this building permit appl cation.
Signature of Owner Date
I, DejjS18 QS QU4DrI ZP_d 04w - as Owner/Authorized Agent
hereby declare that the statements and information on the fclvkgoing application are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury. 4
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
(l.ot 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 a-nd/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
! D p
Building
e. artment
212 Main Street
LGS Room 100 :;
.� 1\16Ah6mpton, MA 01060
phone 41x3.587.1240 Fax 413-587.1272 t
,.� ...A.i{ :25
___APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION A:-S'ITE INF �2MATION
_.:
€; This=sect%o to c
1.1 Property Address: r �.
-NO bf-stnt_I t St a Lot
a.
1
S
District 1 Y X
SECTION 2 - PoOPERTY OWyERSHI-:PfAUTHOa WED gGENT _ _..11
2.1 Owner of Record:
�Rbk A human
Name(Print) Curre�t cling i(ires�
atta Rke Telephone
5((�' �jj33
Signature
2.2 Authorized Agent: NA
Name(Print} Current Mailing Address: QIQa17
(ills) 5217- +1 q I
Signature
Telephone
Sim:1:'3 IlESTIMATED COt S7R "Cl�ION"C0 1'S
Item Estimated Cost(Dollars)to be Official Use Qn;ly
completed by ermit applicant
1. Building (a) Building Permit Fee Ro n J O W
2. Elec.ricai (b) Estimated Totali of
Construction,from: 6`
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) 3 C)0 Check Number
This Section.For.Official Use-Onl
Bulldmgi:Perri mber: Datea'ssued; ,
Building Commissioner%inspector of Buildings Date
140 CHESTNUT ST BP-2006-0139
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C-096 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-0139
Project# JS-2006-0213
Est. Cost: $5350.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sq.ft.): 31842.36 Owner: WHITMAN ROBERT D&CHRISTINE R
Zoning:URA Applicant: RCI ROOFING
AT. 140 CHESTNUT ST
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTON MAO 1027-0309 ISSUED ON.8 15105 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP, PLY & 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 8/5/05 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo