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17A-068
RC.1- R.00f1�1 LLP 40 Maine Avenue P.O.Box 309 Estimate Easthampton, MA 01027 Date Phone(413)527-4775 5/6/2004 Fax(413)527-8469 Name/Address Job Location Joseph Sadlowski 18 Mountain Street 18 Mountain Street Florence, MA Florence, MA 01062 Phone: 586-2598 Terms Rep Estimate valid for 45 days Chris Job Description Total Remove existing roofs. 6,650.00 Furnish&install aluminum drip edge,pipe flashings and chimney 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 shingle. Furnish and install 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$2.00 per sq. ft.for wood replacement if needed. ADD for 50 year shingle..........$570.00 WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total TERMS OF PAYMENT 30%Upon delivery of materials 70%Upon completion Customer Signature ^ ` Registration# 126235 V �- Construction License#074334 Date — ---O Insured by Hackworth Insurance(413)527-9907 — 4:1- 7 900 0.�ttn�rp�, F .ti (rii� �f ��aa;fl1a1)t�tolr _ c� DEPART1.4EI4T OP nUILDrI\G INSPECTIONS — 212 Main Street ' Municipal Dudding Northampton, Mass. 01060 WOMCER'S COMPENSATION MSURANCE AFI,Lf)AVII' @- (Ii c=-ccrJperrnl ticc) J ��ietl a prvncipal place of business/residence at: 51 l�ol s� r ptan IWA 01 cal (I;honc.')Cy.3�`L (st�it~.1/c�ty�staicra p} do hereby certify, under the pains and penalties of perjury, hat an employer providing die following workcr s compcns ion awe age for my ecoplovecs worting on'tl is job: �hFct�, ��tc1Q► v �_ 31S=�i�ia -o4 10 05 amcc Conrany) (Polio. Ntt_nbcr) F--,• Irruor, Da--)7 al:) O I,aat a sole propretor, general contracior or homeowner (ci:c;e one) ano hove hired the coasa(nors listed below who have the folloXVM, worker's coeloensnon policies: (1vt1IDe Oi contnic-mr) On uranc;. CornpanwPoiic; Numi-<i) [rxJlid Qn D11c) (Name of Contraeror) (I.ns-wanc-- CompaayiPolim, Numicr) (Ekpir Lion Due) (Name of Comaelo;) Gnsuranez CompaDyfPolio• N:tmb.r) (Ezpimfto Date) (Name of Contnaor) (Inniran= Comrzoy/policy Numbs) 'Ex �irdtioo Date) (a tl.zc�sddi�coal+'yea it nooesi:y to c�e��iafo�mzj oo per�aini.n6 in.L oom--xo:•�) ( ) I am a sole proprietor and bave no one wor4dng for me. ( ) I am..a home owner performing all the work myself. NOTE:pl== be&wzrt Lvw utJe bomr_vKVcn Ntpo c¢saloY pcsom LO d7 oc c oo c n fir•.olio .d.•cll^�or act more than '• .—Ls is u3ieh the bocmowvcr revdo of oa the p•ouCc`a zgpurt=n=tbeeeo e.•c ax C=:illy arr.&-jri to be employ=undo the c=*=s•:icc Act(GLI52ss 1(5)).appUm6cro by a bomco%-=ry a 6C=C v or pennrt rmy c.ideoac the IcP'c,.'.,of ca�loyer uoder dic Worirdr Com�om.tioa AzL t uodc*saad tha a copy of thia cw--av,y b.for wxi-d to tba Dcp�or tndusrid Aoodc&CfGo•or 1`au.00e for th. oovo -Cc vciGcnioa and Uuj r_iltae to son",covcn V uadcr Ixtion 23A of),(OL 152 na lod to Lb-im�osstioa oraimiasl pc-W- �mg of a riff of up to S 1 300.00 XWor i or up to ooc Yr-U snd evil pmahio io 6C roan ora Stop Worc Ordcr cad a fl=0(1100.00 a day&&Bait Mc- For dcp.rta�i a1 u+c MIty permit Numbcr Lot H S'( aut of Li�sscclPcrnvucc e J SECTION 8CONFl7�T�9 N SERVICES k . 8 1 Licensed Construction Supervisor: Not Applliica�ble ❑ °7 Name of License Holder : t-Ma k ,� PI)IQ. /'17 33'T License Number o - D 7 5 4 Address I Expiration Date g7`l5 Signature Telephone . e e:e . . me vem'en n ra Not Applicable ❑ R. C z. Rrnf; na 12b � 3�5 Company Name Registration Number -40 Main Le UL; - P6o oX 30 5 - b - 0,66 Address Expiration Date Telephone ** SECrI ON0YILO�KERS COMPENSATION INSURANCE AFFIDAVIT(M G L :c, 1;52, § 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_ aaG111 RPO PO EDPORKF the k&aa lica' e .r .+R"" T�"�"�°wr.. ... �`:.... ,:.. .�:. ..:�S�x.'�. ^' nom•�,�.._i !'�lm,:.r'�'�''�,�'r +,�!14.x`y�"`;�''.�k"+��" 'k,� - New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other ( ) Brief Description of Proposed Work: &M we' s tSTirk) C' rap -S Z['L �]� Y1P1t1 Shy 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 6a: "f . ew ou e,. o"""ra�'dd`��tron a:�sfin:g��hous�ing° c mo�l+efe" fhefoflowain�• 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_ SEC NNE ORiZA JON TO RE COM0gbxED IN�HEN OYY N © C0 TRACTOR APPtESF0RBl11LD1NG PER IT'S I+---- ocenli Q p1)5b i, + as Owner of the subject property hereby authorize _ _ ( Mnjf-l� -pe-h5lCj 7 e RmFi nq to act on my behalf, in all matters relative to work authorized by this building permit appi cation. Signature of Owner Date oil QS a uLbpri zed as l- as Owner/Authorized Agent hereby declare that the statements and information on the fdYkgoing application 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: r---"� F) t—�JI orthampton ... . . U i Department Main Street i { NOV 1 5 2004 m 100 L a= i North mp on, MA 01060 13 7-12 0 Fax 413.587-1272 t DEPT OF glallD!'�G INSPECTIONS MA 01060e APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE.4NF0'0 A-;'IQN- K € `This "secti`o yftobe-coin `:tedb:o`fice 'at � ' 1.1 Property Address: �,�•, � P y. � .��, 19 , to =t-d1Yl cS�CPP� aP Lot ElifjS Distract „° CBDi trict } SECTION 2 - PROPERTY OWNERSHIP/AUTHO IZED AGENT 2.1 Owner of Record: _ c 1 ooh dad I our��i 1 Mounfic�n Sfi �InYex�ce� Name(Pri t) Current Mail'n A r ss: Q.ita n.hpj Signature Telephone 2.2 Authorized Agent: — M U. I. 1 o x 9 ' V'1 Name(Print) Current Mailing Address: QI Qa� 527- y�f `l Signature Telephone SECTIOK 3 ESTIMAT' D CONSTRUCTION=COSTS Item Estimated Cost(Dollars)to be Official Use Orly completed by ermit a iicant 1. Building Roo�'� qq r1 a�0.00 (a) Building Permit Fee' - 2. Ele c:rical (b) L:stimated 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 On BuildmgPermit Number: Date Issued; Sl946ture: Building Commissioner/Inspector of Buildings Date ! N 18 MOUNTAIN ST BP-2005-0600 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-068 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-2005-0600 Project# JS-2005-0797 Est.Cost: $7220.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 126235 Lot Size(sa.ft.): 10018.80 Owner: SADLOWSKI JOSEPH J&ELIZABETH Zoning`URA Applicant: RCI ROOFING AT. 18 MOUNTAIN ST Applicant Address: Phone: Insurance: P O BOX 309 (413) 527-4775 Workers Compensation EASTHAMPTONMA0 1027-0309 ISSUED ON.III]7/04 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• Receipt No: Date Paid: Check No: Amount: Building 11/17/04 0:00:00 6226 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo