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17A-048 (4) RC.i.-oo ROofmg, LLP 51B Holyoke Street P.O.Box 309 Easthampton, MA 01027 Estimate Date Phone(413)527-4775 9/9/2005 Fax(413)527-8469 Name/Address Job Location Cathy Walmsley 160 Bridge Road 160 Bridge Road Florence, MA Florence, MA 01062 586-4442 Terms Rep Estimate valid for 60 days Mike Job Description Total Remove existing roofs. 8,600.00 Furnish&install aluminum drip edge and pipe flashings. Furnish&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. WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total $8,600.00 TERMS OF PAYMENT 30%Upon delivery of materials 70%Upon completion Customer Signature Registration# 126235 Construction License#074334 Insured by Hackworth Insurance(413)527-9907 C? -\ Crzt-� of wart 11amptall _ 3 d �lascacfinuttc' m DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 WORICER'S COMPENSATION INSURANCE A F'MAVTT -be.115le of Uhl - R00fil- (U ccnSCr/permittec) With principal place of business/residence at: Jr�a str (phone# {1 -�rj�15 eet/ /s Wzi ty P) do hereby certify, under the pains and penalties of pedwy, that: (V� am an employer providing the following worker's compensation coverage for my employees wording on this job: Xnaloan-Int'1 Gr un- 6 S I bb I D 10 ab ansurance Company) I (Policy Number) (Expiration Dan) ( ) am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the followving worker's compensation policies: Iune of Contractor) (Insurance Comp-any/Policy Number) (Expiration Date) ame of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) Qnsurance Compa>ry/PoGcy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Poucy Number) (Expiration Data) (ecia:h s3dSUon11:hcct if nocc=Luy to ix d information pertaining to all ooatrnetots) I am a sole proprietor and have no one working for me. ( ; I am a home owner performing all the work myself. `COTE:plcaao tic avr4rt that whim homeowners wbo employ patom to do maiaieaa conArueiioa or ttpsair worn an a dwelling of not moce than Lbr"unit:is which the homoow=resides or oa the vwn. s V uruuw thereto an not geaorally mosidend to be cn'P!oy—under the worker:ooavc=tion Act(GL152,ss 1(5)),AMUcatioa by•homeowner for a lice%-or permit may evidence the Iesi:ctatua of an employ«under tho Wodtccec Compe�Ad. I un Serstxnd the a Dopy of this esatemmt may be forwarded to the UeparteraoQ of IadwtriJ Acd4wK Of ce of 10"w-fOr tt» cov=gc vairicatioa aad that fadur a to tauro coverage under soWon 25A of M%152 ca lad to the impcuitiau of aww Pa W'% or;fmc of up to$1, 00.00&Wor im�of tip to oar yt v wd dyn pt'! wea is 6a tam of a Btop Work 0*red fie:a("100.00 a day ttgaitut me For de -fin bl un'dy Permit Number Mag# Lot# `. SiPature of LiccnkcRermittee SECTION 8'-,CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder :y„Ku� _ S e, 117 4 3 3 4 License Number 5 - � oa7 5 . 03 . 0 Address Expiration Date 0413) 527- IT75 Signature Telephone rM� m�`r"ovemen Contr ctor Not Applicable ❑ 12-6235 Corn any Name Registration Number 51 B o t oK e_ Street - P.D. SDA 389 5- 0 b - 0� Address J Expiration Date 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...... ❑ 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 SECTION 5""DES60IPTI�"O"i-'00'6&SED WOOKflche6k,alI applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: e Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll ❑- Sheet❑ 6- 'IfN"ewito se;andorail"difion to":exis"tingtiou"sing;"com"p1'ee�lfiil1i : 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;OWNER AUTHORIZATION -TO"BE COMPLETED WHEN OWNERS AGENT OR�CONTRACTOR? 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: City of Northampton Building Department 212 Main Street Room 100 Northampton, MA 01060 phone 413-587.1240 Fax 413.587.1272 p APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR D lf&[ O Nt�Wn!OlAf4lY'DWELLING f� SECTION 1 -SITE INFORMATION 1.1 Property Address: �� r cam_ ZOIe `� Elm St D istr . �� � CBicf s� SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: fa 1 Name(Prinq Curre a"ng A s• attached Telephone Signature 2.2 Authorized Agent: 9. 0-1- P,U. [fix9 - Easthamot Ma Name(Print) Current Mailing Address: T Ole .. 2.1 Sig ature Telephone SECTION 3 -'ESTIMATED`CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building R00 f (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,Onl Building-Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date a BP-2006-1216 GIs#: COMMONWEALTH OF MASSACHUSETTS " ' �� CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-1216 Project# JS-2006-1800 Est. Cost: $8600.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin RCI ROOFING 126235 Lot Size(sq. ft.): 11107.80 Owner: WALMSLEY CATHERINE A Zoning:URA Applicant. RCI ROOFING AT. 160 BRIDGE RD Applicant Address: Phone: Insurance: P O BOX 309 (413) 527-4775 Workers Compensation EASTHAMPTONMA01027-0309 ISSUED ON.511212006 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 5/12/2006 0:00:00 $25.008676 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Building Commissioner-Anthony Patillo