17A-164 .� 00 BRED
518 Holyoke Stteet JUL 18 1001
P.O.Box:309
Eastharr.pton, MA 01027 Estimate Date
Phone (413),527-4775 7/17/2007
Fax.(413)52 7-5469
N arre/Address Job Location
BANK OF AMERICA I 38 Kimball Street
ATTN: B`11 Grondin i Florence, MA
cr.,-m2-07-07 (860)952-7707
777 Main Street
Hartford, CT 06115
Terms Rep
Estimate valid for 60 days Rich
Job Description Total
Remove existing roofs. 10,000.00
Furnish&install aluminum drip edge,pipe fleshings,chimney flashings and step flashings.
Furnish&instals new lead cot-inter flashings.
Furnish&instail Certa'r.'T'eed Wuiterguard ice&waver barrier along eaves and valleys.
Furnish and install 15 lb.felt over existing deck.
Furnish a-id 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.
15 year CerainTeed Surestart Plus extended material and workmanship warranty included.
30 year CertainTeed material-m ranty included.
All related permits will be obtained by R.C.I.Roofing.
SPECIAL 1TEIAIS NEEDED
Add$$2.50 per sq.ft. for wood replacement if needed.
7HE OWNER HAS THE RIGHT TO CANCEL THE CONTRACT WI FHiN(3)THREE
BUS NESS DAYS OF DATE OF S1GNnvG. Total $10,000.00
TERMS O PAYMENT
501,,Deposit
�1
Balance upc.n complctiDn Customer Signature ✓� (._ VAJ
Registration€ 126235 ,
Construction License 4 074334 r
insured by Reynolds,Barnes&Hebb,Inc.413-447-7376 Daie
r �0 °$ Git� of 'Na r#ilaill moll
9 6 �assachnsrtb'
m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORICER'S COMPENSATION INSURANCE AFFIDAVIT
-Mark- leli_51e of R. P.-T . Roofina
(hcenscrJpermtttec)
,nth a principal place of business/residence at:
>^ (� (phone# - 7?5
street/ ty/statr/ap)
to hereby certify, under the pains and penalties of perjury, that-.
I am an employer providing the following workers compensation coverage f
v) or my
:.tnployees working on this job:
Ameiiean 6iw n5SLYanCE
(Insnrancc Company) (Policy Number) ira on 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)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attadi additioml sbcct ifneccsury to iochx5e information ptxtaiuiag to all oodracton)
O I am a sole proprietor and have no one wonting for me.
( ) I am a home owner performing all the work myself.
NOTE:please be awuc that wElo homcovnxrs who anploy pass=to do m&k1c ace,ooasiructioo or rcpsir work oo a dwelling of
not more than throo units is winch the hon w mr resides or oo the grounds q Wrtcnud thado ate oa geaaany coatukn d to be
cmploycrz under tho wmkces.omv as4on Act(GL152,s 1(5)),application by a homcowna for a 11ccrsse or permit may evidcnoe rho
Iepl rtatlu of an ompioyor under the Worlcda Compamalion Act.
t uod=uzd star a copy of thin axU=coz may be fwwardW to tbo DVuuaoot of lndustrid Aa&oW Office of W xr w for dw
oov=90 vctificdioa ttad that failure to teeun coverage tmdcr section 25A of MOL 152 can lead to the imposition of m=inas pew%ts
oomiv*of a fine of up to$2,300.00 andlor imprisonmcut of up to one year sad civta peoattia in the form of a stop Watt order and a
fins of 5100.00 a day sgainst t�
For use onay
Permit Number
cep# Lot#
r
Si =t of Li /permittce
SECTION't'l-:CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : , May e s e. // /pl T 933
License Number
027 5 -03 - 08
Address I Expiration Date
(q t3) 5 '75
Signature Telephone
en Not Applicable ❑
I, ) U 2,35
Com any Name Registration Number
51P 1 kl po e. Street - P.p. RDA 31)1 5- O b - 08
Address J Expiration Date
Telephon 7.5
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.
I Signed Affidavi`.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 � ttache�
SECTION 5 DES PO$ED WORKr(checkkal !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❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet❑
6a Ifi New t ot` "sAe" a 'd o d"dition to ezistln liousing,.com le h" fiaUM tom:
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?
In. 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 OWN ER,AUTHORIZATION(TO BE:COMPLETED WHEN
OWNERSAGENT`OR CONTRACTOR.APPLIES FOR BUILDING PERMIT
as Owner of the subject property
Fhereby authorize .�, n I n to act on
y half, In all matters relative to work authorized by this building permit application]
-At tA0 ed
w ature of Owner Date
I, Mar k -_D A l� (as 2iu6 Yi Au- t as Owner/Authorized Agent
hereby declare that the statements and information on the foregointJapplication are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
&_1*1 sl e-
Prin=Name
g la o7
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:
s
City of Northampton
Building Department
- 212 Main Street
' Room 100
- Northampton, MA 01060
phone-,413.587.1240 Fax 413.587.1272
i
LAPPLICATION.TQ CO TRUCtT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 ProDertv Address: : g 'Th1ss
32 imba11 Slyee_t
Ma '�
Elm St. Distr ct °
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: L3, Grond'►n C"foL-102.-01-01
--BanK f-Arwiep 'i17.N1a'in St./Aan-64, CT 06115
Name(Print) Curr nt ailin Add 1960)
attach 9� re z- X07
Telephone
Signature
2.2 Authorized A ent:
Ma
Name(Print) Current Mailing Address:
Sig ature Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars) to be Official Use Only
completed by ermit applicant
1. Building R00f i n -4 I QJ 000.00 (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) lCheck Number
This Section For Official Use Only
Building'Permit Number: Date Issued:
Signature
Building Commissioner/Inspector of Buildings Date.
BP-2008-0276
GIS#: COMMONWEALTH OF MASSACHUSETTS
"` 4 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-2008-0276
Project# JS-2008-000399
Est. Cost: $10000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sq. ft.): 20821.68 Owner: BANK OF AMERICA
Zoning: URB Applicant: RCI ROOFING
AT. 38 KIMBALL ST
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTONMA01027-0309 ISSUED ON:911412007 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHIINGLE 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 9/14/2007 0:00:00 $25.0010876
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo