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23D-124 (9) WE` TF'F.L-i i7i-i NGT IL :413562:8007- OC7 1 '02 9 3 3 11 o 0 C1 I F, G 2 R.C.1 ROOFING 40 MAINE AVE, P.O. BOX 309 EASTHAMPTON, MA 01027-0309 C=ES T� PHONE (413)527. 4775 FAX (413)527-5469 D*W: OCTOBER 3, 2002 Estimme STEVE FLYNN 116 FEDERAL ST. FLORENCE, NA. 01062 __ Jnb Phorto: 4i3 505-0392 W-564-2206 JOB DESCRIMION U AIC4 1/;? 61) QVRT &XZg1'ZAU QECK.W.. 1. 44,4 A&LAMM) 1�&IMIZS VA T y R C,T. ROOP-11 SPECIAL ITEMS NFED FLAT SECTION WILL BE KPCHAOTCALLY FASUIVED RUBBIA. AdIth.ovOnfourmllon m4riUi to fifs Job 6stimes Total W(rWed 30%PNOR W 61ART 70%VY0NWMPLViUN -lob Cost-Anlw MOISIM71an 8 120225 FED,IDN 04:3418839 Authorized =45 RUCTION LIUNSEf 074334 SAJ711stu MAW OY MCI WORTHOLAPLANTE WS.(410)5274407 DVPLICATr--r CLIENT COPY + O��ttAMP�O B} 'g �ZD� � 111�7IItt 9 B �iasaacbnsctts' DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATTON INSURANCE AFFIDAVIT (lioensec/Permittee> with a principal place of business/residence at: 140 C LV E- F— 010 hone#) �1/3 -,,Z7- '77 (atrtWcity/9a1d2iP) do hereby certify, under the pains and penalties of perjury, that: Wl'*am an employer providing the following worker's compensation coverage for my employees wolfing on this job: a e WC's-31s- '�11 Z9•o1 Company) (Polity Number) (Expiration Dale) ( ) 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 Comparry/Po(icy Number) (Expiration Date) (Name of Contractor) (Insurance Comparry/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attac}i additi—al zycd if noceaary to iochWe idbraution pertaining to all ooatrn ) ( ) 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 aware that wbilo homeowners who employ pcmm to do m,intca=ccS con=uc6on or repair work oa a dwelling of not more thin throe unite in uitieh the hoamwaec raids cc oo the vwn h appurtenant tbacto arc oot wally oomidcmd to be employ—under the wockAes oompeas4ca Act(GL152.ss 1(5))�application by a homeowwr for a Game or permit may evidcaoc the legal ctan,s of an employer under the wocle ova Com pemaiioa Ad. I und--d that a Dopy of this ehtcm taay be forwwd*d to the Departaioos of T-,h, ial Aacidm&OIBoo of lawranoe forth* coverage verificeioo and that failtme to aoauc aoverago under section 25A of MGL 152 tea kid to this'inVositioa of-kab l peaaltiea ooasistiug of a f oc of up to 51,500.00 and(or iztspeisonme�of tip to om year and civil pcmWe,is the form of a stop W otit Order and a find of 6100.00 a day agniast mc. For&Vrhr=W uao only permit Number Map# Lot Signahtre of Licen,-Ipernnitt, _— R 1 Licensed Construction Supervisor:- �.` Not Applic(a�ble ❑ Name of License Holder: ^ S� 01 ` 33 —` ` license Number Address Expiration Date 5711 T7 Signature P, Telephone 92110,12%MIMM! Not Applicable ❑ �z ) 2, 35 Company Name Registration Number _.� - 11.3 - ay 'Address` l Expiration Date "1 d Jll ii'1 G1�1�. E t�Y1 Telephone w .. h 'i4 4• 1� ... � x r Wit, flVit"'A F! I -NT10 1 p E FF 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 Sunervisor 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`Hdvised 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 fi 'N New House O Addition O Replacement Windows Alteration(s)O Roofing Or Doors O Accessory Bldg. O Demolition0 New Signs [ ] Decks [ ] Siding[ ] Other[ ] Brief Description of Proposed Work: rac"17 5, :� �` /r�'°'S y'�'�✓ � � 3�' ,L 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 fiarM, , 1 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 S,EGII YXIiE[V E M IT.- N* as Owner of the subject property hereby authorize104r ������`c. 00C"',t to act on my behalf, in all matters relative to work authorized by:this building,permit application. Signature of Owner Date I, 6 i� C 'C'T Wv as Gwner/Authorized Agent hereby declare that the statements and information on the foregoing ap tion are true and accurate, to the-best of my knowledge and belief. Signed under the pains and penalties of perjury. M V Z QN 0 0 t Print Name w•� Signature of GyAger/Agent Date Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN-BE .:_DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning b This column to be filled in by _- •_. Building Deg}4trnent, Lot Sin Frontage Setbacks . EMnA t L• R L: R Building Height Bldg.Square Footage % Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume do 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 Conservatioll.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 APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVA�E OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTi0Nr1 .slE ! 1.1 Property Address:, ` ea a co t cY ��6X EXIC_ti SECTION12- PROP,ERT'�QYi►tN RS jlP/AUTHO�(ZED'AGENT 2.1 Owner of Record: , - Name(Print) Current Mailing Address Telephone Signature . 2.2 Authorized Agent: Name(Print) Currerit Mailing Address: q13 21— q 1'"l Signature Tetephone SECTION 11 ESTI ATED,CONSTRUCTION CASTS Item Estimated Cost(Dollars)to be OffiCial Use'Only completed by ermit appl icant 1. Building (a) Building`Permlt:F4ee ' 2. Electrical (b) Estimated Total Gust of Construction.frorn; 6: 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total =(1 + 2 + 3 +4 + 5) t? Check Number ` his Section For-Official Use,O.nl Building Permit Number Date Issued; Signature .; 8u11d� g;Gg�misst�ner(nRtor of B,utldings, ,: DA#e BP-2003.0635 GIS#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2003.0635 Project# JS-2003-1044 Est. Cost: $13800.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 126235 Lot Size(sa. ft.): 20952.36 Owner: FLYNN STEVEN M&SUZANNE Zoning URB Applicant: RCI ROOFING AT. 176 FEDERAL ST Applicant Address: Phone: Insurance: P O BOX 309 (413) 527-4775 Workers Compensation EASTHAMPTONMA01027-0309 ISSUED ON:1121103 0:00:00 TO PERFORM THE FOLLOWING WORK:ST R I P, 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 1/21/03 0:00:00 665 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo