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23D-068 (5) BP-2005-0975 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2005-0975 Project# JS-2005-1349 Est. Cost: $14550.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 074334 Lot Size(sq. ft.): 19471.32 Owner: HICKOK HASTY Zoning:URB Applicant: RCI ROOFING AT: 30 WARNER ST Applicant Address: Phone: Insurance: P 0 BOX 309 (413) 527-4775 Workers Compensation EASTHAMPTONMA01027-0309 ISSUED ON:4/12/05 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 4/12/05 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo .. r 1 ', » T bra{. '"P-'S'i: Q.£t ` ? _..:.�--r" % City of Northampton • atus • Per4 ;j .414. 'f '� 'it,� *k _t `..; 'Ak 9 ��r ti p^ w t .o+' i t , ^7 e .ts '"s : 1� �Y...---- - '.h Building Department Cufl�Ca ve ,,-dr- . . r- ; i1r-```R l212 Main Street !7;irii74i'itfo.lgOrtg:;jii -10'6 #111;g!!')-" r/. ii 4. 1 2 \ Room 100 `'" 'APR �.` ,� ��fi' e s . .x � ' a: Nor hampton, MA 01060 �aSetsof t `c'�rl; a , _ � � RIP ante`413.5,87.1240 Fax 413-587.1272 " ot2i-....4...„Pla'n -6A �z fi j-1)I�t 1,-- (l I l X.t ^t--. r zr. + ',Ls s. ��'z Dir 0 „ ,,' r Qther�SPeciy 5 M r - -----` APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: �, r Thi,Fsect o i:, ty,omPle g4by off�c z � , c 3 1N ar new 51' , 4. ,� :;� 4 �� r Zone }, 44 t ,,OverIayMistrictr 4.a,, x ' s£Elni�St Distract i �a CB t nc �I _:= x SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT.- 2.1 Owner of Record: aSt'I J i(jcKoK 3o l\(arnex St - Name(Print') Current Railing Adrs: attached Telephone - 0 Telephone Signature 2.2 Authorized Agent: JVICUCk Delis le, - R. e. I. f oofi n9 P.O. 6ox 309 - EasAamioi-nni o1oa. Name(Print) Current Mailing Address: 7 --2;1 ( !3) 527- ,V175 Signature Telephone .rS..a T ei Ixi , 6 r. J : SECTON.3.-''ESTIM'ATED CONST:RUCTION°CO:STS Item Estimated Cost(Dollars) to be , Official Use`Only completed by permit applicant I. Building Roo�'i n9 1), 550.00 (a) Building Permit Fee 2. Elec!rical l (b) Estimated Total''Cost:of Construction.from.(6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) I 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 41 1Hi 550.00 Check Number .This Section For Official Use Only BuildingPermit Number: Date:Issued; : Signature: ..... I . ... Building Commissionrll enspec gstor,of Buildin 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: • • sEef 0 D.:M R ST.0'N 0 •� ROPOSEINWOR• KI(check�a,l applicaps'e) ,.. ter „ ,,, m„.,.g,,. T.= New House 0 Addition ❑ Replacement Windows Alteration(s) 0 Roofing IH Or Doors 0 Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding[ ) Other [ ) Brief Description of Proposed Work: 3.btaGlled 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 :5a 1:f T7ew odvs`eld dtoni ddi drtilr Xe istin—fio asking; Comp"1ete f1 e`following: 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 SE(TKO ,N;ERim4OR(Z�AFION TO�BE COMPLETED WHEN f' 0 E 0 COITR""�CTORry'APPLiESkFORBIIILDING PERMIT w I, �H I e'`l'� f L! ) 1 5-r , as Owner of the subject property hereby authorize 'l Deli sle, OS' t C, i . 1oc f 17 to acton my behalf, in all matters relative to work authorized by this building permit application. 3 Signature of Owner Date l,—.L�arc-k. lDe/is/e as Qu borf zed Uq?f71- , as Owner/Authorized Agent hereby declare that the statements and information on the fo going 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 SC 'Of�8 dNSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder : V l oJLk 1/&l l I-PM 33 License Number o (Ma,n _Ay1° - as.harnpton, marl 5 - ,3 - 04 Address Expiration Date � 1131 5a7- j/775 Signature Telephone rn• •-•ue ',C• race > :r P 4' ' ,". »! Not Applicable ❑ R. C • 1. Roofing lab235 Company Name Registration Number �► o JMa n Avennu eJ - P O P3ox 5 - 6 - 0 to Address Expiration Date ES-kh mrJlbn MA O)O 7 TelephoneQl!3) 5a`7-'-M75 SECTION O W.9 SpCOMPENSATI0N 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 0 .- u tk.W, AIO • .,elit fly 1, 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 attar id U attw•r p2, • .. ea;_.,ck'1y /�r� F E ( ii1 al Northampton — A ( �l.s.,te oodles' _ `t - -i DEPARTMENT OP DU1LDrI'C INSPECTIONS -_ - 212 Main Strcct ' Municipal Building • Northampton, Mass. 01060 r�'" WORKER'S COMPENSATION lTh SURANCE AI,"1•D)AVIT I, _AAA P.11 516 @ • R,c — (li ccn.sccJpermi ttcc) 9 with a principal place of business/residence at: 51 Q H01 S-. / FasThamp ton .MA oloa°/ (shonei/)6y13),597-4795 (thr Jci t}/sta.teha p) do hereby certify under th.c pains and penalties of perjury, that . (4 I am an employer providing the following workers compensation coverage for my employees wor±ng on this job: Q)beizii. Jdtual wca 318=317124-0y4 10f5/ 05 _ (Instean=Coctanv) (Policy Nurnbcr) (T:-piruon Dais) ( ) Lam a sole proprietor, general contractor or homeowner (circle one) and have hired the coon-actors listed below who have the following worker's cocoencation policies: (Nanje of Contractor) (Inulran, Coinoanyi?oUc— Nurn ci) (rzpinit:on Datc) (Name of Contractor) (lnsurancc Comoa.nwPo!icy Number) (Exoirztion Date) (Name of Contractor) (I.asrraoc:. Company/Polio Numkr) (Expirtioo Date) (Name of Cootractor) (In_suranc Company/Policy Number) (Ex-piration Diu) (.ascb tdaitiociJ sh,c if oeoct..^•to archer=informs-oo pert.' to.11 comrs.c..on) ( ) I am a sole proprietor and have no one worming for me. ( ) I am..a home owner performing all the work myself. NOTE:plcsc be.wart the N€lo bomcoµvcra..tic coop lay pc't.oat is d,r-. ,e-.,n.,• .V.GJuo r r-aa wcrib oa.d.•cJL^Z of mot mote th-.o _tmits is which the boroce,ocr rid or oo tbo crouods sppurtcntm tbce.o c.•c ax(-moalty oc idac.i to be eeitployc,undo the wod rY..i.2r-r•.+ion Aa(GL152a 1(5)),application try•boaooaam far s lirs_c or permit tzy e.idmoc the lep.1 rtamu of an coploy.r under ttto Wortiol.Goa aoa.yioa Ae. 1 uockreAlul the a copy of this eatemera s..y be for-+.nrd.d to the Dopsrtsocoa of 1o,4.rriJ Acodmtf OQioo of trcur.00e for t.6 oovsra.sc vc ircaioo and th_t L•.iltac to sasuc bovoracc tzocicr soctioa 25 A of MOL 152 cs lad to the i poskioo of rimiest1 penalties corm sing of a rive of up to S 1300.00.MJor imprinocencca or up to ooe year.nd civil pat.tio io be form of.Stop Work Order.od. fire 0(5100.00.thy.prima me For dop.rtat=..t1 u.c only Permit Nuxabcr v Y Iv pw—_ Lot.. Si l tltrr of LiocryscclPcrmiucc DBte 1 i4_, _ „ RC.I. Roofing, LLP 51B Holyoke Street P.O. Box 309 Easthampton, MA 01027 Estimate Date Phone (413)527-4775 12/16/2004 Fax (413) 527-8469 Name/Address Job Location Hasty Hickok 30 Warner Street 30 Warner Street Northampton, MA Northampton, MA 01060 Home: 586-5308 Work: 586-9602 X2 Terms Rep Estimate valid for 60 days Mike Job Description Total Remove existing roofs on house and garage. 11,750.00 Furnish& install 1/2"plywood over the existing decking on house only. (garage see below) Furnish& install aluminum drip edge, pipe flashing and chimney flashing. 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. Furnish& install Versico rubber roof system on flat section. 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 permit will be obtained by R.C.I. Roofing. SPECIAL ITEMS NEEDED • ADD $2,800.00 (if done at same time as house)op ADD., S2.50 per sq.}t. for wood replacement. NOTE: .It his very likely there will be a significant amount of wood replacement needed on garage. !?i l'It'/)tn vi LIU/4j 6'boit aanea 0L-ii M550.0a WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total TERMS OF PAYMENT 64,C Z— 2-6,S 30%Upon delivery of materials /2[mil 70%Upon completion Customer Signature ''1",--r L- Registration# 126235 Construction License#074334 0 -77 Insured by Hackworth Insurance.(413)527-9907 Date (/OS