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43-068
<< BP- 2010 -0966 GIs #: COMMONWEALTH OF MASSACHUSETTS � x:43` -068 CITY OF NORTHAMPTON Lot: -001 ` PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categor BUILDING PERMIT Permit # BP- 2010 -0966 Project # JS- 2010- 001428 Est. Cost: $4700.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 74334 Lot Size(sq. ft.): 18643.68 Owner ACUS EDWARD S & SHARON Zoning: SR(100) //WSP II Applicant RCI ROOFING AT. 80 DUNPHY DR Applicant Address: Phone: Insurance: 6 LINE ST (413) 527 -4775 Workers Compensation SOUTHAMPTONMA01073 ISSUED ON :412912010 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 Sienature: FeeType: Date Paid: Amount: Building 4/29/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo I ° City of Northampton Sta "ttas Building Department Curta`C' 212 Main Street Sear Room 100 " A °ii 2 3 20i0 wat Northampton, MA 01060 phone 413 , L587 -1240 Fax 413- 587 -1272 i?lot%$iCb J Other'5 " APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address This section to be completed by office a o� Map Lot Un Zone Overlay Dlstrlct i Elm St. District CS DNgkt SECTION 2 - PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record CA (3- Iw - Name (Print) Current Mailing Addres : a ;ta e e Telephone Signature 2.2 Authorized Agent: � • 1 Name (Print) Current Mailing dress: �-�-- (1 !. 521- 4115 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by rmit applicant 1. Building oofi _l [ y b� (a) Building Permit Fee r 2- Electrical 1 (b) Estimated Total Cost of . Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5 Fire Protection 6. Total = 0 +2+3+4+5) y' oO . G 0 Check Number This Section For Official Use Onl Boi thing Permit Number. E: Signature: _ Building Commisaloner/inspector of Suddings Dabs 4*�'7 Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Fronta e Sctbacks Front i { Side L: R: L: R: Rear B jilding Height B'dg. Square Footage % { { O - )en Space Footage % (L.)t area rninus bldg & paved pa.-king) # -)f Parking S accs Fill: volume & I pcation _. A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO O DONT KNOW O YES O IF YES, date issued:! IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW © YES O IF YES: enter Book Page and /or Document1.._ „ i B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O 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 O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES O NO O IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO O IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) i New House Addition Replacement Windows Alteration(s) Roofing i Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs (01 Decks • M Siding fol Other [EM' Brief Descripron of Proposed }- Work: �� La�1L11 j Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet I sa. if New house and or addition to existing housing, complete the following: a. Use of buiiding : One Family Two Family Other i b. Number o' rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions i e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each i g. Energy Ccnservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No Depth of basement or cellar floor below finished grade 1 k. Will building conform to the Building and Zoning regulations? Yes No. i 1. Septic Tank City Sewer Private well City water Supply SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject I property � i hereby authorize io act on my be-half, in all matters r ative to work authorized by thislouilding permit application. SignatUre'of Owner Date i i, , as Owner /Authorized Agent hereby declare that the statements and information on the foregoing lication are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. I Print Name L 7_� —lc� Signature of Owner /Agent Date SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor Not Applicable O Name of License Holder Y �P� i s e. '7174,534 License Number A-p r a mix 1 _ 5 A3 - 10 Address - Expiration Date Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable D • o c na 1262-4-6 Company Name Registration Number —,—� I..., ► � S fit- . �5 - �� - 10 Haoruz— Expiration Date ;!Y11 L7 OYl M A . �3 Telephon SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6)) Workers Ccmoensation 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....... ie No...... ❑ 11. - Home Owner Exemption 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.:)r 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 sha0 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. : \!so 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, States and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature alta[� The Commonwealth of Massachusetts Department of Industrial Accidents ' Office of Investigations 600 Washington Street Boston, MA 02111 <r www.tnass.gov /dia Workers' Compensation Insurance Affidavit: Builders /Contractors /Electricians /Plumbers %pplicant Information Please Print Leizibly Nanic ( 13tisittess /organiittion/Indivi(ival): � — %SO, Address: City /Stat /Zile: Phone #: - LA :%re you an employer? Check the appropriate box: Type of project (required): . [Z� am o employer with 2.0 4. ❑ 1 am a general contractor and I 6. ❑New construction employees (fall and /or part - time).* have hired the sub - contractors I ?. ❑ l am a sole proprietor or partner - listed on the attached sheet. 7. ❑ Remodeling ,hip and have no employees These sub - contractors have g, ❑ Demolition employees and have workers' working for me in any capacity. 9. ❑ Building addition �No workers' comp. insurance comp. insurance.* j ired.] 5. ❑ We are a corporation and its 10.E] Electrical repairs or additions requ 3. ❑ 1 am a homeowner doing all work officers have exercised their 1 1.❑ Plumbing repairs or additions mysek".. [No workers' comp, right of exemption per MGL 12. Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] ':fin, applicaw uiat checks box # I must also fill out the section below showing their workers' compensation policy information. I lomeowners %, ho submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have employees. tf th,: sub - contractors have employees, th must pro their workers' comp, policy number. I air an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. i'oiicv # or tielt• -ins. I_ic. #: AJWO— CA 5? 0�1 35 (a Expiration Date: f O - ? O I O Job Site Address: 1 9a -z-, City /State /Zip: zftre�ncr., m _ nj C)(, :Attach a copy of the workers' compel sJion policy declaration page (showing the policy number and expi ration date). i allure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to 1,,,I,>00.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance cove rage verification. I do hereby c ertiji' under the ins and penalties of perjury that the information provided above is true and correct. Sienature: _ _ Phone #: ( .�,. , T a n Ll S Official use onIV. Do not write in this area, to be completed by city or town official. C.ity:or Town: Permit/License # Iss*g Authority (circle one): L Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6 :0'ther Contact Person: Phone #: T� i�am�no�aveal!/� ✓uaaaaa�ri�abld Board of Building Regulations and Standards Construct!gn Supervisor License LIconeeti , CS 74334 10 Tr# 23520 MARK T DELISLE�.' 33 FIRST AVE �-' —. ZZ:1� EASTHAMPTON, MA 01027 Commissioner -------- - - - - -- - - -- -- - - - - -- Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registrations, 126235 i Expiration: 510/2010 Tr# 266063 :Type: Partnership R.C.I. ROOFING MARK DELISLE 51 B HOLYOKE ST.„� EASTHAMPTON, MA 01027 Administrator R.C.I Roofing LLP 6 Line St. Estimate Southampton, Ma. 01073 Date Phone (413) 527 -4775 4/20/2010 Fax(413)527 -8469 Name / Address Job Location Ed Acus 80 Dunphy Dr. 80 Dunphy Dr. Florence, Ma. 01062 Florence, Ma. 01062 (413) 265 -9477 Terms Rep Estimate valid for 30 days Bob Job Description Total Remove existing roofs. 4,300.00 Furnish & install aluminum drip edge, pipe flashings, chimney flashings and step flashings. Furnish & install new lead counter flashings. Furnish & install CertainTeed Winterguard ice & water barrier along eaves and valleys. Furnish and install synthetic underlayment over existing deck. Furnish and 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. 5 -year RCI Roofing workmanship warranty included. 30 year CertainTeed material warranty included. All related permits will be obtained by R.C.I. Roofing. Add $2.50 per sq. ft. for wood decking replacement if needed. Add: $600.00 for Certainteed Landmark Woodscape 50 year shingle. A Certainteed Surestart Plus extended warranty (additional 5 years) will be included with fee ($240.00) absorbed by RCI Roofing if signed within 7 days. Furnish and install 5 -K Gutters A :$400.00 � WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total $4,300.00 TERMS OF PAYMENT 5% Deposit' Balance upon completion Customer Signature Registration N 126235 Construction License # 074334 Date C) Insured by Reynolds, Barnes & Hebb, Inc. 413- 447 -7376