18C-100 .I. Roofing,
51B Holyoke Street
P.O. Box 309
Easthampton, MA 01027 Estimate Date
Phone (413) 527 -4775 5/11/2005
Fax (413) 527 -8469
Name / Address Job Location
Charlotte Morse 23 Gleason Road
P.O. Box 685 Northampton, MA
Scarborough, ME 04070 Maine (207) 883 -9670
586 -0004
Terms Rep
Estimate valid for 60 days Mike
Job Description Total
Remove existing roofs on front portion of house and garage only. 4,350.00
Furnish & install aluminum drip edge, pipe flashings and chimney flashings.
Furnish & install new lead counter flashings.
Furnish & install ice & water barrier along eaves and valleys.
Furnish and install 15 Ib. felt over existing deck.
Furnish and install 25 -year, 3 -tab Certainteed Seal King shingle to match the existing shingles (Frost Blend).
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.
25 year Certainteed 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 $4,350.00
TERMS OF PAYMENT
30% Upon delivery of materials / , �
70% Upon completion Customer Signature . v_/ /CC/Z ��-
Registration # 126235 _
Construction License # 074334 Date
Insured by Hackworth Insurance (413) 527 -9907 / 0Qt
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't .z."�i DEPARTMENT OP BUILDING INSPECTIONS -ol i= ..
212 Main Street • Municipal Building _
Northampton, Mass. 01060 `'''*
WORICER'S COMPENSATION rriSTJRANCE A.F'irll)AVIT
I, ___1 _ /ehsle of il. Tt. f oofinq
�) .1
with a !principal place of business/residence at:
•
5L 1ohj e St./ Eastharn to .Ma. 0.10a.'7 (phone / z3) -i1T15
!street/city/state/rip)
do hhe: eby certify, under the pains and penalties of perjury, that:
/1 am an employer providing the following worker's compensation coverage for my
employees working on this job:
• v • 1t4C231S- 31?t24 -04 10 0
• (. • .. CC Company) (Policy Number) (Expires on Date)
( ) 1 am a sole proprietor, general contractor or homeowner (circle one) and have hired
the co:atractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
,
(Name of Contractor) (Insufancc Company/Policy Number) (Expiration Date)
(Name of Contractor) ( Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach addrtionsl shcet if necessary to include infocn ution pertaining to all contractors)
( ) I am a sole proprietor and have no one w orking for me.
( ) I am a home owner performing all the work myself.
NOTE: please be aware that while homeowners who employ persons to do maiatmance construction or repair work on a dwelling of
not more than throe units in which the bomoowncr resides or oa the grounds appurtenant thacto are not wally 000sidcred to be
employers under the workers . ration Act (GL152,ss 1(5)), application by a homeowner for a license a permit may evidence the
lead ct > w7 of an employer under the Workoes Compensation Ace
I understand that a copy of this uitcneot may be forwarded to tho Deputmeot of Industrial Accidents' Moe of Imur.me for the
covL—agc verification and that failure to secure coverage) under section 2M of MOL 152 can lead to tba imposition of aiati1 lea
oomist� of a fine of up to S1,500.00 andtcr impCisoc ix t of up to oo ytxr taxi civil penalties la the form oft' Stop Wort VII*" ta d t
fax of 5100.00 a day against toe. .
For depsztotail uao only
Permit Number
p Lot #
Signature of Li Jpermittt Ise
SECTION 8 - :CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: �/
visor: NotApppllicable ❑
Name of License Holder : a,v[ !f De I si / / 433
License Number
5l }{ol oke_ &tree . - Eamth arn plb n � Na. 01027 5 -03- O b
Expiration Date
( 413) Sari- gg75
Signature Telephone
rR` , e:7' ' °e •rw`men"•1n is: i �s� z< Not Applicable ❑
c. I. Roof n3 )2.6 235
Comanv Name Registration Number
51B }1okjo1(e. Street - ED. BOX 3Dq 5 - Ob - Ob
Address Lt�f Expiration Date
k asthampton M. ID art Telephon��l� 1Z3, 5x/4 ns
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 a,,t.acheci
SECTIOM DESCRIPTION;OF PROPOSEDAWORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing V
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ]
Brief Description of Proposed Work: - - • _�� �� �i 11�
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative ❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ . Sheet ❑
6a f ew houselandtor addition ciTezistifiThousing,;c6mplete` the f-al blab.
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 APPLIES FOR BUILDING PERMIT
1, charlotfiL J'IQArse (+ , as Owner of the subject property
hereby authorize ,M aYik De1, Sle. Q7 R•�+. RQQfi )( to act on
my behalf, in all matters relative to work authorized by this building permit application.
attaellec1 9- a -05
Signature of Owner Date
}
I, Mary 17e1ts1e. as a►1thoYmeci agent , as Owner /Authorized Agent
hereby declare that the statements and information on the foregoin application are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
Nairh el '►sl e.
Print Name
8 -a4 -a5
Signature of Owner /Agent Date
f �
•
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:
�-1 V - - City of Northampton rl nay.
Building Department
�.
r L,C 2-12 Main Street
' to‘r,,, Room 100
r Northampton, MA 01060
n `rlork' v4i3=5 - 1 Fax 413. 587.1272 ®' to of
a�nr O .
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: Th�s sects o compl t�
23 � �� ���� ! ��� Maps �' ��- � '�
u
• Zone � � ��Ovelay
Elm St. District CB District.
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
Cbar1atie .Morse. P.o. bS h 1)46 Name (Print) Cy rsn�:a n ) Addr ss: Q 014010
attached l Q F
Signature Tel$tfbe p " 3 _9470
2.2 Authorized Agent: ``oo((U U 1
Nlar Tel i s - f PM. C ox 309 - Easthampton, Ma
Name (Print) Current Mailing Address: 01oa/7
(J-113) 5a1?- v77
Sig ature Telephone
SECTION 3 ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building Roof; n3 /4350 (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) W )350.D0 Check Number �� ~
This Section For Official Use Only
Building Permit Number: Date Issued:
S ignature:
Building Commissioner /Inspector of Buildings Date
R
23 GLEASON RD BP- 2006 -0225
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18C -100 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit # BP- 2006 -0225
Project # JS- 2006 -0330
Est. Cost: $4350.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sq. ft.): 14505.48 Owner: RICHARDS CHARLOTTE
Zoning: URB Applicant: RCI ROOFING
AT: 23 GLEASON RD
Applicant Address: Phone: Insurance:
P 0 BOX 309 (413) 527 -4775 Workers
Compensation
EASTHAMPTONMA01027 - 0309 ISSUED ON:8/31/2005 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 8/31/2005 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo