29-524 .I. R 00fin
g, LLP
51B Holyoke Street
P.O. Box 309
Easthampton, X[A 01027 t'
�� m ate Date
Phone(413)527-4775 4/26/2005
Fax(413)527-8469
Name/Address Job Location
Lisa Barondes 13 Gregory Lane
13 Gregory Lane Florence, MA
Florence, MA 01062 Home: 584-4294
Work: 587-3265
Terms Rep
Estimate valid for 60 days Mike
Job Description Total
Remove existing roofs. 5,300.00
Furnish&install aluminum drip edge and pipe flashings.
Furnish& install ice&water barrier along eaves and valleys.
Furnish and install 15 lb. felt over existing deck.
Furnish and install 30 year Tamko Heritage Series shingle.
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.
30 year Tamko 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 $5,300.00
TERMS OF PAYMENT
30%Upon delivery of materials
70%Upon completion Customer Signature A AA i
Registration# 126235
Construction License#074334 Date
Insured by Hackworth Insurance(413)527-9907
� 8
�ls�iachnsctta'
d DEPARTMENT OF IIUII.DING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060 ,
WORICER'S COMPENSATION INSURANCE AI+FMAVIT
--I)ellsle of R. 0.1- Roofina
(ll censet:lperntl ttec)
with principal place of businesslresidence at:
Jr (phone# �15��'_�I??5
strcctl�ty,=Wzip)
do hereby certify, under the pains and penalties of perjury, that:
(1 = an employer providing the following worker's compensation coverage for my
emplovees working on this job:
Al Int 11 Grub b R i bb l D !0 Ob
J=rancc Company) (Policy Number) (Expiration Date)
O 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)
r
(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 Data)
(LI32:.:1 a,"ditiOa2l ShCGt if noocarury to include id0nnAtiOn pataimng,to all 00dMCtM)
( ; I am a sole proprietor and have no one working for me.
( ) X am a home owner performing all the work myself.
NOTE:pl==be aw=that wt@o homcown=wbo employ peso=to do m&kd oe,ooaswidion or tspair work on a dwelling of
nAt roc c than droo units is which the bomoowocr residrs oc oa the gv m&ippu unapt ibado ue oa y 000sWered to be
em loyr s nndcr thn woticr�s o=vcw4oa Act(GU Y4=1(S)),application by a hoatoowna fora 6cepse oc pe rn d may evideme tho
lei ct..t of an amployor under the workaes Compamation AeL
I un ic-staad thss a copy of this ctitamart may be forwarded to the Depauoa Q of Industrial Aao 4m&Omos of Ia mm—for d"c4va,gc vairicatioo and that failure to eocun covetago tttsdet soctioa 23A of MOIL 131 coo lad Lo Ibe'iarpoaikio4 of tximiaat Pena
8 of ai frx ofu�to S 1.SQD,QO taldla�0('tta t4 00o year IDd dV�pemltfd In lbe forla 0�it 6tep WakOfda IOd 1 �+:
0f w 100.00 1 dly ttpit&me.
For dopatrnmbl tue only
Permit Number
r;•
Lot
Si of Licensw/permittee MaP
SECTION a-;CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder a� e �,5 e_
License Number
5 oa7 5 .03 - Ob
Address � Expiration Date
0413) SO- 4q7_5
Signature Telephone
� s 'o""inn"provemen Con FTE-tom Not Applicable ❑
In
—J., UL 2,35
Corn any Name J Registration Number
51� OIN oK e. Street - P.b. Box 31)9 - 0 b - Ok
Address J Expiration Date
Tel 75
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...... ❑
a
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 actin-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 a1h;I heJ
SECTION 5- DESCRIPTIONOF PROPgSED WORK(cheek%all'applicabie)
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❑
6�a;°If�Newiiouse° a»dor"additiontoveXlstingshsing,�c"omple'� h� fi�rloil :
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 -T,0 BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, ��Sa arondes as Owner of the subject property
hereby authorize J'ICLI ��3IC — -LL•C �.—L�06��n4 to act on
my behalf, in all matters relative to work authorized by this building permit application.
a+ �aeh ed 1 t 3d 05
Signature of Owner Date
I, Mark L �'lS'� S 2 tL[lpY=A Aae-nt 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.
Print Name
11 13c) p5
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:
a
City of Northampton
Building Department
212 Main Street
Roodh 100
Northampton,'MA 01060
r _^pholle;:413-587.1240 Fax 413.587.1272
APPud4 i0N'-T-TtQNSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: s
",•This sec 1."
3 Map,.TRA o ;
Y'e4oYV ane
a sa Raa
EIm St. District CB Distrct �. _
SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
kiz-a �Barandes Mv,I Florence
Name(Print) Cur it A
Aft-A ej Telephone `
Signature
2.2 Authorized Agent:
M h'-Ndi i sl— R. C.I. Roofmq P.�.C3ax 9 - 'Eas . araclw Ma
Name(Print) Current Mailing Address: ol�n
(413) gQ;q-
Sig ature Telephone
SECTION ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building Roofing 5300.00 (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) S500.00 Check Number
This Section For Official Use Only
Building Permit Number: Date Issued;
S� nture:
Building Commissioner/Inspector of Buildings Date
1 RY LANE BP-2006-0605
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29-524 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PEHMIT
Permit# BP-2006-0605
Project# JS-2006-0884
Est. Cost: $5300.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sq. ft.): 5967.72 Owner: BARONDES LISA
Zoning.URA Applicant: RCI ROOFING
AT: 13 GREGORY LANE
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Comppensation
EASTHAMPTONMA01027-0309 ISSUED ON:121112005 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 12/1/2005 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo