29-053 Y R
.I. RoOfMg, LLP
51B Holyoke Street
P.O. Box 309 ■
Easthampton, MA 01027 Estimate Date
?hone(413)527-4775 11/9/2005
Fax(413)527-8469
Name/Address Job Location
Robert Joyce House Only
28 Gilrain Terrace 28 Gilrain Terrace
Florence, MA 01062 Florence, MA
585-8637
Terms Rep
Estimate valid for 60 days Chris
Job Description Total
Remove existing roofs on house only. 5,000.00
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 lb. felt over existing deck.
Furnish and install 30 year Certainteed architectural shingle, Frost Blend.
Furnish and install Cor-A-Vent ridge vent.
All roofing related debris to be removed by R.C.I. Roofing.
Al(work will be performed according to manufacturers'specifications.
5 year R.C.I. workmanship warranty included.
30 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 $5,000.00
TERMS OF PAYMENT
30%Upon delivery of materials
70%Upon completion Customer Signature
Registration# 126235
Construction License#074334 Date j 9
Insured by Hackworth Insurance(413)527-9907
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DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFMAVIT
Roofin�_
(liccnsedpermiticc)
with a principal place of business/residence at:
Jr (phone# )52E_.17?Jr
street/ ty/stair)ip)
do hereby certify, under the pains and penalties of penury, that:
(1� am an employer providing the following worker's compensation coverage for my
cmployces woricing on this job:
Amex`tean`In .') gmun b 81 bb l D 10 O b
(?a ran= Company) �— (Policy Number) (Expiration Dale)
O rn a sole proprietor, general contractor or homeowner(circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
dame of Contractor) (Insurance CompM/Poticy Number) (Expiration Date)
(Name of Contractor) (Insurance Comparry/Po6cy Number) (Expiration Date)
(Name of Contractor) (Insurance Compauy/Policy Number) (Expiration Date)
(Frame of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(&-zh sdditioml&beet if necenxry to include infoeenxtion pertaining to all oodmdon)
( ) I am a sole proprietor and have no one worldng for me.
( I am a home owner performing all the work myself.
r
;10TE:pleau be aware thxl wbilo bomcowinn who employ pemm to do maiateaxace,aonovdioa or repass wotic on a dwelling of
not=cc thw throo unit:in wiucb the bomeowaer resider or on the groun6:part nad tbaxto ere not geoecalty coaridered to be
cai,loytn undo the wo Vzes.00mpcasatioa Act(GL152 nl(5)),application by a bomoowna for a liecase oc permit may evidence the
kp ctxau of an employee under the Workces Compemdim Act.
I uadCrAAad d3Ja a copy of thie chtcmmt MAY ba fw worded to tho Dgwtmeul of Indsutrial Aoeidw&Office of Imtreoos fee the
cova�c va ificeloa and that fad=to cxttn covango uudcr soctioa 25A of MOL 152 as lad to tb a kVositioa of ctitniaal pettaldcf
g of x fmc afuQ w 51.300,00 ttUd/cx of tip 10 oae year nod dv�pt�tllla it the ftxm of a Stop WakOtdtt toti t '.�.
fit:4 of'.100.00 i,diy,tpinst me.
FO,dq>ats>z�us.-ay
Permit Number
. I&iii
�-��aNt r•
r Si tiu
Pae of LicrosmTermittee
r
r
SECT(ORt'- 3CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
a �s
Name of License Holder :y �Be We- / 174 ' 3
License Number
5 - ov 5 -03 - ob
Address Expiration Date
Signature Telephone
f s ewe " oTyemen r Not Applicable ❑
. I. oo 'i m ) 2A 2,35
Com any Name Registration Number
}nr Ke. Stream— P.�. )x 3rDq 5- Ob - U
�o
Address Expiration Date
Telephon 175
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,ftachej
SECTION"5= DESCRIPTIONtOF PROPQSED WOFK(chFkiali applicable)
.,... . .:,.w.:. .
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: 1P 41
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet❑
6a h'1f,Newho su eatd`o ticlitionto eXisttnghoising,°complete'thfalli :
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 -OWNER"AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS:AGENt OR CONTRACTOR,APPLIES-FOR'BUILDING PERMIT
4('_e, —, as Owner of the subject property
,
hereby authorize _ Jk O �� �Yla to act on
my behalf, in all matters relative to work authorized by this building permit application.
attached 1:2- b- o
Signature of Owner Date
I, Mark I)AWe- (as ;1161cwl ae t 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.
Print Name
J - b- D5
Signature of Owner/Agent Date
A*3 •
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
0
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:
' . 4
City of Northampton
Building Department
212 Main Street
Room 100
Northampton, MA 01060 >.
phone 41�-587.1240 Fax 413.587-1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This sect°'°' o
1.1 Property Address: $�� ',� � , R �
8 6i 1ral n_�r �� r,Mai
��Y° �S �
Elm St. Distct CBDisict
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
f�ob&Y.` TJc,� a8 �'�Ira►n lerra r-Qo
Name(Print) Currfxt ling&pr
0 bb 91
Telephone
Signature
2.2 Authorized Agent:
Pte. Brix 9 - Easthamclw- Ma
Name(Print) Current Mailing Address:
041-) 527- �igll5
Sig ature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION'COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building Roof ln 5000.00
(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) 5000000 Check Number
This Section For Official Use Only
B.Uilding Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date . , ;;
28 GRAIN TERR BP-2006-0625
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29-053 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: BUILDING PERMIT
Perm # BP-2006-0625
Proi t# JS-2006-0918
Est.Cost: $5000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot size(sg.ft.): 31363.20 Owner: JOYCE ROBERT G&ALICE J
Zoning:URA Applicant: RCI ROOFING
AT: 28 GILRAIN TERR
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTON MAO 1027-0309 ISSUED ON:12 1712005 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 12/7/2005 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo