29-027 AD
•
RCI R00fing, LLP
40 Maine Avenue
P.O.Box 309 Estimate Easthampton,pton MA 01027 Date
Phone(413)527-4775 3/11/2004
Fax(413)527-8469
Name/Address Job Location
Mike Korowski 31 Birch Hill Road
31 Birch Hill Road Florence, MA
Florence, MA 01062 Phone: 584-5663
Terms Rep
Estimate valid for 45 days Chris
Job Description Total
Remove existing roofs. 5,800.00
Furnish&install aluminum drip edge,pipe flashings and chimney 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 shingle.
Furnish and install 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$2.00 per sq. ft. for wood replacement if needed.
WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total $5,800.00
TERMS OF PAYMENT
30%Upon delivery of materials
70%Upon completion Customer Signature A`
Registration# 126235 1 ��-,
Construction License#074334 Date C�j l,;1,3 X y
Insured by Hackworth Insurance(413)527-9907 -
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a .E Crit� rrf ToI:fllullt}itoll _
ass itch nrcIta' - --
o DEPARTMEWT OP nurr_.Drl,,c fNSPECT1011=s —;
212 Train Strcct ' Municipal Building
Northampton, Mass. 01060
WORKER'S CON ENSAnON SURANCE Af MAVIT
(li ccnscc/permi(tcc)
vgth a principal place of business/residence at:
Ye, J F-QS+haMDfM MA ou a,l
(s�ii r~t/c�ty/star c�zi
P)
do hereby ceaify, under dic pains and penalties of perjury:, hi(
(V) I =tn an employer providing die followine xN-orkcr's comocns-n:ion covcrm 'or lily
etuployees «vorldng on'tllis Job-
3 1 r7 1 a,4•033 ►o og
ansiJancC C0MpzM,) (POCK: NU-miy-r) (:x--ptrauor, DaL)
a sole proprietor, general contractor or homeowner(circle one) and hzve hired
the contractors bsted below who have the following worker's coopen_sa6on policies:
(Name of Cont:ac-Loo (Innlrancx Cornpan}vi'oucr Nume.:) (YX01iduon mitt)
(Name of Councior) (lnstuan Company/?o1im, Nu.mccr) (—L-XDir 60n DZIC)
Mame of Conn cid,) (Tasu-ante CornT=)-IPoUq- Number) (Exairz6on Daic)
(Dame of Contractor) (tasuran= Compatry/PoUcy Numbr) 'Expiration Date).
(attach addii-aI 'vices trooaas+ry b uteTtrde=aftxmL�oo pertaiaiy6 to aL oemae'�n)
O I am a sole proprietor and bave no one world.ng for me.
( ) I am,a home owner performing all the work myself.
NOTE:plwe be atran the Nlrle bamra.LVCra wbo cmD1oY pcn*w W do m•, �-=-joo r repair-ork oa.d-,L l C of
aot mote tb o t'�oe tmt�in u-bich the bomoowac reido or oo the P'XXL ,sppurteari thcY.o ,,oot Coccalty ooariderod to be
etaployea ttat'.cr the ko:ker"L oe�,�,�.,�on Acs(GL152ss1(5)),�plictDOO by.bomeopaa fcr L Gcac or permh tt:ay�.ideoce the
1cs"'--'tu of an—Ploys under dto Wor$or. tioa AeL
I uodayuod tb&a copy ortbu mlcmcsa 0.y b.f.",d.d to tbo pcq.rtmcc¢or i kLr w Acod.&Ofroo Or Ir>;vr.oce for tb.
oovozgc VCrjGeaioa.ad aul L JLSc to some bovR>,cc% r uxzioa 25 A of MOL 152 ea lcad to the i p� oa oraimiaA pcaahio
oomiz-68 of a Got of up to S 1-$00.00 arwoc 6=PrL-cKcQ5=of up to ooc yvr Lod civil pcoatuo in 6c form ora Slop Work Order and a
fim 0(5100-00 a day LPI=CD,-
For ux only
PL-rmit Number
Lot K
S't Wtr oruoaiscrJPcrmiucc to
r
'S CMXO 8�xkOR t� 3i:;.`.;.!-....;.. SEl2VICES'� ��'
8.1 Licensed Construction Supervisor: Not Applicable O
Name of License Holder : �M 1J^P li S I e. /7 /'1 33q
License Number
o - 7 5 - 2 - 011
Address Expiration Date
g775
Signature Telephon
u: .: W Not Applicable l7
R. C• z. Rrnf1 na / 26 � 3L5 }
Company Name J Registration Number
•g o .Ma; n A\Itnc.te_ - P 6. ox �o q 5 - b - O�
Address Expiration Date
Telephone 3 6 9V7-J477,r
ii g
EG 0 s SRS'GOMFENSAT ION 1N U Bin ANCEQFFIDAVIT(MSG L ;c 1£52, §25C b)):
a a _ i
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...... O
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)fami!ies
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"homeoNvner"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 SignatureY}P[�
A34a. ¢t '� .R .r
.a......
:+a
New House 0 Addition O Replacement Windows Alterations) O Roofing
Or Doors ❑ I
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 O Renovating unfinished basement Yes No
Plans Attached Roll 0.Sheet 0
e 0 U TROM MMsting tt""o" sing cornp!°lefe' fh follow" to
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
� F
I, J'I1�� K�YOUISKI + , as Owner of the subject property
hereby authorize I 7 to act on
my behalf, in all matters relative to work authorized by this building permit app! cation.
6- 5-0%
Signature of Owner Date
I, J'IQ1(K. IJPIjC�P QS agtboriLtd agent as Owner/Authorized Agent
hereby declare that the statements and information on the fdw 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
Section 4.
ALL INFORMATION MIDST 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:
• r a _ _
City of Northamptont P
Building Department rp
212 Main Street
Room 100 e =
Northampton, MA 01060
phone 413-587.1240 Fax 413.587.1272
'RIP
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
o
1.1 Property Address: Y
t This sectio xbe"%eornpletedjtby gffice
j��N•g.
Ma
�"' - - — Zone M1 Ode lay A.rsttr ct t � `
Elm:'stDistrict taCB D�strct
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Mihe- �OYowsl�l oymcb
Name(Print) Current Mailin Address:
a�taAheA M4 - �b3
Telephone
Signature
2.2 Authorized Agent:
yag.� 17e 5le, C. Z. Roof na Ro. flpx 3o9 - EQsf amofLn NA
Name(Print) Current Mailing Address: QIQa�
�= (-qj3) 5a7- jqgg5
Signature Telephone
SECTION 3-°ESTIMATED do STRUCTfON.'CO"STS
Item Estimated Cost (Dollars) to be Official Use Only
(+
completed b permit applicant
1. Building Q007 I n 54��•b� (a) Building Permit Fee
2 Ele:,rica; 'l 0 (b) Estimated Total Cost of
Ccnstruction from 6
3 Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
o. Total = (1 + 2 + 3 + 4 + 5) 00.0 Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
T
ow1w,_. *
31"BIRCH HILL RD BP-2004-0959
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29-027 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2004-0959
Project# IS-2004-1419
Est.Cost: $5800.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Groin: RCI ROOFING 126235
Lot Size(sg. ft.): 13068.00 Owner: KOROWSKI MITCHEL F&ROSE M
Zoning:URA Applicant: RCI ROOFING
AT. 31 BIRCH HILL RD
Applicant Address: Phone: Insurance:
P 0 BOX 309 (413)527-4775 Workers
Compensation
EASTHAMPTON MAO 1027-0309 ISSUED ON:415104 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• Receipt No: Date Paid: I Check No: Amount:
Building 4/5/04 0:00:00 5291 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo