35-147 (2) R. .I. Roofing
40 Maine Avenue Estimate
P.O.Box 3[19
Easthampton, MA 01027 Date
Phone(413)527-4775 9/26/200
Fax(413)527-11469
Name/Address Job Location
Carl Charrette 746 Ryan Road
746 Ryan Road Florence, MA
Florence, MA 01062 Phone @Bakery: 527-3313
Terms Rep
Due on receipt Mark
Job Description Total
Remove existing roofs. 5,800.00
Furnish&install 2-ply modified bitumen base sheet, torch applied.
Furnish&install IKO modified bitumen cap sheet,torch applied.
Furnish&install .032 edge metal.
All roofing related debris to be removed by R.C.I. Roofing.
All work to be performed according to manufacturers'specifications.
5 year R.C.I.workmanship warranty included.
10 year manufacturers'material warranty included.
All related permits to be obtained by R.C.I. Roofing.
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
Registration# 126235
Construction License#074334 Date
Insured by Hackworth Insurance(413)527-9907
o O
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u - —
o DEPART),4ENT OP DUILDr);G INSPECTION'S
212 Ma'n Strcct ' Nlunicipnl T3uilding
Northampton, Mass. 010GO
W O RICER'S C O\i U E N S A TI O N Cq S U�CE A l:TD7 A V1T
(li ccnsaJperm;ttcc)
v.Ith a principal place of business residence, at:
�o JM ojr7 . Av-6/F-asfhampfon MA 0160
do hereby certify, under dic pain.S and penalties of pcfJury., hzt
(V� I am an employer providing the following workcr's comocnM uon cove—Sc (or in)
eluplovccs wor�hng on tlus job.
J ,i bett jutl al � 1 33 (10 0
trruor, 1Datc)
( ) I am a sole proprietor, general coou-aecor or homeowner (circ:e one) 2nd have hired
the cone actors liste—d below 7-1ho h2ve the follo%vinQ worker's c.=ensadon policies:
('�amc o;Co.^..^c�or) (In2ranc: COIi1D1,'1)'/hGUCI' ��uSIlC�t) �-•'•)1;dU^� Date)
- ( =nc of Couazmor) _— (lnsarancc CompanytPolicy Nunlccr) FExpu Lion Date)
(Name of Coatraelor) (Lasuranec CompaoyfPoUc)• Numbei) (Expiration Dwc)
01 amc of CosTacior) (Insuran(-- Comv.,-- y/Policy Numbs) (Et-pita000 Datc)
(eat-'6�Zoczl if acxury to mcud �afortai c peru inias to ell oom- C-on)
O I a.m a sole proprietor and have no one wor4-.ng for me.
( ) I am,a home owner perforrai.ng all the work myself.
NOTE:plcsc be tw-irc Lhi ui ]c boa co+mcn-bo cmploy pczam w Lb-i ca= -uoo c rcpcu work oo.d-AL-�of
GO(Mort ti-n `LSO:=rJ is ui;3tfi the botnoowvc rmdc or oa the Qmtac`s zppurtcn_rn cot C7.-.-.Dy 0=-r-d=d to tr
catployc-uaG:the- -kcr'z car,cs.clloa A={GL152.=1(5))�appltnaoo by a bosaoaac fart lira or pamh c:y--td—LL'c
Ic�l cU--of to es?loyx under dro Workol.Coazpee.Aa ion AeL
1 undartead dad>copy of tbi,mt.emaa m,-y be foe--,ded to tbo Deportmcoa of ln.d+trritl r.eodaMLY Offf oe of laau+noo for th.
cOvaZ1 va'LG=oa t_nd tact L-ilta-e to toaure tovem�e under soctioa 25 A of MGL 152 cin Ir-d to the i= i -of-i-i peas -
ooeai:ix$of a Sine of up to 51-500.00 u�,Vor=piyoam,=of up to one year tad civil pm.hio io be form of a Stop Wort Order end.
fl=of 5100.00,d_y tpi=ar-
For dcp=rtm�-�u.c only
Pcrrnir Number
Lot
SiGnatun.of Liccnscc/Pcrmiucc
SECTION 8 CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑ I I
Name of License Holder : ��(ak 'DP�;SIe. q /y'7 33'7
License Number
�►o — 7 5 - J — 0�
Address Expiration Date
- 7-�
Signature Telephone
rn
Re " M
Not Applicable ❑
R. C • T. R f'I no l ab � 3�5
Company Name Registration Number
il o Main Ayerwe_, - ft ..o oX 3o i 5 - 6 - O�
Address Expiration Date
Telephone 13 -J 776
SECTION 10 WORKERS' COMPENSATION IKSURANCE_.AFFIDAVIT(M
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 acccptable 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 thejob site will be required from time to time,during and upon
completion of the work fo;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 C�tan �
SECTION 5`YD SCRfPT ONifOF PROPOSED aiVORI<(check Vr 113:61i�-
17
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ) Other [ ]
Brief Description of Proposed Work: S /f, e—c L0
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attached Roll 0- Sheet 0
6�ARI WMou"""" s andipr d-dUiff-6 to eXisting housing mp�l'efe" t i'e foflowing
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 7aOYVNERA_.1710RIZATION ;TXO,BE COMPLETED WHEN
OYYNERS q�EN1ORCONTRACTOR APPLIES;.FOR BUILDING PERMIT'
as Owner of the subject property
hereby authorize II 7 e ROnFi na to act on
my behalf, in all matters relative to work authorized by t„ building permit application.
Signature of Owner Date
JS Q as Owner''Authorized Agent
hereby declare that the statements and information on the fdYkgoing 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 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:
? ty of Northamptonti
h ` �117 lV).�wilding Department
j 3212 Main Street r
Room 100
ampton, MA 01060 e ti
phone 413-5 7-1240 Fax 413-587.1272 rt
- ARPLICAITON TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
this s;ect��:tobeco p et'ecl�b:office s
1.1 Property Address:
"B D,i -1c
Elm_S� DistriEt °�° „� G. t �
SECTION 2 PROPERTY OWNERSH'IP/AU.THORIZED AGENT
2.1 Owner of Record:
f I c�C---i c //C e
Name(Print) Current Mailing Address:
1 ,f'
a fl,, Telephone "
Signature 3
2.2 Authorized Agent:
Yaff� IP-1j5 00fina POof1pX 309 - E05A0'Mnfinn .IYIA
Name(Print) Current Mailing Address:
(-q 13) 5. ,7 q q 7 5
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Offidia11 Use 00ly
com feted by ermit applicant
1. Building D00 ('i n (a) Building Permit Fee
2 Ele,--rical �l 7 _
(b) -..timated Total Cost of
Construction;from: :6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
o. Total = (1 + 2 + 3 + 4 + 5) LJ Check Number
This Section For Official Use Only,
Building Permit Number: Date Issued: -
Signature:
Building CommissioneMnspector of Buildings Date
T
74 0AYq BP-2004-0435
GIS#: COMMONWEALTH OF MASSACHUSETTS
.tic: 35 �i 1r47 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2004-0435
Project# IS-2004-0633
Est. Cost: $5800.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Groin: RCI ROOFING 126235
Lot Size(sq. ft.): 23609.52 Owner: CHARRETTE CARL A&BETHANY L
Zoning: SR Applicant: RCI ROOFING
AT. 746 RYAN RD
Applicant Address: Phone: Insurance:
P 0 BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTON MAO 1027-0309 ISSUED ON:10116103 0:00:00
TO PERFORM THE FOLLOWING WORK.STRIP & INSTALL MODIFIED BITUMEN 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: Check No: Amount:
Building 10/16/03 0:00:00 4255 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo