35-204 (2) . . fin
LLP
I R
0o g,
51B Holyoke Street
P.O.Box 309
Easthampton, MA 01027 Estimate Date
Phone(413)527-4775 6/17/2005
Fax(413)527-8469
Name/Address Job Location
Jim Camposeo 1268 Burts Pit Road
1268 Burts Pit Road Florence, MA
Florence, MA 01062 Home: 586-1581
Work: 584-5911 X254
Terms Rep
Estimate valid for 60 days Mike
Job Description Total
Estimate is for house only. 3,600.00
Remove existing roofs. .A
Furnish& install aluminum drip edge,pipe flashings and chimney flashings.
Furnish& install new lead counter flashings.
Furnish& install ice&water barrier along eaves,valleys and on entire back low pitch dormer.
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 re lacement if needed.
A�
Total $3,600.00
TERMS OF PAYMENT
30%Upon delivery of materials
70%Upon completion
Registration# 126235 Customer Signature "Zolu hlzlr��
Construction License#074334
Insured by Hackworth Insurance(413)527-9907 Date y
4�ttMt Pao XL
L
e Crx [rz �ittllt�ltIIlT
Y
8 d xsssachttsctts'
cfl DEPARTMENT OF BUILDING INSPECTIONS '
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
of U.-T. R00-finn
(licenue/permittec)
with a principal place of business/residence at:
5��3J �)Ivp (phone# 5�?_�??5
sty tyistaWrip)
do hereby certify, under the pains and penalties of perjury, that-.
XI am an employer providing the following worker's compensation coverage for my
emplovees working on this job:
ki kertv Mutual 1irIC2�l�-317t��-oH�i ID �
( cc Company) (Policy Number) (Expiry on Date)
( ) I Lm a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(:tame of Contractor) (Insuuancc Company/Poticy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/PoGcy Number) (Expiration Date)
(auad:i3drtionil sheet if neoeassry to include information pertaining to all ombractors)
i
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that vohilo homoowmn who employ pasoeu to do=.i.�oonsuua oo or repair work on a dwelling of
not more than throe units in which the homeowner reside*oc on the gro m s app utcnant tha<to arc not gcaa'alty oomWcrod to be
employers under the worker's o=V=satioa Act(GL152,ss1(5)),application by a homeowoa for a Haase a Permit may a'idraoe the
legal assn of an eaployer under tho Wockor's C.ompomatioa Ad
I understand that a oopy of thin etate may to foevrardad to the Depwtmwa of ladsatrial Aaidea&OfSoe of In u-w for the
covcrago vaificatioo and that failure to tarry oovorngo under soctiou 25A of MOL 152 can lad to tho iu pOS Oa of aitniaal P=W'%
comaing of a fine of up to S 1,500.00 swot impnso=cnt of up to one year and avt7 peaattia io the form of a Stop Wo'k Order sad a
fttm a(S 100.00 14Y tp inA me
For d Use only
t mp Numer
Wpb{ Lot#
Signature of Liocnsee/pernut#x
:�.��Z'SO t�iG.i°il'u:l•'i�_•S.vsc�i?i.Y.�_ .
J
•L
SECTION S'-:CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : . ay B e isl e- 17433-4
License Number
5 - � ah10 On 01027
Address Expiration Date
J4 13 .5Qrl- X1775
Signature Telephone
ItVE r 1'' ' m17605i'r.v""meit"O n '
r.a, Not Applicable ❑
- R00fi Ila I2.4 2.35
Com any Name J Registration Number
5113 oktnKe, Strut - P.Q. Box coq 5- ob - 0b _
Address J
r7 Expiration Date
�,astbam =Qfl Telephon -t5
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...... ❑
z0 U.,6AX111 F
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
SECTION 151;-,DESCRIPTIoi�,,PROPOSED WORK[check,all applicable)
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❑
6a 'IfiN6SI tise�a00Id o"t f-dIJI1M VIA o'ezhAII'Wh-661it h J comp MUM ftW f611 VW I :
a. Use of building : One Family Two Family Other
b. Number of rcoms 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?
In. 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 0R CONTRACTOR APPLIES FOR BUILDING PERMIT
I �� _ a m �^Seo as Owner of the subject property
hereby authorize A a _to act on
my behalf, in all matters relative to work authorized by this building permit application.
at1.aeA1eA 9- 019- 05
Signature of Owner Date
— Mark J aw Y zed as ent 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.
May
Print Name
q- as -05
Signature of Owner/Agent Date
Section 4.
ALL INFORMATION MUST JE 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
Room 100
Northampton, MA 01060
phone 413.587.1240 Fax 413-587-1272 to
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOU'S1H A.ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION i
1.1 Property Address: Lc� o€ '4 T1i15
a �
gads Buds p
Ma
Oaverlay�Dlsffr
Elm St DistrictCB District .,.
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: r� � ��_w
i m �.D r j eel MOOS eD I v Buyts 1 r t V0 N�in
Name(Prin ) CurrenJ.Jvja,iljng
Telephone���
Signature
2.2 Authorized Agent:
' PBox3Q9 - Easthan�c�t�� Ma
Name(Print) Current Mailing Address: T �—0102.7
41 A 5a - �I'1?5
Sig ature
Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building Roof i n 3bDD.OD
(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) boo, o Check Number
This Section For Official Use:Only
Building Permit Number: Date'lssued:
Signatu
re:
Building Commissioner/Inspector of Buildings Date
1268 BURTS PIT RD BP-2006-0349
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:35-204 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-0349
Project# JS-2006-0512
Est.Cost: $3600.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sq.ft.): 57499.20 Owner: CAMPOSEO JAMES M&LORI J
zoning: SR Applicant: RCI ROOFING
AT. 1268 BURTS PIT RD
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTONMA01027-0309 ISSUED ON.912912005 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 9/29/2005 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo