23A-050 r� !
RC.I. � Date
6 Line St. Estimate
Southampton,Ma.01073 7/8/2014
Phone(413)527-4775
Fax(413)527-8469
Name/Address Job Location
Dan Millman -Zee" 24 West Center St.
24 West Center St. Florence, MA 01062 e,
Florence,MA 01062 -(41-
Terms Rep
Estimate valid for 30 days Chris
Description Total
Remove existing roofs. 14,200.00
Furnish&install 1/2"plywood over existing decking.
Furnish&install aluminum drip edge,pipe flashings,chimney flashings and step flashings.
Furnish&install CertainTeed Winterguard ice&water barrier along eaves and valleys.
Furnish and install synthetic underlayment.
Furnish and install Lifetime CertainTeed Landmark Series shingle.
Furnish and install CertainTeed approved ridge vent.
All exterior roofing related debris to be removed by R.C.I.Roofing.
All work will be performed according to manufacturers'specifications.
Lifetime CertainTeed material warranty included.
All related permits will be obtained by R.C.I.Roofing.
A Certainteed Surestart plus warranty will be included with a fee of$500.00 absorbed by RCI
Roofing if signed within 7 days.This extended warranty means that 25 years of the Lifetime
warranty is covered for labor and materials. The remaining years of the Certainteed warranty
would be covered for material only.
Customer is responsible for securing interior items and any attic debris from roof removal.
Total $14,200.00
TERMS OF PAYMENT , �C ......
5%Deposit
Balance upon complction Customer Signature �(
Registration#126235
Construction License#074334
Insured by Banas&Fickert his. Date _
(413)527-2700
The Commonwealth of Massachusetts
Department of Industrial'Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
mirm mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
,pplicant Information Please Print Leizibly
lame (Business/Organization/Individual);
>.ddress; Cq S�
;
SECTION 8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder: )•( e, / M 43 mil'!
License Number
ma. niona
Address 4 Expiration Date
(413) 1175
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable 13
on Ana 12b�3r
Company Name �\+ Registration Number
HOOreaa ��— -- �l `
Expiration Date
arnr� �Y1 a• t� ��3 Teiephonl�l
slz-
SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(S))
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 Afflclavit Attached Yes....,.. Qr No....., 0
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families
,ind 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 homeoivner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shaD be
responsible for all such work performed under the building permit
,`ks 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 Sable for persons)
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
i
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C7 Siding [rte) Other[[3)
Brief Description of Proposed �.}.aC�,.e�� _
Work:_ LL
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes _No
Plans Attached Roll -Sheet
.6a. If New house and or addition to existing housing, complete the following:
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. Masscheck 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 -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, VIlack OkAk p�-N.' - 0 6'.o' l cA r r S a as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this uilding permit application.
aAtwhe'1 ti - �- iy
Signature of Owner Date
I, Azy k mel L 5',e. aQ 1. as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing 4lication 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. ZONING Ali Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Rear
Building Height
Bldg. Square Footage %
.Oppn Space Footage %
(Lot area minus bldg&Paved
#of Parking Spaces
(volume&Location)
A. Has u Special Permit/Variance/Finding ever been issued for/on the site?
y—�
�-\
NO �_� DON'T KNOY� �~� YES
|F YES, date isaued:>| !
IF YES: Was the permit recorded at the Registry ofDeeds?
��
NO DON'T YES
/ ��'
IF YES: enter 800k ! Page! i and/or Document
�
' . . '
B. Does the site contain o brook, body of water orvvetiandu7 NO \�� DON'T KNOW �_� YES
IF YES, has permit been or need to be obtained from the Conservation Commission?
Needs tnbeobtained »-� Obtained ��` Date |��uod' \ |
' ;
C. Do any signs exist nn the property? YES �~/ NO \~�
— '— - - -- — — — — |
IF YES, describe size, type and (ocation: | |
D. Are there any proposed changes toor additions of signs intended for the property ? YES 0 NO 0
. /
IF YES, describe size, type and location:
' |
` �
E Will the construction activity disturb(clearing,grading, excavation, nr filling)over 1 acre oris it part nfa common plan
that will disturb over 1acre? YES � � NO K l
��
IF YES,then a Northampton Storm Water Management Permit from the DPW is required,
Department use only
_!. _.[� ity of Northampton :Status of Permit:
' I uilding Department Curb Cut/Driveway Permit _
I ' 212 Main Street 'Sewer=/Septic Availability _
Room 100 WaterN.VeII Availability _
Fiectrc, Rurribing&Gas Inspscli bTt�W p
ham ton, MA 01060 Two Sets of Structural Plans _
Northampton, M 87-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify _
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
2L{ w eS•V O—C X t f S Map Lot Unit_
-00{e y,C c i A vA Zone Overlay District _
Elm St.District CIB District _
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
VV, - ?.4 W, Cr n l ter- 0 r r-rX
Name}(Print) Cur ent Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address: �10'
J4115
Signature Telephone
SECTION 3.-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building oofi n '(-A C)C) (a) Building Permit Fee
2. Electrical J (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) dQ - C)e-, Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued: _
Signature:
Building Commissioner/Inspector of Buildings Date
24 WEST CENTER ST BP-2015-0552
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23A-050 CITY OF NORTHAMPTON
Lot:-00 L PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2015-0552
Project# JS-2015-001056
Est.Cost: $14200.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 74334
Lot Size(sq. 1): 5575.68 Owner: MILLMAN DAN
Zoning: URB(100) Applicant: RCI ROOFING
AT. 24 WEST CENTER ST
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527-4775 Workers Compensation
SOUTHAMPTONMA01073 ISSUED ON:11/13/2014 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 11/13/2014 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner