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24C-192 (2) Optional Insulation; 3" polyxso insulation (2-layers of 1--1/2") R-value17.4 ADD : $2,800.00 4.4" polyxso insulation (2-layers of 2.2") R-value 25.2 ADD: $4,500.00 May be required for permit with new base line energy code,for commercial pxopertys. We will review with the building department. Note; Any rotted steel decking above our 1000SF estimate,will be billed as a unit price of $4.00 SF. If 1000SF is not required, as carried in the estimate, will be a credit at completion of project. 'perms: 5b 0 deposzt''at derive y of z�Zater"iaT�.'A►id balailce due Oil comple60-11: References and insurance certificates will be provided upon request. We hope that you select R.C.I. Roofing to do this work for you. To accept this proposal, please sign in the space below and return a copy to us with your deposit. Sincerely, Keith Darnel Estimator Commercial Accounts Accepted by 'e- date 1-7 R.c. i.-io�ofi�ng lt.P 6 Lute Street,Southampton, MA 01073 Phone:413-527-4775 Faz: 413-527-8469 September 5, 2014 Rick Mott Ricks Auto Repair 442 Elm Street Northampton,MA 01040 Re: Roof Replacement Proposal 442 Elm St Northampton Dear Rick; T1�az*your for the opPortunxty,torovide,the fo�lowing estimate for installing new roofing system on the above referenced property: Our scope bf work is outlined below. Scope: Strip existing modified roofing, flashings to existing fiberboard to steel deck Furnish &install 1000 SF steel decking replacement (due to rot) Furnish &install P.T. wood hailers a5 needed Furnish &install 1-7/2" polyisosanurate insulation mechardcally fastebed(R-value 8.6) Furnish &install .060 T PO RlZino Bond attached Furnish & install all penetration flashings Furnish& install .032 aluminum edge metal (white) Provide owner with R.C.I. Roofing 5-year workmanship warranty Provide owner with a 20 -yeas membrane warranty R.C.I. Roofing will obtain all pern-&5 Price: $ 25,800.00 City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: �� f The debris will be transported by: The debris will be received by: � 6 -'N-A N)Sr<I'L XACI 1 Building permit number: Name of Permit Applicant 1zCT ( UQ:; C-x f-i e' 12. Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial`Accidents Office of Investigations 600 Washington Street Boston, MA 02111 wsinv,mass gov/dia Workers' Compensation Insurance Affidavit. Build ers/Contractors/Electi•icians(Plumbers .pplicant Information Please Print Le ibl lame (Business/organization/Individual), d.d.ress; C, Ma, o�o-73 - Phone #, 13 1�a l -Qt-( -(, re you an employer? Check the•approprlate box: Type of project (required):. �.}I am a employer with Z U 4. ❑ I am a general contractor and I 6. ❑ New construction _ employees (full and/or part=time).* have hired the sub-contractors _) I am a sole proprietor or partner- listed ou the attached sheet. 1 7. ❑ Remodeling I ship and have no employees These sub-contractors have 8. ❑ Demolipon working for me in any capacity, workers' comp, insurance, 9. ❑ Building addition [No workers' comp, insurance 5. ❑ We are a corporation and its required,] officers have exercised their 10.❑ Electrical repairs or additions ❑ I am a homeowner doing all work right of exemption per MGL 11.7 Plumbing repairs or additions myself [No workers' comp, c. 152, §1(4), 'and we have no 12, Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp, insurance required.] -- iy applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: :)meowners who submit this affidavit indicnting they are doing all work and then hire outside contractors must submit a new affidavit bidicating such, ntractors that check this box must attached an additional sheet showing the name of the subcontractors and their workers' comp,policy information, m an employer that is providing workers' compensation insurance for my employees. Below is the policy anti job site ormation. u:rance Company Name: p c —7- licy #or Self-ins, Lic, #,_�,J C ' ��,� y Expiration Date:_ 10 d, Site Address: City/State/Zip: tFtch a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). ih.ue to secure coverage as required under Section 25A of MGL c, 152 can lead to the imposition of crinunal penalties of a e up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDFR and a fine up to $250,00 a day against the violator, Be advised that a copy of this statement may be forwarded to the Office of vestigations of the DIA for insurance coverage verification, to hereby cert� under the pains and penalties of perjury that the information provided above is true and correct~ g?iature. D ate; tone Official use only. Do not write In this area, to be completed by city or town official, City or Town: Permit/License # Issulug Authority (circle one): '1. Board of Health 2.Building Department 3, Cityrrown Clerk 4. Electrical Inspector S, Plumbing Inspector 6, Other Contact Person: Phone#: Y , Versionl.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No SECTION 11 OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize{ to act on my behalf, in all matters relative to work authorized by this building permit application. ' ..j Signature of Owner Date _ as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains d e Ili of perjury. Print Name Signature of Owner/Agent Date SECTION 12--CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor Not Applicable ❑ Name of License Holder License Number Address ^ Expiration Date Signature Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)) Workers Compensation Insurance affidavit mine completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildin -p,&rmit. Signed Affidavit Attached Yes No w Versionl.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 G.F.OF ENCLOSED SPACE); 9.1 Registered Architect: . .. Not Applicable ❑ Name(Registrant): Registration Number Address P Expiration Date i Signature Telephone W 9.2 Registered Professional Engineer(s): i Name Area of Responsibility ---�_ � .. m v.w_ I a Address Registration Number Signature Telephone Expiration Date E Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility s Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Company Name Not Applicable El Responsible In Charge of Construction E� Address F Signature Telephone Versionl.7 Commercial Building Permit May 15,2000 8. 'NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front �. .... _. Side L. . R. — L:° R s. e.. . Rear Building Height Bldg.Square Footage /o � 5 s . Open Space Footage ° (Lot area minus bldg&paved _ parking) #of Parking Spaces — Fill: volume&Location A. Has a Special Permit/Variance/Finding eve been issued for/on the site? NO 0 DONT KNOW YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES 0 IF YES: enter Book Page Document# f B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES 0 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 f NO IF YES, describe size, type and location. D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing Change of Use❑ Other❑ Brief Description Enter a brief description here. _ Of Proposed Work: SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 513 ❑ �.w_............. U Utility ❑ Specify M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34).x __ a . Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1 of � _ = St 2nd 2nd _ . �...._..._ ,..�.m.-. _....-..�.�.._.®.�.,,.�._..-_.. . .,..,w,..., rd 3rd F 3 th 4m _ ____ _ __ __ _ 4 `A ...,,.... m._..._ _ _. .. Total Area(sf) J Total Proposed New Construction�sf) Total Height(ft) Total Height ft , , 7.Water Su ly(M.G.L.c.40,§54) 7.1 Flood Zone Information: 3 Sewage Di al System: Public Private ❑ Zone• Outside Flood Zone Municipal On site disposal system❑ Versionl.7 Commercial Building Permit May 15,2000 City of Northampton Stmt , " t IF— Building Department 212 Main Street ivy �` �� � yCEP 9 2015 Room 100 ut �l v i ME Northampton, MA 01060 , -587-1240 Fax 413-587-1272 Pl6tl ite kd � Electric, Plumbing&Ga Northampton,MA 01060 � ©1lter vpecitt 3SG h k k(4 M1 d APPLICATION TO CONSTRUCT, REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Lot Unit 1*2 7— s Zone Overlay District Elm St.District CB District SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: ..w Signature Telephone 2.2 Authorized Agent: Name(Print) Current Mailing Address Signature Telephone —/ SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only om leted by ermit applicant 1.-erg-P-1306,/i C (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 e_ 6. Total=(1 +2+3+4+5) I Check Num 27 1 / This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date File#BP-2016-0300 APPLICANT/CONTACT PERSON RCI ROOFING ADDRESS/PHONE 6 LINE ST SOUTHAMPTON01073 (413)527-4775 PROPERTY LOCATION 442 ELM ST MAP 24C PARCEL 192 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building,Permit Filled out Fee Paid Typeof Construction: REMOVE&REPLACE ROOF New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 74334 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORM TION PRESENTED: —Opooved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Y Sig re uil i Of cial Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. 442 ELM ST BP-2016-0300 GIs#: COMMONWEALTH OF MASSACHUSETTS MM:Block: 24C- 192 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2016-0300 Project# JS-2016-000486 Est.Cost: $30300.00 Fee: $217.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: RCI ROOFING 74334 Lot Size(sq. ft.): 13285.80 Owner: MOTT RICHARD J&LJUBICA Zoning: URB(100)/ Applicant: RCI ROOFING AT. 442 ELM ST Applicant Address: Phone: Insurance: 6 LINE ST (413) 527-4775 Workers Compensation SOUTHAMPTONMA01073 ISSUED ON.911012015 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMOVE & REPLACE 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 9/10/2015 0:00:00 $217.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner