35-293 (6) 101 WOODLAND DR BP-2016-1292
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 35 -293 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-2016-1292
Project# JS-2016-002229
Est. Cost: $8900.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 74334
Lot Size(sq.ft.): 30361.32 Owner: BAGLEY KATE&JANE HIGGINS
Zoning:- Applicant: RCI ROOFING
AT. 101 WOODLAND DR
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527-4775 Workers Compensation
SOUTHAMPTONMA01073 ISSUED ON.5/9/2016 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 5/9/2016 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
artmeiit use OR'y
city of Northampton62
Stat�Esof Pertrtf
Building Department Curb(,' it E16v$uuay Perrrtit
MA
Fr 212 Main Street Seuvrtttept[c Availability
Room 100 WatbrMle{I Au:A[fab[iity`
N rthampton, MA 01060 Two Sats of Str=uetura! Plans:
eEf", ` r� 5$7-1240 Fax 413-587-1272P{ot/S(t f�latts-
--- - -- -
- - _ Other Speolfy,
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMO}i.ISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION:
1.1 property Addrf:ss: :i:� sectii n to bbe oomple.te.d by office
Map Lot, _Unit
Fh-,-w6, ftf A C lo&,;�z-- Zone: _ _Overlay D:istrlct_,___
Elm 5,6 Distti'et;_,—_ CB Dlw.t'tlet,
SECTION 2 - PROPERTY OWNERSHIPLAUTHO:RIZED AGENT
2.1 Owner of Record:
_ Ko te_ f /CI
game(Print) J ICurrent Mailing Address:
Telephone
ignature
?.2 Authorized Agent:
Marne(Print) �r ,-� Current Mailing Address;
gnature _ Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
tem Estimated Cost(Dollars)to be Official.Use.Only
completed by permit applicant
I [3+444+n g — t, (a)Building Permit Fee
? Electrical L14 (0).Estlmatrad To.tai Cost of
Cc nstru.M,lon from.(6)
Piurnbing Building Perrnit:Fee
I Mechanical (HVAC) —
Fire Protection
Total = 0 + 2 + 3+h + 5) Q" �t�;, Gheck Number f This Section For-Off Ictal,Use'Oniy_
3ullding Permit Number:: Date
issued:
>ignature:
Building Commissioner/Inspector of B.uildings Date
ECTION 5-DESCRIPTIOtV QF PR3�PQS-gD 1NOR( ch
–_e k,a apP,ilca b le)
4ew House Addition [7 Replacement WindowsAlterations} Roofing
Or Doors 1`71
{ccessory Bldg. ❑ Demolition ❑ New Signs (Ci} Decks Siding (epj Other(71)
,nef Description of Proposed ��
,Iteration of existing bedroom Yes No Adding new bedroom ___Yes No
.trached Narrative Renovating unfinished basement Yes No
dans Attached Roll -Sheet
a If New h:o:usEa an:d o.r:add[t�to:n to exisi:nc�•housl► �, cornl:efik�cfiall.avuita:
Use of building :One Family Two Family Other
Number of rooms in each family unit; Number of Bathrooms
is there a garage attached?
Proposed Square footage of new construction, Dlmen"lon8
Number of stories?
Method of heating? Fireplaces or Woodstoves„ Number of each
Energy Conservation Compliance. Masscheck Energy Compliance form attached?_Y
Type of construction
Is construction within 100 ft, of wetlands? Yes _ —No. Is construction within 100 yr. floodplain _Yes No
Depth of basement or cellar floor below finished grade
Will building conform to the Building and Zoning regulations? Yes _ No ,
Septic Tank__— City Sewer Private well City water Supply _
_CTiON 7a -OWNER AUTHORIZATION -TO,BE.00MPLETED WHEN
WNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
t3a as Owner of the subject
operty L ?J f
,reby authorize � C(4- L. ��^ Yi-r0 '
act on my,behalf, in all matters relative to work authorized by this building permit a lic;ation,
3nature of Owner Date
as Owner/Authorized
,ent hereby declare that the statements and information onJhe foregoing application are true and accurate, to the best of my knowledge
d belief,
fined under the pains and penalties of perjury.
of Name
r?
nature of Owner/Agent Date ��� _
EiCTION 8 -CONSTRUCTION SERVICES
_;I Licensed Cons#ruction Supervisor: Not Applicable ❑
ame of License Holder;,iM 1 j�;�0 -7�
License Number
n A (D s "� r
Expiration Date
ynalure Telephone L ��
Re.Uis:tered Ho:meJm PoVament C onanactor';;i Not Applicable ❑
- �-� - - - ► 1 aIn'�a _
?Mpanv Name Registration Number
idress Expiration Date
r���L ��E09Telephone� � r�
:CTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G,L.c, 162, §28C:(0'),)
orkers Compensation Insurance affidavit must be completed and submitted with this application. f=ailure to provide this affidavit will result
the denial of the issuance of the building permit,
fined Affidavit Attached Ye;s....... fir' No,.,,,, ❑
11'. 410 ne (Jwielr
The current exemption for"homeowners"was extended to include Owner.-occupted 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, CIgR 780 Sixth Edition Section11 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;)tructures accessory to such use and/or farm
structures, A erson who constructs more than one home in a two-year mod 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 ail such work performed under the building hermit,
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— YlM _—_—
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,
j ,/
Address of the work: C" I lt1,0 o 1,1 e-4
ThEs debris will be transported by: co
The debris will be received by:
Building permit number:
Nat-no. of Permit �Appl' t '� 1..t)� (`-J � �
ca n
Date 6 - 4, Signature of Permit Applicant
RC.1- Roofing Date
6 Line St, Estimate -
Southampton, Ma. 01073 4/21/2016
Phone(413)527-4775
Fax(413)527-8469
Name/Address Job Location
Kate Bagley
101 Woodland Dr
Florence, MA 01062
Terms Rep
Estimate valid for 30 days Chi-is
Description Total
Remove existing roofs. 8,900.00
Furnish& install aluminum drip edge, pipe flashings, chimney flashings(if needed)and step
flashings.
Furnish& install Certainl'eed Winterguard ice&water barrier, 6 feet along eaves and 3 feet in
valleys.
Furnish and install synthetic underlayment over existing deck.
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.
Add$2.50 per sq. ft. for wood decking replacement if needed.
WE LOOK FORWARD TO DOING BUSINESS WITH YOU, Total $8,900,00
TERMS OF PAYMENT
5%Deposit Customer Signature;
Balance upon completion
Registration# 126235
Date:
Construction License#074334
..............
Insured by Banas&Fickert Ins.
(413)527-2700 Shingle Col'o,Selection;
C