44-052 (16) 1140 FLORENCE RD BP-2004-0023
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:44-052 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2004-0023
Project# JS-2004-0039
Est. Cost: $17000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sq.ft.): 165963.60 Owner: SHEEHAN JOHN R JR&JEAN C
Zoning: SR Applicant: RCI ROOFING
AT: 1140 FLORENCE RD
Applicant Address: Phone: Insurance:
P 0 BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTONMA01027-0309 ISSUED ON:7/7/03 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: Receipt No: Date Paid: Check No: Amount:
Building 7/7/03 0:00:00 4192 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
Ed t,�lorthampton S atus of?,Permit ,r
Bu• I ! Department C� ut%Drvewa I,mtizzt'llAtt4
2003 Main Street ewe risepti ailarj l 2 >`,1
Sul ' 7 Room 100 , a er/ag,WeII�A a�`bl i � '�� ` ,
• -:m f n MA 01060 � ,�tf" ' ` rr t ;
p Q SetsYof Str c ra apstlt atil � ,,
• �� tA:7.1 0 Fax 413.587.1272 -
Site Plans" ---t
tis, ,(!N.
Nnp,IN, Other,Specif, 4 , "9t.i, ;eta .'! aR *-` , ''
l
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: This sectionto be°°completedxb tdffic 4, '7,'
Map Lots ray ' • a.,
I I�I D t FJi rence {loadn t a t ' • .�rt� .. Y't
.N an am�/'�in Zone Overlay;D►stric#M{ .;,«
ram/ �. , ,-
A a, r K'..
Ika
Elm St. District CB District r ,AW
SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
clean 3}ee ha ) I I I isse tt Brook dam'. - £'-It n
Name(Print) Current Mailing Address:
57- aaa./.
Telephone
Signature
2.2 Authorized Agent:
C)Ao-- SE_\k \ t— Po c6ox 3O9 o n - 01.oz?
Name(Print / �_��2G /J4� Current Mailing Address:
�� 41 t 3 52,-7 4 11,5
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Budding RC0.l1 `‘ 1 OOO OO (a) Building Permit Fee IS As,ot
2. Electrical (b) Estimated Total Cost of
Construction from (6) I Ili OOO
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 + 2 + 3 + 4 + 5) 6 V fl, bb0.Ot Check Number
.This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings 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:
SECTIONS •'DES lIPTION'OF PROPOSED WORKfcheck all'applicable)
New House ❑ Addition 0 Replacement Windows Alteration(s) 0 Roofing kk.
Or Doors 0
Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding[+ ] Other [ ]
Brief Description of Proposed Work: RerndVe �XIsi t7Q goofZn iiL N21� ,cos
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet❑
6A 1f New hobs and th'additiOrFto"existing iio"using, complete'tthe folioWing:
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 7a-OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
lJQQl Sheehan , as Owner of the subject property
hereby authorize \O..-rK I?StS\t 7 e KOOCi to act on
my behalf, in all matters relative to work authorized by this building permit applicatio
'7- 7- 03
Signature of Owner Date
I, '0oX t . ( C- , as Owner/Authorized Agent
hereby declare that the statements and information on the foregoing ap ation are true and accurate, to the best of my
knowledge and belief.
Signed er the pains and n -ties of p
Print Name
`1- 7-63
Signature of Owner/Agent Date
SECTION 8� 1CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder : MOSAA, �`� `t S�Z C3-7y J3 (.
License Number
y a cvVci, ay ,r \Lcuv 0-z n - oy
Address Expiration Date
S2?-z/7 7S
Signature elephone
11"g "r re TAom rove lieWt Co to actor, ,y " r -`
Not Applicable 0
Company Name Registration Number
c1 - 6 - dy
Address Expiration Date
'k MQ, O-v 1N . 'tea. Telephone 913 57.7—(/77S
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 tk 'No 0
" O. "�.'i"' + 5', + e° •
t" " ®.ome ®wne�E*xempt>< n
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
1.5tiMfPl.
;. Qxt cif 'w t[i&1 � falt 1,
t� =
i .i1fi :ssnchnactta' _ 1_=--:r,
DEPARTMENT OP BUILDING INSPECTIONS 4
' 212 Main Street • Municipal Building
Northampton, Mass. 01060 r'V•'
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
(li censeeIpermi ttee)
with a principal place of business/residence at:
•
1-1 0 rk.a4 r..? _ cw - c ,--ce \ • 0 t6z7 (phone#) 9/3 Sa7'4-1773
(strect/ci ty/staielzi p)
do hereby certify, under the pains and penalties of perjury, that:
M l an employer providing the following worker's compensation coverage for my
employees working on this job:
-.'\ .(. ��h - A._kA.A. Lac ,3153i7(zy OIL /0-5 -03
• cc Company) (Policy Number) (Expiration Date)
() I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
if.
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (lnsl rancc Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional sheet if necessary to include information pczte.infig to all oontrndorn)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:ptcase be aware that while bo0:cowucrs who et plcry persons to d>maiutcuancc,cvrssrrldion or rcpait Vi0eX.on a dwelling of
not more than throe uniu in which the hot:teowver red or oo the grounds s appurtenant thereto art cot NYC,i.11y considered to be
employers under the worker's axnpamatiai Act(GL152,s1 1(5)),application by a homeowner for a license or permit may evidence the
legal status of an amployer under tho Woir.cra Compeooaiion Act_
I understand that a copy of this statcmcut may be forwordod to the Dcpcutasasl of Jnr4 trial Accident-e Oirioo of Iawrwoo for rho
coverage verification and that failure to vxurn covcrays t.rYicr section 25A of MOL 152 can lead to the imposition of criminal penalties .
consisting of a fine of up to S 1,500.00 and/cc imp i oamem()Cup to one year and civil penalties in the form of a Stop Worse Order and a
fine 0(5100.00 a day against me.
For departmental wen only
— �� Permit Number
` Ma0 Lot#
: i Signature of LiccnscLJPcrtnittcc Ibte ` - - • k.
R.C.I ROOFING
40 MAINE AVENUE
P.O. BOX 309
EASTHAMPTON, MA 01027-0309 ESTIMATE
PHONE (413) 527- 4775
FAX (413) 527-8469
Date: JUNE 16, 2003
Estimate To:
JEAN SHEEHAN Estimated By: CHRIS THOMPSON
111 BASSETT BROOK DRIVE Start Date:
EASTHAMPTON, MA 01027 Job Location: 1140 FLORENCE ROAD
NORTHAMPTON, MA
Job Phone: (413) 527-2226
JOB DESCRIPTION
REMOVE EXISTING ROOFS.
FUP,(LTSH AND INSTALL 1/2" PLYWOOD OVER EXISTING DECKING.
FUPJ\IJSH AND INSTALL ALUMINUM DRIPEDGE AND ALL OTHER RELATED FLASHINGS.
FU1iNISH AND INSTALL_ICE AND WATER BARRIER ALONG EAVES AND VALLEYS.
FURNISH AND INSTALL 15LB. FELT.
FURNISH AND INSTALL 30 YEAR TAMKO SHINGLE.
FURNISH AND INSTALL RIDGE VENT.
ALL ROOFING RELATED DEBRIS TO BE REMOVED BY R.C.I. ROOFING.
FURNISH AND INSTALL VERSICO FULLY ADHEARED RUBBER ROOF SYSTEM ON FLAT SECTIONS.
5 YEAR R.C.I. WOR.1ANSHTP WARRANTY INCLUDED.
30 YEAR_ TAMXO MATERIAL WARRANTY INCLUDED.
ALL RELATED PERMITS WILL BE OBTAINED BY R.C.I. ROOFING.
SPECIAL ITEMS NEEDED
Additional information pertainin. to this Job Estimate
PAYMENT TERMS:
30% UPON DELIVERY OF MATERIAL Total Estimated
70% UPON COMPLETION Job Cost $17,000.00
REGISRATION#126235
FED.ID#04 3418839 Authorized CONSTRUCTION LIC.#074334 Signature \.,c l VAO\ C • /� L.t.-2-a_/2--
INSURED BY HACKWORTH/LAPLANTE(413)527-9907
ORIGINAL-ESTIMATOR COPY