38B-099 BP-2021-2148
42 MUNROE ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38B-099-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2021-2148 PERMISSION IS HEREBY GRANTED TO:
Project# EP-2013-0722 Contractor: License:
Est. Cost: 24700 RCI ROOFING LLP 074334
Const.Class: Exp.Date:05/03/2022
Use Group: Owner: MILGRIM DAVID J& KYRA ANDERSON
Lot Size (sq.ft.)
Zoning: URB Applicant: RCI ROOFING LLP
Applicant Address Phone: Insurance:
6 LINE ST (413)527-4775 VWC10060226472021
SOUTHAMPTON, MA 01073
ISSUED ON:11/10/2021
TO PERFORMTHE FOLLOWING WORK:
ROOF �,/�p $�A
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.
Signature:
1
4 ,2 . 3)DiT
Fees Paid: $80.00
212 Main Street,Phone(413)587-1240.Fax:(413)587-1272
Office of the Building Commissioner
1•1�LD MO Zt
Z SKY iLl-ri- 4e 1 RECEIVED
The Commonwealth of Massachus tts
v Board of Building Regulations and St dards NOV - 5 2021 FOMassachusetts State Building Code, 78 CMRM ICIP LITY
US
Building Permit Application To Construct,Repair,R novae �l , sPEcrioNs d Mr 2011
One-or Two-Family Dwellings —___ NOnT"nMrIOn MA 01060
This Section For Official Use Only
Buildin Permit Number: $o_a. Date Applied:
LJl►J / Z55 / /iii'8^zOzj
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
42 Munroe Street,Northampton MA 30B 99
1.1a Is this an accepted street?yes x no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
David Milgrim Northampton MA 01060
Name(Print) City,State,ZIP
42 Munroe Street 413-923-8556
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) IS Alteration(s) 0 Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: remove existing roof,install 1/2"olvwood over existing decking,
install new shingle roof
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Botitgmg Roofing $ 24,700 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fee :$
Check No2Weck Amount. 116 Cash Amount:
6.Total Project Cost: $ 24,700 ❑Paid in Full 0 Outstanding Balance Due:
i r is
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CS-074334 05/03/2022
Mark Delisle License Number Expiration Date
Name of CSL Holder U
32 Old County Road List CSL Type(see below)
No.and Street Type Description
Southampton MA 01073 U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
413-527-4775 mdelisle@rci-roofing.com I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 126235 06/17/2022
RCI Roofing LLP HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
6 Line Street mdelisle@rci-roofing.com
No.and Street Email address
Southampton MA 01073 413-527-4775
City/Town,State,ZIP Telephone
SECTION 6: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 Cfx No 0
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize RCI Roofing LLP
to act on my behalf,in all matters relative to work authorized by this building permit application.
see attached
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pa' s and penalties of perjury that all of the information
contained in this application is true and accurate e best of my knowledge and understanding.
RCI Roofing LLP I I— Z —
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
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RC.1. RoofmgDate
6 Line St. Estimate
Southampton,Ma.01073 7/16/2020
Phone(413)527-4775
Fax(413)527-8469
Name I Address Job Location
David Milgrim
42 Munroe Street
Northampton, MA 01060
Terms Rep
Estimate valid for 30 days Angel
Description Total
Remove existing roofs. //7 c-I v Ct4 k--01 2. p o Cc,1--t.f 24,700.00
Furnish& install 1/2"plywood over the existing decking.
Furnish& install aluminum drip edge,pipe flashings,chimney flashings(if needed)and step
flashings.
Furnish&install CertainTeed Winterguard ice and water barrier along eaves and valleys.
Furnish& install synthetic underlayment.
Furnish&install Lifetime CertainTeed Landmark Series shingle.
Furnish&install CertainTeed approved ridge vent.
Furnish& install .045 re-inforced rubber roof system on flat roof section.
All exterior roofing related debris to be removed by R.C.1. Roofing.
Lifetime CertainTeed material warranty included.
All related permits will be obtained by R.C.I. Roofing.
Add$1000 to replace gutters I!?G I Vc k do rl s y y 1
Add S750 per small skylight to replace,add$1300 to replace large skylight 0
(RCI Roofing is not responsible for any interior work)
------UPDATED PRICING-
March 45,2021
Original estimate of$22,800 has been updated to$24,700 due to the increased cost of materials
required for the job.
Gutter replacement pricing has also been updated from$1,500 to$1,000
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total $24.700.00
TERMS OF PAYMENT
5%Deposit Customer Signature: ram--
Balance upon completion
Registration# 126235 Date: a )4.24
Construction License#074334
Insured by Banas&Fickert Ins. 1
(4131 527-2700 Shingle Color Selection:
ry 4-71" a.r .
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The Commonwealth of Massachusetts
Department of Industrial Accidents
qiI
( Office of Investigations
Lafayette City Center
2 Avenue de Lafayette, Boston,MA 02111-1750
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): RC I Roofing LLP
Address:6 Line Street
City/State/Zip:Southampton MA 01073 Phone#:413-527-4775
Are you an employer? Check the appropriate box: Type of project(required):
1.0 I am a employer with 13 4. 0 I am a general contractor and I 6. ❑New construction
employees (full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers' 9. 0 Building addition
[No workers' comp. insurance comp. insurance.
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑■ Roof repairs
insurance required.] t c. 152,§1(4),and we have no 13.❑ Other
employees. [No workers'
comp. insurance required.]
*Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:AIM Mutual Insurance Co
Policy#or Self-ins. Lic. #: VWC10060226472021 A Expiration Date: 10/05/2022
Job Site Address: 42 Munroe Street City/State/Zip: Northampton MA
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and pen s of duty that the information provided above is true and correct.
Signature: Date: 1 1 — Z " Zd Z j
Phone#: 413-527-4775
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(check one):
10Board of Health 20 Building Department 30City/Town Clerk 4.0 Electrical Inspector 50Plumbing
Inspector 6.0Other
Contact Person: Phone#:
City of Northampton
Massachusetts
y
DEPARTMENT OF BUILDING INSPECTIONS .
212 Main Street • Municipal Building,,
Northampton, MA 01060 'PS
yyti
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
Location of Facility: Shoham Road, East Windsor, CT
The debris will be transported by:
Name of Hauler: USA Hauling & Recycling Inc
Signature of Applicant: Date: 11 - Z -zoz/