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11C-014 'A. BP- 2010 -0337 GIs #: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP -2010 -0337 Project # JS- 2010 - 000458 Est. Cost: $4300.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 74334 Lot Size(sq. ft.): 8015.04 Owner: NOBREGA ROBERT C & ROBERT 3 Zoning: URA(100Z Applicant: RCI ROOFING AT. 3 BERNACHE ST Applicant Address: Phone: Insurance: 6 LINE ST (413) 527 -4775 Workers Compensation SOUTHAMPTONMA01073 ISSUED ON :913012009 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 9/30/2009 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo City of Northampton Status �. U Building Department Curb CU i 21 Main Street SewrS _ 100 Noffhampton, MA 01060 uVa� phone 413 - 587 -1240 Fax 413- 587 -1272 Plot Other Specl v _ r APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION This section to be completed by office 1.1 Property Address 3 Map Lot Unit Zone Overlay District Elm St. District CS District SECTION 2 - OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record � A) <— 0. 3 �Lf C R " e _ S� . Name (Print) Current Mailing Addr ss: 1 '41 - ,�, K; met L4 - co,5 atta6eeA T iephon� Signature 2.2 Authorized Agent: ayk I'l-e-le, - - - - • I • Name (Print) Current Mailing Address: Signature Telephone SECTION - 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by ermit applicant 1. Building 9 00fil 1 1'( 300 , (a) Building Permit Fee 2. Electricai " (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) 00. 0 0 Check Number This Section For Official Use Onl Date Building Permit Number. Issued: Signature: Building Commissioner /inspector of Buildings Date w Section 4. ZONING All 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 Depnbnent Lot Size. Frontage Setbacks Front L__ I Side L I R ......., L L R: _ ...__✓j Rear Building Height B;dg. Square Footage Open Space Footage % (Lot area minus bid & p aved B P I p arkin g) # of Parking Spaces Fill: volume & Lpeation A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO © DONT KNOW © YES O IF YES, date issued:[ j IF YES: Was the permit recorded at the Registry of Deeds? NO © : DONT KNOW Q YES 0 IF YES: enter Book lu_._...__. Page � and /or Document # B. Does the site contain a brook, body of water or wetlands? NO O DoNT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained a Obtained © , Date Issued: C 1 C. Do any signs exist on the property? YES © NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES O NO O 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* common phm that will disturb over 1 acre? YES O NO O IF YES, then a Northampton Storm Water Management Permit from the DPW is required. r SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable 1 New House ❑ Addition [] Replacement Windows Alteration ❑ Roofing Or Doors M ' Accessory Bldg. ❑ Demolition ❑ New Signs (r-3] Decks o_ Siding 10) Other 11:31' Brief Descriprlon of Proposed Work: �1 ri�e.[� Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet sa. If New house and or addition to existing housing. complete the following. j a. Use of building : One Family Two Family Other 11 b. Number of rooms in each family unit: Number of Bathrooms ' s.l f • •..r c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? I 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. 1. 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 as Owner of the subjed property • hereby authorize L 2 to act on my behalf, in all matters r ative to work authorized by this uilding permit application. altl;,AQd . g -?-,3 09 Sig'ruttlre of Owner Date ` ,. m2Y � -Del; s1 io - As au t ' hnY l'Zv A ao U1t , as Owner /Authorized Agent hereby declare that the statements and information on the foregoing Iicatlon are true and accurate, to the best of my krto hicipa and belief. Signed under the pains and penalties of perjury. a Print Name Signature of Owner /Agent Date SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor Not Applicable O Name of License Holder M - AY Pl is I e- / [ - ■ 33"a License Number Address _ Expiration Date Signature Telephone 9. Registered Home improvement Contractor: Not Applicable O �. L �. lemon f ; pia 126235 Companv Name ! T Registration Number Aooreaa Expiration Date Ma . Q 1 CU 3 Telephon • SECTION 10 - WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. C. 162, § 26C(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 AffidLvit Attached Yes....... 0 No...... ❑ 11. - Home Owner Exemption The current exemption for "homeowners" was extended to include Owner- occupied Dwellings of one (1) or two(2) families ur;d 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. ,ks acting Construction Supervisor your presence on the job site will be from time to time, during and upon completion of the work• for which this permit is issued. A!so 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 ihbb for persons) ou 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 ln,P.� - 4 - ttttiMPT ��� (rxfa of ' W=t1jstulptan � d �as,actiA,cti, DEPARTMENT OF BUILDrXG INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 wORI{ER'S COMPENSATION INSURANCE AFFIDAVIT terser- ser/Permittx) wi _H a principal place of business/residence at: E ct/city /st wnp) do '. .iercby certify, under the pains and penalties of perjury, that: ('� am an employer providing the following worker's compensation coverage for my employees working on this job: " • oh f. ec Mn S . Cc, . o G Q N %J 03 L_1\1 lal Gnsuance Company) (Policy Number) (Expiation Dace) { j I zm a sole proprietor, general contractor or homeowner (circle one) and have hired tl:c contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Compauy/Policy Nutubcr) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (BxpiratiaDate) (Name of Contractor Umuraace Company/Policy Number) (Expiration Dabe) (Name of Contractor) ( Insurance Company/Policy Number) (Bxp mftn Date) ( t as abditioaal shod if aeoessuy to ixK3ude lnfbnudoe pataiaint to all 000t odAn () X am a sole proprietor and have no one working for me. () X am a home owner performing aU the work myself. NOTE; please be aarse+e tbse v�ltilo bomoowoeca vrbo maploy patcom 14 do man4etsat�. 000etrllesl00'at ttlptif wofkN �� � o, moca tban tbm =hs is %Vb tba bea»owoar raids of ee tbe I7rouods aQputtemedt6irato an oot y aowidad MM cmploy= uodcr the wockalz comps ullon Act (GLIS2,n i(M ap Uatica by a boatw*uit for a &*"$ a pumas" 1 0101 do 1 es4 cram, of an employs und4r dw WociAes Coaopasation Aot. .0 I undetYtaad that; a oogy o[tbis:estemsot may ba taetnstdad to tba lkpatteroos e!'1a8�ttrW Asrtiasrr OmM dfMHltM�t'i oovaxsc vai8catiae ttad tlut ittihn+tt to sealce oovatt�e artdar sxdon 23A of �tOL 1S'� am Iad b tbtc lmpoddea attttWri }artlal ' , coceistrsg of a -f= of up to S1.5W.00 odor impruWMM t of tip to an ym sod &A patstda is t o"of a 84 Wak0r& t+ld • , t fires of S 100.00 & .&' Y &ping = S i of Liocnsalpermittx r i ✓`ie �oamw�xanuw,all� o�.. /�aa�iuos� ' 'Board of Building Regulations and Standards Constructi n Supervisor License License~ CS 74334 f S 10 Tr# 23520 ' a, i` 0 k A MARK T DELISLE x 33 FIRST AVE t EASTHAMPTON, MA 01027 Commissioner !, ✓fce eoammla acueal a�� /�aaoad�ec�eel Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration :., 126235 Expiration:.5 /6/2010 Tr# 266063 ;Type: Partnership R.C.I. ROOFING MARK DELISLE 51 B HOLYOKE ST. EASTHAMPTON, MA 01027 Administrator .;1 k R,C. I R o fi � g LLP 51B Holyoke Street P.O. Box ton Easthampton, MA 01027 Estima Date Phone(413)527 -4775 6/16/2009 Fax(413)527 -8469 Name / Address Job Location Bob Nobrega 3 Bernache Street 3 Bernache Street Leeds, MA Leeds, MA 01053 584 -6457 Terms Rep Estimate valid for 20 days Rich Job Description Total Remove existing House roof. 4 ,300.00 Furnish & install aluminum drip edge, pipe flashings, chimney flashings and step flashings. Furnish & install new lead counter flashings. Furnish & install CertainTeed Winterguard ice & water barrier along eaves and valleys. Furnish and install 15 lb. felt over existing deck. Furnish and install 30 year CertainTeed Woodscape 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. 5 -Star CerainTeed Surestart Plus extended material and workmanship warranty included. 30 year CertainTeed material warranty included. All related permits will be obtained by R.C.I. Roofing. SPECIAL ITEMS NEEDED Add $2.50 per sq. ft. for wood decking replacement if needed. ADD ........ $1,200.00 ........ for Lifetime Shingle. Add: $117.00 for CertainTeed SureStart Plus 5-Star W rranty (in I ed if signed contract is returned within 7 days). THE O WNE R BUSK ESS R DATE C ANCEL OF SIGNING CONTRACT WITHIN (3) Total $4,300.00 TERMS OF PAYMENT 5% Deposit Balance upon completion Customer Signature Registration # 126235 Construction License # 074334 Date 1 Q Insured by Reynolds, Barnes & Hebb, Inc. 413- 447 -7376 G� 0