11C-029 140 FLORENCE ST BP- 2011 -0763
GIs #: COMMONWEALTH OF MASSACHUSETTS
Map-Bloc 11C - 029 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categor roofin BUILDING PERMIT
Permit # BP- 2011 -0763
Project # JS- 2011- 001259
Est. Cost: $6800.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 74334
Lot Size(sq. ft.): 9626.76 Owner: WEST DALE M & HANNAH L DURRANT
Zonin :g URA(100) / Applicant: RCI ROOFING
AT. 140 FLORENCE ST
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527 -4775 Workers Compensation
SOUTHAMPTONMA01073 ISSUED ON :312412011 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 3/24/20110:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner
RE ,E�VEp ' of Northampton Sta
50 fling Department Curb C ,
24 2 Main Street
,.
Room 100
DEPT R NSPEC77 U hampion, MA 01060 T it
13- 87 -1240 Fax 413 - 587 -1272 IN" 4
Other�S
APP. ,CAT TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING l
SECTION 1 - St` is I NFORMATION ~ �
This section to be completed by office
1 Pr operty , addr
V Map Lot Unit____ { �
E a S fy . Q` c,-,5 3 Zone OwHay Distric I
I
Elm St. District CB Db ttrtat _
SECTION 2 - PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record
Narn (Print) Current Mailing Address:
3 f Telephone
Signature
2.2 Authorized Agent:
nq
- i
Name (f — Current Mslling Address: Q \ cd-1
A4 l 1) 5 27 - �f ? ?5
F, iG, Wu Telephone
SEC' 3 - = ..STIMATED CONSTRUCTION COSTS
Estimated Cost (Dollars) to be OfW&l Use Only
completed by rmit applicant ... �._,.
.00 (a) Building Permit Fee
clectnca! (b) Estimated Total Cost of
2. Construction from 6
3. Plumbing - -- Building Permit Fee
- 4. Mechanica� (HVAC)
5. Fire Protecti
B . Total = - (l - - 2 + 3 + a + 5 Check Number
This Section For Official Use Onl
Date
Building Permit Number. Issued: -
Signature:
i
I ' Suliding CommisslonerAnspector of Buildings Deb
'i _
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 Department
i'iUntil'l' I ( I
Sthack Front
Side L:
F 1 "icight :�1g. Square Footage % j
r I �c n Space Footage %
x area minus bldg & paved
-a
P Of Parkin g Spaces
,nnc & 14�canon
A Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO O DONT KNOW a YES O
IF YES, date issued:!
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES 0
;F YES: enter Book ' Page and /or Document At
Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES
T YES, has a permit been or need to be obtained from the Conservation Commissions'
Needs to be obtained Obtained Date Issued:
C Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location:
L--- __._ --
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:
VWdI the construction activity disturb (Gearing, grading, excavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO O
iF YES, then a Northampton Storm Water Management Permit from the DPW is required.
SEC71ON 5- DESCRIPTION OF PROPOSED WORK (check all applicable
New House 7l Addition Replacement Windows Alteration(s) Roofing
Or Doors ❑
r --
Accessory Sia i
g. Demolition ❑ New Signs (O] Decks (❑ Siding (0) Other((�J'
Vcr Jescri,:- , of Proposed
, a l ta�h_ �-
Vcrk
;,Iteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roil - Sheet
a If New louse and or addition to existing housing, complete the followinsa:
C! Use of D „6ding One Family Two Family Other
Number c ,00ms in each family unit: Number of Bathrooms
Is there a jarage attached?
Proposec Square footage of new construction. Dimensions
e_ Numbe• c� stories?
fil
Methoc of . ng) Fireplaces or Woodstoves Number of each f
i
Energy Cense- , Compliance. Masscheck Energy Compliance, form attached?
h Type of construction
Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr, floodplain Yes No
Depth of t3sement or cellar floor below finished grade
K. Will building conform to the Building and Zoning regulations? Yes No.
i. Septic Tar , City Sewer Private well City water Supply
SECTION 'a - CWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
u('t C? < as Owner of the subject
property
I
- iereoy authcri::e •
act on m� bE half, in all matters r ative to work authorized by this ui ding permit application,
Alt the id -z
Sig'natftredf Ownar Date
M - Ayk , M- t S P - as, jau t Y 7 PA ao t as Owne r/Authorized
Agent hereby ceclare that the statements and information on the foregoing lication are true and accurate, to the best of my knoviAedge
and belief.
Signed under tt,e pains and penalties of perjury.
Print Name
Si gnature of Own arlAgent Date
SECTION 8 -CONSTRUCTION SERVICES
3.1 Licensee! Construction Supervisor Not Applicable 0
Name of Lic Holder M e I q,3 3 4 _
License Number
Address Expiration Date
(�i 1 3) 5 2q - x TZ5
-9 ign3tore Telephone
9 . Registered Home Improvement Contractor: Not Applicable 0 ,
nQ 12 b 235
i Company Name Registration Number
HcorC�� Expiration Dale
i
* arnQ 1 } on � 3 Telephon
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 162, § 26C(6))
Vor�?rs Cc•m_ ensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
n the denial c' :he issuance of the building permit.
Signed A ffiaiot A ttached Yes... - ie No...... ❑
11. -- Home Owner Exemption
1 can ent exemption for "hom was extended to include Owner - occupied Dwellings of one(]) or two(2) families
n. to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
;is ,upervisor. 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
,r is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farzn
„ctures. A person who constructs more than one home in a two -year period shall not be considered a homeowner
- homcowncr - shall submit to the Building Official, on a form acceptable to the Building Official that he/she shall be
r c� L lsible for all such work performed under the building permit.
actin; Construction Supervisor your presence on the job site will be required from time to time, during and upon
;plction of the work-for which [his permit is issued.
he advised that with reference to Chapter 152 ( Workers' Compensation) and Chapter 153 (Liability of Employers to
.r i)!oN for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s)
,; hire to perform work for you under this permit.
I undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
\,),thampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws AInnotated.
Homeowner Signature -- att ac6 e— , <4 _
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N\ orlcers 0)111pensation Insurance Affidavit: Build /C ontractors / Acclricians /Plunthcrs
Applicant Information _ Please Print l'e'gible
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Arc gnu an cnrplocrr'.' I'hccl. the it pprnprr:llc ho y. I cpe of1) rojccl lrerluircdl.
I �,?� I any ;1 cnrpluver with ? ci �. �� I and a �encral contractor anti i ,�
fr . � Na'�c Cn1rti(rl u_llfrn
cnrpio�ec� (hill luld m pillt- Iinrc) tlavc lined the suh contractol.s
t l' our ;r sole poprictor or parurcr_ listed ON the ailachCd shccl. ' �._; I�vnrodelin,�
ship and have no untplovcc�] hrsC sub- conU';_ICtcn's have I k nurlihun
icrukin, for nle ill ,Ill ca p,u i1%. corkers' comp. insurance.
I ..� Ifulldint; addillml
IN -n c,orkcr.. comp. insur:uu:c ❑ WC are tr corporation Mud its —
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1c•yuircd l officer, have cxercucd tltcir
I I Mnr ;1 hoillco .11cr dmnp all work Ight of exemption per iNR IL j NunlhiN- rep;lirs ,w addIIIiM11
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nr�scl1" (No worker.' comp, c. I and cvc Ilavc. nu 1 !'. Roof 1cpair:1
nr�urancc rciluncd empimces (No rcorkcr
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n1;,n'1ri, IIi.i1 rh.rk Iln, h1\A nwa a a.'hcd an additional .hccl shmNmc the naurc of thr Huh - cure rac n,rs an,i fhcn „orkcr, unnp pul+ct m1minalum
1 oiiI ali that is procitliu workers compellmi►irut itrsru•auce for 1111• etuploree.,. Below is the poli(.r nail inh si►c•
ia lnrnn111oN.
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A t l a i I r it r , , p \ Ncorkcr%' compensation Iion page (xho t h e polio\ nit Inhcr and vxpira(ion date).
I ailurc Ill �,ccurr I. O\ is required under SCCtIMI ? >.1 of ,NV I1. c. 1 i, call Icad 10 (he inrpi)sitiIII of criminal penaitics a
line up I1-, � I_�00.00 and onc• ccar irnprisuNrncnt• as well as civil penahics in the 1 o(u S] ( d W( )RK I)kI)I :.P, and a 1
it up ttr 1)I1 a da.N against the violator. IIc Md\ ised that ❑ cope of this statement 111,1\ he liucvardcd to the (IIhcc 111
INCC�Ii ;rtion� of the DI A IM insurance covcra verification.
I ill /IcIcliv c'er►iJi curler thI pailm aucl peuallie.s of periu1)• Neat ►he it►formaliou pro r i'detl rrhilIv is true aacl r•IIrrec•t. --
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il� or face n: Pcrnril /L.ic•cnse tI
I >suin� Allfhor'il, (circle one):
I. Board ol Z. Iluilding Department 3. ( its /`howii (:lurk 4. Flectrical Inspector 5. Plumbing Inspector
h. OI he I i
C oularl Per son : l
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MARK i DELISI E
33 FIRST AVE
EASTHAMPTON, MA 0102'
Jbz
4afficr ul l uu.,uuirr:\hair..\ Btomr+s f {c2ohalion
HOME IMPROVEMENT CONTRACTOR
] Registration: 126; 3',
:
ti t Expiration: 5/6/2012 Ira
type: Warinership
R l: ; RUC�FlNG
MARK DEUSLE
�li ,_IhtE 51
0U %1. 1.1A 01073 ���I n�lcr�rrrrlar+���
10,1111111111111 Roofing RC • Date
6 Line S1. E s ti mat e
Southampton, Ma. 01073 2/22/2011
Phone (41 3) 527 -4775
I ix (41 3) >27 - 8409
Name / Address Job Location
I latlllah Mirrant
140 Florence St.
Leeds, Ma. 01053
Terms Rep
Estimate valid for 30 days Dave
Description Total
kcmovc cxi "[ino roofs. 6.800.00
Furnish & in_ t,lll ala!minum drib edge, pipe flashings, chimney (lashings and step fleshings.
Furnish &' install new lead counter (lashings.
Furnish &. install CertainTeed Wintcrguard ice & water barrier along eaves and valleys.
Furnish qtr install synthetic underlayment over existing deck.
Furnish install 30 year CertainTeed Woodscape Series shingle.
Furnish install CcrtainTecd approved ridge vent.
Furnish & in .Stall lit" filMhoard insulation on flat roof section.
Furnish .A insta!I .0•.05 rc- infOrced rubher rool'system, mechanically attached on Ilat roof section.
All cxlcxior roofing related debris to be removed by R.C.I. Roofine.
Aft work to he performed according to manufacturers' specifications.
3h vcar CC1IAiHTCCd In;Itrrial warranty included.
"UI rcl,;ted permits will he ohmincd by R.C.I. Roofing.
Add r ?.;0 per ,quaic foot for wood decking replacement if needed.
/ "'dd:.S`311.(Itl for Certaintecd Landmark Woodscape 50 year premium shingle.
A ( CrtalnteCd Surestart 1'lu.: cxtcnded warranty will be included with a fee of ($220.00)) t
ahsorhed by IWI Roofing it signed within 7 days. This extended warranty means that 20 of the
3(I vc.n warranty is covered for labor and material. The last 10 years of the 30 year Certaintecd
�warranir would be cnVered for material on y'
WI_ LO( i� F(MWAk1) TO DOING BUSINESS WITII YOU.
Total $6,811((.00
F H W10S clF 1',yA 11: NT
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I(;J1:IIICC ;I Ck':III)ICIIUII Customer Signature
k c9i'(I;III'w tf 12(1? "�
Cow >tructwji I.iccn, +t 117433 -I I)atc
Insured h nan:l & I`jckcrt Ins.
(; 1 3) X27- 270()