12C-049 260 NORTH MAPLE ST BP- 2012 -0074
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map - Bloc 12C - 049 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-2012-0074
Project # JS- 2012 - 000111
Est. Cost: $9300.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING
Lot Size(sq. ft.): 9801.00 Owner: CZEROPOWICZ J OSEPH & ROSE E GRIFFIN
Zoning: URA(100 )/ //RI/WSP Applicant: RCI ROOFING
AT: 260 NORTH MAPLE ST
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527 -4775
SOUTHAMPTONMA01073 ISSUED ON :7120120110:00:00
TO PERFORM THE FOLLOWING WORK.-Strip and Reroof
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 7/20/20110:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner
RECEIVED
C ity c f Northampton sitof�
2 2011 B jildi ig Department CA C
_ . � 2121 Main Street '
DEPT. OF BULDING NSP
NORTHAM.PTCM tqA l(4R Qom 100
Northampton, MA 01060 T
pno,ne 413 - 587 -1240 Fax 413 -587 -1272 010"
IN i
Other
APP" ' !ON TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMIL DWELLING I
SECTION 1 - SITE INFORMATION
1 ! Pro ertL, ;driress This section to be completed by o ffice
?— "Ajo(VV� cc\00. -.C... Map Lot '
Una ---• —
Ce Zone
Overlay Dbtric __
Elm St, District CB DMtrk t r __.___
I
"EC T'iON 2-PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of ecord: ` c^
"ar ^e - ring Current Mailing Address:
Telephone
Sigr,atu; .
2 Autt o: -e _;,aL nt: i
I R iodi rin 4 _ I
w
Name: (Print) Current MaI&VAddress:
'�`T "�"•�
0
; - >ignuw T elephone �
SECI,ON 3 - ESTIMA CONSTRUCTION COSTS
Estimated Cost (Dollars) to be Offidal Use Only
completed by rmit applicant
S,urc: ng l �F1 l �U C) 0 (a) Building Permit Fee
lc
2. Electn (b) Estimated Total Cost of _ ��—
„� Con struction from 6
3. Piumbint) Building Permit Fee
4, Mechanical ;HVAC)
5 Fi re'Prota ctic n
5. Taal = ( ~ w ± 3 * 4 + 5) pp . OCR 1 Check Number
This Section F or Official Use Onl
N:mbe:r Date
Issued:
Building CommissionerAnspector of Buildings Dols
Sr ";ipr +. ?ONING All Information Must Be Completed, Permit Can Be Denied Due To Incomplete Information
i
{ Fisting Proj - rased Required by Zoning
This column to be filled in by
Building Department
i
1-oh :1: I I I
��tbac( front
I
Rear
f nlding l {eight
1
i,3 dg. Footagc %
I I
O Spacc Foolagc %
i
(; �, ren nunu� hldg pavr�f
pia km�)
,rl',irking Spaces
i
Hos a Special Permit /Variance /Finding ever been issued for /on the site?
i0 O DON'T KNOW O YES O
F YES, date issued:'
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES. enter Book Page and /or Document tti
I✓ the site contain a brook, body of water or wetlands? NO Q DONT KNOW O YES
17 YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O Date Issued:
C Do any signs exist on the property? YES O 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 0
IF' YES, describe size, type and location:
�.V 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
1 F Y ;hen a Northampton Storm Water Management Permit from the DPW is required.
F -------
SECT�ON 5- DESCRiPTiON OF PROPOSED WORK (check all applicable)
N W H!, U S 0 Addition F7 Replacement Windows Alteration(&) Rooflng r Lt
i Or Doors
, �C-i:tsory 1,: i,: q L _. j Demolition New Signs (01 Decks [0 Siding [ED) Otheria'
D,I'sclri Proposed
L�edroom Yes No Adding new bedroom Yes No
-'Nitached NErr,ilivt: Renovating unfinished basement Yes No
6.3 1 fNew house and or addition to existing housin-ci, complete the following:
Dn Family
,e of Two Family Other
s in each family uniL
N,irnbe c* roorn. Number of Bathrooms
ci, Proposec Sq,;are footage of new construction. Dimensions
'Mei! - )ealonc 7 ! Fireplaces or Woodstoves Number of each
r, e r,� sericit Compliance. Masscheck Energy Compliance form attached?
ype o'
Is 7,ons�ru,!ion wit,�in 100 ft of wetlands? Yes No. Is construction within 100 yr. floodplain - Yes No
Deptn cl� 1 isament or cellar floor below finished grade
-�g conform to the Building and Zoning regulations? Yes No.
Septic _ ___ City Sewer Private well City water Supply
SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNFRS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject
property
Me -10
��D act or) rr.y _,� alf, in all matters rdlative to work authorized by this' rmit aoplicatio�_�
__,Ma,�, Ll IPA aQ=t-- I&& Owner/Authorized
Agen, here�y c. that the statements and information on the foregoing aabliration are true and accurate, to the best of my krx%viedge
Signed under tl pains and penalties of peoury,
MAY I i S1
Print Name
1 Signature of Ownor/Agent Date
4% The Commonwealih of Massachusetts
- - Department of Industrial ; accidents
; Office of Investigations
600 Washington Street
Boston, MA 02111
xr www.tttusa
NVorI.e i's Compensation Insurance Affidavit: Builders/ Contractors /Electriciatls /Plumbers
AJt >lica Inf'ortuation Please Print Leeibiv
itttlC ;)ln. rocs .;,t)rr;anIzAticrnllndIvid11itI
il\ SI;11 '.il> .c� � 19(V�, �toZ�_ Phonetr:
Check the ;appropriate box: Type of project (required):
2v 4. � I am a general contractor and I
with 6. New construction
. -mplo 'ccs ( :.ill and /or part time,).' have hired the sub- contractors
rat t .;(1Ic proprietor or partner- listed on the attached sheet. 7. Remodeling
.t
� These sub - contractors have
Iliil i.! �la�C no employees F� Demolition
���.�rk,,,�, Ic Inc in itrty captieity employees and have workers' y Building addition
insurance
comp. insurance.
5. We are a corporation and its ME] Electrical repairs or addition, 1
ant ,�on:co�ancr doing all work officers have exercised their 11.❑ Plumbing repairs or additions
ntvsc�!:. , workers' comp. right of exemption per MGL 12.Y Roo frepairs
c. 152, §1(4), and we have no
employees. [No workers' 13.[] Other
— -- - - --
comp. insurance required.]
applw, mi ,.a chcck. !pox u I must also till out the section below showing their workers' compensation policy information.
,,-r> 10 :ub(ml affidavit indicating they arc doing rill work and then hire outside contractors must submit a new at7'idava indicaurlg suck.
a>>ck rl:. lx,.< must auacitckl an additional sheet showing the name of the sub- contractors and state whether or not those entities have
:ni; lave,: I r,.: sui - uuructrrn have ernplu }ees, they must provide their workers' comp. policy number.
i on im cmp,o cr that is providing hvorkers' compensation insurance for mY employees. Below is the policY and job site
rn /urnruflu�r.
AJ W s..
C 1A -_ _4�3.� � ----- Expiration Date: f O
�•,;, �itc ;AdcL aA�n1.ckt -S. City /State /Zip:
Atc arh .a co p of the workers' compensation policy declaration page (showing the policy number and expiration date).
ui�:re t., coverage as required under Section 25A of MGL c. 1 can lead to the imposition of'criminal penalties of it
;rc uih �r 41 �nU �lU mid /or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a
Up t., S- , �u ;u' .I day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
!,�vrstigatio > o> the DIA for insurance coverage verification.
I ,t; hwrel>; r rti/ under the vains curd penalties of perjury that the infnrmution provided above is true and correct.
Do not write in this urea, to be completed by city or town official
Ich , .or n: _ Permit/License At _
yl
TSSi2 g Anihority (circle one):
Denartment 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector
SECTION E - CONSTRUCTION SERVICES
L icens C' nstruction Supervisor Not Applicable ❑ ~�
Name : f Lie en .e Ho.der .T -- e I M 3 , 1 4 i
License Number
1 b
A-0 -a Ma o iQ - 1-
ddress a Expiration Date
(am) 5 -27 - , 4 7 ?5
; ;k; nature Telephone
9. Registered Home Improvement Contractor: Not Applicable O
Com Nn�ne Registration Number
Expiration Date — I
inI n M2 • 0 1 Q Telephon�lj 3,),6 417
I
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6) j
WC - Kegs '.:on. -ensat on insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will resutt
_r_th . Cer., -.11 -f_he issuance of the building permit.
:)i .ffi; , it Attac Yes. No— ❑
11. - Home Owner Exemption
current cxcmption for "homeowners" was extended to include Owner - occupied Dwellintes of one (1) or two(2)families
r : to ailw,ti such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as lipervisor. CMR 780, Sixth Editign Section 108.3.5.1.
0 ofini tion of Homeowner Person (s) who own a parcel of land on which he/she resides or intends to reside, on which there
:r i:; intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm
cu,res. A person who constructs more than one home in a two -year period shall not be considered a howeorruer
h - hom,cowner - shall submit to the Building Official, on a form acceptable to the Building Official that he/she shall be
rc ons iblc for all such work performed under the building permit.
stir: Construction Supervisor your presence on the job site will be required from time to time, during and upon
m,plcti< n of the work•fbr which this permit is issued.
�. c. he advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
:,r )irvecs for in jurics not resulting in Dcath) of the Massachusetts General Laws Annotated, you mar be 110k for person(s)
rirc to perform work for you under this permit.
un c:rsigncd —homeowner— certifies and assumes responsibility for compliance with the `hate Building Code, City of
sunpton Ordinances, Statc and Local Zoning Laws and State of Massachusetts General Laws Annotated.
h ,!neowncr Signature �t�a0
n
If
ti c'titl R:l Ci! lo
M1�a
MARK I DELISLE
33 FIRST AVE
EASTNAMPTON MA 01027
263`,7
Ullicr ut l un.un�ri :Mau. ,A Itu,inr.. Ii c�;uL�liun
3 j? NOME IMPHOVEMt -NT CONTRACTOR
� x
l Reclistratiun: b3_;
1 ,
,. Expiration: »0/ J1: lip
Type: Aartnelship
F? C 1 ROOT -iNG
NARK UEUSLE
Ro o f in Date
�, R C . 1 .
Line St. E
Southampton, Ma. 0107.1 6} t
Phone (413) 527 -4775
tax (4 13) 527 -8409
Name / Address Job Location
Marlyn BULIck 260 North Maple St.
260 North Maple St. Florence, Ma. 01062
Florence, Ma. 01062
Terms Rep
Estimate valid for 30 days Davc
Description Total
Remove existing roots. 9,300.00
Furnish & install aluminum drip edge, pipe tlashings, chimney (lashings and step tlashings.
Furnish & install new lead counter tlashings.
Furnish & install Ccrtain'feed Wintcrguard ice & water barrier along caves and valleys.
FLIMish and install synthetic underlayment over existing deck.
Furnish and install 30 year Certain'I'ecd Woodscape Series shingle.
Furnish and install CertairiTeed approved ridge vent.
All exterior roofing related dehris to he removed by R.C.I. hoofing.
All work will be performed according to manufacturers' specifications.
All work will he performed according to new OSHA 6/15/2011 standards.
30 year Ccrtain'I'eed material warranty included.
All related permits will be ohmined by R.C.I. Roofing.
Add $2.50 per sq. ft. for wood decking replacement it' needed.
Add: $950.011 for Ccrtainteed Landmark Woodscape 50 year premium shingle.
A Certaintced Surestart Plus extended warranty will he included with a tee of ($330.00)
ahsorbcd by RCl Roofing if .signed within 7 days. This extended warranty means that 20 of the
all year warranty is covered for labor and material. The last M years of the 30 veal Ccrtaintced
warranty would he covered for material only.
WF LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total $9.300.00
ITI MS OF PAYMENT
5`%, Deposit r
Balance upon comI)IC6011 Customer Signature
;�W 6
Registration # 126235
Construction License # 074334
DtItc
Insured by Banos & Fickert Ins.
(413)527 -2700