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12C-051 BP- 2010 -0091 k GIS #: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c. 142A) Category BUILDING PERMIT Permit # BP- 2010 -0091 Project # JS- 2010 - 000100 Est. Cost: $6900.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 126235 Lot Size(sq. ft.): 13024.44 Owner: SCHMIDT CHRISTIAN F & KATHRYN Zoning. URA(100, //RI /WSP Applicant. RCI ROOFING AT. 24 CLOVERDALE ST Applicant Address: Phone: Insurance: P O BOX 309 (413) 527 -4775 Workers Compensation EASTHAMPTONMA01027 -0309 ISSUED ON. 712712009 0:00:00 TO PERFORM THE FOLLOWING WORK: STRI P & 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 7/27/2009 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo City of Northampton Sfax or Building Department CurbC'f 212 Main Street Y v L 2 Y X09 Room 100 Northampton, MA 01060 phone 413 -587 -1240 Fax 413 - 587 -1272 i�lot/5`Ib` � Other'5 - - APPLCATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address This section to be ttmn d by offte �f I► C� O \? e r R� e� Map Lot U�t......_ Zone Overlay Die Elm St. District ce SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record r Name (Print) Current Ma ng ress- Telephone Signature 2.2 Authorized Agent: may - • A Name (Print) Current Mailing ren: O , (� 13 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only comp leted by rmit applicant 1. Building I R o of, ! oc . 00 (a) Building Permit: Fee 2. Electrical (b) Estimated Total Cost of , Constnidion from 6 3. Plumbing Building Permit Fee 4.::Nb3ctianical (HVAC) 41MOT otection 6. Total = (1 + 2 + 3 + 4 + 5) GO ' G C5 Check Number This Section For Official Use On Date Permit Number. Issued; « v c Bulldb V Commissloner/lnspector of BWdtnps } ♦ • F i y,. A KI 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 Depsrtment Lot Size Frontage Setbacks Front ' 3 I L: f.._ i I r Side L: R: ' Rear Building Height B'. dg. Square Footage . _. oho tt Open Space Footage % (Lot area minus bldg & paved arkin # of Parking Spaces Fill: _ volume& Location) _...,......_..._ __... __.__� A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO Q DONT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW © YES O IF YES: enter Book ' Pagecc 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 © Obtained © , 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 0 NO O IF YES, describe size, type and location: E. Will the construction activity disturb (Gearing, grading, excavation, or filling) over 1 acm or Is it part of a common pla that will disturb over 1 acre? YES O NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. p SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House [7 Addition Replacement Windows Alteration(s) Roofing Or Doors 13 Accessory Bldg. ❑ Demolition ❑ New Signs (❑] Docks Siding (p) CWwr(CA' Brief Description of Proposed }}{- Work: i 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: a. Use of bu +.ding : One Family Two Family Other j b. Number or rooms in each family unit: Number of Bathrooms . i.. 1 c. Is there a garage attached? i•� r 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. Masscheck Energy Complianoe.forrn 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 i OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, n Owner of the atr*d property Wit hereby authorize • to act on my behalf, in all matters rdlative to work authorized by this ui ding permit application. { Si "f Owner Date I, as Owned td wtwd Agent hereby declare that the statements and information on the foregoing lication are true and accurate, to the best of my Ww*tdps and belief. Si ' finder the pains and penalties of perjury. Print M Sig'na'flof Owner /Agent Date tt y M1.i. SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor Not Applicable O Name of License Holder �����. I l '7 43 53, 4 j Ucense Number 9 — OS - 10 Address _ Expiration Date Signature Telephone 9, Registered Home improvement Contractor: Not Applicable O 8 . "Roo finq 126235 C om pa ny Name ` Registration Number / ' - T ` Agoreaa Expiration Date 3 Telephon • SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6)) 1 Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit WO to" ! in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... 0 No...... 0 1 . - Home Owner Exemption 'rhe current exemption for "homeowners" was extended to include Owner- oecunied Dweflinrs of one (1) or two(2) families 'Md to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner aeta 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 " homeow shall submit to the building Official, on a form acceptable to the Building Official that he/she shag be responsible for all such work performed under the building permit. .ks acting Construction Sunervisor your presence on the job site will bc,required from time to time, during and upon corr.pietion 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 Bmploymto Irmployees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you mar be Liable fix permi(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, Chy of'' 'Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. j Homeowner Signature attan_InP� 7 `�t y r s .; A (&xi laf bt11t�1 Qtt ,�tassaci> »sots' DEPARTMENT OF BUILDIIQG INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 WORFMS COMPENSATION INSURANCE AFFIDAVIT 'Mar JkLsle. of U!.-r ftJ%rAW%'^ (licensexJpermtttec) wit, a principal place of business/residence at: c OAaL. OkgM3 (Phone# tj oxmu cltilstawnp) do `:ereby certify, under the pains and penalties of perjury, that: ('� I am an employer providing the following worker's compensation coverage for my employees working on this job: ms Cp. o� �'.�s�,,.� -Q. Q� v�c_3�311taB ►a�s•o9 o m�ce Company) (Policy Number) Mxitiratla Dille) (; I = a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following worker's compensation policies: (N=e of Contractor) (Insurance Compaay/Policy Number) MxpitWw DMd) (Name of Contractor� (Insurance Company/PoUcy Number) (ExpimdnDO) (Name of Contractor) (Insurance Compaw/Poliey Number) (P.xpiratltaa DW (Dame of Contractor) ( Insysance Company/Policy Number) tl Deb) ( &"ch additional zboa irn a=uy to ind] lafocm oo pwftiaiag 9A an awmdon) {) I am a sole proprietor and have no one woftg for me. (} I am a home owner performing all the work myself . . NOTE: plessebasaesr��w' bolo6omoavaaawboemglvl► yetsomtod�am�iatemaa ,eoaalroetibo'ar�dptitwakNt�wl�d o, mom ib= dm ualu in winds tbs bomeaftw resida at oo the ttouo& gpute W dWdn one% SWUMaoaiid�nNtM c=loymunderthawotkalzco *=dim Acs GL1S?, ss 1( 5)1, sppl iadmby% boaseowwforallogWorpemkmy0linOeto lc it d=u of as ewployw ua&rtba Wockaft Composa$on Act �t r r�oae�s t�at�taaogyotai�ststam�tmsyt�eton�►.r dedtotlte0ap. eei, eatotiednstrW�1w11rr01Mtf !'YA1�11�ri ., co•ruxgc vctiftessio�o end tbst Li>t;t+t to reams oawet� taodee t3eeden x,SA dT~t�,1l1 am ladlet5td+p� lee dalYlMi_ �1 . oocsis n of x •fine bf up to S1,W.00 Other impsh=Mcat of tip tome yev &ad *A P=ft it *s 1=of a glop tlYldtOtMlelrl L : i L4 of 5100.00 a *Y i8ing t•N � 1 � i QfLio=vripermittoe late -- . r- fix � fie �oarx�nan� o�../uaeaaa�iu ` Board of Building Regulations and Standards Constructipn Supervisor License Lic eftwN CS 74334 r- 10 Tr# 23520 ' MARK T DELISLC, 33 FIRST AVE ', "; ` .`" rij �y - ... '` EASTHAMPTON, MA 01027 Commissioner Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration:\, 126235 ,Expiration: -51P/2010 Tr# 266063 4 ! Pa6ership 4� R.C.I. ROOFING MARK DELISLE 51 B HOLYOKE ST. EASTHAMPTON, MA 01027 Administrator A • t ', N Q J R,, C, I. i Roofing 51B Holyoke Street P.O. Box 309 ton Estimate Date Easthampton, MA 01027 Phone (413) 527 -4775 5/22/2008 Fax (413) 527 -8469 Name / Address Job Location Kathy Schmidt 24 Cloverdale Street 24 Cloverdale Street Florence, MA 01062 Florence, MA 01062 413 - 585 -0627 Terms Rep Estimate valid for 20 days Rich Job Description Total Remove existing shingle roofs. 6,900.00 - F urnish and install lashin on membrane o0 Furnish & install aluminum drip edge, pipe flashings, step flashings. Furnish & install CertainTeed Winterguard ice & water barrier along eaves and valleys. Furnish and install synthetic underlayment 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 -year RCI Roofing 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 $800.00 for Land mark-Woodscape Premium shingle. Add $150.00 for Certainteed Surestart lu 5 -Star extended warranty. WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total TERMS OF PAYMENT 5% Deposit Balance upon completion Customer Signature Registration # 126235 -- - Construction License # 074334 Date 6/61 Insured by Reynolds, Barnes & Hebb, Inc. 413 - 447 -7376 — Pagel