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15B-040
I I 4i&ur- 212 CHESTERFIELD RD Q BP- 2011 -0765 GIs #: i7 COMMONWEALTH OF MASSACHUSETTS Map:Bloc 15B - 040 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: roofing BUILDING PERMIT Permit# BP- 2011 -0765 Project # JS- 2011- 001261 Est. Cost: $13000.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 74334 Lot Size(sq. ft.): 104108.40 Owner: ROZENFELD LAURIE S Zoning: RR(90)/URA(1O)/ Applicant: RCI ROOFING AT. 212 CHESTERFIELD RD 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 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner 0 of Northam ton S P 'La ilding Department 046c' 212 Main Street Room 100 Wit Northampton, MA 01060 phone 413 -587 -1240 Fax 413 - 587 -1272 F�(otlSi� Other`8 f, APPS ,CATION T CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION t - SITE INFORMATION This section to be completed by office 7, ; Prope �� Map Lot y Unit__, i ��f g lno L 1 O 5.3 one Overlay Dlatric a' Elm SL District CB Dla trtct ( SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner o R occord �: Cl c y� �c Name (Print) C ntnt Mailing � 1 �— 3 q l 333 Telephone Signatu _ _. 2.2 Authorizes Agent: Q Name (Print) Current Msilinp Address: 0 k O� Signa Telephone j SECTION 3 - ESTIMA CONSTRUCTION COST$ Estimated Cost (Dollars) to be Official Use Only completed by unit ap licant „ 1. Building Ooo ` CSC) (a) Building Permit Fee 2 E!ev,,ical (b) Estimated Total Cost of Constnxbon from 6 Building Permit Fee 4. Mechanic a ' HVAC ) ! 5. F ire Protec'o 6. Total = (, - 2 + 3 + a + 5) Q Q n . `•,' c Check Number ^a This Section For Official Use Onl � - -- -- Date Boilding Number. Issued: Signature: _ Building Commissioner/Inspector of Buildings Dabs Se ction 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 i. Si/,c F: t >nttt �c Sthacks Front Side I Rcar i I tl ;ilding Iicight ( i t-- H Jg. `;yuare Footage % i t) cn Spacc footage % t1 a area nunus hldg t paved I — r in 1 �t i'arkin S )acts I umc K location I A Has a Special Permit /Variance /Finding ever been issued for /on the site? NO O DON'T KNOW O YES O IF YES, date issued:: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES Q IF YES: enter Book Page and /or Document /t� B, Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES 0 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 O NO O iF YES, describe size, type and location: VVill 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. SECTION 5-DESCRIPTION OF PROPOSED WORK (check all applicable New House Addition Replacement Windows Alteration(s) Roofing f Or Doors D r -- Accessory el.lg _] Demolition ❑ New Signs [0] Decks (❑ Siding fol Other[D7]' I "ne' Descni; in of Proposed 'Work: t.. t %Jteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attache , Roll - Sheet 6a If New ho use and or addition to existing housing, complete the foilowina: Use of t;. iding One Family Two Family Other _ Number � • rooms in each family unit: Number of Bathrooms Is there a ;arage attached? Proposes Square footage of new construction. Dimensions Numbe c' stories? Veth,oc o; nearing? Fireplaces or Woodstoves Number of each Energy C::nservation Compliance. Masscheck Energy Compliance form attached? n Type of construction Is constru.xion within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No Depth of 1 or cellar floor below finished grade Will bui;ci, g conform to the Building and Zoning regulations? Yes No, Septic Ta! City Sewer Private well City water Supply SEC''ION 7a - OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT t. A as Owner of the subled D openy — -- hereby autnori: e • 'o act on my be half, in all matters rdlative to work authorized by this ui ding permit application. ft P SignatiKegf Own ar Date . Y e l she a S all tbnY i 7.e� as e-n C as Owner /Authorized ,agent hereby caclare that the statements and information on the foregoing Itcation are true and accurate, to the best of my krKrMedge and belief. Signed under the pains and penalties of perjury. I 1• . Lit, Print Name SECTION 8 -CONSTRUCTION SERVICES 8.1 Licensee{ Construction Supervisor Not Applicable ❑ p N o f Licon!: Holder nn � l� ! I q 3 License Number (a M a . t -Q 12, Address Expiration Dale 52q- Nq'75 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ 1 . f! nQ 1.2 623-6 Company Name Registration Number HaorCO, Expiration Date ` le i► 2 0 LC�_Telephon& SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 162, § 26C(6)) l /Vorkers Cr:: er,saUon Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result M the denia of the issuance of the building permit. Signee Affir t Attached Yes... .. �z No...... ❑ 11. - Home Owner Exemption : he current exemption for "homeowners" was extended to include Owner - occupied Dwellings of one (1) or two(2) families :rr,i to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts ;is supervisor. CMR 780, Sixth Edition Section 1Q8.3.5.1. 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 farm arcs. A Berson who constructs more than one home in a two -year period shalt not be considered a homeowner ,omcoWIWI' shall submit to the Building Official, on a form acceptable to the Building Official that he/she shall be s ponsible for all such work performed under the buildine permit. `actins Construction Supervisor your presence on the job site will be required from time to time, during and upon ctt ;: plction of the work-for which this permit is issued. o be advised that with reference to Chapter 152 ( Workers' Compensation) and Chapter 153 (Liability of Employers to ployees fir injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) c ,, hire to perform work for you under this permit. 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 A/nnoU ted. Homeowner Signature t 7 The Commonwealth of Massachusetts Department of Indwiria /Accidents ��- Office of Invesligalions i 600 Washington Street Boston, MA 02111 M \vorl;ers' Coinpensatiot Insurance Affidavit: Buiiders/ Contractors /Electricians /Plumbers • ppiicant Infor'nratiorr Please Print Legibly S'itL•,�.I {t �a�.1L� - - I OLA . 11o11 i; - - -- �� :+n employer? Check the appropriate box: - Type of project (required): �I ;tat ;t �nthlt,jr.r t�ith 20 4. ❑ I am it general contractor and ! 6 ❑ New construction ;full and /or part- time).* have hired the sub - contractors listed on the attached sheet. 7. ❑ Kermodeling I ;um a solc iiroprieior or partner >hii, a ,,i ht,�'e no employees These sub- cantractors have g. ❑ Demolition « for ,nc in any capacity. employees and have workers' y ❑ Building addition � Ne iv orkers' comp. insurance comp. insurance. - �. We are a corporation and its 1 U.❑ Electrical repairs or additions rrq t:, r�: �i ! ❑ j _] i am homeowner doing all work officers have exercised their 1 1.[] Plumbing repairs or additions right of exemption per MGL [�fR i !No �,vorkers' comp. 12. nst;r;t�,�� rcyuirccl.)' c. 152, §](4), and we have no employees. [No workers' 13.❑ (.ether_ - - - - __ comp. insurance required.) ap,�li�, hc�k.c Nw.t s must also fill out the section below showing their workers' compensation policy information. lo:I •coo Iles. >> u„ 'Nil bn,it this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. � unua,ao,� 111:1 - ,IlCC: this be,x atust attached an additional sheet showing ttte name of the sub contractors and state whether or not those entities have nt,lucr s. I 1 sub - Contractors have employees, they must provide their workers' comp. policy number. am a/r employer that is providing workers' compensation insuranc fur nry employees. Below !s the policy and job site i�rlr�rnurlio�r. Expiration Date:_ L_� " �� C - ss:_ � �(� ���n�>\ �i�. City /State/Zip: U . ��k :j attach a copN of the workers' compensation policy declaration page (showing the policy number and expiration date). ;flare t , e .;rr �t >�ertge as required under Section 25A of MGL c. 152 can lead to the irrtpositiort of criminal penalties of a )06 llidior one -year imprisonment, its well as civil penalties in the form of - a STOP WORK ORDLK and a fine �I uh to 3 "_'qtr 00 a Ja; against the violator. Be advised that a copy of - this statement may be forwarded to the Office of 1;jvc,st igatii,n:. ol:hc UI,.\ for insurance coverage ver ification. I rl.. he rCht' .' :'r,ifi' , / /t[/er the ins and penalties of perjury that the information provided above is true and correct. _— ate: 3 -- 1i �rtgtUre: )'none. tJ_��� (�fficruJ u+ �, on/ Y. Do not write in this area, to be c•ornpieted bj cilia or town uffTciaL C10rdr Town Permit/License g Y� no Authority (circle one): :•., Yawn Clerk 4. Electrical Inspector 5. Plumbing Inspector 1 � now it �'titf iCi�: c! �V. OO , f•``'''' MARK 1 DELISLE 33 FIRST AVE EASTHAMPTON, MA U1©27 _� � Ufllrr ut t uu.u�riri a((airn .A ISu�iur >. Ilrkul4tiun �!{ HOME IMPROVEMENT CONTRACIOR Royislration: ?6 3 Expiration: 5/61201;? lea . "1i�ia�i type: Partrieishp ROOf-(N6 NtAf h DEL ISLE 5QU 1 rt 1 l_)14 MA 0 1073 1 nilrrsci rrf;iI -- RCI' O Roofin g S ' m e Dale O Line 51. Southampton, Ma 01073 2/14/2011 Phonc (4 13) 527 -4773 I•ax (4 13) 527 -M09 Name / Address Job Location Lori Rosenfeld 4 Shepards Hollow Rd. Leeds, Ma. 01053 s Terms Rep Estimate valid for 30 days Dave Description Total R21nove existing profs. 11,600.00 Furnish & instiill aluminum drip edge, pipe fleshings, chimney fleshings and step (lashings. FUrnISh & install new lead counter (lashings. FUr'1115h & install CCrtainTCed Winterguard ice & water barrier along eaves and valleys. Furnish and install synthetic underlaymcnt over existing deck. Furnish raid install 30 vear CertainTeed Woodscape Series shingle. Furnish and install Certainl'eed approved ridge vent. All exterior roofing related debris to be removed by R.C.I. Roofing. l All work will be pertOrmed according to manut'acturers'specil'ications. 30 year CC taint ecd material warranty included. All related permits will be obtained by R.C.I. Roofing. Add 52.50 per sq. 0. lM wood decking replacement it' needed. " ",ld: '61,100.00 f()! C crtaintced Landmark Woodscape(50 year premium Shingle. A Certaintecd Swcstart Plus extended warranty will be n luded with a 1'ee of ($560.00) abst>I hc<! by RCI Roofing iI* signed within 7 days. This extended warranty means that 20 of ttre 3(I yc;rr wrrranty is covered for labor and material. The last 10 years of the 30 year Certainteed�� wurrilldy would be covered for material only. 4 , �r � �y r WE LOOK FORWARD TO DOING 13USINESS WITH YOU Total $11.600.00 TFIMIS OF PA) MEN "I t)Cl3o5i( Customer Signature vA !3alancc. ulxrn crnnpletion kegisnit(ion 11 120235 Ccrosimciion Liceirsc ti 1174334 Date 111 iw •cl by M111:1s & Fick Ins. (413 527 -2700