17C-214 (3) R .C.I•Roofin
6 Line Street, Southampton, MA 01073
Phone: 413- 527 -4775 Fax: 413 527 - 8469
September 14, 2009
Konstantine Sierros
679 Park Hill Road
Northampton, MA 01062
Via Fax to 413 - 586 -1096
Re: Roof Repairs at Miss Florence Diner
Front Section Barrel Roof:
1. Remove and dispose of existing shingles.
2. Furnish & install CertainTeed ice & water barrier.
3. Furnish & install CertianTeed 30 -year Woodscape shingles.
4. Install rubber flashing membrane at angle change.
Flat Roof Section:
1. Furnish & install pressure treated wood nailer.
2. Furnish & install ' /2" fiberboard insulation over existing membrane.
3. Furnish & install .060 TPO membrane, mechanically attached.
4. Furnish & install all related flashings.
5. Furnish & install .032 aluminum edge metal.
Total labor & materi. : $12,000.00
Accepted AM. date: 1 \ 0
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«"� r DEPARTMENT OP BUILDING INSPECTIONS � 1 ,
212 Main Street • Municipal Building
Northampton, Mass. 01060 24
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
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7 _______sBark -
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(heen-permi)
wi n a principal place of business/residence at:
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a hereby 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:
Nati or tai "UnLor Fe
Co. of flitts- u.r Q , PA • \AC31,31 q68 io /os /o9
(?nuance Company) J (Policy Number) ( Expiration Date)
) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
*she contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
•
•
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) ( Expiration Date)
(tasch tioosl sbott if necessary to imolude information pertaining to all co *slots)
( ) I am a sole proprietor and have no one w orking for me.
() I am a home owner performing all the work myself.
NOTE.: please be are Oast wbilo homeowners who =ploy pas=s to do maideasace, aoattruetioaor repast work on t *Wand
not more than throe traits in which the homeowner resides oc ca the grounds appurtenant thereto are not ge ncesity oeerideled is be
employes under the worker's Ismnpensatica Act (OL152.,ss 1(5)), application by a homeowner for a limp's or permit may evidence the
s� l tzt6u of an employer wader the Woritees Compeoeation Ant.
I u o d e n t a n d that a copy of this t u t e e s = m a y be i t i o n riled to tin Deput iced of l ckablei Acelddtlft 011oo etkimmit Att e
Oovaxgo WrifiC4100 tend that adult to:aara romp under semen 23A otMOL. !Sian lad to the' *Wei i li ed pli Iai .
eoosisii g of & •foe of up to S1,500.00 *odfor imitrssonmeat of tip to one year and civil pmsltla io the form Mateo Stop Waktbder ad a •'
`.:ere of S 100.00 s day wing me.
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Pe rmi t Number
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Version1.7 Commercial Building Permit May 15, 2000
SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11) I
Independent Structural Engineering Structural Peer Review Required Yes O No O
SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
'1, K.o ` sk \: ti ivc. S. Z✓e cos , as Owner of the subject property
hereby authorize +l. C' 1. oo f T 5 to
act on my behalf, in all matters relative to work authorized by this building permit application.
{tachecl _ l
Signature of Ov mer Date
1 .. ___ ci Y h e � s / Re.I."RooYin5 Agent ! , as OwneN/kuthorized,
AaenLhereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Si ned under the pains and penalties of perjury. _ ..
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ateK ._ ... 1 _P,..a
Print Name
! __I Z l _.._.___�___..___._.._
Signature of Owner /Agent Date
SECTION 12. - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder C..J.171.31 . .G i s It ......... ......_ . _ .... ._ ___. _._. _ __- .!
License Number
, o1iofte._ cep -_ Easy ampfion Ma. 010211 L .... =_ 10
Address Expiration Date
•
Signature Telephone •
SECTION 13 - WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(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 Affidavit Attached Yes • No Q
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Version1.7 Commercial Building Permit May 15, 2000
SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 36,000 C.F. OF ENCLOSED SPACE)
9.1 Registered Architect:
- 1 Not Applicable 0
Name (Registrant):
I Registration Number
Address r
1
Exp iration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
.- --_
I
' I ______ —
Name Area of Responsibility
Eli
_
Address Registration Number
• __
Signature Telephone Expiration Date
_ .
L
1"
-* --
1
Name Area of Responsibility
_ ..... _
1 I. . I
Address Registration Number
I F 1
• I _ . ... _
Signature Telephone Expiration Date
1
Name Area of Responsibility
i
1 1 ' I
Address Registration Number
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Signature Telephone Expiration Date
I i
Name Area of Responsibility . .
1 F
Address Number
1
1 I I /
• /-
Signature Telephone Expiration Date
9.3 General Contractor
1
_______________. 1 Not Applicable 0
. ' Cblitany Name
•
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1:, ,• _
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Itiii0obstlie In Charge of Construction
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Telephone •
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Version1.7 Commercial Building Permit May 15, 2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size 1 [ 1 ... _ ____
Frontage L 1 1 ....__._ ...
—
Setbacks Front
Side L:'_ R: 4 L:1 ..... R �.. ___. I r . _ [ . ii
Rear I...... ___.
Building Height l
Bldg. Square Footage F s 1 % :_ i , , _
Open Space Footage I % 44 .
(: .ot area minus bldg &paved ! I { i_ _ _ __ �
parking)
r of Parking Spaces 1 _ _ _ I ` _. -.1 �-
Fill: i.
( "olume & Location) ; _ .__... . _.. .. _.
t . Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 0 YES 0
I F YES, date issued: i_. 1
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 • DONT KNOW 0 YES O •
IF YES: enter Book Page 1 and /or Document i#
E. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW O YES O
IF YES, has a'permit been or need to be obtained from the Conservation Commission? .
Needs to be obtained 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO O
IF YES, describe size, type and location: 1
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: I
• E. Will the construction activity disturb (Gearing, grading, excavation, or filling) over 1 acre or is it port of a common plan
that will disturb over 1 acre? YES 0 NO 0
• IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
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Versionl.7 Commercial Building Permit May 15, 2000
SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 36,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs ❑ Additions ❑ Accessory Building 0
Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing❑ Change of Use ❑ Other ❑
Brief Description Enter a brief description here.
Of Proposed Work: I
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly A -1 ❑ . • A -2 ❑ A -3 ❑ IA ❑
❑ A-4 ❑ A -5 ❑ . • 18 ❑
B Business ❑ 2A ❑
E Educational ❑ 2B ❑
F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ I -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R -1 ❑ R -2 ❑ R - ❑ 5A ❑
S Storage ❑ S-1 ❑ S -2 ❑ 56 ❑
U Utility ❑ Specify:
M Mixed Use , Specify: j
S Special Use ❑ Specify: j
.
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND/OR CHANGE IN'US
Existing Use Group: t ! Proposed Use Group: l _ _
Existing Hazard Index 780 CMR 34): F . I Proposed Hazard Index 780 CMR 34): ! ._ _..._ _ __ __..___... ...... .__I
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY •
Floor Area per Floor (sf)
t.
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+ �, `tt.if, 1*,.4 °e .Fa F:
1st I t _ .. i th' .F
2nd _ ._.. _. - 2nd l._ ._..- _..._. � i P > n
� 4���� A �r r � 4 ��t
I _ _ � Sty y " �
3 � eF T„. I >
S
4th 4 ` ''t �..t n si7 r r ' .
Tofal Area (sf) r~ 1 Total Proposed New Construction (sf) p '
J IT b yg
l ry x
Tote Height (ft) I , � +f .,L {
, I . 1 a F tl�1 i „1 E M ; � � 4
S n s
( , a�
Total Height ft I qq� " ` f #
• I :: uRb �' X, •w ' t
7 Wa ter Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public 0 Private D Zone F .,. __ . .,__,_ _ _ 1 Outside Flood Zone❑ _ Munidpal ❑ On site disposal system°
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Version1.7 Commercial Building_ Permit Ma 15 2000
City of Northampton Statusof 7 , 1 . 1 ',,,„ , . `$';
Building Department Curb 'C • v , 40 :4 ,' `;! .. ' .
212 Main Street Se
Room 100 W , _.
Northampton, MA 01060
phone 413- 587 -1240 Fax 413 - 587 -1272 Plot/Site 1 1,,
OthersSp ' : ., , tl
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION ���� ,
1.1 Property Address: ��
This section to be completed by office
I q9 pn 0..i v ., M ap Lot Unit
`O t; '>... .X., / '0/Va. . Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
K d�s r . e-c- -oS l 1 .. ?oc -K._ a\ ....eA. __. .
Name (Print) Current Mailing Address:
Signature a tt a c h e d Telephon' 91 : 3) sg(. 14 (,,`i 0
2.2 Authorized Agent:
11 K'L 'Deli s R.,13_o:ox Q9 asf am .
Name (Print) Current Mailing Addressv
• L( _541 w � __- _ -.
Signature / `�1 Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building {hoof) n 1 z 000 00 (a) Building Permit Fee
2. Electrical I ( b) Estimated Total Cost of L _.___._ _ l
Construction from (6)
3. Plumbing Building Permit Fee
4 Mechanical (HVAC) -- -
r _
5 (Fire Protection
_ 6. 'Total = (1 + 2 +3 +4 + 5) a la 0 .00 Check Number /5 (? d --- _ tolg
This Section For Official Use Only
BifilairigPermit Number Date
Issued
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,,' ., L PM • Y
9 t :.
�7 missioner/Inspector Date
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40. .. is
I.
99 MAIN ST BP- 2010 -0700
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:POOkf 17C «- 214 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 t/ BP- 2010 -0700
Project # JS- 2010- 001029
1st. Cost_ $ 12000.00
Fee: $72.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 74334
Lot Size(sq. ft.): 44474.76 Owner: FLORENCE FAMILY ENTERPRISES LLC
Zoning: GB(100)/ Applicant: RCI ROOFING
AT: 99 MAIN ST
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527 -4775 Workers Compensation
SOUTHAMPTONMA01073 ISSUED ON:2/2/2010 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF & INSTALL NEW
MEMBRANE 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 2/2/2010 0:00:00 $72.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo