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18C-100 .I. Roofing, 51B Holyoke Street P.O. Box 309 Easthampton, MA 01027 Estimate Date Phone (413) 527 -4775 5/11/2005 Fax (413) 527 -8469 Name / Address Job Location Charlotte Morse 23 Gleason Road P.O. Box 685 Northampton, MA Scarborough, ME 04070 Maine (207) 883 -9670 586 -0004 Terms Rep Estimate valid for 60 days Mike Job Description Total Remove existing roofs on front portion of house and garage only. 4,350.00 Furnish & install aluminum drip edge, pipe flashings and chimney flashings. Furnish & install new lead counter flashings. Furnish & install ice & water barrier along eaves and valleys. Furnish and install 15 Ib. felt over existing deck. Furnish and install 25 -year, 3 -tab Certainteed Seal King shingle to match the existing shingles (Frost Blend). Furnish and install Cor -A -Vent ridge vent. All roofing related debris to be removed by R.C.I. Roofing. All work will be performed according to manufacturers' specifications. 5 year R.C.I. workmanship warranty included. 25 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 replacement if needed. WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total $4,350.00 TERMS OF PAYMENT 30% Upon delivery of materials / , � 70% Upon completion Customer Signature . v_/ /CC/Z ��- Registration # 126235 _ Construction License # 074334 Date Insured by Hackworth Insurance (413) 527 -9907 / 0Qt .StttPT • a do , . fl Crxf of N t[1ampthn =* ...____:::. • swigs- tiii! tISas -.-_,-1.0,w-- 't .z."�i DEPARTMENT OP BUILDING INSPECTIONS -ol i= .. 212 Main Street • Municipal Building _ Northampton, Mass. 01060 `'''* WORICER'S COMPENSATION rriSTJRANCE A.F'irll)AVIT I, ___1 _ /ehsle of il. Tt. f oofinq �) .1 with a !principal place of business/residence at: • 5L 1ohj e St./ Eastharn to .Ma. 0.10a.'7 (phone / z3) -i1T15 !street/city/state/rip) do hhe: eby certify, under the pains and penalties of perjury, that: /1 am an employer providing the following worker's compensation coverage for my employees working on this job: • v • 1t4C231S- 31?t24 -04 10 0 • (. • .. CC Company) (Policy Number) (Expires on Date) ( ) 1 am a sole proprietor, general contractor or homeowner (circle one) and have hired the co:atractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) , (Name of Contractor) (Insufancc Company/Policy Number) (Expiration Date) (Name of Contractor) ( Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach addrtionsl shcet if necessary to include infocn ution pertaining to all contractors) ( ) 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 aware that while homeowners who employ persons to do maiatmance construction or repair work on a dwelling of not more than throe units in which the bomoowncr resides or oa the grounds appurtenant thacto are not wally 000sidcred to be employers under the workers . ration Act (GL152,ss 1(5)), application by a homeowner for a license a permit may evidence the lead ct > w7 of an employer under the Workoes Compensation Ace I understand that a copy of this uitcneot may be forwarded to tho Deputmeot of Industrial Accidents' Moe of Imur.me for the covL—agc verification and that failure to secure coverage) under section 2M of MOL 152 can lead to tba imposition of aiati1 lea oomist� of a fine of up to S1,500.00 andtcr impCisoc ix t of up to oo ytxr taxi civil penalties la the form oft' Stop Wort VII*" ta d t fax of 5100.00 a day against toe. . For depsztotail uao only Permit Number p Lot # Signature of Li Jpermittt Ise SECTION 8 - :CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: �/ visor: NotApppllicable ❑ Name of License Holder : a,v[ !f De I si / / 433 License Number 5l }{ol oke_ &tree . - Eamth arn plb n � Na. 01027 5 -03- O b Expiration Date ( 413) Sari- gg75 Signature Telephone rR` , e:7' ' °e •rw`men"•1n is: i �s� z< Not Applicable ❑ c. I. Roof n3 )2.6 235 Comanv Name Registration Number 51B }1okjo1(e. Street - ED. BOX 3Dq 5 - Ob - Ob Address Lt�f Expiration Date k asthampton M. ID art Telephon��l� 1Z3, 5x/4 ns SECTION 10- 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 ❑ The current exemption for "homeowners" was extended to include Owner - occupied Dwellings of one (1) or two(2) families and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts 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 "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion 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 Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(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, City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature a,,t.acheci SECTIOM DESCRIPTION;OF PROPOSEDAWORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing V Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ] Brief Description of Proposed Work: - - • _�� �� �i 11� Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative ❑ Renovating unfinished basement Yes No Plans Attached Roll ❑ . Sheet ❑ 6a f ew houselandtor addition ciTezistifiThousing,;c6mplete` the f-al blab. a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? 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. Mascheck Energy Compliance form 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 OWNERS AGENT OR-CONTRACTOR APPLIES FOR BUILDING PERMIT 1, charlotfiL J'IQArse (+ , as Owner of the subject property hereby authorize ,M aYik De1, Sle. Q7 R•�+. RQQfi )( to act on my behalf, in all matters relative to work authorized by this building permit application. attaellec1 9- a -05 Signature of Owner Date } I, Mary 17e1ts1e. as a►1thoYmeci agent , as Owner /Authorized Agent hereby declare that the statements and information on the foregoin application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Nairh el '►sl e. Print Name 8 -a4 -a5 Signature of Owner /Agent Date f � • Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES 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 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ?YES _ No IF YES, describe size, type and location: �-1 V - - City of Northampton rl nay. Building Department �. r L,C 2-12 Main Street ' to‘r,,, Room 100 r Northampton, MA 01060 n `rlork' v4i3=5 - 1 Fax 413. 587.1272 ®' to of a�nr O . APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: Th�s sects o compl t� 23 � �� ���� ! ��� Maps �' ��- � '� u • Zone � � ��Ovelay Elm St. District CB District. SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Cbar1atie .Morse. P.o. bS h 1)46 Name (Print) Cy rsn�:a n ) Addr ss: Q 014010 attached l Q F Signature Tel$tfbe p " 3 _9470 2.2 Authorized Agent: ``oo((U U 1 Nlar Tel i s - f PM. C ox 309 - Easthampton, Ma Name (Print) Current Mailing Address: 01oa/7 (J-113) 5a1?- v77 Sig ature Telephone SECTION 3 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building Roof; n3 /4350 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) W )350.D0 Check Number �� ~ This Section For Official Use Only Building Permit Number: Date Issued: S ignature: Building Commissioner /Inspector of Buildings Date R 23 GLEASON RD BP- 2006 -0225 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18C -100 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit # BP- 2006 -0225 Project # JS- 2006 -0330 Est. Cost: $4350.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 126235 Lot Size(sq. ft.): 14505.48 Owner: RICHARDS CHARLOTTE Zoning: URB Applicant: RCI ROOFING AT: 23 GLEASON RD Applicant Address: Phone: Insurance: P 0 BOX 309 (413) 527 -4775 Workers Compensation EASTHAMPTONMA01027 - 0309 ISSUED ON:8/31/2005 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 8/31/2005 0:00:00 $25.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo