23C-069 R Esti
Southampton. Ma. 01073 IU /13/201I
Phone (413) 527 -4775
Fax (413) 527 -5460
Name / Address Job Location
William Jones 118 Bliss St.
118 Bliss St. Florence, Ma. (II O62
Florence, Ma. 01062 (41 3) >84 -2083
Terms Rep
Fstimate valid for 30 days Dave
Description Total
Remove existing rooks. 9,500.00
Furnish 2. install aluminum chip edge, pipe II ishings. chimney H u4iings tad step fl�ishin�s.
Furnish & install new lead counter flashings.
Furnish & install CertainTeed Winterguard ice & water harrier along eaves ,ind valleys.
Furnish and install synthetic underlayment over existing deck.
Furnish and install 30 year Certain'heed Woodseape Series shingle.
Furnish and install Certain'I`eed approved ridge vent.
All exterior rooting related debris to he remover) by R.C.I. Rooting.
All work will he performed according to manufacturers' specifications.
30 year Ccrtain"hecd material warranty included_
All related permits will he obtained by R.C.I. Rooting.
Add $2.50 per sq. ft. tar wood decking replacement if needed.
Add: I. 1)1).01) for Certainteed Landmark Woodscape 50 year premium shingle.
A Certainteed Surestart Plus extended wauranly will he included with a lee at 5440.011 ahsorbed
by RCI Roofing if signed within 7 (lays. 'hhis extended warranty means that 21) of the 30 year
warranty is covered for labor and ntnterial.'I he last 10 yews it the 3)) year Certai warrawy
�t�d ceove blot material ( >r:J �S ? /rr'" 71- 1` .1-AAS.77 �ttt 1-16
WF LOOK FORWARD TO I)OIN(i IIUSINFSS WI FI t YOL.
Total $9,500.00
I FRvlS OF P rA Y Mf : N "l ��
5% Deposit „�--..,y;� - -- , � g •777
tatlance upon e Customer Signature �M
Registration tt 126235
Construction License # 074334 Date ) '21 7 77—
Insured by F3anas & Fiekcrt Ins. (413)527-2700
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SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : M'1 'De i t e, ill.' 334
License Number
51 fl Hno)e St.- Easth Ma. oioaq 5 - 03 -2
Address 1 Expiration Date
...00,
(q q'1 ?5
Signature Telephone
5�7-
9. Registered Home Improvement Contractor: Not Applicable ❑
ft :.i. 'Roo 11. C . I . f RO 0 fi nci 126235
Company Name Registration Number
5i 8 }1o1yoke Street - P 0. 'Box 309 5- Db - 1 z
Address n � Expiration Date
EIS tharnpThn � . Q � o ! TelephonE01 ' 4775
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 ❑
11. - Home Owner Exemption,
The current exemption for - homeowners . ' was extended to include Owner - occupied Dwellings of one (I) 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 he, 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 he 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 liar 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 atta
t•
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House Addition f] Replacement Windows Alteration(s) J Roofing ri
Or Doors El
Accessory Bldg. I Demolition I New Signs [0] Decks [C] Siding [0) Other [O]
Brief Description of Proposed a i P a h
Work: L r 1
Alteration of existing bedroom Yes No Ad g new bedro Yes No
Attached Narrative Renovating unfinished asement Yes No
Plans Attached Roll - Sheet
6a. If New house and or addition to existing housing, complete the following:
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. Masscheck 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
I, � � o - O , �:"`s , as Owner of the subject
property
• •
hereby authorize ! • I • f • a •
to act on my behalf, in all matters relative to work authorized by this *Lidding permit application.
Att. aehe.d - 2.-1 z
Signature of Owner Date
I,
jvtayi "Del l Ste. 2S aU t or ► zeci aCie.nt , as Owner /Authorized
Agent hereby declare that the statements and information on the foregoing aalplication are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Vert sl e
Prin
- 2. -I2,
Signature of Owner /Agent Date
Section 4. ZONING Atl Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Lxisting Proposed Required by 'Zoning
"Ellis column to he Filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building height
Itldlg. Square Footage
Open Space Footage ib
Lot area minus bldg & paved
parking)
of
Parkin ;,4 Spaces
Fill:
(volume & location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DON'T KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW O YES 0
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained O , Date Issued:
C. Do any signs exist on the property? YES 0 NO 0
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 0
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
RECEIVED City of Northampton Status of Permit:
Bailding Department Curb Cut /Driveway Permit
'• {a', — 72012 212 Main Street Sewer /Septic Availability
Room 100 Water/Well Availability
Nor hampton, MA 01060 Two Sets of Structural Plans
N1 87 -1240 Fax 413 - 587 - 1272 Plot /Site Plans
Other Specify
APPLICATION 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 completed by office
C € S ST Map Lot Unit
Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: rr�
W \\cvor) ACS \ `�\ � - . �t : \ d: cv�L� tea, 61O�Z�
Name (Print) Current Mailing Address:
attached phone y- 24R3
Telephone
Signature
2.2 Authorized Agent:
Plark i09 I6 - Q.C.I. } oof, n L' .nes Ez,SQutl arnpton ,Ma.
Name (Print) y Current Mating Address: 010713
(H13) 521• 4T15
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building Roof! 5U® t, o (a) Building Permit Fee
2. Electrical ni (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) $ q _ 5 0 , Check Number /
This Section For Official Use Only '
Date
Building Permit Number: Issued:
Signature.
Building Commissioner /Inspector of Buildings Date
18 BLISS ST BP- 2012 -0769
CIS #: COMMONWEALTH OF MASSACHUSETTS
vlap:Block: 23C - 069 CITY OF NORTHAMPTON
_,ot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
?ermit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit # BP -2012 -0769
Project # JS- 2012 - 001351
Est. Cost: $9500.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 74334
Lot Size(sq. ft.): 161 17.20 Owner: JONES WILLIAM P & BARBARA A & STEPHEN JONES & M W JONES
Zoning: URA(100) //WSP Applicant: RCI ROOFING
AT: 118 BLISS ST
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527 -4775 Workers Compensation
SOUTHAMPTONMA01073 ISSUED ON:3/7/2012 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 3/7/2012 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner