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31A-178 (2)
R.CT . . Roofing 6 Line St. Southampton, Ma. 01073 Esti rm a to Date Phone (413) 527 -4775 Fax (413) 527 -8469 9/4/2009 Name / Address Job Location James Haug 15 Washington Avenue 15 Washington Ave. Northampton, MA 01060 Northampton, Ma. 01060 (413) 584 -0169 Terms Rep Estimate valid for 20 days Bob Job Description Total Furnish and install 1/2" fiberboard insulation, mechanically fastened. 2,800.00 Furnish and install .045 reinforced rubber roof system. Furnish and install all related flashings. Furnish and install .032 aluminum drip edge. All exterior roofing related debris to be removed by R.C.I. Roofing. All work to be performed according to manufacturers' specifications. 5 year R.C.I. workmanship warranty included. All related 'permits will be obtained by R.C.I. Roofing. Back Lower Roof: $900.00 VL 46 7 6,rw_et.'' dvz. sj„,,,kft • WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total $2,800.00 PERMS OF PAYMENT 5% Deposit Balance upon completion Customer Signature Registration 4 126235 Construction License 074334 Date q — 26 - 6 1 ° Insured by Reynolds, Barnes & Hebh. Inc. 413 -447 -7376 .- 7g, .. -J,�, • , s l Boa of Building Regulations and Standards Constructipn, Supervisor License `; f ._ Lu1se►� CS 74334 ( ; � --- SP /2010 Tr# 23520 ' ` ;- t J' II MARK T DELISLE - ' ' , ', > ' 33 FIRST AVE -;L:- �, `' �'Z.' --� �-.-' EASTHAMPTON, MA 01027 Commissioner k • Board of Building Regulations and Standards I _ i / HOME IMPROVEMENT CONTRACTOR (( - " Registration:.‘ 126235 i ,; Expiration::5/6 /2010 Tr# 266063 i • • T Partnership • R.C.I. ROOFING MARK DELISLE : > ;' 51 B HOLYOKE ST. ....., EASTHAMPTON, MA 01027 Administrator • 4 -cti.A tP ?� "` ' (yin laf nljttiittnn �„ * _ 4 4 yr�iifl{Cattit «/• A � � �� ': - DEP ARTMENT OP BOILDITjG INSPECTIONS �� 1 j . r 212 Main Street 'Municipal Building � Northampton, Mau. 01060 z.+ WORKER'S COMPENSATION INSURANCE AFFIDAVIT . - Del 1 s i e of R. l.I. f nef i (li 1permittec) with a principal place of business/residence at: - . a. - , • •_ ■ - . o \. o _(phone #4 5afj -q? ?5 ' . • - dty /sta1eJnp) do `aercby certify, under the pains and penalties of perjury, that: (41I am an employer providing the following worker's compensation coverage for my employees working on this job: )...0-V- cw...‘ U..'n.of 'F, re... ins. Co. of cr,ks‘o , Q44 \A)c3 (.311tilb 10-S o9 - (Insurance Company) (Policy Number) (Expirabbn Date) • () 1 am a sole proprietor, general contractor or homeowner (circle one) and have hired the 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 Contactor) (Insurance Company/Policy Number) (Expiiation Date) (,.:sat additioosl Mod if noccsury to Muck information pertaining to all ooatatiors) ( ) 1 am a sole proprietor and have no one w orking for me. O 1 am a home owner performing all the work myself. a . NOTE: pica= be awe that %halo boascowo:rs who employ pecsom to do maiobomor, oomtrUdionor resp*wedt at teleeatltog K • ao: moca than tiro Units is which the bomeowaerraitles or oa the grounds appuutteoaatthereto we oot SaocridlyaeeeidaelbM czloyas =Ida tho woritt es maspeosstiao /let (GL1S2,23t(5)), appicatioo by a bomaooroet for a &emote permit nay e$i oeoe the c1 clan= of as employee =Seethe Wotltot1/4 Compensation AoL ; fi g • I unclastan4 theta copy *tags stataoeotmaybeforewsdedtotheDe eroecot ofIedmtri lAtalthetdOdicKlattttse4tlr oovane vaiaeatioo and that Wm to soatrcc muss. under seetloo 2SA of MQi,131 am lad to die *Nat da illid its , . ocnsi,ttiag of a fix bf up to SI,S00.00 taw of nip to one year sod dV maths at s is the them of s Slop Watt net a '' . fm: of 5100.00 a day agaiatt tae. • 't t .00P,g5';'44:: ' ford9atmmiglisa* , ' ....:::: ' • . :*: t uy (T I411 \ , f ' ; l.. y S: gnaturt; o Li sCJ?e r itt+ • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : May 11 'Del is e. '7 3 3'f License Number • 1 - a , s. V. • 5 -03 - Address Expiration Date • (4 13) 521- 4/175 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ . C . . " Rh() f 126235 Company Name • Registration Number - Sr 5 -0b -10 Aaore Expiration Date I Eo uZtifarnptort , Ma . 01673 Telephony 1I 3)521 7'15 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 deniai of the issuance of the building permit. Signed Affidavit Attached Yes No 0 11. - Home Owner Exemption 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 docs not possess a license, provided that the owner net 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 shaU 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 Uabk 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 attached • • . , • $ • • • • tnr' a SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House E] Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Ce Or Doors ❑ • • Accessory Bldg. ❑ Demolition ❑ . New Signs [0] . Decks,[[] , Siding [Di Other [Cr Brief Descript on of Proposed a ( !el J 4, h Work: L 1 Alteration of existing bedroom Yes No Adding new bedroom Yes No ' Attached Narrative Renovating unfinished basement 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, Q M e_ ■ �• , as Owner of the subject ` property Q ^�'' r • hereby authorize L1aY 17 s, e.. of fi • t3. -1.. ROOT I n to act on my behalf, in all matters r ative to work authorized by this b uilding permit application. 9 a ,t 1rhe d 0 2 Sig7ttfte:of Owner Date I, Yay P_1 i St e_ -as al] \1nY 1ZPyl aq e.nt , as Owner/Authorized . Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. • Signed under the pains and penalties of perjury. ' " ' it Alta 14-Yli . _ , Print Name Signature of Owner /Agent Date Section 4. ZONING AU 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 Lot Size I 1 F.. ... ____ ______i Frontage i y ... . 1 .__ Setbacks Front C.. 1 Side L:1 : R :1 1 L i...~_. RI -... Rear Building Height i ..__ .._..,, . _.1 C. 1 B; dg. Square Footage �_... �' % � .... _._� � �._� (' Oben Space Footage (Lot area minus bldg & paved I . r i ..... . E parking) # of Parking Spaces L.. ..�� _ Eli w.. Fill: 1 } { {volume & Location) _. _ _ ...._ ....... .... ............ .. ...... .._, _..._ .J ._ .W .__ ..____........._._. �� A. 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: - IF YES: Was the permit recorded at the Registry of Deeds? NO 0 •: DONT KNOW Q YES Q IF YES: enter Book i Page[ j and /or Document #I 1 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 Q Obtained O , Date Issued: f J C. Do any signs exist on the property? YES O NO Q 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 (clearing, grading, excavation, or filling) over 1 acre or is It part of a common pan • that will disturb over 1 acre? YES © NO O IF YES, then a Northampton Storm Water Management Permit from the DPW is required. LW _ City of Northampton Sta 4 � s q 4 . Building Department Curb Ctit/p+ • ,lr " 212 Main Street �� Room 100 Wat ekinr > ; g" �} • Y x Northampton, MA 01060 ve p �, ,. p� ,� hene ~413 - 5871240 Fax 413 - 587 -1272 'lot! °»e _. _.. - Other "Specify " ,ate , APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY C.` SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by ctfice 1 I Map • Lot Unit c��`��= Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record; Name (Print) Current Mail' Address: t.2ee� 1vo n� `M�.. otC�T.,p Telep ne q Signature ��(.a l 2.2 Authorized Agent: . 1 ,, laYk [ P� .� - .C.z. Roofi l.�r�a � • _ S,4U.�Yj(a r'`iYl,l� C � Name (Print} J Current Mailing ddress: � ( 13) 521- 4775 �. Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building ROQf � 4 3 ( h c ' Q Q (a) Building Permit Fee 2. Electrical V (b) Estimated Total Cost of . • Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection _ 6. Total= (1 +3 +4 +5) 1. ' 7 0 Check Number / 3ij 6( *33-- This Section For Official Use Only Date Building Permit Number._ Issued: Signature: Building Commissioner /Inspector of Buildings Date • • • 4 t ;i_ BP- 2010 -0625 GIS #: COMMONWEALTH OF MASSACHUSETTS ;n 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 # BP- 2010 -0625 Proiect # JS- 2010 - 000911 Est. Cost: $3700.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 74334 Lot Size(sq. ft.): 1 1325.60 Owner: HAUG JAMES & ALEXANDRA KENNEDY Zoning: URB(100)/ Applicant: RCI ROOFING AT: 15 WASHINGTON AVE Applicant Address: Phone: Insurance: 6 LINE ST (413) 527 -4775 Workers Compensation SOUTHAMPTONMA01073 ISSUED ON:12/28/2009 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL NEW RUBBER ROOF SYS 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 12/28/2009 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo