32A-037 . Ro oflng
(, Line St. Estimat
Date
Southampton, Ma. 01073 7/I4/201 1
Phone (413) S27 =4775
I ;ix 013)527-S469
Name / Address Job Location
Joseph Panzica 10 Parson St.
341 Chapman St. Northampton, Ma. 0106(1
Greenfield, Ma. 01301 (413) 774 -5 I 1 I
Terms Rep
Estimate valid for 30 days Dave
Description Total
RCmove cxisling roofs. 17,000.00
Furnish & install aluminum drip edge, pipe (lashings, chimney [lashings and step !lashings.
I urnish & install new lead counter (lashings.
Furnish cA install Ccrlain'I'eed Winlcrguard ice & water harrier along caves and valleys.
Furnish and install synthetic underlayment over existing deck.
Furnish and install 30 year CertainTeed Woodscape Series shingle.
Inurnish and install Certain heed approved ridge vent.
All exterior roofing related debris to he removed by R.C.I. Roofing.
All work will he performed according to manufacturers' speck icalions.
30 year Certain'1 Ted material warranty included.
All related permits will be obtained by R.C.I. Roofing.
Add 52.50 per sit. ft. for wood decking replacement if needed.
Slate roofs only (including plywood): 55,700.0))
WIC; LOOK FOR WART) TO DOING BUSINESS WITH YOU.
Total 517.000.00
I FRMS OF PAYMENT
5'i I)cIn it
l3 d uu -�� upon completion Customer Signature'"°
i! isiration N I26235 r"
onsl Liccuse W 07411,4 /
slic Date {1 t ed by lianas l fickcrt Ins.
13) 527 -2700
l ''''' The nr »n wh ref Mhustts
:..
Dep of � assac tccirlen
Cr `—�'�� Office of Irt■'estigutiutrs
.':' .I 600 Washington Street
S. ' c4'
., 47.-7, Boston, MA 02111
�-.`` ►vw w. MUSS. gv► /dia
Workers' Compensation Insurance Affidavit: Builders /Contractors /Electricians /Plumbers
:Applicant Information Please Print LeEibly'
t
N itt1C ( Ili , incss %C3r /lndiriduttl)• — \--\. -
•
.` \l1dresS: `- V ,,A
.i re you an employer? Check the appropriate box: Type of project (required):
I ,tin ;t cmplos e.r with 2, C ' 4 . [ ] 1 am a general contractor and 1
emploi Lies h and /or part-time).* have hired the soh contractors 6. Li N ew construction
2. L I tm a sole proprietor or partner- listed on the attached sheet. 7. [ R emodeling
ship and have no employees These sub - contractors have 8. (-] D emolition
working for me in any capacity. employees and have workers' 9. [ B uilding addition
1 N0 ll. .>rkers' comp. insurance comp. insurance.:
requircd.1 ❑ e are a corporation 5. We d its I00 Electrical repairs or additions
E an
r] I an a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
nivseli .
No workers' comp. right of exemption per MGL i 2.2
insurance required.)
1 c. 152, § 1(4), and we have no
employees. [No workers' 13.1 Other
comp. insurance required.]
:illy apelic tit r. ,i, r.he k; bu.v n I must also fill out the section hel showing their workers comperisation policy information.
Ikmic.n + ,110 submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such
- Contri.auts that cheek this hex must attached an additional sheet showing the name of the sub - contractors and state whetter or not those entities have
employees. If thh.: sub - contractors have employees, they most provide their workers' comp. policy number.
i ant an employer that is providing workers' compensation insurance for my employees. Belo is the policy and job site
rIt /urntation.
n ;t
sur ried np ;lt„ Na,ne. - _ 4 r.--C _4__Q.-- -we\ V =- ',- - _ _ ______ -____—
(, r, or ti I1 ins. l.ic. u:1) 11, C 3 0 _ - _. — 1 \piration Date: _ L � _ ' _ - =. 0 1 0
.h>h Site Addtess:_1O 90.eSpx\ S\- City /State /Zip: ►'1 t {Vla.. 0 1060
It.r a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
;blare It> src .,re coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
Line up to SI.. and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
or up to 525(1 -0P a day against the violator. Be advised that a copy of' this statement may he forwarded to the Office of
lnvestigatious of the DlA for insurance coverage verification.
I do hereby (crtif t' under the ins and penalties of perjury that the information provided above is true and correct.
fgnatore�._ -_ . _ ��- --__�. ___________Date; - -- .._.� '_? -1
Phone ii:' (13.,) ,5e., i -u-1-15 ____ __-.._____ _ �__ _ - --
officiai use only. Do not write in this area, w he completed by city or town official.
City., fir "1'0 w n: Permit/License f
Y ;ii`ing Au thorny (circle one):
• 1 `Board of health 2. Building Department 3, City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6 fath
r"nnte ct Person: Phone a:
SECTION 8 - CONSTRUCTION SERVICES I
— T
1 Licensed Construction Supervisor; T le Not Appllicble 1 Licnse M k .___11_ L � _l_..] __� - - -- -- -- - -- - .- - - --- NumMx
( ./ Lt q. e , � „ J O f l , , s . : 1141 LIS w e • • ' - I - -- --- - -- --- _
%address, - Expiration Date
(_'L±3) ,5 .7 • - Li'17 5 - —
,,,ei,,,,
.. R,nature Telephone
9. Registered Home ^IImhprovvem�e/n^t Contractor: Not Applicable + ❑
Company Name Registration Number
' _ -_�,
gore,,, I Expiration Data
�_ in 1- ��TQ�1 r - _ 1lA 111 _t . __..___ -._1 elephonkiii i �� -- t
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G,L. c. 152, § 25C(6))
1
\iorhers Ccmaensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
.n he denim of the issuance of the building permit.
Signed Atliclit Attached Yes No _. ❑
1 I. - Horne Owner Exemption
current exemption for "homeowners was extended to include Owner - occupied Dwellings ofonc (1) or two(2) families
r,; to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner Acts
nn upervisor. CMR 780, Sixth Edition Section 108.3.5.1.
) cIi nit ion of Homeowner: Person (s) who own a parcel of land on which he/she resides or intends to reside, on which there
:s Jr is intended to be, a one or tw'o family dwelling, attached or detached structures accessory to such use and/ or farnl
nires. Verson who constructs more than one home in a two -year period shall nQt,be considered A homa4w r•
o,1:, h homeowner shall submit to the Building C)(licial, on a firm acceptable to the Building Offcial,thal belshe !hall be
rcponsible for all such work performed under the building permit.
;Acting Construction Supervisor your presence on the job site will he required from time to time, during and upon
,: , :npletion of the work.for which this permit is issued.
•\H,,) be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
,.,rnloyces for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be lilt* for persan(s)
ymi hire to perform work for you under this permit.
1'i),: 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 Sit nature _t1..'dt' .t-ace
t
,r
ct ;:r,,.
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House 1 1 1 Addition 1 Replacement Windows Alteration(s) n Roofing rVi
Or Doors L] •
t
Accessory Bldg, l ' ] Demolition 1 , New Signs [CI] Decks [(] Siding (DI Other (CI'
brie, of Proposed a ltaeheJ
Vork
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
l Plans Attached Roll - Sheet
6a. If New house and or addition to existing housing, complete the following:
a. Use of budding One Family Two Family Other
Number c rooms in each family unit: _ Number of Bathrooms
,.
0. Is there a garage attached? . • • ' •
d. Proposed Square footage of new construction. Dimensions
e. Numbe- d stories?
Method of heating? _ Fireplaces or Woodstoves Number of each
g. Energy anservation Compliance. Masscheck Energy Compliance form attached?
Type of construction
Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
;. Depth oft 3sement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
Septic Tank City Sewer • Private well City water Supply
I -
SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
, as Owner of the subject
property y,
hereby authori ; :e aY j( ^� el i Sl e, o f I ] Q
• c. I . RDOfir
l
;o act on my behalf, in all matters r ative to work authorized by thisbutlding permit application.
'attgcrhe -I
Sig'natyte,of Owner Date
u ' t- • • • • ' , 0 as Owner / Authortzed
Agent hereby d•clare that the statements and information on the foregoing • .lication are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
SIL
Print Name
Sigriature'of Owner /Agent Date
Section 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
t,,,t Size ' , i I
Fi ontagc 1 ,
Si-thacks Front 1
i
Side 1,:' R: 1 R.
I
Rear L
B.tilding 1 eight t -�
13 Jg. Square Footage % i
(Then Space Footage
(l, arca minus bldg & paved ,
b _)f Parking Spaces ,
umc & Location) --
i
A Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued:!
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 .. DONT KNOW 0 YES 0
IF YES: enter Book Pagel ! and/or Document # l
13. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW C YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained O Date Issued: ( j
I )
C. Do any signs exist on the property? YES Q NO Q
IF YES, describe size, type and location: 1 `
D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO 0
IF YES, describe size, type and location:
E VVdI 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 r; ) NO 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
.wA,�' . £h i t �C� .� ♦ 1. . p:.
� 7700 YY' City of Northampton SiauV , 'V •
•
: uilding Department CurbC , ` •
161 466 212 Main Street Sewer • �'
.
�oNS Room 100 V ifeteW:i , ! „ ,,
LYt - • ,,
� • amptol� MA 01060 Tom` _r ��•.
.'• • one 413- 587 -1240 Fax 413- 587 -1272 PlotlShb b ■¢$644 r ' '.
{
Other Speck .; *, ±R r ”, n ' wI •••• .t`^
APP._ :CATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION -
This section to be completed by office
1.1 Property =.ddress:
t V 9o+.r' S O `5 e- Map Lot Unit
� \- t Zone Overlay District
Eim Si.. District CB Dlstrtct I
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
�o 0.1 9 0.nzr\ t )( C\-,aQMaYt 5 _ Grc- c4C‘C. S.
Name (Print) Current Mailing Address:
(9131 T14-1Sll
t.2 �� Telephone
Signature
2.2 Authorized Agent:
Ma 1 - .C.s. oaf' _ -. _
lT1Q e + •• ►e�
Name (Print) ) Current Malting • •dress: 0 1 Q ..;t3
� - ( 13) 521 4115
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION CQ$T$
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building )3 1„.1 1 flOo ` 0 (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of •
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5: Fire Protecnon
6. Total = (1 2 + 3 + 4 + 5) 4 I-'. 60Q.°0 Check Number `7 23 S
This Section For Official Use Only
t _
Date
*ding' Permit Number. Issued:
I
Signature:
Building Commissioner/Inspector of Buildings
Date
51 ��4 a
p':
10 PARSONS ST BP- 2012 -0192
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32A - 037 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit # BP- 2012 -0192
Project # JS- 2012- 000297
Est. Cost: $17000.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 74334
Lot Size(sq. ft.): 25787.52 Owner: PANZICA JOSEPH A JR & JOSEPH F & CHRISTOPHER & EDWARD &
MARYA
Zoning: URC(100)/ Applicant: RCI ROOFING
AT: 10 PARSONS ST
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527 -4775 Workers Compensation
SOUTHAMPTONMAO1073 ISSUED ON:8/24/2011 0:00:00
TO PERFORM THE FOLLOWING WORK: ST RI P & 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 8/24/2011 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner