37-011 Jul 15 02 12:59p James McElroy 626 285 -9844 p.
07/23, 11: 11 413- 527 -369 PC1 PO0FING PAGE 02
R.C.I ROOFING
40 MAINE AVE.
P.O. BOX 309
EASTHAMPTON, MA 01027 -0309 ESTIMATE
PHONE (413)527- 4775
FAX (413)527409
De : JULY 23, 2002
EEtInvwt. To:
JAMES NCELAOX pejrnoied Ely: NARK D °L7SL.
629 FLORENCE RD. rt Dam:
C7YIRTHAMF TUN, H11 . 01060 Job LarAtion: 629 PLCRENCE A
NORTHAMPTON, HA. 01060
Job Phon4: 913 397 -9725 FAX M 347 -9
. DESCR?FPI7ON ;
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30 YE5 R..,T J° 1/.^F. r 0P.R3jijY I1 rr.6' ...._ �......
SPECIAL irElIPS NEEDED ' ' '' , 1' v. n "
AID $2.00 PER FT. FOR M7OD REPLR`£MENT IF NEEDED
—
Aok ci:o
iVanri intratien oerirniny to this Jab Estir�as r :; ;n ,, ' , e , ,, ?,ti , '
TERMS OF PAYMENT
304. PRIOR To s rANt Tot+rf Eamimmbd
70'4 uACA+COMPLETION Job Cost j3 200.00
REOl4TRA' i i act39 -
FEDERAL I. D.404 34 MN Auto/Led
CO*:4 LICENSE i 074734 Slgnrlunr , /,'
POVRA0 !Et HACeSWORTH INSIRANCC {+131 527.9407 • :., -—
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BrU'�� ► (( sl`B assachusetta' _
' .. ...,_47A1 DEPARTMENT OF BUILDIT(G INSPECTIONS d i °=:°!i
212 Main Street • Municipal Building
Northampton, Mass. 01060 `"‘
'ORDER'S COMPENSATION INSURANCE AFFIDAVIT
(li censee/permi tree)
with a principal place of business/residence at:
t '
q 0 YY1 c o sc QV f..- E -h Yea, . Oloz_lhone #) 41/3 -s - -f 7 75
(street/city/slate/zip)
do 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:
\- .%\nt-L v,,1- ` 'W C`5. - 3(5.3. I l Z9 • o I I /0'5'07,
Company) (Policy Number) (Expiration Date)
( ) I 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)
r .
(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)
(much additional surest if necmary to include infoemstion pertaining to all contractor,)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE: please be aware that while homeowner who employ persons to do maintenance, wremuaioo or repair work on a dwelling of
not mat than three units in which the homeowner resides or on the grounds appurtenant thereto are not filly considered to be
employers under the worker's carqxassation Act (GL152,a3 l (5)), application by • homeowner for a lieeme a permit may evidence the
legal state of an employer under the Worker's Compeaaation Act
I understand that a copy of this statement may be forwards-4.10 the Department of Industrial Aecidmi? Oflioo of Imurs000 for the
coverage vmficatioa and that failure to satire coverage twvi-r section 25A of MOL 152 cm lead to the imposition of crimia4 penalties , .
consisting of a fine 'of up to 51, 500.00 and/or imprisoaascnt of up to one year and civil penalties in the form of a Stop Work. Order and a
fine of S (00.00 a day against me.
For dial use only
Permit Number
Maps! Lot # .
� S of Liccnsee/Pcrm.ittce Late .
t.
SECT O „B uNbjTRUCTION SERVICES
8.1 Licensed Construction Supervisor: � ` Not Applicable ❑ t
Name of License Holder : V\ 0.f 01 33 1 `"1
License Number
-4 . C � � .1 5 3 • o
Address , Expiration Date
r X 3 - 521 - 4 -11 - 75
Signature Telephone
Klink�7i a1iiYit :�7fiti7l Not Applicable ❑
Co mp�\ <� / 2, �� �� s1 � 1 2. 35'
_ - ame Registration Number
R P \ ce (\t - -0y
Address Expiration Date
L /0 1114ir dl L GLV 1 1 - On Telephone 9/3 - 527 -Li 775
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 .la No ❑
The current exemption for "homeowners" was extended to include Owner - occupied Dwellines 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
s.'4•� }l+n ir •r .. G"a' , >
.11i P EDi c • al a I;
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f or ' • ® _ , �� bl
+43!!rY'AlA 'R
.. > RY. NF"/^."FA^T^" ^ " _NM1II!: hrl4Mn. WSIkNt -.' IVY -. v:'u" 4 .s...l
'm :: ,.. .... 'A¢::!AS'J'fn!.TF O' G . .'
' : ^: :y:' ul"sz44 `asp? "g r : 3L i . sa tsY ;g4;.'^ s 444 w '
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Igc
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ]
Brief Description of Proposed Work: Ki✓),4AAV?:. E< 1 Cbc.C- €t 'S - n\ ?—
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attached Roll 0 Sheet 0
WittiaellatiOiThWata 'it to igt "rn h Burn ,cant ret' t "Mil 0" ii`r§:
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 AUTH 'TO BE COMPLETED WHEN
OWNERS ' AGENT;ORLCQNTJACTOR APPLIES FOR BUILDING PERMIT
---
I, 0 �\ , as Owner of the subject property
hereby authorize \O \( E� �S� `C -- r'1 0 to act on
my behalf, in all matters relative to work authorized by this building permit application.
1 - z9 - oz
Signature of Owner Date
I, MaKA , I C� Z, - (. e_71- ikrr) s. +'� , as Owrrer /Authorized Agent
hereby declare that the statements and information on the foregoing app i tion are true and accurate, to thetest of my
knowledge and belief.
Signed under the pains and penalties of perjury.
'CY1
ac ■ sc_ C Z- Co o C k
Print Name
v
Signature of Owfter /Agent Date
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 vo
(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:
•//
//l
J � P
IC � r (:, L' \ ,' i ... _ i ty of Northampton •1 ref #i ^ �lt�
r
u Department ®��)�� 1
�,
PUG �, 212 ilding Main Street r`" �'��?h,iIittP�
L PUG 2 ; 2002 " I Room 100 - l, f ) � )tli
��� �� � - I a ar
i _ No thampton, MA 01060 Y o ,gi of . frkm a r ft
DEPT OF BULD NC INS b3Ne 413 587.1240 Fax 413 - 587.1272 wA -� )7
NoRTH r,, Ya 010
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
—
SECTION 1- SITE IN
a °� i h sec . /:r� ' ' to C Qrtr
1.1 Property Address: o' • � . "
t o //� 1 may^ , a "" ` l ,, "'
ebb t s ' Y-ra , } 1'"p 3 e .ikit'�' a'
Elm St District °.a; 1' * , , 'i p �. i „Tt'
SECTION 2 PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: •
,-.1 o iv\9.. YA.C�CIA -C<za jq I O n -a-\`' k, -
Name (Print) Current Mailing Address
t x! G� , c _,. L.. d"\. &a •
Telep ( 13) 37,7 - 9`1 5
Signature
2.2 Authorized Agent:
Mo-f \< — Of — 1 xs:>___ga ,oboa
Nam (Pri " t) �f� Current Mailing Address:
� ( ) 521- ii ii5
Signature Telephone
SECTION 3 ESTIMATED CONSTRUCTION COSTS •
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building it3 O� 9� (a) Building Permit Fee
2. Electrical J (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
I 5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) Check Number
This Section For Official Use Only
Building Permit Number: - Date issued:
Signature:
Building Commissioner /Inspector of Buildings Date, .
.
BP-2003-0195
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:1314k: 31- o11 ° CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit # BP- 2003 -0195
Project# JS- 2003 -0356
Est. Cost: $3200.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sq. ft.): 27007.20 Owner: MCELROY JAMES
Zoning: SR Applicant: RCI ROOFING
AT: 629 FLORENCE RD
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527 -4775 Workers
Compensation
EASTHAMPTONMAO1027 -0309 ISSUED ON:8/27/02 0:00:00
TO PERFORM THE FOLLOWING WORK: ST R I 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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 8/27/02 0:00:00 3015 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo