23D-114 (4) •
RC. . Roofing, LLP
51B Holyoke Street
P.O. Box 309
Easthampton, MA 01027
Esti m a to • Date
Phone (413) 527 -4775 11/11/2005
Fax (413) 527 -8469
Name / Address Job Location
Elsa Vitols 216 Federal Street
216 Federal Street Florence, MA
Florence, MA 01062 584 -5669
Terms Rep
Estimate valid for 60 days Mike
Job Description Total
Estimate is for front of house only. (Side porch not included) 7,000.00
Remove existing roofs.
Furnish & install aluminum drip edge, pipe flashing and chimney flashing.
Furnish & install new lead counter flashings.
Furnish & install ice & water barrier along eaves and valleys.
Furnish & install 15 lb. felt over existing deck.
Furnish & install 30 year Tamko Heritage Series shingle.
Furnish & install Cor -A -Vent ridge vent.
Furnish & install Versico rubber roof system on flat roof section.
All 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.
30 year Tamko material warranty included.
All related permits will be obtained by R.C.I. Roofing.
SPECIAL ITEMS NEEDED
Add $2.50 per square foot for wood replacement if needed.
NOTE: Chimney should be repaired PRIOR to any roofing work.
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total $7,000.00
TERMS OF PAYMENT
30% Upon delivery of materials
70% Upon completion Customer Signature gar.■
Registration # 126235
Construction License # 074334
Insured by Hackworth Insurance (413) 527 -9907 Date
3 s� - dnt. iorpo ntt 9a6v !l -06-'
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`�' y DEPARTMENT OP BUILDING INSPECTIONS yl
. 212 Main Street • Municipal Building _ V
Northampton, Mass. 01060
WORKER'S COMI'ENSATTON TNSURANCE AFFIDAVIT
1 , _Jtark Tel of it.t2.I. koofinj
(li1)
with principal place of business/residence at:
51 0 t. Eastham fio .Ma. G►oa7 (phone#�j'113) 5 a7_ Jf ?75
,� ' $street/ /statehi
tY P)
do hereby certify, under the pains and penalties of perjury, that:
04 ). am an employer providing the following worker's compensation coverage for my
employees working on this job:
AmeiteanInt'1 Grnup 681bbID IO f 51Ob
(lnsu ancc Company) (Policy Number) (Expiration Date)
( ) 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) (I.nsurancc 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 Contractor) (Insurance Company/Policy Number) (Expiration Date)
(gnat addttioaal toot if necenary to include information pertaining to all cocdradors)
i
() 1 am a sole proprietor and have no one working forme.
( 1 am a home owner performing all the work myself.
NOTE: please be aware that while bomcowncn who employ person: to do aiamimiac , ooastructioa or repair work on a dwelling of
not more than throe unite in which the botneowna resides oc oa the grounds appurtenant thereto are not go:walty 000sidatd to be
cmployr s undo the woric,c's c x p:medica Ad (GL152f11 1(5)), application by a botnoowner for a license or permit may evidenoe the
1ega: cams or.. employer under tho Waite?' Compensation Act_
i understand that a copy of this =tamed may be forwarded to tho Departmcol of lndustrial Accidents' Moo of rasuraooa for t
covedgc verification and that failure to secure covetugo theca scrooa 25A of MQL 152 can kid to the imposition of aiming pensitios
(*ca of a EL= 'of up to 31,300,00 talcs' of tip to mu rased civil peratitla in the form of a Mot) Work Order the t
fit" of S 100.00 a day against tnc.
Far dcp>stmmtal V OOty .
P Number 0 :\
p Lot
t
Sipialnc of Lioarsee/Permittee L ate
,," ii ..
- Y
SECTION - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not '1'74334 Appplicable ❑
Name of License Holder : i aY f� e�.S
License Number
5] B � 1 ole. Street - fEastll a npton Na. ()loaf/ 5 -03- 012
Address Expiration Date
( 13) 5�.r1- X1775
Signature Telephone
li' 111.• ;;1;v=rn -ri .• , N
� "� � Applicable ❑
e. T. � oof\n 12,b 235
Com'ban Name J Registration Number
51 R }40lynl�. Street — P.O. Box 3()�' 5- Ob - 0b
Address M Expiration Date
asthampion Ma. 01027 Telephone(AIt3 5a7- ' u7-/rrtt 75
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 affid
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) familie
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner act!
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, tluring 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(
you hire to perform work for yoti 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 _ ai taeheel
S DESCRIPTION!OP PROPO ED applicable)
ise ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing V
Or Doors ❑
pry Bldg. ❑ Demolition❑ New Signs [ J Decks [ ] Siding [ ] Other [ ]
ascription of Proposed Work: att. aeh,
on of existing bedroom Yes No Adding new bedroom Yes No
ad Narrative 0 Renovating unfinished basement Yes No
4ttached Roll 0 - Sheet 0
ad "di tEM tcY&istin f slug, ;co MI5 Ibiatli `I`I
se of building : One Family Two Family Other
Dumber of rooms in each family unit: Number of Bathrooms
s there a garage attached?
Proposed Square footage of new construction. Dimensions
Number of stories?
Method of heating? Fireplaces or Woodstoves Number of each
Energy Conservation Compliance. Mascheck 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 of basement or cellar floor below finished grade
Will building conform to the Building and Zoning regulations? Yes No .
Septic Tank City Sewer Private well City water Supply
ECTION'7a - OWNER'AUTHORIZATION - TO BE COMPLETED WHEN
WNERS,AGENT "ORCONTRACTOR APPLIES FOR :!BUILDING PERMIT
E LS a VI �+ , as Owner of the subject property
{�
ereby authorize .. U lisle. o7 R•C.I. RO XI to act on
iy behalf, in all matters relative to work authorized by this building permit application.
attae \ieGI g - '1 — 0b
ignature of Owner Date
•
Mark ""')L el i sl e. as i t% on Z.e agent , as Owner /Authorized Agent
iereby declare that the statements and information on the foregoin application are true and accurate, to the best of my
:nowledge and belief.
>igned under the pains and penalties of perjury.
,MaY� eltste
'rint Name
Q -7 - 06
>ignature of Owner /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
(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 2 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:
+A.
City of Northampton€��
Building Department
212 Main Street , ?)0
Room 100 i ,( /9f :1i
Northampton, MA 01060��;�rt
phone 413 - 587.1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 SITE INFORMATION
*This sec i t
1.1 Property Address:
0716 Feder Al St
F 1 nYCI✓ Zone
Elm St. District CB D strict.. F.° r
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
F 1 sa Vi tol s ,216 Federal St.) Floren ce.
Name (Print) Current Mailing Address:
e 58 �'6bq
attach
Telephone
Signature
2.2 Authorized Agent:
N131 1/el isle. - R R. T. f{oo tn9 R o. t)ox 30 Easthampto Ma
Name (Print) Current Mailing Address: O'etari
(xliA) 523- itr/75
Sig ature Telephone
SECTION 3 ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
y� compplleted by permit applicant
1. Building Ro of i n9 `� / o00• oo (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 •
�.5�
6. Total = (1 +2 +3 +4 +5) 41 '7000.00 Check Number �- ° 6
This Section For Official Use On y
Building Permit Number: Date Issued:
Signature:
Building Commissioner /Inspector of Build Date
r
216 FEDERAL ST BP- 2006 -0791
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23D - 114 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit # BP- 2006 -0791
Project # JS- 2006 -1209
Est. Cost: $7000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sq. ft.): 15638.04 Owner: VITOLS ELSA C
Zoning: URB Applicant: RCI ROOFING
AT: 216 FEDERAL ST
Applicant Address: Phone: Insurance:
P 0 BOX 309 (413) 527 -4775
EASTHAMPTONMAO1027 - 0309 ISSUED ON:2/9/2006 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 2/9/2006 0:00:00 $25.008256
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo