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24D-158 SIEGFRIED PORTH A R C H I T E C T A.I.A. 116 PLEASANT ST. SUITE 331 EASTHAMPTON , MA 01027 PHONE: 413- 529 -9434 12/19/12 TO: CHARLES MILLER NORTHAMPTON BUILDING DEPARTMENT 212 MAIN ST. NORTHAMPTON, MA 01060 I SIEGFRIED PORTH ARCHITECT REQUEST THAT YOU GRANT A MODIFICATION TO WAIVE THE REQUIREMENT FOR CONTROLLED CONSTRUCTION FOR THE PROJECT LOCATED AT 154 KING ST. NORTHAMPTON, MA. BECAUSE THE WORK IS OF A MINOR NATURE, AND WILL NOT AFFECT HEALTH, ACCESSIBILITY, LIFE SAFETY, OR ANY STRUCTURAL ELEMENTS. ARCy / T � �C? ((oeDP09FCC ANK Y�•� ///' • �� y - I O NOR MA �� 44'4 TH Of 0 RC.I. Roofing 6 Line St. Estimate Date Southampton, Ma. 01073 12/11/2012 Phone (413) 527 -4775 Fax (413) 527 - 8469 Name / Address Job Location Bill Canon 154 King St. 26 Ashley Circle Northampton, MA 010650 Easthampton, MA 01027 (413) 527 -6535 Terms Rep Estimate valid for 30 days Chris Description Total Furnish and install 1/2" pressure treated wood nailer over existing roof. 3,500.00 Furnish and install 1/2" fiberboard insulation, mechanically fastened. Furnish and install .060 TPO roof system, mechanically fastened. Furnish and install .032 aluminum edge metal. Furnish and install all related flashings. All work to be performed according to manufacturers' specifications. All exterior roofing related debris to be removed by R.C.I. Roofing. 5 -year R.C.I. workmanship warranty included. All related permits will be obtained by R.C.I. Roofing. WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total $3,500.00 TERMS OF PAYMENT 5% Deposit Balance upon completion Customer Signatur eI�'r...�.,r Registration # 126235 Construction License # 074334 Date ¶V t2- 120°6 Insured by Banas & Fickert Ins. (413) 527-2700 The Commonwealth of Massachusetts Department of Industrial Accidents trial 1 Office of Investigations � °e 600 Washington Street _.. 4 ° - �� i = • Boston, MA 02111 www.mass.aov/dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): R c?„ ov�, nok Address: ( L, r. \-° City /State /Zip: ,c \, rya. o1 3 Phone #: ( /3) 5 ?'1 - ( 41'15 Are you an employer? Check the appropriate box: Type of project (required): 1. ©I am a employer with 2,0 4. ❑ I am a general contractor and I 6 n New construction employees (full and/or part- time).* have hired the sub - contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. t 7 ❑ Remodeling ship and have no employees These sub - contractors have 8. 7 Demolition working for me in any capacity. workers' comp. insurance. 9. u Building addition [No workers' comp. insurance 5. U We area corporation and its required.] officers have exercised their 10.7 Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL 11.7 Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12.[rRoof repairs insurance required.] t employees. [No workers' 13.1 Other comp. insurance required.] Any applicant that checks box X11 must also fill out the section below showing their workers' compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers' comp. policy information. f am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. [ nsurance Company Name: 4 - \ `„ er n Cam, , Policy # or Self -ins. Lic. #: \ 0(..s 05 Expiration Date: 1 U 5. 1 3 Job Site Address: / 5 (.( n Sr - City /State /Zip:/\ o L A. J ;. c? 10(o c Attach a copy of the workers' cpensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: - Date: 11 13 - Phone #: C 1 l3 41 `( 5 • Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): • 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: pp po Not Applicable ❑ Name of License Holder : Kay 1 h De i s 1 e. J ( I 334 License Number 51 Hol St.- Easth ton Ma. o lox/ 5 - 03-1 4 + Expiration Date 041 52'- L1r ?5 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ ft e ;n 9 126235 Company Name Registration Number 51 a Nolyoke Street_ - P. D. ax 309 5- Address Expiration Date Eas tharn pThn Ma. o o al TelephonEen 3)527.4775 SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. G. 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 (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 attached • • SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing al Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [El] Decks [E] Siding [❑] Other [p] Brief Description of Proposed a� CarhPr1 Work: L 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, -J ∎ \\ C t1 , as Owner of the subject property ( ! hereby authorize �l ayk Del; sl e o€ • C. I . Roofi n to act on my behalf, in all matters relative to work authorized by this b uilding permit application. at,taehed J - (3 I Signature of Owner Date J4 k TeL ► st e. a au h i lea a f l , as Owner /Authorized Agent hereby declare that the statements and information on the foregoing alication are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Clark I i•e Print Name Signature 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 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 & Lpcation) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW Q 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 Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained (.2) Obtained , 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 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: Building Department Curb Cut /Driveway Permit 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans . phone 413- 587 -1240 Fax 413- 587 -1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMO O FAMILY DWELLING SECTION 1 - SITE INFORMATION C ✓� � d t 1.1 Proper Address: � y This section to be completed by office 154 I� t n S _ Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Name (Print) Curr nt Mailing Addresij: attaehed ine 57- 1 -(0.53s Tel Signature 2.2 Authorized Agent: .Malik i)e. . le, - q.C.z. am tan ,Ma. Name (Print) Current Mailing Address: p 01013 ('4 13) 5 - 175 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building ft 'j 00Fi 4 3,5 C © Vic, (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) �' n5 5. Fire Protection V 6. Total = (1 + 2 + 3 + 4 + 5) $ ��� G0 Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner /Inspector of Buildings Date Northampton, MA Property Detail Page 1 of 2 City of Northampton, MA: Commercial Property Record Cal New Search Property Type Classification Code Reference Card 1 of 1 Parcel - Location - Zoning - Assessment Map -Block -Lot: 24D -158 -001 Zoning: Assessment: Location: 154 KING ST Neigborhood: 303 Land: 198,40 #Living Units: 3 Deed Book: 7403 Building: 118,80 Class: C -013 Deed Page: 345 Total: 317,20 Building Information Building Sketch 13 18 Bldg #: 1 20 12 Year Built: 1870 # of Units: 3 23 -6("ARS 4 Quality Grade: C 5 # Efficiencies: 0 FA /2sFR /PB 4 # 1- Bedroom: 2 19 22 7 18 # 2- Bedroom: 1 # 3- Bedroom: 0 15 15 18 18 1 Covered Parking: 0 21 scB 30 Uncovered Parking: 0 4 19 4 19 Total Unadj RCN: 131,250 14 6 OP 1sCB Total Unadj RCNLD: 160,220 4B 12 Grade Factor: 1 26 # Ident Units: 1 Func/Econ Factor: .75 Detail Information: RNCLD: 120,170 Levels Use Ext Walls Heat AC % Good Un, Attached Improvements - B1 91 Hot Air 0 Type Meas -1 Meas -2 Meas -3 # Units - 01 84 Frame Hot Air 0 RP5 48 0 1 1 - 02 11 Frame Hot Air 0 SF2 26 0 1 1 - Al 11 Frame Hot Air 0 - 01 34 Brk/Conc Blk Hot Air 0 - 01 84 I Conc. Block Hot Air 0 Land Data Outbuilding Info http:// www. northamptonassessor .us /noho /commdetail.php ?map_no= 24D -15 8 -001 &page... 12/17/2012 File # BP- 2013 -0657 APPLICANT /CONTACT PERSON RCI ROOFING ADDRESS/PHONE 6 LINE ST SOUTHAMPTON (413) 527 -4775 PROPERTY LOCATION 154 KING ST MAP 24D PARCEL 158 001 ZONE HB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out "2 -" Fee Paid ./g&,3 J Typeof Construction: INSTALL NEW ROOF SYS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 74334 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ON PRESENTED: pproved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND /OR Special Permit With Site Plan Major Project: Site Plan AND /OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management je olition Delay ..0 0.°°°" ' /,‘..'--/ Sig • re o tuilding Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning & Development for more information. 154 KING ST BP- 2013 -0657 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24D - 158 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- 2013 -0657 Project # JS- 2013 - 001083 Est. Cost: $3500.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 74334 Lot Size(sq. ft.): 4835.16 Owner: CANON GAIL M Zoning: HB(100)/ Applicant: RCI ROOFING AT: 154 KING ST Applicant Address: Phone: Insurance: 6 LINE ST (413) 527 -4775 Workers Compensation SOUTHAMPTONMA01073 ISSUED ON:12/27/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL NEW 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 12/27/2012 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner