23D-002 (8) ROPOSED ►VOR` ch� Ian licao e)
tall() iC-AD
ter. T m
ogior > sA ,4 . nneh i-fa'iY:W ,z - sue.:'' i.` 'rarag:
. 7,,Y 't:'44:;tr., ; 4;„4? ,:;z;,.n.i, ..;..SAX'. r-'r ,; 4.,� n"-°�,,,..u' 1�'C,,�,
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other[ ]
Brief Description of Proposed Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative U Renovating unfinished basement Yes No
Plans Attached Roll U - Sheet U
:SKIfINEWled - •Ultion io a fit ng ho sing cc°i a le e he a rdWiW :
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`AUTHORIZATION -,TO BE COMPLETED WHEN
OWNERS AGENT.OR:CONTRACTORAPPLIES FOR BUILDING PERMIT
, as Owner of the subject property
hereby authorize to act on
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I �U K LA— C r c-c6 , as Owner/'u orized A•e.'
hereby declare that the statements and information on the foregoing application are true and accurate, to the se . - y
knowledge and belief.
Signed under the pains and penalties of perjury.
Print Name
/
Sig..- ore of Owner Date
SEgr O j G 3I 14-11FlQN SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: e%IA/ p2(3 G fT CS 0>k a;,'" ?
License Number
S6 0i , cG,l< -sl ! Peel/ /OA d - c c • Cry
Address p Expiration Date
Sig i0;e V Telephone
' mYciY 1 �wW ntiu e ws,. ,,.� . ; .. - i Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
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 ❑ No ❑
tl.orift'
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
4�t pTO _
�1'rti• i(Y Blxiaxcifsactta _! ,_
It Z.;We-SO DEPARTMENT OF BUILDING INSPECTIONS ^: { 1
' 212 Main Street • Municipal Building y� ��� '
Northampton, Mass. 01060 r
WORKER'S COMPENSATION INSURANCE: AFFIDAVIT
(licensee/permittee)
with a principal place of business/residence at:
�S CQ 000 -/c S1 G e--v.....A._s .A.41.5- e)to..s' (phone#)—1-74.7/i-.
(streeticity/statelap)
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:
- (Insi auce 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)
If
(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)
(attach additionst thect ifnecessary to include information pertaining to all contractors)
f>4Iam a sole proprietor and have no one w
— orking for me.
( ) I am a home owner performing all the work myself.
•
NOTE:please be aware that while homeowners who esnplay persons to do era int;inn,construction or repair work on a dwelling of
not more than throe unite in which the homoowner resides or oa the grounds appurtenant thereto are oat generally considered to be
employers under the worker's compensation Act(GL152,ss1(5)),application by a homeowner for a license or permit may evidence the
legal status of an employer under the Worker's Compensation Act_
I understand that a copy of this statement may be forwarded to the Departm=2 of Industrial Ac idmti Ofoo of Iuwrsnoe for the
coverage vaificatioo sad that failure to axon coverage under section 25A of MOIL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to S1,500.00 and/or impri onmcai of up to one year and civil penalties is the form of a Stop Work Order and a
firm of 3100.00 a day against me.
For departmental use only
1 I, r permit Number
/ Ji..4iSt:>. --- Malt ,Lot#
' '•s of Licrosee/Permittee Cate
:
Lj
‘)D [
- L
JAN 2 8 2002 U .
1. $
()CPT
flrrs
k4.‘
A 1 • )1.0
'11 (11
'11 I 441 41' 1 ( /if
1'1 if 14 11.
•
•
43 NONOTUCK ST BP-2002-0898
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23D-002 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2002-0898
Project# JS-2002-1470
Est. Cost: $2500.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 074334
Lot Size(sq ft.): 36938.88 Owner: HARDING MARY JACKSON
Zoning:URB Applicant: RCI ROOFING
AT: 43 NONOTUCK ST
Applicant Address: Phone: Insurance:
P 0 BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTONMA01027-0309 ISSUED ON:4/18/02 0:00:00
TO PERFORM THE FOLLOWING WORK:STR I P, PLY & 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 4/18/02 0:00:00 522 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
•
Versionl.7 Commercial Building Permit May 15,2000
EJmck.: ,,,yass's c:,za.., coil,
y-.e€#Rrthampton -- -it, ,s t,
i ![; f,,-..,n j';, i 1i` BId) [department 0� �r.�,� u rE, E .Q,
i;1.r' r---— -- — __-�_. __ 222 I�in Street ��.„( 3..1�, ,_ ; , ,i��� ,,„
1',i I. Ro 'rfn 106 m,g � , ,�, �a,w b,('h
fi� Northarn, •n, MA 01060 �,yzo . , , „,la: a,„r,,aur a”, >,,.1.' _
phone 413.587.12,.0 Fax 413.587-1272 v4546�i yqv1* :" =- - '
I ke.-ioct`wr ."0,-Pi€ d
APPLI ATION TO CONSTRUCT;• - • -, •ENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
•
SF ON . S T IIIr F R O 0 ,,7,:,,„"''n`
1.1 Property Address: r= , �,
Li - 5 r
x za x.,
6 ,�k a• tg T SEC 1QN 2 P ROPER 'Y 0 HIIUTQ �
2.1 Owner of Record:
{710,C• i.44' ( c , r ) t/ 3 rico0 1VCK
Name(Print Current Mailing Address:
c.,, /007
. Signature Telephone
2.2 Authorized Agent: •
C\1\ —0 i',\k S\ 9c) cil_ o 30c) - esi_Sr,A \n, rte•
Name(Print) Current Mailing Address:
(k-i
k 3) Sz`1 - 4115
Signature
Tphone
-, r F' ° t £ ;,i'' , ,;s„ .. � -.43"
SECTION r3' EST�Tt Q S I9,` ® a 1 �'�'
z. . 'v,m.<�,. ui,� c'�°F�7a
h rP n � t T
Item Estimated •Cost(Dollars)to be , . ,,rt ,. ,, •, • e � a� ®�� ,`. �� j
completed by permit applicant ,f: ; �. '-4 !rte " 4 ;9 �`
1. Building (a) B,g141 Perr7. r,i rF
;
v ';r i '4, r xex iiik .
g.
2. Electrical 77 „ .
(�)Etr17aed o a $ f m
Contruction frc6), ;04, a , roo '�,
=,-
� ldgct` �3. Plumbing Bui int rmve � , `' 3 T A x , i
a
4. Mechanical (HVAC) A
5. Fire Protection .� �� �'��
, �j ,,y f oo y ,�te
x 'kt k 'f i dk a ;n�'� , � ri d
6. Total (1 + 2 + 3 +4+ 5) v 5� �C4 Umera p" � ,41 �°„
,
t-n a. & i t oor.0ffc U - on.`� r 4� i'1`.'>r ,,; ,T, , qz, , SM x , a kola I' =ice a
1 Y i< N Qs 1 97 7 '— F 7 � i 7 4 c or � # f" A
sy
.g x , ,zg v `e'" ._ '�^'�.,�' :.,K„�r..� "� ✓ '3':, �
.. 'w r .t t �' ? ? �� w- ,�� "" �s�sm �,�.,. ue.
:
44 a 7 " 51 § » v.gx%3� r � ,..t.1,,,f3;14,:: r 1t�
pS� � nn � � ' � a " ,,
�
si 4669 k - :. y6 y � -� � tr Y i%,,,,., 41 o� �
Version!.?Commercial Building Permit May 15,2000
4 a v'S 7l^r k", d ,,—IT ; wq g .,„ . -7;7-7
Interior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing L
❑ ❑
Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ]
❑ Accessory Building[ ] Repairs
[ ]
JV� 'e,T--P7�' ' '� Iczc J✓e f amj(j ) yC�
„ ` t s ,- A}e$s s•l+, ri - ---7=7' sg"r
E S,C TlO 000. gyp, ® ® I� t ,
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly I❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ 1.1 ❑ 1.2 ❑ 1.3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R.2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S.2 ❑ 5B ❑
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
S Special Use yy❑ Specify:
'! y �APhw th y. :TAO'' i$y f4 -.:W,,,, ,:',,".. .E .'114.7=',- A 3 { 3
i,' pO^44 ET- .._ xz. �, It EX ,„ ROIING1RW CIO hD, ITI® e ` ,T �G 44 ,&E
{
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECT10 #6 BlItaNp p G°f 1 . 0 . £ -
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION $` u,,-, .. c''_ `' :
Floor Area per Floor(sf) 1St
}�,F �
1st 2nd �,
3rd
2nd Ti
3rd 4th
4th
Total Area (sf) Total Proposed New Construction (sf) s "
Total Height(ft) —
Total Height ft [[
P f�e,
Version1.7 Commercial Building Permit May 15,2000
7. Water Supply(M.G.L.c.40, §54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ 1 Zone: Outside Flood Zone ❑ 1 Municipal ❑ On site disposal system ❑
8. NORTHAMPTON ZONING
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 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:
Version1.7 Commercial Building Permit May 15,2000
. k°°,0( ® R if ". . ° .:1007(*)1. ®). ' 0 1. , y�i4 F 1 -
9.1 Registered Architect:
Not Applicable ❑
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
92 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
Not Applicable ❑
Company Name:
Responsible In Charge of Construction
Address
Signature Telephone
Versionl.7 Commercial Building Permit May 15,2000
�a� �
SEC ,0 w6' �� � � ®
Independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑
•
SEC 0 °_.� ® ' �" ° � ®W ®J� D 711
,s e : 77,7 .,,. ',7'7—;7:;4r7;;7--,,/--,/,.---7-,.. r6 �'' P w" m� � i`" 4° .,;'.r' 3, .:z,,,,
I, , as Owner of the subject property
hereby authorize to act on
my behalf, in all matters relative to work authorized by this building permit application.
•
Si nat of w Date
I, C \ E 12,ot> `n , as Owner/Authorized Agent
hereby declare that the statements and information on the foregoing applicatio. re true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
Print Name
Signature of Owner/Agent Date
SECy!, 1,12 ° Ct
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:nlo�C'VN -0 01 H
License Number
�i • '11 ' `oLk • a_ _ . _ ._ _.. 1. . • 5— 03 — 0 Z
Address Expiration Date
_
LIB l5
Signature Telephone
` 'SECINi3 , O a C® S Ci ID:AV174M G g
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 ❑
,o,„ tS '
O4SttAMP,.O �
s Oil
Oi x� i if Nox#ITainp f Qf 1 =*°V
�rt: `... �6 lxsaxdlnactta =_*'
r•,�s_ DEPARTMENT OF BUILDING INSPECTIONS •
;tit!
-
212 Main Street • Municipal Building
Northampton, Mass. 01060 am'
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, 'C'(\0.--CV \_) � \Z " C1+ . 1 , \06C\
(licenser/pennittee)
with a principal place of business/residence at:
•
440 CYIa►Y1ce . •_ •.i.‘.. , •• - . ..' (6- .hone#X.M),5Z1-41.
(.a -. city/stateJap)
do hereby certify, under the pains and penalties of perjury, that:
( am an employer providing the following worker's compensation coverage for my
employees working on this job:
\; \ '�rw. LC \ )CA-31 S •31112.�I•011 10-5-07„
�ce 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:
rr
'. '
q: (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 Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additioenl:beet ifneecssuy to include information pertaining to all=tractors)
( ) 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 wails homeowners who employ persons to do..•..m= ,construction or repair work on a dwelling of
not mo c than three units in which the homeowner resides or co the grounds appurtenant thereto arc not Generally considered to be
employers under the worker's compensation Act(GL152,1s l(5)),application by a homeowner for a license or permit may evidence the
legal its of as employs under the Worker's Compensation Ad.
I understand that a copy of this statcmast may bo forwarded to the Department of Industrial Aocideaer Office of Ineurmoe for the
coverage verification and that failure to secure coverugo under section 25A of MOL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to S 1,500.00 and/or itnp isoament of up to one year and civil penalties in the form of a Stop Work Order and a
fine 0(5100.00 a day against tux.
For dgsartma>ta1 use Daly
/`/ Permit Number
tvfapd{ Lot#
z Signature of Lea-nscrmPrm;nrr Late
•
• R.CI . Roofing
40 Maine Ave.
Po Box 309 ESTIMATE
Easthampton, MA. 01027-0309
PHONE(413) 527-4775
FAX (413) 527-8469 Date: JAN 18 02
Estimate To:
MR MRS MICK Estimated By: CHRIS THOMPSON
54 WASHINGTON ST Start Date:
NORTHAMPTON,MA 01060 Job Location: NORTHAMPTON
Job Phone: 413 585 9741
JOB DESCRIPTION
REMOVE EXISTING SLATE AND WOOD SHAKES.
FURNISH AND INSTALL 1\2"PLYWOOD.IN THE FRONT SECTION OF HOUSE.
FURNISH AND INSTALL 151b ROOFING FELT.
FURNISH AND INSTAL,T, ICE & WATER BARRIER ALONG EAVES.
FURNISH AND INSTALL ALUMINUM EDGE METALS AND ALL RELATED FLASHING.
FURNISH AND INSTALL 30YR TAMKO SHINGLE.
FURNISH AND INSTALL CORA RIDGE VENT.
ALL ROOFING DEBRIS TO BE REMOVED BY RCI ROOFING.
PROVIDE 5 YEAR RCI WORKN$NSHTP WARRANTY
PROVIDE 30 YEAR MANUFACTURERS WARRANTY.
ALL WORK WILL BE PERFORMED IN ACCORDANCE WITH MANUFACTURERS SPECIFICATIONS.
PERMIT INCLUDED.
SPECIAL ITEMS NEEDED
Additional information pertainin. to this Job Estimate
TERMS OF PAYMENT
30%PRIOR TO START Total Estimated
70%UPON COMPLETION Job Cost $5,300.00
CONSTRUCTION LICENSE#074334
FEDERAL I.D#3418839 Authorized
REGISTRATION#126235 Signature
INSURED BY HACKWORTH&LAPLANTE 527 9907
ORIGINAL-ESTIMATOR COPY
p\etiS-e
tve1