29-496 040
wX .I. R fin
00 g, L LP
51B Holyoke Street
P.O.Box 309
Easthampton, MA 01027 Estimate Date
Phone (413)527-4775 5/5/2005
Fax (413)527-8469
Name/Address Job Location
Mike Szostak 581 Burts Pit Road
581 Burts Pit Road Florence, MA
Florence, MA 01062 Home: 582-0152
Work: 527-2330
Terms Rep
Estimate valid for 60 days Mike
Job Description Total
Remove existing roofs. 10,500.00
Furnish&install aluminum drip edge,pipe flashings and chimney flashings.
Furnish& install new lead counter flashings.
Furnish&install ice&water barrier along eaves and valleys.
Furnish and install 15 lb. felt over existing deck.
Furnish and install 30 year Tamko Heritage Series shingle. 5-0 �r qV tjh 1P7 �, 7�,rrp
Furnish and install Cor-A-Vent ridge vent. ✓
All roofing related debris to be removed by R.C.I. Roofing.
All work will 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 sq. ft. for wood replacement if needed.
Estimate includes larger of 2 sheds in back yard.
Remove corrugated panels and 2 skylights on shed and cover with 1/2"plywood.
Per >l�>Scu ti;o� 411fll /414- ' n,o r///A — — We It//// �e
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total .
TERMS OF PAYMENT ) 0—e)
30%Upon delivery of materials
70%Upon completion Customer Signature
Registration# 126235 Ww
Construction License#074334 Date
Insured by Hackworth Insurance(413)527-9907
O�CttAH P,- -
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8 e �,��:,zrhtrfrtt.'
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
i - 7DA-sle of Roofina
with a principal plac.e of business/residence at:
5_ A4 (phone# ���
street/ ty/statdap)
do�he-cby certify, under the pains and penalties of perjury, that:
(V) I am an employer providing the following worker's compensation coverage for my
employees worEng on this job:
eci kertN, Mutual meta ls-317t24-oH 1015105
C=1 &ancc Company) (Policy Number) (E4ira on Date)
( ) I = a sole proprietor, general contractor or homeowner (circle one) and have hued
the co,itractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance CompanyRolicy Numer) (Expiration Date)
('.dame of Contractor) (Insurance Company/policy Number) (Expiration Date)
(Name of Contractor) (Insurance CompaaylPolicy Number) (Expiration Date)
(Tame of Contractor) (Insurance Company/Poticy Number) (Expiration Date)
(attach sheet ifnaocuary to inCWC information pcitainiug to all oocrtnn rs)
f
( ) I am a sole proprietor and have no one working for me.
( ) Z am a home owner performing all the work myself.
NOTE:ptcaac be aware thai whilo homcowoer3 wbo cmplay pasom to do aminicn=•r construction or rspaa work on a dwcQing of
not moss than throo units in which the homeowner resida oc oa the grounds q irkawA the eto arc not gataally oomidered to be
employr:s under the wort&s.00mpcas4oa Act(GL152,ts 1(5))�application by s homeowner for a bccase a permit may evidcnoe the
lasl ctnau of an acxployec under the workoes Compomation Act_
I undcratand that a copy of this et-cmmt may be foewordnd to tbo Dcpertmnnd of Industrial Attiden&OlLoo of lnauanoe f".
oovcr-a'o Verificarioo and that failure to secure coverage under scwoa 25A of MGL 152 can lead to&4osition of uiminst Pia
oomistiug of a fine of up to S 1,500.00=Vor ia� of lip to ox ytv end avta pemtWes in the form of a Stop Work Order and fa "
firm of S100.00 a day tgpinst ma
EMa:p# use caly
Number
Lot#
Y Sig nature of Liccnsee/permittm-
` 'r
44 •
SECTION 8'-.CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : a e '�S 717 43 3
License Number
5 - r 027 5 - 63 - Ob
Address 1r�_^/ �� •/ Expiration Date
Signature Telephone
R°"" r m'" i'rn r"""vemen "n r Not Applicable ❑
R-0. 1 R oof n l 2.b 2.35
Com any Name Registration Number
51 9 x 3oq 5- Ob -
Address J Expiration Date
Telephon ?jr
SECTION 10—WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.GL. 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...... ❑
• o RZ. e� x
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 a.t.t.ae60-
J-6
SECTION 5- DESCRIRTIONaOF PR6POSED WORKV°(che'ck all apalicab1_0
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❑ Renovating unfinished basement Yes No
Plans Attached Roll 0 - Sheet❑
"""" and addition to ezistin housing, corrmple a th _36t1offl
sa.`If Newhouse=
a. Use of building : One Family Two Family Other
b. Number of rcoms in each farnily 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-OWNEWAUTHORIZATION''-TO BECOMPLETED WHEN
OWNERS AGENT,'OR°CONTRACTOR APPLIES FOR BUILDING PERMIT
I, LMiA 52CX5tA as Owner of the subject property
hereby authorize 'Mark Del slP C7 R-0.1, Rno ind to act on
my behalf, in all pmatters relative to work authorized by this building permit application.
a AVC�, A O-2q—()JS
Signature of Owner Date
F ellC aS nY 17.e� AQ ent- as Owner/Authorized Agent
by declare that the statements and information on the foregoin application are true and accurate, to the best of my
wledge and belief.
Signed under the pains and penalties of perjury.
P-h sl e-
Print Name
Signature of Owner/Agent Date
Section 4.
ALL INFORMATION MIDST 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 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:
City'of Northampton
Building Department
212 Main Street
Room 100
''Northampton, MA 01060 _
phone 413-.$87.1240 Fax 413.587-1272 R Slt
APPLICATION-TaCONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SE TION 1 -SITE INFORMATION
ax
1. Property Address
°°
Zorie Overlay�bistr ctr �
EImSt. District . CB Dist'rict
SE TION 2 - PROPERTY OWNERSHIP/AUTHORIZEDrrAGENT
2.1 Owner of Record:
5%1 BUMP.t Rd - VloreneA
Na e(Print) Currer�Mig Ad`-'r`.��
Telephone
Sig ature
2.2 Authorized Agent:
P.U. x_ oq - East araptb n_ Ma
Na e(Print) 01 Current Mailing Address: 010217
Sig ature Telephone
SE 60N 3 ESTIMATED CONSTRUCTION COSTS
Ite Estimated Cost(Dollars) to be Official Use Only
completed by ermit applicant
1. Building RoOfi n t !, �5��a� (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
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 I'
'AMTS Prr RD .,......r BP-2006-0227
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29-496 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-0227
Project# JS-2006-0332
Est.Cost: $11250.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Groin RCI ROOFING 126235
Lot Size(sq.A.): 30012.84 Owner: SZOSTAK MICHAEL P&MARGARET J
Zoning: SR Applicant: RCI ROOFING
AT. 581 BURTS PIT RD
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTONMA01027-0309 ISSUED ON.813112005 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 8/31/2005 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo