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411 Maine Avenue Estimate
P.O. Box 309
Easthvnpton, MA 01027 Date
Phone(413)527-4775 8/18/2003
Fax(413) 527-8469
Name/Address Job Location
Carol Anderson 263 Ryan Road
X63 Ryan Road(4(-,3 ) Florence, MA
Florence, MA 01062 Phone: (413)586-5738
Terms Rep
Due on receipt Chris
Job Description Total
Remove existing roofs. 6,500.00
Furnish&install aluminum drip edge and all other related 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 shingle.
Furnish and install ridge vent.
Furnish and install soffitt vents in between rafters.
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.1. workmanship warranty included.
30 year Tamko material warranty included.
All related permits will be obtained by RC.I. Roofing.
SPECIAL ITEMS NEEDED
Add$2.00 per sq.ft. for wood replacement if needed.
Total $6,500.00
TERMS OF PAYMENT
30%Upon delivery of materials
70%Upon completion Customer Signature CD-AC -C, C.
Registration# 126235
Construction License#074334 Date
Insured by Hackworth Insurance(413)527-9907
i M
ORS t W-!PTO
Crif� ofirrfl1alll}ltoll -
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DEPARTMENT OP BUiL.D0\10 INSPECTION'S
212 Alain Street ' Municipal Building '
Northampton, Mass. 01060
«rOMa R'S COMPENSATION LNSUTUNCE A
L, —AaLL Tflis I c t?t),n Wo
vvlLh a prMcipal place of business/residence at:
jgioV-1ojliP- ./ 1`� , I .a:sMampf,on -MA 01j0Qq (Tho0e')k3) 7--q r
( caty/SUa IaP)
do hereby ccrufy, under Lhc pales and penalties o'L pcfJtv-y, ,hat
(� I am Wn employer providing the following \t,ork-&s comocnsz or) cove-ge ',or 11)y
eluplovccs worUng on'tllis jub.
v�c5-3IS= 3��la -o33 lo 0
Comr-=v) (Pobc-, Numbcr) (r:•pirruor Due)
O I am a sole proprietor, general contractor or homeowner (ci c;e nee) and have hired
the coon actors listed below cvbo hzve the foUo%vioQ worker's coo:)eju-aaon pc!icies:
(Name Of Co`?!^cwr) (In urancc Cojnp3 i)-/PoGc-,
(Name,of Contractor) (lns -ancc COMDan)'/POJCI• NLLMo-:r) (—Ex-D r lion Date)
(Name of COnn-aeto,-) (bas�rranc: ComrU)./Pol e)• Num r) (txDLr,000 Date)
01 amc of Contractor) (Insurance Comrany/Poucy Numbs) (Expifalioo Date) .
(nn --0=J dca if oca.-vry w c�cucc�nfo2a�oc perviiaias to..0
( ) I am a sole proprietor and bave no one wor4dog for me.
( ) I am.a home owner performing all the work myself.
NOTE:plcsc be cwlrC the ut.Jo bomco'-ocn tvbo ctaptoy pc-som w dU -• c=,--ac oo r rrpzir work ou.d�x-LL=g of
act mote tb-- L r---l!a in ussrh the bornoowocz read..of oc the zpputtcnx tbcc�e c.•c cot Cca.--=lly oecrd7cd to be
cmploy—uadc the wuiu's oc tine qa(GL152-=1(5)).appLintioo by a bommwoc fcr a bay^v or Penns rz:y C%ldm« he
Icgil naau or ea—;Royer uoder tbo Wockj et Cocapem,lion Aat-
I undQrt,.cd tho a copy of this catcmcat m.y tw forwwrd-d to the Dotwrtmcoa or lomuriJ Amd—&Mo.of If= one for Lb,
covcn.gc va-LGcsioo-ad that Ld ac to smut covciasc under soctioa 25 A of I.tOL 152 m Ic-d to the i:itioe of eiminal pcosltics
oocaising of a Gnc of up to 51-500.00 and/or imprisoc� of up to ooc ycsr Lod civt1 pm.ruo in t5c form of a Stop Worti Ordcr and.
ftm
0(S 100.00 s dsy Lpl=me
For dc9.rtm= u. o,Jy .
Permit Numbcl
Lot
SiC,naaur,of LiccnScc Pcrrriucc J
SECTION 8 nCONSTRUCTION S,ERYICES
8.1 Licensed Construction Supervisor: Not Applicable ❑ c
Name of License Holder : IoMaff- 1�elisle, q7'1/ 33 JT
License Number
-qo - Roslb ahnn. Ae 016a7 5 - J - 0�
Address Expiration Date
X775
Signature Telephone
9Reg stered��.orneImpt:ovemen. Not Applicable ❑
R. C . T. R f'I no I 26 2 3,5
Company Name Registration Number
-Li d Noi r) AVe.nLjej - P D o OX 3()q 5 - b - 0,)4
Address Expiration Date
Telephone /3)
SECTIONIO WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M GL
., x. f
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...... ❑
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)fami!ies
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 them
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 aaan'Apeg
f -
f
f ' y
�-zip " aG
SECTION D'ESCRfPT ONO ROE?OSED�INORK Check aflgaop'laca le)
s '` F'kk: x ut -'=+ "°A- Sk"», S"3t�°"tae _
" > ;i
New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ) Decks [ ) Siding[ ) Other ( ]
Brief Description of Proposed Work: Remove, esistina S�i o1e-S Ins, !l f? AdoJ�
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attached Roll 0• Sheet❑
6a031'f T7evir ouse and off'r ad !i.,'f`on to existing ho sin c�p1et tfie f071`,. n
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. s 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 .
1. Septic Tank City Sewer Private well City water Supply
ma
SECTION 7a ;WNER �U HORIZATION TAO BE COMPL'ET»ED WHEN
OWNERS AGE NTOtCONTRACTOR APPLIES FOR BUILDING PERMIT
I, PaXnl A nelef Snn as Owner of the subject property
hereby authorize I sle, Ron i na to act. on
my behalf, in all matters relative to work authorized by this building permit appl cation.
Qi an6A I I - 3- 6�
Signature of Owner Date
- JNa& '11olisle, as qtjiLLDrized Qgmf as Owner/Authorized Agent
hereby declare that the statements and information on the foykgoing application are 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
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 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 413.587-1240 Fax 413.587.1272 t
,e e
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: hissect'ro to e c mp. fd'by'"'ffice
�: `, ..
ab3 Ruan 1600A MaP Lo �t
��Ye nc Zoe Over a. st c
f
ElmSt District CB:Di ct -,
SECTION 2 - PROPERTrY OW..NERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
(aAn I Anne ,5bn
Name(Print) Current Maili, o Address:
Q� Phi (413) 5$6 - 5'738
Telephone
Signature
2.2 Authorized Agent:
, az.� Tel. - U- 1. �oo�'► na Poo �x 309 - EasAarnjoji)-ir1r JMA
Name(Print) ��— Current Mailing Address:
(-q13) 5a7- +jq5
Signature Telephone
SECTION 3 - ESTIMATED CONS-fRUCTI'ON COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by ermit applicant
1. Building Roo ('I n 6.5D0.00 (a) Building Permit Fee
2 E!e--_ncal l 7 (b) 'Estimated Total'Cost of
Construction:frbm: 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) �j �.QQ Check Number
This Section For Official Use Only,
Building Permit Number: Date'I"ssued;
Signature: _
Building Commissioner/lnspector,.of Buildings Date
T
BP-2004-0536
GIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2004-0536
Project# JS-2004-0757
Est. Cost: $6500.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sq. ft.): 12022.56 Owner: ANDERSON DONALD E&CAROL CHAM
Zoning:URA Applicant: RCI ROOFING
AT. 263 RYAN RD
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTON MAO 1027-0309 ISSUED ON.1114103 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• Receipt No: Date Paid: Check No: Amount:
Building 11/4/03 0:00:00 4755 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo