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31C-011 (2)
RCI ROOFING 30 HIGH ST EASTHAMPTON MA 01027 ESTIMATE (413)527 4775 FAX (413)5'27 8469 Datw §,23,00 Estimate To: Estimated By: MARK DELZSLE MARK FATTER Start Date: P d •F-r4 L Mawr Z Job Location: 10 WARD AVE NORTHAMPTON InIcL: EIAQ q SMAU__Ne j R CIARA4gE - Job Phone: 586-4011 JOB DESCRIPTION TIJGL FS TALL _TQv & WATER JRARRTER ALONG EAVES AAID VALLEYS T.r. Arnr MOSS TMHTRTTQR N r? TV AnnnRn4NTr'r' WTTFf VAVFTFAr-TfTPP1?- cDCr'TFT('AmTnr* SPECIAL ITEMS NEEDED INC. IN Q jorE: C�J.rT&IM SACK D iP Eb(iE FOR IN taM BA - coN V,-r,* PFKniT- iP ANy-7o U 01bT W0 IaY Vou- SPRA-f n)T CaLarqN.S. Ni LE Co 04k To Re O No; INS u .0 Quo'f6 P4 o r GE k9,PL CaNTAq- aN PAIN W E N c p ^_ 6 Y 4 bul 1.10 T T'-G To &J Ac ON 4AG oQ F Additional information pertaining to this Job Estimate TERMS OF PAYMENT 30liPRIOR TO START Total Estimated 7 ./Ob Cost_$s5 000.00 0%UPON COMPLETION CONSTRUCTION LICENSE 0 074334 FEDERAL I.D 03418838 Authorized �w REGISTRATION 0126235 Signature � l 1 • '' RvT_ INSURED BY BANAS INSURANCE(413)527 0288 ORIGINAL-ESTIMATOR COPY , F E C>r of TorfIla11tpton __- Q� E �las��chnartta .-�' DEPARTMENT OP BUILDING INSPECTIONS - 212 Alain Street Municipal Building Northampton, Mass. 01060 WORIQIZ'S COMTENSA'MN [NSU A-NCE AFFIDAVIT K, -De - v,rlth a principal place of business/reside,nce at: —��"—h--__.ST /`'�`G`� ? �' • (Phone;')C_�1�S,� � �f 77.5 tylstaicrzj P) do hereby certify, under the pains and penalties of perjury, that (� I am an employer providing the following workeF`s comae SZ!Don cove mge for my employccs worljng on ulis job. C- Coo=,,,) (PoLic: Nu_mirr) (Expiration Datc) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who hive the follo%ving Workef s GmDtnsadon policies: (Nnmc o.Co=cwr) (InR nnc Companyi'Gbc-, ?,,'usnbcr) (i:x ir�uon Datc) i� (Name of Coolracior) -- Rnsurancz Compaa,,,/Pobc�, Nu>mcrr) »ir lion Date) (Name of Contractor) Gnsuranc: Company/PoUic) Number) (Expirtion Date) (Name of Contractor) Gnsufanc-- Comca-uy/Policy Numlxr) (Expiration Datc) (6CIlCh 3dili:OC1r f'_ur1 U flCG�ii=1'l0 tK C.L..LLvorTm-600 P-ru ains to'11 ocaQ r—...X-0A. ) O I am a sole propnetor and have no one working for me ( } I am a home owner performing all the work myself. NOTE:plc be twar<t},,,uW- 0 bcara"mc,H.bo cmploy pczoni to d��--.�*- c ,oo c rrpau work to f d-•c og of cot Mort than t�-.,toe mi'u in t•iD�Lt-bolm -Uv r rcudo«oo the a-our -zppurtcw-tbcdo L,ooc G,=c:ly oc-c=,6--cd to be employa-s untie-the .v i rz z alioo Act(GL151n 1(5)�np Ujcaoon by n homeoavcr far e Lc=c-,--oc permn mn y c dcooc the Iept ftnnu of rn c�ployx under tlio Wor4df eoo�o Act I uodcrrtxnd dw x copy of thi, m y bo f«xnrdod to tbo pcpnrtrnco¢of Ic>dutrirJ ArodcoiY OT,-of lrcunnoo for th< covm,St va-LGc%tioo nad lh t LiJ nc to eocure eov T-&�under soCtioa 25 A of MoL 152 can Irsd to the i�oa of cnmio.sl penallia ooatismg of►fiat of up to S 1_50o.00 and/or 6=priloamcni of up to ofx ytnr End ci�jj Pm C,in Cx form of a Stop Word Ordcr and a Gm of S 100.00 id--y L&inA uD, FordNI Num u,c only _- Permit Number �f �G i.�ap;; - - lot Signature of Liccnscc[Pcm6Ucc e T�bM' CONSTRIJ TION:SERVI S 1 Licensed Construction/Supervisor: Not Applicable ❑ Name of License Holder License�er /o Address Expirati Date sigifature Telephone .,� Not Applicable ❑ Company Name Registrati n Nu ber �' C Address Expira on Da e Telephone .S��' q 7;7S— SE�T14N 9 WORKERS'C©MPENSATON°INSURANCE AFF'IDAV'IT�M.G L c.jI52,§25Ct0 , 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. igned Affidavit Attached Yes....... © No...... ❑ 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 09, i`a e 3 New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other[ ] Brief Description of Proposed Work: S'k rh� t Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll ❑ - Sheet❑ 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? 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 SEC tON 7'a OWNEFt;AtJTH4RIZATION -TO Ot COMPLETED WHEN OW >f S AGENT QR C�N"r"t�►GT��t�411�PLIES 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 ` &atthe as Owner/Authorized Agent here y declare statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. 0044ligned under the pains and penalties of perjury. (k,,,r t Print Name 114, Da Signature of Owner/Agent 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: LAU I 120M City of Northampton 'B U ilding Department QFFT OF SU;Lri� � 'NH T1(0N 212 Main Street r Room 100 Northampton, MA 01060 phone 413.587.1240 Fax 413.587.1272 APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING 5 CT18N 6ITE.INFORMATION 71 1.1 Property Address: /0 E,4, nc & CTIO114 -P,RtIF►)rRfiY GYVNERSHIP/.,AUTHORIZED AG£Nfi 2.1 Owner of Record: ma t- r I ".fte c ame(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: (W 7 -3 'S-':)- 7 Signature T lephone SEAN 3 >I STIMA 4NS I�I.��'1� OSFS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a) Building Permit Fee 2. Electrical (b)Estirrl ted1otad Cost of Constructio>",turn ' a 3. Plumbing BcjildilrtgRermit:Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 + 2 + 3 +4+ 5) Check,Ngmber T,his:5e�llnn,For OfficiaN Use Only BtldFn l :rrrtt Nrrffer 'Date,issued. Signatre B llding Comntissiopertinspector 6 Bullclings Date, r 10 WARD AVE BP-2001-0157 GIs#: COMMONWEALTH OF MASSACHUSETTS r4VARLBlock: 3 1 C-011 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category:roofing BUILDING PERMIT Permit# BP-2001-0157 Proiect# JS-2001-0263 Est.Cost: $15000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO Const.Class: Contractor: License: Use Group: RCI ROOFING 126235 Lot Size(sq.ft.): 160736.40 Owner: FUTTER THOMAS Zoning:URA Applicant: RCI ROOFING AT: 10 WARD AVE Applicant Address: Phone: Insurance: 30 HIGH ST (413) 527-4775 Workers Compensation EASTHAMPTONMA01027 ISSUED ON:8114100 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF POST THIS CARD SO IT IS VISIBLE FROM THE STREET nspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: 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: wilding 8/14/00 0:00:00 238 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo