32C-315 (3) Kc.l. RoOf*"%�
11 LLP
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40 Maine Avenue
P.O.Box 309 Estimate
Easthampttoo (1
Easthampton, MA 1027 Date
Phone(413)527-4775 3/11/2004
Fax(413)527-£469
Name/Address Job Location
Jan Bak 41 Henry Street
41 Henry Street Northampton, MA
Northampton, MA 01060 584-3557
Terms Rep
Estimate valid for 45 days Chris
Job Description Total
Remove existing roofs. 5,500.00
Furnish&install aluminum drip edge,pipe flashings and chimney flashings.
Furnish&install ice&water barrier along eaves and valleys.
Furnish&install 16oz. copper valleys.
Furnish and install 15 lb.felt over existing deck.
Furnish and install 30 year Tamko shingle. \�
Furnish and install 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$2.00 per sq.ft.for wood replacement if needed.
9 ADD for garage roof 500.0
or 50 year shingle..........$400.00(house)
years ingle..........$150.00 garage
WE LOOK FORWARD TO DOING BUSINESS WrM YOU. Total
TERMS OF PAYMENT
7550.DO
30%Upon delivery of materials
70%Upon completion Customer Signature
Registration# 126235
Construction License#074334 Date 3
Insured by Hackworth Insurance(413)527-9907 —
r O�YiW-faro
A E V If�7 t7f �LTI f Ilillll}Jf011 _
i
o DEPARTMENT OP BUILDr)\C INSPECr)ON's
212 Train Strcct ' Municipal Building
Northampton, Mass. 01060
%Y OIUCER'S CO INV ENSA'nO N EN S URAN CE A F M A VI-1-
(liccvscxJperm;ctcc) 9
With a prui lcipal place of business/residence at:
no. Ave,. / FQSfhamnfa>7 MA 0110��/ (phone=) - qM
(s�r�t/c�ty�sta�c•'zJ P)
do hereby certify, under thc.pa_u-U and penalties of per'ury, h?i
an employer providing the following worker's comocnsadon cove^'c nor i11)
erluployces xvorUng on'tius job:
►o o
Corer.n.) (PoLicr):u_-ter) (r pirauor Dat;)
O La1n a sole prooriecor, general contractor or homeowner (c cie one) and have hired
the contractors listed below wbo have the FoUo%ving workers coEn- pens-ation policies:
(Name of Conimaor) (Innlranc; Compa,a)ri'cii-; �ttlrrl!C;) (Yx)lidGOn Mac)
(Name of Cootraaor) Raslaran= Comoany/Po!im, Nunbco (Emir iion Date)
(Name o(Coturacto,) Omsuranc; Compare)•/PoUq• Nambu) (Exairdoo Daic)
(Name of Coaaractor) (Instuancc Company/Pobcy Numb°J) (Expiratioo Dau).
(b aduD opal thca it nxcury to ctcudc iaforma_E oo pertaini alJ oo�ar on)
O I am a sole proprietor and bave no one wor4dng for me.
( ) I am..a home owner performing all the work rnyseif.
NOTE:plea be aware tb+d Mj:i.lo bomcaumcn wbo oaplay pesom to LD -, t ac,ao c rc air work .d..e1L:g of
nrx mort th:o t'--=?j in wbicb the bom owoa rcado or oa the none{,zpputcn:rs tbc- ec oo(Cep.-ally oo=.d-mi to be
aitploy—trnCc the..=kmr"—p - xica M(GLI52 m I(S)l appliearion by a bomcowoa fm r Gcr--.or permit=y evidcom the
Iegal rtanu of an C=Ployer under die Wockmeg C.ocmpom,yi.oa ACL
I uodastand that a copy orthi,m�tcmcsR may b+foro+wrd..d to the Dcp�tmcoa of]artasrirl Aco:damf Oa;.or u=--o—ra Lb.
oovaxbc vcrWcaioo&M Ow L.iltat to saaue)cove undo soetioa 23A of),(OL 152 an lad to the impcuidoo oraimiaz!pea+hia
comar6a ora fiat orup to S 1}00.00 ar]drar of up to aac year and avil pcoaltio in t'.x form ora Slop Work Order and a
Gan of 5100.00 a day tpdaza tae
For dcp.rusUal u,c only
Pcrmit Numbcl
1,/,z P.,— Lol "
Sip;ab;tM Of LicrslSC C.,_iucc M3 e J
S��,ON)8��CO�N;��T�,Rt�CTION SERVICES �w��.
8.1 Licensed Construction Supervisor: Not Applicable ❑ c
Name of License Holder:_ IoM I%Sde. TP 33'I 7
License Number
o - 7 5 - __ 0 4
Address Expiration Date
Signature Telephone
Ret:ster•_e` orne kmnrouement. ontracfor Not Applicable ❑
R. • z. R f. no 1
2b 2.35
Company Name Registration Number
-I In .Mai n Aym e, - box 3o 1 5 - 6 - &(o
Address Expiration Date
F.6sibampthn - AA 0)69-7 Telephone l3 -J-1T76r
SEGII�ONOI+YERSmCOMPENSATION INSURANCE AFFIDAVIT(MJG 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...... ❑
Ron ;oAP n Em, a ml tin
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 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"homeo%vner"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 thejob site will be required from time to time,during and upon
completion of the work fix which this permit is issued.
Also be advised that wia,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
} E 0 S P O.N 0 .PR01?OSE�ORK che.cka `�1ica"b�e. -.
Tw
New House 0 Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: RPr77QVP, exi5tw
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative O Renovating unfinished basement Yes No
Plans Attached Roll 0• Sheet 0
a f ew =o se" ah o�d'd`it to" ez sting h ing comp e e th- Wilu"WR
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
t�SEE TAO LSE 7 Hps'IZq�FfON-PTO BwE GOMPLE ED WHENr f
E 0 CONT ACTOR A�PPLIESFflf13JCL0ING PER 1T �` x
M �
+ as Owner of the subject property
hereby authorize I 7 to act, on
my behalf, in all matters relative to work authorized by this building permit app! cation.
Signature of Owner Date
` ,III " 0ri ed nQ 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
6 -o4
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 %
(I.ot 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 De.partment
212 Main Street x r
Room 100
Northampton, MA 01060 e
phone 413.587.1240 Fax 413.587.1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1'-S'ITE fNFb2MT1ON
_ . r
1.1 Property Address: ; ;' ' h secti`o t� a co feted ffie
s M ±
fni s — Nnr
I� t Districts CBS
w
SECTION 2 WNERS P ZED SCENT
2.1 Owner of Record:
Tj M lga 1 - 'Sfr'ee t
Name(Print) Curren Mailin dress:
Q,tta.�lP� _ 5�� - X3557
Telephone
Signature
2.2 Authorized Agent:
i�
yM. elisle, - R. C. 1. Eon Ana P.O. tLx 309 - EasAamjotn. .N1A
Name(Print) Current Mailing Address: f
-q)3 5 p qqq
Signature Telephone
5ECT1011 3 E5=TIMAT«ED COSTRUCTION COSTS
Item Estimated Cost(Dollars)to be OfficiafUse Only
completed by ermit applicant
1. Building (a) Building Peirnif'Fe!e,
Roof n 7550.00
2. Electrical (b) :-E: timated Tot I aViCost of
Construction from.: E
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
1 5. Fire Protection
6. Total =(1 + 2 + 3 +.4 + 5) Q Q Check Number
This Section:For Official Use Only.
BuIldmgPermt Number Date Issued;
_.
Signature:
Building Commissioner/,Lnspector.;.of Buildm s. Date
_
g
41 HENRY ST BP-2004-1258
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:32C-315 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2004-1258
Project# IS-2004-1898
Est.Cost: $7550.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sq. ft.): 5488.56 Owner: BAK JAMES A
Zoning URC Applicant: RCI ROOFING
AT. 41 HENRY ST
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTON MAO 1027-0309 ISSUED ON.619104 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 6/9/04 0:00:00 5554 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo