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35-147 (2) R. .I. Roofing 40 Maine Avenue Estimate P.O.Box 3[19 Easthampton, MA 01027 Date Phone(413)527-4775 9/26/200 Fax(413)527-11469 Name/Address Job Location Carl Charrette 746 Ryan Road 746 Ryan Road Florence, MA Florence, MA 01062 Phone @Bakery: 527-3313 Terms Rep Due on receipt Mark Job Description Total Remove existing roofs. 5,800.00 Furnish&install 2-ply modified bitumen base sheet, torch applied. Furnish&install IKO modified bitumen cap sheet,torch applied. Furnish&install .032 edge metal. All roofing related debris to be removed by R.C.I. Roofing. All work to be performed according to manufacturers'specifications. 5 year R.C.I.workmanship warranty included. 10 year manufacturers'material warranty included. All related permits to be obtained by R.C.I. Roofing. WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total $5,800.00 TERMS OF PAYMENT 30%Upon delivery of materials 70%Upon completion Customer Signature Registration# 126235 Construction License#074334 Date Insured by Hackworth Insurance(413)527-9907 o O �\Tcrfljuiiip toil ri f RZcs opt(hntrtto _ u - — o DEPART),4ENT OP DUILDr);G INSPECTION'S 212 Ma'n Strcct ' Nlunicipnl T3uilding Northampton, Mass. 010GO W O RICER'S C O\i U E N S A TI O N Cq S U�CE A l:TD7 A V1T (li ccnsaJperm;ttcc) v.Ith a principal place of business residence, at: �o JM ojr7 . Av-6/F-asfhampfon MA 0160 do hereby certify, under dic pain.S and penalties of pcfJury., hzt (V� I am an employer providing the following workcr's comocnM uon cove—Sc (or in) eluplovccs wor�hng on tlus job. J ,i bett jutl al � 1 33 (10 0 trruor, 1Datc) ( ) I am a sole proprietor, general coou-aecor or homeowner (circ:e one) 2nd have hired the cone actors liste—d below 7-1ho h2ve the follo%vinQ worker's c.=ensadon policies: ('�amc o;Co.^..^c�or) (In2ranc: COIi1D1,'1)'/hGUCI' ��uSIlC�t) �-•'•)1;dU^� Date) - ( =nc of Couazmor) _— (lnsarancc CompanytPolicy Nunlccr) FExpu Lion Date) (Name of Coatraelor) (Lasuranec CompaoyfPoUc)• Numbei) (Expiration Dwc) 01 amc of CosTacior) (Insuran(-- Comv.,-- y/Policy Numbs) (Et-pita000 Datc) (eat-'6�Zoczl if acxury to mcud �afortai c peru inias to ell oom- C-on) O I a.m a sole proprietor and have no one wor4-.ng for me. ( ) I am,a home owner perforrai.ng all the work myself. NOTE:plcsc be tw-irc Lhi ui ]c boa co+mcn-bo cmploy pczam w Lb-i ca= -uoo c rcpcu work oo.d-AL-�of GO(Mort ti-n `LSO:=rJ is ui;3tfi the botnoowvc rmdc or oa the Qmtac`s zppurtcn_rn cot C7.-.-.Dy 0=-r-d=d to tr catployc-uaG:the- -kcr'z car,cs.clloa A={GL152.=1(5))�appltnaoo by a bosaoaac fart lira or pamh c:y--td—LL'c Ic�l cU--of to es?loyx under dro Workol.Coazpee.Aa ion AeL 1 undartead dad>copy of tbi,mt.emaa m,-y be foe--,ded to tbo Deportmcoa of ln.d+trritl r.eodaMLY Offf oe of laau+noo for th. cOvaZ1 va'LG=oa t_nd tact L-ilta-e to toaure tovem�e under soctioa 25 A of MGL 152 cin Ir-d to the i= i -of-i-i peas - ooeai:ix$of a Sine of up to 51-500.00 u�,Vor=piyoam,=of up to one year tad civil pm.hio io be form of a Stop Wort Order end. fl=of 5100.00,d_y tpi=ar- For dcp=rtm�-�u.c only Pcrrnir Number Lot SiGnatun.of Liccnscc/Pcrmiucc SECTION 8 CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ I I Name of License Holder : ��(ak 'DP�;SIe. q /y'7 33'7 License Number �►o — 7 5 - J — 0� Address Expiration Date - 7-� Signature Telephone rn Re " M Not Applicable ❑ R. C • T. R f'I no l ab � 3�5 Company Name Registration Number ­il o Main Ayerwe_, - ft ..o oX 3o i 5 - 6 - O� Address Expiration Date Telephone 13 -J 776 SECTION 10 WORKERS' COMPENSATION IKSURANCE_.AFFIDAVIT(M 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)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 acccptable 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 fo;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 C�tan � SECTION 5`YD SCRfPT ONifOF PROPOSED aiVORI<(check Vr 113:61i�- 17 New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ) Other [ ] Brief Description of Proposed Work: S /f, e—c L0 Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0- Sheet 0 6�ARI WMou"""" s andipr d-dUiff-6 to eXisting housing mp�l'efe" t i'e foflowing 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 7aOYVNERA_.1710RIZATION ;TXO,BE COMPLETED WHEN OYYNERS q�EN1ORCONTRACTOR APPLIES;.FOR BUILDING PERMIT' as Owner of the subject property hereby authorize II 7 e ROnFi na to act on my behalf, in all matters relative to work authorized by t„ building permit application. Signature of Owner Date JS Q as Owner''Authorized Agent hereby declare that the statements and information on the fdYkgoing 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: ? ty of Northamptonti h ` �117 lV).�wilding Department j 3212 Main Street r Room 100 ampton, MA 01060 e ti phone 413-5 7-1240 Fax 413-587.1272 rt - ARPLICAITON TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION this s;ect��:tobeco p et'ecl�b:office s 1.1 Property Address: "B D,i -1c Elm_S� DistriEt °�° „� G. t � SECTION 2 PROPERTY OWNERSH'IP/AU.THORIZED AGENT 2.1 Owner of Record: f I c�C---i c //C e Name(Print) Current Mailing Address: 1 ,f' a fl,, Telephone " Signature 3 2.2 Authorized Agent: Yaff� IP-1j5 00fina POof1pX 309 - E05A0'Mnfinn .IYIA Name(Print) Current Mailing Address: (-q 13) 5. ,7 q q 7 5 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Offidia11 Use 00ly com feted by ermit applicant 1. Building D00 ('i n (a) Building Permit Fee 2 Ele,--rical �l 7 _ (b) -..timated Total Cost of Construction;from: :6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection o. Total = (1 + 2 + 3 + 4 + 5) LJ Check Number This Section For Official Use Only, Building Permit Number: Date Issued: - Signature: Building CommissioneMnspector of Buildings Date T 74 0AYq BP-2004-0435 GIS#: COMMONWEALTH OF MASSACHUSETTS .tic: 35 �i 1r47 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2004-0435 Project# IS-2004-0633 Est. Cost: $5800.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin: RCI ROOFING 126235 Lot Size(sq. ft.): 23609.52 Owner: CHARRETTE CARL A&BETHANY L Zoning: SR Applicant: RCI ROOFING AT. 746 RYAN RD Applicant Address: Phone: Insurance: P 0 BOX 309 (413) 527-4775 Workers Compensation EASTHAMPTON MAO 1027-0309 ISSUED ON:10116103 0:00:00 TO PERFORM THE FOLLOWING WORK.STRIP & INSTALL MODIFIED BITUMEN 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 10/16/03 0:00:00 4255 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo