36-017 RCI Roofi`�ngZ LLP
51B Holyoke Street
P.O.Box 309
Easthampton, MA 01027 Estimate
Date
Phone(413)527-4775 10/6/2004
Fax (413)527-8469
Name/Address Job Location
Claire Musante 29 Forrest Glen Drive
29 Forrest Glen Drive Florence, MA
Florence, MA 01062 584-1691
Terms Rep
Estimate valid for 60 days Mike
Job Description Total
Remove existing roofs. 6,650.00
Furnish& install aluminum drip edge,pipe flashings and chimney 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.
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.
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total $6,650.00
TERMS OF PAYMENT
30%Upon delivery of materials J
Customer Si 70%Upon completion nature y I Zc� / t{
Registration# 126235
Construction License#074334
Insured by Hackworth Insurance(413)527-9907 Date / C '
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c� DEPARikfENT OP DUILDr)�,iC INSPECT'1011•s
212 Main Strcet ' Municipal Building
Northampton, Mass. 01060
«'OI CCIZ'S CO\'TENSAT70N LNSURANCE Al=, A�Tj'
I,
a principal plaec of business/residence at:
5� S HDI 3t A oloal (phone:')
(s>Ir>wt/ci t}•/sta-tclz�p)
do hereby cerTif.-, under tb.c p�� and penalties of perJwy, hat
(� I am an employer providing die follo%vi «orkcr s colnocnsZDoI coverage for Iny
etuplovees working on'titis job:
h��4, ut�iQl via. 3i s= �i�►a -oy► 10 05
Conr�ny) (polio: Nu_ hcr) (r:-pinion D=)
( ) I am a sole proprietor, ge feral contractor or homeowner (ci cie one) and have hired
the cooi;actors listed below wbo hzve the following workers caonensation pe!icies:
(11fltIlC Oi CO.^.'Tnaor) (In umncc Cotnpa i)-Pi o6c ?�t1IIl� 7) (r?:J1iJ Qi l�alC)
(Name of Cono-aaor) (Laurance Company/?ok), Num�cr) (%xair-.6on Datc)
(Name of Connaelo,) Rmsuranc; Compan}•/poLc-)• N:tmbj) (—Expirdon Date)
(name of Conaaclor) (Insurance Comcwy/Policy Number) (Exxiration Data) .
(saacb sdu�ocaJ rSca it cox-airy w c�cudc iafortv..'i oo pcnainins to.L oom-_c.o:-�)
( ) I am a sole proprietor and bave no one working for me.
( ) I atn..a home owner performing all the work myself.
NO T�:plese be caryrc 4 C home.+ven to Y P=%-O-tp dD r• .,= ar mpau-ork on.d..e1L: of
act wo t th n tt7w �in u�ieb the bornoowoer raid.or oo the p-ouort.-r r tbeeto e,cot -illy oc,ridaoi to be
employ--une-the C—P—ioa Act(GL152=1(5)).aFPlimaoo by s homooevc fv c lice.or prnnrt rr:y e.idms tbe
'eS l nsau of na exployer uod--r dva Wo,+. .C000p..mu Act
I undc'rtaad tba a copy of tbii c=cOO =o1.y be roe-++nrd.ed to tbo Dceperrtoxoa of lnauuicl Aecdw'office or IraYaory rot tb.
covo'l a vQ-%Gcnioo aetd a"'L"'Lm to soeure`oovery6�under soetioa 25A of Mol-151 eto 1,..d to the impautioa ora==31 peaiib-
000sinin of a tint of up to S 1 So0.00 and/or at�riyq�or up to ooc year snd ci%i]pmattio is the form of a Slop Work Ordcr and a
fim of S 100.00 a d:y tpj=MD
For dqp � t u• only
Permit Numbcr
N/Lap° Lot s
Sire of Lio=i--ccJPcrrniucc DBte J
5�CT30N 8t01STRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑ '
Name of License Holder :_moo 1� J5�2 q7'7 337
License Number
o - 010a? 5 - - 04
Address Expiration Date
(-q/,3 ) 5,27- 'I775 .
Signature Teiepho4
r a ter-e %6-m—elffi r uernen ,Mn "rac r Not Applicable ❑
Company Name Registration Number
. -go Main _AvtnslP2 - P-6 . OX �O I 5 - 6
Address Expiration Date
Telephone 3 50,17-1117,r
SECTIOhF O W0 KERS' COMPENSATION I:KSURANCE AFFIDAVIT(M §.25;C(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....... ff No...... ❑
MEN T11, xeiII7 t ;,II:
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 then:
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 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 (j f ir7n.l'1p-tq
qr
ON "ir S P O�N'O R OSEd�NORK all ca`i1`e
Yg,G le
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolitionp❑ New Signs [ ] Decks [ ] Siding[ ) Other [ )
Brief Description of Proposed Work: iS�f rw existing �i11�Y1p� ca�)o Ir►alact
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll D• Sheet 0
5a. f T7"ew �o`�t"s"e' a'fid o; a diteo�n to eztistin housing comp e e fhe` -611M :
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
SEC1 WNW O (ZA��10N r�TOBE COMPLETEDu WHENa
;0 E D CO TRACTOR APPLIES FOR BUILDING PERMIT
n b! + as Owner of the subject property
hereby authorize — ,,�(anX. LJe'I Sf e, 67 Re to ac;. on
my behalf, in all matters relative to work authorized by this building permit appl cation.
(1.+ j Ya] log
Signature of Owner Date T
Lis f1U�12ori d Qq'W 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
1/a
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:
_ .ity_of_Northampton
E5,pil jing Department
----- -` 2-1 Main Street -�
b0m 100 I,
4, jAr� J 2 J@ffjtham:pton, MA 01060 e•s >'
phone 413-587-12, 0 Fax 413-587-1272 .}t
I AfPt CATION TO CONSfR — ,—ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION:,1 - SITE INF R fON
1.1 Property Address:
T,:is�secto, to tie com t :d li office "`
�.9 Forrest GIB, l�riy , Lott
�.
,EIn�S; Distr ct .a €� CB Di r ii ct:°� ,� }
SECTION 2 PROPERTgY OWNERSHIPlAUT1i.0 IZED AGENT
2.1 Owner of Record:
C'I4lrp- ML�an P
4 0
FnYyjeStC
Name(Print)
1 Curr_reQnt�Mailjri 1 dress:
atta n eA Telleepuhonn�e 66
Signature
2.2 Authorized Agent:
'Ma)J? 1�e/;S1f - NA
Name(Print?,,,,- Current Mailing Address: QI�a11
-113,) 5 p 7- +j q n
Signature Telephone
SECTION. ESTfMAT.ED CON'STRI�CTION�COSTS `"
Item Estimated Cost(Dollars) to be Official Use Only
completed by ermit applicant
1. Building 107 i 1'Z �b�o•�o
(a) Building Per,mit Fee
_.
2. Electrical (b) L: timated 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.
Bu_Iding'Permit:Number: Dated"ssued:
Signature:. ,.
Building Commissioper/Inspector.of:Buildings. Date
29 FOREST GLEN DR BP-2005-0743
GIs#: COMMONWEALTH OF MASSACHUSETTS
MM:Block: 36-017 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-2005-0743
Project# ]S-2005-1040
Est. Cost: $6650.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sq. ft.): 14331.24 Owner: MUSANTE DAVID B JR&CLAIRE
Zoning.URA Applicant: RCI ROOFING
AT. 29 FOREST GLEN DR
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTON MAO 1027-0309 ISSUED ON:1128105 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 1/28/05 0:00:00 6561 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo