25A-101 s ,
R,C,, . 1,-ko�o o�fi n�g
LLP
51B Holyoke Street
P.O. Box 309
Easthampton, 01027 Estimate
Date
Phone (413) 527-7-4775
Fax (413) 527-8469 1 5/19/2008
Name/Address Job Location
Ray Capers Garage & Addition Roof
344 Bridge Street 344 Bridge Street
Northampton, MA 01060 Northampton, MA
586-1892
Terms Rep
Estimate valid for 60 days Rich
Job Description Total
Remove existing roofs. 12,600.00
Furnish & install 1/2" plywood over the existing decking.
Furnish & install aluminum drip edge, pipe flashings, chimney flashings and step flashings.
Furnish & install new lead counter flashings.
Furnish & install CertainTeed Winterguard ice and water barrier along eaves and valleys.
Furnish & install 15 lb. felt.
Furnish & install 30 year CertainTeed Woodscape Series shingle.
Furnish & install CertainTeed approved ridge vent.
Furnish & install .045 re-inforced rubber roof system on flat roof section.
All exterior roofing related debris to be removed by R.C.I. Roofing.
5-year R.C.I. Roofing workmanship warranty included.
30 year CertainTeed material warranty included.
All related permits will be obtained by R.C.I. Roofing.
SPECIAL ITEMS NEEDED
THE OWNER HAS THE RIGHT TO CANCEL THE CONTRACT WITHIN (3)
THREE BUSINESS DAYS OF DATE OF SIGNING. Total $12,600.00
TERMS OF PAYMENT
5%Deposit
Balance upon completion Customer Signature
Registration# 126235
Construction License#074334 Date
Insured by Reynolds,Barnes&Hebb,Inc.413-447-7376
0 o
e . 9 Crz#�r a� �az�#E�ttnt�tun
8 e �lassar}lasrtla
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
i
lelislp tif R. r.).T . RO&YIn
(icenscel mnittee)
`with a principal place of busiriessJresidence at:
5 B (phone#) 13 ww ■_A 715
5trcet/ ty/statrJzip) ��--
do hereby certify, under the pains and penalties of penury, that:
l
(Vy I am an employer providing the following worker's compensation coverage for my
employees worm on this job:
The_=nsurance, mpan� d
i. eOtbled Pen nsgWan►a 1�1C' 68873x5 0 05 0
aaau-aucc Company) (Policy Number) iratton Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following workers compensation policies:
(Nome of Contractor) (Insurance Company/Policy Numbcr) (Expiration Date)
r
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Compary/PoLicy Number) (Expiration Date)
(Name of Contractor) (Lnsumnce Company/Policy Number) (Expiration Date)
(attach ads i oaal sheet ifncocs ry to ir,} iafori oa puiaining to all 000tredors)
( ) I am a sole proprietor and have no one working for me.
( } I am a home owner performing all the work myself.
NOTE:please be awam that whilo homcowncrs who auploy persom to do m,;,,+,,,•,,n cvosuuctioa or repair work oo a dvrelling of
not more than du units is which ttx bomoowncr resides oc oa the gnwnds appurtcnani then do an no(geoa,4 oomidered to be
cmp{oyr:s undo 11-4 worker's ooaipccatioa Act(GL152,ss 1(5)),application by a hon=wou for a lioam a permit may-idcaoe the
legal status of an employe<under the Wor$nes C.ompwaLtion Art
I und=a%nd taut a oopy of this statement may be forwarded to the Doputmao2 of Industrial Acd&c,&OlEoe of rn---for the
coverage vaifictdoo and that failure to toeurc coverttgo under soctioa 25 A of MGT_152 can lad to the imposition of aimin'd penalriea
comisting of a fine of up to S 1,300.00 sad(or imprison of up to one year and civil pcadfies in the fain of a stop Work Order and a
fins of:S 100.00 a day apinst mc.
Fa d uao only
Permit Number
Maps Let# _
r Signature of Liocnswjper=ttce
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: S I e, 7?q U 3 4
License Number
5) B &jqnheSt.• EaSthamn�n . Ma. wox? 5 - 03 - 10
I-Address — Expiration Date
0413)
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
6•a. I. twos 6- 126235
Company Name Registration Number
519 A luoke Street - P D. X am 5-AL 10
Address i
�1�f Expiration Date
Fa. stharnpfior, . Ma. fo�nz Telephon - 1
SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.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...... ❑
11. - Home Owner Exemption
The current exemption liar"homcovvners"sv as extended to include Owner-occupied Dwellings of one(1) or two(2)families
and to alloyv 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
snructures. 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 tbrm 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 rcquired from time to time,during and upon
completion of the work (,or which this permit is issued.
Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153(Liability of Employers to
E nployces lix injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to perlbrm vv-ork for you under this permit.
'Pic undersigned "homeowner'certifies and assumes responsibility fi>r compliance with the State Building Code,City of
Northampton Ordinances.State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature -ta�h��
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House Addition El Replacement Windows Alteration(s) �=Other Or Doors I]Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [C]
Brief Description of Proposed }.
Work. A
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing complete the following:
a. Use of bailding : 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. Masscheck 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 7a -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
RamnnJ a oers as Owner of the subject
property
hereby authorize ' R.C. I.
to act on my behalf, In all matters relative to work authorized by thislouilding permit application.
att2Ae.j g bw log
Signature of Cwner D to
1, as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing at lication are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Print Name
?laolo8
Signature of Owner/Agent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
I:zisting Proposed Required by Zoning
This column to be filled in by
Building Department
I.ot Size
Frontage
Setbacks Front
Side I.: R: I,: R:
Rear
t3uilding I Icight
Bldg. Square Footage
Uhen Space Footage
(Lot area minus hidg K pace]
pakine)
# )f larking Spaces
Fill:
(cnlumc K Lpcition)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DON'T KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DON'T KNOW O YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 Date Issued:
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO 0
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading, excavation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
J
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
Room 100 WaterlWell Availability
- Northampton, MA 01060 Two Sets of Structural Plans
Alonq,443-587-1240 Fax 413-587-1272 Plot/Site Plans
+ I Other Specify
APPLICATION TO,CON$Tt�UCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECT1014-1-•°SITE INFORMATION
1.1 Property Address: c This section to be completed by office
(J
'3�q Bfl Jae t��Y�t Map Lot Unit
V Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
RaV mond Ca PeXS 3gg Br1146e.�St. 11�('tnn
Name(i"'rint) Current Mailing Ad s —T
ed8b - 1971
attach
Telephone
Signature
2.2 Authorized Aqent:
P.o. % 3hq - as a.rnnr� a.
Name(Print) Current Mailing Address: ' 010417
�-- (113) 5 2'7- -4 1 15
Signature Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building oof� ' D��IJ Qt 1_p0�oo (a)Building Permit Fee
2. Electrical �C (b)Estimated Total Cost of
Construction from 6
3, Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = 0 +2 +3-+4 +5) 1 at Q Check Number M57 tl�71-1-
This Section For Official Use Only
Building ermit Number: Date
g Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
f
_. r BP-2009-0216
GIs#: COMMONWEALTH OF MASSACHUSETTS
' : 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-2009-0216
Project# JS-2009-000281
Est. Cost: $12600.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sq. ft.): 29185.20 Owner: CAPERS RAYMOND L JR&PHYLLIS
Zoning:URB Applicant: RCI ROOFING
AT. 344 BRIDGE ST
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTONMA01027-0309 ISSUED ON.812812008 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• Date Paid: Amount:
Building 8/28/2008 0:00:00 $35.0012693/12658
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo