25A-158 . . Roofing,.,.
51B Holyoke Street
P.O. Box
Easthampton, MA 01027 t' m ate Date
Phone (413) 527-4775
Fax (413) 527-8469 6/12/2008
Name/Address Job Location
Darcy La Rock .4- 6' re93 66,rr e(- 242 North Street
242 North Street Northampton, MA
Northampton, MA 01060 584-9550
Terms Rep
Estimate valid for 60 days Rich
Job Description Total
Remove existing roofs. (Front porch excluded) 10,400.00
Furnish & install aluminum drip edge, pipe flashings, chimney flashings and step flashings.
Furnish & install new lead counter flashings.
Furnish & install CertainTeed Winterguard ice & water barrier along eaves, valleys, and entire
front porch & rear addition.
Furnish and install 15 lb. felt.
Furnish and install 30 year CertainTeed Woodscape Series shingle.
Furnish and install CertainTeed approved ridge vent.
All exterior 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. 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 $10,400.00
TERMS 0 PAYMENT _
5%Deposit
Balance upon completion Customer Signature
Registration# 126235
Construction License# 074334 Date
Insured by Rcynolds. Barnes&Hebb, Inc. 413-447-7376
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DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AF'FEDAM
L �.Na leli5le of Poofina
(licensec/permiuee)
with a principal place of business/residence at:
-51aA4*—StjEas ampthin -Ma.
st=Uc ty/statdz:ip)
do hereby certify, under the pains and penalties of perjury, that:
WI am an employer providing the following worker's compensation coverage for my
employees worlan on this job:
The=nsurance, ;ompanj d
-gestate f Pen A6 a 0 05 0
(Insurance Company) (Policy Number) irat>,on Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Numba) (Fjcpixa6oa Date)
(Name of Contractor) (lasurance Compaay(PoUcy Number) (Expiration Date)
(Name of Contractor) (Insurance Compa y[Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additioml:beet if noc c=x y to iochsde iafonnatioa pertaining to all oocdmd rs)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:pi==be aware that whilo homeowners who=plat pcssom to do mai a=nce,oc==aioa or repair work on a dwelling of
not morn than thrvo units in which the bomoownrr rt4dm oc oa the grtwt 6,appurteuard tb=w arc not&moaa11y ooaikkrcd to be
cmploycrs under the worker's,=np=satfcn A t(GL152,ss 1(5))�application by a homeowner for a fiomse or permd may evideooe the
legal ctatua of an employer under tin Workers Compematioa Ad.
I undczataud tb a copy of this rutty of may be forwarded to tbo Dcputcn o of Industrial Aoddea&Ofboo of Insunnoe for the
cvverago vcri cdioa and that failure to secure eave:r p under souion 25A of MOL 152 can toad to tba imporition of criminal penalties
consisting of a fine of up to S1,500.00 and/or i 4r6onmcnt of up to ono ytar and civil pasalties is the fcxm of a Stop Work order and a
fum of 5100.00&.&Y against M
For&vW11b1 uw cot)'
Ao/c& #
permit Number
r Signature of Liceasee/Permittee Late ;.
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: M. k p. j(S I e. t7?Jq 33'/j�
License Number
51 ES Munk amp n Ma. o 11)21 5 - M - 0
Address Expiration Date
Signature p hone
9. Registered Home Improvement Contractor: Not Applicable ❑
.L' . 1. on Ana 12b235
Company Name ) Registration Number
�1 wak S _Y t - P o. x X09 5-0L-10
Address i Expiration Date
M.1- 01 Q 17 Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(S)) _7
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...... ❑
1 1. - Home Owner Exemption
ITe current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families
anJ 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.
Stich"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 buildine 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,States and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House Addition ❑ Replacement Windows, Alteration(s) ❑ Roofing
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks Siding[O] Other[o]
Brief Description of Proposed }.ache�
Work: ��L
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 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. Masscheck E=nergy 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 builcing 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
I, Y 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.
a �tas! ed g laolog
Signature of Owner Date
I,
may SIC
as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing 4lication are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Print Name
81201og
Signature of Owner/Agent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Let Size
Frontage
Setbacks Front
Side L: R: I,:-
Rear
Building I leight
Bldg. Square Footage
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fi!1:
(N c,lmnc&l.pcation)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DONT KNOW 0 YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW 0 YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued.
.l
C. Do any signs exist on the property? YES 0 NO Q
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO
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 0 NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
•w
Department use only
AF
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Pe mlt E
212 Main Street Sewer/SepticAvailabitity.
C6 j'6 Room 100 WaterNVell Availability
_ Nort ampton, MA 01060 Two Sets of Structural flans _
Phone 4' 587-12,40 Fax 413-587-1272 Plot/Site Plans ' '.
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
02)42 Worth Stye-et Map— Lot Unit
Zone_ Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Da2J4 2 North. . I Ct on
Name(Print Current Ad
Telephone
Signature
2.2 Authorized Aqent:
P.0 &x 30!1 - East a a.
Name(Print) Current Mailing Address: 01021
1 527- 4115 ELI
Signature Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building }� K)/ 400-00 (a)Building Permit Fee
2. Electrical w (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 +2+3+4+5) 1 Q . Check Number
This Section For Official Use Onl
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
BP-2009-0215
pis#: 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-2009-0215
Project# JS-2009-000280
Est. Cost: $10400.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sq.Al 32060.16 Owner: LAROCK DAVID R&DIANNE L
Zoning URB Applicant: RCI ROOFING
AT: 242 NORTH 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 STREE77
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