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25C-232 SUN 5 �as\no ect`on R.C.1.-R-- oofin ��e�t<iG�oc hamC 1u 6 Line Street,Southampton, MA 01073 Phone: 413-527-4775 Fax: 413-527-8469 C. Miller Building Inspector Northampton Building Dept. I request that you grant a modification to waive the requirement for control construction for the project at 161A — 163B Bridge St. in Northampton because the work is of a minor nature, will not affect health, accessibility, life and fire safety, or structural requirements and is impractical in that the cost of control construction is considerable when compared to the cost of the proposed work. Thank you for your consideration. Respectfully, Mark Delisle (partn R.C.I. Roofing, LLP 6 Line St. Southamptopn, MA 01073 Roofill RC.I. � Date 6 Line St. Estimate Southampton, Ma. 01073 3/22/2014 Phone(4 13)527-4775 Fax(413)527-8469 Name/Address Job Location Amy Perrier 161A-163A Bridge St. 4 Birchwood Dr. Northampton, MA 01060 Huntington, MA 01050 �l Terms Rep Estimate valid for 30 days Chris Description Total Remove existing roofs. 13,500.00 Furnish & install aluminum drip edge, pipe flashings, chimney flashings and step flashings. Furnish & install CertainTeed Winterguard ice &water barrier along eaves. Furnish and install synthetic underlayment over existing deck. Furnish and install Lifetime CertainTeed Landmark 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. Lifetime CertainTeed material warranty included. All related permits will be obtained by R.C.I. Roofing. Add $2.50 per sq. ft. for wood decking replacement if needed. A Certainteed Surestart plus warranty will be included with a fee of$580.00 absorbed by RCI Roofing if signed within 7 days. This extended warranty means that 25 years of the Lifetime warranty is covered for labor and materials. The remaining years of the Certainteed warranty would be covered for material only. Customer is responsible for securing interior items and any attic debris from roof removal. T Total $13,500.00 TERMS OF PAYMENT c. 5%Deposit Balance upon completion Customer Signature It Registration# 126235 Construction License# 074334 Date Insured by Banas&Fickert Ins. (413)527-2700 The Commonwealth of Massachusetts Department of Industrial`Accidents Office of Investigations 600 Washington Street Boston, MA 02111 r mm.mass.gov/dia Workers' Compensation Insurance Affidavit; Build ers/Contractors/Electricians/Plumbers pphcant Information Please Pi7n:t Legibly (ame (Business/Organization/Individual); ��,' tip�� C,,g� ,ddress; ;ity/State/Zip; ­ V, '7 3 Phone #; (x Q) SFr -Z5 re you an employer? Check the appropriate box; Type of project (required): I am a employer with Z 0 4• ❑ I am a general contractor and I 6, ❑ Tvcw oonstruction employees (full and/or part-time),* have hired the sub-contractors ❑ I am a sole proprietor or partner- listed on the attached sheet. Remodeling ship and have no employees These sub-contractors have 8, 0 Demolition working for me in any capacity, workers' comp, insuuance, 9. ❑ Building addition [No workers' comp, insurance 5. ❑ We are a corporation and its required,] officers have exercised their 10•❑ Electrical repairs or additions ❑ I am a homeowner doing all work right of exemption per MGL 11•❑ Plumbing repairs or additions myself, [No workers' comp, c• 152, §1(4), 'and we have no 12. Roof repairs insurance required,] t employees, [No workers' 13.7 Other comp, insurance required.] iy applicant that checks box fl must also fill out the section below showing their workers'coinpensation policy information: Dmeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new offldavlt uidicating such, ntractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers' comp. policy information, m an employer that Is providing workers' compensation insurance for my employees. Below is the policy and job site ormatiom urance Company Name, licy#or Self ins• Lic, #; W C � (0lA3y O 5 Expiration Date JO Site Address; RA A -�(;:S A Vic-,, X o,e_ City/State/Zip;eUav-� ,%,, tvI �1,1n ,01 t 0 tach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date), ilure to secure coverage as required under Section 25A of MGL c, 152 can lead to the imposition of criminal penalties of a ,e up to $1,500,00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine up to $250,00 a day against the violator, Be advised that a copy of this statement may be forwarded to the Office of vestigadons of the DIA for insurance coverage verification, to hereby certify under the pains andpenalties of perjury that the information provided above is true and correct. Date: ° F-0 ly mature, .� tone Official use only. Do not write In this area, to be completed by city or town official. City or Town: Permit/Llcense # Issuing Authority (circle one); i. Board of Health 2.Building Department 3, City/Town Clerk 4, Electrical Inspector 5, Plumbing Inspector i 6, Other Contact Person; Phone #; SECTION 8 • CONSTRUCTION SERVICES 7 8.1 Licensed Construction Supervisor; ��1 Not Applicaablle ❑ Name of License Holder: N�2Y 4.[[r`1S l e, '77U34 License Number Address Expiration Date Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ 'L 'Roo Ana 1.�b235 Company Name J Registration Number HcoreS� Expiration Date 0 , ��3 TelephonE�11, - '7 SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152, §25C(S)) 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 for"horpeowncrs"was extended to include Owner-occupied Dwellings of one(1) or two(2)families <<rd 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'onc 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-for which this permit is issued. ,also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153(Liability of Employers to Fmployees 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 i SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition [❑ Replacement Windows Alterations) ❑ Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[] Siding [®] Other[®j Brief Description of Proposed }� Work. Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes —No Plans Plans Attached Roll -Sheet 6a. If New house and or addifion to existing ho.usin_q, 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 Energy Compliance form attached? h Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr, fioodplain Yes No j. Depth of basement or cellar floor below finished grade K Will building conform to the Building and Zoning reguiatlons? 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 I t cc- �'` as Owner of the subject Property y, hereby authorize Y?S e �• ���� to act on my behalf, in all matters relative to work authorized by thisIbuiCcling permit application, a tai d s°- 7o-IQ Signature of Owner Date U nY 17� as Owner/Authorized I 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 5_Za J 'l Signature of Owner/Agent Date ^ Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomp(ete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Rear Building Height Bldg.Square Footage % .Open Spate Footage % (Lot area rninus bldg&paved 4 of Parking Spaces A. Has aSpedai Permit/Vahance/Finding ever been issued for/on the site? _ NO 0 DON'T KNOW 0 YES 0 ' ` IF YES, date issued,! / IF YES: Was the permit recorded at the Registry o/ Deeds? NO ��� � DON'T KNOW �~��� YES /�L�� IF YES: enter Book | Page! } and/or Document �! ' B. Does the site contain a brook, body of water orwetlands? NO ��� � DON7 KNOW �—��� YES y-��� IF YES, has permit been or need to be obtained from the Conservation Commission? Needs tnbeobtained /�� Obtained �`� Date Issued: | »�� k�� ' ' | C. Do any signs exist on the property? YES ��/=~� �� NO �~� IF YES, describe size, type and iocatinn' | | . | D. Are there any proposed changes toor additions of signs intended for the pnoperty ? YES ��/-� NO IF YES, describe size, type and location: � ! E. Will the construction activity disturb(clearing, grading vahnn, or filling)over 1 acre or is it part ofa common plan that will disturb over 1 acne? YES / � NO �� »~v �_� IF YES, then a Northampton Storm Water Management Permit from the DPW|a required. Department use only I City of Northampton status of Permit: C� I H Building Department Curb Cut/Driveway Perm., _ 1 I 212 Main Street sewer/Septic Availabiitty- MAY 2 3 2014 j Room 100 :Wa�terMell Availabil ty orthampton, MA 01060 Two Sets of Structural Plans tectric, Plumbing&Gas i ;�4 3-587-1240 Fax 413-587-1272 PIot/'Site Plans Northamplcn, h1A 01060 [Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 •SITE INFORMATION This section to be comp ted by office 1.1 Property Address: y i to( A I - 1( 3 A I&I", � Map `' Lot �J Unit Ajo"C'��-�° F�"� ,\ n'� Zone Overlay District _ Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Qmtut �N�f`, ie- LA �.rc�.�ex,c� Sir. 1�ttirs�,e➢e ,n� Mrs oto.So Name(Pr' i) s Curr nt Mailing Address: 19 ttaehed �yta� . - �t�tzg Telephone Signature 2,2 Authorized Agent: {/^ Sc'-I�amo /^' Ma. Name(Prim) � Current Mailing Address: 527- '4775 Signature Telephone SECTION 3.•ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building &D fin 4 ? C ®o ± (a) Building Permit Fee —1I 2. Electrical J J 'J (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) oo c Check Number T L2 This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date Northampton, MA Property Detail Page 2 of 2 Prime I 110ther Improvements: Site L I creage Type yp Street/Road T e Acres alue no no information information Sales Info 1FPermit Info ate Type Price Validity Date Permit# Price urpose 07/29/2011 Land+ 685,000 =V - 07/27/2007 96 35,000 EW SIDING Bldg http://www.northamptonassessor.us/noho/commdetail.php?map_no=25C-232-001&pageca... 5/27/2014 Northampton, MA Property Detail Page 1 of 2 City of Northampton, MA: Commercial Property Record Card New Search Property Type Classification Code Reference Card 1 of 2 12 Parcel - Location - Zoning - Assessment Map-Block-Lot: 25C-232-001 Zoning: Assessment: Location: 159 BRIDGE ST Neigborhood: 8 Land: 114. #Living Units: 7 Deed Book: 10614 Building: 358, Class: A-111 Deed Page: 40 Total: 473. Building Information Building Sketch Bldg #: I Year Built: 1900 3 F 13 'G 4 # of Units: 3 4 22 Quality Grade: C # Efficiencies: 0 1B 7e 1s `� # 1-Bedroom: 0 # 2-Bedroom: 3 5 4 # 3-Bedroom: 0 12 UAl2sFRIB Covered Parkin g: 0 ° 16 5 Uncovered Parking: 0 4 Total Unad. RCN: 123,700 Total Unadj RCNLD: 177,880 18 73 Grade Factor: 1 22 # Ident Units: 1 12 10 D 7 E 7 Func/Econ Factor: 1 RNCLD: 177,880 [Attached Improvements Detail Information: ype Meas-1 Meas-2 Meas-3 # Units Levels Use Ext Walls Heat ©% G--ood na RP7 72 - B 1 91 F-1 F_ 88� 1�� - O1 11 Frame HW/Steam F �0 C ® 88 HW/Steam❑C�C 154��� _ Al 86 Frame ��❑��C 1 700 1 1 and Data 110utbuilding Info S ware Foot T yp e jUtilities Descr Length Yr Phys Fur Widt or Size Qua Built Cond Uti SQ Value no Type Feet information no F,5771 114,570 information http://www.northamptonassessor.us/noho/commdetail.php?map_nO=25C-232-001&pageca... 5/27/2014 File#BP-2014-1258 APPLICANT/CONTACT PERSON RCI ROOFING ADDRESS/PHONE 6 LINE ST SOUTHAMPTON (413)527-4775 PROPERTY LOCATION 161A- 163A BRIDGE ST MAP 25C PARCEL 232 001 ZONE URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out AL I Fee Paid Typeof Construction: STRIP&SHINGLE ROOF New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• Owner/Statement or License 74334 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOY04ATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demoliti9fl.Pelay �-y Sigdl4awf Bui dig fficial Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. 161A- 163A BRIDGE ST BP-2014-1258 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 25C-232 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2014-1258 Project# JS-2014-002118 Est. Cost: $13500.00 Fee: $81.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: RCI ROOFING 74334 Lot Size(sc. ft.): 6577.56 Owner: GOLOB BERNARD M C/O AMY M PERRIER Zoning. URC(100)/ Applicant: RCI ROOFING AT: 161A - 163A BRIDGE ST Applicant Address: Phone: Insurance: 6 LINE ST (413) 527-4775 Workers Compensation SOUTHAMPTONMA01073 ISSUED ON.6/4/2014 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 6/4/2014 0:00:00 $81.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner