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25C-105 (6) RCI ROOFING 30 HIGH ST -- EASTHAMPTON MA 01027 ESTIMATE (413)527 4775 FAX (413)527 8469 Date: OCT 6 2000 Estimate To: NICK REPETELLIS Estimated By: CHRIS THOMPSON 236 BRIDGE W.54- Start Date' NORTHAMPTON,MA 01060 Job Location: NORTHAMPTON Job Phone: 586 5106 JOB DESCRIPTION FUgNTSH A Up INSTATL ICE & WATER F3ARRTFP ALONG EAVES AND VALLEYS. SPECIAL ITEMS NEEDED Additional information pertaining to this Job Estimate TERMS OF PAYMENT 30%PRIOR TO START Total Estimated 70%UPON COMPLETION Job Cost $8 000.0 CONSTRUCTION LICENSE#074334 FEDERAL I.D#3418839 Authorized REGISTRATION#126235 Signature INSURED BY BANAS INSURANCE(413)527 0288 DUPLICATE-CLIENT COPY i(Ub O PT0 IF - a 6xsaxriinsctta' m DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT with a principal place of business/residence at: ca/v Z 7 _ 1/1 11-/ n 41 �� Sf yr► 1 /'�� (phone#) �l/3 �. - q 7 7S (suet ty/statf'/ap) do hereby certify, under the pains and penalties of perjury, that (- am an employer providing the following workers compensation coverage for my employees working on this job: ce Company) (Policy Number) (Expiration Date) O I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workees compensation policies: (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Compar y/Policy Number) (Expiration Date) (Name of Contractor) (Insuran(-- Company/Pohcy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (atlacn additioml shed ifneocnary to i cWc mflx uAon pertaining to nil ooatrac rs) ( ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:please be aware that whilc homcowom who employ pcznaas to do maiulcnancc,omst ton or repair worts oa a dwelling of not more than throe units in which the homoowncr residcs or on the grounds appurteuan1 therdo arc no(generally ooandcred to be employers under the worker's ocmp=,ztion Ad(GL152,ss 1(5)�application by a homcowwr for a loam or permit may evidcnoe the legal stazua of an employer under the Wor$ees Compomation Act I undastaad that a copy of this statement may be forwarded to tho Dcpartu.A of Industrial Accide-&Oflioo of Insurance for the rlkk coverage verification and that failure to sect=ooverago under st'-U a 25A of MOL 152 can lead to the imposition of crw=x1 penalties ooaiisiiag ofa fine of up to S1,5oo.00 andlor imprisosmxslt of up to one year and civil peaaltia in the form of a stop Worts Ord-and a fine o(5100.00 a day agairbsi ma For dT-tmentnl—only Permit Number Map4 Lot# Si gnahtre of Licensce/pe=ttee e .-.00N5TRUCTION S 1 Licensed Construction Supervisor: I Not Applicable ❑ ,/ Name of License Holder : / '� o e l°S I P 0 y 3 3- r License Number Address Expiration Date Signature Telephone Not Applicable ❑ Company Name _ Registration Number (10 Af Address Expiration Date Telephone 5-j -7 q 7 7,S SECTION 10 YYC�RKERS'COMPENSATION 1NSt1 NP�APFi13AVIT(M G L C.152;§2SC>GFt}) 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 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 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 s ., New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing J' Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work:_S�0 S/,, d Alteration of existing bedroom Yes No Adding new bedroom Yeso Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll ❑ - Sheet❑ 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? 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 Cl ION 7a 0,1� R A,,'UM MA" ION TO 1, 'OMPL_ Wt#Et� fNlFiS AGf "O GO �RAOPPLES Qi BFt1.t11G PIMl1"' 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. Signature of Owner Date as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. igned under the pains a pens ies of perjury. Grp /9 5- Print Name Signature of Owner/Agent Date r 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: R City of Northampton Building Department 212 Main Street Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413-587.1272 APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING &,ECTIi�N 1 ,SI�'E INF4�FIIVIATIi�N .. ' , 1.1 Proper y Address: f 1 Y��''��4✓�� +.: y '' < ley ' ✓� SECT 3N 'w I RQ tT1C 4WI RSHIt��l�ta1'HO"ED A jilk 2.1 Owner of Rec(�ord: t' Name(Print) Current Ma.Wrig Address: Telephone C �. Signature J (cr 2.2 Authorized Agent: di GrT /' D P . Sly' Genf 5 � 7�h � 4 , Name(Print) Current Vailing Address: Signs ure Telephone CQSJ ON , Item Estimated Cost(Dollars)to be Oflrcial Use Only completed by ermit applicant 1. Building (a)Building Permit fee= 2. Electrical (b)EO[ftted Total,Cost cif' Canstr ct�an from 6 .', . 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 +2 + 3 +4+ 5) pfd h cC q.p er . Building permit Numbed: Date issued° Date Bulldin COrr�rrti* lor��Y/tnsp tc�r of�utldings' . F 236 BRIDGE ST BP-2001-0507 GIs#: COMMONWEALTH OF MASSACHUSETTS Qap.Block:25C- 105 CITY OF NORTHAMPTON Lot:-001 Permit: Buildinq Category:roofing BUILDING PERMIT Permit# BP-2001-0507 Project# JS-2001-0874 Est.Cost: $8000.00 Fee:$25.00 PERMISSION IS HEREBY GRANTED TO Const.Class: Contractor: License: Use Groin RCI ROOFING 126235 Lot Size(sq.ft.): 10497.96 Owner: REPETELLIS NICK Zoning.URB Applicant: RCI ROOFING AT. 236 BRIDGE ST Applicant Address: Phone: Insurance: 30 HIGH ST (413) 527-4775 EASTHAMPTONMA01027 ISSUED ON.11120100 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. Inspector of Buildings Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: 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: Fee Type: Receipt No: Date Paid: Check No: Amount: e**, Building 11/20/00 0:00:00 1495 $25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo