25C-181 RCI
RoOlYlg, LLP
51B Holyoke Street
P.O. Box 309
Easthampton, MA 01027 Estimate Date
Phone(413)527-4775 6/15/2005
Fax(413)527-8469
Name/Address Job Location
Lydia Collins House only
91 North Street 91 North Street
Northampton, MA 01060 Northampton, MA
Cell#: 374-5836
Terms Rep
Estimate valid for 60 days Mike
Job Description Total
Remove existing roofs. 6,300.00
Furnish&install aluminum drip edge,pipe flashings and chimney flashings.
Furnish& install new lead counter 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 Heritage Series shingle.
Furnish and install Cor-A-Vent 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 $6,300.00
TERMS OF PAYMENT 30%Upon delivery of materials y►.t V�;4
70%Upon completion
Registration# 126235 're Customer Signa
Construction License#074334 Date d
Insured by Hackworth Insurance(413)527-9907
tIAM P J &1\
04��°$ CrLZf� lorf �.drz#t�ttnt��un
$ 6 �asfachnntte'
m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSUIL NCE AF i AVTT
i, Yar- -��A. sle
(li censcc/permi flee)
with a principal place of business/residence at:
(phone#
street/ ty/staie/rip)
do he:eby certify, under the pales and penalties of perjury, that:
XI am an employer providing the following worker's compensation coverage for my
employees wording on this job:
ertv Mutual )992-3IS-317124-1)q 10 5 D
( cc Company) (Policy Number) (Expiry on Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the co:atractors listed below who have the following workers compensation policies:
(,lame of Contractor) (Insurance CompMlPoticy Number) (Expiration Date)
rr
C`l ame of Contractor) (Insurance,Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attad-additioml sixct iFnocexury to include iafonnation pertaiaing to an ooatmc 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 whilo homoowncn who employ pasoas to do mxkacn•n r,cotnretioo or repair work on a d—Wag of
not morc th:.n throe units is winch the homoo racr residcs oc on the grounds appurtenant thatto arc not gCa 4 oomidard to be
cmployrrs undo the workex.00a4>cns4oa Act(GL152,ss l(5))�application by s homeowoa for a licenz cc permit—Y-id—the
legal nano of an oaployoc under tho Woricoet Compomatioa Act
I un.irntaad tbai a copy of thin alai cmcw may be forwarded to the Depart=nd of Industrial Aocsda&Oflioe of Imo-w for%be
cowry Sc vaificatioa aad that failure to seatre nova-xv under seciioa 25A of ROL 152 can lad to tba itttpositioa of aiminsl ptalwa
ooasistatg of a&ne'of up to S 1,500.00 tmd(or imprisottttten!of up to one ysat end tivt7 P=&WC$is t6a foon of a Stay Word 4r+dtr WA t '
fuse of.;100.00 i day Lpinst ma.
For d --caly
permit Number
ap _ Lot
j„ #
t; Sigaatnro of Lic=--wJPer=ttcc
SECTION.8'-.CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :y ay is)e— f7 74 ' 3 4
License Number
5 - �asl b a im n Na. n=7 5 -03 - Ob
Address Expiration Date
Signature Telephone
Rs° ererrie a ovement ontreto ,�,� ��� Not Applicable ❑
0o i�a 12-6 235
Com any Name Registration Number
519 &WD e- S rejet - ED- Box 301 5- o b - OIL
Address J Expiration Date
Telephon 7.
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...... ❑
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 actin-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 a.t ,al.�1e
tNewHouse DESCRIPTItON'&PROPOSED WORK'(66e k all applicable)
❑ Addition ❑ Replaceme nt Windows Alteration(s) ❑ Roofing
Or Doors ❑dg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attached Roll 0 - Sheet 0
6a. If New house acid or addition"fo exi'sting Kddsing complefie tth f t1-6V
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?
In. 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,-OWNERAUTHORIZATION-TO BE COMPLETED WHEN
OWNERS.AGENT.OR CONTRACTOR APPLIES,FOR BUILDING PERMIT
Fhereby CQ1ii ns (+ as Owner of the subject property
authorize ,Marls D141 SlP �7 ��.��� Ind to act on
behalf, in all—matters relative to work authorized by this building permit appplication.
C�L�aC f 1 P A
Signature of Owner Date —
[hereby Mark ` A 1 SI L G15 'Au nY l A a4 °�--nt as Owner/Authorized Agent
declare that the statements and information on the foregoin application are true and accurate, to the best of my
nowledge and belief.
Signed under the pains and penalties of perjury.
Print Name
ti Jai 05
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
f 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:
a
City of Northampton
_._ — Bitricng Department
r
; `J.2 Main Street
_. Room 100
Northampton, MA 01060
ahbniG 3-58-Y-1240 Fax 413-587.1272 t
A PLICA, l'bl I',0 CON; TRUCT�ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: Thls sec#i ` #o bean'°y t
91 KDY'� S Y�d' 17
Ma � �
Zone r 0verlay��UtstAr,
v M
Elm St. District CB Distrct
SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Lv i a, /David eollins 1 XaA St. 1 h)`-Ian
NarAe(Print) Cu i I i n r s
attached ��� s:
Telephond
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address: 0102. /
0113) 5a7- WN S I
Sig ature Telephone
SECTION 3 ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building ROOf 1 n 3001-00 (a) Building Permit Fee'
2. Electrical 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) �Q. Q Check Number
This Section For Official Use Only
Building Permit Number: Date Issued;
Signature:
Building Commissioner/Inspector of Buildings Date
9=1 NORTH ST BP-2006-0351
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 25C- 181 CITY OF NORTHAMPTON
Lot: -001
Permit: Buildinq
Category: BUILDING PERMIT
Permit# BP-2006-0351
Project# JS-2006-0514
Est.Cost:$25.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sq. ft.): 5706.36 Owner: COLLINS DAVID W
Zoning.URC Applicant: RCI ROOFING
AT: 91 NORTH ST
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTONMA01027-0309 ISSUED ON.912912005 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 9/29/2005 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo