28-018 (2) RCI R LLP
51B Holyoke Street
P.O. Box 309 „
Easthampton, MA 01027 Estimate Date
Phone(413)527-4775 4/15/2005
Fax(413)527-8469
Name/Address Job Location
Justin West 203 Sylvester Road
203 Sylvester Road Northampton, MA
Northampton, MA 01060 586-8305
Terms Rep
Estimate valid for 60 days Mike
Job Description Total
Remove existing roofs. 7,300.00
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. `�, D
5 year R.C.I.workmanship warranty included. �e(2 N
30 year Tamko material warranty included. )goo 0 cw6 �,1j 5ea C
All related permits will be obtained by R.C.I. Roofing. yV �tJTT ,„`
SPECIAL ITEMS NEEDED ?&11-12000D
Add$2.50 per sq. ft. for wood replacement if needed.
Price includes repairing metal roof with EPDM flashing at no additional charge.
Leak is most likely around chimney.
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total $7,300.00
TERMS OF PAYMENT
30%Upon delivery of materials
70%Upon completion Customer Signature
Registration# 126235
Construction License#074334 Date
Insured by Hackworth Insurance(413)527-9907
4tttANPT
�Q ape
� e
,�assachnsttta'
of Wart Ilaillp ton E_�
m DEPARTMENT OP BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE A.FFA MA.VIT
(li censerJpermi flee)
with a principal place of business/residence at:
5111 Ll•� (phone#X�� _.gq'75
atreev
do hereby certify, under the pains and penalties of perjury, that:
XI am an employer providing the following worker's compensation coverage for my
employees woridng on this job:
JU kert v M teal 10/5/05
ce Company) (Policy Number) (Expua on Date)
( ) I Lm 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) (lnmuance Company/poticy Number) (Expiration Date)
(Name of Contractor) (Insurancc Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Comparry/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Colnparry/Poticy Number) (Expiration Date)
(attac?'a.3ditiocal sheet if ne�eessuy to include information pertaining to all ooatra.dors)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:ptcaae be aware that whilo bomoowncra who employ p=om to do maic�oomtrviceioa or repair work w a dwelling of
not more than throo units in which the homeowner midcs or on the€rounds zppurtcmant thereto are not generally comakmd to be
emp1or 3 under the work&%ooaVc=4on Act(GL152,sa 1(5)),application by a homeowner for a liaise or permd may evidc=tho
legal clams of an ecsployer under the Workoe,Compensation Act
1 un icrstand thrt a copy of thu ctatemcat may be forwarded to the DVutmmQ of Industrial Ao6dea&Office of Irora+noe for the
coverage verification and that fadurt to socttre Covcrago tinder SCCtioa 25A of MOL 152 can land to tho imposition of aiminal pataltios
00austin of a fine of up to S 1,500.00 andlor bnprisoanxd of tip to one year and eivt7 penawes in the form of a stop WA Order and a '
fires of S 100.00 a day against the
For degs-fta rd tun Cary
Permit Number
Mao Lot#
Signa.brc of LiccnscrlPcrmitfcc �{y[.r•
T ,
SECTION 8:-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :- e S e.
License Number
5 - �a7 _ 5 -03 - Ob
Address Expiration Date
0413 523- 4U
Signature Telephone
R Tf MsTef e m Mt r. vme nr Not Applicable ❑
!2.b 235
Com any Name Registration Number
51 B Ap vn a, Street - P.p3m. Box 3 5- Ob - Ob
Address Expiration Date
Telephon (5
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 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 a t.taebe�
f
I�
SECTION 5-�6ESCRIPTI614iOI PR'OPOSED�WORK(chi&all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative ❑ Renovating unfinished basement Yes No
Plans Attached Roll 0 - Sheet 0
6a IfNewhouseand �tlditlon° toezisting;hoising, cormple 'eth�fl`lo L;
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?
h. Type of construction
L 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-OWN ER-.AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS.AGENT OR;CONTRACTOR APPLIES FOR BUILDING PERMIT
n Y�est- as Owner of the subject property
hereby authorize aY sl P Ro&na to act on
my behalf, in all matters relative to work authorized by this building permit application.
eAIed 9-q-05
Signature of Owner Date
I,
Mark 'D AWL 2i6 1 4 en t. as Owner/Authorized Agent
hereby declare that the statements and information on the foregointJapplication are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
Aolsl e--
PrintNaame
9•9- 05
Signature of Owner/Agent Date
VW «.
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:
City of Northampton
Building Department
212 Main Street
Room 100
Northampton, MA 01060
phone 413.587.1240 Fax 413.58TI-2-72-
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH-A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: This sec d
Zone Oi►erlay Dis r c
nT
Elm St. District CB Di�tnct
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Jus n))Aesfi z3soi6e Ion�____
Name(Print) C�e�gt lvlaMi i��dsjr�s:
Aft-A6e Telephone (�
Signature
2.2 Authorized Agent:
NIaYh'-A)e.1i51e, - 9. 0.1 Rooflno P.U. Y, • EaAhal notes Ma
Name(Print) Current Mailing Address: 0102.1
513) 522- 1 75
Sig ature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars) to be Official Use Only
completed by ermit applicant
1. Building ROOF l n ��OO•W (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) 0.0Q 1 Check Number
This Section'For Official Use Only
Building Permit Number: Date Issued:
Signature`
Building Commissioner/Inspector of Buildings Date"
203 SYLVESTER RD BP-2006-0270
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 28-018 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category BUILDING PERMIT
Permit# BP-2006-0270
Project# JS-2006-0391
Est. Cost:$7300.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor., License:
Use Group: RCI ROOFING 126235
Lot Size(sg. ft.): 108900.00 Owner: WEST JUSTIN P
Zoning:RR Applicant: RCI ROOFING
AT. 203 SYLVESTER RD
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTONMA01027-0309 ISSUED ON.•911212005 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 9/12/2005 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo