12C-069 (2) RC.i. Roofing, LLP
51B Holyoke Street
P.O.Box 309
Easthampton, MA 01027 Estimate Date
Phone(413)527-4775 2/23/2006
Fax(413)527-8469
Name/Address Job Location
Joe Bednarz 52 Carolyn Street
13 Connshire Drive Florence, MA
Waterford, CT 06385 (860)443-5132
Terms Rep
Estimate valid for 60 days Mike
Job Description Total
Remove existing roofs. 5,150.00
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 IN THE LATE SPRING.
Total $5,150.00
TERMS OF PAYMENT
30%Upon delivery of materials Q, /
70%Upon completion Customer Signature ( (c�
Registration# 126235
Construction License#074334 Date
Insured by Reynolds,Barnes&Hebb,Inc.413-447-7376
=Or�O e + •oaKa.�
Grit r of 'Nar littmptnll
8
,r_� �laasachnsctta'
DEPARTMENT OF BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060 <,
W ORTCER'S COM ENSATION INSURANCE AFMI AVIT
e of R00fina
(litxnscrltxrmiutx>
'Mth :: principal place of busiucssJresidence at:
Jr (phone# -�T75
strut/ tylstawzip)
do hereby certify, under the pains and penalties of perjury, that:
am an employer providing the following worker's compensation coverage for my
emplovices working on this job:
Al Group 681bb1D l0 5 Ob
0-us rance Company) (Policy Number) (ExpirationDate)
O am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
:lame of Contractor) (Insurance CompanyiPolicy Number) (Expiration Date)
I-Name of Contractor) (Insurance CompanyrPolicy Number) (Expiration Date)
(Dame of Contractor) (Insuranm Company/Policy Number) (Expiration Date)
(Frame of Contractor) (Insurance Company/PoGcy Number) (Expiration Date)
(etta h az'ditioaal shcct if neccssuy to include iofocmatioa perbdaing to all ooatedors)
( ; I am a sole proprietor and have no one working for me.
( ; I am a home owner performing all the work myself.
'.'TOTE:plcsac be aware thu whilo hoeocowncra who cmptay pasom to do M_ - ce,om&ucdoo or repair work on a dwelt'snt of
not more thsn tbroo units is winch the boaww=raids oc oa the grounds gVutteoaa tbmto are not Scowa1ly eoasidered to be
czn loycrz undo tho worktes coaTc=tioo Act(GLI52,sa l(5)),application by a homeowner fora 6ocpx or permit may evWme tho
lci : status of an omployec under tho Workoes Cotupemation Ad.
I un&=sund ttuc a copy of this etatemmi may be foewardod to the Deputm cd of Industrial Aoeidm&Office of Lour ooa for$n
covcng vaMcsdoa and that failure to sure mw mp uoder soction 25A of MOL 152=lad to the iwpos cn of aimimat PMWO
cocitii:sg of&fmc of up to 51,300,00 v0cc k*isott c d of tip to ooe yen And dyn pmwes to the ft><at of it step Work 0*and I
f1>--of 6100.00 i d><y tpitA me
For dvtm= ►t Wo ody
PeXmit Number _
Map# Lot (.
r. S=Pat=of Liccnsee/Permittee
SECTION 8-,.CONSTRUCTION SERVICES
8.1 Licensed Constructions Supervisor: Not nApplicable ❑
Name of License Holder:;l�l S �. ( 33 "1 jf
License Number
5 - 027 _5 -b3 - 06
Address Expiration Date
Signature Telephone
-R re in >r'v"°`men n r Not Applicable ❑
) a.b 235
Com any Name Registration Number
51 B &ktnK . Stre.zt - P tLBU 301 5- o b - off_
Address Expiration Date
_Uist�ampTon 3. 11)Qrl Telephon 75
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 to 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,daring 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 � ra�.he�
. i
SECTION 5- DESCRIPTION+OF PROPOSED,WORK(che�k�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 0 Renovating unfinished basement Yes No
Plans Attached Roll 0 - Sheet 0
— If M �n NW- ETN ` n b � o :
a. Use of building : One Family Two Family Other
b. Number of rcoms 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
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
J-0e, &idnaYZ as Owner of the subject property
hereby authorize Aark S P c f1vin to act on
my behalf, in all matters relative to work authorized by this building permit application.
'In .5/101 06
Signature of Owner Date
I, Mark -De1Wt. (as -Ut'n nii agent. 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 beief.
Signed under thepains and penalties of perjury.
Prin=Name
51101016
Signature of Own(r/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
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
uilding Department
212 Main Street
Room 100
N, hampton, MA 01060
phone 43.587-1240 Fax 413-587.1272
i O Sp& all
APPS;ICAIt,f Nti4.&. N-STRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
J
SECTION 1 -SITE INFORMATION
This sects `°' b"'co ° t
1.1 Property Address: f
aYo u n
St
Maps of
py
f1K,e!'1C�_ Zone a Oi►erlay�Dsis
Elm St. District -- ,CB'-District °
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: 3 Con nShIYG 1�'-
eJ'op, �a' eYrc�. CT 0(313 5
Name(Print) Curre t ai n Ad ss
Add :
attacher-I �y 4 A 513Z
Telephone
Signature
2.2 Authorized Agent:
M9 - Easthamnt r, Ma
Name(Print) Current Mailing Address: T 0IO2.1
Sig ature Telephone
SECTION 3 -'ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
—completed by ermit applicant
1. Building Roof i n -4 5 V•lJO (a) Building Permit Fee
2. Electrical (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 Check Number
This Section For Official.Use Only
Building Permit Number: Date Issued:
Signature:
Building,Commissioner/Inspector of Buildings Date
w
' BP-2006-1215
GIs#: COMMONWEALTH OF MASSACHUSETTS
ONAMOMW CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category BUILDING PERMIT
Permit# BP-2006-1215
Project# JS-2006-1798
Est. Cost: $5150.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Groin RCI ROOFING 126235
Lot Size(sq. ft.): 13155.12 Owner: NOLL GERTRUDE&
Zoning:URA Applicant: RCI ROOFING
AT: 52 CAROLYN ST
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTONMA01027-0309 ISSUED ON:511212006 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 5/12/2006 0:00:00 $25.008676
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo