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12C-063 (3) R.C.I ROOFING 40 MAINE AVE. P.O. BOX 309 EASTHAMPTON, MA 01027-0309 ESTIMATE PHONE (413)527- 4775 FAX (413)527-8469 Date: May 5, 2003 Estimate To: JACK DALANEY Estimated By: CHRIS THOMPSON 11 CLOVERDALE STREET Start Date: FLORENCE, MA 01062 Job Location: 11 CLOVERDALE STREET FLORENCE, MA Job Phone: (413) 586-0564 JOB DESCRIPTION REMOVE EXISTING ROOFS. FUgNISH & INSTALL ALUMINUM DRIPEDGE AAjn ALL OTHER RELATED FLASHINGS, FURNISH & INSTALL 151b.FELT OVER EXISTING DECK. FURATISH & INSTALL 30 YEAR TAMKO SHINGLE. 10 YEAR R.C. T. WORI(MANSHTP WARRANTY INCLUDED. SPECIAL ITEMS NEEDED ADD $2. 00 PER SQ. FT. FOR WOOD REPLACEMENT IF NEEDED. Additional information pertaining to this Job Estimate TERMS OF PAYMENT 30%PRIOR TO START Total Estimated 70%UPON COMPLETION Job Cost $5.,600.00 REGISTRATION#126235 FEDERAL I.D.#04 3418839 Authorized , � CONSTRUCTION LICENSE#074334 Signature ��� /c-341 " �1192� INSURED BY HACKWORTH INSURANCE(413)527-9907 ORIGINAL-ESTIMATOR COPY A= yE (riff of partlia))tptoll _ �Zasa+tthntrlla' c� DEPARTMENT OP 13UIt.Df,C [NSPECTIOI:s 212 Main Strcct ' Munic,pal Building Northampton, Maas. 01060 WORKER'S CoMrENSAUoN LtSMZANCE AI'FL7)AV1-I' (LC=SccJperm,ttcc) 9 v-11tb is principal place of business/residence at: ve,_._/ FasA nfon MA 011)a,,Z (phone-,.) ( c tar/statchip) do hereby certifj=, under Lhc.p?-m and penalties of perJury., :N11 (� I am an employer providing the follo%ving worker's comocns-aon cove a,e for my employees \vorUng on't1us job: — �c .1� ciQl v1�5-3�s= �l�la -o33 10 . —. --n=Conraav) (Policy Nwaixr) (ajIrzuor Dat ) ( ) I= a sole proprietor, general contractor or homeowner (ci:cie one) and hive hired the contractors liste+ below vvbo have the following workers camp--nsz6on pokies: (NQR]c Oi Co acto-) (InR rang Coinoan)v'Pobc; N=uIIl!'Cr) (x-mi-juen D:Itc) (N me of Contractor) (lnsuranc-- Comoanvi?o!im, NtunCCr) (::�tir,:tion Date) (Name Of Conuaetor) (msluanc: Company/PoUcy Nambu) (Expiation D31c) (Nam,-of CContractor) (I=ancc Company/PoUcy Numb;.r) (Expiation Dale).(attach(attach addY oral tSeG if eoocaasy w ctdudc ieforma�oo pertaioin6 to.11 oo�aco a) ( ) I am a sole proprietor and bave no one working for me. ( ) I am..a home owner perforTning all the work myself. NOTE:plcx be aware the..{Je boa=,mm wtio flay pe�om w rl� -• c e�oo c ncoa work oo.d..c1Lg of W more tb n e':ra:era is u+uicb the 6o:aoowoe reido«oo nc�aouc+cl,z,purtcen theca Ls wr�o:aV oce:edavi to be c-Ployer undo the wec•k=h o=P==tioa Act(GL152-=1(5)�apptieaoa by a bomoowaa for a lic="Of permit may c%idco=the legal cL% a of an==Ploy.r under dae Wockoet CompemaiioQ AcL f uodcraaod that a non of thin-oc=m..y be foro+ard to the pop.r%ax,d of toi�arri.l Amin y Otrrioe of L>;—for th. *ovcr&cc vaisctioc=W a1u t:iltae to Lacu t:toovC-zv t:ndct soaioa 25 A of MOL 152 mA tad to the imP s OQ of C imiaal pcealtia comistmg of a Gee of up to S 1}00.00 arwce i m yo orup to one year and a.it pcn.ltio in t5c form ora stop Wort;Order and a Gm OCT a day apj=me f«.�.�-r•••�•ruxonry Pcrmit Numbcr Y Lot y SiSnatim of LiamsccJperrniU gg 8 1 Licensed Construction Supervisor:^ Not Applicable ❑ I I Name of License Holder: (o (�Il�. LP, Sle. / /'7 33'4 License Number 7 5 , 3 - 0� Address I Expiration Date x'7'1'5 Signature Telephon e e r Not Applicable ❑ R. C• :r. Ronf� no l ab � 35 Company Name �I-J — Registration Number -40 'Mai r) .11MUC, — P D o BOx 307 5 — L — O Address Expiration Date EQ,(3JhaMDt0n . AA C)169�J Telephone - 117 y,ryR s real `s°yY�, t,qa: R e SSE S' MOMP�tS�1�lONN�FiANCEAFFIDAVIT(MGL c 1k52, § 2.:5C�6J): 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....... $01, 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 (�fIFCl1L � .:;,ski� �m+3t::i .� © =P E I�. :...:...,.. New House 0 Addition O Replacement Windows Alteration(s) O [Roofing Or Doors O Accessory Bldg. ❑ DemolitionO New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work:_RP.ma_Y_e P-xlS'rlr)n Yhhi e Snsfi h Y00, Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative D Renovating unfinished basement Yes No Plans Attached Roll O• Sheet D e 4 ati` Iron ewfstin Ong co#*p th IgRMEI ;• 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 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 '. 41�X'XGfi�1;4 _ tr \ 1 iC 'IiY. hM• i as Owner of the subject property hereby authorize I 7 to ac.t. on my behalf, in all matters relative to work authorized by this building permit app! cation. aHan6A a- 19 -og Signature of Owner Date QS QUApYI z2d agezl- as Owner/Authorized Agent hereby declare that the statements and information on the fcIrkgoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name 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 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 � r Room 100 _ . nn;'4 'Northampton, MA 01060 e F` phone 413. 87-1240 Fax 413.587.1272 t APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLIN SECTION 1 - SITE INFORMATION 1.1 Property Address: �•'ba ��This s,ection�to be`�corrtpfe'�d�byo�ffice �> � � S Zon Ove a D tr�cf �` YPYI ,e. �•� � ,. �EIm St District t CB Distr-ICt4X' a rN SECTION 2 -'PROPERTY OWNERSHIP/AUTHORIZED gGENT .::. 2.1 Owner of Record: tTa � 'Dal a,n 11 Cl ov�xda ��. - �rQnc-pJ Name(Print) Current Mailing Address: at n , Telephone Signature 2.2 Authorized Agent: ,Max*7e/15If, Roof na P.O. fox 3o9 - Eaf 6amptni MA Name(Print) Current Mailing Address: Q�Qa,7 (,�►3� 5q,7- +1q5 Signature Telephone SECTION-:3 - ESTIMATED CONST.RUCTI`ON.COSTS Item Estimated Cost(Dollars) to be Official Use Only completed by ermit applicant 1. Building Roo? n 5600.00 (a) Building Permit Fee 2. Electrical (b)7 (b) F timated Total`Cost of Construction,from. 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 51000.00 lCheck Number This Section'-For Official Use Only Building Permit Number: Date Issued. Signature: _ Building Commissioner/Inspector of Buildings Date T 9 I 11 CLOVERDALE ST BP-2004-0802 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 12C-063 CITY OF NORTHAMPTON Lot: -001 Permit: BuiidinQ Category: BUILDING PERMIT Permit# BP-2004-0802 Project# JS-2004-1192 Est. Cost: $5600.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 126235 Lot Size(sa. ft.): 7492.32 Owner: DELANEY JOHN B JR&JUNE L Zoning:URA Applicant: RCI ROOFING AT. 11 CLOVERDALE ST Applicant Address: Phone: Insurance: P O BOX 309 (413) 527-4775 Workers Compensation EASTHAMPTON MAO 1027-0309 ISSUED ON:2118104 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• Receipt No: Date Paid: Check No: Amount: Building 2/18/04 0:00:00 5143 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo