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17A-298 (3)
RCI ROOFING 30 HIGH ST EASTHAMPTON MA 01027 =ST1MATE (413)527 4775 FAX (413)527 8469 Date: AUG 15 2000 Estimate To: NEIL BACH Estimated B : CHRIS THOMPSON 148 HILLCREST Start Date: NORTHAMPTON,MA 01060 Job Location: NORTHAMPTON Job Phone: 582 0221 JOB DESCRIPTION FURNISH AND TNSTATT, 151b ROOFING FELT. FURNISH A NO TNSTALT, TCE & WATFR BARRIER ALONG EAVES AND VALLEYS. A MANUFACTURERS ALL ROOFING DEBRIS TO BE REMOVED BY RCT ROOFING. PROVIDE 25 YEAR ALL fVOR.K WILL BE PERFORMFI) TN ACCORDANCE WITH YAIVUFACTUIRERS SPECIFICATIONS, PERMIT INCLUDED, SPECIAL ITEMS NEEDED Additional information pertaining to this Job Estimate TERMS OF PAYMENT 30%PRIOR TO START Total Estimated 70%UPON COMPLETION Job Cost $5,000.00 CONSTRUCTION LICENSE#074334 FEDERAL LID#3418839 Authorized REGISTRATION#126235 Signature P�l INSURED BY BANAS INSURANCE(413)527 0288 DUPLICATE-CLIENT COPY ORt Al/J f P),O - R <E Grim of �\Tcir ljallipjnli ; A E a3SAchncr(Is DEPARTMEIJT OP DUILOWIG INSPECTION'S _ 212 Alain Street ' Municipal Building Northampton, brass. 010G0 N-'O R1Q;I Z'S CO tvT EN S A'n O N [N S URAN CF A I`It M A VIT soh— (li cetls<xlpctzrli ttcc) principal place- of busiotss/residence at: Inc; V (sn iwt/ci ty/stale-/zip) do hereby certify, under the pans and penalties of penury, that ( ) I am an employer providing the toilowint worker's com, S t 1) cove-, r,c 1' 1 etrmployces warUng on t-111s)ob o 2-nc� Comm--E-) (Polk: Nu.•nbcr) (T:piruor, Date-) ( ) 1 arm a sole proprietor, general contractor or homeowner (circle one) and leave hired the consactors listed below who hive the folloW`M' S worker's co��enszhon pollens: v (Name of cont-,-actor) — - (Iclnumncc Cotnaan)-ii'cue, ?,,Lmbcr) Date-) (Name of Contractor) --- (lnstrance ComDaaviPo!ic-v \umcrr) E\pir.uon Date) (Name of Contractor) (InSwanc; Compaoy PoUc)• Numb r) (Expi uoo Datc) (Name of Contractor) Gasu=c-- Company/PoLicy Number) (L-xpiraiIon DaLO (.tudh ::;cc-1 c'xczifoccc-ian to info... pertain Lo.11 ( ) I am a sole propnetor and have no one worLing for me. ( ) I am a home owner performing all the work myself. NOTE:plc..sc be cw uc(1- bcar.oµw_-r3 to anplay pczom W d,r� ;•-� ,�. cc-.�.-',r� c rr,}au�ori:oo i C-1r_.�of oDt tnac th:o LI--tai,%in or oo the QouDb zppurte —tbe-e o 2 ape Gc�-c:11y arc:dam L3 be employ un6-- the t.o:k&-a=a p _%on Act :ppticaiion by.homeoaver fm e lice a permit n_,y-ideax Lbe IcPJ ct of.n-=PIOVer uodcr trio Work-,Coaipc,b.lion Aei- I undvsta d di.1 a oopy of thu a,-u a my bo f---,Jed to tho Drtmaai of I< irrial AmduII�'O(1,; .f Ircurzooc for the covm.sc vcrti[ctioo.nd lh1 f_ilt�c W acxwc wvcinsc u»dx socxioo 25 A of hSoL t S2 c�a 4csd to the i!;z,�dioa of aiminsl pcniltin oocaiAmg of a fiDe or up tD S I SOO.00 and/or impriioomc,-yt or up W ooc yev t-Dd a�i1 Pm t.io in tK form or n Stop Work order eod a fim o(S 100.00 a d_y apinst me For dq��-tn»l u�c only [�CttR1l Nl1II]bCr Lot Signature-of Licclisec/Pcnniacc e M t CTiON CONSTRUCTI" N:SER1/1.0ES 771 ,.1 Licensed Construction Supervisor: I P Not Applicable ❑ Name of License Holder: ` /`— 0 2 y S-,? License Nu er s - �r Address Expirat' n Date 572- 7 26 cT Signature Telephone Not Applicable ❑ Company Name _ Registratio i Num er Address Expira on Date Telephone—% 3 5,17 '9 2j SECTIONA0."KIE-RS',09PIPENSATION INSURANCE AFFIDAVIT(M.G'.L.c. 152,§250(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. 0WAgned 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 cabl New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: rQ AoJ , S �� kt ler /h 5�4 It s— / kf , ^ d - Alteration of existing bedroom Yes No Adding new bedroom Yes No 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? iType 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 StOTION 74-OWNER AUTHO, *TIbN a BE�OMPL.A WHEN OWNERS AGENT'OR Cats' 'C'TOOR APPLIES FOR BUILDIN i PN~RM)1" I, 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 I, 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. ned under the pains and nalties of perjury. l ' Print Name Signature of Owner/Agent Date v y. 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: V 8 �s m City of Northampton Building Department .212 Main Street Room 100 DEt�Q HAp ll"G 1NSPEC 6th 1240 ax 4136 87 1272 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING S f:TIQI�I SF E INF MAT ON This 1.1 Pro' ert Address: des/ � o- �w D + bll l,E C SECTION 2 PROPERTY OWI+IERSH P./AUTHOR1'P AGENT , 2.1 Owner of Record: J/(?t k/ 9q /'/, //C me(Print) Current M'in Address: Telephone Signature 2.2 Authorized A en Cr t- J� ( �j' �C n )L /fl9 Name(Print) �: Current Mailing Address: Sign ure Telephone ' STt�ATFD CNS" h : Ifs Cat OS" Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Cislist air tion,from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 + 2 + 3 +4+ 5) 4>0 CheokNurnber Chris Sectlon"'For Official Use"4n1 0101ng Permr"t Nimter late Issued. sigh U'ur' Buildingcmnniianer/Inspector"©f'Buildings Date 4 , 148 HILLCREST DR BP-2001-0273 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-298 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category:roofing BUILDING PERMIT Permit# BP-2001-0273 Project# JS-2001-0444 Est.Cost: $5000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: RCI ROOFING 126235 Lot size(sq.ft.): 20342.52 Owner: BACH NEIL Zoning:URA Applicant. RCI ROOFING AT. 148 HILLCREST DR Applicant Address: Phone: Insurance: 30 HIGH ST (413) 527-4775 Workers Compensation EASTHAMPTONMA01027 ISSUED ON:9114100 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 Tyne: Receipt No: Date Paid: Check No: Amount: Building 9/14/00 0:00:00 MO $50.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo