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17A-295 (2) RCI ROOFING 30 HIGH ST EASTHAMPTON MA 01027 ESTIMATE (413)527 4775 FAX (413)527 8469 Dam: 9,20,00 Estimate To: JEFF&RUTH MACKENZIE Estimated By: MARK DELISLE Start Date: Job Location: 120 HILLCREST NORTHAMPTON Job Phone: 586-7933 JOB DESCRIPTION FURNISH AND TNSTALL #15 ROOFING FELT FURNISH AND LUiaTALL 25 YR TAMKO SHINGLE ALL ROOFTNG DEBRIS TO RE REMOVRD BY RCI ROOFING, SPECIAL ITEMS NEEDED Additional information pertaining to this Job Estimate TERMS OF PAYMENT 30%PRIOR TO START Total Estimated 70%UPON COMPLETION Job Cost $5,600.00 CONSTRUCTION LICENSE#074334 FEDERAL I.D#3418839 Authorized REGISTRATION#126235 Signature Cv INSURED BY BANAS INSURANCE(413)527 0288 ORIGINAL-ESTIMATOR COPY O��ttAMp2O 9 $ 9 6 �asartcgnsctfa', DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT G r K with a principal place of business/residence at: l A mi 7 7 (Phone#) e%I s S--2-7 4/77,5 (street/city/statrhip) do hereby certify, under the pains and penalties of perjury, that: I am an employer providing the following workers compensation coverage for my employees working on this job: ansuran&Company) (Policy Number) (Expiration Date) ( ) I 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: (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Ins-urance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (E)piration Date) (Attach additional shoed if nooeauy to include infvcmuioa pertaining to all ooatract ) ( ) I am a sole proprietor and have no one wort ing for me. ( ) I am a home owner performing all the work myself. NOTE:please be aware that while homeownm who employ persons to do mainfexianoe,om&uctionor repair work on a dwelling of not more than three units is which the homeowner resides a on the grounds appurtenant thereto are not ge]necally oomuiertd to be employes under the worker's compensation Act(GL152_a 1(5)),application by a homeowner for a license or permit may evidence the legal stabs of an employer under the Wotkoes Comcpamation Act. I undmund that a copy of this rtatemeut may be forty tuxded to the Deputmea2 of Indu,,*ial Aocideed Ofhoe of Im ulnoe for the coverage verification and that failure to secure eovenga under section 25A of MGL 152 can lad to the iazposrtion of criminal pemltita oocsisting of a fine of up to S1,500.00 and/or imprison of up to one year and civil penalties in the form of a Stop Wank Order and a firm of S 100.00 a day against Me. gPermit ial use only n Number p -3. Lot# Signah re of Licensee/Permittee ' SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holde License Number Address Signature Telephone iWISMIN"N"', OW 1 Not Applicable 0 Company Name Registration Number Telephone 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. The current exemption for"600eowzers"was extended toinclude one(1) or two(2)taoUiem and to allow such homeowner to engage au individual for hire who does not possess ulicense,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-Vear 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 Superviso your presence on the job site will le required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that vdhroK:reuce0oChapter 152(Workers' Compensation) and Chapter l5J (Liability of Employers to Employees for injuries n ot pue ukbo bu Death)o[thu MuoouohusettoOonoru|Luwo&mnotated.You may be liable Ompeoo n(x) 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 uy Massachusetts General Laws Annotated. Homeowner Signature ' ` SECTION 5 DESCRIPTION OF PROPOSED WORK(check 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 ❑ - Sheet❑ 0944itib „ ii1 -11 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 SECTION 7a -OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR'APPLIES FOR BUILDING PERMIT 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 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. Signed under the pains and penalties of perjury. Print Name Signature of Owner/Agent to 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 8" 212 Main Street Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413.587-1272 i APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION This sectltobe com leted byIfiee 1.1 Property Address: Map, t .r - k cam' 1 y y Elm�St'Dl5trict b SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: <. /e- S fl'1 C Inc' n� �f' ���—�F' r Name(Print) Current Mailing Address: Telephone , Signature 2.2 Authorized Agent: 01C,. rK k eI , S /.0 Name(Print) ' ' /� Current Mailing Address: Z Signature Telephone SECTION 3 ESTIMATED CONSTRUCTION COSTS 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 Construction from 6 3. Plumbing Building Perm itFee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 +4 + 5) C,0 Check Number This Section For Official Use Only Building Permit Number: Date Issued: ...Signature: Building Comm issionerllnpector of Buildings Date 120 HILLCREST DR BP-2001-0773 GIs#: COMMONWEALTH OF MASSACHUSETTS eftIMML.Block: 17A-295 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category:roofmg BUILDING PERMIT Permit# BP-2001-0773 Project# JS-2001-1449 Est.Cost: $5600.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: RCI ROOFING 126235 Lot Size(sq. ft.): 20386.08 Owner: MACKENZIE JEFFREY M&RUTH G Zoning.URA Applicant. RCI ROOFING AT. 120 HILLCREST DR Applicant Address: Phone: Insurance: 30 HIGH ST (413) 527-4775 Workers Compensation EASTHAMPTONMA01027 ISSUED ON:414101 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF POST THIS CARD SO IT IS VISIBLE FROM THE STREET nspector 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 Type: Receipt No: Date Paid: Check No: Amount: 'Building 4/4/010:00:00 332 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo 120 MLLCREST DR BP-1999-0764 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-295 CITY OF NORTHAMPTON Lot:-001 Permit: Buildina Category:Non structural interior renovations BUILDING PERMIT Permit# BP-1999-0764 Project# JS-1999-1397 Est.Cost:$9000.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Roger Clark 021310 Lot Size(sq.ft.): 20386.08 Owner:_MACKENZIE JEFFREY M&RUTH G Zoning-: Applicant: -Roger-Clark AT: 120 HILLCREST —R Applicant Address: Phone: Insurance: P O Box 34 (413) 584-1170 LEEDS 01053 ISSUED ON:311911999 o:oo:oo TO PERFORM THE FOLLOWING WORK.-FINISH FAMILY ROOM & STUDY IN BASEMENT 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: <j��y�Y�J�'Z'/ Rough Frame: Gas Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Cr' "� ✓,l�l ? Final: Smoke: Final: L? THIS PERMIT MAY BE REVOKED BY THE C OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULAT ONS. Certificate of Occupanc i nature• " Fee Tyne: Receipt No: Date Paid: Check No: Amount: Building 3/19/1999 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo a > o '9 .0 �o -' rn 3 Z co ham, O n d (p G E R b Z n'Is � � v: qp � o• -1 cn Z cn O W' `c Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations ✓ a NORTHAMPTON, MASS. �tt`Gk i �,� 19 ` Additions APPLICATION FOR PERMIT TO ALTER Repair Garage 1. Location 0�0 /TI'�/G t�GS F1 d rc, Cc— Lot No. 2. Owner's name Te�44--jl -�--e,to Address fad k1 )f C rye S )L t1 3. Builder's name )eUtqrl Address &©X 3 e f L-� 5, Mass.Construction Supervisor's License No. G 3 f D Expiration Date y 00 4. Addition 5. Alteration 13,,,r`/d Fr.E_,y, , K 1'019m S n bet Se'mC+f 6. New Porch /V::51 7. Is existing building to be demolished? 8. Repair after the fire /gyp 9. Garage //If J No.of cars Size 10. Method of heating b"-f 11. Distance to lot lines 12. Type of roof 13. Siding house 14. Estimated rose- �9 QQ v The undersigned certifies that the above statements are we to the best of t knowledge and belief. Signature of responsible app,icant Remarks - s d �asaacfltrsrtta e n MAR DEPARTMENT OF BUILDING INSPECTIONS DEPT 0F Bli1, pi ,L 2 Main Street ' Municipal Building ' G INSPI� = Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE t MAVIT r (licenserJpermittee} with a principal place of business/residence at: BeyK 3 L` LA S, /`far t��Gj'3 (phone#) (street/ci ty/statelri p) do hereby certify, under the pains and penalties of perjury, that: O I am an employer providing the following worker's compensation coverage for my employees working on this job: (In_uance, Company) (Policy Number) (Expiration Date) ( ) I 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: (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Compau/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additioml sfxd ifnx�uy to include informrtion pertaining tC all codradora) 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 chit whilo hooxouvers who caaplay pcaom to do mniMwmcc o=sbm tion or rWair work on a dwelling of not more than throe units is which the homeowner resides oc oa the grounds appurtenant thereto arc not generally oo=dacd to be employes under the%vodcces ration Act(GL152,m 1(5)�application by a homeowner for a liccnx oc permit may evidence the les2l dacha of an employer under tho Workoes C.ompomation Act I understand d3A A Copy of this ru tcrucat may be forwnrdod to tho Dcpart=&of l—butrial Aeddw&OfEoe of Inxu'°oc for the coverage verification and that failure to secure covcrago under section 25A of MOL 152 can lad to the'imposition of aiminal penalties ooaustmg of a$ne of up to S1,500.00 andlor im{uiso�of up to om year and civil pemltia in t6o form of a Stop Work Order and a fine of 5100.00 a day rgaiust tnc For d ts'o Oaty �/� p permit Number 16. � Maly# _—Lot# Sivaalfine of LicenscdPermittee _ s ° Zi wn � }1 d r W f , - 6t lot #-10.��dz1'�3�= 19 1 1& Do any signs exist on the property? YES NO IF YES, describe size,type and location: Are there any proposed changes to or additions of signs intended for the property?YES NO IF YES,describe size,type and location: 11 . ALL INFORMATION MAST BE COMPLE'T'ED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. This colu= to be filled in by the Building Department Required Existing Proposed By Zoning Lot size Frontage Setbacks - frnnt - side L: R: L: R: - rear Building height Bldg Square footage %Open Space: (Lot area minus .bldg &paced parking) # of Parking Spaces # of Loading Docks Fill: Avolume--& location) 13 . Certification: I hereby certify that the information contained herein G is true and accurate to the best of my knowledge. DATE: /�D��I APPLICANT's SIGNATURE NOTE: Issuanoe of as zoning permit does not relieve arf ap lioanis burden to oomply with all zoning requlrements and obtain all required permits from the Board of Health, Conservation Commission, Department of Publio Works and other applionble permit granting authorities. FILE # l} i Fr S MAR 1 61999 DEPT_0F BU FL:NG INcySyPryECT10tP"', File No. ZONING PERMIT APPLICATION (§10 . 2 PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: Address: &6x 321 1-,e eop S . %"lc,, UlC�3-3 Telephone: Sj�'`/'-0 90 2. Owner of Property: Y�'C p�L �"- eu /4-�C Address: j%-, PCif C, cr- Telephone: T 3. Status of Applicant: Owner V*�Contract Purchaser Lessee Other(explain): 4. Job Location: /aQ )'IdleLLes - 0 , Floi-cn �-P Parcel Id: Zoning Map# Parcel#�?J— District(s): -,1 O- D IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property s2�9 )e ��l sit >'y 6. Description of Proposed Use/WorklProject/Occupation: (Use additional sheets if necessary): e Y►t i t t. rou m i- S /-L v i n b a,Se.A c�K 7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files. 8. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW t-' 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# 9. 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: (FORM CONTINUES ON OTHER SIDE) File#BP-1999-0764 APPLICANT/CONTACT PERSON Roger Clark ADDRESS/PHONE P O Box 34 (413)584-1170 PROPERTY LOCATION 120 HILLCREST DR MAP 17A PARCEL 295 ZONE URA THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildin Permit Filled out Fee Paid o l Typeof Construction: FINISH FAMILY ROOM&STUDY IN BASEMENT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 021310 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION: Approved as presented/based on information presented. Denied as presented: Special Permit and/or Site Plan Required under: § PLANNING BOARD ZONING BOARD Received&Recorded at Registry of Deeds Proof Enclosed Finding Required under: § —w/ZONING BOARD OF APPEALS Received&Recorded at Registry of Deeds Proof Enclosed Variance Required under: § —w/ZONING BOARD OF APPEALS Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Signature of Building fficial Date Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. t 120 HILLCREST DR BP-1999-0764 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-295 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category Non structural interior renovations BUILDING PERMIT Permit# BP-1999-0764 Project# JS-1999-1397 Est.Cost: $9000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Roger Clark 021310 Lot Size(sa.ft.): 20386.08 Owner: MACKENZIE JEFFREY M&RUTH G Zoning.URA Applicant: Roaer Clark AT• 120 HILLCREST DR Applicant Address: Phone: Insurance: P O Box 34 (413) 584-1170 LEEDS 01053 ISSUED ON.•311911999 0:00:00 TO PERFORM THE FOLLOWING WORK.-FINISH FAMILY ROOM & STUDY IN BASEMENT 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 Siunature• Fee Type: Receipt No: Date Paid: Check No: Amount: Building 3/19/1999 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo