17C-029 R.C. 1. Roofing
51B Holyoke Street
P.O. Box 309
Easthampton, 01027 Estimate Date
Phone (413) 527-7-4775 8/26/2008
Fax (413) 527-8469
Name/Address Job Location
Stanley Pollack 1 Bardwell Street
1 Bardwell Street Florence, MA
Florence, MA 01062 585-9070
Terms Rep
Estimate valid for 20 days Rich
Job Description Total
ESTIMATE IS FOR MAIN ROOF ONLY. 6,500.00
Remove existing roofs.
Furnish & install aluminum drip edge, pipe flashings, chimney flashings and step flashings.
Furnish & install new lead counter flashings.
Furnish & install CertainTeed Winterguard ice & water barrier along eaves and valleys.
Furnish & install 15 lb. felt over existing deck.
Furnish & install 30 year CertainTeed Woodscape Series shingle.
Furnish & install CertainTeed approved ridge vent.
Furnish & install 1/2" fiberboard insulation on flat roof section.
Furnish & install .045 re-inforced rubber roof system, mechanically attached on flat roof
section.
All exterior roofing related debris to be removed by R.C.I. Roofing.
All work to be performed according to manufacturers' specifications.
5-Star CertainTeed Surestart Plus extended material and workmanship warranty included.
30 year CertainTeed material warranty included.
All related permits will be obtained by R.C.I. Roofing.
SPECIAL ITEMS NEEDED
Add $2.50 per square foot for wood decking replacement if needed.
?e-place- c., Pro K. 1 ' u�vn,,'num l►�'r+�
THE OWNER HAS THE RIGHT TO CANCEL THE CONTRACT WITHIN (3)
THREE BUSINESS DAYS OF DATE OF SIGNING. Total $6,500.00
TERMS 01' PAYMENT
5%Deposit
Balance upon completion Customer Signature
Registration# 126235 t.
Construction License# 074334 Date � 2
Insured b��Remolds. Barnes&Hebb, Inc.413-447-7376
0�� Oy
a� a Gzt� Of cNa rtIlailtptoll
� 6 �assachnsctts•
R V
o DEPARTMENT OP BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMTENSAITON INSURANCE AriTiEDAVrr
Roo�nj_
(li ten-sce/permi ltcc)
v,II a principal place of businesslresidence at:
��
Ad —L
strccUc ty/staltJnp)
do 'nereby certify, under the pains and penalties of perjtuy, that:
I :m an employer providing the following worker's compensation coverage for my
ei_:olovices working on this job:
National union Fire-
Try. CO. of f'ittsbLtra PA 'WC3b31 `lb9 10105/09
C-asu cc Company) (Policy Number) (E)pirarion Date)
� ) I �_m a sole proprietor, general contractor or homeowner (circle one) and have hired
t .e 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/Poticy Number) (Expiration Date)
(Name of Contractor) (Insurance CompanyRolicy Number) (Expiration Date)
(1''ame of Contractor) (Insurance.Company/Policy Number) (Expiration Data)
,-:1-11 additional I-1—t if n--try to in h information pertaining to all coatr ors)
; ) I am a sole proprietor and have no one working for me.
I am a home owner performing all the work myself.
r
NOTE:please be awzm that wtz 1a bomcowocrz who employ persons to do mieatmaaet�nor tn►aioo or tZpair vroric on a dwelling of
rAt tore than thrw units in which the homoowocr resides oc oa the gnuads zppuRenant thado an not Ccoailly 000sidcrcd to be
c=ploycrs unties the wmk tel mmpcasatiea Act(GL152,13 I0A application by a homeowner for a liccwe or perm:d may evidence tho
coil status of an omployoc under thn Worlccel Companation Ad.
I uni'=: d trot a copy of this rtxL=cat may be forwarded to tho Department of In&utrial Aoddmte ofsoe of W%-oos for the
�v �vrrificstioa and that fa tltsrc W t note covrragv tuldct soaioa 23A of MQL 132 rxn tad to tba'itYt�OSititxi of aimiA pm
We$
pill- of tt fine'of up to S1,S00.00 andloc imprisoa>�of up to one ymr and civil penalties is the form of a Stop Work Ordw and a '
:nor of:;100.00 a day against mc.
Foe dTaeatsl use oaty
permit Number
Lot#
Signature ofLiC=_'WJpermitt= MTF
r
SECTION 8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
M 1 '.c 1 j.�.
Name of License Holder:_ J"1 zy �e i! l e. �? '!
License Number
Il�o a mox. i q - - 10
Address Expiration Date
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
Company Name Registration Number
,519 Adwoke Sfireet - p o. x Soy -N,- /o
Address i Expiration Date
Ma. m a ig Telephon •J47
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(i)7)
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 buildi g permit.
Signed Affidavit Attached Yes....... No...... ❑
11. - Home Owner Exemption
TIC current czanption Ior"homcoNvncrs`vvas extended to include Owner-occupied Dwellings of one(1) or two(2) families
and to alloyv such homeowner to engage an indiN idual for hire who does not possess a license,provided that the owner acts
as supervisor. CM 780, Sixth Edition Section 108.3.5.l
Definition of homeowner: Person(s)«ho own a parcel of land on which he/shc resides or intends to reside,on which there
is.or is intended to be,a one or 1\vo family dNNelling,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.
S_ich "homeo\\ner"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
A,;acting Construction Supervisor Nour presence on thcjob 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 Ny ith reference to Chaptcr 152(Workers' Compensation) and Chapter 153 (Liability of Employers to
Lmplo}ces for injuries not resulting in Death)of the Massachusetts Gencral Laws Annotated.you may be liable for person(s)
ou hire to perform vyork for Nou under this permit.
I!ic undersigned •,homcovvner"certifies and assumes responsibility Ibr compliance with the State Building Code,City of
Northampton Ordinances.State and Local Zoning Laws and State of 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 E]
Accessory Bldg. ❑ Demolition ❑ New Signs 10] Decks Siding[Oj Other[01
Brief Description of Proposed
Work: [�L1'I'. l — 1 7
Alteration of existing bedroom Yes No Adding new bedroom V Yes No
Attached Na,rative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing, complete the following
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, Masscheck 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 cf basement or cellar floor below finished grade
k. Will bui ding 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
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.
att:1ehed 10hg/09
Signature of Owner Date
I, as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing lication are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Print Name
toga
Signature of Dwner/Agent Date
f
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by 'Zoning
This column to be filled in by
Building Department
I'ot Si/.c
Frontaac
Setbacks Front
Side I.: R:
Rcar
Building I leight
Bldg. Square Footage 0/4,
Open Space Footage yb
(1;)t area minus hldg K paecd
p.:rkine)
gflf Parking Spaces
1 11:
iolumc� Ltcnlim)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DON'T KNOW 0 YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DON'T KNOW O YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained 0 Date Issued:
C. Do any signs exist on the property? YES O NO 0
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO Q
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading, excavation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
i
Department use only
City of Northampton Status of Permit:
�'-�B WJ,,ng Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
�f1�RR� Boom 100 Water/Well Availability
n. — rul`�PVorth'�i'mpton, MA 01060 Two Sets of Structural Plans
phone 413-5W-1240 Fax 413-587-1272 Plot/Site Plans
as Other Specify
APP'CICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: } This section to be completed by office
1. BaYU ri eI l S 1 re°& Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
81anlev Fol I wK 18ard W l I S t• / Flore_ru,e-)
Name(Print) Curr M d n Addre
a .taehe-d .�g�g90
Signature Telephone
2.2 Authorized Agent:
• P.O.&X 3n9 - E:a� ha�r�n a.
iName(Print) Current Mailing Address: TMI
�— ) 52h- J4115 �[
N13)Signature Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building 00 i 5C- O.0D (a) Building Permit Fee
n F� W
2. Electrical (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = 0 +2 + 3 +4 +5) 5Co.
p Check Number s—
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
p t BP-2009-0404
GIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categor BUILDING PERMIT
Permit# BP-2009-0404
Project# JS-2009-000544
Est.Cost: $6500.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sq.ft.): 14374.80 Owner: POLLACK STANLEY B&JOANNA VARADI
Zoning:URB(100)/ Applicant: RCI ROOFING
AT. 1 BARDWELL ST
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTONMA01027-0309 ISSUED ON:101912008 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 10/9/2008 0:00:00 $35.0012984
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo