17C-029 (2) ` • 4
R.C.I ROOFING
40 MAINE AVE.
P.O. Box 309 F(fI MA TE
EASTHAMPTON, MA 01027-0309
PHONE (413)527- 4775
FAX (413)527-8469
�f ub it Date: MARCH 5, 2002
Estimate To:
STANLEY POLLACK Estimated By: CHRIS THOMPSON
1 BARDWELL ST. Start Date:
FLORENCE, MA. 01062 Job Location: 1 BARDWELL ST.
FLORENCE, MA. 01062
Job Phone: (413)585-9070
JOB DESCRIPTION
FURNISH & INSTALL ALUMINUM DRFPEI)CF AIVD ALL OTHER RELATED FLASHTIVGS.
FLIRNISH & INSTALL 30 YEAR TAMKO SHINGLE.
P
INCLUDED,ALT WORK WILL PERFORMED ACCORDIAIG To MANUFACTUgEgS SpECIFICATIONS,
10 YEAR R.C.I. WORKMANSHIP WARRANTY INCLUDED.
30 YEAR TAMKO MATFRTAL WARRANTY
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_$2_,000.00
REGISTRATION#126235
FEDERAL I.D.#04 3418839 Authorized /
CONSTRUCTION LICENSE#074334
INSURED BY HACKWORTH INSURANCE(413)527-9907
ORIGINAL-ESTIMATOR COPY v
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DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street a Municipal Building
Northampton, Mass. 01060 ••
WORM{ER'S COMPENSATION INSURANCE AFMAVIT
(IicensedPermitt=)
with a principal place of business/residence at:
�f 0 YYI
%,(\J, Q.V F_ OI OL'-phone#)�l13"SZ7-y-7%7_7
(strCWcity/state'
do hereby certify, under the pains and penalties of pegtuy, that:
�am an employer providing the following worker's com easation coverage for m
P 8 Y
employees working on this job:
�o��� Yyl. � 'W C3.-315•�111 z�,01 I /O• S-O�
ans CQmpanY) (Policy Number) (Expiration Dan)
( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hired
the contractors listed below who have the following worker's compensadon policies:
(Name of Contractor) (Insurance Company/Policy Numbcr) (Expiratioa Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiradoa Date)
(Name of Contractor) (Insurance Comparty/Policy Number) (Fxpiradon Date)
(Name of Contractor) (Insurance Compauy/Policy Number) (Expiration Date)
(.mach additional,twee irneocnuy to iacluds iafocma>;oa pefulLing to sll o,atr,dor,)
O I am•a sole proprietor and have no one working for me.
O I am a home owner performing all the work myself,
NOTE:plum be aware that whilo hee000unoera wbo employ P=%om to do com uctioa or mpoir work oo a dwt&g of ,
not taoc+o thsa throo unite is whirr tha 6omeowoer raidr�a oa thes gcvuad,appuctettant thetceo,se trot genetalty 000s;dasd to bo
cwPloyaa under the wocice''s coatpeautim Act(01.152.=1(3)).aWU=tioa by•h*c=ww for a Gocase oc p-mk may-Mewe rho
1cgaJ stahu of as employK under the Wodcoes Compooaation AAA
I uodetstaad clue a Dopy ottbis siatemwt may be farwaided to the DcpartmooC of Ic�Lttrial Aoddeot�O$oe aC Iowcaooa to t6s
cowcrage vaiaC41oc sac!that faiiuce to some coverage uod=suction 23A of MoL 132 as tad to the*WvosiBoa of w';0* sl peaatda
oomiuiag of a Erse Of uP to$1'5W-oo nrd/ar iazpeisoOUWOt of"P to 000 year rod eivna PCOXWCS itt the fom of s Stop Walk Ocdw and a
faro of 3100.00 a day agarast tan.
For d tun only
permit Number
py Lot#
'cti� Sigaaturc ofL1c=* c?crmittcc :
A
8_1 Licensed Construction
Supervisor! Not Applicable 0
Name of Llcense Bolder t_� lQc^ �U S� O� k 33
�Ucense Number
y o rnC1_,,�, c���� �r :1 "'T 3. 0q,11
Address Expiration Date
Signature Telephone
Not Applicable D
Company Name Registration Number
Address Expiration Date
yd rnou n t Q\/F- C t+oY1 Telephone
now FF�b,AVll'4r1fIG�L.cy 152E 'Ln ��
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.........0- No...... 0
', E' �;..
The current exemption for"homeowners"was extended to include Owner-occupied Dwellines 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 Sunervisor 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"hdvised 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
w r
Y•
a
New House O Addition 0 Replacement Windows Alteration(s)0 Roofing
Or Doors 0
Accessory Bldg. 0 Demolition0 New Signs [ ] Decks [ ] Siding( Other[ ]
Brief Description of Proposed Work: wLr� S �A Sin•n���t- v\SF��It _u�.; 3 �,�. �j , ,`� .
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
Mwm I
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
-S,E�j�I �V
OYYI,JRS� 0 C�0 p, U NG PERMIT " ))
as Owner of the subject property
hereby authorize ESlls t Vii.L'1 1,100C",N Y\A to act on
my behalf, in all matters relative to work authorized by,this building,permit application.
3 - .5 C
Signature of Owner Date
I, mag-y-,. f\ Cam. 9\r)nk7\ � , as Gwner/Authorized Agent
hereby declare that the statements and information on the foregoing applbtion are true and accurate, to the•best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
M � o 0
Print Name
Signature of G?wlaer/Agent Date
.Section 4.
ALI INFORMATION MUST BE COMPLETED, or PERMIT CAN-BE
DFNED DIIE TO LACK OF INFORMATION `
..,.
Existing Proposed Required by Zoning
This coludan to be filled in by
Building Deg tmeat
scar,- _ •�.
Lot Size
Frontage
fi' f
... .-.4w+MM.•w.....,y�.rwn+n.,rwV..,.. „..M1,. ......... :.. ... ..... .,,..•eM �M:a.w YMM.a...y. ...., - ..
i L: R L: R
Building Height'
Bldg.Square Footage %
Open Space Footage % ,.
(Lot arcs minus bldg do paved
puking)
#of Parking Spa c es
at
Fill:
volume do Location
r_
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 contaln'a brook, body of water or wetlands? NO DONT'KNOW
YES .
IF YES, has a'permit been or need to be obtained from the Conservatio -commission?:
Needs to be obtained Obtained , Date Issued:
4("
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
a,
No
_-.: IF YES, describe size, type and location:
City of Northampton
Building Department
212 Main Street
14,�; , '�� Room 100
Northampton, MA 01060
phone 413.587+1240 Fax 413.587-1272
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVA�E OR DEMOLISH A ONE OR TWO FAMILY DWELLING
1.1 Property Address:
�, ec obe c e
SECTION'2.-PfOP X11Q�YIfPaUTHOZED t
2,1 Owner of Record:
S c 1�e�1 �C��tc�L1� r. ' c: r�v�c �� `�� °�dr �t�`i✓. VA
Name(Print) - Current Mailing Address:
t ' 0-10
zk _� -.i �_
Telephone
Signature 4..
2.2 Authorized Agent:
Name(Print)0 Qurrerit Mailing Address:
q 1— 7-I
Signature Telephone
w
NICOST
Item Estimated Cost(Dollars)to be Qrffi��il,USe'4ly
completed by ermit applicant
1. Building '(a)Buildirig`Permit'Fee
r C> C C C., c)
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) Check-Number
Thi"s Section For.Official Use?Onl
Building Pejmit Nurnler^ Date:'Issued ,�` r ' ;r
t
y yL
Signature d. I I MM Y 4� Y t •Tt f ' *A y
.. e
-=Bu lldigraissl�n'erll ;aptor'of D? r:�
A �
I BARDWELL ST BP-2003-0791
GIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2003-0791
Project# JS-2003-1300
Est. Cost: $2000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sa.ft.): 14374.80 Owner: POLLACK STANLEY B&
Zoning.URB Applicant: RCI ROOFING
AT. 1 BARDWELL ST
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTON MAO 1027-0309 ISSUED ON:3126103 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 Si¢nature:
FeeType• Receipt No: Date Paid: Check No: Amount:
Building 3/26/03 0:00:00 1900 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo