17C-058 (4) R.C. 1. R-,
oofin
g LLP
51B Holyoke Street
P.O. Box 309 Estimate
Easthampton, MA 01027 Date
Phone (413) 527-4775 7/10/2008
Fax (413) 527-8469
Name/Address Job Location
Sarah Whittier 190 Chestnut Street
190 Chestnut Street Florence, MA
Florence, MA 01062 584-1784
Terms Rep
Estimate valid for 60 days Rich
Job Description Total
Remove existing roofs. 7,200.00
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 and install 15 lb. felt over existing deck.
Furnish and install 30 year CertainTeed Woodscape Series shingle.
Furnish and install CertainTeed approved ridge vent.
All exterior roofing related debris to be removed by R.C.I. Roofing.
All work will be performed according to manufacturers' specifications.
5-Star CerainTeed 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 sq. ft. for wood decking replacement if needed.
THE OWNER
RIGHT CONTRACT WITHIN (3)
THREE BUSINESS DAYS OF DATE OF SIGNING.
Total $7,200.00
TERMS OF PAYMENT
5%Deposit / /Balance upon completion Customer Signature ��,<�!
Registration# 126235
Construction License#074334 Date y ZU
Insured by Reynolds,Barnes&Hebb.Inc.413-447-7376
s a �zf >if 'Wart 11allip tall
9 6 was:achttsctta'
DEPARTMENT OP BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COM n ENSATION INSURANCE AFMA.VTT
R. C.T . Roofilin
(li censceJpermi tree)
with a principal place of business/residence at:
•5� (phone# 1 ( =�??5
str>reU ty/staie/ap)
do hereby certify, under the pains and penalties of pegury, that:
WI am an employer providing the following worker's compensation coverage for my
employees workin an this job:
The=nsunarkxl�o Panj d
theState,d Penns'4Iyanta C' V91325 0 05 0
a==Cc Company) (Policy Number) irahon Dale)
( ) I an. 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 Comparry/Policy Numer) (Expimtion Date)
r
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (insurance CompanylPo6cy Number) (Expiration Date)
(Name of Contractor) (insurance Company/Policy Number) (Expsmtion Date)
(attach additimal shcet ifnco=ury to include information p=,&ining to all ood radors)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:plcsaa be aware that whilo homcowwm who cmplay perrom to do M&Mdalm(—,,ooasbry on or rcpair work on a dwelling of
not mote tb=throo units in which the homoowocr resides or oa the grounds Vpuctenant tberdo are not gmemity oo=Wcrcd to be
cmploycrs under tho works coavc wAtim Act(GL1S2,ss1(5)),am&2.6on by a bomeowner for a license oc permit may cVi& a tho
lcq.l status of an omployec under tho Workers C.ompeosation Ace.
I understand that a copy of thin ru fcmcut may be forwarded to tbo Dcpwu=o2 of Industrial Ao6de&OfSoo of 1-u-006 for the
coverage vcsIfi=00 and that failure to retort covaago under sectioa 25A of MOL 152 can lead to tbe'imvositioa of aiminsl p=wcS
oom iuiug of a fine of up to S 1,500.00 andlor imprison of up to one year and eiva pa 46ts in the focm of a Stop Worts order and a
f=of 5100.00 a day against tnc
For df uao only
Permit Number
Map'+1 Lot# t'
f:. signatarc of Liccnseapermittce Date
SECTION 8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: J�aY� e,/ S I r 7 q ,3 v'1
License Number
51 B Munk St.- Easlh melon . Ma. o ioan 5 - 03 - 10
Address Expiration Date
Signature Telephone
— ��X 1/0----
9.Registered Home Improvement Contractor: Not Applicable ❑
126235
Company Name j Registration Number
519 Adijoke Are-et - P 8. X 3oy - 1 D
Address i Expiration Date
Fastharn�fi�T
Ma. o j o 2? Telephon A5.2fl-4TY
SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6))
Workers Compensation Insurance affida it must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the buil ng permit.
Signed Affidavit Attached Yes....... W No...... ❑
11. - Home Owner Exemption
The current cscnption for"homcow,ncrs-yeas 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.
Srrch-homeowner-shall submit to the Building 011icial,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
F.mployces for injUU-ics not resulting in Dcath)of the Massachusetts General Laws Annotated,you may be liable for person(s)
Nou hire to perlorm work for you Under this permit.
1 me 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
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) F-� Roofing
Or Doors r-1
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [M Siding[p] Other[0]
Brief Description of Proposed a��a�,n
Work: ,(
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative 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 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
l' 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.
at_taehed g aaloS
Signature of Owner Date
I, as Owner/Authorized
Agent hereby/declare that the statements and information on the foregoing a4lication are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Ule,
Print Name
912;109
Signature of Owner/Agent Dat
f 1
Section 4. ZONING Alt Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
I;.Xisting Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Si/.c
Frontage
Setbacks Front
Side I.: R: I,: R:
Rcar
Building I ieight
MCI L'. Syutu-e Footage
Open Space Footage %
fl:,t area minus hldg K paeed
parking)
of Parking Spaces
Fill:
( hune K I_tcation)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DON'T KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW O YES Q
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained 0 Date Issued:
C. Do any signs exist on the property? YES 0 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 0
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 0 NO Q
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
S
Department use only
citY'pf,N6rtihampton Status of Permit:
,t,661ding Department Curb Cut/Driveway Permit
212 Main at eet Sewer/Septic Availability
� om 00 1\1 Availability
�,��N� hampton,MA 01` 60 Two Sets of Structural Plans
pho6 413-587 124b � -587-1272 Plot/Site Plans
Other Specify
APPLICATION TaCONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION —7
1.1 Property Address: This section to be completed by office
190 ekest , , ,/. dt Map Lot Unit
I l.• �[�• Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Sarah Whl ie r _i90 Ghest1u L 5L. l F'/orerrLy
Name(Print) Current Mailing Address: �� ,I
ata eh e d Telephone !t
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address: T01041?
(113) 527- �??
Signature Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS -T
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building ROOF I W./yl (a) Building Permit Fee
2. Electrical VlJ �«�.JJ (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 +2+3 +4 +5) , Check Number jZqj
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
r {
BP-2009-0219
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)
Category BUILDING PERMIT
Permit# BP-2009-0219
Project# JS-2009-000284
Est.Cost: $7200.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sq.fQ: 14897.52 Owner: WHITTIER SARAH JANE
Zoning:URA Applicant: RCI ROOFING
AT: 190 CHESTNUT ST
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTONMA01027-0309 ISSUED 0X:812812008 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 8/28/2008 0:00:00 $35.0012693/12691
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo