17C-140 (2) RC.1. R L LP
g
51B Holyoke Street
P.O. Box 309 Estimate Easthampton, MA 01027 Date
Phone(413)527-4775 7/5/2005
Fax(413)527-8469
Name/Address Job Location
Amy Clough 46 North Maple Street
46 North Maple Street Florence, MA
Florence, MA 01062 Home: 584-4155
Work: 256-0349
Terms Rep
Estimate valid for 60 days Mike
Job Description Total
Remove existing roofs. 9,900.00
Furnish&install 1/2"plywood over the existing decking. '
Furnish&install aluminum drip edge,pipe flashing and chimney flashing.
Furnish& install new lead counter flashings.
Furnish&install ice and water barrier along eaves and valleys.
Furnish&install 15 lb. felt.
Furnish&install 30 year Tamko Heritage Series shingle.
Furnish&install Cor-A-Vent ridge vent.
Furnish&install Versico rubber roof system on flat section.
All roofing related debris to be removed by R.C.I.Roofing.
5 year R.C.I.workmanship warranty included.
30 year Tamko material warranty included.
All related permits will be obtained by R.C.I. Roofing.
SPECIAL ITEMS NEEDED
Estimate does not include carport roof.
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total $9,900.00
TERMS OF PAYMENT
30%Upon delivery of materials
70%Upon completion Customer Signature
Registration# 126235
Construction License#074334 Date
Insured by Hackworth Insurance(413)527-9907
�°'- °"; `
�z > Wart1ialltptatt _
6 Massachusetts' I
m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060 `
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
of U).T - R00finn
(NcenserJpetmittec)
with a pr`incipal place of business/residence at:
51—B11� (phone# -JIT75
street/ ty/staWzip)
do hereby certify, under the pains and penalties of pedury, that:
(1lS.I am an employer providing the following worker's compensation coverage for my
emplovees working on this job:
Ame'tean-Int'i nun 681bb10 t0 Ob
(Insurance Company) I (Policy Number) (Expiration Da e)
( ) 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:
I2tne of Contractor) (Insurance Company/Policy Number) (Expiration Date)
a,
Name of Contractor) (Insumcc Compaay/Policy Number) (Expiration Date)
(frame of Contractor) (Insurance Compaay/Policy Number) (Expiration Date)
(Frame of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(etta:a a.:iditioaal s'ocet if necessary to include information peru iaing to all ooC taCWr%)
( ) I am a sole proprietor and have no one wor�ng for me.
( ) X am a home owner performing all the work myself.
*TOTE:please be awuc that wbilc homcowo=wbo cmptoy prism to do maat mmcce consbvcdoo or tepair work oa a dweUing of
not mac than throo units in which the bomoow=raids or oa the grounds:pNdtdaat tbx an not Coxmlly coosidend to be
cm,loy=uDdcr the worker's coaVcasatioo Act(GLI52m l(S)),aWliatioa by a homeowner for a Gecme a permit may evidence the
lei ctatua of an employee under the Workces Compeooation Act.
u:kicxund that a oopy of this rutemmi auy be forwarded to the Depa tmcnt of ID&Mtrisl Acddmtsf Office of tmuranoe fvr the
oovaz verification and that failure to wears coventgo trader socuoa 25A of MOL 152 txo lad to the'impp oa 40 imioal voc"a
oocitii7g of&2W of up to 51,500,00 Uwe(hq is�of tip to am year end dvil pmrWa is the form of a Stop Wale Order wit t
of 5100.00 01y agruui me
For depactaatl tree only
Permit Number
Map#_ Lot� _ _•
r Sign==of LiarlsWRermittee
ti
SECTI'ON.8-:CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: ^Not Applil !c'able ❑
Name of License Holder : . a j S e, 1 ?? 3 '/
J,�
License Number
51 e - o;q 5 -o3 - o
Address � Expiration Date
f r
Signature Telephone
v men . Not Applicable ❑
oo i� ) It 235
Com any Name Registration Number
5 l B o f n1f, Street. - ED. BDx 3t)l 5- O b - U
Address 0 Expiration Date
oell—
Ma. 6102&7 Telephon ?5
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.
Signed Affidavit Attached Yes....... ❑ No...... ❑
REM.1 11 M11 — is
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
SECTYON 5 DESCRIPTIbNfOIF PROPOSED WORK(ch0 Gk�all apalicable)
r
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 o Renovating unfinished basement Yes No
Plans Attached Roll ❑- Sheet o
6a, IfNewhouse "a'h`"da d"diti'on tope is#ingfiousing, comp'teeth�ftto"�!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
SECTION 7a-OWN EWAUTHORIZATION -TO BE COMPLETED WHEN
OWNERS.AGENT OR�cbNtidC ,R APPLIES FOR;BUILDING PERMIT
I, c d(1Qli as Owner of the subject property
hereby authorize Aark to act on
my behalf, in all matters relative to work authorized by this building permit application-
attao-leA 11 - 3- 05
Signature of Owner Date
Mark -DA Wl., as auflinii aQ�nt as Owner/Authorized Agent
hereby declare that the statements and information on the foregoin application are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
Print Name n^
Signature of Owner/Agent Date
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:
r
City of Northampton
Building Department
212 Main Street
Room 100
Nort} a, pton, MA 01060
phone 413-557.1240 Fax 413-587-1272
t
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 SITE INFORMATION
1.1 Property Address: This�sectt
�� NoY+h Mabl S�'Y�pi' p 7
Z
7
one ' ' "
k
EIm.St. District CB'Diiricrt� ` '
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
AYYN c►o.lah
Name( rint) Curr M ing A r s •
Signature Telephone
2.2 Authorized Agent:
EaAt amptw Ma
Name(Print) Current Mailing Address: O'�^x
Sig ature
Telephone
SECTION.3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building Roofi n -4 1 9 Out) (a) Building Permit Fee
2. Electrical (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) ��,�d Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
nature: r .
Building Commissioner/Inspector of Buildings Date;
46,NORTH MAPLE ST BP-2006-0517
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map-Block: 17C- 140 CITY OF NORTHAMPTON
Lot: -001
Permit: Buildbg
Category: BUILDING PERMIT
Permit# BP-2006-0517
Project# JS-2006-0765
Est. Cost: $9900.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor., License:
Use Group: RCI ROOFING 074334
Lot Size(sq. ft.): 9931.68 Owner: ALTWARG AMY S&
Zoning URB Applicant: RCI ROOFING
AT: 46 NORTH MAPLE ST
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTONMA01027-0309 ISSUED ON.11 1712005 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP, PLY & 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 11/7/2005 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo