17C-133 RC-1. R
P.P. Maine Avenue Estimate
O.Box 309
Easthampton, MA 01027 Date
Phone(413) 527-4775 11/3/2003
Fax(413)527-8469
Name/Address Job Location
Bernice Andrus 95-97 High Street
93 High Street Florence MA
Florence, MA 01060 Phone: (413) 586-0383
Terms Rep
Due on receipt Chris
Job Description Total
Remove existing roofs. 13,500.00
Furnish&install 1/2"plywood over existing decking.
Furnish&install aluminum drip edge,pipe flashings and chimney flashings.
Furnish&install ice&water barrier along eaves and valleys.
Furnish and install 15 lb.felt.
Furnish and install 30 year Tamko shingle.
Furnish and install ridge vent.
All roofing related debris to be removed by R.C.I.Roofing.
All work will be performed according to manufacturers'specifications.
5 year R.C.1. workmanship warranty included.
30 year Tamko material warranty included.
All related permits will be obtained by R.C.I. Roofing.
SPECIAL ITEMS NEEDED
WE LOOK FORWARD TO DOING BUSINESS WITH YOU IN TIE SPRING.
Total $13,500.00
TERMS OF PAYMENT
30%Upon delivery of materials
70%Upon completion Customer Signature
Registration# 126235
az tz
Construction License#074334 Date i Q
Insured by Hackworth Insurance(413)527-9907
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a DEPARTMENT OP 13UILDt•)\,10 INSPECTION'S
212 Main Strcct ' Municipal Dudding
Northampton, Mass. 01060
«'ORJQ:R'S C01Q'ENSATI0N INSURA�CF AITU)A\f1-'
(1;aysccJpcnni tree)
,- iLb a principal place of business/residence at:
J40 to I P. Ave,;L fan MA 01 D 25 (j hone==) ► , )50 7- 7`/'S
do hereby certify, under die pains --Dd penalties of perjtuy, hzl
(V� I aril an employer providing die followinL worker's cotnpcnseDon covervgc for Iny
employecs worlDng on'tllis job:
L%24-033 io g- o
�c= Coal=v) (Polio N'Um X'i) (r;piruor, Dal--)
O I.am a sole proprictor, geoeral contractor or homeowner (ci cie one) and have hired
the coon-actors Listed below cvbo have the follokving worker's Ca0 policies:
(NIMC Of Contncior) (1n urancc Coinpa1)YPOUCi (Fx-PinGon. Dale)
- (Name of Cootraeior) (l.nsarancc COmDaa)•/Polim, Num6:0 (Expiration Dae)
(Name of Conaaelo,) (Iusuraacc CompaD)•/PoUcy Nust•,,:f) (Expiratioo Date)
CN2—Mc of Conaaclor) (Lasuranc-- Compaoy/PoLicy Numbs) (Etipi adoo Data).
(aaich �ocaJ bcG if coocu�•w c,cu�iarorci,.�oo pctaiaizts w..0 oo=m o:�) ,
( ) I
am a sole proprietor and bave no one wot-j6og for me.
( ) I am.a home owner performing all Lbe work myself.
NOTE:plcx be ewuc 0--•Je bcc=,-acn.vbo cmplvy pciom Lo ca^,sy esoo r rrnir wvri:on.d%%ell-;,of
ont more th_c t'=• --tetra in%,hieb the botnoc, n rmdo or oo eke p vc c&z zg�-tbeco r_-r ox -^nity oeczid.7af w be
aitploy---"C—eke--kcf"o=p=t ioa Act(GLI S2.n 1(5)).apptir_zntioo try a bomw%D=fm c Iie=c-x or pavan rney c%ideooe the
icga.l n,^••of m e=:Ployat under dw Worfolr Comp000ceio Act
I uodertaad th-a copy orthi.mtcm nt ma.y bo fded w rbo peq.,remao¢or l..w OIL-or 4zau+ooa f-
oovc�c vaircxioo a d titst L iltse w cewrc corerase tzndcr soC3ion 23 A or I fOL 132 c,,lad to the impositiea of aimiaal pcnallic
000siriag of a Gx or up to S i 3oo.00 utdJor iarizoam of up to ooc year tad ci vil praahio m ts-rorm of.Slop Wort Ordc r Lod■
fits of 5100.00 a dry ap-iast roc
For uac Doty
Permit Number
Y r
Map., L.ot
SignzWrt of Lic==,J- crrniucc Wte J •:
1, GTE, SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑ L
Name of License Holder : �M44 'I 1;51 e. °7 /'� 33-,7
License Number
o - 7 5 - 3 - 04
Address Expiration Date
��.�r� - 'Y775
Signature Telephone
WRe aRe ome Improvement CbTil tor` Not Applicable ❑
R. z.
Ronf, nq / 26 4? 3.5
Company Name Registration Number
-► o No; n .1itnwP, - U . box .coq 5 - 6 - at
Address Expiration Date
Telephone /3) -'y775
SEC�TI10 410h110 K MPENSATION;;INS�URANCE 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...... ❑
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)famines
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-near period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acccptable 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
SECTelO.Ni. DE5CRCP :ONTO P,ROPOSEDIORK :e ali%a`�e•�� � .
`_ ez
°,:...:. #..'
New House ❑ Addition ❑ Replacement Windows Alteration(s) C1 Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ J Siding[ ) Other [ )
Brief Description of Proposed Work: i ci, new
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
6a.: Thou :eg ndor "addi"iron toex►singh u=ncomp 'e WHIR
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 .
1. Septic Tank City Sewer Private well City water Supply
}SEC Ot 7a D-W ERMUJHORIZATION TO BE MP
COLETED YVHEN
OIY EFSGE T 000NTRACTOR APP'LIES,°FOR BUILDINGrPER1 T "
I, y d An ri15 as Owner of the subject property
hereby authorize f . to ac,t on
my behalf, in all matters relative to work authorized by this building permit application.
Q ian6A a 5 C)*
Signature of Owner Date
hSle, QS QIJILdZed as Owner/Authorized Agent
hereby declare that the statements and information on the fdYkgoing 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 Date
Section 4.
ALL INFORMATION MIDST 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
-kin
#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:
f Northampton
Q �( SB i i g De.partment
Main Street t
om 100
AEG 2 5 544o t am ton, MA 01060 e
phone 413• 7.1 40 Fax 413-587-1272
APP LI „'P1 STRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 S;LTE fNFOMA?ION
r :
Fi'ss�ection to -a"""" fi°c
1.1 Property Address: ';'
9r--,-qr1 'N'lg�) sty-ed M.
!*CTION 2 PROPERT*Y OWNERSHIP%AUTJiOIZED GENT.-
2.1 Owner of Record:
"�yn'ice. ,Andrus 93 Alah 5t. - i Ior
Name(Print) t Curr n ai l g Address:
a�.ta�ed �� -0.38 3
Telephone
Signature
2.2 Authorized Agent:
-so - Easi ampto JYIA
Name(Print) Current Mailing Address:
�{►3 52°1- ggq5
Signature Telephone
SEC IC1N�3 ESaTIMA7Et d`0 S�CR -CTION'C`0'fSTSfi`
Item Estimated Cost (Dollars)to be OffIdiaLUse Qn.y
com leted by ermit applicant
1. Building (a) Building Per mit Fee
2. Elec;ricai (b) Estimated Total[Cost:of
Construction fromi;;5'
3. Plumbing building Permit F"ee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) 3 50�.�0 Check Number
This Section for Official Use-,Orfl ..
Bwldmg'Pe�m t Number :... ... _ Date Ttsued
Signature:
Building Corl7mks ion er/(nspector.;;of Build..ings Date
i
95-97-HIGH ST BP-2005-0231
GIs#: COMMONWEALTH OF MASSACHUSETTS
M_aR;_8 k 17C- 133 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Build'Inq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2005-0231
Project# JS-2005-0283
Est. Cost: $13500.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: RCI ROOFING 074334
Lot Size(sg. ft.): 33410.52 Owner: ANDRUS BERNICE R&CAROL ANN
Zoning URB Applicant: RCI ROOFING
AT: 95-97 HIGH ST
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTON MAO 1027-0309 ISSUED ON.8125104 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• Receipt No: Date Paid: Check No: Amount:
Building 8/25/04 0:00:00 5861 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo