17A-069 (3) RCI R
40 Maine Avenue s t� m ate
P.O.Box 309
Easth,inpton, MA 01027 Date
Phone(413)527-4775 10/30/2003
Fax(413)527-8469
Name/Address Job Location
Clyde Morrell 16 Mountain Street
16 Mountain Street Florence, MA
Florence, MA 01062 Phone: (413) 584-0634
Terms Rep
Due on receipt Chris
Job Description Total
Remove existing roofs. 7,000.00
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 over existing deck.
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.I.workmanship warranty included.
30 year Tamko material warranty included.
All related permits will be obtained by R.C.I.Roofing.
SPECIAL ITEMS NEEDED
Add$2.00 per sq.ft. for wood replacement if needed.
WE LOOK FORWARD TO DOING BUSINESS WrM YOU IN THE SPRING. Total $7,000.00
TERMS OF PAYMENT
30%Upon delivery of materials
70%Upon completion Customer Signature L 4
Registration# 126235 �
Construction License#074334 Date /Q
Insured by Hackworth Insurance(413)527-9907
A E Crii� of la tIlaII1:Ptoll _
R,c�sRrhntrfle'
i --
DEPARTMENT OP DUIL.D0\1C INSPECTION'S
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WOR IR'S CON'TENSATION LNSURANCE AF, ' AVIT
(liccvseclpe:Tmincc�— "� J
\14th a principal place of business/residence at:
. / fas III
a►�nf�t7 MA 0160-/ (phone ') _r 7q,5
do hereby certify, under tllc pains and penalties of perjury., illal
an employer providing the followine workcr's compensa ion coverts for my
employees wortong on'ulis job:
vUS-La s=.��i-o33 10 o�L
Conn •) (Polio:?:umber) (ra�ptrnon Dzie} '
O Lam a sole proprietor, general contractor or homeowner (circle one) and live hired
the coniTaciors taste+ below rgbo have the ;ollo%ving workers caMpensabon pokiest
(Name 0-1 Co_^.lr..etor) (Insurance. Coinpanyoi o6c umh-c:) ( zpi;at on Dale)
(Name of CODdZCIOr) (I11SttrZtl Comoan-wPolim, i:umbcr) (ia�ir tion Due)
Mame of Coatraetd:) (Lasutanez ComT=3-/PoL-c-• Numbu) (Expirtion Date)
(Name of Contractor) (LnsZltan Compaay/PoUcy Number) 'Ex
xttanoD Date),
(atueb addtiooal rhea J000=&ry to 6r a udc taforsaaaoo pertaiaiog w.11 oo�st o a)
( ) I am a sole proprietor and bave no one working for me.
( ) I am..a home owner performing all the work myself.
NOTE:plese be ecru 5�N{^Io bo,=, ,,u'bo c=p10Y pezgot t.0 do o==--=0o Cr mpair work m a d.•e1L:^of
oCC morn rhea t'�oe tmt�is tc-Wch the boraoowoa reido or oe the aouac a i�Pam the eo ce Cot oecr=vd to be a
cdploy=une., the waketa 00=P=aim Act(GL152ss 1(5))�LWU=tioo lry a bomcowoa for z Goy or permit ra:y c-.idcx the
Iegar m--of m ct;rloyar uoder tlto Wor1GCle Corny ema(ioa Ad
I u"Cr"Aad th+a a Copy of this raLCC*cc t may be for-~dad to the pop�of lnmttriel Aeodoory off.or u=.r x s for th.
Coverage VaiLctiioo LM tlt:.t LAIL=to soMMC'CovsrLCC cadet suction 25A of),10L 152 ma lad to the imposition oraimiam peo4dcs
000st4as or rwc or up to s 1}oo.00 and/or°h em*(up to ooc Ycu end evil pmaljo is t5c form ore Slop Work Order aced a
race of 5100.00 a day apiast mG
For dcp.,%o: l u.e Doty
Pcrmit Numbar
1;
i. ap..'-- Lot
cn
S'gnamjre of UosccjPcrmiucc �Ee .
SAC'0 a SERVICES � M�
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holde Mal el iSl e. q7'11 33'4
License Number
7
Address Expiration Date
X775
Signature Telephon
e r e.`m v: .: n:,� ., r Not Applicable ❑
R. C • I. Rrnf� no I 2 � 3,5
Company Name Registration Number
-4o Ma; n kitnue-, - P 6 o ox .3nq 5 - b - O
Address Expiration Date
Fasibaynothn. AA 01=2 Telephone f!3 59,q-JP77jr
SSE�T O; *D 0� 9R�S� OMP�NSA710`N"9N�S*lJ'�F3ANCE�AFFIDAI/IT(M��L c 15..2, § 25;��,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)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 aaaa6eq
} rye i
0, a
New House 0 Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding( J Other [ ]
Brief Description of Proposed Work: s
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
ls1JU 0 yin co pile a IIatwtn
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
t�E � 1_ ® IZ 0[�"'i'O�BE�COMPLETED.�IIYHEI� w
+ , as Owner of the subject property
hereby authorize �',�� ne I S e, d7 !L. l,• 00 1 to ac: on
my behalf, in all matters relative to work authorized by this building permit appl cation.
Signature of Owner Date
I, ,_ l7eJ�sl� oS Q0112r7ri zen 0Q'=1- , as Owner/Authorized Agent
hereby declare that the statements and information on the foYbgoing 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 MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to 6i 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:
City 6,f Northampton _ P
Buiiding�pe.partment
212 Man Street f .<
1 � L
-Room 100 _
.Northampton, MA 01060 e
phone 413.587.1240 Fax 413-587.1272 °o to
APPLIC"ATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: m` _ {,yotion to�becm feteb �offce µ
����, F This se L
itr�y
b .nn�ounfiaa h �"� Ma, Lo t �t
y
TlQYen Le.,
Eln)mSt�District �'`� �, CBDistrict �° `° '
SECTION 2 - PROPERTY OWNERSH'P/AUTHORIZED AGENT
2.1 Owner of Record: ��f
e I orrej I 16 �H mriitaa n
Name(Print) Current Mailing Address:
qttapleA Telephone
Signature
2.2 Authorized Agent:
Yag�7eI/'s1f, - U-1. Inca POa x 309 - �aS�ha»m�tna�NA o�
Name(Print) Current Mailing Address:
(-q 13) 5q7- jq� q �
Signature Telephone
SECTION:-3.- ESTIMATED CONSTRUCTION.COSTS
Item Estimated Cost(Dollars) to be Official UseOn,ly
completed by ermit applicant
1. Building 7
Roo ('i I,� � 60p,C0 (a) Building Permit Fee
ROCS
2. E!,,-,rical (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) X00. 0Q Check Number
This Section'For Official Use Only
Building permit Number: Date slued;
Signature: _
Building Commissioner/Inspector.,;of Buildings Date
a
i
16 MOUNTAIN ST BP-2004-0917
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A-069 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-2004-0917
Project# 35-2004-1368
Est.Cost: $7000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sa.ft.): 10018.80 Owner: MORRELL CLYDE E&ARLENE A
Zoning:URA Applicant: RCI ROOFING
AT. 16 MOUNTAIN ST
Applicant Address: Phone: Insurance:
P 0 BOX 309 (413)527-4775 Workers
Compensation
EASTHAMPTONMA01027-0309 ISSUED ON:3129104 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• Receipt No: Date Paid: Check No: Amount:
Building 3/29/04 0:00:00 5267 $25.00
212 Main Street,Phone(413) 587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo