17A-048 (4) RC.i.-oo
ROofmg, LLP
51B Holyoke Street
P.O.Box 309
Easthampton, MA 01027 Estimate Date
Phone(413)527-4775 9/9/2005
Fax(413)527-8469
Name/Address Job Location
Cathy Walmsley 160 Bridge Road
160 Bridge Road Florence, MA
Florence, MA 01062 586-4442
Terms Rep
Estimate valid for 60 days Mike
Job Description Total
Remove existing roofs. 8,600.00
Furnish&install aluminum drip edge and pipe flashings.
Furnish&install new lead counter 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 Heritage Series shingle.
Furnish and install Cor-A-Vent 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$2.50 per sq.ft. for wood replacement if needed.
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total $8,600.00
TERMS OF PAYMENT
30%Upon delivery of materials
70%Upon completion Customer Signature
Registration# 126235
Construction License#074334
Insured by Hackworth Insurance(413)527-9907 C?
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�lascacfinuttc'
m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORICER'S COMPENSATION INSURANCE A F'MAVTT
-be.115le of Uhl - R00fil-
(U ccnSCr/permittec)
With principal place of business/residence at:
Jr�a str (phone# {1 -�rj�15
eet/ /s Wzi
ty P)
do hereby certify, under the pains and penalties of pedwy, that:
(V� am an employer providing the following worker's compensation coverage for my
employees wording on this job:
Xnaloan-Int'1 Gr un- 6 S I bb I D 10 ab
ansurance Company) I (Policy Number) (Expiration Dan)
( ) am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the followving worker's compensation policies:
Iune of Contractor) (Insurance Comp-any/Policy Number) (Expiration Date)
ame of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) Qnsurance Compa>ry/PoGcy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Poucy Number) (Expiration Data)
(ecia:h s3dSUon11:hcct if nocc=Luy to ix d information pertaining to all ooatrnetots)
I am a sole proprietor and have no one working for me.
( ; I am a home owner performing all the work myself.
`COTE:plcaao tic avr4rt that whim homeowners wbo employ patom to do maiaieaa conArueiioa or ttpsair worn an a dwelling of
not moce than Lbr"unit:is which the homoow=resides or oa the vwn. s V uruuw thereto an not geaorally mosidend to be
cn'P!oy—under the worker:ooavc=tion Act(GL152,ss 1(5)),AMUcatioa by•homeowner for a lice%-or permit may evidence the
Iesi:ctatua of an employ«under tho Wodtccec Compe�Ad.
I un Serstxnd the a Dopy of this esatemmt may be forwarded to the UeparteraoQ of IadwtriJ Acd4wK Of ce of 10"w-fOr tt»
cov=gc vairicatioa aad that fadur a to tauro coverage under soWon 25A of M%152 ca lad to the impcuitiau of aww Pa W'%
or;fmc of up to$1, 00.00&Wor im�of tip to oar yt v wd dyn pt'! wea is 6a tam of a Btop Work 0*red
fie:a("100.00 a day ttgaitut me
For de -fin bl un'dy
Permit Number
Mag# Lot# `.
SiPature of LiccnkcRermittee
SECTION 8'-,CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :y„Ku� _ S e, 117 4 3 3 4
License Number
5 - � oa7 5 . 03 . 0
Address Expiration Date
0413) 527- IT75
Signature Telephone
rM� m�`r"ovemen Contr ctor Not Applicable ❑
12-6235
Corn any Name Registration Number
51 B o t oK e_ Street - P.D. SDA 389 5- 0 b - 0�
Address J Expiration Date
Telephon 7,
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...... ❑
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
SECTION 5""DES60IPTI�"O"i-'00'6&SED WOOKflche6k,alI applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: e
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑- Sheet❑
6- 'IfN"ewito se;andorail"difion to":exis"tingtiou"sing;"com"p1'ee�lfiil1i :
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;OWNER AUTHORIZATION -TO"BE COMPLETED WHEN
OWNERS AGENT OR�CONTRACTOR?
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:
City of Northampton
Building Department
212 Main Street
Room 100
Northampton, MA 01060
phone 413-587.1240 Fax 413.587.1272
p
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR D lf&[ O Nt�Wn!OlAf4lY'DWELLING
f�
SECTION 1 -SITE INFORMATION
1.1 Property Address:
�� r cam_
ZOIe `�
Elm St D istr . �� �
CBicf s�
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
fa
1
Name(Prinq Curre a"ng A s•
attached Telephone
Signature
2.2 Authorized Agent:
9. 0-1-
P,U. [fix9 - Easthamot Ma
Name(Print) Current Mailing Address: T Ole
.. 2.1
Sig ature Telephone
SECTION 3 -'ESTIMATED`CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building R00 f (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) Check Number
This Section For Official Use,Onl
Building-Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
a BP-2006-1216
GIs#: COMMONWEALTH OF MASSACHUSETTS
" ' �� CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-1216
Project# JS-2006-1800
Est. Cost: $8600.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Groin RCI ROOFING 126235
Lot Size(sq. ft.): 11107.80 Owner: WALMSLEY CATHERINE A
Zoning:URA Applicant. RCI ROOFING
AT. 160 BRIDGE RD
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTONMA01027-0309 ISSUED ON.511212006 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 5/12/2006 0:00:00 $25.008676
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo