17A-121 (2) *, T
. Roofing,L,1
51B Holyoke Street
Box n
Eas Estimate Date
Easthamptoton, MA 01027
Phone (413) 527-4775 4/6/2009
Fax (413) 527-8469
Name/Address Job Location
Helga Boyle 54 Claire Avenue
54 Claire Avenue Florence, MA
Florence, MA 01060 586-0284
i
1
Terms Rep
Estimate valid for 20 days Rich
Job Description Total
ESTIMATE IS FOR BACK PORCH ROOF ONLY. 1,800.00
Remove existing roof.
Furnish and .nstall 1/2" fiberboard insulation, mechanically fastened.
I Furnish and install .045 reinforced rubber roof system.
Furnish and :nstall all related (lashings.
Furnish and install .032 aluminum drip edge.
Replace (2) two shingles on main roof.
All exterior roofing related debris to be removed by R.C.I. Roofing.
All work to be performed according to manufacturers' specifications.
5 year R.C.I. workmanship warranty included.
All related permits will be obtained by R.C.I. Roofing.
I
i
THE OWNER HAS THE RIGHT TO CANCEL THE CONTRACT WITHIN (3)
THREE BUSINESS DAYS OF DATE OF SIGNING. Total $1 ,800.00
TERMS OF PAYMENT
5%Deposit
Balance upon completion Customer Signature
Registration# 12623
Construction License#074334 Date
Insured by Reynolds,Barnes& Hebb, Inc.413-447-7376
Gi 'af wart 1 allip tell
� ;{8 ,f�assachnsrtta'
A �
T Q DEPARTMENT OF BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSAITON INSURANCE AFF AVIT
(licxnurJpermittcc)
a p -rlcipal place of business/residence at:
Jrl '1� (phone#
',��� 6trcct/c /staie/a
h' P)
de .hereby certify, under the pains and penalties of perjury, that:
lv i lam an employer providing the following wolkces compensation coverage for my
enlolcvices wor4L ng on this job:
Nate01Lal U>r wn Five.
T_ns• Co. of flttsku.YQ PA WC3b31g69 10/05/09
C nit ranCC Company) Y (Policy Number) (Expiration Date)
( j I Ln a sole proprietor, general contractor or homeowner (circle one) and have hired
t .e con,ractom listed below who have the following worker's compensation policies:
(N,.me of Contractor) (Insurance CompanyRoticy Numer) (Expimtion Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Daze)
(Name of Contractor) (Insurance CompanyRolicy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
�..:tadt additioazl a.'xci if neceivry to include information pertiiniag to all ooakndon)
12.In a sole proprietor and have no one working for me.
; ) I am a home owner perfon ing all the work myself.
NOTE:pfozac be awuc that whi]o homwwnm wbo employ per:oas to do M• C*+• oonstruwoe or repair work on it dwelling of
:.ot mcc-�than throo ttniti in which the homoowocr raids oc oa the(,rounds zpputtenacrt thado arc nob genertlty oowidend to be
Tloyr,-a under the wockex com9cas4oQ Act(GL152-ts t(S)�,application by t homeowner for a Uccme a pe and mty evidence the
(S l rtztuc of an a=ployoc under tbo Wor4dc ConVa=tioo but
I uajc Ytaad that a Dopy of this cutcmmt auy be forv^nnied to tho DWuUncod of Inriurtrial Aoti4edy 015oe of tawrtooe fot dw
�v�vaificstion sad that failure to coon wvatagv ttodct soctioo 23A a(MOL 1 S1 qn lead to Ise'ianposilioa of criasiwl pewldd
�misiiag of a fine'of up to S 1,500.00 tndlor im{>riso=3C d of up to one year tnd did pemlties in the form of a Stop Wtxit Order sad a '
m of Z;100.00 a day gtiwt ma.
For&Pam w U-ooty
Permit Number
�{-17-09 rp Lot#
�'„ Sigaabue of LiocnscrlPcrmitttx
SECTION 8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: Mays � c
P1 i S I e. 7 g 3 3 4
License Number
5)ES &1iuo e St Ea ithmnlon Ma. oioah 5 - 1) -10
Address —r Expiration Date
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
6.0'. Z. 12 b 23.5
Company Name J Registration Number
5I S uolija e Aree - P. D. x 309 _ 5-nb_ /0
Address ��11
tt11 Expiration Date
East aYn 0TOn . Ma. Q)02,7 Telephon -?"
SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6))
Workers Ccmpensation 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 buil ng permit.
Signed Affidavit Attached Yes....... No...... ❑
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families
quid to allo« 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-homeovwncr"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.lor which this permit is issued.
Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153(Liability of Employers to
:mployees for injuries not resulting in Death)ofthe Massachusetts General Laws Annotated,you may be liable for person(s)
:.ou hire to perform work for you under this permit.
f'he 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 attached
1
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
I
New House ❑ Addition Replacement Windows Iteration(s) ❑ Roofing
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [lam] Decks [CJ Siding[O] Other[❑]
F
Brief Description of Proposed _ M
Work:/ '�,
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Mans 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
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
as Owner of the subject
property
hereby authorize ell
ina
to act on my behalf, in all matters relative to work authorized by thislouilding permit application.
2d 2 Cbe d g-17-09
Signature of Owner Date
I, as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing 4lication are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Print Name
�- 17-09
Signature of Owner/Agent Date
R
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
I:�isting Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
F~outage
S_tbacks Front
Side L: W
Rear
Building I leight
Bldg. Square Footage 0%
C"pen Space Footage %,
fLotarea minus hide&paved
:rkine)
#of Parking Spaces
( olume&Lpcation)
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 Q YES O
IF YES: enter Book Page and/or Document #'
E. Does the site contain a brook, body of water or wetlands? NO 0 "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 Q
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 Q
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 0 °
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
, w
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
Room 100 WaterNVell Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A;4 NH OR.,-iW,0'Fr�MI�"Y Co
EL;LtNG
SECTION 1 -SITE INFORMATION
1.1 Property Address. T�t pn to be complLted office
5q Claire .A eAu.e_ Map . Unit
Zone - Overlay District
Elm St.District CB District
SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Prfri Cu rr actin Ad re s: T-
at bpd-��
Telephone
Signature
2.2 Authorized Agent:
• P.O.&Y. 31)9 - Each mnto�r a.
Name(Print) Current Mailing Address: 01021
�- N13) 527- '4?? _r
Signature
Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
I. Building oofI �I ' �Q�•�O (a) Building Permit Fee
2. Electrical 1- (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) U
5. Fire Protection �5• 06
6. Total= 0 +2+3+4 +5) 1 DO v 00 Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
5�i >%. . BP-2009-0863
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block{ 17A;- 141.. 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-2009-0863
Project# JS-2009-001266
Est. Cost: $18000.00
Fee:$35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING
Lot Size(sq. ft.): 10759.32 Owner: BOYLE HELGA R&BRIAN R BOYLE
Zoning: URA(100L/RI Applicant: RCI ROOFING
AT. 54 CLAIRE AVE
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775
EASTHAMPTONMA01027-0309 ISSUED ON:412412009 0:00:00
TO PERFORM THE FOLLOWING WORK:ROOFI N
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 Siznature:
FeeType• Date Paid: Amount:
Building 4/24/2009 0:00:00 $35.0013842
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo