17A-166 (2) R.C.I ROOFING
40 MAINE AVE.
P.O. BOX 309
EASTHAMPTON, MA 01027-0309 EE S TI MA TE
PHONE (413)527- 4775
FAX (413)527-8469
Date: APRIL 11, 2003
Estimate To:
RICHARD FIN,Ck Estimated B : MARK DELISLE
44 KIMBELL ST. Start Date:
FLORENCE, MA. 01062 Job Location: 44 KIMBELL ST.
FLORENCE, MA. 01062
"JobPhone: (413)584-6048
JOB DESCRIPTION
FURNISH & INS TA 1,L ALUMINUM DRIPFT)C-,F AND ALL OTHER RELATED FLASHTNGS.
FURNISH & INSTALL 30 YFAR_TAMKO SHINGLE,
FURNISH & TNSTALL RIDGE VENT.
FUP,N-rSH & INSTALL 11211 FTRFRBOARD INSULATION ON FLAT SECTION,
FrMh7T.179 X INSTALL .045 E.P.D.M. (RUBBER) ROOF SYSTEM 0,N FLAT SECTTON.
ALL WORK WILL PERFORMED ACCORDIXG TO MANUFACTURERS
10 YEAR R.C.I. WORKKANSHIP WARRANTY INCLUDED,
30 YEAR TAMKO MATERIAL WARRANTY INCLLTDED.
SPECIAL ITEMS NEEDED
ADD $2.00 PER SQ. FT. FOR WOOD REPLACEMENT IF NEEDED.
Additional information pertaining to this Job Estimate
TERMS OF PAYMENT
30%PRIOR TO START Total Estimated
70%UPON COMPLETION Job Cost $5,400.00
REGISTRATION#126235
FEDERAL I.D.#04 3418839 Authorized,�,-
CONSTRUCTION LICENSE#074334 Sig nature,.
INSURED BY KACKWORTH INSURANCE(413)527-9907
ORIGINAL-ESTIMATOR COPY
�K t1AM p�O
Boo °a Crzt� Jay wart 11alliptoll
a � �aSE AChtibfflE, ,
e
DEPARTMENT OF BUILDITIG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
(IicenserJpermittec)
with a principal place of business/residence at:
( city/stafrizip)
do hereby certify, under the pains and penalties of perjury, that:
I am an employer providing the following worker's compensation coverage for my
employees working on this job:
ce Comp-ay) T (Policy tdumber) (Expiration Date)
( ) I 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:
(Name of Contractor) (Insurance Company/Poky Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Nanic of Contractor) (Insurance Company/PoLicy Number) (Expiration Date)
(Name of Contractor) (LnsZuance Company/Policy Numlr_r) (Expiration Date)
(attach additioml slid ifn<ccaaary to ncauuc iafortnstioa perta'tiro&to all O tractors)
( ) I am a sole proprietor and have no one 'vorkulg forme.
( ) I am a horne owner performing all the work myself.
NOTE:please be atrrrc that wtulc hoaxnwvcrs wbo crnploy persom to 6)Inaintc�cc,cart nuaoa or rrpair work on a&%ruing of
not mac than throo uruits in which the homeAtvcr rraidcs a oa the Erouod,appurtenant thado arc oot Generally oomiclercd to be
emploYrn u.''dcr the veQckts's coa�—atioa Act(GL152.ss l(5)�appticatio❑by a homco-Ama for a bcrasc or permil may evidence the
legal rtatua of an omployec undrr the Wockr e&CompoosaLion Ad-
I und=vAnd that a ropy of this rzatcmcrs may be forwarded to tbo D"t—d of Indaratrial Accidco&Offioo of 1—um0os for tho
covaxga vaificatfoo and that failure to sxure courage uudcr soctioa 25A of MGL 152 can lead to tho imposition of aunt sl penalties
ooasisiuxg of a fine'of uP to S1,500.00 and/or imprisormxszt of up to one Year and civil pcoaltia in the form of a Stop Work Order and a
frno of S 100.60 a day tgaiast mc.
_.,i Ei 7= =�se On:U:::]-'j✓ �,. %p/� ?`'
t#
�, Sipuabat of Li�ey perniittce
SECT,1I ONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :�,�rkr`� ���.� 0� "7
License Number
fi
Add7ss�� Expiration Date
Signature Telephone
, •� .;
Not Applicable ❑
lZ (, 735
Company Name Registration Number
C-, .i__ .S - (, Cif
Address J Expiration Date
qU 04,�i Lt, Q u Telephone 7 23
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...... O
'ome� ��wner�EXempti�n'
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
SE�TIONIS DSCRIPTION OF PROPOSED WORKIcheck'all'applicable)
q
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] 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
6aYIf N WW ho. se afid o—e dditiorvto"existing housin , corriple"te the.4foTlowing:
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?
In. 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"MCONTRACTOR APPLIES FOR BUILDING PERMIT
I, RI chaxd as Owner of the subject property
hereby authorize (1`A-rx c'V, �� 5 / - 1n , \a to act on
my behalf, in all matters relative to work authorized by this building permit appli ion.
Signature of Owner Date
as Owner/Authorized Agent
hereby declare that the statements and information on the foregoing applic Nn are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
Print Na e
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
puking)
#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:
n ,
_ m1
I o prthampton S r
O'lepartment .
21i Street
t JUN 1 2 2003 100
Northa pton� MA 01060
phon 58 241 Fax 413.587.1272 Pao 1. tie P
nF�or��l�tolF�c!�s°ECT c.:�s
A ON TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE JNFORMATION
This sectionktd�be'---"'Iet"d`";'y
1.1 Property Address: z
�H Kimball street
Map ' ' fLot tt"
I r
Zone OverIayD�st� � .
�+ e:n wr Spa ,C 9^ fir.tr1 h y ?
Elm St. District CBDistr�ct�
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Ri ch atC rFi nak �H tai'm 1xw Sired,
Name(Print) Current Mailing Address:
—50-
Telephone
Signature
2.2 Authorized Agent:
Name(Print) ;' Current Mailing Address:
Signature Telephoo5
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars) to be Official Use Only
completed by ermit applicant
1. Uuadia8 �Rbbqi n (a) Building Permit Fee
S�Qb.Db
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) 51400,00 Check Number
.This Section For Official Use Only
Building Permit'Numberr Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
L T
BP-2003-1136
GIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2003-1136
Project# IS-2003-1797
Est. Cost: $5400.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sq. ft.): 33410.52 Owner: FINCK PRISCILLA P TRUSTEE
Zoning:URB Applicant: RCI ROOFING
AT. 44 KIMBALL ST
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTON MAO 1027-0309 ISSUED ON:6112103 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 Occupangy Signature:
FeeType• Receipt No: Date Paid: Check No: Amount:
Building 6/12/03 0:00:00 4094 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo