17A-219 (2) R.C.1 ROOFING
40 MAINE AVE.
P.O. BOX 309 F=ES /MA TE
EASTHAMPTON, MA 01027-0309
PHONE (413)527- 4775
FAX (413)527-8469 1
�jpDate: MARCH 10, 2002
Estimate To:
DICK VENNE Estimated B : CHRIS THOMPSON
164 N. MAPLE ST. Start Date:
FLORENCE, MA. 01062 Job Location: 164 N. MAPLE ST.
FLORENCE, MA. 01062
Job Phone: (413)586-6940 (W) 584-1460
JOB DESCRIPTION
REMOVE FXTSTING ROOFS,
FURNISH AND INSTALL TrF ANT) WATER RARRIER ALONG EAVES AND VALLEYS
FURNTSH AND INSTALL 15r.R. FELT,
FURNISH AND INSTALL .10 YEAR TAMKO SHTNGTF.
FURNISH AND INSTALL RrDCF VENT,
ALF, RQQFTNG RELATED QFRRT-q To RE REMOVED By R.C-1- ROOFING,
FURNISH ANL2 TNSTALL -045 VERSICO FULLY AnHEARED ROOF SYSTEM ON FLAT SRCTTON,
10 YEAR R-('-I. WOR ANSfflP WARRANTY IMCLIMED,
ALL RFTATFn PERMITS WZ-TT, BE OBTATIVED By R.C.I. ROOFING,
SPECIAL ITEMS NEEDED
Additional information pertaining to this Job Estimate
TERMS OF PAYMENT
30%PRIOR TO START Total Estimated
70%UPON COMPLETION Job Cost $8,500.00
REGISTRATION#126235
FED.ID#04 3418839 Authorized
CONSTRUCTION LICENSE#074334 Signature
INSURED BY HACKWORTHlLAPLANTE INS.(413)527-9907'
ORIGINAL-ESTIMATOR COPY
�.CKM1P�.
0 of Nartljaiiiptan
M �
�8S5ACIt liStltB -
n" DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR
212 Main Street * Municipal Building
�.
Northampton, MA 01060
r r j
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 78OCMR 108.3.4 to
act as iris/her construction sul : . isor. The stale defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends to be, a one or hvo family
dfvelling, 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
home owner."
The building department for the City of Northampton wants any person(s) who seek to
use the home owner exemption, to act as their own construction supervisor, to be aware
that by doing so you become responsible for compliance with state building codes
and regulations. The inspection process requires that the building department be called
to inspect work at various stages, which include foundation/footings (before backfill),
sonotube holes (before pour), a rough building inspection (before work is
concealed), insulation inspection (if required) and a final building inspection. The
building department requires these inspections before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occupancy
until the work can be inspected.
If the homeowner hires other trades to perform work (electrical, plumbing & gas) the
homeowner will be responsible to make sure that the trades hired secure their proper
permits in conjunction to the building )ernilt issued, and that they get their required
inspections. Failure of the individual trades to secure the permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
I, understand the above.
(Home owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date
Address of work
location
6 �Z�[SIIA(h IlSCIIII �I _�
f _x
&itl) of 'Nartilaillp!Lill
z � 1>EPAR:I'MEl��f OP BUILDING INSPECTIONS
212 Main Street ' Municipal BI61ding
Northampton, Mass. OVA,()
WORICI�R'S CONM-P NSATION INSUMNNCE AFFIDAVIT
(liC--hs-ci e,m i It )
whir a principal place of businesdresidence at.
(phclnc'i;' -
CIO hemby eC1W nlWOV TC ; ,..i1S ai1C1 pCil2ltiCS Oi Der)111N, iil!i
I --m an employer providing Te ibllowiny 'w;orker�s cool,"ensallon coves e hor illy
tlIlploy s w0i. ng. 11 t,,is joh.
(Insn icz Cor Pw") (Peiic;Number) (h_pi ion Date)
O I ari a sole prourictor, general contractor or homeowner (circle one) rind 'gave toted
the contractors Reds MO %010 love the fono iEig wOCke�S COI�Uerl�?i10P. pC11C!�S:
(Name of Conwams) —(insu ancc Cool: a.r-Polk, Nt n't ;l cell D ac)-
(Nam of Con amoo (i:_,u.•.ncc C o Z11yliy/Po!lc, )ale)
Tame of Contlactoi) iIl$ZII IK (_ni i;ail}'/POlic}' NiIIP}}'_i� �t gar ---t13t��1
(Name of Consamor) (I11sz:r2slc Comra-nylPolicy Date)
(ruadt:-dai:imil cac•i..._�r.z.:-:c. ..._-_.- ...t--{r.:.:i:K:;- ,a�nirr•..,ei;;,_<._��.�..-.)
O i tun a role propli,-,oi ;::!:i halve no ogle meking For me_
am a holm' Ovmc: ;fA`,i ilml; A HIC°. wul myscif
N0•I1:plc.ac lx Awa� Tc tl:a' .�' ]c f c;o�ti:r_ta +; c nplay ir_a to c.) cc'.rm:n;c,:,n -:i_�-a =r
not uKvc than throo units in ui_iCii cr at tl-- zz?turtcnsnm, o uc rxt vrslly c;,::::ir:ai:�h-
cmployc�uti:cr the tvoci ri m y___.�tim r-,(;,LI «1>71au:: .roc
API ctahtc of an om:loyx untie tho VV"ici a c:<uu;xrr itioct/.d
I undcnund that a ro,y of t}i,a ctatcn Art r:�) bo fortivnniod to tln LYtxirrrrsxi of l tvrirJ AD66 &CLlioo of!:-.lour n for 11 rc
coverage vcrificitioa and tlut r ilurc to cn, c n:Vttno,ur—�-r s4 ,ion 25A of 2.101,152 can lc�d to Om in:positia-t u(cn maA- persl.:cs
mnsidAg of a fine of up to S I,SN100 anscr of up to cox }t ?,M civil pcmitia in dx Eton of
Lr>roCSlOO.Dda city c;�.imt[
1 OC W trm"u>+c c:nty
SLgna c of i
ICU
SECTCON 8 NSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
r
Address Expiration Date
Signature Telephone
�f'R"bm�'mprbvema"f Co trn acfor _ "i �T Not Applicable ❑
�(te�"tereda„ E
Company Name Registration Number
Address Expiration Date
Telephone 5, 7 22
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...... ❑
. � �011l, : � ;pile E` TI
The current exemption for"homeowners"was extended to include Owner-occupied Dwellinjzs 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 _ -
SECTIONf''i'�DESCRIPTION`OF PROPOSED=WORK(rheck�all applicable):
�---
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing X
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks f[ ] Siding[ ]] Other [ ]
rief Description of Proposed Work: > '�"�
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll 0 - Sheet❑
6a�If New house andto additioWWdkistingr housing,"-d miftlete' the fol"fowink:
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
SECTfbN 7a,�;'OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT.
as Owner of the subject property
hereby authorize to act on
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
as Owner/Authorized Agent
hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
Print Name
a Signature of n 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
parking)
#of Parking Spaces
Fill: I
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 'S at v
Building Department C r
212 Main Street
Room 100 Wa erlWe' _v
Northampton, MA 01060 ' et t>
phone 413-587-1240 Fax 413-587.1272 P11 ite P
OtheraSpe �.`
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address:
This sectionk o bexo'mp-Il,by " ice
q
/y Maps Loth a f v � � ntYf ,
Zone Overlay District3
r
i
Elm St. District CB D�strict
SECTION 2 - PROPERTY OWNERS'HIP/AUTHORIZED AGENT
2.1 Owner of Record:
Narne(Print) Current M g Address:
- __ Ja
Telephone)J
Signature
2.2 Authorized A ent:
Name(Print Current Mailing Address:
Signature Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by ermit applicant
1. Building (a) Building Permit Fee
2. Electrical (b) stimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4 Mechanical (HVAC)
5. Fire Protection
6. Total = 0 + 2 + 3 + 4 + 5) Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building,Commissioner/inspector of Bui(dmgs Date
� � yk BP-2003-0772
''p 99
GIs#: COMMONWEALTH OF MASSACHUSETTS
91046""w CITY OF NORTHAMPTON
Lot: -001
Permit: Buildina
Category: BUILDING PERMIT
Permit# BP-2003-0772
Project# JS-2003-1272
Est. Cost: $8500.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: RCI ROOFING 074334
Lot Size(sq. ft.): 19035.72 Owner: VENNE RICHARD W&RHONDA J M
Zoning.URB Applicant: R.CI ROOFING
AT. 164 NORTH MAPLE ST
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTONMA01027-0309ISSUED QA:3121103 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 3/21/03 0:00:00 1897 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo