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17A-196 (6) r . RCI ROOFING 30 HIGH ST - EASTHAMPTON MA 01027 ESTIMATE (413)527 4775 FAX (413)527 7690 Date: MARCH 27 00 Estimate To: ALAN BERTRAND Estimated By: CHRIS THOMPSON 151 NORTH MAPLE ST Start Date: NORTHAMPTON,MA 01060 Job Location: NORTHAMPTON Job Phone: 584 7156 JOB DESCRIPTION REMOVE THREE LAYERS OF SHINGLES FURNISH AND IINSTATT, ICE & WATER BARRIER ALQjVG EAVES AND VALLEYS. FURNISH AND TNSTAT,T, ALUMINUM EDCIF MFTATS Alv.T) AFT, RFTATED FLASHING. FURNISH AjVD INSTALL COBRA RIDGE VENT. ALL ROOFING DEBRIS TO BE REMOVED BY RCT ROOFING, ALL WORK WTFT, RE PERFORMED IN ACCORDANCE WITH MANUFACTURERS SPECIFICATIONS. roll SPECIAL ITEMS NEEDED >` ? i LA L° Additional information pertaining to this Job Estimate TERMS OF PAYMENT 30%PRIOR TO START Total Estimated 70%UPON COMPLETION ,lob Cost $4,500.00 CONSTRUCTION LICENSE#074334 FEDERAL LID#3418839 Authorized REGISTRATION#126235 Signature (I6z"0 `� \ INSURED BY BANAS INSURANCE(413)527 0288 ORIGINAL-ESTIMATOR COPY r � o 1 61tl3 crf Port 11allip toil � � �Icsancflncrlla _ u o DEPARTTAUNT OP DUfIjfNG INSPECTIONS — 212 Train Street ' Municipal Building Northampton, Mars. 01060 yVORICER'S CO'i QUENSATION INSURANCE AFFIDAVIT C;E e 'C o n - - �; V'rith a principal place of business/residence at J� � 3 p ` f'1 S �p�" M ci 0 l a Z none:' C. (str�t/ci ty/s�aicfz�p) do hereby cerffy, under the pains and penalties of perjury, .hat N/I am an employe: providing the following workcrjs cornocns:.ao:; cove:-2�c nor Illy etuplovices wor4�ng on this job 1(2 l�1 S- Insur Corer� ) (Polio; Numb-- ( ) I am a sole proor,etor genera] contractor or homeowner (elide one) a-nd have hired the contractors listed below who l zve the following vor�ef s com )en -non pohctes: (Nano of Co_t;:+ctor) (Intern Cotnpan fPoGc, �'um _. (Na inc of Contractor) -- (inssr2ne Comoajv/pOIIC \umc�r) ���r Lion Date) (Name of Contractor) (Lasw-ancz Compan}•/Pot,iq- Number) (L-xpir aotl Date) (Name of Contu ctor) (In_s-ua-nom Com>,,any/Pohcy Nuinlys) - (Expit21ion Dai-c) (mach sddi:;oc�l:'_xcS Joe�;a to c �ucL uzform.:i oc pertsinins to all ( ) I am a sole proprietor and have no one wor4 og for me- ( ) I am a home owner performing all the work myself. N071_:plc—be aware LL,wt:_)c hcar.,o.iv_r�.,j,cxaploy pciont to do C .0 ca acr, rcpav%-o K of t d—u--^of not n�occ t1L.n Isom Lmi',in a{,,;�' Lx b,mooAvc rcid—or oa the z +_ e -� �pvr'lCn:r1 ilreto e.-c Y Ev-�eclly eee.ie.--c�to be x ployc-3 once he .v SL ,�I�m Ar,(GL152-Tz 1(5)�:-�lication try a hocncoHVa foi c Lcsv or pernvt a_y—r&mm aLc I< I n ^ -fan c=Plov-unG-r d— <:o�A,�x- I und—L—d t tut>oopy of this"IL—c-s may bo for--fed t,o tyo D,, � of lndsixri cl.1cnd�t�O1L oo of[-�for tha covmgc vcrificiioo and th.t L-JL-c to toa-L c covcjn�Ma icr�Cioo 25A of MGL 15-2 can Irad to tlx u^poSitioo of airmail pcsillb s coosistmg of a fmc of up W S 1 500.00 anNcx anpruo=xy of up w one yc:r tad ci%i1 l�d�,tx form of a Stop Wort Otdc end e fire o(S 100.00 t d_y tpimt ar C—���G✓� PCTIRII t`Ill]➢I CT ---- Lot " — — Signatul-C of Lica]_ccJl'crmittcc e ti GT1QN :-CONSTItU T N SERVICES -.1 Licensed Construction Supervis/or: Not Applicable ❑ Name of License Holder: �G r`� OGpp [ ;s / e- d < 3 �^ 1 ,� � License Num er G� �YI /��►. c��v U Address Expirauu Date --�;�/, ,Z, Signs ure Telephone Not Applicable ❑ © 0� /a6 -� 31 Company Name Registration Nu b �. . ci- o1oy7 _ a 2 Address Expira ion Me Telephon 2 7 77 SECTION . Yff RKER ' 3MPENSA- ION INStJ LANCE AF DAVIT(M G L.,c.152,§.°25C(5)) 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. red Affidavit Attached Yes....... ❑ No...... ❑ 3 d 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 New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: fl l/e "le S VT 5 , Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll ❑ - Sheet❑ 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? 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 IeCTION Ta 01i!t,N.'F- ,AUTH.O,, ATION �±� B�CQMPLET O WHEN OWNERS AGENT'QR'CbNT�tjff6R 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. AiP%igned under the pains and penalties of perjury. Xr Print Name b/ci G� 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 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: 1 r. ` M City of Northampton Building Department 212 Main Street Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413.587-1272 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 S, iNF RMATION This spa plate 1.1 Property Address: Gr Maple yj' 2 ✓ f yJ Y✓iir' G / C � f SE TIf N 2 PR 3PER7"Y OWNEI'ISHIPIAUTHORM, 1D AGENT 2.1 Owner of Record: J—/C, ✓� P-C-I -Ci / do� & S� me(Print) Current Mailin Addre s: � Q :2 sM Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Ad ess: Sig ture Telephone ° r�Ti13fi�1'3 ESTIMATE'Q CONSTRUCTION'CO TS Item Estimated Cost(Dollars)to be Official Qs&OnCy completed by ermit applicant 1. Building (a) Building_Perrriit�Fee 2. Electrical (b) E,stimated Total Cost of Con struction frog 3. Plumbing Build-lIng Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 + 2 + 3 +4+5) Check Nurnber ! "" ' tivtl:Tar 0f T is Selc fiiclal ti ip Only 'ilding Permit Number, Date Issued: Signature: Btri Iding.Corr missl'o'her/i nspe6tor of--Buildings Date a 151 NORTH MAPLE ST BP-2000-1 100 GIS#: COMMONWEALTH OF MASSACHUSETTS a :Block: 17A- 196 CITY OF NORTHAMPTON Lot:-001 Permit: Buildinq Category:roofing BUILDING PERMIT Permit# BP-2000-1100 Proiect# JS-2000-1965 Est.Cost: $4800.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: RCI ROOFING 126235 Lot Size(sq.ft.): 9539.64 Owner: BERTRAND ALAN L&CAROL R Zoning:URB Applicant: RCI ROOFING AT. 151 NORTH MAPLE ST Applicant Address: Phone: Insurance: 30 HIGH ST (413) 527-4775 EASTHAMPTONMA01027 ISSUED ON:617100 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. Inspector of Buildings r'll-tinderground: Service: Meter: Footings: Rough: Rough: House# Foundation: 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: Fee Tyye• Receipt No: Date Paid: Check No: Amount: Building 6/7/00 0:00:00 MO $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo