17C-172 (3) RCI RoOfMg, LLP
51B Holyoke Street
P.O.Box 309
Easthampton, MA 01027 Estimate Date
Phone(413)527-4775 11/3/2005
Fax(413)527-8469
Name/Address Job Location
Wendy Stein 27 Fairfield Avenue
27 Fairfield Avenue Florence, MA
Florence, MA 01062 586-8736
Terms Rep
Estimate valid for 60 days Mike
Job Description Total
Remove existing roofs. 9,400.00
Furnish&install 1/2"plywood over the existing decking.
Furnish&install aluminum drip edge,pipe flashing and chimney flashing.
Furnish&install new lead counter flashings.
Furnish&install ice and water barrier along eaves and valleys.
Furnish&install 15 lb.felt.
Furnish&install 30 year Tamko Heritage Series shingle.
Furnish&install Cor-A-Vent ridge vent.
All roofmg related debris to be removed by R.C.I. Roofing.
5 year R.C.I.workmanship warranty included. ���auk `��'r �'�
30 year Tamko material warranty included.
All related permits will be obtained by R.C.I. Roofing.
SPECIAL ITEMS NEEDED
v,?S ,�_f � ,:.. y�r,�, / GU/J-�
Price includes removing chimney to below level of roof. Need to specify if this is to be done before starting
job. �����
Estimate does not include back addition. I
WE LOOK FORWARD TO DOING BUSINESS WITH YOU IN THE SPRING.
Total $9,400.00
TERMS OF PAYMENT
30%Upon delivery of materials
70%Upon completion Customer Signature ���r
��
Registration# 126235
Construction License#074334
Date j
Insured by Hackworth Insurance(413)527-9907
I N
a $
� e �laeaarhnsrtt.'
DEPARTMENT OP BUILDING INSPECTIONS
212 Main Street a Municipal Building
Northampton, Mass. 01060 kv��--Zy-
WORICEWS COMPENSATION INSURANCE AFMAVIT
(limnscrlpermittec)
onth . principal place of business/residence ai:
Jr� �Ql � (phone# ��??Jr
street/ ty/statd2
do hereby certify, under the pains and penalties of pegury, that:
(1� i am an employer providing the following worker's compensation coverage for my
emplovees worlang on this job:
AMaxiaanlnf l Grouts bgtbbl0 10 Ob
(?=,r= Company) (Policy Number) (Expiration Dace)
( ) A 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:
;?Iame of Contractor) (insurance Con4 any/Policy Number) (Expiration Date)
,Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (insurance Compaay/Policy Number) (Expiration Date)
(Name of Contractor) Gasumce CompanytToticy Numbers) (Expiration Date)
(attazli a6ditioaal:hcc(if neceniq to include infortnatioa perhiaing to all coatratton)
( ; I am a sole proprietor and have no one working for me.
( I am a home owner performing all the work myself.
,10'1-E:plcSae be awzrc that while homeowneta who employ pesons to do ma itlteaatux,oonunution ar repair wotic on a dvftLrmg of
not Mac than throe units is which the bomoowocr sides oc on tht Vvia s:ppttrtemot tbercto are not Cco=lly oomWered to be
cm).oycrs under the work&i comp=satioa pct(GLI 52,=1(5)),applic&6an by a homeowner for a riotme or permit may evidraoo the
kgu dater,of an employer under the Workoes CouVemation Ad
I ua•icra=d that a oopy of this aatcment any be forwarded to the Depa u m2 of Industrial A=Ww&Offioe of Wswu m for dw
coverage vaifiwdoo and that failure to seam oovemp uadcr'souioa 25A of M%132 can lard to lbo itttposwoa of rerun W peadit
of&Em cf to SIX0,00 vWbr'
°0��8 up of tip to tme yeet;tnd dull pt�Illa in the farnt of a Slop WakOtdlt ttbd tt
fir•of S 100.00 a day against tnc
For d p=ft0td use enh'
Ptxmit Number
Lot#
f:: S':gnature of Liccusce/Permitiee
SECTION 8- {CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : . flay e— r7r7433
License Number
oa7 5 -b3 - Ob
Address Expiration Date
013) ,523
Signature Telephone
tit v me Not Applicable ❑
nQ 126 235
Corn anv�•Njame ��// J Regissttration Number
r,Z' 19 ����1DI1� treat P•�• BDX 3D9 Expiration ODaAte OL
Address
' 75Telephon
SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.GL. 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 tims.to1ime,during and upgn
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 a � �y
t
SECTION 5 DESCRIPTIi04tbj PROPOSED WORK(checkiall applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ) Siding[ ] Other[ ]
Brief 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 o
6a.TlftNd-WRKNse JOUro ddition to` existiff9Kh6-UMng comps"e'te"" th Mr.CMI >I w:
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
SECTIONIA OWNER,AUTH,ORIZATION -TO BE COMPLETED WHEN
OWN ERS;AGENT OR�CONTR'ACTOR APPLIES'fOR.BUIL DIN G PERMIT
I, Wend I '?lp"! n (+ as Owner of the subject property
hereby authorize .Mark DJG S�P (�7 R.C.I. O0f it to act on
my behalf, in all matters relative to work authorized by this building permit application.
atae'ne-A �41.31 0L
Signature of Owner Date
I, mayk 1 JAisle ._as ;111 .V141 � a4 t as Owner/Authorized Agent
hereby declare that the statements and information on the foregointJapplication are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
Print Name
Signature of Owner/Agent Date
' a
w ,,r
Section 4.
ALL INFORMATION MIDST 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$ aces
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:
qoy orthampton
r� Q Department
21�2 i n Street
t eet
-' r R 100
A N"ortharrmpton', MA 01060
t�., phone 413-58 240 `,Fax 413.587.1272 e
AP,PLICATibN TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: his sec:'I
�� ff'• /1
tIYTiP-� ttVpYlLiP ,M p£� °
lone O � Y bps
Elm St-Pistrict .CB:Difrictag ,_ �'_
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
)► Mdu FairFfield Ave, Flora-"e,
Name(Print Cu�eDt�Mailing j� d�ess.
e Telephone
Signature
2.2 Authorized Agent:
. T. hahlcitc,- Ma ��11
Name(Print) Current Mailing Address: T
J4 I3.) 5T7 Igg5
Sig ature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building Roofi n -1� •�0 (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) I-}�Q.Q Check Number
This Section For Official Use Only'
Eluilding.Permit Number: Date Issued:
Signature: g -
Building Commissioner/Inspector of Buildings Date ,
01 '� .:";- mi. BP-2006-1054
COMMONWEALTH OF MASSACHUSETTS
t,bn—, �
CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-1054
Project# JS-2006-1559
Est. Cost: $9400.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sq. ft.): 5619.24 Owner: STEIN FREEMAN&WENDY S
Zoning:URB Applicant: RCI ROOFING
AT. 27 FAIRFIELD AVE
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTONMA01027-0309 ISSUED ON:41512006 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• Date Paid: Amount:
Building 4/5/2006 0:00:00 $25.008488
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo