24C-157 (3) RCIIro O ntng 6 Line St.
• • Estimate Date
Southampton, Ma. 01073 5/29/2015
Phone(413)527-4775
Fax(413)527-8469
Name/Address Job Location
Morey Phippen
36 Arlington St.
Northampton, MA 01060
Terms Rep
Estimate valid for 30 days Chris
Description Total
Remove existing roofs. 9,000.00
Furnish & install aluminum drip edge, pipe flashings, chimney flashings(if needed)and step
flashings.
Furnish& install CertainTeed Winterguard ice&water barrier, 6 feet along eaves and 3 feet in
valleys.
Furnish and install synthetic underlayment over existing deck.
Furnish and install Lifetime CertainTeed Landmark Series shingle.
Furnish and install CertainTeed approved ridge vent.
All exterior roofing related debris to be removed by R.C.I. Roofing.
All work will be performed according to manufacturers'specifications.
Lifetime CertainTeed material warranty included.
All related pen-nits will be obtained by R.C.I. Roofing.
Add$2.50 per sq. ft. for wood decking replacement if needed.
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total $9,000.00
TERMS OF PAYMENT
5°'o Deposit
Balance upon completion Customer Signature
Registration# 126235
Construction License#074334 Date—
(413)
Insured by Banas&Fickert Ins.
527-2700
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111 , S 150A.
Address of the work: 36, Arfit,j ft„ 3t 4/,1 /ka,,R n ,7
c
The debris will be transported by:
The debris will be received by: 0-,,o e-\O lei
I
Building permit number:
Name of Permit Appl"cant /\i`
Date Signature of Permit Applicant
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: `` Not Applicable
� ❑
Name of License Holder: 1�' ( K 11 P_ _ 19 - 3'M
License Number
Address Expiration Date
Signature Telephone
9. Renistered Home Improvement Contractor: Not Applicable ❑
y.C , 1. I���c, inn � alo3��
Company Name Registration Number
Address Expiration Date
n�0`7 Telephoned �J
SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§2SC(8))
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....... N( No...... ❑
11. - Rome Owner Exemption
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 fi•om 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 (I—A(,L kpd
SECTION 5-.DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) r7 Roofing
Or Doors ❑ _
Accessory Bldg. ❑ Demolition ❑ New Signs [O] 'Decks [Q Sidi [0] Othe p]
"T , ZL . 'r
Brief Description of Proposed MTO
Work:
Alteration of existing bedroom Yes No Adding new bedroom___Yes No
Attached Narrative Renovating unfinished basement _ Yes _No
Plans Attached Roll -Sheet
5a. 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. 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
I, as Owner of the subject
property rr
hereby authorize �C1UC--�(� p_��C1�k B .C . 1. & 4 10 '
to act on my behalf, in all matters relative to work authorized by this building permit aR ication.
d
Signature of Owner Date
Ocli k as, n U- )o,(17 Pry n Q n-+- as Owner/Authorized
Agent hereby declare that the statements and information on& e foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
&v 1'
Print Name
Signature of Owner/Agent Date
= N r Al
1 - � Department use only
' City of Northampton Status of Permit:
Ii�I 1 JUN 2 2 X015 Building Department Curb Cut/Driveway Permit
l t ' ; 212 Main Street Sewer/Septic Availability
Room 100 Wlater/Well 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 ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
This section to be completed by office
Map Lot Unit
36, Ar/,jj ;, :a
��/ r f`i� ,��, /�q ►�, �� Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
M ree 'y' 3 f�rIin.-,j4—r,11
Name(Print) Current Mailing Address:
See, y/3 - 3D-3
S e ' a&w i e Telephone
Signature
2.2 Authorized Agent:
Ala ;l:K 0 C • T. (o Lin' ��
Name(Print) �-/✓� Current`Mailing Address: n
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) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = 0 +2+3+4+5) DO Check Number ' (�
This Section For Official Use Only
Building Permit Number: Date_ Issued:
Signature:
Building Commissioner/inspector of Buildings Date
36 ARLINGTON ST BP-2015-1343
GIS#: COMMONWEALTH OF MASSACHUSETTS
MM:Block:24C- 157 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2015-1343
Project# JS-2015-002447
Est. Cost: $9000.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Groin: RCI ROOFING 74334
Lot Size(sa. ft.): 11804.76 Owner: ADAMS BRIAN&PHIPPEN EDITH M
Zoning: URB(100)/ Applicant: RCI ROOFING
AT. 36 ARLINGTON ST
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527-4775 Workers Compensation
SOUTHAMPTONMA01073 ISSUED ON.612212015 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 Occupancy Signature:
FeeType• Date Paid: Amount:
Building 6/22/2015 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner