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38C-079 Kc.1.1i ofnng 6 Line St. Estimate Date-- - Southampton,Ivla. 01073 8/27/2015 Phone(413)527-4775 Fax(413) 527-8469 Name/Address Job Location Elaine Apthorp 212 Grove St. Northampton, MA 01060 Terms Rep Estimate valid for 30 days Chris Description Total Remove existing roofs. 4,800.00 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. 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 permits will be obtained by R.C.I. Roofing. Add$2.50 per sq.ft. for wood decking replacement if needed. Add$2200.00 for the garage. h WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total - ° "PERMS OF PAYMENT /1 5%Deposit Balance upon completion Customer Signature Registration# 126235 Construction License#074334 2 m r, Insured by Banas&.Fickert Ins. Date (413)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: 4- crotx� S/ The debris will be transported by: l The debris will be received by: (i�j Y\I\P/e-/k�•bl (� (4-ct Building permit number: Name of Permit Applicant z �? p., Date Signature of Permit Applicant 9 The Commonwealth of Massachusetts Depar-trnent of Industrial Accidents Office of Investigations 600 Washington Street Boston, AM 02111 �"` "'v w�tirw,massgov/dia Workers' Compensation Insurance Affidavit; Builders/tom o.tats,actors[Electiricians/Plumbers Applicant Information Please Mal Legibl SECTION 8 -CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: 12 { 'p_ —_ I 9 id S_A License Number SA; hCw,cAon M6 01 CI r7� ---- o�� n(D:, �0 Address ✓� ��� Expiration Date Signature Telephone 9, Registered Home Improvement Contractor. Not Applicable ❑ C ompany Name ,J Registration Number // Address Expiration Date C)�09'L:-� TelephoneL .ZL.-�` SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M,G.L,c. 162, §2SC(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 YE:s,...... C( No...... ❑ 11. - Home 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.QgR 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 per,od shall not be considered a homeowner. Such"horneowner"shall submit to the Building Official,on a form acceptable 1:o 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_ a-- (,)-CbpJ —__ SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House Addition ❑ Replacement Windows [Alterations) ❑ Roofing�- Or Doors ❑ Accessory Bldg. [❑ Demolition ❑ New Signs [0] Decks [M Siding [0] Other[p] Brief Description of Proposed Alteration of existing bedroom _Yes, No Adding new edroom Yes N Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ea. If New house and or addition to existing housing, complete the fo,llowina: a. Use of building : One Family _ Two Family Other b, Number 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, Fl a i& ° C l� rr'n�G�(�.✓ as Owner of the subject property -- hereby authorize _MCLf V,` 0+ to act on my behalf, in all matters relative to work authorized by this building permit aR ication. 7 C,d Signature of Owner Date I, `' ' L _(s, - (1 u-ri`)oVl?of 0(le 2+ as Owner/Authorized Agent hereby declare that the statements and information ondhe foregoing application 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 -- Department use only �, City of Northampton Status of Permit: 9 `ZOO J 3uilding Department Cu'rb CuvDriveway Permit 212 Main Street Sewer/Septic Availability U &Gas Inspect`ons Room 100 Water/ Well Availability Ftumc+no&w,QA060 hampton, MA 01060 Two Sets of Structural Plans. E{ectri NorthamP phone 413-587-1240 Fax 413-587-1272 Plbt/Slie'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: Thl's section to be completed'by office /.- C�7'O yf'e, `l^ - Map------- Lot —Unit Zone _ _Overlay District— Elm St,District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Flame', Al_h©r p Weernetkae, 2/2 62cie_ /; Aln-lAQ.Wft� oi,06e Name(Print) ` Current Mailing Address: &"17 /ed _-- !0/'7 's?f- ���(%h_!. Telephone Signature 2,2 Authorized Agent: 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 z (a)Building Permit Fee n Poe. 2. Electrical t,,,) (b) Estimated Total Cost of _ Construs,tio_n from.(6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection _ 6. Total = (1 +2+3+4 + 5) 7 Da7I. ry Check Number This Section For Official Use On!y Building Permit Number: Date_ Issued: Signature: Building Commissioner/Inspector of Buildings Date 212 GROVE ST BP-2016-0301 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38C-079 CITY OF NORTHAMPTON Lot:-00 L PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2016-0301 Project# JS-2016-000487 Est.Cost: $7000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 74334 Lot Size(sq. ft.): 11674.08 Owner: APTHORP ELAINE SARGENT&THERESA JO HERRNECKAR zonin : URB(100)/ Applicant: RCI ROOFING AT. 212 GROVE ST Applicant Address: Phone: Insurance: 6 LINE ST (413) 527-4775 Workers Compensation SOUTHAMPTONMA01073 ISSUED ON.911012015 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 9/10/2015 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (4 13)587-1272 Louis Hasbrouck—Building Commissioner