17C-234 (3) RCI ROOfM LLP
40 Maine Avenue
P.O.Box 309
Estimate
Easthvnpton, MA 01(127 1;" � ' Date
Phone(413)527-4775 I IVIIAY � ,' ���4 4/13/2004
Fax(413)527-8469
Name/Address 1 Job Location
Diane Bowman 33 Bardwell Street
33 Bardwell Street Florence, MA
Florence, MA 01062 Phone: 584-6706
Terms Rep
Estimate valid for 45 days Chris
Job Description Total
Remove existing roofs. 15,030.00
Furnish&install 1/2"plywood over existing decking.
Furnish&install aluminum drip edge,pipe flashings and chimney flashings.
Furnish&install ice&water barrier along eaves and valleys and entire front porch.
Furnish and install 15 lb.felt.
Furnish and install 40 year GAF Slateline shingle.
Furnish and install ridge vent.
All roofing related debris to be removed by R.C.I. Roofing.
All work will be performed according to manufacturers'specifications.
5 year R.C.I. workmanship warranty included.
40 year GAF material warranty included.
All related permits will be obtained by R.C.I.Roofing.
SPECIAL ITEMS NEEDED
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total $159030.00
TERMS OF PAYMENT
30%Upon delivery of materials
70%Upon completion Customer Signature
Registration# 126235
Construction License#074334 Date t}
Insured by Hackworth Insurance(413)527-9907
0.1tW rPT
0
R E Cf �Na fl?allipf0)t
a 7 a ttrh ns rl Is' —
c.� DEPARTMENT OP DUILDr,\,C INSPECTIONS
212 Main Strcct ' Municipal Building
Northampton, Mass. 01060
«'ORICI:R'S COl'[PENSATION l,`'�SURAN(--E AFFMAVIT
>, _� @ R• -7"- Ana
_
p;ccnsalpermjttcc} 9
��,�th a principal place of busineWresidence at:
1Q,,Maj np. Ave. j FasA A Olaf (phone=)(ry►T�7'J5
( cry/sZarcrap)
do hereby certify, under thc.pa m and penalties of per7RUy, h l
(� I arn an employer providing alle follo�vine worker's coin
oensz%Zjon coverage for ink
etuployces Nvorldng on'this job:
v5-31�=t3���a�-o3 10 o _
(Lastd-an=Cod==s,) (Polio: Numbecr) (ailmnor, Datc)
a sole proprietor, general contractor or homeowner (cii c:e one) 2Dd have hired
the contractors liste 1 below vgbo have the following worker's caopensa6on paicies:
MMe Oi Cont^eior) Onssurancx— Coinpany/?oIJCi ilU1Lr ) (i: airat on Datc)
(Name of Contactor) (Insuran= ComoaayfPolin, Numcrr) (Ekp r Rion Date)
(Name O(COntractor) (Insurane; Compaoy/Policy N-ambu) (Exoimaoa Date)
(Name of Contractor) (Iasurmcc Compa-_z /Pobcy NumbJ) (Expir.!lion Date)
(atrseb sddit Ona1 rSr�if 000o3aS}la c,cude tnftxma�oe perta iaiaC to a.0 oo=rs=,o 7)
( ) I am a sole proprietor and bave no one worldog for me.
( ) I a,a home owner performing all the work myself.
NOTE:plea be atran the..h.l.bomcowvcm wbo ctnplcry pcsom w dD c. • o==jc+oo o:rear work oo a d.•cll Z of
orx mote thso ' oe�rj is wbicb the bomoownc revde or oa the awac;,sppurtea.n th,=. am not spy aecrid=rd Lo be
aarploy—uaGa the wakds Lon A=(CLI S2ss 1(5)).amIJ=L ioo by a bomcowocr for-lido or permit wusy--id—the
1cPsl—of as—ployer under dw wwkAe,competait;�m Ant
I nodes And the a copy of thin mlammt t>say be(6,-Nwrd to the Dop.rtzocm orlomatritl A.&.dY OT,,00 or Ira—ror tho
ooveasc veircaioo L:d th:t f:D=w some'overate t l:action 23 w of MOL 152 eta kzd to tbo impoa oa of aimias!pcaallic
000sis Mrs of a Gx orup to S 1300.00 and/or 6wimamc=orup to ooc year and civil pos.tio in 6c form or.Stop Wort Order Lad a
Gm of 5100.00 a day api=me
For dq—u.^"J uae ogly
Pcrmit Number
1.L7p�'
Lot n
S't;zWn of Li ucc —ire
S GTi�ON y C 17L+T ON SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
� 1J
Name of License Holder:_(o ^ T
ebslt 2 33—T
License Number
7 5 - J - 06
Address Expiration Date
8775
Signature Telephon
e t . u Not Applicable ❑
R. C . I. R f.lno lab � 35
Company Nam 1J Registration Number
-40 'Ma; n .1duej - P D a 0% .3o1 5 - b -
Address Expiration Date
Telephone 3 --Y'776
E 1j, yl Er .
_...i ..yK �
SSE x bN 10 ERS�COMPENSA ION N '1�3ANGE AFFIDAVIT(MSG>L c 1{52, §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 them
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 acecptable 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 dap6-el
New House ❑ Addition O Replacement Windows Alteration(s) ❑ Roofing dal.
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ J Other( J
Brief Description of Proposed Work:_ReY uje,e(i5tw- QLes. =nsri l --in 4i>j QaS�Ip�c
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attached Roll O• Sheet O
a e, olitto n o exs rrr =n g -ot"efh (I o rin:
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
O
as Owner of the subject property
hereby authorize _t n1[� 17e�1 She, d7 to ac: on
my behalf, in all matters relative to work authorized by this building permit appl cation.
nifan6A 5-17-0
Signature of Owner Date
I, K IJSle. as QU�bnrl zed oQmf as Owner/Authorized Agent
hereby declare that the statements and information on the fob going 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
I
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:
City of Northampton ; .a u .
Building Department f
u*
212 Main Street
Room 100
Northampton, MA 01060 e3
phone 413.587.1240 Fax 413-587.1272Po �°rtfr
APPLICATION TO CONSTRUCT, ALTER, REPA�R,�iRE"VATEi1DR DEMOL�15H A ONE OR TWO FAMILY DWELLING
1 LC04
SECTION 1 - SITE INFORMATION
This sec ion�to beYcomplefed;by office
1.1 Property Address: ,01
VI
33_ IstyP P Ma � LolJ tt ,
Zone }Y T7, U_ days istrict
EImSt�Distr,ict _ .:<CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
_Diane- SoWman 33 C3cu u)el ��" }' FioYPrrp ,
Name(Print) Curr t �ilwn ling —
ai [p eA Telephone-+- `D
Signature
2.2 Authorized Agent:
.Mag. 1Te/lsle, - RoofinQ x 309 - Easit amot>> l
Name(Print) Current Mailing Address:
Signature Telephone
S.S.
SECTION 3 'ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by ermit applicant
i. Building (77 00 i n 15� o3Qe�� (a) Building Permit Fee
2 E! ca' 'l (b) •=: timated Total Cost of
Construction from:(6)
3. Plumbing Building; Permit Fee
4. Mechanical (HVAC)
5. Fire Protection r� -
6. Total = (i + 2 + 3 + 4 + 5) umber
This Section For Official Use Only
Building Permit Number: TDate Issued-_
Signature: - -
Building Commissioner/Inspector of Buildings Date
r
33 BARDWELL ST BP-2004-1177
GIs#: COMMONWEALTH OF MASSACHUSETTS
Man:Block: 17C-234 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: BuV'- DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-�
Project# JS-ZL �_-
Est.Cost: $15030.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: RCI ROOFING 074334
Lot Size(sa.ft.): 261,^ Owner: DREESZEN CRAIG A&DIANE BOWMA
Zoning.URB Applicant: RCI ROOFING
AT. 33 BARDWELL ST
Applicant Address:_ Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTONM^ '09 ISSUED ON.5124104 0:00:00
TO PERFOR, �-)LLOWING WORK.-STRIP, PLY & SHINGLE ROOF
POST THIS CAPT_' ' " VISIBLE FROM THE STREET
Inspector of Plumbic. r of Wiring D.P.W. Building Inspector
Underground: Meter:
Footings:
Rough: House# Foundation:
Driveway Final:
Final:
Rough Frame:
Gas: o a r t ment Fireplace/Chimney:
Rough: Insulation:
Final: _ Final:
THIS PERMIT IN ` "_'.'QED.QED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RU . GULATIONS.
Certificate of Occ' ' Signature•
FeeType: IJ L No: Date Paid: Check No: Amount:
Building 5/24/04 0:00:00 5457 $25.00
'_12 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo