17D-007 FAX ND. Tan. 21 20OL; 10:29qM Pi
.L.
Hc'yoke Street
P.Q. Bv-, 309 Date
Eastha,riptorl, MA 0102-7 Este m ate ��
Pr-one 1112
�413', 527-4775
:0��8
Fax (4-'3) 527-8469
7 Job Location
CCRNERS70NE CHAPEL 580 Bridge Road
P 7?hradrick Northampton, MA
1580 P-ridge Road 253-2747
Nortri-ampton, MA 0106)0
Ttrrns Rep
Estimate valid for 20 days Rich
Job Description Total
Rf--rno,,e existing roofs. 32,300.00
Fjrnisr,i & instal!vented nail board with 2" polyisocyam-i rate insulation, R-Value 12.1.
Furnisli �, install aluminum &i.p edge, pipe flashlno,s, chimney flashings and step flashings.
F,rniso & install new lead counter fiishincs-
7,nisri & install CertainTeed I-Vinterouari lc?&water barrier along eaves and valleys.
F.;rniq-, ari,.1 install Rooftop Guard synthetic underlayment,
Fw rn i'3,i anj install Jfvtiin!e Cfflrta'nTeed Woodscape Series shingle,
Furnis,) anz install CertainTeed app-oved ridge vent.
I Ali exterior roofing related debris tz) be removed by R.C.i. Roofing.
All wort:vy 11 ie perf`ormed according to manufacturers' specifications.
5-yea f ;k,C.1, Roofing workmanship warranty included.
U,'Pt;ma CaartainTeed rnaterial warranty included.
All related Permits will be obta ned by R.C.I. Roofing.
'"PECIAL 17EMS NE��'DED
Add $2.50 Per sq, ft. for wood decking replacement if needed,
T'r4E CAVINER JAS THE RIGHT TC CANCEL THE CONTRACT WITHIN (3) Total $32,300.00
,.kE7- BUSINESS DAYS OF DA-M OF SIGNING-
VERMS OF PAYMENT
"D
Custome
r Sionato
Re{ t'3t;nz1
126215
Date
Baj• es&H..bh,in C.»13-447.7i',6
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s`% n GriN of �Dx��IM11l�J�QIt
o 'er DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060 ,
WOR=R'S COMPENSATION INSURANCE AFFIDAVTr
1�_51.e-__of Yin
(liccnst:cJperuiittcc)
z. ;principal place of business/residence at:
n 11 (Phonef� l j - ?�jrJ
� � StMcUc /statdzi
ty P)
/;iercby c�rtiry, under the pains and penalties of perjury, that:
I n an employer providing the following worker's compensation coverage for my
working on this job:
N ati octal UniAn Fore-
'Ins. Co. of fl►tt:&LYa PA V4C3b3►'T6g 10/05/09
--- _asliarcc Company) J (Polity Numbct) (Expiration Date)
j a sole proprietor, general contractor or homeowner (circle one) and have hired
co:,:.ractor, listed below who have the following worker's compc=tion policies:
me of Contractor) (Lnsurance Conipany/Pofty Number) (Expiration Date)
'Name of Contractor) (Insurance Comparry/Policy Number) (Expiration Date)
(Naaie of Conlractor) (Lnamancc Compauy/Policy Number) (Expiration Date)
me of Coat uctcr) qn urance Company/PoGcy Number) (Expiration Data)
uad a d tiocil sip if nccuvry to irx- x infoanition pertaining to all oontraetonj
I sole proprietor and have no one working for me.
I am a home owner performing all the work myself.
plc—be awu<that v;kilo homcowncca who c=V loy persam to do us.ia�wcnuvctioo or rwait work an it dwelling of
-.ut,xc ti;:n Lbrco units in w•tzida tsc be metrwncr rtude or on the pounds vwrtenatd thecdo are not ecoatlly oowW red to be
rZr,. 1oyr�unc.�z thse worker's COMP =tioa Act(GL152 SS l(5)},application by a homeowoa for a liccme or pernnd Mal evidence tho
:e,, I c'sti a of an ompIoyoc under tic Workce%C,ompoaw6*n A.et.
t un.:e-riind teast.>eoFy of this stxtcment may be f«wurd-d to rho DVaranuA of 1-&% tiai Avd a li Offtoo of t mwm for*9
x•rCMsC vcifI-- tioo:zd that failttz,C t9 couuo 9OWTIF under setxiOM M dMOL It an tad to W*os+tian ofQimiod P=Kd
" t of a ax'of up to S1,300-00 and/or irapriso�of uP to one ytu and civil P=d6a in lbe Corm of a Stop Work Ordet and
zw
of--100.00 a day Lpi=t mc.
For depashmaw use only
pt+tno�it Nr :
Map4 I.ot# _ t
{1 Signatzun of Litx /permittx
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Version 1.7 Commercial Building Permit May 15, 2000
SECTION 1C-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No 0
SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as Owner of the subject property
hereby authorize '`' C TOOT,TA to
I act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
.Maki elisle f RX-1.169,na I Agent
as Owner/Authorized-
_J
PoenLherebv declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
I and belief.
Signed under the pains and penalties of perjury.
MpYK
Print Name
Signature of Cwner/Agent Date
SECTION 1 -CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: a Not Applicable El
Name of License Holder: d't O` ell S le,
j License Number
518 NUl o ie firett - E.aSiht fion Ma oioa? o,5 - 0 - 10
Address W I Expiration Date
5 775
II Signature Telephone
h
SECTION 13 -WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
n the denial of the issuance of the building permit.
Signed Affidavit Attached Yes No O
Version 1.7 Commercial Building Permit May 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES -FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
F9.1 Registered Architect:
Not Applicable ❑
Name(Registrant): , f
Registration Number
I Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
i
I
Address Registration Number
Signature Telephone Expiration Date
^Jame Area of Responsibility
i
I
Address Registration Number
Signature Telephone Expiration Date
Name ArResponsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
Company Name:
Not Applicable ❑
a `
N
Responsible In Charge of Construction
Address
Signature Telephone
Version 1.7 Commercial [wilding Permit May 15,2000
8. NORTHAMPTON ZONING
I;Xisting Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
St-thacks Front
Side I.: R:
Rcar
13,61ding I leight
13.dg. S'quurc Footage (N
Open Space Footage
(Lot area minus bldg d paved
arkine)
�i of Parkin<o,Spaces
F.
(v flume K Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW O YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained O Date Issued:
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0
IF YES, describe size, type and location:
E Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
4
Version 1.7 Commercial Building Pcrmit May 15,2000
r
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs 0 Additions C1 Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign El New Signs❑ Roofing Ce Change of Use❑ Other❑
Brief Description Enter a brief description here.
Of Proposed Work: ?%P ►n5ulat{an. rum) .56
SECTION 5 -USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educatioral ❑ 2B f ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
l M� MercantiV= ❑ 4 ❑
IR Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage orage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Utility ❑ Specify:
M Mixed Use, Q Specify:
S Sr pecial Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGI✓IWUS�
Existing Use Group: Proposed Use Group:
Exists ing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
_T_
SECT—ION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
1 s`
nd 2nd
,2
3d 3d
4,h 4 h
Total Area (sf) Total Proposed New Construction (sf)
I
Total Heigh' (ft)
jTotal Height ft
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone[—] Municipal ❑ On site disposal system[]
i
S
Version 1.7 Commercial Building Permit May 15,2000
Department use only
j City of Northampton Status of Permit:
Building`Qepartment Curb Cut/Driveway Permit
212 Maly1 Street Sewer/Septic Availability
I 'Rg6m 100 Water/Well Availability
A Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
AI PPLICATION TO.CONSTRUCT, REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY
OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
'i.1 Property Address: �This section to be completed by office
580 B'688e RcaJ Map 1 ! Lot GO ? Unit
Zone Overlay District
Elm St.District CB District
SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
corrne 510ne Chapel 5to Bridge Rd, WfLn
Name(Print) Current Mailing Address:
253 -a7W7
Signature � a eh ed Telephone
2.2 Authorized Agent:
MaYK delis P.O. BN 309 /E2 thampton M2i-
Name(Print)
Current Mailing Address:
Signature
— Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
r —
Lem Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building Roofs n A 32, 300.00 (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) 3a '300.0o Check Number
This Section For Official Use Only
Date
Building Pe,,-nit Number
I
Issued
Signature:
i
Building Com nissioner/Inspector of Buildings Date
I 1
P i
BP-2009-0656
GIS#: COMMONWEALTH OF MASSACHUSETTS
M:Bloct<: r7D-'007 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category_ BUILDING PERMIT
Permit# BP-2009-0656
Project# JS-2009-000956
Est. Cost: $32300.00
Fee: $198.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sq. ft.): 124146.00 Owner: CORNERSTONE CHAPEL OF THE ASSEMBLIES OF GOD
zonin : RR(100)//Rl Applicant: RCI ROOFING
AT. 580 BRIDGE RD
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTONMA01027-0309 ISSUED ON:112312009 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 Ri nature:
FeeType• Date Paid: Amount:
Building 1/23/2009 0:00:00 $198.0013514
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo