18-004 (4) i 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
REALTY WORLD 285 King Street
Paul Labbee Northampton, MA
285 North King Street 586-3333
Northampton, MA 01060 Cell#: 563-2877
Terms Rep
Estimate valid for 60 days Mike
Job Description Total
Remove existing roofs. 6,400.00
Furnish&install aluminum drip edge,pipe flashings and chimney flashings.
Furnish&install new lead counter flashings.
Furnish& install ice&water barrier along eaves and valleys.
Furnish and instal 15 lb.felt over existing deck.
Furnish and install 30 year Tamko Heritage Series shingle.
Furnish and install Cor-A-Vent 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.
30 year Tamko material warranty included.
All related permits will be obtained by R.C.I. Roofing.
SPECIAL ITEMS NEEDED
Add$2.50 per sq. ft.for wood replacement if needed.
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total $6,400.00
TERMS OF PAYMENT �t 3017(7. 00
30%Upon delivery of materials �A,14/0 'G(3 80, d0
70%Upon completion Customer Signature
Registration# 126235
Construction License#074334 Date -Z2 05
Insured by Hackworth Insurance(413)527-9907
3 8
�lae■actin■rti■'
m DEPARTMENT OP BUILDITIG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORTCER'S COMPENSATION INSURANCE AFFMAVTT
--t-Mak- —
NcensuJpermittec)
with a principal place of business/residence at:
(phone# 1 =�??5
street/ /staWz:i
tY P)
do hereby certify, under the pains and penalties of peg ury, that.
WI am an employer providing the following worker's compensation coverage for my
employees working on this job:
Amer lean-In t `1 C�YYZ1.tn. 6 8 t bb 10 10/5 O b
(?ns j r-.o nce Company) T— (Policy Number) (Expiration Dau)
O m a sole proprietor, general contractor or homeowner (circle one) and have hunt
the contractors listed below who have the following worker's compensation policies:
'Name of Contractor) (Insurance Company/Poticy Number) (Expiration Dab.)
N ran
,Name of Contractor) (Insurance Company/Po6cy Number) (Expiration Date)
(Name of Contractor) (Insurance C.ompany/PoUcy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(&113:'1 a6dit cc d lhcct if ri"xnjuy to iu�inform3lioc perbdning to all 000tra.cton)
O I am a sole proprietor and have no one working for me.
( ; I am a home owner performing all the work myself.
`ZOTE:please be aware that whilo hoarowocrs wbo moplay pctroa:to do taaiateaaac�camtsuaion or reQait vvoeK ott a dwelling of
not Mocc than thtroo units is which the hameowoa raids cc on the grounds¢pputteawA tha+cto are cot generally oomkkred to be
at loyr s under the worker's co rq=s4oa Act(GL152�ms 1(5))�applimtioo Uy a homeowner for a GceP:e a permit may evidence tha
I tSal ctntui of an omployot under the Wukoet C.ompomatsoa Act.
un iC►taad that a copy of thin ctat-r—t may bo forwarded to the DVwt=cd of Indsutrid Aaidoo&Ohio■of knunooa for dr
— agc verification and that failure to uwre coverngv tinder sdejoa 25A of MOL 152 coz lad to tbo impQW-0a of acimind peaowa
oociaizag of A Esc ofuq to 41, 00,00 WN0( of up to ore ytxt land dvn pmltles in the to=of a mop Walt Order tlbd t
fi> cf 100.00 a day agxitut ax
For dgmtmmw a so only
Permit Number
r.,
Ma
Signature of Liccnscrlpermit3ce i Lot _ ,'
SECTION 8--CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor:
Not Applicable ❑
Name of License Holder : L �■ '{ i ,/
� ;s ,7433
License Number
251 It oa7 5 -03 - Ob
Address 0000., t Expiration Date
Signature Telephone
R e s ei� ed m-e m vemenn-t Cont acto Not Applicable ❑
R.P. S. oofina 126 235
Com anyName Registration Number
kt oK Street - ED. Box 30 5- 0 b - 0 k _
Address J Expiration Date
Telephon 7.5
SECTION 10-,WORKERS' COMPENSATION INSURANCE AFFIDA,VIT`(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 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 shire who does not possess a license, provided that the owner acts
as supervisor. CMR 780, Sixth Edition Section 108.3F5.1.
Definition of Homeowner: Person(s)who own a parcel pf 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 hole 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. 1 1, d .
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 resVIting,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, States and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
SECTION"5 DESCRIPTION#0� PRO�OSED'WORK(chg�c4a11 applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing lye
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 ❑ - Sheet❑
fia Ifi�Newh�ouse a°�i'd otatldtion�foezisting�::hou'sing,°compl'ete'thef�]`lo�ii :
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?
In. 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!v OWNER`AUTHORIZATION -'TO BE COMPLETED WHEN
OWNERS.AGE NIT OR�CON7R4CT.OR'APPLLES FOR BUILDING PERMIT
1, i'�111�.a6f1ee, as Owner of the subject property
hereby authorize .Mark DJi,: le, D7 R.C.IRoQ&aq to act on
my behalf, in all matters relative to work authorized by this building permit application.
-at tae41e 3-17. Ob
Signature of Owner Date
I, Mares -De1Wt- as -A aQant as Owner/Authorized Agent
hereby declare that the statements and information on the foregoinyapplication are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
N aA 'i s.e-
Print Name
3-Irl-GL
Signature of Owner/Agent Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF 14ORMATION
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
l 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:
r •
ti
City of Northampton
Building Department
212 Main Street
Room 100
Northampton, MA 01060
phone 413-587.1240 Fax 413.587.1272 ' e
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: 3Thij sect
a
• 'R""1 3
M-1 ap
77"
r
Zone £} Overiaybst
Elm St. District GB,District ,
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
heal tv 1nloYld / harc _ _ahti,�P. ,
Name(Pri ) C MaiJ�j ess:
Telephone J
Signature
2.2 Authorized Agent:
Ma
Name(Print) Current Mailing Address:
0+I-) -5;v7- �i q q!; Wok.
Sig ature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed b permit applicant
1. Building Roof i n 6'70000 (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) Check Number
This Section For Official Use Onl
Building Permit Number: Date Issued:
15i;gnature: �'
Building Commissioner/Inspector of Buildings Date,,
i
5 NORTB ING ST '' BP-2006-0963
GIS#: COMMONWEALTH OF MASSACHUSETTS
�w" "��.a�� W CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category BUILDING PERMIT
Permit# BP-2006-0963
Project# JS-2006-1439
Est. Cost: $6400.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sq ft.): 8407.08 Owner: DULONG DAVID I&PAUL A LABBEE
Zoning: SR Applicant: RCI ROOFING
AT. 285 NORTH KING ST
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Worker,
Compensation
EASTHAMPTON MAO 1027-0309 ISSUED ON:312112006 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 3/21/2006 0:00:00 $25.008402
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo