25A-041 (3) 26 MARSHALL ST BP-2016-1278
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25A-041 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-2016-1278
Project# JS-2016-002196
Est. Cost: $4500.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 74334
Lot Size(sq. ft.): 10193.04 Owner: PASCUCCI DAVID E&DIANNE MACK
Zoning.URB(100)/ Applicant: RCI ROOFING
AT. 26 MARSHALL ST
Applicant Address: Phone: Insurance:
6 LINE ST (413)527-4775 Workers Compensation
SOUTHAMPTONMA01073 ISSUED ON:5/3/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP, PLY & 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 5/3/2016 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
-- _ --; Dep#tmemt use only
City of Northamptonstates of Permit:
30ding Department Curb Cuv rieway Per mwIt
212 Main StreetSgwe. Septic Avatlab.ility
MAY ' 2 0 11 6 Room 100
4NatOr, ell Av6ifability
N rthampton, MA 01060 Two S`ets.o.f Structural,Plans
DEFT O �< l��tt3�tts41 •587-1240 Fax 413-587-1272 PtotlSlte t�la�s
Other Specify.
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE,'.OR DEMOI-ISH A ONE OR TWO FAMILY DWELLING
SECTION�1 -SITE INFORMATION'—�
1,1 Property Address: 1 hl' ec:tlon to be compl6bad'by office
�(o /�9Ctr�htcil S1.
Map—.-_-_ Lot —Unit
Mort-h atx/ion, P),11 Zome___ _Overstay District__.
_ Elm St.Dlatrlot —_ CI3 District,_
SECTION 2 -PROPERTY OWN ER>HIP/AUTHORIZED AGENT
2.1 Owner of Record:
aihd /9C`1(;w-c�
Name(Print) Current Mailing Address: �O�f/
l� �Qrx c�fz��7 dot
_s31 - 0 3 7
Telephone —
Signature
2.2 Authorized Agent: —
I �
Name(Print) ',� Current Mailing Address:
Signature Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be - Official Use Only
completed by permit applicant ___
1 Ng (a:)Building Permit Fee
—
2. Electrical c�J (b) Estimated Total Cost of
_ Construction from.(6)
3. Plumbing Bul!dincd Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 +2 + 3 +4 + 5) f SAO. Check Number
This Section For'OffIcal Use Only —
Building Permit Number:_ Date
Issued:
--
Signature:
Building Commissio.nertlnspector of Buildings —_ Date
SECTION 6.DESCRIPTION�OF PROPOSED WORK(:check all applicab e)
New House Addition Replacement Windows Alteration(s) F7 Roofing�—
Or Doors ❑ -- _
Accessory Bldg. ❑ Demolition ❑ New Signs (ED) Decks (❑j Siding (Ctj Other[ED)
Brief Description of Proposed
Work;, _ _ Pa-(41 Q ---
Alteration of existing bedroom -Yes. No Adding new bedroom _--,_Yes No
Attached Narrative Renovating unfinished basement — Yes —_„No
Plans Attached Roll -Sheet
6a. If New hO;use and oraddt"tlori 1; exfstit g,;hous:ilig,, 02MMet th+� 110wiima:
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 T--.�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,, a Ui _ Cct ' ' _— as Owner of the subject
property r �^ r
hereby authorize —tom�a _t�r2_l C� {�-� 0 , L„ � ("YYi-tfes{' lic --
to act on my behalf, in all matters relative to work authorized by this building,permit aR ation.
(!"�a C, A
Signature of Owner Date �- /fo
I, m,cu'� (�� as l}��rl(91'11_Pr� C�C�Yt�" _, as Owner/Authorized
Agent hereby declare that the statements and information onde foregoing application are true and accurate, to the best of my knowledge
and belief,
Signed under the pains and penalties of perjury,
a-< 1s
Print Name
Signature of Owner/Agent Date
SECTION 8 -CONSTRUCTION SERVICES
8A Licensed Construction Supervll§or: Not Applicable ❑
N � I i rW
Name of License Holder: `�� � i, t�,�P 1i��
License Number
C 7`Lok-4-.bC srhn40n #Yl 01 u-7 A C��> �0 S w 1 G0
Address y� �—�— Expiration Date
Signature Telephone
9, Re.aistered HG.me;improvement Contractor Not Applicable ❑
Com2aany Name J Registration Number
Address —`��� Expiration Date
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M G.L,c,162, §26C(6))
Workers Compensation insurance affidavit must be completed and submitted with this application. f=ailure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached YE3S....... IV: No...... ❑
The current exemption for"homeowners"was extended to include Owner•ocennied 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.CIVIR 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-feat•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 nerformed under the building 2ermit.
As acting Construction Suiervisor 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_ [ _Tw_
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
W
Boston, MA 02114-2017
www.mass.gov/dia
NVorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PEIRMITTING AUTHORITY.
Applicant Information Please Print Let?ibly
Name (Business/Organization/Individual): Rop ��q ,LLP
Address; ,L/6
City/State/Zip; A11-1 0/073 Phone #; L-,�/3J��'7 - /-/'775
Are you an employer?Check the appropriate box, Type of project(required):
L(em a employer with_ 1�_o employees(full and/or part-time).* 7, 17 New construction
2.7 I am a sole proprietor or partnership and have no employees working for me in 8. E Remodeling
any capacity.[No workers'comp, insurance required.]
9, ❑ Demolition
3.7 I am a homeowner doing all work myself, (No workers'comp.insurance required.]t
4.7 I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will 10 E] Building addition
ensure that all contractors either have workers'compensation insurance or are sole 11.7 Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.7 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13,�Roof repairs
These sub-contractors have employees and have workers'comp.insurance.$
6.7 We are a corporation and its officers have exercised their right of exemption per MGL a 14,Q Other
152,§1(4),and we have no employees. (No workers'comp.insurance required.]
Any appl icant that checks box 4 1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and them hire outside contractors must submit a new affidavit indicating such.
'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'bomp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:_ All-
Policy
ll Policy#or Self-ins, Lic, #; r!yG Q " y0`✓ Expiration Date: /0
Job Site Address:4.2 filQr611a.0 City/State/Zip: e,
Attach a copy of the workers' compensation policy declaration,page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250,00 a
day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify undert ains a d penalties of perjury that the information provided above is true and correct.
Signature: / ate:
Phone#: All3 -7 — '/7 ZS_
Official use only. Do not write in this area, to be completed by city or town official,
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2. Building Department 3. City/Town Cleric 4. Electrical Inspector 5. Plumbing Inspector
6, Other
Contact Person: Phone#:
City of Northampton 212 Marin 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,
ThEe debris will be transported by: Co N10'e,1--�..
y
The, debris will be received by: 0-0 "\R 1e,/f-e�,b(�
Building permit number:
Name; of Permit Applicant (LC,
Date Signature of Permit Applicant
0
RC-1. Roofi*���
ngEstimate
Date
6 Line St.
Southampton, Ma. 01073 4/6/2016
Phone(413)527-4775
Fax(413)527-8469
Name/Address Job Location
David Pascucci
26 Marshall St.
Northampton, Ma. 01060
Terms Rep
Estimate valid for 30 days Chris
Description Total
Remove existing roofs. 4,500.00
Furnish& install 1/2" plywood over existing decking.
Furnish& install aluminum drip edge,pipe flashings, chimney flashings (if needed) and step
flashings.
Furnish& install CertainTeed Winterguard ice&water barrier along eaves and valleys.
Furnish and install synthetic underlayment.
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.
Estimate is for garage.
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total $4,500.00
TERMS OF PAYMENT ){
5%Deposit Customer Signature: / =
Balance upon completion
Registration# 126235 Date:
ConsuRuction License#074334 -�
Insured by Banas&Fickert Ins.
(413)527-2700 Shingle Color Selection: