06-042 (4) tt $ARDOr BP-2009-0758
GIS#: COMMONWEALTH OF MASSACHUSETTS
� ( CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateenrv: BUILDING PERMIT
Pemritu BP-2009-0758
Project# JS-2009-001127
Est. Cost: $10100.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class Contractor: License:
Use Groun: RCI ROOFING 126235
Lot Size(sq. ft.): 17554.68 Owner: WAGNER PATRICK W&JOYCE M
Zoning:SR(100)/ Applicant: RCI ROOFING
AT: 279 HAYDENVILLE RD
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTONMA01027-0309 ISSUED ON:3/19/2009 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP, PLY 3 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 tt Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Depar ment 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 3/19/2009 0:00:00 $35.0013732
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Building Commissioner- Anthony Patillo
' - -- - Department use only
r City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septio Availability
•
li n: 2T09 Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
' _- Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1,1 Propene Address This section to be completed by office .�
all JIaydcnvi Ile- Road Map Lot Unit
Leeds Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner et Record:
Jilt watner _ . a tJiaydtnvi.11e��'oad
Name
(Print) tp� CurrentIviaill}rg Address,
a`taPIiers Teleptrnne(ej/�t • S(
Signature
2.2 Authorized Agent:
Mark P e — 1 .f.t,. 1 cnfinc P.O.Rox 349 - Fartthamptan Na.
Name(Print) J Current Mailing Address. r 01021
(lel527- X95
ri Signature Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building Roof, b.t ,t Orrn aO (a)Building Permit Fee
yR -F .1 V
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3 Plumbing Building Permit Fee
4. Mechanical(HVAC)
5 Fire Pro t ction fir. 7
6 Total =(1 +2+3+4+5) toy 1C0.00 Check Number
This Section For Official Use Only 44
Building Permit Number: Date
issued.
Signature:
Building Commissioner/Inspector of Buildings Date
•
Section 4. ZONING All Information Must Be Completed. Permit Can Be Dented Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
of Size
Frontage
Sathaeks Front
Side I.: R: I.: It:
Rear
Building I leight
Bldg. Square Footage ran
Open Space Footage .o
11 oa area minus bldg R pa'cd
pakmg
of Parking Spaces _
HI: _. . . .
n plume E Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW 0 YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book Page and/or Document/t
B. Does the site contain a brook, body of water or wetlands? NO, 0 DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and Location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O
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 O NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5.DESCRIPTION OF PROPOSED WORK(check all applicable)
New House fl Addition f i Replacement Windows Alteration(s)
Or Doors ❑
Accessory Bldg. I I Demolition I New Signs [❑] Decks I❑ Siding[CI] Other(o]
Brief Description of Proposed y.} p
i work r�l • • .44! r 1 •
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 houseand or addition to existing housing.complete the following:
a. Use of building: One Family / Two Family Other
Number of rooms in each family unit—,_ Number of Bathrooms
c. Is there a garage attached?
Proposed Square footage of new construction_ Dimensions
a •Numbe'of stories?
Method of heating4 Fireplaces or Woodstoves Number of each
g Energy Conservation ComplianceMasscheck Energy Compliance form attached?
h. Type of construction
is construction within 100 ft. of wetlands? Yes No. is construction within 100 yr. floodplain Yes__No
Depth ct basement or cellar floor below finished grade
k. Wilt building conform to the Building and Zoning regulations' Yes_ No
I. Septic Tank City SewerPrivate well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
� ,as Owner of the subject
property
1
lteiet. RooF
t.
hereby authorize
m LIMaIIsit of l 1 ,ni
to act on m+•behalf_in all matters re W afore to work authorized by this trading permit application.
att.2(41Pd __. 4169
Signature of Owner Date
, • • "♦ • • ,• .as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing .s.lication are true and accurate,to the best of my knowledge
and belief
Signed under th0 oaios and penalties of perjury.
S:tel;sl
Peat Name
.3
1167
Signature of DwnerfAgent Date
SECTION 8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Y Q Not Applicablep /c'J0 /�Lf
Name of License Holder: Mark -DeliSle. / 4334
License Number
511\ Holyoke. St.- Ftstkampton Ma. nloa7 5 - 43 - 10
Address Expiration Date
(413) 527- 4795
SignatureTelephone
9.Registered Home Improvement Contractor: Not Applicable 0
C. I. 'Roof;n9 126235
Company Name Registration Number
51BNoiu•ke Street - P. O. eBoX 309 5-06- 10
AddressJ 1 Expiration Date
- - •I !• • • V - . • i Telephon�413)52['4775
SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6))
Workers Compensation is Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of builds g permit.
Signed Affidavit Attached Yes [ No ❑
11. - Home Owner Exemption
The current exemption for-homeowners"was extended to include Owner-occupied Dwellings of one(I) or two(2)families
and to allots such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
:Is supervisor.("AIR 780, Sixth Edition Section 108.15.1.
Definition of Homeowner:Person is tt ho 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 lumilr duelling,attached or detached structures accessory to such use and/or farm
structures. 4 person who constructs more than one home in a two-year period shall not be considered a homeowner.
inch-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.
As acting Construction.Supervisor your presence on the Joh site will he j required from time to time,during and upon
completion of the work for which this permit is issued.
Also he advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to
"_mplo}ccs for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s)
ou hire to perform work fn'you under this permit.
lie undersigned"homeowner-certifies and assumes responsibility for compliance with the State Building Code,City of
i orthampton Ordinances,State and Local onine lasts and State of Massachusetts General Laws Annotated.
Homeowner Signature attached_____
•
0 .;p1tTQ
j Gifu of Northampton t� ,
Pt ¢laseac'ynsrttx. l =
DEPARTMENT OP BUILDING INSPECTIONS -'!
f rt
212 Main Street a Municipal Building III
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AkT1DAVTT
), _Mar -teli.sL_nf f� (1.1 koaf
(iictnseeJpmmittrr)
vC. a )rincipal place of hi siness/residence at
513�oaStJEas'hbarnp1onectiec.Ma. oio (ehondik-11fl;) 5a.?-+1775
certify, under the pains and penalties of perjury, that.
as employer providing the following worker's compensation coverage for my
e:::nlovets worming on this job:
National Union Fiie-
Ins. Co. of Putts', Irr PA WC3b317b8 to'05/09
(.as+:raacc Gapaay) J (Policy Numixr) (Expiration Date)
_ r-:n a sole proprietor, general contractor or homeowner (circle one) and have hired
._., ;Tactors listed below who have the following worker's compensation policies:
i*utc o:Coneractor) (insurance Compauy1Policy Number) (Expiry on Date)
(Name of Contractor) Unsure=Company/Polley Number) (Expiration Date)
(Name of Con¢anor) (Insurance Company/Policy Numtrr) (Expiration Date)
(name of Contractor) (tnsuance Company/Policy Number) (Expiration Date)
:✓'Jr w.il sheet Irneewryt sol de inforoutioa pewping a all wCrotlan)
} I all a sole proprietor and have no one working for me.
} I am a home owner performing all the work myself.
'NO:I::piroso be wart tbu whirs bomcow,cn who employ perm=to da=Sour awwvaioaor repair work on admtliog of
:.0 tint-th a tGm wets in wbirhate bouwwoa raids or on the Woods ap wvmdthetto ere sot rattily aamih+d to be
assulnyan M.r trn.w&Ca noro..autim Act(GLtS2nt(5))yylicatiwty a.homonym Tor abaax oc pound may°vidrnce We
tool stunt or an employer coder the wakda C,ompm ntioe Ark
I no-du-nand that a copy oft is vale==t may be f°rwenied'a du Durasmrmt of Industrial Aacdoebe 06o.of£mars for the
os+taasc wiiiadoo=Ward faiiurctosavrz coving°nada aaioa]SA or/404152 as laden Ihd lseeidancf orkSa pCSdeI
bmiC.-:g
of a fir efupb SISCQ.O0 sed«aapriwmuvy of up to ow you-tcivipatdtia is the form of la Mott Wok Ott sod.
-z of.:100,00 a day amino or
....< .� / FPaefdmaait tNm'tberw °nY
` / # 4< Sheik, MapfL
oh p •
IfI
Sigtz 11
c£Liotusx{permittcc L6te
RC I. Rofnio g
IP
518 Holyoke Street
Easthampton,
Estimate Date
_asthamp[on, MA OSQ27 Estimate GG
°hone (413) 527-4775 3/4/2669
MX (413) 527-9469
Name%Address
Job Location
Pat Wagner 279 Haydenville Road
279 Haydenville Road Leeds, MA
Leeds, MA 01053 584-7199
Terms Rep
Estimate valid for 20 days Rich
Job Description Total
I ESTIMATE DOES NOT INCLUDED GARAGE ROOF. 10 100.00
Remove existing roofs.
Furnish & Install 1/2" plywood over the existing decking.
Furnish & install aluminum drip edge, pipe flashings, chimney flashings and step flashings.
t-urnlsh & install new lead counter flashings.
nurnish & install CertainTeed Winterguard ice and water barrier along eaves and valleys.
Furnish & install synthetic underlayrnent.
Furnish & install 30 year CertainTeed Woodscape Series shingre.
I Furnish & install CertainTeed approved ridge vent.
Furnish & install .045 re-inforced rubber roof system on flat roof section.
All exterior roofing related debris to be removed by R.C.I. Roofing.
5-Star CertanTeed Surestart Plus extended material and workmanship warranty included.
,30 year CertainTeed material warranty included.
All related permits will be obtained by R.C.I. Roofing.
I SPECIAL ITEMS NEEDED
lei
THE OWNER HAS THE RIGHT TO CANCEL THE CONTRACT WITHIN (3)
'THREE BUSINESS DAYS OF DATE OF SIGNING. Total $10,100.00
IS 2?IS OF PAYMEN I
5s Deposit
Balance upon completion Customer Signaturer"'" ' N '"
Rcgislrationp 126235 � ��
mntwcuon Licenses 074334
Date f(�
I Insured by Reynolds. Barnes&Hebb.Inc.413-147-7376 D f''