24C-159 (7) 22 ARLINGTON ST BP-2020-0081
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24C- 159 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-2020-0081
Project# JS-2020-000131
Est.Cost: $10800.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: RCI ROOFING 074334
Lot Size(sq.ft.): 10890.00 Owner: HYMAN SHERRY B&ARTHUR
Zoning: URB 100)/ Applicant: RCI ROOFING
AT: 22 ARLINGTON ST
Applicant Address: Phone: Insurance:
6 LINE ST (413)527-4775
SOUTHAMPTONMA01073 ISSUED ON.7/22/2019 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMOVING AND REPLACE EXISTING ROOFS,
INSTALL WINTERGUARD, PIPE FLASHINGS AND DRIP EDGE
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 7/22/2019 0:00:00 $40.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
6p-
Department
use only
City of Northampton Status of Permit: 3 r
Building Department Curb Cut/Driveway Permit
s
212 Main Street Sewer/Septic Availability
'�; 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 Speciifyp
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RE TOR0iVLIJH�/O O O FAMILY DWELLING
Ij
)�� U
SECTION 1 -SITE INFORMATION a C.f
1.1 Property Address: h s s ton to c pieted by office
a s Ar l I n'n S+ M
`J /� El,clric,Plum mg spec i Unit
Nor4anm 0nl 1 r r 11M rt�;ew,'I�ton t o 01060
�" verlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
A1+hur u im(Ah �a A�iir;4 ,r, +, r�rarnc34� (Y1i� OlUloo
Name(Print) Current Mailing A ress:
�PP Q r�rho� ---`41.3 58y- x137
Telephone
Signature
2.2 Authorized Agent:
�- (�L ice' Q S3+ . Sr)u4ha o3 tin (T)I-'1
Name(Print) Q Current Mailing Address:
�a
Ll 99's
Signature
Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed bv permit applicant
1. Building n (a)Building Permit Fee
P) i10 Ro.b
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) L4O•U D
5. Fire Protection
6. Total= 0 +2+3+4+5) o Check Number C
This Section For Official Use Only
Building Permit Num er: Date
Issued:
Signature: -7_ 19 Z��9
Building Commissioner/Inspector of Buildings Date
S-N)ornpson @ rci roo--I*t,� .cam
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) 7
New House ❑ Addition Replacement Windows Alteration(s) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks [Q Siding [❑) Other[❑j
Brief Description of Proposed '
Work: See t o d
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 house and or additiontoexisting housing, complet?the following:
a. Use of building : One Family Two Family Other
b. Number of rooms in each farnily 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 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
Ar"ur ' !Jrnco as Owner of the subject
property
hereby authorize P1Ci A[y1t in' q
to act on my behalf, in all matters relative to wofJ authorized by this building permit application.
Sep (2 40r hod ()2/2119
Signature of Owner Date
I, Mcul� (1,S l4hOrl _ep ren+ as Owner/Authorized
Agent hereby declare that the statements and information on the foie oing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Print Nam /
CA 111 i
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: f Not Applicable ❑
Name of License Holder:-- Mar L 00.1 I�le_ C S — ( 7 V33
License Number
rl Eo,,S OIGa 05 - 03- QQa0
Address � Expiration Date
yl,3.)
Signature Telephone
9.Reaistered Home Improvement Contractor: Not Applicable ❑
P) C l R C ?t"i nG LLP /a 1-0 a L3,5
Company Name U IRegistration Number
U Line 3+ . 50k am 1n 1'Yl 10`l Ds - 05 - a6a0
Address Expiration Date
TeIephone_q0--,ia7-
SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152,§25C(90
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...... ❑
RC.i.6
Roofing Date
Line St.
Estimate
Southampton,Ma. 01073 6/25/2019
Phone(413)527-4775
Fax(413)527-8469
Name/Address Job Location
Arthur Hyman
22 Arlington St
Northampton, MA 01060
Terms Rep
Estimate valid for 45 days Chris
Description Total
Remove existing roofs. 10,800.00
Furnish& install aluminum drip edge,pipe flashings, chimney flashings(if needed)and step
flashings.
Furnish& install CertainTeed Winterguard ice&water barrier,6 feet along eaves and 3 feet in
valleys.
Furnish and install synthetic underlayment over existing deck.
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.
Add$2.50 per sq. ft. for wood decking replacement if needed.
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total $10,800.00
TERMS OF PAYMENT
5%Deposit Customer Signature:
Balance upon completion
Registration# 126235 �,
Construction License#074334 Date:
Insured by Banas&Fickert Ins.
(413)527-2700 Shingle Color Selection: (e f !J'�
f ►�s�q,(( v-ti O'c� CLt`ham ret-,j
/'�(y►1 S C%0,
City of Northampton
Massachusetts
{ tit
.c
;t
DEPARTMENT OF BUILDING INSPECTIONS at
212 Main Street • Municipal. Building tJ ,Cam.
Northampton, MA 01060 ssy •.•�)�10
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes. Prior to
performing work on such homes, a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L. Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing
at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note:If the honteowner has contracted with u corporation or LLC, that entity musd
�t be registered.
Type of Work: �joci i t Est. Cost:`+# Io. goo
Address of Work: Aa Y 1 no-�On 51. f�lc�raint�-�6n , I YI�I
Date of Permit Application: l
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law(explain):
_Job under$1,000.00
_Owner obtaining own permit(explain):
Building not owner-occupied
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L. Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
6 .C , 1. EwA*ng LL /Q(0135
Date Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
City of Northampton
Y
Massachusetts QW
DEPARTMENT OF BUILDING INSPECTIONS r`
212 Main Street •Municipal Building
Northampton, MA 01060 fs�y1••• �����
Debris 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.
The debris from construction work being performed at:
Q;� I n ' lQ (41Cu-nn:nn
(Please print ho a numbee and street namb)
Is to be disposed of at:
W.0-5_ferel 6e y 4d inn T 'n s-{Pr- F c i 6
(Please prin ame a d location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
rxulinu d kynclrn�
(Company Nadhe and Address)
Signature of Permit Applicant or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
The Commonwealth of Massachusetts
_ Department oflndustrial,4ccidents
1 Congress Street, Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTI]VG AUTHORITY.
Applicant Information r Please Print LeObly
Name (Business/Organization/Individual): �, l (x�Ft n2 . LL.P
Address: b Ll n e 3+rep+
City/State/Zip: Sp r)j Phone#: �(,113) 59h VJQ5
Are you an employer?Check the appropriate box: Type of project(required):
I.ZI am a employer with employees(full and/or part-time).* 7. ❑ New construction
2.17 i am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3.71 am a homeowner doing all work myself[No workers'comp,insurance required.]t
10 E] Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 1 1.❑Electrical repairs or additions
proprietors with no employees. 12.❑Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet.
These sub-contractors have employees and have workers'comp.insurance.t 13. y toof repairs
6.7 We are a corporation and its officers have exercised their right of exemption per MGI,c. 14.❑Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#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 then(tire outside contractors must submit a new affidavit indicating such.
tContractors 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'camp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. n
Insurance Company Name: 111, hl t+U0J Irl,5 H 04 LQ_
LQ_ W.
Policy#or Self-ins.Lic.#:_V W L I n 0(n n a a(o y 7a 6 1� A Expiration Date: /0- U 5- a 0 1 c/
Job Site Address: City/State/Zip: UV(G0
Attach a copy of the workers' co► ensation policy declaration page(showing the policy number and a cpira ion 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 under the pains d penalties of perjury that the information provided above is true and correct.
Signature: Date:
Phone#: L131\ 517- 9775
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 Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#: