30B-007 (4) 88 WARNER ST BP-2020-0521
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:30B-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: ROOF BUILDING PERMIT
Permit# BP-2020-0521
Proiect# JS-2020-000901
Est.Cost: $3600.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: RCI ROOFING 074334
Lot Size(sa.ft.): 38115.00 Owner: LUCEY DAVID J&
Zonin : URB(100) Applicant. RCI ROOFING
AT. 88 WARNER ST
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527-4775 Workers Compensation
SOUTHAMPTONMA01073 ISSUED ON:10/25/2019 0.00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE GARAGE 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 Shinature:
FeeType: Date Paid: Amount:
Building 10/25/2019 0:00:00 $40.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
l`VE
. Department use only
.r City of No 77 am ton I V tus of permit:
Building D part en c b cu Driveway Permit
212 Mal Str et �C� 4 S wer/ eptic Availability
!i Roo 10 209 ater ell Availability
Northampt n, 9A'0 wo S is of Structural Plans
a. IV I
\�- phone 413-587-12401 " �Ero lot/S to Plans
- _-- k1A e1oso Othe Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWOFAMILYDWELLING
SECTION 1 -SITE INFORMATION 6/~ a7v/ /
1.1 Property Address: This section to be completed by office
9 � W0-fnV
er 15+• Map L-� Lot c -7 Unit
F jorer\Cet (Ylr-) Zone Overlay District
Elm St.District C13 District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
bayiA LLic" 9Z Warne_rS+. F1oreace I m
Name(Print) a Current Mailing Address:
.Sc, d4arhed �seco -a a9�
p Telephone
Signature
2.2 Authorized Agent:
C (o Ll n Q S+ . Sc)u+kc,we +or) I )R Ui0`7
Name(Print) ,.' Current Mailing Address:
�yl�,) 5a-7 - L1995
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building n (a)Building Permit Fee
�bo1"in
2. Electrical (b)Estimated Total Cost of
__..._Construction from (6) _
3. Plumbing Building Permit Fee
t/J7
4. Mechanical (HVAC)
5. Fire Protection
6. Total=0 +2+3+4+5) 6 — Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature: /j 9
Building Commissioner/inspector of Buildings Date
S+hornUson @ rCi rocr�i'n� .corn
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
_.
1 Si Ir �•. 0"
r I
r 1 1 -� i
,; Y.,,..
r
i�r+i . ' .
r
r _. � ,
i
._ _ ,
�. �,._�
r
�, M t•y ,• ...
!lftCi; F t tib! l$� � S'�•(cif ly,�$ i.:r'r fib"^ o �t it Lr i�
i `•
r ti 1
��� � a
� x � ���
�` � 'ti.
•1.:
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks [❑ Siding [❑] Other[❑]
Brief Description of Proposed '1
Work: S e e CL-I�(a ched
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 addition to existing housing complete the following:
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 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, oa-V id L-o Ce. as Owner of the subject
property
hereby authorize �l C
to act on my behalf,in all matters relative to wo authorized by this building permit application.
-- s-ep (240oW /0 - a3 - ao►cf
Signature of Owner Date
I, -r IJP,liS a 5 aU_--lhOrl ZPd a�2tT - as Owner/Authorized
Agent hereby declare that the statements and information on the fo Keoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Print Nam /
Signature of Owner/Agent Date
f
l
. i
i
S
i
Gi
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0\
Name of License Holder: Mod(K f jod 15V1e_ C S — / y 3 3
License Number
ri E s 0103 05 - 03- a0 a 0
Address � Expiration Date
L13) L5a7- LUSTS
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
1, Cz (�CCAnG LLP /atod3s
Company Name URegistration Number
L,n_ A 01023Qs - v5 - Q0Q0
Address Expiration Date
Telephone y13-Sa7-Y995
SECTION 10-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
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... d No...... ❑
J
C. •
r.
5 1
{
City of Northampton
Massachusetts
'A wt
' DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060
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 homeowner has contracted with a corporation or LLC, that entity must be registered.
Type of Work: �j o4i n(y Est. Cost: 4 3t,000
Address of Work: 'K & l l oa t\e( i3+ P l ofk w P
Date of Permit Application: I o/a 31 ar 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:
lo /,-�-A, l6 .C . I. &nOA-nu LLP /a(o135
Date Contractor Name U 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
PY)>f. h nM::,. ,...y.y Fr ry .M^r :.*MI �., !^ .-:r.., w-• ,j.. ,1+ .y�r,.l:t., rtn,^s. m
City of Northampton
Massachusetts
1. .A
" DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street •Municipal Building r
Northampton, MA 01060Svyy ��`�
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:
Z Z WOE( r\E_( S-t F10(eYICC-
(Please print house numbgr and street name)
Is to be disposed of at:
Wzs+,Prn 6e(ur.11•na FCcri hly
(Please printffiame a d location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
U M (XlA iria - d kVC(ra1n4
(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.
t
I
3 t
'J, '.P'+;.:e t';E3� i.►Gt.'2`:'�"�' "Ct��^4«f:•':.1+ v".t ��. �, •k:. G t f i• _? :.{ {-:ae.�t"r3 L7t3�..v.
":i
The Commonwealth of Massachusetts
= Department of Industrial Accidents
o I Congress Street, Suite 100
a
Boston,MA 02114-2017
www mass.gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Leeibly
Name (Business/Organization/Indivi dual): I R(X7t 1 fl4 _ LLP
Address: b LI n e. 5+rpo+
City/State/Zip: SOU-On(tM aj�rj. A 01093 Phone#: L413� 5a - 05
Are you an employer?Check the appropriate box: Type of project(required):
1.[ZI am a employer with_15 employees(full and/or part-time).* 7. New construction
2.❑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. El Demolition
3.7 I am a homeowner doing all work myself[No workers'comp,insurance required.]t
10E] 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 I L❑Electrical repairs or additions
proprietors with no employees. 12.❑Plumbing repairs or additions
5.711 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. y� p
toof repairs
These sub-contractors have employees and have workers'comp,insurance.:
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q 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 hire 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'comp.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: AIM, ffir}V0_1 -T S lJ ra4 t p
Policy#or Self-ins.Lic.#:_V W C I n 0(nn a s to V 7Q p 1 A Expiration Date: _ 10- 0 5 - a U (%
Job Site Address: Z� LOM Y\P t St City/State/Zip: F I UTP YIC1, (Y)6 OIC�to�
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required ander MGI.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: to a 1
Phone#: L13\J 5Q7- L1295
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#:
. .
.
_ ., � .�_
4
t,
... r .. .. .. .,
z
i
i_.. . .... ... - .... . . � ,. . .
f'�.. .?.� ,. ..
RC.i. REstimate Date
6 Line St.
Southampton,Ma. 01073 10/15/2019
Phone(413)527-4775
Fax(413)527-8469
Name/Address Job Location
David Lucey
88 Warner Street
Florence, MA 01062
Terms Rep
Estimate valid for 30 days Angel
Description Total
Remove existing roof from detached garage 3,600.00
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.
Tota I $3,600.00
TERMS OF PAYMENT / j
5%Deposit Customer Signature: /
Balance upon completion '% W
Registration# 126235
Construction License#074334 Date:
Insured by Banas&Fickert Ins.
(413)527-2700 Shingle Color Selection: Gr\