24C-162 (5) BP-F 022-1261
6 ARLINGTON ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24C-162-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
•
Permit# BP-2022-1261 PERMISSIONIS HEREBY GRANTE I TO:
Project# FOUNDATION REPAIR Contractor: License:
Est. Cost: 38500 DAVID OSIECKI CSL089376
Const.Class: Exp.Date:01/05/2024
SCHWARTZ DEBORAH E &ALDER ILAY
Use Group: Owner: STEINBAUER
Lot Size (sq.ft.)
Zoning: URB Applicant: WESTERN MASS MASONS LLC
Applicant Address Phone: Insurance:
383 COLLEGE HIGHWAY 413-527-1800 6S60UB4N95684A21
SOUTHAMPTON, MA 01073
ISSUED ON:10/05/2022
TO PERFORM THE FOLLOWING WORK:
FOUNDATION REPAIRS •
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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOL TION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
I
Fees Paid: $250.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Buildine Commissioner
d' "�..
4,.
.14 The Commonwealth of Massach Setts <�
Board of Building Regulations and tans. ds cs �1/ FOR
W Massachusetts State Building Cod , 78g' MR F� �lz;`MUNIF PALITY
tISE
Building Permit Application To Construct,Repair, gar Si Demoli l eevised,kar 2011
ry'e%,,
One-or Two-Family Dwelling -,ya,..''),1 ;
-'^
This Section For Official Use Only it ,r,sow
Building Permit Number: .�!',62- of,.•/:ACI,J Date A plied: 0.,- O't,s /,
. , 1 I 6• 0
Building Official(Print Name) )11\14etilkSjignature � t
SECTION 1:SITE INFORMATION
1.1 Property Addre • -� 5% 1.2 Assessors Ma &Parcel Numbers
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private CI Municipal_ Outside Flood Zone? Municipal❑ On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of R j J (Atn,..ni
,
are„� S��'f Z I' IName(Print) City,State,
itAl' /` ,09 (SZ3-3k a1
No.and Stre Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: _
Sce A-�Ii} a a.A
SECTION 4:ESTIMATED CONSTRUCTION COSTS
I
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x_ _
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire $ —
Suppression) Total All ), it
Check Nol9 -iCheck Amount: -19 -Cash Amount:
6.Total Project Cost: $ Te/t/ 0 Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 6 P 13 2d /.S -0)-3
if) (c& 16. License Number Expiration Date
Name of CSL Holder
) G� Cam` List CSL Type(see below)
No.and Street Type Description
,$ cr 2 / /to. G a23 U Unrestricted(Buildings up to 35,000 Cu.ft.)
City/Town,State,Z lJ( R Restricted 1&2 Family Dwelling
n M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
3'317/d'<-c, Q IJjekie/ep". i, c,ni. cc— I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 0;7 6
7dd
L t'3 I ("- W41 ! nJ HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name nn,, __ ee
No.and Street , . Email address
City/Town, State,ZIP Telephone
SECTION 6: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 Issuan of the building permit.
Signed Affidavit Attached? Yes No .0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is . and accu to to the best of my knowledge and understanding.
Print Owner's or Authorized Age s afne( lectronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches _
Type of cooling system Enclosed Open _
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
1
City of Northampton
K�n,_AMFY
Massachusetts ��} «. �<<,
: , W. *
DEPARTMENT OF BUILDING INSPECTIONS 'S a° 4
212 Main Street • Municipal Building y �
!* Northampton, MA 01060 4 .,,gi'3ti1
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, 554, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
Location of Facility:
The debris will be transported by:
(/'Name of Hauler: v( J� ��
Signature of Applicant: Date:
""". The Commonwealth of Massachusetts
-...m- f Department of lndustritll.-Accitlent'
�s:rA,
tmmtsj,)or I,
1 Congress Street, Suite 100
Boston, MA 0211 4-2017
,•: ,-. ` WWw.mass.gov/dia
1%urkers'('ompc.satioa Insurance:lf idasit: Builder.('out ractorsil lectriciauul'lunthcrs.
TO BE FILED WITH I Ill['E:RN1I ITIM::11 111014111.
Applicant Information Please Print Lest ihls
n
Name(Business 0rgantzationilndnldual): Lief 11/ot�.-Maj� r!J
Address:
3i-3 cc,C
(IN/State/Zip: Sea/ i ,(/0. Uto; Phone : J fet7— ;',ii:<
'ire i,tiu*e ewptoyer?fleck the,appropriate box: Type of project(required):
1 .,nt a employer with ,employees(full and'or part-tiara).• 7. 0 New construction
` I.Ili.1 ..ie icior of •rtnersh' and have no employees work' for MC it*�� partnership �' � Ei. 0 Remodeling
.ir ,._J.i 1t ..(No workers'ei.tnp.insuranix required.)
9_ 0 Demolition
,, 1 311:.1 homvwwnrr doing all work myself.No workers'car.insurance rstluiind.)'
3.0 I am a hcuneowner and will be luring contractors to conduct all work on my property. I will U®Building addition
-r ensure that all eantra ton either have workers`t.'0O3pOSKSOLiell aivurancr or am sole 11.Q Electrical repairs or additions
proprnton with no employees.
12.0 Plumbing repairs or additions
so I am a general contractor and I hale hired the sub-contractors:listed on the attached sheet.
These sub-contractors have employees and have workers'comp.in surance. I Q Roof repairs
6.0 we are a corporation and its officers hat e exercised their right of exemption per MGL c. 14. Other—_.-
152,*I t+II,and we have no employees.(No workers'corms.insurance requires.)
'Any applicant that chocks box PI must oho fill out the section below showing their workers'compensation policy information_
t Homeowners who submit this atdukutt indicating they are doing all work and then hire outside contractors mast submit a new affidavit indicating such.
lContnnctors that cheek this but must attached an additional sheet showing the name of the sub-contractors and state whether or nut those in Imes have
,mpl,n,,, lithe sub-contracts is kite employees.tiler most provide their workers'eolnr.p.,10::,nulnh,.•r
I um an employer that is providing workers'compensation insurance for my employees. Below is the police and job site
information. , -s
Insurance Company Name: �Ct� ./�' Slat- - A0
Policy#or Self-ins.Lie.#: 1110 CP 1` Expiration Date: 4/'�/t 2_
Job Site Address: 6 if.A 1'' ' Gti 5/ City,StateiZip: 4 l 1:66;
Attach a copy of the workers'compensation policy declaration page(showing the policy nuns and espithou date).
Failure to secure coverage as required under MGL c. 152.§25A is a criminal violation punishable by a fine up t $I,500.(X)
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up o S250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA f insurance
coverage verification.
do hereby certify the pa curt en des of perjury that the injormation provided above is tree and 4ecL
Signature: 1).ttc ',12
Phone#: %'iJ , r2- (,c.,
Official use only. Do not write in this area.to be completed by city or town official
('its or Tossn: Permit/License #
Issuing:authority(circle one):
I. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone a:
363 College Highway . "• •rt.
am; QUOTE
Southampton, MA 01073 f N LICENSED • REGISTERED
(413) 527-1800 c4" a. . INSURED
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DEBORAH SCHWARTZ Date: 3-05.2022
To: 6 ARLINGTON AY!.S%: Quote# 893289
NORTHAMPTON MA Project: FOUNDATION
Phone: 503-320-2166 E-mail: ,
Description of Work To Be Done: '
The rear section of the foundation is becoming structurally unsound and deteriorating.
deterioration can be noted in bowing of the walls and the brick spalling and mortar turning
back to dust from years of water penetration.
Facing the foundation from the rear of the house the area that needs to be replaced on the
right hand side to the walkthrough door across the entire back and return to the first
window.
Support the existing house as necessary and remove the foundation along with the
concrete floor up to the fireplace.
Excavate down 4 feet and pour new concrete footing with rebar.
Install new concrete block and brick to tie into the existing foundation. vertical rebar every
six feet filled solid and block to the sill plate of the home.
Install two new double hung standard windows to replace the existing.
Tie in 2 existing downspouts underground and create new drywell in the rear of the yard.
Backfill with existing material. Pour new concrete floor in the area described abovle. Loam
and seed all damaged areas.
Pull all necessary building permits and call dig safe before construction is to start.
Any and all additional work that may be needed in order to complete the job such as but not
limited to carpentry, plumbing and electrical or any other areas that will need to be
reconstructed because of the new areas of construction will be a additional cost arid a
change order to the original contracted price below.
WE HEREBY PROPOSE TO FURNISH MATERIALS AND LABOR- $ 38,500.00
IN ACCORDANCE WITH THE ABOVE SPECIFICATIONS,FOR THE SUM OF:
This quote may be withdrawn from us if not accepted within 30 days.Quote Prepared By: David Osiecki
Thank You For Choosing Western Mass Masons!
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QUOTE
r LICENSED • REGISTERED
Sc�uth,trnpton, MA 01073 �' . a.Li
(413) 527-1800 -4',v • igii ,' INSURE•
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TERMS:Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and
above the estimate By signing this quote,you agree and understand all the above terms and conditions that apply to this job.Any changes that are to be mode,must be
discussed poor to construction and agreed upon by contractor and may also affect to the final price.
PAYMENT TO BE MADE AS FOLLOWS:One half of quoted amount is due when job construction has begun.Remaining balance of bill will be paid in full when job is
complete A Frnan a Charge of 1-1/2(18%annual rate)per month will be added to any unpaid balance over 30 days.
ACCEPTANCE OF PROPOSAL:the above prices,specifications and conditions are satisfactory and hereby accepted.You are authorized to do the work as specified.
Payment will be made as outlined above.
Si a Sinn Signature: Date:
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Thank You For Choosing Western Mass Masons!