35-159 (2) BP-2023-0658
767 RYAN RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
35-159-001 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-2023-0658 PERMISSION IS HEREBY GRANTED TO:
Project# CHIMNEY LINER 2023 Contractor: License:
THERMOCRETE CHIMNEY SWEEPS
Est. Cost: 2300 LLC 094627
Const.Class: Exp.Date: 10/18/2023
Use Group: Owner: GALEN HOSTETTER,
Lot Size (sq.ft.)
Zoning: SR/WSP Applicant: THERMOCRETE CHIMNEY SWEEPS LLC
Applicant Address Phone: Insurance:
36 NOWAK CIR (413)589-8626 400-7036213
LUDLOW, MA 01056
ISSUED ON: 05/22/2023
TO PERFORM THE FOLLOWING WORK:
INSTALL CHIMNEY LINER
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 VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
I i ' 6 _52 cgr
, .
I '
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax (413)587-1272
Office of the Building Commissi ner
V.myva
The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CMR MUNIU�ALITY
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For_ Official Use Only
Building Permit Number: 6, A 3 ' (4 S 7 Date Applied:
•,
�r
Building Official(Print Name) Signature D
SECTION 1:SITE INFORMATION
1.1 Property Address: zidi 1.2 Assessors Map&Parcel Numbers
yo
1.1a Is this an accepted street?yes X 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 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system Cl
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1p wner'of Recco d:
CTt/t rr /510 SAE ,yc— !l #44 app. m /414
Name(Print) City,State,ZIP
74 7 dy/., I. ( Goo) - 4/G-ao 3 Cr"fie., . yo Ile /Yew a . O r�
No.and Street Telephone Finail Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building Cl Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.❑ Number of Units Other Specify.
Brief Description of Proposed Work2: S;„f/e wo// ;,.i— "v
7`/ems Waaaf j..A r
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
I. Building $ I. 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 (I-IVAC) $ List:
5.Mechanical (Fire
Suppression) Total All F s:$ t
Check No. V Check Amount: Cash Amount:
6.Total Project Cost: $ d 3 oci 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) dQy% 7
!O -4-- a3
g4., 3tot p t I. License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
34 A"j4. KK Gr .
No.and Street Type Description
/�v �1� G/0 S U Unrestricted(Buildings up to 35,000 cu.ft.)
(•-�'►�/ R Restricted 1&2 Family Dwelling
City/Town,State,ZIP 4 Masonry
`C Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
y'3` ,sty-fGa(0 -77s- .ies/site frosty" I Insulation
Telephone Email address , Demolition
5.2 Registered Home Improvement Contractor(HIC) /9,/ G S L 5/3/a? y
!✓Y t r a 7`a e.fy�'iw n♦ f is tc,1 LG( HIC Registration Number Expiration Date
I J,Compapy Name or BC Registrant'Name
aurK Y. TLSk eo s e,#*7a.'i
N 4
and eet Email addre.
e—r/ 0/0 S.6 4//3-Sr,- Pc..)o
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 Issuance of the building permit.
Signed Affidavit Attached? Yes No .❑
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 true and accurate to the best of my knowledge and understanding.
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
I. 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"
re...,
gas.....,, The Commonwealth of Massachusetts
a4TatlikTriA Deportntent of Industrial Accidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
wsvw.mass-goy/din
vs co kers'('111111pensation Insurance Affidavit:Builders/I'antractors/Electricians/Plumbers.
i 0 BE k tt.t1)WITH THE PERMITEING A inriuntivi.
1rmlirant Information Please Print tegibli
. .
Name(Btu inex tiTitanization'individual i:7/1 de err 47 c.r.e.,IC of. y ,,rss/ire..0.01/ ze<
at-
---
CityiStatefZip: Z0 o/Z)t-f /1'1-4 0/0 S C# Phone#: i'i;^
Are'es so employee?('beck the agapriaprialte hest
Type.1 project(required):
t l rnmoyer wih -2
. i 7. 0 Ne% conbitiruction
)
2.1:3 1 ant a wik propneror or panneratup and have nu ernplox rex working for cm itI S.. c3 Remodeling
an C41%3Cliy.1.i0%cater**,...oinp.tn_suranre moistly!.I
1 9. 0 Demolition
:40 I am a Wow:owner doing all sours inytell.(Nu+0.4.ukeix'comp inaurance regional)• ,k
10 0 tiltitidtn#addition
IEll aro a tiunicaviries math,ill be histitg Lxwitractota to cornin‘i 4H w rak on tit)property. I w ill
vaunt.that all 4.11191Mitin entail biLLI:V.Itniet1.l'iiMptIV.:410:1131*Urat14.1.:is WV 501C I I 0 Eloctrical repairs or additions
propnocnin w irk nu employee.
1 12.0 Plumbing repairs or asidetion.s
SO I on a paietal conhactoi and t have hatai the sUb-grintrAaLvt hated on il* attached dicci.
130 Roof repairs
These sub-eorkoricsors tisse curpli.lor.and have winher?."curvy.unurance /
i6.0 i 4.001.ite't f'oote•P,te;t1 Wc ant a oorpocativri and a.%oaken.to r exemixed then richt of can-ea:aunt per MCA.c
152.§114t.and v.::hAo.e no lataphipari.I No artaten.'taxitp.insurance required I
I Po,e..--
...sw,appts.siii that chedk%box 'i mini atmn till uut the sectsian kelow xhiniig their ntakurs'4:oinpei*.ation policy information
l' nou -n.rx who%uhinit rho au/4k it indicating dtcy an:doing all wort mut then hue:Airsick,:tantraslorx aunt•iithrtitt a new itertilai.it itailieitung Mick
;t'urityseton that eilect this tot.tuto4 al tA.-tietri an...x.t.i.tionai t.lu.x.-t ahoy.ing the name or the min-,:ontra%:tots and date v.h.-ther or not thouc mtiticx hat.:
...niple:r.cc, If the ue1A-coottacioi>.Kett'etSirkr)IX,Ilk...4 Masi!MY.ik,k;tlx..Ar workers.'..oinp. polu:!,th.int\.-t
I am an employer that is providing workers compensation insurance far ay employees.. Below is the policy and lob site
information.
In.surance Company N a Mir A.7344 147%4'AA a. / — „ ..—_--
POlity#or Self-im-.Loc.st: 9001' 7o.3 (,4) 2 - 42o0 3041 Expiration Date:
Job Site Address: 74 2 4.v-k a,e ,..-ity Su teZip: -toilr-..",.4.7.........4-t4
Attach a copy of the worker 'compensation policy declaration page(showing the pokey number and exipiration date).
Failure to secure coverage as required under MGL c. 152.*25A is a..:rtininal violation punishable by a fine up to S1,500.00
anikor one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.0O a
day against the violator.A copy of this statement may be forwarded to the°trice of Investigations of the DR fur insurance
cos erage verificatior
i do he - certify andunde e allies ' , e information provided above Is true and correct
Stirrhi ion: Daic.
Phone:---: Zt/l—'317— 5cop 2 Co
t , _,
Official use only. Do not write in this area.to be completed by city or town official
i City or Town: Permit/1..icense k .1_
1 Issuing Authorit) (circle one):
I. Iiirard of Health 2. Building Department 3.(4V-town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6. Other__
( .'" - r • '
*intact Pers.on: Phone 4: ..!'
__._____ _ .
THERMOCRETE
CHIMNEY S EPS, LLC
JONATHON BUREK 36 NOWAK CIRCLE
(413)589-8626 a LUDLOW, MA 01056
TCSweeps18@gmail.com ,;F,
I .
DATE:4-7-2023
SITE ADDRESS NOTES
Galen Hostetter Additional cast of the permit Fee will be added to price
767 Ryan Rd. below.
Northampton,MA
602-616-1303 galen.hostetter@via.org
SPECIFICATIONS
1.Install 15ft of Type 304 stainless steel crossover flex liner(6"dia.) to first floor wood stove.
2. Install stainless steel top plate, clamp and rain cap.
3. Install stainless steel t-section with 18" snout and end cap.
4. Insulate liner with ceramic fiber jacket.
5. Make custom damper plate.
6. Lay masonry crown.
NOTE: Lifetime guarantee on liner and components.
PRICE: $2300.00 We DO NOT accept credit cards. Quote is valid for 30 days after the date listed above.
Two Thousand Three Hundred***DOLLARS To be paid upon completion of job.
If you wish to schedule the job,please read the TERMS AND CONDITIONS listed below and sign. Return the yellow copy to the address above. We will then set
a date for beginning your chimney work. Thank you.
OWNER THERMOCRETE CHIMNEY SWEEPS, LLC
Date: Date:
Print: Print: Jonathon Burek
Signature: Signature:
TERMS AND CONDITIONS
1.THERMOCRETE agrees to furnish materials and services set forth on front side hereof for the work on OWNER's property. OWNER agrees to pay THERMOCRETE for such services the
amount set forth on the front side of this agreement upon completion of the job.
2.It is understood that the start&finish dates are approximate dates only. THERMOCRETE shall not be liable for delays due to unforeseeable causes beyond the control of,and without
the fault or negligence of THERMOCRETE including corrections for concealed damages,mechanical or structural defects,Acts of God,acts of the OWNER,fires,strikes,and unusually
severe weather.
3. Matching of materials,colors,designs,etc.,will be done nearly as readily available materials will allow. All dimensions and designations are subject to adjustment as required by job
conditions.
4. THERMOCRETE will perform work in a workmanlike manner,in compliance with applicable local codes and ordinances,and in conformity with accepted industry practices and
commercially accepted tolerances. No claim for adjustment shall be construed as reason to delay payment in full.IThe manufacturer's specifications and warranties are the final
authority on questions about any factory produced items.
5. This contract shall not be binding until accepted by THERMOCRETE and shall give OWNER written notice within 30 days. In case of rejection,any deposit paid by OWNER shall be
returned thereof.
6. This contract constitutes the entire agreement between the parties,and no statement,promise or inducement made by any party hereto which is not contained herein shall be
binding or valid,and this contract may not be enlarged,modified or altered except in writing signed by all parties hereto.
City of Northampton
0.W.81MPyO.w 15 -+ SI
? ' ' Massachusetts A 1- �'�,::,
i,' I DEPARTMENT OF BUILDING INSPECTIONS g.
s ' 212 Main Street • Municipal Building Jp �b
s+' Northampton, MA 01060 s3'r . 01"ti
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, 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:
Signature of Applicant: --___ Date: f—/0 -d 3