31A-058 rROPOSAL
PFROP0$AL,NO
11 0040
MA REG 4, MARTIN CUSTOM MASONRY CO. LICENSED SHEET NO. . •.,
(413) 592- 3595P 103 SHIERIDAN7 STREET REGISTERED E 01 ,
(413)331 -0043F CHICOPEE, MA 01020-2725 INSURED DAT2 10/25/11
PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT:
NAME ADDRESS'
A Ge al Contrartr)rn - .",asraano 13es7.-ddenca
ADDRESS' ; , y
P.O. Box 448 270 Cresent St Harthai tan, MA 01 ✓1
DATE OF PLANS
Leeds, MA 01053
PHONE NO.
ARCHITECT >".`•
f 41 1 1 5Rd _A9R?
We hereby' propose to furnish the materials and perform the labor necessary for the completion of
CHT:MTTtTP.`V Rv:P4►,IR (2' . x 3' $ r, 1i 5 t)
- (11ta<i t't 1:11 cirg permit – - nsFa 1 1 :wOrtd 'forms f l �hi;n7' benea�
1
pour new concrete cap tap of chi.mn r
- T:;rp scaffn1d
1.1t3-
–trip foris instal piece blue
–
t fgas eyed ; en
damaged portion of brick masonry
n aPprox 3 down from existing –Strip scaffoldi gP•Pra1 c1 roman ,
cone e - .p
* * *WE GITARAIMTE OUR WORK***
- Tn5tal l approx 400 new red clay dular 1 yr-- WATERTIGHT'
brick to 'match existing ";id Westfield" 5yrs WOR1{ "3ANSUIIP
brir'k to exist_ dimensions' & code height
I�fa11 netv 87' x 13" clay flue liners
to hatch s ne u ox 8
All material is guarante in to b as g e as specified , and ( t1] p move wotk to be performed in accordance with the drawings and specifi-
cations submitted for above work and completed in a substantial workmanlike manner for the sum of
Two 'Pi and Fifty and 00/140 - -= ,-- =- Dollars . _ ) ._
with payments to be made as follows. or $1,025. as material��•'deposi
the balance due upon '' corn eti
START:
COMPLETION: �„
( _
Respectfully submitted '..
An alteration or deviation from above specifications involving extra costs
will be executed only upon written order, and will become an extra charge
Per
over and above the estimate. All agreements contingent upon strikes, ac-
cidents, or delays beyond our control. Note — This proposal may be withdrawn
by us if not accepted within 14 days.
ACCEPTANCE OF PROPOSAL
The above prices, specifications and conditions are satisfactory and are hereby cepted. are authorized to do the work
as specified. Payments will be made as outlined above.
Signature _
Date /d Signature
NC 3818 -50 PROPOSAL
City of Northampton
a r'
Massachusetts r,
DEPA RTMENT OF BUILDING INSPECTIONS r .
212 Main Street • Municipal Building 11 Z
�'" Northampton, MA 01060
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his /her
construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which
he /she resides or intends to be, a one or two family dwelling, attached or detached structures
accessory to such use and /or farm structures. A person who constructs more than one home in a two-
year period shall not be considered a home owner."
The building department for the City of Northampton wants any person(s) who seek to use the home
owner exemption, to act as their own construction supervisor, to be aware that by doing so you
become responsible for compliance with state building codes and regulations. The inspection
process requires that the building department be called to inspect work at various stages, which include
foundation /footings (before backfill), sonotube holes (before pour), a rough building inspection
(before work is concealed), insulation inspection (if required) and a final building inspection.
The building department requires these inspections before the work is concealed, failure to secure
these inspections can result in failure to obtain a certificate of occupancy until the work can be
inspected.
If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be
responsible to make sure that the trades hired secure their proper permits in conjunction to the building
permit issued, and that they get their required inspections. Failure of the individual trades to secure
the permits and inspections as required can DELAY the project until such time as the proper permits
and inspections are made
I, understand the above.
(Home owner /resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit issued to me.
Date
Address of work location
•
The Commonwealth of Massachusetts
Department o f Industrial Accidents
Office of Investigations 600 Washington Street
a e= ,;
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business /Organization/Individual): / /Ia./ //11 I 'r v 0 l
r
Address: (o3 it- Palk) S C C
City /State /Zip: l>C , I / f D ?.PJ Phone #: ( , r r) (72- 2
Are you an employer? Check the appropriate box: Type of project (required):
1. ❑ I am ployer with 4. ❑ I am a general contractor and I
loyees (full and/or part-time).* have hired the sub - contractors 6. El New construction
2. I am a sole proprietor or partner- ors have listed on the attached sheet. 7. ❑ Remodeling
These sub - contract h
ship and have no employees 8. ❑ Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.$
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3. ❑ I am a homeowner doing all work officers have exercised their 11. ❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12. ❑ Roof repairs
insurance required.] t c. 152, § 1(4), and we have no
employees. [No workers' 13. ❑ Other
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.
Contractors 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:
Policy # or Self -ins. Lic. #: Expiration Date:
Job Site Address: City /State /Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the D • • insurance covera t e verification.
I do hereb ertify er the pain a p ' ties of perjury that the information provide abov is true and correct.
Signature: L Date: / C
Phone #: ( 3) ?sic
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 #:
°SECTION 8 CONSTRUCTION SERVICES
8.1 Licensed Construction isor: Not Applicable ❑
Name of License Holder : L A' /MALE h' W 71 71 2 —
License Number
(o S/ i1 t7 C rnu=6 t- �� 10 / /rL
Address Ci? iCb 'nn JI o f o2-0 Expiration Date
Signature Telephone
-6-7 s ,ed orne
ero r ," 11 a, Not Applicable ❑
r /Ku 04IZG( / 4 . 'e
Co . an Name Registration umber,
/ 0 C Previ Dat cril/C 6://i.e14-r, et/ 0/ 621
i . °9 P /// ?
Address Expiration Date
Telephone (q4) 6 I ( ( J /
SECTION 10. • WORKERS' COMPENSATION INSURANCE AFFIDAVIT {M G L c.p452, §25C(6))
Workers Compensation Insurance affidavit mus completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building it.
Signed Affidavit Attached Yes No ❑
•-7 . e ,1 :Ill 11 r ptiol
The current exemption for "homeowners" was extended to include Owner- occupied Dwellings of one (1) or two(2) families
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor. CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner: Person (s) who 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 family dwelling, attached or detached structures accessory to such use and/ or farm
structures. A person who constructs more than one home in a two -year period shall not be considered a homeowner.
Such "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 job site will be required from time to time, during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
•
SECTION 5- DESORPTION OF:PROPOSED WORK.(check all applicable]
New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing ❑
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [1:11] Decks [(] Siding [O] Other [
Brief Description of Proposed
Work: ggaA[A 6X'LSI7')lfl9 4 (/11
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
s e�nr ouse;arad,onE.a eregheff6ii iih :
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 OWNERAUTHORIZATION TO BE COMPLET WHEN
:OWNERS AGENT OR CONTRACTOR FOR BUILDING� PER }
, 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.
Signature of Owner Date
( (fft T. i'7 44 47bU2A) C040 a tJvY , as Owner /Authorized
Agent hereby declare that the statements and information on the foregoing application are t ue and accurate, to the best of my knowledge
and belief.
Si u der insa and penalties of perjury.
/tilt
Pnsat Name
r
Signat'.. Owner /Agent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
_ b
Existing Proposed Required by'Loning `4 al
This column to be filled in by
Building Department
Lot Size t 0 /� l 1 I '
'i
Frontage ZS - }6) ; 1
Setbacks Front i ? 1
i l --
Side L:' ' R:'° L:i s R:` i
Rear
Building Height Z i i
CAP l; .s=lat
Bldg. Square Footage 1' 1 1 E % s 7-1
Open Space Footage %
(Lot area minus bldg & paved `, ? s i � I l I
parking)
11 I I L
# of Parking Spaces
Fill: I
(volume & Location) I 11 i 6
A. Has a Special Permit /Variance /Finding ev been issued for /on the site?
NO 0 DONT KNOW YES 0
IF YES, date issued::
I
IF YES: Was the permit recorded at the Regi of Deeds?
NO 0 DONT KNOW YES 0
IF YES: enter Book , I Page! and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained , Date Issued:
i
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES l NO
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, exc ion, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
. .
270 CRESCENT ST BP- 2012 -0458
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31A - 058 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: chimney rebuild BUILDING PERMIT
Permit # BP- 2012 -0458
Project # JS- 2012- 000746
Est. Cost: $2050.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: MARTIN CUSTOM MASONRY 77732
Lot Size(sq. ft.): 6490.44 Owner: SAVIANO CARL R & BRIDGIT A W
Zoning: URB(100)/ Applicant: MARTIN CUSTOM MASONRY
AT: 270 CRESCENT ST
Applicant Address: Phone: Insurance:
103 SHERIDAN ST (413) 592 -3595
CHICOPEEMA01020 ISSUED ON:11/8/2011 0:00:00
TO PERFORM THE FOLLOWING WORK:CHIMNEY REPAIR
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 11/8/2011 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner