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17D-056 - WE HEREBY PROPOSE TO FURNISH MATERIALS AND LABOR - t ______ IN ACCORDANCE WITH THE ABOVE SPECIFICATtONS, FOR THE SUM OF: This quote may be withdrawn from us if not accepted within 30 days. kj BBB Oxfam Ramoturr Quote Prepared By: David Osiecki PROGRAM 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 made, must be discussed prior to construction and agreed upon by contactor and may also effect to the final mice. ViS4 PAYMENT TO BE MADE AS FOLLOWS: One half of quoted amount is due when job construction has begun. Remaining balance of bit will be paid in full when job S complete. A Finance Charge of 1-112 (18% annual rate) per month wit 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. Signature: f i Date: 1 Signature 1 Date • Thank You For Choosing Western Mass Masons! AC ' • LICENSED REGISTERED INSURED WESTERN MASS r MASO 383 COLLEGE HWY, SOUTHAMPTON, MA 01073 • (413) 527-1800 • WWW.WESTERNMASSMASONS.COM QUOTE To: CHRISTINE NAGY Date: 4-02-2010 12 VERONA ST. Quote # 78945 FLORENCE MA Project: CHIMNEY Phone: 586-4587 Description of Work To Be Done: THE FURNACE CHIMNEY IS DETERIORATED BY HAVING WATER DAMAGE AND VERTICAL CRACKING OF THE BRICKS. THIS CHIMNEY SHOULD BE TAKEN DOWN AND REBUILT. THE CHIMNEY WILL ALSO BE EXTENDED TO THE CODE HEIGHT. THE CHIMNEY WILL BE TAKEN DOWN TO THE ROOFLINE AND REBUILT WITH NEW BRICKS, FLUE AND LEAD FLASHING, A PRECAST CONCRETE CAP WILL BE INSTALLED AT THE TOP. THE METAL CAP WILL ALSO BE REINSTALLED. THE AMOUNT OF TAR THAT IS AT THE BAS E OF THE CHIMNEY AND ON THE ROOF WILL MAKE IT HARD TO HAVE A WATERPROOF SEAL. THE SHINGLES AND STEP FLASHING WILL BE TAKEN UP AROUND THE CHIMNEY AND REDONE. NEW ICE AND WATER BARRIER WILL BE INSTALLED ALONG WITH NEW STEP FLASHING AND NEW SHINGLES STEPPED IN. WESTERN MASS MASONS VVILL PULL THE NECESSARY PERMIT FOR THE JOB AND RECYCLE ALL OF THE OLD MATERIAL. ADDRESSES OF SOME OF THE WORK WE HAVE DONE iN THE AREA 540 ELM ST. NORTHAMPTON CHIMNEY 91 PROSPECT AVE. NORTHAMPTON CHIMNEY 1486 NORTHAMPTON ST. HOLYOKE CHIMNEY 19 LOVEFIELD ST. EASTHAMPTON CHIMNEY Thank You For Choosing Western Mass Masons! 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 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 backfdl), 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 •ermits 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 l; 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 Date Address of work location • , ■ i . • , ■, The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street e l =iv= z Boston, MA 02111 . * , www.mass.gov/dia • -Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly -' ---. Name (Businesstorganizationfindivirin.D: ki(,)(c_r>-- .. ."661 - li y eeel - dzi fri .• Address: ',3E3 cidi ic,-, .- . City/State/Zip: , c,,y2... ,(4, Phone.#: Are you an employer? Check the appropriate box: Type of project (required): I • 1. III-Kca a employer with ___4&__ 4. 0 I am a general contractor and I 6. 0 New construction have hired the sub-contractors employees (full and/or part-time).* listed on the attached sheet: 7• 0 Remodelin:r, 2. 0 I am a sole proprietor or parmer- ship and have no euloyees These sub-contractors have 8• 0 Demolition • envloyees and have worke rs' . . - working for me in any capacity. 9 -E1 Building addrtiOn [No workers' comp. insure= 10.0-Electrical repairs or additions . .. . 5. 0 We are a corporation and its 3. 0 I am a homeowner doing all work officers havetmercised their . 11.0 Plumbing repairs or additions 1- myself [No workers' comp. lien of exemption per MGL r-r 12 - .L j .tcoof repairs • - insurance required.] t • c. 152, §1(4), and we have no _ 13.0 employees. [No workers' Other • CO n* insurance requiredd • ' *Any applicant that checks box #1 must also fill out the section below showing their workers' ccmipensatim policy information. , - I Homeowners who submit thii 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 lumber. lam an employer that is providing workers' compensation insurance for my einployees. Below Ls the policy andjob site information. Insurance Company Name: 4 1 /e . . / / / e'l - e. Policy # or Self-ins. Lic. #: P 7945 iir Expiration Date: „ Job Site Address: --... UC rut/ A- 5 / - City/Sta jc te/Zip:* ew „4./1 G ' - . , Attach a copy of the workers'” compensation policy declaration page (showing the policy number tnd expiration date). Failure to secure coverage . as required Mid& Section - 25A 'OfMGL c. 152 can lead to the iinpOsition of Criminal Penalties of a fine up to 51,500.00 ancVor one-year imprisonment as well as civil penalties in the form of STOP WORK-ORDER and a fine of up to S250.00 a cLay against the violator. Be advised that a copyof this statement may be forwarded to the 0135:Ce of Thffeitiiiii6iiiiif the ttA for insurance coverage ierificaiion. herabypartifr e p and penalties ofpediay that the 'informationprovided_abov'zittrue_antliop-ert . . Sisznature: ' Dat: <-5 . , Phone ii: Official use only. Do not write in this area, to be completed by city or town'OfficiaL . . City or Town: 0 - 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 . f- 0 ° Contact Person: Phone #: $ SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Su rvisor �p G�1/1 / Not Applicable ❑ `� Name of License Holder : r C V� i ^ , iT / 3 6. ` License Number 3i-37 Address / Expiration Date Vd2_ </ !� c%✓ Sign Telephone c;"L , A €..s3:'- ;iT.; . Ie,',: , `i •_ iu ia1 Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone 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 ID" No ❑ k a 4 ® `I i i 11°4 $ I to 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- DESCRIPTION OF PROPOSED WORK (check all aaalicable) New House ❑ Addition Replacement Windows Alteration(s) Roofing Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [E] Decks [C] Siding [0] Other [0] Brief Description of Proposed p II � 7� .. 6% Work: �'�b �.. c , Z r h Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet s Isir:rO I�ti��r1<+its� c re>ir�ti+riirp: 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 , 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 cc ! < ` , as Owner /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the ins and penalties f perjury. Print Na� ' � - 0 ) Sign - ('e of • nt Date A t Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size 1 € I _ I Frontage ) '` Setbacks Front i i �� " Side L:z..__._ R:. L:f _..? R:I € Rear = 1 1 . Building Height 1 Bldg. Square Footage I - 1 % l 1 I Open Space Footage % 1 (Lot area minus bldg & paved L..... i parking) # of Parking Spaces ' - --I Fill:_ (volume & Location) 1 _ A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO ® DONT KNOW 0 YES 0 IF YES, date issued:I I IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 1 IF YES: enter Book Pa and /or Document # B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained , Date Issued: C. Do any signs exist on the property? YES 0 NO 0 , IF YES, describe size, type and location: ! l D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO 0 IF YES, describe size, type and location: i _. E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. f M 9 i y8 04._ ` j g q � 3 �p 5 r x ¢ City of Northampton ''° Building Department . 0� µ :i ` ,ti ,,, 212 Main Street Room 100 : ; 7 E q el 1 2.U10 No th mpton, MA 01060 ° ,, s 11'' ` phone 4'�3 -58 -1240 Fax 413 - 587 -1272 , , , , , . APPLICATION TO • STRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office /02 Map Lot Unit ()C. ( U a °L- Si Zone Overlay District Elm - St.Dlstrtct .` CB District SECTION 2 -- PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: pia %�►ti ,tiky r ,� Name (Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: Li 65/e e'i�. ��f,�Jv/2 5d3 C�i /P e 17�� - o Name (Pri Current Mailing Address: Sign Telephone SECTION 3- ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) c31p�S C/ - °� Check Number 3 — S 5 - - This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date . . 12 VERONA ST BP- 2010 -1048 GIS #: COMMONWEALTH OF MASSACHUSETTS Map :Block: 17D - 056 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -1048 Project # JS- 2010 - 001544 Est. Cost: $3250.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: WESTERN MASS MASONS 089376 Lot Size(sq. ft.): 12501.72 Owner: NAGY CHRISTINE A Zoning: URB000)/ Applicant: WESTERN MASS MASONS AT: 12 VERONA ST Applicant Address: Phone: Insurance: 383 COLLEGE HIGHWAY (413) 540 -1959 WC SOUTHAMPTONMA01073 ISSUED ON :5/21/2010 0:00:00 TO PERFORM THE FOLLOWING WORK :REBUILD CHIMNEY ROOFLINE UP 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 5/21/2010 0:00:00 $25.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo ti , P ' • 12 VERONA ST BP- 2010 -1048 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17D - 056 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -1048 Project # JS- 2010 - 001544 Est. Cost: $3250.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: WESTERN MASS MASONS 089376 Lot Size(sQ. ft): 12501.72 Owner: NAGY CHRISTINE A Zoning: URB(100)/ Applicant: WESTERN MASS MASONS AT: i` VERONA ST Applicant Address: Phone: Insurance: 383 COLLEGE HIGHWAY (413) 540 -1959 WC SOUTHAMPTONMA01073 ISSUED ON :5/21/2 01 0 0:00:00 TO PERFORM THE FOLLOWING WORK :REBUILD CHIMNEY ROOFLINE UP 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: G K /t2 + to (, 4 ( 5 Rough: Oil: Insulation: Final: Smoke: Final: ©}C THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. /44.4•04 Certificate Certificate of Occupancy Sif'I� �oCi Signature: FeeType: ate Paid: Amount: Building 5/21/2010 0:00:00 $25.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo 12 VERONA ST BP- 2010 -1048 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17D - 056 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -1048 Proiect # JS- 2010 - 001544 Est. Cost: $3250.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: WESTERN MASS MASONS 089376 Lot Size(sq. ft.): 12501.72 Owner: NAGY CHRISTINE A Zoning: URB(100)% Applicant: WESTERN MASS MASONS AT: ,i� f._ 2 CSt Ji u t �7 i p Cicant Address: Phone: Insurance: 383 COLLEGE HIGHWAY (413) 540 -1959 WC SOUTHAMPTONMA01073 ISSUED ON:5/21/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: REBUILD CHIMNEY ROOFLINE UP 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: G k 51, L a t i Rough: Oil: Insulation: Final: Smoke: Final: OK THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. / pg per •Jar• �/•04.4 Certificate of Occupancy S(2 �k JC Signature: FeeTvpe: ate Paid: Amount: Building 5/21/2010 0:00:00 $25.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo