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31B-287 (2) 1 . \" 5011 IA SIEGFRIED PORTH A R C H I T E C T A. LA. RECEIVED 116 PLEASANT ST. 2 8 SUITE 331 EASTHAMPTON , MA 01027 oEPr. BUILDING NSPF , cnoN$ PHONE: 413 - 529 -9434 NOrm+AMPTON, MA Cum TO: CITY OF NORTHAMPTON, MA 07/25/11 ATTENTION: CHUCK MILLER BUILDING INSPECTOR SUBJECT: 40 CENTER ST. CHIMNEY REPAIR I HAVE INSPECTED THE EXISTING CHIMNEY WITH THE MASON AND WE BOTH CONCLUDED THAT IT WILL HAVE TO BE REMOVED TO THE SECOND FLOOR DECK. A NEW 16" X 16" CMU CHIMNEY WILL BE ADDED GOING STRAIGHT UP WITH BRICK VENEER ABOVE THE ROOF. THE WALL PARALLEL TO THE ATTIC STAIR WILL HAVE TO BE OPENED SO AS TO HAVE ACCESS TO THE CHIMNEY. THE CHIMNEY HAS MOVED A LOT AND AS A RESULT THE RAFTERS HAVE BEEN DAMAGED, SO ADDITIONAL WORK TO THE ROOF SYSTEM WILL HAVE BE DONE, AS WELL AS, CLOSING IN THE EXISTING OPENINGS. JIM VAN NATTA THE CONTRACTOR WILL DO THE REQUIRED CARPENTRY AND ROOFING REPAIRS. I WILL INSPECT THE ATTIC FLOOR AND ROOF AGAIN ONCE THE CHIMNEY IS DOWN. I HAVE ATTACHED PLANS AND A SECTION INDICATING THE WORK THAT IS TO BE DONE. 7 SING RELY, • H 00 Po,s; 0 ), ARC/ CT u, c� 140. 6634 NORTHAMPTO, LICENSED REGISTERED INSURED - - WESTERN MASS _ _ 383 College Highway, SOUTHAMPTON, MA 01073 • (413) 527 -1800 WWW.WESTERNMASSMASONS.COM QUOTE To: RUTH FLOCHMAN Date: 5-30 -2011 40 CENTE Quote # 565675 OWNER EN BOWEN Project: CHIMNEY Phone: _ Other / D7- / _ Phone Description of Work To Be Done: THE CHIMNEY WAS INSPECTED AND WAS FOUND TO HAVE EXTENSIVE STRUCTURAL DAMAGE IN THE ATTIC AREA. IT WAS REBUILT FROM THE ROOFLINE UP AND LINED BUT THE WORST SECTION IS IN THE ATTIC. THIS CHIMNEY MUST BE TAKEN DOWN TO THE ATTIC FLOOR AND REBUILT, IT MUST BE REBUILT STRAIGHT FROM THE ATTIC FLOOR FOR TODAYS CODE. THE CHIMNEY CAN BE MADE SMALLER (16" X 16 ") A NEW HOLE WILL BE CUT THROUGH THE ROOFLINE AND THE OLD HOLE WILL BE FILLED IN AND SHINGLED IN. CHIMNEY BLOCK WILL BE USED IN THE ATTIC AND BRICK THROUGH THE ROOFLINE, STEP FLASH AND SHINGLE, LEAD FLASHING AT THE ROOFLINE, PRECAST CONCRETE CAP AT THE TOP, REINSTALL STAINLESS STEEL LINER. WESTERN MASS MASONS WILL PULL THE BUILDING PERMIT AND RECYCLE ALL THE OLD`, BUILDING MATERIAL. WE HEREBY PROPOSE TO FURNISH MATERIALS AND LABOR - $ 5850.00 IN ACCORDANCE WITH THE ABOVE SPECIFICATIONS, FOR THE SUM OF: This quote may be withdrawn from us if not accepted within 30 days. �OKLINI Quote Prepared By: David Osiecki ELIABIAM - - -- 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. M' Any changes that are to be made, must be discussed prior to construction and agreed upon by contractor and may also effect to the final price. VISA 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 Finance Charge of 1-1/2 (18% annual rate) per month will be added to any unpaid balance over 30 days. OF PROPOSAL: The Above Prices, Specifications And Conditions Am Satisfactory And Hereby Accepted. You Are Authorized To Do I l � The Work As Specified. Payment Will Be Made As Outlined Above. Signature: Date: Signa . .f • Date: 9 !( Thank You For Choosing Western Mass Masons! ' . The Commonwealth of Massachusetts • Department of Industrial Accidents Office of Investigations 600 Washington Street • Boston, MA 02111 www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders /Contractors/Electricians /Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): Wes Jj (61 .„ (1l di Address: sor--3 �z City /State /Zip: ce Phone #: Sd , Are yo an employer? Chetk the appropriate box: Type of project (required): 1. I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part- time).* have hired the sub - contractors listed on the attached sheet. 7. ❑ Remodeling 2. El I am a sole proprietor or partner- These sub - contractors have 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: 41. n . % /� Policy # or Self-ins. Lic. #: P ? /L ^ (' Expiration Date: l 4 " a Job Site Address: (1 6'0 / c S/ - City/State /Zip: z L "A"" C7/de 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 DIA for insurance coverage verification. I do hereby certify un the ain nd penalties of perjury that the information provided above is true and correct. Siznature: Date: 11 Phone #: Se) 7/P 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 #: Version 1.7' Commercial Building Permit May 15, 2000 SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No 0 SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property hereby authorize �. �..,. . �._..._ w_. _ to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, s_ e _ _.r..._..,,.... _ __ _._....._ ..._..... �_.__ _ , 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 pains and pen (ties of perjury v ���� Print Name / 7 ,lam �� �i ___ ~ ...,. __ , __ Signature of Own J, ' .e Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: ..__._,0c u (4- l_.... . _ License Number Add ( Expiration Date Sign re Telephone SECTION 13 - WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152,;§ 25C(0) 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 buil • g permit. Signed Affidavit Attached Yes No 0 1 I � Versionl.7 Commercial Building Permit May 15, 2000 SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name (Registrant): Registration Number Address � "���� Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name: Responsible In Charge of Construction Address Signature Telephone Version 1.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size .._.... Frontage Setbacks Front Side L. , _. _ R....___. L: R:' ..... Rear Building Height Bldg. Square Footage „.,_.__. .... . % Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained C Obtained , Date Issued: C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 0 IF YES, describe size, type and location: 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 Q IF YES, then a Northampton Storm Water Management Permit from the DPW is required. r Version1.7 Commercial Building Permit May 15, 2000 , SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 k , a.. . CUBIC FEET OF ENCLOSED SPACE r Interior Alterations ❑ Existing Wall Signs ❑ Demolition El Repairs ❑ Additions ❑ Accessory BuilINSES 1 Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ OUer ❑ Brief Description Enter a brief description here. Of Proposed Work: -� SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly A -1 ❑ A -2 ❑ A -3 ❑ 1A I ❑ A -4 ❑ A -5 ❑ 1 B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B r ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ I -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ I 5A ❑ S Storage ❑ S -1 ❑ S -2 ❑ 5B ❑ U Utility El Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE Existing Use Group: Existing Hazard Index 780 CMR 34): . .. _. Proposed Hazard Index 780 CMR 34): , .. _. _ .,_ _.......,. _ SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) 1 s t 1 st 2nd ._. , 2nd 3rd , ,. ,_ . ,.. 3' d 4th . Total Area (sf) Total Proposed New Construction fsf) Total Height (ft) Total Height ft 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public 0 Private El Zone Outside Flood ZoneD Municipal ❑ On site disposal system El s VeFsionl.7 Commercial Building Permit May 15, 2000 Department use only " '� z q 5g • ity of Northampton St wtPe t ' It - _ _ V D : ilding Department ° Cu u t Dnrre a y Pe ` ; 212 Main Street Sewer /s'ep tcAvatlathhty = JUL ' Room 100 -',. 'i' later/Well Avallablrlty N. hampton, MA 01060 Twa<Set`S of StructuratPlan , '''ti DEFT OF BUILDING IN'e a =;,' 13 587 -1240 Fax 413 - 587 -1272 Plot/51te.1?lan NORTHAMPTON MA 01080 ©fhef - Sped yc APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION This section to be completed by office 1.1 Property Address: • I/O Map Lot Unit V c'v4! I e r- cS�, Zone Overlay District ,_m -_ -.m. ....w..._, .. _ .._._ - Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: �,✓� oi..•e ( ci d iiiffic ht !/ Name (Print) Current Mailing Address: Signature Telephone 2.2 Authorized Agent: 3� c4CrJ /A r mil Name (Print) Current Mailing Address Signature T elephone SECTION 3 TIMATED 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) „ ._ _ ... _ .. f cc 0 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) c. 5 -4"Sp. GU .Check Number * `lam 11 This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2012 -0029 APPLICANT /CONTACT PERSON WESTERN MASS MASONS p nl"' ' 2 ADDRESS/PHONE 383 COLLEGE HIGHWAY SOUTHAMPTON (413) 540 -1959 . J / PROPERTY LOCATION 40 CENTER ST MAP 31B PARCEL 287 001 ZONE CB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT F52-Paid "tuildini. Permit Filled out Fee Paid S . OPT _ 'Z Typeof Construction:_Rebuild Chimney New Construction Non Structural interior renovations ' Oki‘./ Addition to Existing ip Accessory Structure N tt1P Building Plans Included:j Owner/ Statement or License 133234 IJ�' etp1J5 3 sets of Plans / Plot Plan Q fL THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: n L6 Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND /OR Special Permit With Site Plan Major Project: Site Plan AND /OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission _ Permit DPW Storm Water Management Demolition Delay nature of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning & Development for more information. 40 CENTER ST 9. BP- 2012 -0029 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31B - 287 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 -0029 Project # JS- 2012- 000054 Est. Cost: Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: WESTERN MASS MASONS 133234 Lot Size(sq. ft.): 4748.04 Owner: BOWEN KENNETH B & CARROLL S Zoning: CB(100)/ Applicant: WESTERN MASS MASONS AT: 40 CENTER ST Applicant Address: Phone: Insurance: 383 COLLEGE HIGHWAY (413) 540 -1959 SOUTHAM PTONMA01073 ISSUED ON: 7/28/2011 0:00:00 TO PERFORM THE FOLLOWING WORK: Rebuild Chimney 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: 0 ('' dJ f ( C4(, THIS PERMIT MAY BE REVO I I BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND ' UL Certificate of Occupan v ature: A C ZS h 444 44041 FeeType: Date Paid: Amount: Building 7/28/2011 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner