29-065 (3) WESTERN MASS MASONS
LICENSED :ig. INSURED
147 Middle Read
SouftmpM MA 41073
(413)540-1959
W W W.WFSTERNMASSMASONS.COM
QUOTE DATE 717-05
QUOTE#78322
TO: BARBARA KOWALSKI
23 GR1 AJN TER.
FLOP,ENCE MA.
FAX# 586-3751
CHIMNEY WILL BE REBUILT FROM THE HIGHEST POINT OF THE UPPER
ROOFLINE.
NEW BRICKS WILL BE USED(MATCH AS BEST AS POSSIBLE)FLUE,AND
FOAM AND POUR A CAP.
A CLEAR BRICK SEALER WILL BE USED ON ENTIRE CMD EY.
NEW LEAD FLASHING WILL BE CUT IN ON LOWER SECTION OF CIIIMNEY.
TWO STAINLESS STEEL CHIMNEY CAP WILL ALSO BE INSTALLED ON THE
,FLUES.
TOTALS 3488.00
$ � ,�'ilasaachusrffa
DEPARTMENT OF BUILDDZG INSPECTIONS �
:r
INSPECTOR '212 Main Street • Municipal Building '>o
Northampton, MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 78OCNIR 108.3.4 to
act as his/her construction sup( :' sur. The state defines "Homeowner" as, ".Person(s)
who owns a parcel on which he/she resides or intends to be, a one"or tW
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."
Tlie wilding departmentfor the City ofNci thanlpton-warns-any-person(s)-whn-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 backfiIl),
sonotube holes (before pour), a rough buildine 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
- is-sued-te me_
Date-
Address of work
location
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F{e Grid laf _
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R 8 gt'.3 achncctla' _
-o DEPARTMENT OF BUILDING INSPECTION'S
212 Main Strcct TTunicip.al Building
I -
I Northampton, Mass, 010G0
WOW=.R'S COi OENSATTO-N ONSURA..NCE ?:I7I'II)A.Vn'
i
� (li�ns�'Jpc-iTV ttcc}
vvlth a prb'-lcipal place of businesSfresidence at:
I
(phone')
j (sa-r_..t/ritylszalct:>;p)
do hereby cerr,-, under thc.pairls and penalties of pc9ury, har
O I am an employer providing the following %:orkcr's colnoc�sa:ior. cove age for Intl
emplove%s ,vor ong on tills job:
(I�sur�c Colter,.cy) (Pc1lc':!��
( ) I am a sole proprictor, general contracor or homeowner (c cie one) and have hired
the contractors lined below TgbO have the 'i0UO%viog worker's coMper_a tiOn peLlcies:
i
i
(1;aMc Of CO'_-^�ior) (In51!r-S,nc-- Cornpa1I)'/!'loUCi }Nt�rr;) (Expi uon D:IIC)
I
CN—c of Concaaor) (III51ian COmpaa)vPoticv `u bcr) (–I:%-otr-a6on Dare)
(Name of Coa=cid. (nsvran c_– ComTanyfllaUcy Numb,'-[) (Exairz6on Dale)
i
(N2me of Contractor) (IPS1== Comrzny/.Policy Numbc-6 (Etpirauon Daic).
(aC1C1 sC�i�oaJ t'xd,tfaccc.a.-s tv•ccttsvi inform,�on pctcsaans to a.lI ooarrta:s) -
j
j I am a Safe pFoprietor and -have no one wor'dDg for me.
I
( am.-a home owner perfor Wing all the Nvork myself.
NOTE:pi=-%c be car thz:Lilo bcm ),--s w-bo etapley pe--=ca cL� :.-s,-•9r_ a rap=-wic m-,d.•cn_a of
oot tnxe the n t..t•rr_L---rl is W�sdl.the bomoawvC'reed.oc oe the p-vu_•,S ox C^r..._Rv 0:.-=.d.-Cd be
eupIcyes uoe the wui ct ==;—•,:en A=(GL1152-.1(5)),;ppU=6cz by a bom-a v=re-1��=-a Pc' �7 nid�x tL-
ler'.1 rz" or cn e.=plcyo aoder tho woke'e'C.oaspmsctioa Act_
I tynd'=rr •ad die a Dopy of this cazemc a may tx foes orded to tiw Dopdnmml of Inmi�ncl Ac�d�e Obi°°°f 1�"c'°ei far tb.
eovctse vcrMc=lioa=nd the L-iltac w>:==bovczto„c uadc 3.a oa 23 A of MGL 152 as 1--d to the ice,Osaioa of eim:a pen%W=
comi:iag ora foe crup to 51300.00 andfce orup to roc y:-s and atii]peaat•-ja m t5 form ora Stop wart Ortt "nd
fi=cc 5 1 oo.00 c day t-ptiast me
For dcpa*ttz+��use only -
- permit NumbaT
Lct K F
Sig�a -t of Licccr_s IPcrrrtiUc L)Ke
'SECTION4-CONSTRUCTION SER1/IGES i
8.1 Licensed Construction Su ervisor: Not Applicable ❑
Name of License Holder
License Number
mod'
Ar Expiration Date
Soviure Telephone
n .�_ Not Applicable ❑
2oor�esmprmeine `
Company ame Registry on Number --
/�?
AddAdd-- S Expiration Date
Telephon
SECTION.10-WORKER
S'ddMPEN'SATION`1 SUR #CERI F0AYf
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...... ❑
111trt=
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 1083.5.1.
Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends 10 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 shaU 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 buildine 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
r
SECTION 5--.DESCRIPTION:OF PROP,OSED:W.ORK(check alF,,aodlicable)
New House ❑ Addition []:;: Replacement Windows Alterations) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[D] Other[p]
Brief Description o o sed
Work: E
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roil Sheet
,•
sa�t' svi� t�aas�+a� tr maces �rfs�-,aristnu rtteh` Cra
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'?
L Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservaton Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction witivn 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basemert or cellar floor below finished grade
k. Will building confcrm to the Building and Zoning regulations? Yes No.
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a OWNED AOTHORIZATION TO BECOMPCETEQ Wfi1EN
OWNERS AGENTOk Pt1E FOlx BUILD 1�lG 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.
Signature of Owner nate
as Owner/Authorized
Agent h e y de are th the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Sig ed unde`the pas andlpenalti f perjury.
Print Name
l r�-d-
Sig ore of Owner/Agent Date
Section 4. ZONING All Informatioh 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
Frontage
Setbacks Front '
L
Side L R:= L:'—� Ra
Rear
Building Height -�
Bldg.Square Footage i % r--.
Open Space Footage %(Lot area minus bldg&paved i i
arkin
#of Parking Spaces
Fill: f j
(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 Q DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q 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 tj NO 0
IF YES, describe size, type and location: j
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 r) ,. NO 0
i
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
City of Northampton -
^. Building Department
212 Main Street
Room 100 _
Nort mpton;'MA 01060
phope�M 7-1240 Fax 413-587-1272
APP YIU'TI.O CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
.SETION 1 ITEINF_ORMATION
tt Th�s4secttonto 6e cetn�tetedtbby`offtce
1.1 Property Address:
As s t
'G1F*"-�� �'iS�- "'" .'.u�4ru-�'St� h���fi-zudy. C� v"hMCn��ia"i.M1 TNT•'S7+.
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SECTION 2:-PROR_ER'i Y OWNERSHIPJAUTHORIZIP A!
2.1 CWmer of Record:
A f C✓
Name(Print) —T Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3.-:E3TIMAIED.CONSTRUCTION.COST3
_.
Item - Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building (a)°Building Perrnit Fee
2. Electrical =(b}:Estimated Total Cost of
Coristnrction.from .6
3. Plumbing sBuildingPerrnit,Fee:-
4. Mechanical(HVAC)
5.Fire Protection
6. Total=(1 +2+3+4+5) d d t;heck.Number
THis Section`-ForxOfflcial`Use Onl
pate,;
Buildin Perinif'Number-,
Signature: '
t
Building Commissioner/Inspector of Buildings- Date
23 GILRAIN TERR BP-2006-0228
'--.&S#: COMMONWEALTH OF MASSACHUSETTS
MW:Block: 29-065 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category BUILDING PERMIT
Permit# BP-2006-0228
Project# JS-2006-0333
Est.Cost: $3488.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: WESTERN MASS MASONS 133234
Lot Size(sq. ft.): 18513.00 Owner: KOWALSKI PAUL E&BARBARA K
Zoning:URA Applicant: WESTERN MASS MASONS
AT. 23 GILRAIN TERR
Applicant Address: Phone: Insurance:
147 MIDDLE RD (413) 540-1959
SOUTHAMPTONMA01073 ISSUED ON.813112005 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:
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 8/31/2005 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo