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28-018 LICENSED REGISTERED INSURED A" MASONS WESTER IM L�SS 147 MIDDLE ROAD, SOUTHAMPTON, MA 01073 - (413) 540-1959 WMMESTERNMASSMASONS.COM QUOTE To: JUSTIN WEST Date: 4-24-06 203 SYLVESTER RD. Quote# 876523 NORTHAMPTON MA. Project: CHIMNEY Phone: 586-8305 Description of Work To Be Done: BECAUSE OF EXTENSIVE WATER DAMAGE TO THE TOP SECTION OF THE CHIMNEY, THE TOP 3, MUST BE TAKEN DOWN AND REBUILT. THE STONES WILL BE REUSED AND RELAYED IN NEW MORTAR. TOP SECTIONS OF FLUE WILL BE REPLACED. A NEW CONCRETE CAP WILL BE FORMED AND POURED. SILICON HAIRLINE CRACKS AND ACID WASH SOME PARTS OF THE CHIMNEY. SPRAY A CLEAR SEALER OVER ENTIRE CHIMNEY. WE HEREBY PROPOSE TO FURNISH MATERIALS AND LABOR- $ 3685.00 IN ACCORDANCE WITH THE ABOVE SPECIFICATIONS,FOR THE SUM OF: This quote may be withdrawn from us if not accepted within 30 days. BO�drMs Quote Prepared By: David Osiecki 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 contractor and may also effect to the final price. 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 1-112(18%annual rate)per month will 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. Signatu Da Signature: Date: Thank tou F©r Choosing Western Mass Masons! ¢St1AMP�. Y �)1A34AChltSttt9 s" DEPARTMENT OF BUILDING INSPECTIONS f INSPECTOR 212 Main Street • Municipal Building Northampton, MA 01060 s r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as iris/her construction sups;:,isor. 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 i 4�iVJfp2, . Ffi y� GT'N) of �c�rflli3111�)fDll _ _ I A y � ��clancfl nr:clla' — —° DEPARTMENT OP BUILDr�C [NSPPCr10).'S - 212 Alain Strcct Municipal Building Northampton, Mass. 01060 j: «'O MCC IZ'S COiKPENSATTON MSURANCE A1=, AV1-I' I (Ii CCnSaJjXTU7J ttCC) \%,I th a prb,-tcipal place of business/residencC at: (phone-') � _ (sit/city/starch p) do hereby certify, under tlic pains and penalties of perjury; h2i ( ) I ate an employer providing the following %vorkcr�s comoensED'on covervge for in) et-oplovecs ivoriong on Lilis job: 3, (Inst>_r-:mac Comrz) (Folic: Nu_m�cr) Fixpirtior,Dal^) O I ain a sole proprietor, general contractor or homeowner (c e;e one) and have hired the contractors listed below wbo have the follo%vine workers comperl_tauion policies: (i+flfll: Of CO't^cior) (Insumnc^- CoiTio uI)'lIjGU(:— ?�ttLQ1LC7) (Name of Contractor) (InS'-W7 occ- Comoanvipolim N'LL0 cr) (LiDir,.6on Date) i (Name of Connaadr) (In_niran= Compa.n)-/Polic)• Nambe.r) (Expiraen Date) (Name of Contrdaar) (Insurance Comrazy/Policy Numb r) (Expirttion Daft} . (ntisc>5_daiC•oc7.l ncoei..--y to ctcud:iarorm.aaoa P=%.!+iCLG to'U ( ) I am .F sole prop,ieLul and have no One woridng for me. ( ) I am.-a home owner performing all Lbe work myself. NOTE:plcx be eorzit tti..v f )e booxo iacn wbo cmploy pcnoai eo do c=_I c,00 r mac work M.d..elL^--;of aot most the Lbrxx tmrs is%t-b a the bomo,,_r=d=oc oa tde Qound,zppute>Lr_tbc,n,ox CxeUy«rrd rai to be ciiployci aa'C the-vi sts ocrpciioa Aa(GL152ss 1(5)1;*LL=.600 by n bomao.-=fm c Gam.or r'=rmit=y cvidcn=the IcSa cLz--u of a.n exployec under dL Workxec comp, ,yioa A.e[_ l uadcaand tL.t x oopy of tLi.c=-=-W my be for+ardud to the pcpanmcot of Iadtictricl Ac d..&OIL—or G�—for the ; oov=x c vcriGaiioo--td th:1 L•iltzc to senuc bover LCc un6er:,o ioa 25A of l.(QL 152 un lmd to cbc im?ozitioo of==i=1 pcailtia aoo_s of a rinc of tP b S 1300.00-rWor�� orup to ooc yor and c�-U pm,ihim in 6c form of a Stop wort;Order aad, rim of S 100.00.dzy.PimA me For dG�u,c ody ptTID.7l )'t 11II2I)CT Date ) F SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0� f Name of License Holder License Number / Addre Expiration Date "Ab Si n Telephone Not Applicable .❑ UU(3 13 royementGonia � . Company Name Registration T4umber Address Exl!'ation Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT-(M.G.L.c.152,§25CN) 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...... ❑ �� ,��� px, ' 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 applicable) New House 71 Addition Replacement Windows Alteration(s) Roofing Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [ED] Decks [M Siding[0] Other[[3] Brief Description of Proposed / Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet A1.4 fewious a oumto ti �an nga ]avuag: 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? t. 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`COMP.LETED;WHEN •OWNERS AGENTOR'CONTRACTOR::APPLIES'fOR..l3UILDING 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 Date 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 penalties of perjury. i r Print ame 00 Signat r Owner/Agent Date - � " - , , ' 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 Frontage Setbacks Front Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bidg&paved #of Parking Spaces (volume&Location) A. Has a Special Perm it/Variance/Fndi ng ever been issued for/on the site? NO 0 DON7KN0W 0 YES 0 IF YES, date issued:! IF YES: Was the permit recorded at the.Registry of Deeds? ' NO 0 DON7KNOW 0 YES IF YES: enter Book Page!, and/or Document#! ����� �� B. Does the site contain o brook, body of water orwetlands? NO �_��� DON7 VV KNO YES �~� IF YES, has permit been or need to be obtained from the Conservation Commission? Needs tobeobtainmd ��� @btained x�� Date �~� �_� ' . C. Do any signs exist on the property �� ��� YES �~� NO v�� IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? yES �~� NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,gradingexcavation,nr filling)over 1 acre orioit part r�o common plan that will disturb over 1 onm? YES K l NO ��� ] |F YES,then o Northampton Storm Water Management Permit from the DPW iorequired. `_O d ,.Northampton Buildir`t Department .; 212Main Street 2 Z � Rooni100 ' Northappton,'MA 01060 w phorre 413-587-1,240 Fax 413-587-1272 « � � APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE°INFORMATION This secUan to be camQitefed by afiice 1.1 Property Address: , at Unit 1 2:one ��' -Ove�Ta�C�,fstrrct S Eirn t vstuct CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record:' , rh VvlS / Name Print) Current Mailing Address: Telephone Signature 2.2 Authorized A ent: Name(Print) or Current Mailing Address: Signature Telephone__F_ SECTION-1.-ESTIMATED CONSTRUCTION COSTS-- Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building Building,Permit Fee 2. Electrical (b)Estimated Total Cost"of Construction from:6 3. Plumbing Building Permit Fee- 4. Mechanical(HVAC) 5.Fire Protection qq� 6. Total=(1 +2+3+4+5) 3 d.5'00 Check Number dV& This Section For Official Use Only Date Building Permit'Number Issued: Signature: Building Commissioner/Inspector of Buildings Date BP-2007-0090 G1S#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot:-001 Permit: Building Category: BUILDING PERMIT Permit# BP-2007-0090 Project# JS-2007-0138 Est.Cost: $3685.00 Fee: $25.00 PERHISSIONIS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: WESTERN MASS MASONS 133234 Lot Size(sq. ft.): 108900.00 Owner: WEST JUSTIN P Zoning_RR Applicant: WESTERN MASS MASONS AT: 203 SYLVESTER RD Applicant Address: Phone: Insurance: 147 MIDDLE RD (413) 540-1959 WC SOUTHAMPTONMA01073 ISSUED ON.7Z2SZ2006 0:00:00 TO PERFORM THE FOLLOWING WORK:R E B U I L C H I M N E 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 7/25/2006 0:00:00 $25.002568 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo