17A-088 (2) LICENSED REGISTERED INSURED
Y Y EST-TO .Y MA4%
Am' M- -ASONS ' L
147 MIDDLE ROAD, SOUTHAMPTON, MA 01073 - (413) 540-1959
WWW.WESTERNMPkSSMASONS.COM
QUOTE
To: SARA.PEASE Date: &-41-2007
3 MOUNTAIN ST. Quote# 56238
FLORENCE MA. Project: CHIMNEY
Phone: 586-3040
Description of Work To Be Done:
i
BECAUSE OF EXTENSIVE DAMAGE TO THE BRICKS AND MORTAR,THE CHIMNEY MUST BE
REBUILT FROM THE ROOFLINE UP.
THE CHIMNEY WILL BE REBUILT WITH NEW BRICKS, FLUE AND LEAD FLASHING.
A CONCRETE CAP WILL BE FORMED AND POURED AT THE TOP.
DISPOSE ALL OLD MATERIAL.
1
I
WE HEREBY PROPOSE TO FURNISH!MATERIALS AND LABOR $ 3750.00 �
IN ACCORDANCE WITH THE ABOVE SPECIFICATIONS,FOR THE SUM OF:
This quote may be withdrawn from us if not accepted within 30 days.
Quote Prepared By:David Osiecld
TERMS:Any alteration or deviation from above s)edlicaiions involving extra costs will be executed only upon written orders,aid will become an
extra charge over and above the esturnate.By signing ft quote you agree and undashand 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 etfec to the W{rice. 10TS4
PAYMENT TO BE MADE AS FOLLOWS.One half of quoted mount is due when jab construction has begun.Remaining balance of bill wdi be paid
in full when job is complete.A Finance Charge of 1-111(18%annual rate)per month will be added to any unpaid balance over 30 days.
ACCEPTANCE OF PROPOSAL-The Above Prices,SpeaficaWns And Corrdrtions Are Satisfactory And Hereby Accepted.You Are Authorized To Do
�i
The Work As Specified.Payment Will Be Made As Outlined Above.
Si�sattae�� natal Date-
Thank You For Choosing Western Mass Masonsi
CEPr'�TM=NT OF EUII.DrNG UN7SPECTIONS
212 M x
ain Strt • Mu kipal E uikiim! "-
INSPECTCR
Nortbxnptan, MA 01060
The State of Massachusetts allows the homeowner the right under 780C1a 108.3.4 to
act as zi_/her construction sups: or. The stag defines "IIomeowner" 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 hom-e owner exemption; to act as their own construction supervio, 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 backfil).
so-notube holes (before pour). a rouzh building inspection (before work is
co,ace.al€&).iRsul<ation-insRection (if required)and-a-final-huildina.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-insb-e ted..
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
� y
?die Commonwealth of Afassachuse is
—�-- Department of In dustrial Accidents
"W r Office oflnlesti?ations
600 Washingaton.Street
Boston,-,V4 01111
�`�,%� rvww.massgai/dig
Workers" Compensation Insurance Affida-,it: Build'.ers/ContractorslElectricians/Plumbers
ADDlicant Information Please Print Le--jblti
-Name (Business/Or,a=ization/Individual): W e v e j-,&, 1"-T r,}r
Address:
City/Stag/zip: vr, Phone.T: YC% j ,_S`f
Are you an employer?Check the appropriate box: Type of project(required):
4. I am a gene-al contractor and I
1.ram a employer with � -- 6. ❑New construction
employees (foil and/or part-time).* have hired the sub-contractors
f ?. I am a sole proprietor or partner- listed on the ached sheet 7. ❑Remodeling
These sub-contractors have Demolition
ship anti have no employees 8. (�Lemoauon
working for me m any capacity employees and have workers' 9. Building addition
[No workers' cane:.iMS-1 once comp. in urance_- I I n f
required] S. U W e are a corporation and its 10.!_! Electrical repairs or additions
❑ I am a homeowner doing aU work olfcers have exercised their 11_❑Plumbic--repairs or additions
myself. [No workers'ca right of exemption per NfGL
�- 12.�Roof repairs
insurance required.]t c. I52,§1(4), and we have no .
employees. [No workers' 13.❑ Other
coum_insurance regnire:d-]
---'- ;% Psi per pox r.anus also n out a section oe:ow suowm� err worra-s'compensanon.policy information. — ---
i Hoseowne s who subrn>it this affidavit indicating trey are doing alt work and they hire outside contractors must subirdt a new affidavit indicating such-
*Contractors @par check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
-Vioyees. If the sub-contractors have=npioyrs,they rra=provide their workers'corm.policy ntanbe.
lam an employer that is providing workers'compensation insurance for my employees Below is the policy and job-site
information.
Insurance Company Name:
Policy n or Self-ins-Lic.m: ��� `l Expiration Date:
\ �
Job Site Address: ._
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to se-,zre coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to S 1;500.00 and/or one-year im t risonme=4 as well as civil penalties in the form of a STOP WORK ORDER and a fie
of up to 5250.00 a day against the violator. Be advised tbat a copy of this statement maybe forwarded to the Office of
Investisations of the DL4 for ins-,trance covera?e verification.
l do hereby cerd der th d enakies of perjury that the information provided above is true and correct
- t
Dare: 0
Phone r:
f
(( UULC=use only. tiro not write to this area,to be completed by ciry or town o FciaL
y or Town; 1?�r-mit/License�_
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact person: Phone;:-
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: / Not Applicable ❑
Name of License Holder: �YF(i �� d/ (A
License Number
Address Expiration Date
Signature Telephone
9.Registered Hoine Improvement Contract6r ° Not Applicable ❑
LIU ts 5e " , -� 133
Company Name Registration Number
�c ±z f ,3j
C,
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....... No...... ❑
11. - Home Owner Exemylif%on
The current exemption for"homeowners"was extended to include Owner-occupied Dwellines 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-vear 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
or �
SECTION b-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing ❑
Or Doors 1]
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Siding[0] Other[Mr-'
Brief
Work:Description of Proposed �r✓�. i ,s
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a. If-New house and or-addition to.existinct housing, complete the following:
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
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
0 �� 1� , 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.
Print Name
Signature f 0 ner/Agent Date
ti
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
Side L: R: L: R:
Rear ..
Duilding IIcight
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg&paved
Darkine)
#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 0 Obtained 0 , 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 U NO U
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
w
Department use,only
Cit)t-of Northampton Status at Permit
�`SJIdijig Department Curbs Cutltlrtveway Perim
212,Main Street SewerfSepticAvailability
(doom 100 IIUater/WellAvailabllity +'
^� �� orthampt n, MA 01060 Vivo Sets of.Structural Plans
Lor
q
hone 413--58 124p Fax 413-587-1272 Plot/Site Plans -
Other Specify.
APPLi&ATION TerCONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address:
Map Lot Unit
Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERS HIPIAUTHORIZED AGENT
2.1 Owner of Record:
1
A th
Name(Print) Current Mailing Address: : -s
� F • caG
Telephone
Signature
2.2 Authorized Agent: /
Name(Print) Current Mailing Address:
�S 'a�� -/
Signatur Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit 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) ,i > c ` Cheek Number ✓
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
- - -- - -- ---
Building Comm_is s—io-ne r/lns—p ec td--dfBui ings Date
BP-2008-0461
GIs#: COMMONWEALTH OF MASSACHUSETTS
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-2008-0461
Project# JS-2008-000672
Est. Cost: $3750.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: WESTERN MASS MASONS-1 33234
Lot Size(sq. ft.): 14810.40 Owner: PEASE SARAH A&LINDA SHARKEY
Zonin�URA Applicant: WESTERN MASS MASONS
AT. 3 MOUNTAIN ST
Applicant Address: Phone: Insurance:
147 MIDDLE RD (413) '540-1959 WC
SOUTHAMPTONMA01073 ISSUED ON.1012912007 0:00:00
TO PERFORM THE FOLLOWING WORK:R E B U I l-D CH 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 10/29/2007 0:00:00 $25.003040
212 Main Street,Phone(413)587-1240.Fax: (413) 587-1272
Building Commissioner-Anthony Patillo