17C-258 (6) WESTERN MASS MASONS
Quotation i
To:ROBER F
C QNS
S rC�
pEaT
OF p�ijjLDNIG INSPI
'�j;,�ON,MA 01060
58 NORTH MAIN ST. Quotation#:72442
FLORENCE MA.01060
Date:8-1942
Customer ID: F8945
INSTALL FIVE NEW LOLLY COLUMNS IN BASEMENT WITH CONCRETE PADS. CUT INTO EXISTING CONCRETE
FLOOR AND POUR A NEW CONCRETE PAD.
FORM AND POUR 16 X 22 SECTION OF BASEMENT WHICH WILL HAVE A 3 1/2 INCH STEP UP BECAUSE OF
FORM. NO EXISTING DIRT WILL BE TAKEN OUT OF FLOOR.
SCRUBS MAY NEED TO BE CUT BAD OR EVEN TAKEN OUT ALONG WITH BASEMENT WINDOW, SO CEMENT
TRUCK CAN FIT SHOOT INTO THE BASEMENT.
TOTAL$ 1875.00
Quotation valid for 30 days.
Quotation prepared by: DAVID OSIECKI
HOMEOWNER-OWNF FOR ONE I LALF OF-1 OIAL AMOUNT OF BILL WHEN JOB
ME _R WILL PAY MASON CON"T RAC
TOR
RUCTION HAS BEGUN,REMAINING AMOUNT OF BILL W 1F,;_BE PAIL)IN FULL WHEN JOB IS COMPLETED.
To accept this quotation, sign here and return:
147 Middle Rd.
Soudianlpton,'VtA 0 107 3
(413)540-1959 C,11 (413)5512-6311
4�1�MP20
•�O e
9 . � (11,x1 lOt� �i7Z���I1t�1�tITT
9 B �lasaachnactta'
m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060 '
WORI{ER'S COMPENSATION INSURANCE ArITEDAVIT
1,
(li censeeJpermi ttee)
with a principal place of business/residence at:
(phone#)
(stree 6ty/sta&zip)
do hereby certify, under the pains and penalties of pegury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance CompM/Poticy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Con=ctor) (Insi=ce Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Compauy/Policy Number) (Expiration Date)
(attach additioonl sheet ifnoarssry to iocWe infix-nudon pertaining to all cca4ad.ors)
( ) I am a sole proprietor and have no one working for me-
( ) I am a home owner performing all the work myself.
NOTE:please be aware that whilo homcown=who employ pcxiom to do=inicnincy.commxtioo or repair work on a dwelling of
not more than three units in which the homeowner midcs oc oa the groins appirtenant tbacto are not gcncr-44 eoandacd to be
employes under the wmikc' ntim Act(GL152,ss 1(5)�application by a homeowner for a 110am a permit may evidence the
legal status of an employer under the Workeet Compensation Act_
I understand that a copy of this statement may be forwarded to the Dcpertmcn2 of Industrial Accidcn&OfHoo of Lasurinoc for the
coverage verification and that failure to 5-0c=coverage under sceiioa 25A of MGL 152 can lead to tho imposition of criminal penalises
oomistmg of a fine of up to S1,500.00 and/or impsiso�t of tip to one yrar and civil penalties in the form of a Stop Work Order and a
firm o(3100.00 a day against tnc
For 1 trso poly
permit Number
gyp# Lot#
.r Signature of Licensee permittce e
w
SECTIO8-;CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
Not Applicable ❑
kAJ 6,
Company Name Registration Number
/!`/�) � ,>, (/
Address / Expiration Date
Soo It , C Telephone ZJIU ! \
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...... ❑
'tea§ M
m 0 4e . ° 6�� .lI
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' DESCRIPTIOJOF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacemeryt Windows Alteration(s) Roofing El
Or Doors t�
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: Gv ,�ro/� 7uu 6-3e % v. wj_A+
__
Alteration of existing bedroom Yes_ _�No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll 0- Sheet❑
6IfiNewho�isea duo" iid�tiori x>to:eicisting-h.oiising, cornpletetheWfo1'l:owin�g:
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. Mascheck 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 CONTRACl'OR 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
()S I�:.�0 ' �` kle5�C/�v �( � /�f'✓{Iah S as Owner/Authorized Agent
herebrdEbare 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.
Pri e
y�
Si ture of wner/ en Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF 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
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 DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Date Issued:
C. Do any signs exist on the property? YES NO
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:
I y of Northampton
Q ilding Department
12 Main Street
I �
SEP 2 2002 Room 100 rt ampton, MA 01060
on 3-5 7.1240 Fax 413-587.1272
DEPT OF BUILDING INSPECTIONS -
ICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 SITE INFORMATION
This section" a1be empl`ete by ftce
1.1 Property Address:
/'ri orM .�1�1- .n S�\ Maps
Zone ! ere str ct'
SECTION2- PROPERTY OWNERSHIP/AUTHORIZED AGENT`'
2.10 r of Record:
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3"-°ESTIl`MATED 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) Check Number
'This Section For Official Use Only
Building°Permlt`Number: ?` 2— Date Issued:
Slgrtature _ `
DOt �!.
Bufldirag�or�►r�nssconerftnspe�tgr of,Bwld�ng$_.n
File#BP-2003-0322
APPLICANT/CONTACT PERSON WESTERN MASS MASONS
ADDRESS/PHONE 147 MIDDLE RD (413) 540-1959
PROPERTY LOCATION 58 NORTH MAIN ST
MAP 17C PARCEL 258 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid i
Typeof Construction: BASEMENT LOLLY COLUMNS CONCRETE FLR,REPLACE BASEMENT WINDOWS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License 133234
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
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 Co ' ion
Signature of Building Official Dale
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.
58 NORTH MAN§T- ; BP-2003-0322
GIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2003-0322
Project# JS-2003.0540
Est. Cost: $1850.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Groin: WESTERN MASS MASONS 133234
Lot Size(ss . ft.): 23870.88 Owner: STEWART ROBERT
Zoning.URB Applicant: WESTERN MASS MASONS
AT. 58 NORTH MAIN ST
Applicant Address: Phone: Insurance:
147 MIDDLE RD (413) 540-1959
SOUTHAMPTON MAO 1073 ISSUED ON:9127102 0:00:00
TO PERFORM THE FOLLOWING WORK.-BASEMENT LOLLY COLUMNS,CONCRETE FLR,
REPLACE BASEMENT WINDOWS
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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 9/27/02 0:00:00 1342 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo