22B-013 (4) 45 MEADOW ST BP-2020-0770
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:22B-013 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: REPAIR BUILDING PERMIT
Permit# BP-2020-0770
Proiect# JS-2020-001326
Est.Cost: $8950.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: WESTERN MASS MASONS 089376
Lot Size(sq.ft.): 8712.00 Owner. LIERMAN LIZ
Zoning: URB(76)/URA(24)/WP(151/ Applicant. WESTERN MASS MASONS
AT. 45 MEADOW ST
Applicant Address: Phone: Insurance:
383.COLLEGE HIGHWAY (413)540-1959 WC
SOUTHAMPTONMA01073 ISSUED ON.12/30/2019 0:00:00
TO PERFORM THE FOLLOWING WORK:REBUILD FOUNDATION
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 Sip-nature:
FeeType: Date Paid: Amount:
Building 12/30/2019 0:00:00 $65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
? Department use only
City of Northa pton Sta u f Per it:
Building Depa men OEC 3 0 ' Curb t1Dr4eway Permit
212 Main Street ,�
eweepti Availability
Room 1 q0 nFPr of Watej7;ve, vailability
`' �uorn�c tructural Plans
, Northampton, MA f31Q�flRrNg1�P, NSPF ophone 413-587-1240 Fax 413-587- N'��q°_ htotsOthe
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
G w S Map O Lot 0/]teUnit
// UUU I
G../'(4,
'�J1• Zone Overlay District
Elm St. District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: < p
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent: /
Name(Print) Current Mailing Address:
G//f-
Signatu Telephone
SECTION 3-ESTIMATED 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)
5. Fire Protection
6. Total =0 +2+ 3+4+5) Check Number
This Section For Official Use Only
Building Permit Number: r � ' 7 Date
Issued:
,
Signature: la/30
90
IF
Building Commissionedlnspector of Buildings Date
/
Gr,�C,l y Pk/P S%C r.�.,�1/l1,�J .114'07j�
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
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
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 Q DON'T KNOW Q YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW Q YES 0
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW Q 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 Q
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 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[lam] Other[0]
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
6a. If New house and or addition to existing 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
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
-3v j
Signature O er gent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor:
Not Applicable ❑
Name of License Holder: 0"(-,
License Number
Ad'". Expiration Date
S' to ' Telephone
9.Reaistered Home Improvement Contractor: Not Applicable ❑
iC\j&S/
'ti.
Company Name Registration Number
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....... LkinNo...... ❑
City of Northampton
Massachusetts
r
DEPARTMENT OF BUILDING INSPECTIONS
r 212 Main Street •Municipal Building � P
Northampton, MA 01060
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building
permit all debris resulting from the construction activity governed by this Building Permit shall be disposed
of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
1
Zile"'41
(Please print house number and street name)
Is to be disposed of at:
Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and AddP ss)
C—)X/1- I
Sigrqtury6fPerrr4f Applicant or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
The Commonwealth of Massachusetts
Department of IndustrialAccidents
= I Congress Street,Suite 100
a
Boston,MA 02114-2017
www mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name(Business/Organization/Individual):
Address:
City/State/Zip: Phone#: �l .��'�'r�c-c
Are you an employer?Check the appropriate box: Type of project(required):
1.YQ`am a employer with employees(full and/or part-time). 7. ❑New construction
2.❑1 am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling
any capacity.[No workers'comp.insurance required.]
9. El Demolition
3 F-11 am a homeowner doing all work myself.[No workers'comp.insurance required.]t
10❑Building addition
-1❑1 am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees.
12.E]Plumbing repairs or additions
5❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ p
Roof repairs
These sub-contractors have employees and have workers'comp.insurance)
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[:]Other 1/C
152,§1(4),and we have no employees.[No workers'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 andjob site
information.
Insurance Company Name: Krr_^ tS/"_/C t '�
Policy#or Self-ins.Lic.#: f pey! Expiration Date: —//-,/o G
Job Site Address: � C t01+- J11. City/State/Zip:/K rl,
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby cern under t pai an nalties of perjury that the information provided above is true and correct.
Signature:
9 Date: 111L_`TG .r
Phone#:
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
383 College Highway QUOTE
Southampton, MA 01073 L` LICENSED - REGISTERED
(413) 527-1800 INSURED
lAfM.WESTERNMASSMASONS.COM "" Doaw„
AngleFs list.
LIZ LIERMAN Date: 11-12-2019
To: 45 MEADOW ST. Quote# 238909
FLORENCE MA Project: FOUNDATION/CHIMNEY
Phone: I E-mail:
Description of Work To Be Done:
1. THE REAR SECTION OF THE FOUNDATION TO THE LEFT SIDE OF THE DOOR, THAT
RETURNS TO THE INSIDE CORNER IS STRUCTURALLY UNSOUND AND MUST BE
REPLACED. BECAUSE OF THE AGE OF THE HOME THERE IS NO CONCRETE FOOTING
AND THIS SIDE IS NOT BELOW THE FROST LINE. THIS CAN BE SEEN IN THE VERTICAL
AND STEP DOWN CRACKS IN THE BRICK, ALSO THIS AREA HAS BEEN PATCHED AND
THE BRICKS ARE FAILING. FROM THE OUTSIDE CORNER TO THE INSIDE CORNER WILL
BE TAKEN DOWN AND REBUILT. DIG DOWN T AND POUR ANEW CONCRETE FOOTING
WITH REBAR. INSTALL 8” BLOCK FOR NEW FOUNDATION AND INSTALL THE WALL
WITH BLOCK AS WELL FOR COST SAVINGS. SUPPORT THE HOUSE AS NEEDED.
HOMEOWNER TO HAVE GAS TANK TEMPORIALLY MOVED.
TOTAL$ 8950.00
2. THE CHIMNEY ABOVE THE ROOFLINE IS IN VERY POOR CONDITION AND MUST BE
REBUILT FROM THE ROOFLINE UP WITH NEW BRICKS AND LEAD FLASHING. FORM
AND POUR A CEMENT CAP. a
TOTAL$ 4285.00
WE HEREBY PROPOSE TO FURNISH MATERIALS AND LABOR-
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 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 1-1/2(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.
Thank You For Choosing g ` estern Mass Masons!
Tn4e sW54
___
383 College Highway
r QUOTE
Southampton, MA 01073 LICENSED • REGISTERED
(413) 527-1800 `
INSURED
MAMMESTERNMASSMASONS.COM
. Angier list. _eta:
Signature: Date: Signature: Date:
I IYA
Thank You For Choosing Western Mass Masons!
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