38B-060 (2) BP-2024-0427
279 SOUTH ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38B-060-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2024-0427 PERMISSION IS HEREBY GRANTED TO:
Project# BULKHEAD 2024 Contractor: License:
Est. Cost: 13750 DAVID OSIECKI CSL089376
Const.Class: Exp.Date: 01/05/2025
Use Group: Owner: BRUNELL SHARI L
Lot Size (sq.ft.)
Zoning: URB Applicant: WESTERN MASS MASONS LLC
Applicant Address Phone: Insurance:
383 COLLEGE HIGHWAY 413-527-1800 4283978
SOUTHAMPTON, MA 01073
ISSUED ON: 04/11/2024
TO PERFORM THE FOLLOWING WORK:
INSTALL NEW BULKHEAD
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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
Fees Paid: $90.00
2 12 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
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(4/u/ / wktet, (bace/1 .
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APR
14 The Commonwealth of Massachusetts i 1 20 /
JjJ' Board of Building Regulations and Standards / TY
' Massachusetts State Building Code, 780 CMR vo°T LlL1)m�l^ICIPALI
Building Permit Application To Construct, Repair, Renovate Or Demolish a "Revrhh± 4045111 j
One- or Two-Family Dwelling - �`
Tliiis Section For Official Use Only
Building Permit Number:`} 5‘'' ''1'? Date Applied:
e
U/i.) ` BOSS /�/�/G— 14-11" ZY
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address:2) , ,S.U4yl Sf 1.2 Assessors Map& Parcel Numbers
1.la Is this an accepted street?yes / no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: (� ,/ -� ^ /�,/
s i A r-i �IN I lr vr- r"1 11 `1 ,i,i4 • (mil U 10
Name(Print) City,State,ZIP
,?..7 ? So-Th aT 531' 7116
No. and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work':
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2.Electrical $ ❑Total Project Costa (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $
Check No.0) Check AmotitCtO Cash Amount:
6. Total Project Cost: $ / 3�7.37�'w ❑Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) /hn3?‘ `—��5--
)� ��, e c 1<, License Number Expiration Date
Name of CSL Holder
3�3 C�6 e 4_ �/-/ List CSL Type(see below)
No.and Street & Description
CI: `1N /,, 4 a (0 l? Z Unrestricted(Buildings up to 35,000 cu.ft.)
'� R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
]7;
� SF Solid Fuel Burning Appliances
. )' 6 3/( (i I.%�o L..t3/c(/r44:1J &i .t(1 I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) ^
I A)1.)re rr— 44�1 , -C," i �'77 y�� i—s S
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
‘1-.3e -J1 j l W/7 E 3T« iAsh„„£CA
No. Street Email address
City/Town, S te,ZIP Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. § 25C(6))
Workers Compensation Insurance affidavit must be com leted and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance the building permit.
Signed Affidavit Attached? Yes No 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S 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.
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
contained i I's application's true and accurate to the best of my knowledge and understanding.
PP
Prin rIA s Authorized ent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"maybe substituted for"Total Project Cost"
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
` • `' Massachusetts ��5 y._ �'1
* a tr
DEPARTMENT OF BUILDING INSPECTIONS �'
y U ‘''
•; 212 Main Street • Municipal Building yvy
, Northampton, MA 01060 rsMjy ado.
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, 554, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
bitsLocation of Facility: lirc, i Q pecr If
The debris will be transported by:
Name of Hauler: Urg 3/ V I A/4W Ad 7
Signature of Applicant: Date:
• The Commonwealth of Massachusetts
•
Department of Industrial Accidents
I Congress Street,Suite 100
r-1 Boston, MA 02114-2017
,r,t'►c.mass got/dia
11 uu kers' ("ro Milt nS ation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
i'o BE FILED WITH THE PERMITTING AUTHOR(tl'.
_Sinitic:int Information Please Print LeBibiv
Name(13usrnrss Organtzzrtt"rt Indrvitittal): k f4 I try— ,/141 //14)()1 J ..__.
Address:_ 3 c d 4g_ l
City/State/Zip: U Oki3 Phone#:
Art ys.an employer'Cheek the appropriate hot:
7)pi of project(required):
I.eirrim a employer with.__1(f) employees(full aad4a pan-tansy* 7. 0 New construction
201 am a sale proprietor or panncnhip and have no employees.working for aft in 8. ZyRodeling
any capacity.[No workers"comp.insurance required.]
9. 0 Demolition
3E3lam a homeowner doing all work myself.[No%ot ers'comp_insurance spared_]
1.0 I am a homeowner and will be hiring contractors to conduct all work on my property i will I Q Q Building addition
ensure that all ewttra:tocat either have makers"compensation insurancre to are sot I 1 a Electrical repairs or additions
proprietors with no cmplo}'eras.
12.0 Plumbing repairs or additions
SO I am a ga ete)contractor and I have hired the sub-contractors tilted on the attached sly. 13 Q ROOFIY 8ira
on rs These sub-ctracto have employees and have trotters'comp.insurance.: p
6.0 We are a corporation and its officers have exercised their tight of exemption.per MOIL c. 14.0 Othet
IS2., HA).and we have no employees.[No workers'rump.insurance required.]
"Any applicant that chocks box tKl num*also fill out the section below showing their workers'compensation policy information
'Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mart submit a new attida it indicating swell.
1C ontraetors thwt cheek this hot moil attached an additional sheet showing the name of the sub-contractors and state whether orr not those/mtrties has.:
<nrployees. If the sub-contractors have empl.os ec,.they must pro%ide their 'workers'comp.pulley number
I am an employer that is providing workers'compensation insurance for rot'employees. Below is the policy and job site
information.
Insurance Company Name: 5`
Policy#or Self-ins.Lic.#: Ltl Y�� Expiration Date: ''/1 —)
Job Site Address: 0/7 f go ,e7 of• Citystate zip:A,rir%%tc.,.4 „/r, �c
Attach a copy of the workers'compensation policy declaration page(showing the policy number a expiration date).
Failure to secure coverage as required under MGL c. 152,r25A is a criminal violation punishable by a fine up to S 1.500.(1Q
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 52541.00 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 r rtlfy under the poi and ;mollies of perjury that the information provided abore is t true and correct.
Sr>ttattuc Date: ' // 2/y
Phone
Official use only. Do not write in this area, to be completed by city or town official.
City or Town: Permit/license 4
Issuing. uthorith (circle one):
I. Board of Health 2. Building Department 3.('its 'fotsn Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person:_ Phone#:
RN
383 College Highway -
• QUOTE
Southampton, MA 01073 \ In LICENSED • REGISTERED
(413) 527-1800 INSURED
WesternMassMasons.com '""�3 0 ;►'� ACCREDI7EP
'EfZEEss
quality@westernmassmasons.com T T C) H!S
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SHARE BURNELL Date: 3-02-2024
To: 279 SOUTH ST. Quote# 672367
NORTHAMPTON MA Project: BULKHEAD
Phone: 413-531-7566 E-mail: 1p.T ING
44, O
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Description of Work To Be Done:
* ( ARS *
Excavate out the existing bulkhead down to the footing of the foundation of the home and
dispose of all old material.
Form and pour new concrete footing with rebar. cS t 1 C 0
Install block foundation.
Tar the exterior the foundation and backfill with clean material.
Install new steel bilco door and stair stringers.
Clean all damaged areas. •
Call dig safe and pull building permit.
WE HEREBY PROPOSE TO FURNISH MATERIALS AND LABOR- $ 13,750.00
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 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 affect 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.
Thank You For Choosing Western Mass Masons!
RN
, QUOTE
383 College Highway
Southampton, MA 01073 ( 1 LICENSED • REGISTERED
(413) 527-1800 f Ile k INSURED
WesternMassMasons.com 2 ^'z' • , ACC
REDITED
quality@westernmassmasons.com 7 I I 0 fri)
aee
'9S
ONS
•
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.
Signatur ' Da e: Signature. Date
J
Thank You For Choosing Western Mass Masons!