31D-112 LICENSED REGISTERED INSURED
. 2 WESTERN MASS
383 COLLEGE HWY, SOUTHAMPTON, MA 01073 • (413) 527 -1800
WWW.WESTERNMASSMASONS.COM
QUOTE
To: EDWARDS CHURCH Date: 4-23 -2010 I
297 MAIN ST. Quote # 67457
NORTHAMPTON MA Project: FRONT STEPS
Phone: 587 -1267 , ( ;_.= ATTN BILL LETENDER
Description of Work To Be Done:
THE FRONT STEPS OF THE CHURCH WERE INSPECTED AND FOUND THAT THE CONCRETE
UNDERNEATH IS DETERIORATING AND THE STONE IS FAILING.
THE WHOLE LENGTH OF THE FRONT STEPS WILL HAVE THE STONE REMOVED, AS WELL AS
THE FRONT PORTION OF THE LANDING WHERE THE STONES ARE LOOSE.
THE CONCRETE WILL BE CLEANED OFF FROM ANY LOOSE DIRT AND A FORM WILL BE MADE
TO REPAIR THE STRUCTURE OF THE CONCRETE STEPS AS NEEDED.
NEW THERMAL BLUESTONE WILL BE USED ON THE TREADS AND THE RISE. THE TREADS
WILL HAVE A 1" OVERHANG AND BE PITCHED TO SHED THE WATER.
* ** PLEASE FEEL FREE TO CONTACT US WITH ANY QUESTIONS.
WESTERN MASS MASONS RECYCLES ALL IT'S OLD MATERIAL.
WE HEREBY PROPOSE TO FURNISH MATERIALS AND LABOR - $ 5850,00
IN ACCORDANCE WITH THE ABOVE SPECIFICATIONS, FOR THE SUM OF:
•
This quote may be withdrawn from us if not accepted within 30 days. BBBOalrw>E
Quote Prepared By: David Osiecki Niktittutirr
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. VISA
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 -1t2 (18% annual rate) per month will be added to any unpaid balance over 30 days.F
ACCEPTANCE OF PROPOSAL: The Above Prices, Specifications And Conditions Are Satisfactory And Hereby Accepted. You Are Authorized To Do ,
1 The Work As Specified. Payment Will Be Made As Outlined Above.
Thank You For Choosing Western Mass Masons!
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
T 600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians /PIumbers
Applicant Information p A0207 Please Print Legibly
?
Name ( Business /Organization/Individual): (4/ (b T.) ./ i2�'• i; ,`.r ? _
Address: c7 c 3 Ccf4(C
City /State /Zip: 5,- /�� /L ,, .. Phone #: Sd`7 ( c
Are you an employer? Check the appropriate box: Type of project (required):
1.
[917. m a employer with 4. ❑ I am a general contractor and I
employees (full and/or part- time).* have hired the sub - contractors 6. ❑New construction
2. El I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub - contractors have 8. 0 Demolition
working for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers' comp. insurance comp. insurance.*
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3. ❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. 152, § 1(4), and we have no
employees. [No workers' 13.0 Other
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 and job site
information.
Insurance Company Name: 6 S /'t- 7 (n J
Policy # or Self -ins. Lic. #: 7 y ` 46713 Expiration Date:
1 V - 42L � l/
Job Site Address: , 7 ? .ill • 4.57- City/State /Zip:. <.
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify der t e pains a enalties of perjury that the information provided a / bove is true and correct. -
Signature: Date: G `� G
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 #:
r
Versionl.7 Commercial Building Permit May 15, 2000
SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No 0
SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, , _ .... _._ .. . ____. _._ .. _ as Owner of the subject property
hereby authorize
act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I ��l/•T."_ ._. ?, { _,._,_.. _ , 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
Signat Owner gent Date
SECTION 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable E3 Y37
Name of License Holder : _ In i ..._Cc k< ....
License Number
P CSC ,/ ,. = 102
Address Expiration Date
Sig r Telephone
SECTION 13 - 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 build' g permit.
Signed Affidavit Attached Yes No 0
Version1.7 Commercial Building Permit May 15, 2000
SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable
Name (Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
(A/ C C! __.....__.w, ��d /1 _1 _ Not Applicable ❑
Company Name:
Responsible In Charge of Construction
Address
#41 �o? „..„„ ,
Si. ;r Telephone
Version1.7 Commercial Building Permit May 15, 2000
8. NORTHAMPTON ZONING
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 _ d „•
parking)
# 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
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 , Date Issued:
C. Do any signs exist on the property? YES (3 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 0 NO 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
N
Version1.7 Commercial Building Permit May 15, 2000
SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑
Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑
Brief Description Enter a brief description here.
Of Proposed Work:
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly El A -1 ❑ A -2 ❑ A -3 ❑ 1A 1 ❑
A -4 ❑ A -5 ❑ 1 B ❑
B Business ❑ 2A ❑
E Educational 0 I 2B r ❑
F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
1 Institutional ❑ 1-1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑
S Storage ❑ S -1 ❑ S -2 ❑ 5B ❑
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
S Special Use ❑ Specify: . . _ -. - _ ._, �� eb ___ _ -.
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE
Existing Use Group: _._.._.._. Proposed Use Group ._.._.._._
Existing Hazard Index 780 CMR 34): . _._ ._ __ .._...._ Proposed Hazard Index 780 CMR 34).._,......
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor (sf)
1st 1s
2
2nd nd
3rd 3rd
__
4th 4 t"
Total Area (sf) Total Proposed New Construction (sf)
Total Height (ft)
Total Height ft
7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system
Version1.7 Commercial Building Permit May 15, 2000
Depe use or
City of Northampton
Building Department tuattfqtqrlveYvp*F!e:rrpt6,ivr
212 Main Street
Room 100 Vatereivaitabiit
Northarrpton, MA 01060
phone 413'=587 Fax 413-587-1272
Other Speciy
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
„ -
SECTION 1 - SITE INFORMATION
This section to be completed by office
1.1 Property Address:
,91?7 Map Lot Unit
,;,4 6 ,,
. Zone Overlay District
' EIm St District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
,
Name (Print) Current Mailing Address:
. . .
Signature Telephone
2.2 Authorized Agent:
04V 0 _ _ .
cfP 1 3-
Name (Print) Cun Address:
Signature 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 = (1 + 2 + 3 + 4 + 5) 3L3.. Cci Check Number m ;
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
File # BP- 2010 -1213
APPLICANT /CONTACT PERSON WESTERN MASS MASONS
ADDRESS/PHONE 383 COLLEGE HIGHWAY SOUTHAMPTON (413) 540 -1959
PROPERTY LOCATION 297 MAIN ST
MAP 31D PARCEL 112 001 ZONE CB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out �/
Fee Paid �� t 4( .
Tvpeof Construction: REPAIR BLUESTONE TOPS ON STAIRS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 089376
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 Commission Permit DPW Storm Water Management
Demolition Delay
(1/10
Signature of Building Official Date
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.
1297 MAW BP- 2010 -1213
GIS #: COMMONWEALTH OF MASSACHUSETTS
an;Black: 31 -112 ` 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- 2010 -1213
Project # JS- 2010- 001768
Est. Cost: $5850.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: WESTERN MASS MASONS 089376
Lot Size(sq. ft.): 16814.16 Owner: EDWARDS CHURCH OF NORTHAMPTON
Zoning: CB(100)/ Applicant: WESTERN MASS MASONS
AT: 297 MAIN ST
Applicant Address: Phone: Insurance:
383 COLLEGE HIGHWAY (413) 540 -1959
SOUTHAMPTONMA01073 ISSUED ON:7/1/2010 0:00:00
TO PERFORM THE FOLLOWING WORK: REPAIR BLUESTONE TOPS ON STAIRS
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 7/1/2010 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo