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32A-107 (2) 50 MARKET ST-NORTH AUTO BP-2019-0146 GIs#: COMMONWEALTH OF MASSACHUSETTS Man:Block:32A- 107 CITY OF NORTHAMPTON Lot-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeorv,ADD BATH BUILDING PERMIT Permit# BP-2019-0146 Proiect# JS-2019-000236 Est Cost:$13635.00 Fee:$95.00 PERMISSION IS HEREBY GRANTED TO: const.Class: Contractor: License: Use Group: GENE BOROWSKI 106527 Lot Size(sa.It.): 6490.44 Owner: WISNESKI JOSEPH A Zoning:URC(100 Applicant: GENE BOROWSKI AT. 50 MARKET ST- NORTH AUTO ApplicantAddress: Phone: Insurance: 117 SLINNYMEADE AVE (413) 687-3777 WC CHICOPEEMA01020-1780 ISSUED ON:8/7/2018 0:00.00 TO PERFORM THE FOLLOWING WORK.RELOATE BATHROOM WALL FOR NEW SHOWER, DEMO OF STORAGE WALL NEW COUNTER WALL AND SINK 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: FeeTvoe: Date Paid: Amount: Building 8/7/2018 0:00:00 $95.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File 0 BP-2019-0146 APPLICANT/CONTACT PERSON GENE BOROWSKI ADDRESS/PHONE 117 SUNNYMEADE AVE CHICOPEE (413)687-3777 PROPERTY LOCATION 50 MARKET ST-NORTH AUTO MAP 32A PARCEL 107 001 ZONE URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST OSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid TypeofConstruction: RELOATE BATHROOM ftLL OR NEW SHOWER DEMO OF STORAGE WALL NEW COUNTER WALL AND SINK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 106527 3 sets of Plans/Plot Plan THE��///FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INIwRMATION PRESENTED: rr 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 fre of ui tcia Date Note: Issuance 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. 0, Versionl.7 Commercial Building Permit May 15,2000 RECEIVE ity 0 Northampton of p�: Ili g Department 3 2018 212 Main Street QUGR oro 100 IN ham ton, MA 01060 Two J r,FPT 'PT Or "o nw 7-1 40 Fax 413-587-1272wORiHAM� 1 Or APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION I-SITE INFORMATION 1.1 Property Address: This$SCUM W be completed by 011i 41') Map Lot 1,67 Unit Zone Overlay District Elm St District CBDWWd SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current�MMAMm' /I Alec Signature Telephone 2.2=Aaent- Name(Print) Current Mailing Add2y C14 -7 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTA I Item Estimated Cost(Dollars)to be Official Use Only completed by p mirt avolicant 1, Building 2- (a)Building Permit Fee 2. Electrical -----------— 11------ (b)Estimated Total Cost of 19r e0 Construction from(6) 3. Plumbing 376906� Building Permit Fee A- ' - 4. Mechanical(HVAC) 5 Fire Protection 6. Total=(l -2+3+475—)--. /3 nK Check Number This Section For Official Use Only Building Permit Number Date Issued Sign re. g/�/ ISMilding'C"ornmissidlierAns ftr of Buildings Date v Version L7 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❑ Naw Signs❑ Floating El Change of Use❑ Other ❑ Brief Description Enter a brief description------ "� `��1ro�/t iii r' A/Mai -'may(��p��` Of Proposed Work: O12i71/i Y/a' o7Co' PW�/1 /;PLU 6b��fe'�/�/Rtet na{ SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Cheek as applicable) CONSTRUCTION TYPE A Assembly1:1A-1 11A-2 ElA-3111A 13 A4 ❑ A-5 ❑ 1B ❑ B Business 2A ❑ E Educational ❑ 2B ❑ F Facto ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B El 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 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(so 2' 3" 9f° 4°' .._._ 4m ..... Total Area(so Total Proposed New Construction (so _ Total Height(ft) Total Heightft 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❑ I Versionl.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING:.. Existing Proposed Required by Zoning This column to be filkd N by Buddwg Dcpvunrnt Lot Size Frontage -- ---- -- Setbacks Front Side L.�i1 R' A? L.__ R --_ --. Rear 16' - -' Building Height Bldg.Square Footage ( % ----- Open Space Footage -.. % -- (Lota inus bid,&pavN __ ._.- ..... _. r)uv #of Parking Spaces Fill: volume ffi Locatiov ......-.-- .-''—_------ A. A. Has a Special Permit/Variance/Findin ver been issued for/on the site? NO O DONT KNOW YES O IF YES, date issued: IF YES: Was the permit recorded at the Reg' try of Deeds? NO O DONT KNOW YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES NO O 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: E. Wil the construction activity disturb(clearing,grading,ex tion,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES © NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Version L7 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 118(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 Atltlress Registration Number Signature Telephone Expeaticn Data Name Area of Responsibility Address Registration Number Signature Telephone Exp lion Date Name Area of Responsibility Atltlress Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 Generai Contractor �n21 (,trS�A Not Applicable Company Name Responsible IndGrIarge Construction r is Signature v Telephone 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 O No O SECTION 11-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize SP,r. l o� -l� f . Ito 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 oerlury Print Name ..._ .... ..... Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervi/sKne, � 'sJ Not Applicable ❑ Name of license Holder / License Number Address Expiration Date cy C /o Signature Tel ne SECTION 13- RKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(S)) 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 C) City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste 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 defiined,,//by MGL c 111, S 150A. i// Address of the work: at'��o- 5f The debris will be transported by: S/1- The debris will be received by: Building permit number: Name of Permit Applicants Date ignature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02174-4-20011 www.massgov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. A licant IHforuination Please Print Legibly Business/Organization Name: &tl Address: //7 / t ®�/P /Q> �7 City/State/Zip: �h Phone#:C�/3)kjp 7— Are yon employer?Check t e appropriate box: Business ype(required): L I am a employer with�` _employees(full and/ 5. Mil orpart-time).• 6. ❑RestauranrBar/Eating Establishment 2.0 1 am a sole proprietor or partnership and have no 7, ❑Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers'comp. insurance required] 8. Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemption per c. 152,§1(4),and we have 10.❑ Manufacturing no employees. [No workers'comp.insurance required]' 11 ❑Health Care 4.❑ Weare a non-profit organization,staffed by volunteers, with no employees.floo workers'comp.insurance req.] t2.0 Other 'Any amiteant lost checks box#1 mum ate,fill out use section below showing&on wotkets'compensation policy mfomution. "Ifthe cos cone officm have exempted themselves,but We corpomtlon has other employ=s,a workers compensation policy is mgwmd and such an orgasaawn should check box#1. I am an employer that is provid/in��w orkers'pFompensation insurance for my employees Below is the policy information. Insurance Company Name:_ /�A L'G-CP/Y Insurer's Address: 1^f City/State/Zip: q Policy#or Self-ins.Lic.# .2 /07637 Expiration Date: 1 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, 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 ofthe DIA for insurance coverage verification. I do hereby certify, oder the ai s andpen 'es of perjury that the information provided above is true n�d correca Signature -"ter` Date: 3 /25 Phone#: go $ 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.Cityrfown Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www mass gov/dia Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However,the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shal I not because of such employment be deemed to be an employer." MGL chapter 152,?125C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,¢25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply your insurance company's name,address and phone number along with a certificate of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required.Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pernitAicense number which will be used as a reference number.In addition,an applicant that must submit multiple permiblicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary). A copy of the affidavit that has been officially stamped art marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture(i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street Boston, MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 www.mass.gov/dia F.Rcviscl02-23-15 ' -J b.MO ,j ,. 1ai4vJ�najy Y,'.•y .717 -7) �.`N ec.00td - g/jf.�v_n�jv it_iJ-�7._•� .,ro�.,y �-. .� �y`��'��,y2�5yQ��C} -3 4��0/J