20 Westwood BP-19-5520 WESTWOOD TER BP-2019-0055
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 35 - 135 CITY OF NORTHAMPTON
Lot-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGLLcc.1144/2A)
Category.KITCHEN&BATH RENO BUILDING PERMIT
Permit# BP-2019-0055
Protect JS-2019-000084
Est Cost: $17200.00
Fee: $110.0 PERMISSION IS HEREBY GRANTED TO:
Const.Class:Contractor: License:
Use Group: WALTER MAREK III 055201
Lot Size(sp.fi.): 9888.12 Owner: W MAREK iNC
zones Applicant. WALTER MAREK III
AT: 20 WESTWOOD TER
ApplicantAddresN: Phone: Insurance:
73 SOUTHAMPTON RD 413) 527-7667 O
WESTHAMPTONMA01027 ISSUED ON.7/23/2018 0:00:00
TOPERFORM THE FOLLOWING WORK.-REMODEL KITCHEN & BATHROOM, REPLACE 3
WINDOWS & DOORS
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 sienature;
FeeTvpe: Date Paid: Amount:
Building 7/23/20180:00:00 $110.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2019-0055
APPLICANT/CONTACT PERSON WALTER MAREK III
ADDRESS/PHONE 73 SOUTHAMPTON RD WESTHAMPTON (413) 527-7667 Q I
PROPERTY LOCATION 20 WESTWOOD TER
MAP 35 PARCEL 135 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OITT
Fee Paid U.
Building Permit Filled out
Fee Paid
TWeof Construction: REMODEL KITCHEN&BATHROOM REPLACE 3 WINDOWS &DOORS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included
Owner/Statement or License 055201
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INT94MATION 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 ofHealth 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
olition Delay
i-:natmeof
rgnature ofBuildin fficial Dat
Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all reguIred permits from Board of Health,Conservation Commission,
Deparmisent 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.
Department use only
City of Northampton Status of Permit:
Building Department Curb Cutlorivewsy Pennh
212 Main Street Sewer/Septic AvailabilityA
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 PloUSite Plans
Other Specify.
APPLICATION TO CONSTRUCT,ALTER, REPAIR RENOVATE OR DEMOLISH
rA
ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION J"\- `
r l
tlress: This section to be completed by office1.1 ProoeM Atl
ao
dress:
MapAll; Lot 11 Unit
n' w -
Zone Overlay DisMct
Elm SL District Ca District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
tA i fi,
Name(Prim) CuCura'lMeilirg[ress:
Tolepr2le
Signature
2.2 Authorized Agenic ,r/J',^hlE
Name(Pant) Cunard Mailing Md.
Signature TelepMone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed bpermit plicard
1. Building r i a)Building Permit Fee
2. Electrical b)Estimated Total Cost of
Construction from 6
3. Plumbing Sao Building Permit Fae
11
DD
4. Mechanical(HVAC)
V
5.Fire Protection
6. Total=(1 +2+3+4+5) Check Number
Thls Section For Official Use Only
Date
Building Permit Number: Issued:
Signatur .
Building Coi isslunadlnspector of Buildings Date
WInLyee<3 @ UVk1\Ca1-.N'-
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 8-DESCRIPTION OF PROPOSED WORK(check all applicablet
New House Addition ReDplao orwnl,;Inows Aheratlon(s)Roofing ElOr
Accessory Bldg. Demolition New Signs [0) Decks [q Siding[01 Other[II"
Brief Des ption o p
work oY ° `t ,+3atk . AA1Q Ren a- 3 wig 3 O ar
Alteration of existing bedroom—Yes No Adding new bedroom Yes k No
Attached Narrative Renovating unfinished basement `Yes _No
Plans Attached Roll -Sheet
Ga.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 f 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 constrection within 100 R.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 behait, in all matters relative to work authorized by this building permit application.
Signature of Owner
ly1l, //
Date
I,b o 1" art as OwnerlAulhorized
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 hep/gins d penalties of perjury.
PrintN
U
Signature of Owner/Agent Da[e
Section 4. ZONING All Information Must M Completed.Permit Can M Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Q
Building Depanmart
Lot Sim
Frontage
Setbacks Front
Side L: R:L: R:
Rear
wilding Height
Bldg.Square Footage
Open Space Footage nu
Lot arca minus bldg&paved
aur
017poking Spaces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW ® YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O 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 O NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O
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 O NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
City of Northampton
Q--MassachusettsI)6PAe1 S OF BOZLDZNG ZNSFBCTIONS212lYinetieat •Nml 01 HuilGiegaostnavpton, em 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 performedat:
Please print house number and street name)
Is to be disposed of at:
UUd f Ca jj-
Please print namo and l0 on of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
y(
Company Name and Address)
Signature of Permit 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.
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction S I rvisor: Not Applicable 0
Name of License Holder: G CS o + 010 1
1.1
3 So Ia R ( J vi,—* . MA
n Na jr
EwiraGon ate
signature Telephone
9 Roulstered Home Improvement Contmetor: Not Applicable
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT)M.G.L.e.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......
City of Northampton
Massachusetts
DEPARIMBML' OF BUILDING INSPNCTSONS Z
212 win atrMt • Nunieipal Building a cNorth,o n, Na 01060
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes.Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L.Chapter 142A requires that the"reconstruction, alteration,renovation, repair,modernization, conversion,
improvement, removal, demoltbon, or construction clan addition to any pre-existing owner-occupied building containing
at least one but not more than four dwelling units....or to structures which am adjacent to such residence or building"be
done by registered contractors.
Note:/f the homeowner has contracted with a corporation or LLC,that entity st be registered.
Typeof Work: I-y"A N)'
fly'
Est Co OD
Address of Work:1b e I^c.. 06ery,
Date of Permit Application:
7 va-
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law(explain):
Sob under$1,000.00 Y I1
O Owner obtaining own permit(explain): C (J"Y1VX- "( {ML( _G)'^'4r't'Ar 1 SCIT v Ot/Pttteee
Building not owner-occupied
II
t
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
Date Contractor Name HIC Registration No.
OR:
No wt standing the above notice,I hereby a p y for a building pt as the owner of the Bove property:
I l j6
Date Owner Name and Signature
The Commonwealth ofMassaehusefGc
Department oflndustria/Aecidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
wwmatassgov/diaW11twkers'Compensation Insurance Affidavit.Builders/Contnemrs/Electrldansn4 tubers.
TO BE FILED WITR THE PERMITTING AUTTIORITY.
Applicant Information Phase,Print Lezibly
Name(Business/OrganiMfioNindividml): VIC
Address: 12 tM";}"
City/State/Zip: r' M6 Vu.) Phone#: 41 G,),) 9 l
Are you an employer+Check the apprvprlate lona: Type of project(required):
Ida]..employmwiu _employees(MI soo,m on-o.t.7. New construction
2.(anawle pmpriebrorpuuership and Mvemem loyees wohiog f6,mm g. Remodeling
anY capacity.Mo wmkm'comp.in.mauce required.]9. Demolition
3.I am a hommwmr doivg ell woh myaetf.[N.wadren'nam.inuvmmrequired.]t
4.lamahomeownca.dwi Wdngwnh.aa co.d,ctaltwo onmypmpcM. lwiu 10 Building addition
mama Wnau cantreama eNur Mvc wohas'co npenvtianivvmmmaesok Il.Electrical repairs or additions
fietam witb m employees.12.Plumbing repairs or additions
5.lamegercrd caoaac li
ivve dMv.ve o
Mve hir t brmmac[ots sted m Neamehedshxr 13.RwfThesesubcoamnorsMveeloyxsandwrkers' W..1 repairs
6.We are a amp uw avd its officers have eaerei awr right ofnemptioo per MGL c.
14.Other
152,51(4),and we have no empkyxs.Mo workers'comp.iauuaaa rtqu'ved.l
Any applicant dist checks brut#1 rmat dw fill an the s«am below showingtheb wvAov'coleomuon pobry infwmah.
t Home..who t this affidavit indicatingdrey.m doing all workand tlen hire outride runnacmm uuM wbmit.new ef6lavit truncating such.
Conhacmutut check Us box moat Luched an additional shit showing the name ofthe aab.cwtnxunsaod sere wbts m mnot throeenrities Mve
employes. IftM wbcmtmcmn Mve cwploy they mut povide We'a "der - .Mlwy numbs.
I am an employer dud is providing wworkers'compensadon insurancefor my employees. Below is duepolicy andjob site
Insurance C L` l: 1 coInsuranceCompanyName:''(,,
nn,yQPolicy#or Self-ins.Lic.#:(XC O 1LAt Sg 4D Facpimtion Date: q
Job Site Address:
V C. e— City/State/Trp: fvcc , " `l" J
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage m required ruder 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 from of a STOP WORK ORDER and a fine ofup to$250.00 a
day against the violator.A copy ofthis statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby cerb)ry under rile rides ofperjwy dist due injbrmadon unue and correct
S1 M: !tel/Date /
phone t
Official use only. Do not write in this area,as be completed by city or down of ficial,
City or Tower: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.Cityfrowo Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
71412018 Office of Consumer Affairs 8 Business;Regulation-MasaGw
HIC Registration Complaints
Registration 159488
p Cen "ealth or Massachusetts
Registrant W.MAREK INC. f Division of Professional Licensure
Name WALTER MAREK III Board of Building Regulations and standards
ConstrucRon'SopeNisor
Address 73 SOUTHAMPTON RD.
City,State WESTHAMPTON,MA 01027 CS-055201 LAyires:06123/20
Dip 3-JExpiration042N9/2020 WALTER L MARS ...:'
Date 73 SOUTHAMPTON ROAR
WEBTINMPT SIA 01gV: `.
Complaints Details
1.."'
No complaints found for this registrant
Commissioner
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