32A-212 (2) 21 BUTLER PL BP-2020-0680
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32A-212 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Porch Repair BUILDING PERMIT
Permit# BP-2020-0680
Project# JS-2020-001161
Est.Cost: $35000.00
Fee: $245.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: WILLIAM TUROMSHA 000515
Lot Size(sa. ft.): 9670.32 Owner: SERVICE KATHRYN F
Zoning: URC(100) Applicant. WILLIAM TUROMSHA
AT. 21 BUTLER PL
Applicant Address: Phone: Insurance:
P O Box 141 413 586-4005
LEEDSMA01053 ISSUED ON:121312019 0:00:00
TO PERFORM THE FOLLOWING WORK.DEMO EXISTING PORCH AND ROOF,
CONSTRUCT NEW
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. iwimin., Inspector
Underground: Servic�: 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 12/3/2019 0:00:00 $245.00
12 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Versionl.7 Commercial Building Permit May 15, 2000
Department use only
RECEIVED Ci y of Northampton Status of Permit:
BL ilding Department Curb Cut/Driveway Permit -
��C 2 2019 12 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Nort iampton, MA 01060 Two Sets of Structural Plans
DEPT.OF BUILDING 1 mm4sl 3- 87-1240 Fax 413-587-1272 Plot/Site Plans
NORTHAMPTON,MA 01060 Other Specify
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
1.1 Property Address: This section to be completed by office
9 '.2/ 13ay-i-Er PLAce Map ? Lot -2 Unit
NORTHAMP +0Oj Mp i Zone Overlay District
s
i
Elm 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:
Name(Print) Current Mailing Address:
17
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars) to be Official Use Only
completed by permit applicant
1. Building # 1�d, oa (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of m ....
Construction from 6 __.._. ._. ___,__, _._.._....
3. Plumbing Building Permit Fee
i
4. Mechanical (HVAC) � j t _
5. Fire Protection
6. Total = 0 + 2 +3 +4 +5) Check Number 2
This Section For Official Use Only
Building Permit Number `h M /, Q/7 Date
Issued
Signature- /
r
�
is 3 11
Building C missioner/Inspector of Buildin ' Date
Versionl.7 Commercial Building Permit May 15, 2000 -
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations [I Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign E] New Signs El Roofing[] Change of Use❑ Other X_... VeMoust4 ejusp-r. -nAjo stow 'Po*- iN w,.,,Z) RooF
Brief Description Enter a brief description here. Cous-muc-r $44") 'T'wu sic—, Pa, p,4a RAF
Of Proposed Work: SErz pTrPw-NF4 rt,-" A"b Sp�Q,FCn-res
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
❑ A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 313 ❑
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: j
i
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: RE�Ar�,ac,a Z�.__� Proposed Use Group: fi
Existing Hazard Index 780 CMR 34):la _Ja,_,__ 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
_ St
1:t _� 1
2nd 2nd
4ch
4 h
Total Area (so Total Proposed New Construction
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 0 Zone Outside Flood Zone❑ Municipal 0 On site disposal system El
Versionl.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:M"O R: 9 L: R: __-
Rear d 3 Z 11 Kin
Building Height
32: 13=2
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved .�
parking)
#of Parking Spaces
............._......
Fill:
(volume&Location) ---m---------�---------- --
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW 0 YES 0
IF YES, date issued: ~..
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T 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 ® DON'T 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 0 Date Issued:
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES Q 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 u
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Versionl.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:
_.. w. _._.._.. __. ...
Not Applicable
4; 3
Name(Registrant):
Registration Number
�T p-e tzT Q2TH prn t o � �}
Ad
Expiration Date
Si na re Telephone
9.2 R ter ofessional Engineer(s):
Name [Area of Responsibility
Address _ Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address � Registrationmber�
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
• Not Applicable ❑
Company Name:
Responsible In Charge of Construction
Address
All
Signature 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 0 No
SECTION 11 - OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject property
1
hereby authorize H to
act on my behalf, in all atters relative to work authorized by this building permit application.
Signature of Owne Date
I, .� ._ �<�OAIn .�� L►?. L� . .. .m.._ .... mm�.R ._.... m ..m_ . . as 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.
Si ned under the pains and penalties of perjury.
Print Name _
� f
Signature of$sxpar/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:i Lo 00,5/S I
License Number
Address Expiration Date
Signature Telephone
I T_
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 building permit.
Signed Affidavit Attached Yes llNo 0
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 defined by MGL c 111 , S 150A.
Address of the work: 1 Q - a," 'F3u$LEr_ FLAcs Alknj,4 phot
The debris will be transported by: Ci az E2T FIw r us m 6pumP5:Mr'j
The debris will be received by: B�allti ? �,�4►-rg
Building permit number:
Name of Permit Applicant P/za,, J.. I urzom-sHA
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
= Department of Industrial Accidents
1 Congress Street, Suite 100
Boston,MA 02114-2017
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www mass.gov/dia
Workers'Compensation Insurance Affidavit: General Businesses.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Business/Organization Name: �, ►u ao r,-,s Ha T F s t ..0 9, o t- imzu_ail bN
Address: I t lllan�s
City/State/Zip: Phone#: '�j3 S�6 CfDoS'
Are you an employer?Check the appropriate box: Business Type(required):
1.❑ I am a employer with employees(full and/ 5. ❑Retail
or part-time).* 6. ❑Restaurant/Bar/Eating Establishment
2.2 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.❑ We are a non-profit organization,staffed by volunteers,
with no employees. [No workers' comp.insurance req.] 12.0 Other GF-s4im a e- Lor..�a^cmA.
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
"'If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an
organization should check box#1.
I am an employer that is providing workers'compensation insurance fiefs Below is the policy information.
Insurance Company Name: -T72AuELr,e�
Insurer's Address: P.O TSOX 56,00
City/State/Zip: HN T%2.Q . C.T 04.10 2-
Policy
Policy# # fl, T4 Q -b 6S 3N 4 I - Expiration Date: J -9 - ZO 2 O
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,under the pains andpenalties ofperjury that the information provided above is true and correct.
Signature: Date:
Phone#: `4/3 63L L U oo
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.Licensing Board 5.Selectmen's Office
6.Other
Contact Person: Phone#:
www.mass.gov/dia
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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 a joint 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 shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(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 permit/license number which will be used as a reference number.In addition,an applicant that
must submit multiple permit/license 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 or 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 home owner or citizen is obtaining a license or permit not related to any business
or commercial venture(i.e.a dog license or permit to burn 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
Form Revised 02-23-15
Pro`ect: The Project is
Remove existing enclosed 8'-0" x 8'-0" two-story porch and roof
from property located at 19-21 Butler Place, Northampton, MA. Construct
new two-story porch with new roof. Specifications refer to plan by Metcalf
& Associates dated 10/15/2019.1
Porch decks and roof to be attached to exterior house walls, with
three concrete piers (to support outside corner and stair landing).
1 precast 56" pier with 2'-0" x 2'-0"footing
2 poured concrete piers 12" diameter x 56"
Main corner support 6" x 6" pressure post.
Post supported by "precast concrete pier"
Stair landing platform supported on the outside by 2 — 12" diameter
steel reinforced poured concrete piers
Roof Framing
2" x 10" spruce 16" on center
Roof decking 1/2" 5-ply CDX plywood
Deck Framing
2" x 8" pressure treated southern yellow pine 16" on center
Stair Landing
3'-0" x 4'-0" 2" x 6" pressure treated o
Stair Stringers
Pressure treated 2" x 12", 3 stringers per staircase
Decking and Stair I reads
5/4" x 6" pressure treated southern yellow pine
Railings (See detail drawing)
All pressure treated southern yellow pine
Top rail 2" x 4"
Balusters 11/4" x 1 1/a" square 4" on center
Bottom rail 2 pieces 3/a" x 31/2" life span preprimed
All fasteners to be galvanized to prevent rust.
Agreement includes all demolition, dumpster, excavation, setting
precast concrete pier, poured concrete piers, two 3'4" x 4'-0" x 12" thick
steel reinforced concrete pads, one at the base of each staircase, framing,
finish, all materials and labor, new foam/rubber membrane roof, clean up
and removal of all construction debris from construction site.
Total Cost $37,400.00
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