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35-169 (19) 1345 BURTS PIT RD BP-2020-1068 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 35- 169 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: KITCHEN RENO BUILDING PERMIT Permit# BP-2020-1068 Proiect# JS-2020-001812 Est.Cost: $28500.00 Fee.$185.25 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: WALTER MAREK III 055201 Lot Size(sq.ft.): 19994.04 Owner: PELIS LAUREL Zoning: Aoolicant. WALTER MAREK III AT. 1345 BURTS PIT RD Applicant Address: Phone: Insurance: 73 SOUTHAMPTON RD (413) 527-76670 Workers Compensation WESTHAMPTONMA01027 ISSUED ON:4/23/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-KITCHEN ADDITION AND RENO 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 4/23/2020 0:00:00 $185.25 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit �: 212 Main Street APR 2 2 2iSewer/Septic Availability 1► Room 100 Water/Well Availability Northampton, MA 010- - -- Two•Sets of Structural Plans phone 413-587-1240 Fax 413-58741 72 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office 13y 5 ��- Map36� Lot Unit� Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of eco d: 41re 13 H S Name(P Current Mailing Address: Telephone Si natu 2.2 Authorized AgenMq A/ rtl Name(P' t) Current Mailing Address: 11� ';7�z Lj 13 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 0 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of o&) Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5) Check Number Q This Section For Official Use Only / Building Permit Number: V��' � Dsued: Late Z &70 ��R�r Signature: VU Building Commissioner/Inspector of Buildings Date v EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size �,('l(} a�i�(7 r�f Frontage OUB ou Setbacks Front SU 1-N � ,1, i' Side L:0 k1 R: �0 L: R: �� Rear IvU I(J� Building Height Bldg. Square Footagef�e % J3 9 Open Space Footage �W o % (Lot area minus bldg&paved parking) #of Parking Spaces all Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 4 DONT KNOW O 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 JW 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 kv IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ReplacementtWWindows Alterations) E] Roofing F-1Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding[l]] Other[d] Brief Descrip(ian of ropod Work: A J �� Alteration of existing bedroom YesO�_No Adding new bedroom Yes K No Attached Narrative Renovating unfinished basement 'Yes _No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building:One Family t9< Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? i 1 d. Proposed Square footage of new construction. j� Dimensions I V IX e. Number of stories? ' f. Method of heating? Oil Fireplaces or Woodstoves ' FP Number of each g. Energy Conservation CompWance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade y/ 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, Lau' "' 'e/I 1` ,as Owner of the subject property c- hereby authorize to act on my behalf,Alftearrs relative to work authorized by this building permit application. Signature of Owner Date I,—O(X ftV /144f ,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. Signeg unper the pains and penalties of pedury. Print Name ' Signature ner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Co structioo Su� {rvi or: ,gyp Not Applicable ❑ Name of License Holder: �-"1 �r �'� C3 G �t Live7;� m er E � Add Bss Expiration Elate Signature Telephone 9.Re Istered Home Improvement Contractor: Not Applicable ❑ LJ�-�010,( - ! sq Lin Company Name RegitraTV0,110 n Number 3 n Ad(dres))s /f ExpiratiDate V TelephoneLl' G�� Ct"� SECTION 10.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....... No...... ❑ i ———— I I --------- - ---- ------ ----- LVL -- --- - ---- ------ ----- LVL Engineered Beam to carry Exsisting Roof ADD"WR \\ I I }=XSIStInCJ m &ceiling Load � House New Addition (KITCHEN) EXsistin9 (W—w #ti - Hatchway GlmfSene DI rugsher lu I O - BACK ELEVATION 5c-ale 1/8" - - 12, 3�E 5 1st Floor 5cale 1/4" ADDITION-1345 Burts Pit Road-1345 Burts Pit Road W.Marek Inc. l3 5outhampton Rd. Westhampton, Ma. ROOF SYSTEM 2x8-12'Rafters 2x8-12"Gelling Joists 5/8"Zip Sheathing EXTERIOR TRIM Underlatment/Ice Barrier Match House Trim Drip Edge Eaves-12"Vented 30 Year Shingle Rakes-4"Solid Ridge Vent INSULATION R-19 FRAME WALL5 WALL SYSTEM 8-411 CEILING 2xb Exterior Walls 1 b"oc R-19 BASEMENT WALL5 1/2"Zip Sheathing Siding as House FLOOR SYSTEM Exsisting 2X10-Floor Joists Gut Access to Basement, New Grdwl5pace Basement 3/4"Advantech Sheathing 4"Concrete 51ab F_xsistina Basement', 2xb PT Plates -- - -------I I I ---- Gross Section I I New Addition I I I I Scale 1/4" 8"x1b"Footing 8 I I I I 8"x5'0"concrete Walls l ---J ------------ I 12' 5' ADDITION-1345 Burts Pit Road Foundation W.Marek Inc. Scale 1/4" 13 Southampton Rd. Westhampton, Ma. Of —�� °5 r _ ' os 01 `7&kCC 9 s I QO -- ' � 71, l 1 1 � ♦ 4 DATE(MM/DD/YYYY) nco CERTIFICATE OF LIABILITY INSURANCE 02/06/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT K.S.K.INSURANCE AGENCY,INC. PHONE 413 527-7859FAX 413 527-8314 203 Northampton St. E-MAILS. Lravissias ksk-insurance.com P.0.BOX 597 INSURERS AFFORDING COVERAGE NAIC# Easthampton MA 01027 INSeRERA; PHENIX MUTUAL INS CO INSURED INSURER B: ASSOCIATED EMPLOYERS INSURANCE CO W.Marek Incorporated INSURER C 73 Southampton Rd INSURER D: Westhampton MA 01027 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DDL UB POLICY EFF POLICY EXP POLICYLTR NUMBER LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 FM CLAIMS-MADE OCCUR DAMAGE TO RENTED $50,000 �P0719447 11/01/2019 11/01/2020 MED EXP(Any oneperson) $5,000 PERSONAL 8 ADV INJURY S1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000 000 POLICY❑PRO ❑LOC PRODUCTS-COMP/OP AGG $1,000,000 JECT OTHER S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per acadent) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS 'Per 5 UMBRELLA LIAB HOCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S R T TI N $ WORKERS COMPENSATION 'PTARTHTE OTH- AND EMPLOYERS'LIABILITYFIR ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E .EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? N/A WCC-500-5014290-2020A 02/10/2020 02/10/2021 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) GENERAL CONTRACTOR CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. R /'� AUTHOED REPRESENTATIVEJv � <DA> ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD -------------------- Commonwealth of Massachusetts Division of Professional Licensure ` Board of Building Regulations and Standards Constructibn'Sapervisor CS-055201 T EXpires:0612312020 WALTER L MAREK,III Y 73 SOUTHAMPTON ROAD ti J WESTFIAMPTON-MA 01027' Commissioner ��ouurrournrw�(�r o� Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Cmorabo r on Reoi�trat on 0412 159488 W.MAREK INC. WALTER MAREK III 73 SOUTHAMPTON RD. Undersecretary W ESTHAMPTON,MA 01027 F The CQYrtfflllftFl/ECtltl2 DfMtfsSGrClfttse'tt5 Delw7riment of lniltdsti-ial Accicfe its 1 Coli ress Street, Suite 100 j Boston,M4 02.114-20.17 � " �.�, �` Ft�tvFt:ft2ass.govlrlia Workers'Compensation IusuranceAffidavit;Buildors/CoutractorsfEttectrici ins/Plnmbers. TO BE MUD'VITHTHE MIN11TTING AUTHORITY. f Applicant Information Please Print Legibl } Name(Business/Organization/Irtdividuat)?�'�Nr 1 �1� \� C•• l r Address: uJ� '� ''� City/State/Zip: �� >r� /� 't vi i Phone it: Are you an employer?Check appropriate box: Type of project(required): I�I am a employer with_--_�__ etoployees(Cull and/or part-time).* 7. 0 New construction 2- 1amasole proprietor orpartnershipand have noemploycesworking for me in S. QRemodeling any capacity.[No v,orker comp.insurance required.] i { 9. ❑Demolition i I 3•(--J lama kcmeowmcrdoing all workmyself [\o workers'comp.iaa<rrancc required.)t t j 10❑Building addition ; 4:FJ I am a homeowner and will be hiring contractor to conduct all work on my property.I will ensure that all contractors either have workers'compensation inswance or are sole I Ln Electrical repairs or additions 1i proprietors with no employees. 12.n plumbing repairs or additions 5.❑I am a general couhactorand I have hired the sub-contractors listed on the allacbed sheet. 13.❑Roof repairs Thasc sub-contractorsbave employees and haveworkers'comp.insurance-1 6.E3 We are a corporation audits officers have exercLcd their tight of exemption perMGL c. 14.❑Others 152,§10),and we have no employees.[No workers'comp.i nsuraacerequired.] *Any applicant that checks box N1 most also fill aut the section below showing their1vorkers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all York and then hire outside contractorsmust submit a new affidavit indicating such_ tContmctors that check this box must attached an additional sheet showing the nacre of the sub-contractors and state whether or not those entities have employees. 1f the sub-contractors have employees,they must provide their woftrs'comp.policy number. I ant an employer that irprovidiug workers'compensation instrraacefor my employees Below is thepalicy and job site ittfortttatiotr. Insurance Company Name:{,_ Policy#or Self-ins.Lic.#;W ' (700 ~ 1t� Expiration Date: a`� ! r Job Site Address: i�- t t , l i _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 MGL c. 152,§25A is a criminal violation punishable by a fine up to S 1,500.00 and/or one-year imprisonment,as melt as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 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. _ Ido hereby certify viiier the pants td penal' fperjury that the information provided above is trite and correct. SiLmaturc Date: Phone#: Official use only. Do not ivrite 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 S.Plumbing Inspector 6.Other Contact Versa= Phone#: jt