32A-016 (8) 9 WALNUT ST BP-2020-1110
GIs#: COMMONWEALTH OF MASSACHUSETTS
ME:Block: 32A-016 CITY OF NORTHAMPTON
Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: REPLACEMENT STAIRS L UI LD IN G PERMIT
Permit# BP-2020-1110
Proiect# JS-2020-001864
Est.Cost:$2500.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: WILLIAM TUROMSHA 000515
Lot Size(sq. ft.): Owner: FAYTELL DAVID
zoning: Applicant: WILLIAM TUROMSHA
AT. 9 WALNUT ST
Applicant Address: Phone: Insurance:
I I WILLIAMS ST (413) 586-4005
NORTHAMPTONMA01060 ISSUED ON:5/7/2020 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPLACE STEPS AND LANDING
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 Si;mature:
FeeTvpe: Date Paid: Amount:
Building 5/7/2020 0:00:00 $65.00
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 tr>'aY Curb Cut/priveway Permit
212 Main Street q�er/Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two,Sets of Structural Plans i
phone 413-587-1240 Fax 413-587-1272- Plot/Site Plans
Other Spec6
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
qs), 9,/n a �— ) Map Lot1Unit
A)Qro..6"p�lI D a Zone Overlay District
Elm St. District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
le t) Current Mailing Address: ,
Telephone
Signkurldl
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
_ _ f
Signature Telephone
_J
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Buildingoc� (a) Building Permit Fee
0250 .
2. Electrical (b) Estimated Total Cost of
Construction from 6 i
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total= 0 +2 +3+4+5) Check Number Z
This Section For Official Use OnlBuilding Permit Number: a_.j0_ �� D Date
Issued: 7 � L
Signature:
Building Commissioner/Inspector of Buildings Date
G5 3 @ C� l�t4-nl c oil
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
Frontage
Setbacks Front
Side L:17.j R Ll R:I
6.. ...� ................
Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
(Lot area minus bldg&paved ...,_
parking)
#of Parking Spaces
Fill:
i
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DON'T KNOW YES 0
IF YES, date issued: ___.
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW YES Q
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 Q , 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 0 NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, gradin , excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all amilcablel
New House F_� Addition ❑ Replacement Windows Alteration(s) Roofing
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [[:3] Decks [0 Siding [p] Other
Brief Description of Proposed /
Work: Rf IQ1 Ct_C.I: .[
Alteration of existing bedroom Yes No Adding new bedroom Yes __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 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 of 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 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
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,
-_bov(. ce r `l as Owner of the subject
p perty
hereby authorize
toc my be f, ' I tters relative to work authorized by this building permit application.
Signature of Own r 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 perjury.
L Lel'C./
Prinma
of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
6. Registered Home Improvement Contractor: Not Applicable ❑
DrAAC(S CS�ti l��ocJ'�S �CCUid- �(n5
Company Name Registration Number
q. 1 /leo r- 5fi /Uo r �, � �I- ati c7 ) -+6111
Address 7� Expiration Date
/
41aA Telephone (Q j/,,Lj�
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...... ❑
City of Northampton
Massachusetts �5� _
DEPARTMENT OF BUILDING INSPECTIONS x
212 Main Street •Municipal Building
w Northampton, MA 01060 � '.u•, �`��
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 performed at:
-q -B �) 4-A rwl -
(Please print house number and street name)
Is to be disposed of at:
Q Ct-L4 6 e �
(Please Orint name and Iodation of facil )
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
*ignat4ure(bfF)6rmi p icant 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.
City of Northampton
Massachusetts
NY,
DEPARTMENT OF BUILDING INSPECTIONS
r
212 Main Street • Municipal Building Ja..
Northampton, MA 010601
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, demolition, or construction of an addition to any pre-existing owner-occupied building containing
at least one but not more than four dwelling units .or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note:If the homeowner has contracted with a corporation or LLC,that entity must be registeretL
Type of Work: +Lari Est. Cost: �5 D O D C)
Address of Work: 4 B �J h U 4— :547
Date of Permit Application:
I P11
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law(explain):
_Job under$1,000.00
7X Owner obtaining own permit(explain):
Building not owner-occupied
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:
Notwithstanding the a notice,I hereb ppl�for a building permit as the owner of the above property:
v1
Dae n e apeSignature
The Commonwealth of Massachusetts
Department of IndustrialAccidents
d I Congress Street,Suite 100
r Boston, MA 02114-2017
r
www mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Apiflicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address: q B lilt 01 1.
City/State/Zip: A klr4 a vK oizmA x4hone#: `"( (3 —4;)-,3-7--- 4 LI%3L—
Are you an employer?Check the appropriate box: Type of project(required):
1.❑I am a employer with employees(full and/or part-time).' 7. ❑New construction
2.❑1 am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling
any capacity.[No workers'comp.insurance required.]
9. El Demolition
3,F-1 I am a homeowner doing all work myself[No workers'comp.insurance required.]t
10[]Building addition
4.�1 am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.[D Electrical repairs or additions
proprietors with no employees.
12.[:]Plumbing repairs or additions
�.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E]Roof repairs
These sub-contractors have employees and have workers'comp.insurance: p
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
152,§1(4),and we have no employees.[No workers'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:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: 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$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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage v ification.
I do hereby ce under t s d pen ies of perjury that the information provided uhove is true and correct.
Date:
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#:
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SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: �l//t prh t�r� r,, }t�y CS —O O O Cr 6-
License
License Number
o M oz/k/ 900 d �2D
Address Expirbtion#Date
7P V4
Signature Telephone
9.Registered Home Improvement Contractor Not Applicable ❑
fCl a►-•a r riffs" /0/;1ZZ
Compspa vnv Name Registration Number
l� Lt/ill�pr..e 5!Q.fs i�"j- /�o:e3}�rar.p�s J �Y1✓a (��
Address Expiration ate
Telephone X1/3575 49yn
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...... ❑
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellines of one(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.CMR 780, Sixth Edition Section 108.3.5.1
Definition of Homeowner: Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the buildine permit
As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 1.53 (Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature