32A-121 71 KING ST UNIT A COMMONWEALTH OF MASSACHUSETTS BP-2021-1811
Map:Block:Lot:32A-121-
001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2021-1811 PERMISSION IS HEREBY GRANTED TO:
Project# Contractor: License:
STOSZ CONSTRUCTION &
Est.Cost: 7700 PROPERTY SERVICES INC 002209
Const.Class: Exp.Date:03/29/2022
Use Group: Owner: J W INC
Lot Size (sq.ft.)
STOSZ CONSTRUCTION &PROPERTY SERVICES
Zoning: CB Applicant: INC
Applicant Address Phone: Insurance:
115 MARKET HILL RD (413)374-4715
AMHERST,MA 01002
ISSUED ON:08/30/2021
TO PERFORM THE FOLLOWING WORK:
ROOF OVER BACK LOW SLOPE
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.
Signature: I 51-11
• el
' I
Fees Paid: $100.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
.13
v� G>
S'pG
' : c G The Commonwealth of Massachusetts
`.,' ? Office of Public Safety and Inspections
�r' N Massachusetts State Building Code(780 CMR)
Bu ldin it Application for any Building other than a One-or Two-Family Dwelling
0 oz (This Section For Official Use Only)
Building Permi N`Qmber: 17• Date Applied: Building Official:
SECTION 1:LOCATION
_71 King Street Northampton Ma 01060 Whalen Insurance
No.and Street City/Town Zip Code Name of Building(if applicable)
3.A • jZI
Assessors Map# Block#and/or Lot #
SECTION 2:PROPOSED WORK
Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below
Existing Building x Repair x Alteration 0 Addition 0 Demolition ❑ (Please fill out and submit Appendix 2)
Change of Use 0 Range of Occupancy 0 Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 NO
Is an Independent Structural Engineering Peer Review required? Yes ❑ *lo ❑
Brief Description of Proposed Work Install New metal standing seam roof over back low slope 16 x24 roof with new side and
end wall flashings.Repair/replace various pieces of water damged exterior trim
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 0 E: Educational 0
F: Factory F-1 ❑ F2❑ H: High Hazard H-1 0 H-2 0 H-3 0 H-4❑ H-5 0
I: Institutional I-1 0 I-2❑ I-3❑ I-4❑ M: Mercantile 0 R Residential R-10 R-2 0 R-3 0 R-4 0
S: Storage S-1 ❑ S-2 0 U: Utility 0 Special Use 0 and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA 0 IB 0 HA CI IIB0 IIIA0 RIB IV 0 VA 0 VBD
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item)
Water Supply: Flood Zone Information Sewage Disposal:
Trench Permit: Debris Removal:
Public CICheck if outside Flood Zone 0 Indicate municipal❑
A trench will not be Licensed Disposal Site 0
Private 0 or indentify Zone: or on site system 0 required 0 or trench or specify:
permit is enclosed 0
Railroad right-of-way: Hazards to Air Navigation
Not Applicable 0 Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed 0 Yes 0 or No 0 Yes 0 No 0
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction:
Does the building contain an Sprinkler System?: Special Stipulations:
Design Occupant Load per Floor and Assembly space:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
JWInc
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information
Peter Whalen 413 5861000 - peter@whaleninsurance.com
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes:
Michael Stosz 115 Market Hill Road Amherst Ma 01002
Name Street Address City/Town State Zip
to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1)
If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here O.
Otherwise provide col strudion control forms(see section 107 in the rode)as required.
10.1 Registered Professional Responsible for Construction Control (the professional coordinating document submittals)
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
Stosz Construction&Property Services Inc
P y
Com an Name (� y1/
Michael Stosz CS 002209 U ) )'4
Name of Person Responsible for Construction License No. and Type if Applicable
115 Market Hill Road Amherst Ma 01002
Street Address City/Town State Zip
413 374 4715 413 374 4715 stosz@hotmail.com
Telephone No.(business) Telephone No.(cell) e-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152.§25C(6))
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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.
Is a signed Affidavit submitted with this application? Yes iisa No C]
SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor '
and Materials) Total Construction Cost(from Item 6)=$7700
1.Building $ 7700
Building Permit Fee=Total Construction Cost x sa nn(Insert here
2.Electrical $ appropriate municipal factor)=$ $56
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$t 00.00 (co 'pali
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost $7700 (contact municipality)and write check num /b
SECTION 1&SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this
application is true and accurate to the best of my knowledge and understanding.
Michael I Stosz president 413 374 4715 8/23/20021
Please print and sign name Title 'elepbpne No Date
115 Market Hill Road Amherst Ma 01002 tos otmail.com
Street Address City/Town State Zip Email Address
Municipal Inspector to fill out this section upon application approval: D-Z 1'ZOZ I
Name Date
City of Northampton
.v.„.,:,,,,4,,,.
Massachusetts
lr j
DEPARTMENT OF BUILDING INSPECTIONS f
w; 212 Main Street • Municipal BuildingA
-- Northampton, MA 01060
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
Valley Recycling
Location of Facility: 234 Easthampton Rd. Northampton, MA 01060
The debris will be transported by:
Name of Hauler: Stosz Construction & Property Services Inc
Signature of Applicant: Date: 8/23/2021
The Commonwealth of_%lasutchusetts
Delr artntentof Industrial.4ceidents•
I Congress'Street,Suite 100
Bosun, 12114-201
wwrttmass.govldia
11titkern' ('orripensatiem Insurance Affidarit:Builders/ ontracturr'FlectriciansiPlunibt:rs.
It)t31r. I ILIA)% 1111 I III Mkt!!Cfi\t:.tt fktt R1 I1..
1u,1ic Out lnforniatiun Please Print Let!ihk
�ita,ir 11 ln,. s tnlanrzatIon tn.}t•,,,t,;. Stosz Construction & Property Services Inc
Address:___ 115 Market Hill Road, Amherst Ma 01002
City.State;' ip:__ Piton.2 413 374 4715
%rrti tin tvgttwet?('`cck Ilbr appropriate ltae:
7'y pr of ltrojecl(required).i.-r::s a:a•„•+v=ntr 8 :m}-'t•a'CC<ri:r^:ru tax-t` '- `t t etYtai.li3litiUil
—0 e ant a 11.1It ptatrtl tetul tit pal int:0cup alio Itaa-a ii s C1111i10y/x,eea lMU/Zt ra,t fan el'r r a s Remodeling
ar!.t Lit4.(No a.orki,:t$'',amp.insurance moused.)
9. Demolition
3.0 Ian a hturA miner doing ai.1 aitrk m.a<!t tNt a,s(kaz••'cun•gt uwurr:t.r regLus !.
10 fl Budding addition
t.n f am u hurler allet and t lI rho flunks cenmrru'tvn, ciandutt all stark t*Il nur prrsixrt . I will
` a:�•.LIt t::r:.11;a•.u1t:lc:.lcs clfla i..,ta .+.!ik.ts au¢t ,.0 iI..t;.u;4r i:t ti us l:,.uk 1 10 i:Ic'.tii.ai tepairN err lilEllt:'.t3ir
gttt.(gf t a s tei at c n,h y'CCs_
i 2; Illll:iitJ311};l4"�:ilt"s tli .iilfli[i.trla
:• ,.._,a •I•.._•' r a,l!l: :.a.t.d'I• I!•r..t t ,r;.r `.t t.:_'..•l.°I :.e.t,`ia .ic..:
These•rub-contra.tln•have entplcryce,and Isae a%%-o kern'comp.imenmnee I3.JRoof repairs
l4.Cl Other
to r4t are a cor'rptirtutxafl and IN taker,.ha'. t::t.i^ccd lb en rwki et-exemption pa IOW_e.
i{= �tlit.and we have no titlptuyee.,I\u'sunken.'i.trznp.tnm./:MCt:tyuttral-1
':nll,t ,xt:Li.s,l t tIl.>w Cikvii eita:.s.:...,u t t .:.ts1 .ta+/ ..:s .one cination pulp;le i.xxl:alto r.
,?t^•the•«eshttrt th--xStisl.•,.t iat+ac:»tar they arc tlotna:aft wr.tk and d•ken tint:tie t.t•:•:t lI.-_tt - mt_•t.4444 a re+e attid as It,eructax:
cheek 1-St, mu t set_cKrd an add41,.nal sdle,t s raa tn=:I:.'nattu:-f the:r:U?--.:amrrntl:r�:at1 srae,a ht:itter rtr:lot ten:•.c:rsttit:,h_
empl..ayee r. It the sub-cunta_utter llAse e-tnrlu%.ts.the}must piii I k tnttr 'l.trkers'.Vnp.patent-manner
1 urn on emplut'e'r that is providing n•errders'compensation insurance fi/r my emphiyers. Below A the policy and job site
in/orrnuliun.
lil.t-7.7ra�t_a;i-':r5'• :[?ili travelers
Putter r,r Solt=tn . l_a.. 7Pjub-2e29014-9-21 I-tptratiors t)irt.:: 6/27/2022
lob sire Address: _._7_.1_.King...Sireet...._..__.,_.__--._...._. c its Slate Zip: Northampton MA 01060
Attach a cope of the r+orkers'compensation poled'declaration page(showing the policy number and e•ytir,tl i'iii
Failure tee secure<or'er;ige,i,required under M( L e. 152. ,'SA is a criminal t ic,ratron punishable by a line up to ' t a t
and ctr one-year imprisonment.as well as civil penalties in the form if a STOP 1W't7RK ORDER and a line of up lc '':l fi.I)1U a
day awaimstthe violator. A copy of this statement may be forwarded to the()nice tit Inv e ttrattuns of the [MA for insurance
cot erage v'ert Ire:ation.
1 do hereby t erti/i•utrder the pains um!penalties n/perjury sheet the iralrrrrnrttion provided above i.trite yin rt t orret t.
krte iaa.�ataig 8/23/2021
413 374 4715
Official use only. Do not write in this area.to be completed by city or town official_
City or'Coon: Pernriti License P
Issuing Autlwritr icirele• tine):
I. Board t+f health 2. Buildin;:Itepartnwnt 3.( t 'Tarsn('lerk 4.I?,lectrical Inspector 5. Plumbing !ropectar
6.Other
('otttat:t Person: Phone#: