17A-272 BP- 2011 -0557
GIS #: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
' Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ADDITION BUILDING PERMIT
Permit# BP- 2011 -0557
Proiect # JS- 2011- 000809
Est. Cost: $92000.00
Fee: $552.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOHN ZIEMINSKI 017889
Lot Size(sq. ft.): 18730.80 Owner: ZUKOWSKI PAUL A & MARYELLEN SALA
Zoning: URB(100)/ Applicant. JOHN ZIEMINSKI
AT. 138 OAK ST
Applicant Address: Phone: Insurance:
8 WOODRIDGE CIRC (413) 247 -9014 Workers
Compensation
HATFIELDMA01038 ISSUED ON :1212112010 0:00:00
TO PERFORM THE FOLLOWING WORK.- CONSTRUCT 16 X 32 ADDITION
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 OccuRancy Signature:
FeeType: Date Paid: Amount:
Building 12/21/2010 0:00:00 $552.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner
File # 13P- 2011 -0557
APPLICANT /CONTACT PERSON JOHN ZIEMINSKI
ADDRESS/PHONE 8 WOODRIDGE CIRC HATFIELD (413) 247 -9014
PROPERTY LOCATION 138 OAK ST
MAP 17A PARCEL 272 001 ZONE URB000)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildiniz Permit Filled out OQ
Fee Paid
T_ypeof Construction: CONSTRUCT 16 X 32 ADDITION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/ Statement or License 017889
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN PRESENTED:
pproved 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 of Health 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
Demolition Delay
L2 M,�Vt /,;?- /D
Signature of Building Of icial Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health, Conservation Commission, Department
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.
r i)Cpar rrCentps
City of Northampton Stags rifer>rit "
Building Department "uiib'sY
.; 212 Main Street �§ Q1N$epl�`i42F�3£Fly z ae a Pr w
Room 100 y 515 t p 1
n Va$/11Va]laU111
r• x+� a`, '2rw a `R .
Northampton, MA 01060 Two Sets�l"Structural P�ahs � � � ��
phone 413- 587 -1240 Fax 413 - 587 -1272 I?telite Pia�ns § d 4
t
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
Map Lot Unit
Zone Overlay District
EfiniSt °District CB District
SECTION 2 -PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record
l% I& - - 1 PA' r 3 Sa c c i ST�rc i (I c 2 �7�i9c�,97 j�,
Na r ( ; in t) Current Mailing Address:
r - " Telephone
S igp6ture
2.2 Authorized Agent:
4,Y t 71 tt PGL"` C 0C
Name (Print) Current Mailing Address:
Signature Telephone
_ _ - - --
SECTIO - ESTfMATED CONSTRUCTION!COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by ermit applicant
1. Building J (a) Building''Permit'Fee
2. Electrical (b) Estimated Total Cost of
O d� Construction from: 6
3. Plumbing S' O L Building Permit Fee
i
4. Mechanical (HVAC) `F, c-
5. Fire Protection '
6. Total = {1 + 2 + 3 + 4 + 5) �j' 2 � C> Check Number 5 r
This Section For Official
Building Permit Number. sue
ed:
Signature:
Building Commissioner /Inspector ofBuildings! Date
f� a
'
'
`
/
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
Re
Building Height
Bldg. Square Footage %
'
Open Space Footage --------- %
(Lot area minus bIdg & paved
# of Parking Spaces
(volume & Location)
A. Has a Special Permit/Vahance/ Finding ever been issued for/on the site?
�� �� ��
NO ��, DON7KNOYY \�� YES �~�
IF YES, date issued:
IF YES: Was the permit recorded at the Registry ofDeeds?
t� »
NO ONTKNOYY YES
'8�� '
IF YES: enter Book Pagd and/or Document#
��
B. Does the �tecontain a brook, body of water orwetlands? NO t�� DON7KNOVV �~� YES
IF YES, has permit been or need to be obtained from the Conservation Commission?
Needs tobeobtained «�� �btaned �~� Date|ssued' ------1
m�� ' ` 'L___—_____{
' »r� .
C. Do any �gnsex�ton the prmpe�y? YES v+� NO
IF YES, describe size, type and location: �
... .............. _-___�_____-__ ...... ........... ....
_�
'
"'
=`~'~'^~' � YES x�� NO ~,p^'`, �~�
|F YES, describe size type and location:
E Will the construction activity disturb ng, grading, excavation, or filling) over 1 acre oris it part nfo common plan
that will disturb over 1 acre? vEs 01
mo
'
|F YES, then o Northampton Storm Water Permit from the DPW is- required.
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition Replacement Windows Alteration(s) Roofing
Or Doors E3
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding [oj Other [ O]
Brief Description of Proposed /4''e ?Z' ' � "�v.� -7V — 'Fr� s7�TJ� ✓ « CF sC -
Work: tir�D�_J�L�cnG�.u�tJ�!Cr� �FZ�!s�rri A'M,�d
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -CS heel'
sa: lf.Nerlu hose and vc addition.to`ez�s�rrg:f�ouslrag; cciinpCete:the.folfowlrig:
a. Use of building : One Family ?e Two Family Other
b. Number of rooms in each family unit: ? Number of Bathrooms
c. Is there a garage attached? & - 7^1C-
d. Proposed Square footage of new construction. S ! Dimensions �3 2-
e. Number of sto ries? C
f. Method of heating? IA Fireplaces or woodsteves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction 4 I
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 AUTHORIZAT70N -'1 O BE COMPLETED "WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject
property
hereby authorize
to act o I mattter relative to work authorized by this building permit application.
Signature of Owner Date
1 "- /&5-� - asAOwrier /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.
Print Name
4 de 144 - - --
Signature f ner /Agent Date
SECTION 8 - CONSTRUCTION SERVICES I
8.1 Licensed Construction Supervisor Not Applicable ❑
Name of License Holder : �� I _' l7 ! l/�/ C l '
License Number
Address Expiration Date
Signature J Telephone
9 . Rdaisferer3. lonie °Improverfent.ContracfoT3 ._3.s. r ... -. ...., ..,..'' ...' Not Applicable ❑
r e-
Company Name Registration Number
L % Z
Address W5 Expiration Date
Telephone '2 If 3i ae
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 162,.§ 25Cf6)
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....... AC No...... ❑
1". ;�Hr�mwner���=Kmtoi
_The_current_exemption.for. "homeowners" was ext ended to include Owner - occupied Dwellings 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 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 ordetached 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 building 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 153 (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
ort amp on r i anc a s General )Jawslnnotated.
Homeowner Signature
s
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washing, ton Street
Boston, MA 02111
'���• www.massgov/dia
- Workers' Compensation Insurance AfflidaNlt: Builders/ Contractors /Electricians/PIumbers
Applicant Information / Please Print Legibly
Name ( Business /Organization/Individual): ✓ F ��nJ h`. � /E�I� ti S/C/ � L lG Z��L � �� C�
Address:
City /State/Zip: Phone. #: c GEC `
7, A you an employer? Check the appropriate box: Type of project (required):. i
. I am a e to r with l 4.. E] I am a general contractor and I
employees full d/or part- time).* have hired the sub- contractors
listed on the attached sheet 7. Remodeling
2. ❑ I am a sole proprietor or partner-
ship and have no employees These sub - contractors have. .g. Demo',ii'don
working' for me in an ca _aci employ a nd have workers'
- - y p - ty' _ 9. {- Building addition
[No workers' comp c . ms,ran ompinsman
required] 5. F We are a corporation and its 10,R ElectricaI repairs or additions
31 I am -a omeo-uFner Being all �vorlc -- - -_ _._ of eers�aa xercised their __.I_I P um .Bing repairs or additions
myself [No workers' comp. right of exemption per MGL 12. VI Roof repairs
insurance required] t c. 152, §1(4), and we have no
employees. [No workers 13.0 Other
comp, insuran required.}.
*Any applicant that checks box #.1 must also fill out the section belowshowing their workers' compensation policy information.
t Homeowners who submit this affidavit.indicating they are doingaR work and then hire outside contractors must submit anew affidavit indicating such
zContractors 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: SJ CL."<ti /z 4 6' d ,,� e -7 � .
Policy # or Self ins. Lic. #: SGG�D G' fir /a l / Expiration Date: �1_3zlll
Job Site Address: S: ` /: "Z2% 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 Section 25A of MGL' c. 152 can lead to the imposition of criminal penalties of a
fine up to $1 and/or one imprisonment; as well as civil Penalties in the form of a STOP WORK ORDER and a ane
of up to $250.00 a day against the violator. • L e advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage Verificat
I do hereby:_certif under the pains and penalties of perjury that the information provided_above islrue- aridcorrect -__ __
Si tune: Date:
Phone #.
Official use only Do nvt wrrte in this area, to be completed by city or fawn offciaL
City or Town: Permit/License #
Issuing Authority (circle one):
I. Board of Health 2. Iluildinb Department 3. City/Town Clerk .4. Electrial i
cnsp ector 5. PIumbing Ins pector_
6. Other
-._ _
Contact Person: Phone #:
Massachusetts - Department of Public SafetN
Board of Building Re- ulations and. Standards
Construction Supervisor License
License: CS 17889
Restricted to: 00
JOHN H ZIEMINSKI a '
8 WOODRIDGE CIRCLE 48
HATFIELD, MA 01038 k #`
Expiration: 2/25/2012
t'un►mi,tii»ur Tr #: 15199
Office of Consumer Affairs & Business Regulation
HOME IMPROVEMENT CONTRACTOR
_ Registration: 400133 Type:
A — _ Expiration: 6/9/2012 DBA
JOHN H. ZIEMINSKI BUjLDER /CQNTR.
i
John Zieminski
8 CIRCLE DR. a�_��,
HATFIELD, MA 01038' Undersecretary
i
7
F
13 �-'� e '`" „ ' �"� / i C""� �� p� L::..t ��C`S(u f+.�� " "� „ ��'' � ,r 1_'� =•.:f F;pa�:. 4 � ,� +'±L' f:; ?��g T
�^" 1 ` 9'� 4 � • ���" . ��.i ��; `� ' .�_ � � �a - ,x,11
i
� I
�1
j
d ! 1�,-'V w
it
,; ' 4 6TtCi.cSG�J
3 tar {
yN f k
7 '
� IA
k � i
December 20, -2010 '
John Zieminski
8 Woodridge Circle
Hatfield, MA 01038
Subject Property:
138 Oak Street
Northampton, MA 01062
Mr. Zieminski
The plans for the 16 x 32 addition dated 12 -18 -10 have been approved as noted;
1. Engineering for truss and LVL submitted before rough inspection.
2. Structure must conform to 780 CMR 7 th addition 1 and 2 family with 2009 IECC.
a. Ceilings R -38 insulation after air ceiling.
b. Walls R -20 cavity insulation or R -13 cavity and R -5 continuous.
c. Existing walls exposed without insulation add R -3 per inch of wall.
d. Floors R -30 or fill the cavity, but R -19 minimum. Push up rods 2' O.C.
e. Basement walls R -13 cavity or R -10 continuous.
f. Slab R -10 for 2' at perimeter, add R -5 at edge if radiant heated floor.
g. Windows .35 U- Value.
3. Smoke and CO per code, plan and as noted.
a. A smoke and CO detector at the bottom of the stairs and a heat detector in the garage.
Charles Miller
Assistant Commissioner of Buildings
E
.L
F
Ra i
i
r
}
i
t
f� \
n LU
e
C
9 d 91 I �� ' � £ 1p !As I�' II`� I
� L I ,
siawl• z�
a�+.+r. m+azer >uo S,.r i'6 dYOi°�AT4V Msl AlYS>.✓ _ l� -� IC � � /(-(,
�? Ra,l Umt
(MSibK
Yry 2 <�JII•
_ ��yrr� • TiL t% '6 41 1 1 1 i) wwr
2
NN o
A, �
� n./ f✓ti.
-. Rar•. rN �_ I I
• w_bMr �brl� -• _�.
�,/ — - n✓ew.wq
d - re• rrw. u� 'aJ' .r. aena 1
as.
•,. r w a• � �"� 1 Gwsu /wars
l aw
✓ww.a^ .necr 'S' 11Y� rw 0 rp'n...7 1 .
.LrsS M¢.K � �� (AO) p 1 �� ���I� L•�1
® t.a -.L -c. grwrvL .,. ,., a�� � � �• v v I
(;. 'L. "'ric FVe„r rRw' a. -� ,• 1 ' —d ..� w_.. .��+ sx,c{e
�N �ysti.
V +MNF wa(. FCa�:: tort.. _ N.,. [wr.1 •• � , -
=nY
1
\, aw
=a — — — —
g.ru: --nb - �
�e ily i Yrmww
S,W>mm lr Nrc. .✓ r•vsn..w n.)w 4i J r.r.
/'CNfll ,ypJ J/Y �T4 4HLF. bmo ens. I -
.GVRW�( ^,M � �A
SW /ORr Cc1 .�.Lf 1 CNG ✓ I, 1
Pow c. w .Y+ +.... r• -e -e.e j
4✓ aua - ubrJ
i L'w//n t lwOr.v
$Melt,+ jrB.^
w.ta at w /...sn -rn.n.♦ a }e (yAJp✓ . AI'N lNeIJ
Nw).. aan;>` -•'x• wn +Lror ;�. __ II- _ _ - _ — -- - }_ _ � - _ lad wsc ar Fwro.+, ^"
m. «y w +.w fy/N XIN '. NY NLMJ
s 9Y. ✓rHw✓ ✓AW d[ Cft ewer n�bY
/Me w/I/ arD .A' NL(DfD S/Ml! 14 • Oj
ICf✓l'NN -Nw yrnnrw ... 'w Rtl ,w a..r / b, .7PUx1 200M 4r' r
NQI /4`YIiW Lt.VL- .QVa Gfftn.i! OMY
pL y/v d.NNtd A4.iD R.f AN)r