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17A-272 (2) .h° BP- 2011 -0494 GIS #: COMMONWEALTH OF MASSACHUSETTS 21� CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2011 -0494 Project # JS- 2011- 000809 Est. Cost: $10000.00 Fee: $60.00 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 :1112912010 0:00:00 TO PERFORM THE FOLLOWING WORK .-CONSTRUCT FOUNDATION ONLY FOR 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 Occupancy Signature: FeeType: Date Paid: Amount: Building 11/29/2010 0:00:00 $60.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner x�� aflepa . merit use only ,a y City of Northampton Sttu ysf Pemr�t g <' _.�..._.. _._ Building Department Ct��u .9rivewa Perrr4it a ."L 212 Main Street aevrterlse F Availabill tVh � � r , T NOV 2 3 2010 Room 100 Owe Northampton, MA 01060 ns t phone 413; 587 -1240 Fax 413- 587 -1272 PJdfl�f ri 3 s " " %V j " �is� 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 /3� 0,fk 57 — Map Lot: Unit °Zone Overlay District EIm,St" District CB District SECTION 2 PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record L d !2 of W > lIC /u` S %�T .. f <% �. ,r�/t>n> Gof�e ,,Cy•i Name rint) Current ailing A dress: 6 IBS 2 " Telephone Signature 2.2 Authorized Agent: - 7 � Name (Print) Current Mailing Address: Signature•, Telephone SECTION 3 ESTIMATED C64STRUaTOWCOSTS ' Item Estimated Cost (Dollars) to be Official Use Only com leted by ermit applicant 1. Building nD0 (a) Building Permit Fee 2. Electrical (b) estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee t ^ 0 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) Check Number This Section For Official Use Only I Date Building Permit Number: Issued Signature: u 1 Building Commissioner /Inspector of'Buildings Date j rzk i c SECTION 5 DESCRIPTION OF PROPOSED '''WORK'(check all applicable) New House ❑ Addition © Replacement Windows Alteration(s) ® Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Sign [O Decks [C] Siding [O] Other [C]] Brief Description of Proposed Y 371 f " Work: t 1 ST)A( I♦ east 1 pt �c„�i�sG f l.�r 'i SuC 7r� .SiYore aT (3�i`7}f5 r KIT Alteration of existing bedroom X Yes No Adding new bedroom x Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet l sa: If Newhouse =and ' " addI666 to `existing holi slug' complete th64 olcawind: a. Use of building : One Family X,'_ Two Family Other b. Number of rooms in each family unit: 4 Number of Bathrooms Z c. Is there a garage attached? L X1577,je� d. Proposed Square footage of new construction. 512- Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves 6Zs s77 Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction We %old rFrz,tw c i. Is construction within 100 ft. of wetlands? Yes X_ 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? x Yes No. I. Septic Tank City Sewer X Private well City water Supply !�C SECTION 7a -OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT `. 1, 1 ,2 1 4 ,Q G2 /� C' c JS,C�/ as Owner of the subject property hereby authorize to act on r�r .y behalf, in all matters relative to work authorized by this building permit application. Signature of Owner V Date as C maw /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. ./ d%l�� ll Z ice �'-'I �.� s✓�/ Print Name Signature of ne Agent Date SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor Not Applicable ❑ Name of License Holder: License Number _/__)c e vD d/* C C ( ­l C G" /' *7 f J r Address Expiration Date y13 2. rqc 3 Iq 6 Signature TelephoneZ ZS —/2- 9 Ream #en�'d:Home.li'proverr"ieni<:C n � ..�.,�<�,.� >tatu. - � _. ._ .�._. Not Applicable ❑ �'j � /� - "� %L✓vl i iJ 5 /�% rJ L<-� CG� � ll Cc -{b <��„� Company Name Registration Number o t< =i 1r ,4- �� ° >� 10 Expiration Date Gc�C Lt C Zj51�d Telephone (, / SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, §;25C(6))i 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...... ❑ �.�._:.Hone�tJwrier Ez+wmption' The current exemption for "homeowners" was extended 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 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 fonn 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 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 Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature The Commonwealth of Massachusetts Department oflndustrial Accidents Office of In vestigations 600 Washington Street Boston, MA 02111 s• i www.mass gorli a -Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/PIumbers Applicant Information g Please Print Leibly Name ( Business /Orgmization/Individ J ual): t 1 f 4 �Z f t 1­ .I t (� EVE f C �,-✓�? gym,. v�2 Address: �� w r 'b 4s b 6 E C -e r. City/State/Zip: l'� "tom `� /`f •�- G >/ c �s' Phone. #: Are you an employer?. Check the appropriate'box: Type of project (required): /� 1. I am a e Io er with 4.. E] I am a general contractor and I y 6. ❑New construction employees (full and/or part-time).* have hired the sub- contractors 2. Ej I am a sole proprietor or partner- listed on the attached sheet 7. Remodeling shi and. have no : eioyees These sub - contractors have. .8. [] Demolition working for me in any capacity. employees and have workers'. f _ 9 E1,130ding iLM66n [N�e workepl eortilr insurance - 10 Electrical r required ] 5. [� We are a corporation and its ❑ epairs or additions 3.0 I am a homeowner doing all work officers haveGercisec their l l.❑ Plumbing repairs or additions myself [No workers' comp. right af exemption per MGL 12 Roof repairs insuran required.] t P. 152, §1(4), and we have no employees: [No workers' 13.[:] Other Pomp. nisurane required.]. "Any applicant $sat checks -box #1 must also fin out the section below.showiug their workers'. compensation policy information: t Homeowners who submit this affidavit. indicating they are doing an work and then hire outride cont wtots must submit anew affidavit indicating such. :Contractors that check this box must. attached an additional sheet showing the name of the sub = contractors add state whether or not those entities have employees. If the sub-contcac.�tors have employees, they nnrstprovide their workers' comp..policy number. Jam 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: #: `J 6 6t y e Expiration Date: , " _ Job S itar Address: 3 S" nk« 57. f "mac ?. /c c- cC City(5tafe/7ip: Attach a copy of the workers" compensation policy declaration page the p9Iicy number andexpiration date). Failure to" secure coverage as regwred'untter-.Sectio of MG. c. 152 cau lead_to flie imposition of crinunal penalties of a fine up to $1,500.00 and/or one. -year imprisonment, as well as civil.penalties iii the form of a STOP WORK -ORDER and-a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the ".Offi'ce. of Inveshations ofthel IA for insurance'coveraze verification I do her eb • eerti under the ains�gn : ' _ d enalties o - — f3' P P. fP�jY that the information provrded abovE istrue and cnrrecL_____ Si ttzre: - -= ate: / Phone #: 4 t 3 Offs -W use only. Do not write in this area, to be completed by eiily or town officiaL City or Town: Permlt/License # Issuing Authority (circle one): .1. Board of Health 2. Building Department 3. City/Town Clerk .4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size l81 j 7 30_ f r - / B 7 3 - 7 Frontage Setbacks Front y � Side L: L:1 R: ��' t L: R: Rear 1 �7C rrw?ril�usc Building Height Bldg. Square Footage 7 d, % 32i i Open Space Footage __.__ _? % (Lot area minus bldg & paved s /G�03 f$ ✓`5 Z.l ' v. p arkin g) # of Parking Spaces — �— Fill: volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO Q DONT KNOW � YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW 0 YES 0 IF YES: enter Book I Pag ? and /or Document # B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q 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 Q NO IF YES, describe size, type and location: j D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO 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 Q NO C) IF YES, then a Northampton Storm Water Management Permit from the DPW is required. I s ! At 4 R tlk I Y t`• R .. ,� I se 1 t V Et �1 iFt Q. �R k ti L Z4 c7 b4 • 41 o Vi 14- > , rV : r� 7i7r ; s Ao— E 1 e 4 L N P 3 4 i 1 { t A .a I V ' uu W o � con v $ W oo� N V s — ' 3 g D � r . Cn `D v, N 14 co j Z o _N ° -4 cn O v J o D a o D - D N 0 o ? N C V c V o C CIN N 1S NVO _ c V N m cn cm N O W C A _.a v D D D o ?' o iv a N N N N f1� U 00 W N is V N N W Ul N c O IV 91 O N N W 4 O 1 d m ca cri � p cn CJl co � m f�J co V 00 O -� N i 0 OD 4 V N Cn V (n -4 a) W N t Ve f Northampton, MA Property` Detail Page 1 of 2 City of Northampton, MA: Residential Property Record Card New Search Properly T , e Classification Code Reference Card 1 of 1 _ Parcel - Location - Zoning - Assessment Map - Black -Lot: 17A- 272 -001 Zoning: Assessment: Location: 138 OAK ST Neigborhood: 5 Land: 138,100 #Living Units: 1 Deed Book: Building: 145,800 Class: R -101 Deed Page: Total: 283,900 Dwelling Information Building Sketch Style: Ranch Year Built: 1950 Story Height: 1 �,/, ,�; S� 7 " ° Attic. None Basement: Full Des Total Rooms: 6 A :I FA 24 125 s Bedrooms: 3 B_EFP Full Baths: 1 F6 264 sIt Half Baths: 0 soo 25 E 600 sgft Exterior Walls: Alum/Vin Q:oFP Unfinished Area: 0 24 25 sgft 12 Ground Floor Area: 1256 Total Living Area 1256 t B 22 E FP Finished Basement Living 2s 0 X 0 1FrfB Area: 28 FI 20 12 Basement Recreation Area: 0 X 0 Woodburning Fireplace 19 Stacks /Openings: 1 / 2 32 Metal Fireplace 0 / 0 Stacks /Openings: Heat/Central A/C: Basic Heating System: Hot Water Fuel Type: Oil Quality Grade: C+ Physical Condition: Average Addition Information: Interior/Exterior: Sarre Condition/Desirability/Jtility: GD Vacant/Dwell/Oby Status: Dwelling Lower 1st Story 2nd Story 3rd Story Area Additional Features: Basement One Story Frame 1256 Brick Trim: 0 X 0 Stone Trim: 0 X 0 Enclosed Frame Porch 264 Frame Garage 600 http:// northamptonassessor- us/ noho /propertydetail.php ?map_no =17A- 272 -001 &pagecard =l 10/29/2010 Northampton, MA Property Detail Page 2 of 2 Remodeling Data: Open Frame Porch F 25 Year Remodeled: 0 Kitchen Remodeled (Y/N): Bath Remodeled (Y/N): Land Data Outbuilding Info - ..Square-Foot-Type _ . SQ Utilities Type Feet Value no Prime information Site L8, 138,060 Type Qty Year Size 1 Size2 Grd Cond ❑aoc�ao no information Acreage Type Street/Road Type Acres Value no no information information Sales Info Permit Info Date Type Price Validity Date Permit #Price Pu ose I no information no information http: / /northamptonassessor.us/ noho /propertydetail.php ?map_Po =17A- 272 - 001 &pagecard =l 10/29/2010