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25C-095 (3) '1 001. C]N© . D 3S 41,41... +•"•"' GOM" . 1 \ ___- 4141 ----4141 o :£ _� -- am •••• mom =rte ligniimi 41.11_ -- It • -----? ---- -- i o®-o. is' 7 mg am — -1- ,,,N, I & INK MI Am ke-H III!IIIiirrr«i ,00F DEC K RooF I I i l m Him I f tEtow I UNIT E ! 4 � i� UNITD E� 141P , . 1 m-I- 't �'�'. MUM.. .11111.114/11111.4 �r ......./ ....u„ .....ms monism. SEG ND FLOt7R 1111110111 I ...... \ _...�... I 10041 / 1 i pz.rt,,,..., 1 1 are ■ 1_________._.__--3---R-* Mi 1 t: :`i► ". : rIi TOP Cevr~ wow. woos war \sta. Xi .. Al - ' \.-----.\ Ir--- ,... ..1 ,,,, . ____-- ---r........., ....... . tiT ~001"1" ��_ A te"` , 1001101r o rris i T rote ♦ %c a -�}C�' Cr oat (..w wtit }14fa� t g fti.c.00 1 l A UNIT O .""r...,. woo 3' 0" --- • Nowa . ■- mew . . """". . am"""` ■..... SECOND FLOOR /• -vow am•L 4 � uN4T c �' ! 4 CL No m s-x 57' IOI111IIMIQ111 ,00r DECK RooF isio ======4 tztow UNIT E r UN IT D 740 SECOND FLOOR 1 11111 1 s�stn•,, rr .� 1 1 1 mi, jik R. , 1 Se 1 AlwtN r,,,.. +++"' US*" s 1 r 1 U 1\ � r+r � 'r St. les y tR R war \ ELV. i ... _____b .. %I 1 . . . ,........1....._.\ g ,- .---- \ I I I I 11 th, t . .. . 1 1110/111000 iii. . Masi. VONIONr IS Ike ptp• tyasu•T _ -�- -------- r tiffs ROO 4 The Commonwealth of Massachusetts --- Department of Industrial Accidents �,:�.•j1 Office of Investigations - 600 Washin Street } Boston, MA 02111 www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): WI1l At; 3 1 1'+A Address: 58 fRArt- O. I Lemos .1Y)/a 0,053 City /State /Zip: Phone #: L / /3. 5 86.• LlcoS Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part- time).* have hired the sub - contractors 6. [j] New construction 2.)4 I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub - contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' • Y P tY 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10. E] Electrical repairs or additions 3. ❑ I am a h omeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.0 Other 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: �"" \ j 1 .e v1LSWu.AUG'!e Cr)_. Policy # or Self-ins. Lic. #: 3- rt' z 1,1,$' -42.' 3l0'i Expiration Date: ( - ZO • l Job Site Address: DJ .bC 4 QQ'T }]evTH p % City /State /Zip: (Nlpho 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 $1,500.00 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. Be advised that a copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Sienature: 1f 9, [ig I r. Date: 1' • 3A • 2 s 1J Phone #: 13 • S24,_- L{OoS • Official use only. Du 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 #: .5 Version1.7 Commercial Building Permit May 15, 2000 SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No 0 SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT tz• ?z,VNAIRS5 , as Owner of the subject property hereby authorize 7. , _ — _ to act on my be - ative to work authorized by this building permit application. - - • • 2.0\k Signature o Owner / Date \I- - 17.4easzembil , a,s.-CiwAritf/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 arid penalties ofperjug,_„__ Print Name _ 0.1 Signature of Owner/ gent I 11414.1.4 Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder : . DOZ.-. 5,1.57 License Number L Leans_ HA 010.53 _Z. Address Expiration Date WM. 9, Signs ure Telephone SECTION 13 -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 of the issuance of the building permit. Signed Affidavit Attached Yes No 0 . 4 1 ^ . ` Version 1.7 Commercial Building Permit May 15, 2000 SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) 9.1 Registered Architect: r -- ------------ ---- --- ' --------- Not Applicable [] -----�-- -- ---' �_ _ -- _ _ __--_ -.--- _ __-_____ __ �_ - Name (Registrant): 1 -- --- ------ { Registration Number - ---------------- ----- i Address -------- --- -----'— [---�---------- �poauonoo� „„__„ _ „..„___ Signature Telephone 9.2 Registered Profe sional Engineer(s): ________ _-_____-__-'_ - ___ _______ ___ -_____ _____ Name _ _ Area mnaa Responsibility __ ---- | ------------- --- - --- ' _ _-__~___ Address Registration Number . Signature Telephone Expiration Date r ------ --- --- — / � - - --- -- -- --_- - �-_ __ _____-�__-__�___� I_ ____� _ wamv mvam Responsibility [ ---- --------- --} __- __-_-_ ' — � L - __ - ------ Address �� r- ,_—__--; � | j / _— --------- _ Signature Telephone Expiration Date ---' - --- • — ----'— � __ ------ w ame *muo/Responsibility [ '-------- ---- -- --. --� ---' | F -- -------- '-' ---�-------- ---------- ''---- -------- ---------' ------'------ Address Registration Number , ---, __ _ ___ � I ___�____�� _l _--- ---------�---� , Signature Tolepxono � sxp�monoam i ------------- --------- �----------'-------' ------ ------ ----- . .- ---- -----�----------'-'---------------'------ �----------------------- Name ��ocxne Responsibility -- - . ------ ------ / | | _ i I --- ' � ------'----- --- Address ne i trauon Number - ---- ,• -- — J -------� Signature Telephone Expiration Date ' - 9:3 Contractor - — '�---- , --�--- -� ! ,,. S A b 4. •u.133 DAV f4t.i_i Not Applicable 0 Company wame: ____ ___ _ _ � ' :» �� .. _ -_ �h Responsible In Charge of Construction Address ��/��~ ^�~._ YLL614:3!.g9S Signature Telephone • 3 Versionl.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON.ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size 3 qL332-_Sq... 3.._._: __&4_,_31 L _S1_.�'._ _.. _ ..._.__. _ .. .... ....... ... __� Frontage ,,,2Z6 • . :_..._ .... 22$h __ ...__. ._ . _.w_...___._. . . , _.._. _ ___ Setbacks Front :7617 N Side L:.0___.. R:-tQse L Q R i _g .; _______ Rear Z3 23'_ ___f__. Building Height - . _ Bldg. Square Footage - _ w Open Space Footage % _ ____. ___ (Lot area minus bldg & paved 1 6a2 — L. i`__�._ .J Ig if i _ parking) _.. ._...... . - _ --- r -- ---1 # of Parking Spaces 24-1- i M i s a a e 2 + 2. lco, p `"' -"-- Fill: ij 4 (volume & Location) . _ N A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW Q YES OD IF YES, date issued: Z3•' 4r -Zoo 1 IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 4 IF YES: enter Book 6,2 Page' age and /or Document # B. Does the site contain a brook, body of water or wetlands? NO a) DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained 0 , Date Issued: — C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: 'Ata,14s49 S19N 6 =o" y_1=04 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, grading, 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. Z Version1.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑ Brief Description Enter a brief description here, %sµo ye 'S f *l. S1 .. 6AStt 'grtrwee A. W+it C. AM Of Proposed Work: I P P 1 i T A %OSTA11 w 3 ` r R p i g h ' T IA - s►iwpgile S T 4 . 114 its Pt4 t f a e_Ten. oPeMass SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly A -1 ❑ A -2 ❑ A -3 ❑ 1A I ❑ A-4 0 A -5 0 1B ❑ B Business ❑ 2A 0 E Educational ❑ 2B , r ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ I -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑ M Mercantile ❑ 4 0 R Residential ❑ R -1 ❑ R -2 ❑ R -3 Dia 5A ❑ S Storage ❑ S -1 ❑ S -2 ❑ 5B I 13, U Utility ❑ Specify: ` M Mixed Use 0 Specify: f 'uaN _ Se Paw a n _ S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE Existing Use Group: ___. ___ _., ._._..__,_. __. ___..____ __ I Proposed Use Group: _ _____ _ _ Existing Hazard Index 780 CMR 34): .. ___ .._. _,. Proposed Hazard Index 780 CMR 34): L____ _ _ __ _ ___I SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) 4 1st i 1st i. _ V 4...3_.. _ _ _ . �i 2 n d 2„d 3813 3`t t .._ — __.._. _ .__... _.. 3 � t ,. __ �.. ____ . ._u 4 Total Area (sf) 1 o ,off Total Proposed New Construction (sf) _ _ _ Total Height (ft) _3o 0 �._________...._. _ Total Height ft 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public Egi Private ❑ Zone'__ ____,_ Outside Flood ZoneD Municipal N On site disposal system • Version1.7 Commercial Building Permit May 15, 2000 AttrADO ei 6 Al* City of Northampton „tt Building Department Ciitb''C'6t/JD evia"'". , swiatz.,,, 212 Main Street = Room 100 lotatere titirtt g iR 6 ‘ ‘ N - 4 , , orthampton, MA 01060 Two, phone 413-587-1240 Fax 413-587-1272 PlooStte.*Ians-- •qA Other SPeCitt. .,„ ' APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION This section to be completed by office 1.1 Property Address: Map Z c Lot 1 Unit 211 Nom. sra.ECI N oThTh,4 hi A Zone ijizis Overlay District ______________ EIm St District cs District SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: _ .C_ Name (Print) Current Mailing Address: ) 4, - Signature / AP' Telephone I I/3 • 53o - 0010 2.2 Authorized Anent: Wt1.111aPN Z • TUR-0/71S HA _ ___ Name (Print) Current MailihaAddress: Is 0 154,51.1" Signature thl • 9. Telephone yi,A . S84, . SECTION 3- ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 4.00. 00 6. Total (1 + 2 + 3 + 4 + 5) / 2, Lew). ** Check Number 07.5"r This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date File # BP- 2011 -0639 APPLICANT /CONTACT PERSON WILLIAM TUROMSHA ADDRESS/PHONE P 0 Box 141 LEEDS (413) 586 -4005 PROPERTY LOCATION 211 NORTH ST MAP 25C PARCEL 095 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out � J� J Fee Paid 7" Typeof Construction: REPLACE SPIRAL STAIRCASE BETWEEN UNIT C & D New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 000515 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION PRESENTED: A 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 it)-41 Signature of Building Official 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. BP-2011-0639 GIS #: COMMONWEALTH OF MASSACHUSETTS 1 ,. CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit # BP- 2011 -0639 Project # JS- 2011- 001039 Est. Cost: $12600.00 Fee: $75.60 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: WILLIAM TUROMSHA 000515 Lot Size(sq. ft.): 8189.28 Owner: BARRON TODD J & ANDREA D Zoning: URB Applicant: WILLIAM TUROMSHA AT: 211 NORTH ST Applicant Address: Phone: Insurance: P 0 Box 141 (413) 586 -4005 LEEDSMA01053 ISSUED ON:1/20/2011 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE SPIRAL STAIRCASE BETWEEN UNIT C &D 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 1/20/2011 0:00:00 $75.60 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner