25C-095 (7) DESIGN& CONSTRUCTION
21 October 2013
Louis Hasbrouck
Building Commissioner
City of Northampton
Dear Louis,
The subject is 211 North Street,Northampton, MA. Two-story five-unit mixed use
building,Units C and D. Unit C is located on the first floor and Unit D is located on the second
floor. Currently,both units share the same common entry and lobby. There is no privacy
separation from the lobby.
The attached proposal is for a one-hour fire-rated wall on the first floor. This wall will
have a one-hour wall with a one-hour rated SCBU solid entry door with steel frame and two 12"
x 60" fire-rated glass side lights.
The second floor is to have a one-hour fire-rated wall with a one-hour SCBU door with 5"
x 20" view glass and no other fenestrations.
The new walls separate the office units, leaving the current stair and lobby as is. The
staircase remains unobstructed as does the egress through the lobby. This building has a
complete NFP 13 fire suppression system with one-hour rated partitions separating all the units
and the common hallway areas. Please see the attached plans showing the existing conditions,
constructed in 2002, and the proposed alterations.
Respectfully submitted,
/1//h,,, 9, to4eryn
William J. Turomsha
WJT/djt
Wm. J. TUROMSHA ♦ P.O. Box 141 ♦Leeds ♦ Massachusetts 01053
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington 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): LII/1 J4 ► J. �Gt�ec ,n.sk.4 _
Address: 58 f 1 2 o,v 2- 5 7 7?
City/State/Zip: ,5Fs os /2/u Q/O'S 3 Phone#: Ws 64 4, 9 o'tr
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
6. ['New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ig Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers' 9 ❑Building addition
[No workers'comp.insurance comp.insurance.$
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.El
am a homeowner 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.❑ 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: %,e.43 ri 'Lf P S
Policy#or Self-ins.Lic.#: 7? SIJ - OIoS 3X/`/ Expiration Date: 4,gD•/e/
Job Site Address: Z//dVo,¢27V 4722.5,57— C +`D City/State/Zip:A TN jdTod 11,4 9)063
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 cerrttifyiundeerr the pains and penalties of perjury that the information provided above is true and correct.
Sienature: G�//2- Date:
Phone#: ,__47-8 .s
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#:
' .
Veroioo1.7C0000c,du Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes No «��
SECTION 11 'OVYNERAUTMOR�AT]ON-TO8ECOK8PL2TEDVVHEN -- ~~
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
. ^-��o o*«� �� ����w�����
---- _' --.aoVwnerof the subject prope
__
.1 ^
hereby authorize p\�w/h4w~ ^� �|w^�
=, __ _ _ho
act on my behalf, I. '- -lative to work authorized by this building permit appl
;'
Signature mower Ar/~ ---'— --- -----------------'--
Date
!. �id ux ti^�
-- ----' --- ------------------------ - --- --- -- ,as
Agent h declare tha 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 ofperjuOL� ___.___-_----__.__-___-__
/
Print Name
��� .„___ _ ��
- ______-_ _'
Sig�ure=e=e"°yeu
Date
SECTION 12-C SERVICES
10.1 Licensed Construction Suiervisor:
— Not AppUuable []
„
Name of License Holder: __ __ _ _� 0005�1 5~
_______________________________________
License Number
� �
`�^' �.����41v�_' ^����' ���� ___� *�
Address ,_�� -- -
- _ ^�
�o""=~'=,�~�~ ^'*~~�`��=�_–' m^�^�c�^�«m'
Signature ^� 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 denial of the issuance of the building permit.
��
Signed Affidavit A��ohod Yes ��' No x~/
,3
Version1.7 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 5.6r_3..1 _m �....: . ._ . .....,_._._ ..�
Frontage Z,7 L .. 2Z,S' •L•_
Setbacks Front �QN�� O
Side L . Rr./. L:D_.... R /4'22
Rear .417
Building Height
Bldg. Square Footage d
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO C DONT KNOW 0 YES 4,4
IF YES, date issued: 2$7/4,CY__.Z /
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW ® YES 1!)
IF YES: enter Book 17/ Page O/3 and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW O YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained ® Obtained ® , Date Issued:
C. Do any signs exist on the property? YES 4►.10 NO 0
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES ® 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 0 NO C.
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
y.
Version1.7 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:
. ___„ . Not Applicable ❑
Name(Registrant): __
Registration Number
Address .._,..... _. .._...... .. .
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area Responsibility
rea of Res onsibili
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
�J... .....[71-Moms . � �QS ?L41 ...._,. Not Applicable❑
Company Name:
Responsible In Charge of Construction
Tko ti T 7 E .L 'Evs_./ __.Q'.�o5.3_._
Address
-9, /1/4-17/12-$4--- Y/3 676..yacts-
Signature Telephone
•
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. T N arb II epa-},e:,s a•.,. P b !A t P n,,,,,mar
Of Proposed Work: 3EP5,•r, PQi'.o ea f,erra7 T o PP,c ts Pii y q.*ia.) Au C,.o
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 ❑ A-5 ❑ 1B I ❑
B Business ® 2A ❑
E Educational ❑ 2B r ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ _ 3B ❑
M Mercantile ❑ 4 ❑
R Residential 10 R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Utility ❑ Specify:
M Mixed Use ,® Specify
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
.
Existing Use Group: _ __. ._ _.___ .___ Proposed Use Group: __.__ ___...„. ___. .. _._ ._ ._.._.._
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34)
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
1st 1st
,. _... .
2nd .. ... .. _ . . ._,_._. ...., 2nd
th __ ._____.
Total Area(sf) Total Proposed New Construction(sf)
Total Height(ft)
Total Height ft
.. .................. .... .... .. ....
7.Water Supply(M.G.L.c.40, §54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone Outside Flood ZoneD Municipal ❑ On site disposal system
1
■ Version1.7 Commercial Building Permit May 15,2000
. Department use only
1, 'I` l; City of Northampton Status of Permit ,
Building Department Cutb-6ut/Q1'iueway Perr*
Z 201 212 Main Street Sewer/Septic •
Availability
Water/Well Availability
pect�ons Room 100 ty -
4o Northampton, MA 01060 Two Sets of Structural Mans
`'e ' phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
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
1.1 Property Address: -d This section to be completed by office
Map Z s c, Lot it%6, 96 Unit
211 NORTh STI .eET' 1P
Zone U r%.13 Overlay District
moK i NAtit PTou t
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
To w) 4 • rL�ora Z6 C}t►Mul2a Rona 1-14.t' ,e ._M{i 01 035.
Name(Print) Current Mailing Address:
711
Signature %/ Telephone ' g? 3;-� ,
2.2 Authorized A.e, :
\ iII(ANt . ._ 1 tAreo.r, s t 1 x PS2__FoAx..I'll-...LEEDS_.l" A 0i053 _
Name(Print) Current Mailing Address:
Signature k.. yy1 . 1(/G1 el)1.S Ii a_ Telephone
SECTION 3-ESTIMATE CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building _ ..._...___�. .___ ...._.....
20 s oe , — (a)Building Permit Fee .
.. .
_._.. . w
.. .
2. Electrical . _ ,
- . ......._
_ ..
(b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) _,.___...._._.___.
5. Fire Protection �}
6. Total=(1 +2+3+4+5) #2,0046-00 7°' Check Number 59/0 $)■123
- This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2014-0532 1-101,0 f®
APPLICANT/CONTACT PERSON WILLIAM TUROMSHA I LKf P
ADDRESS/PHONE P 0 Box 141 LEEDS (413)586-4005
PROPERTY LOCATION 211 NORTH ST-UNIT C&D
MAP 25C PARCEL 095 005 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out O
Fee Paid r 10 •
Typeof Construction: INSTALL PARTITIONS FOR PRIVATE ENTRY
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
INFQRMATION PRESENTED:
V Approved 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
1010
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.
211 NORTH ST-UNIT C&D BP-2014-0532
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 25C-095 CITY OF NORTHAMPTON
Lot: -005 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit# BP-2014-0532
Project# JS-2014-000915
Est. Cost: $20500.00
Fee: $123.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: WILLIAM TUROMSHA 000515
Lot Size(sq. ft.): Owner: BARRON TODD J&ANDREA D
Zoning:URB Applicant: WILLIAM TUROMSHA
AT: 211 NORTH ST - UNIT C & D
Applicant Address: Phone: Insurance:
P O Box 141 (413) 586-4005
LEEDSMA01053 ISSUED ON:11/18/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL PARTITIONS FOR PRIVATE ENTRY
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 11/18/2013 0:00:00 $123.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner