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24D-118 (3) E 0 NI E D City of Northampton Building DepailmeAt Electric,Fiu^nr'l 19&Gas lnspec ions Phan RgVI@W Nort'l --' pt_ n kAAL"060 212 Main Street Northampton, MA 01060 A ENSTRY RAF ROOM•3 REMOVE EXISTING WALL r AND RELACE WITH 2�d FLOOR CHIMNEY \ 3 1/2'X 9 1/4'LVL BEAM EXI5TIN5 FLOOR KITCHEN NEW 3 1/2'X 9 114' ROOM+I `" LVL BEAM E]JSTW E!<TERKJR WNL Is+FLOOR ROOM•2 ` REMOVE EXISTING WALL DN _ (2)PEW 31/2'CONC.FILLED LALLY COLUMN @ EACH END HAU,WAY BA5EMENT E%ISTRG FpRDAT1pN WAIL J (2)NEW 24'SO.FOOTING LH 24 O' FIRST fLOOR NT5 SECTION A NT5 � 1 � 1 LIVING ROOM/ SPARE BEDROOM • Remove 12' of existing wall between living room and spare bedroom • Install LVL Beam to support the second floor • Remove existing closet doors and re-frame opening • Sheet-rock walls • Tape new walls with three coats of joint compound • Sand and prime walls • Paint walls with two coats of paint (color samples will be provided) BASEMENT • Install 6 Lally columns in total • 3 supporting play room and 3 supporting 12' opening between living room/spare bedroom • Providing proper footing for each Lally column ELECTRIC • RE-locate light switch and wall outlets HARDWOOD FLOORS • Re-finish 550 sq.ft. of hardwood floor • Apply three coats of polyurethane *Dumpster and all permits included TOTAL JOB $ 9,700 At start $4,850 ' Balance at completion $4,850 /c��:�r -.mss � � •.�.�—^,-•�'� Tomasz Karas achel Hannel P.O.Box 1 Ludlow,NIA 01056 Karas Home Improvement General Contractor, LLC... Tomasz Karas P.O. Box 1 0 Ludlow,MAO 1056 CONTRACT Section A:Parties involved: This contract is dated 11`h day of August 2015 between Customer:Rachel Hannel 11 Church st. North Hampton Ma 413-320-2490 AND Karas Home Improvement General Contractor,LLC... *P.O.Box 1 Ludlow, MA 01056 Telephone: 413-374-8638 Email: Karastzc(in2mai1.com Website: Karasgc.com Section B: Description of work and terms: CEILING • Remove existing ceiling near the staircase from 1St to 2nd floor • Reinforce existing framing • Sheet-rock ceiling • Tape ceiling with three coats of joint compound • Sand and prime • Paint ceiling with two coats of paint • Paint walls near the staircase from 1St to 2nd floor (color samples will be provided) PLAY ROOM • Frame 13' of wall with a door opening and frame closet with two sets of door openings • Sheet-rock walls • Tape new walls with three coats of joint compound • Sand and prime walls • Paint walls with two coats of paint (color samples will be provided) • Install all trim (door trim/ baseboards), (match existing) • Paint all trim • Install doors (play room entry doors/two sets of closet doors • Paint all doors • Install closet shelf and hanging rod City of Northampton 212 Main Street, Northampton, Na 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: The debris will be transported by: Ak, The debris will be received by: Building permit number: Name of Permit Applicant Date Sign-ature of Permit Applicant City of Northampton Massachusetts F- c' DEPARTMENT OF BUILDING INSPECTIONS �: x 212 Main Street • Municipal Building rJI b Northampton, MA 01060 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT [acceThe State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her sso onstruction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which e/she resides or intends to be, a one or two family dwelling, attached or detached structures ry 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 home owner." The building department for the City of Northampton wants any person(s)who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill) sonotube holes (before pour) a rough building inspection (before work is concealed) insulation inspection (if required) and a final building inspection The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made 1, understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location 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): Address: City/State/Zip: Phone #: ��, _ 3/� �G 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. E]New construction 2.® 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' insurance.$ 9. ❑Building addition comp.[No workers' comp. insurance required.] 5. ❑ We area corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ 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. tHo meowners 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: C2 Crnt Policy#or Self-ins.Lic. #: 7/3 3�/,3a g� Expiration Date: —19 � Ciy/State/Zip:Job Site Address: C 01060 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 ofperjury that the information provided above is true and correct. S_ignature: f�r`s�GS-t? y 1e, Date: Phone#: y13 371/ �6 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.EIectrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: ECTION 8-CONSTRUCTION SERVICES / 8.1 Licensed Construction Supervisor: Not Applicable £ Name of License Holder: I n M Z K4`Ct �xj?7/9 License Number i I Address Expiration Date /-I/3 - 37// - Y6 3 Signature Telephone - _ - ,,, ..... 9 Registered Homeamprovement"Contractor Not Applicable £ Company Name Registration Number p a . ��k �.� o�c s �= 7 Address f� ^� Expiration Date Telephone / `3 SECTION 10-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 Attached Yes....... £ No...... £ 11 Home Owner.Egemption 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 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 Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature i SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ( Roofing Or Doors C] Accessory Bldg. ❑ Demoli - n ❑ New! ig s [Oj D [Cl Siding [O] Other[O] Aft LL"_4 Brief Decr' tion of Propose Work: s ear t TG-j t h I� Iteration of existing bedroom Yes No Adding new bedroom Yes _No fsr Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa If Neuv:house andor add:flon to exisfna.housmg,`complete the fotlowlnct: a. Use of building :One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction 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 AUTHORIZATION-TO BE COMPLETED WHEN .OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, , as Owner/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. 01 e L2 CQ S Print Name Qs� Signature of Owner/Agent Date i Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information ., Existing Proposed Required by Zoning ?t This columnito be filled in by ' Building Departmept Lot Size �� Frontage Setbacks Front Side L:= R:`—_ L:I I R= r�-- Rear �� l — Building Height Bldg.Square Footage % r-- S Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces 1-----� T Fill: r (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW Q YES Q IF YES, date issued:f— IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW Q YES Q IF YES: enter Book L- �1 Pagel i and/or Document#i�' 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 Q Obtained Q , Date Issued: C. Do any signs exist on the property? YES Q NO Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO Q 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 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. i t s°� Departrpent use only �n t i �i � h of Northampton Status ofPermtt; k� F , i� ttrr4 ty `� xFa?ri 4 tii l—t Nib d //� ing Department Ctrrb Cut/Driye�!tay Perini# � � �i3i� "ysft ,it_ '' t7W ` � 12 Main Street SewerlSepticAvaiCa611iit 7'n a tlhi rr tity r Room 100 UVaterlU!feltAuailability t r. EfZ 1.' I J IL ,'trlC, P:iJt acS in3 mpton, MA 01060 IT walSefs ofS#ructurai Plans a 1 xh' Northamptcr., 1 U n t 7tI , 7-1240 Fax 413-587-1272 PIo/Site Plans N t t 7 ;t riC yr� "t ki "f t Uthe>z5pepifjf�? .... r 4 r APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This sectiort to be completed by gffice 1.1 Property Address: F t t �/ C/�►�1� Map Lot t r ,r Umt i � )9 O``-50 Zone +. Overlay D�strtct /"1 /(/(7 ...' _Eim St District , 't CB Dlstnct SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED AGENT: 2.1 Owner of Record: �/ ��,%� Ralf L1t�L(?�!SeC Name(Print) Current Maili dress: Telephone Signature 2.2 Authorized Agent: iCAtIC E j�a ,s P, o. Box f l A llw ozac % Name(Print) Current Mailing Address: �,w�sr �,ic�s Signature Telephone SECTION 3 ESTIMATED CONSTRUCTION COSTS. . Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a)Building'Permit Fee 2. Electrical (b) Estimated Total'Cost of 7dv Construction from 6 3. Plumbing Building Permit Fee Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5) Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissionerllnspectorbf Buildings: Date File#BP-2016-0243 APPLICANT/CONTACT PERSON TOMASZ KARAS ADDRESS/PHONE P O BOX 1 LUDLOW01056(413)374-8638 PROPERTY LOCATION 11 CHURCH ST MAP 24D PARCEL 118 001 ZONE URB(100) THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: SHEETROCK CEILINGS ADD CLOSET TO PLAYRMAEMOVE WALL&INSTALL LVL BEAM INSTALL 6 LALLY COLUMNS IN BASEMENT _ New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 099719 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOR 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 D of ' y 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. 11 CHURCH sT BP-2016-0243 GIs#: COMMONWEALTH OF MASSACHUSETTS MM:Block: 24D- 118 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category: renovation BUILDING PERMIT Permit# BP-2016-0243 Project# JS-2016-000399 Est.Cost: $9700.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: TOMASZ KARAS 099719 Lot Size(sq. ft.): 7100.28 Owner: HANNAH RACHEL&PAMELA BOCKOL zonine: URB(100)/ Applicant: TOMASZ KARAS AT. 11 CHURCH ST Applicant Address: Phone: Insurance: P O BOX 1 (413) 374-8638 WC LUDLOWMA01056 ISSUED ON.91812 015 0:00:00 TO PERFORM THE FOLLOWING WORK:SHEETROCK CEILINGS,ADD CLOSET TO PLAYRM,REMOVE WALL & INSTALL LVL BEAM, INSTALL 6 LALLY COLUMNS IN BASEMENT 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 9/8/2015 0:00:00 $65.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner