17C-237 (4) JAN-18-2007 15:21 MACKINTIRE INS AGENCY INC 508 366 5202 P.01i01
PRODUcER (306)366-6161 FAX (508)366-5202 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Mackintire Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE OR
11 West Main Street ALTER THI:COVERAGE CERTIFICATE ED 9Y THE PNOLrICE BELOW.
Westborough, NIA 01581-1931
INSURERS AFFORDING COVERAGE NAIL#
INauREp A.D.I. Contract ng, Inc. INSURERA: National Grange Mutual Ins CO. 14788
4 Orton 5t. INSURERS' Citation Insurance Company 40274
Worcester, MA 01604 msuReRc: American Home Assurance Co.
INSURER D:
INSURER E;
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMFNT WITH RFSPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
rA D' TYPE OF INSURANCE POLICY NUMBER POLICY F6CTIVE P LICY EXPIRAT LIMITS
GENERAL LIABILITY MPS86478 05/14/2006 05/3.4/2007 EACH OCCURRENCE a 11000,0001
)( COMMERCIAL GENERAL LIABILITY DAMAGE MISER I RENTED ; S00 000
CLAIMS MADE Q OCCUR MEO EXP(Any one person) S 10,000
PERSONAL a ADV INJURY 6 1, 000,000
GENERAL AGGREGATE S 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMINOP AGO S 2,000,0()o
POLICY 0 dEC D LOG
AUTOMOBILE LIAaLm 06MMYK$014 03/14/2006 03/14/2007 COMBINED SINGLE.LIMIT
ANY AUTO (Heeecldentl
ALL OWNED AUTOS BODILY INJURY
S
(Par woon) 100,000
0 X SCHEDULED AUTOS
HIRED AUTOS BODILY INJURY
NON-OWNED AuT08 (Petseciaent) 5 300,00
PROPERTY DAMAGE 6
— (Per moddent) 100,000
GARAOE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN FA ACC 6 —�
AUTO ONLY' AGG S
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S
OCCUR L.._'.I CLAIMS MADE AGGREGATE t
6
DEDUCTIBLE S
RETENTION 3 $
WORKERS COMPENBATION AND WC 895-15-76 02/01/2006 02/01/2007 WCSTATU• 0TH•
EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ 100,000
C ANYPROPRIFTORIPARTNER4XF-CUTIVE
OFFICERIMEM$EREXCLUDED? E.L•DISEASE-EA EMPLOYEE $ 100400
U X011,describe under
SPECIAL PROVISIONS below E.G.DISEASE-POLICY LIMIT i 500,000
OTNER
OESCR)PTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SP19CIAL PROVISIONS
SHOULD ANY OF THR ABOVE DESCRIGED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL
City of Northampton 10 DAYS WRITTEN NOTICK TO THE CERTIFICATE'HOLDER NAMED TO TH%LEFT,
Building Department BUT FAILURE TO MAIL SUCH NOTICE SHALL NPOK NO OBLIGATION OR LIABILITY
212 Main St. Room 100 OF ANY KINDAN THE INGURKII,ITS AWAT604 R t3ENTATIVES.
Northampton, MA 01060 AUTNORIXEDRE N TIV
�3. Michae e
ACORD Z8(2001108) FAX. (413)587-1272 CACORD CORPORATION 7998
TOTAL P.01
Jan 04 07 02: 09P RE/MAX ADVANTAGE 1 508-767-0474 P. 1
,tan. 4. VNI 1:41NM—"G�Rii15H ROUSSEAU-------- No. 1997----P, i/l
Flab '!1'V[`IA1►i MORTGAGE INSPECTION PLAN r-
PEOisTERMc LAND sua:vFYesRs IQALlE JARRETT J. KRCISOG$KA
m
75 NAMMDNb STREET — FLOOR 2
WORCESTER, WA 01610-1 72 3 LOCATION 135 NORTH MAN STREU
PHONE: 502-752-am
FAX; 608-752-805 N09THAMP70N. MA
RMTOCOM NSM NET
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REGISTRY_HAMPSWBE 4744/00
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HOUSE
LOT 237
BARDWELL STREET
OWN 9Y:JOB
CME1HCla aY:
Board of building Ragutat{ons and,Sstandards
MOMS tMPR4VEMENT CONTRACTOR
RggistratFan: 1.37004
Exoo*opo� WM2008
pia Corporation
A p I CONTRACTING MIG.
DAVID PIETROW—ICZ _
4 ORTON ST
WORCESTER,MIA 01604 Deputy AdWaist OOT
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IT trltt�o9l° ' 181$
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ADI Contracting, Inc. Facility Management Specialists
General Contractors
January 2,2007
Jarrett Krosoczka
135 North Main St.
Northampton,MA 01062
Please review the following proposal for your renovation project.
Pre-Construction $
Site Plan $ -
Design $ 94.50
Permits and fees. $5.00/$1,000.00
Does not include legal counsel if required. $
Variance,Special Permit Finding,Board of Appeals
Interior Construction-Second level bathroom. $ 11,991.42
Demolition
Remove and store existing claw foot tub in basement.
Demo existing water closet,lavatory and cabinet.
Remove existing drywall from walls and ceilings.
Remove existing door frame and save.
Remove existing flooring.
Rough Plumbing
Provide and install new rough plumbing to existing stack. Allowance $ 2,400.00
Provide and install new fiberglass bathtub. Allowance $ 350.00
Rough Electrical
Provide and install new rough electrical. Allowance $ 1,200.00
Provide and install new exhaust fan. 100 CFM Allowance $ 95.00
Rough Carpentry
Remove existing window and close opening.
Sheath and install cedar clapboards to match.
Insulate four walls of bathroom.
Install duro-rock cement board in wet areas.
Install blue board and plaster. Smooth finish on walls;Texture on ceiling.
Finish Carpentry
Install ceramic tile tub surround.
Install ceramic tile floor.
Install baseboard and trim.
Finish Electrical
Provide and install ground fault outlet,vanity light.
Finish Plumbing Allowance $ 600.00
Provide and install new Strasser Woodenworks Euro Lav Allowance $ 150.00
Provide and install Moen 4925 Lav faucet. Allowance $ 150.00
Provide and install Kholer K-3423 water closet. Allowance $ 150.00
Provide and install Moen 2353 Tub/Shower Valve
Painting
Prepare,prime and paint two coats all walls. $ 756.00
Materials
Framing materials and supplies
Subfloor,cedar clapboards
Finish trim and millwork supplies
Flooring and walls. 604.80
Approx. 120 sq.ft ceramic tile,grout and mortar 4.00/ft.the allowance $
Disposal 10 cubic yds $ 315.00
Total $ 13,761.72
4 Orton St., Worcester,MA 01604, Office 508-755-5151,Fax 508-752-8561
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 11 Name of license Holder: 1 C-5 0-;�/&
License Number
Add C) Expiration Date
Signature Telephone
,9,,,R tis'tL +6ihe lm�rwd�uerner tiro le r: Not Applicable ❑
eW v l y3l� 005/
Company Name Registration Number
Address ,� Expiration Date
49 tie„ � P 1 r .- fit # o to °o Telephone
SECTION 10!-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.162,§25C(8))
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...... ❑
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
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alterations) 2f Roofing ❑
Or Doors 171
Accessory Bldg. ❑ Demolition ❑ New Signs (0) Decks [E] Siding[0) Other[p)
Brief Description of Proposed
Work: /✓ VJ;F_ i d�
Alteration of existing bedroom Yes L, No Adding new bedroom Yes No
Attached Narrative n Renovating unfinished basement Yes No
Plans Attached Roll J-Sheett
sa Nern�; weYr _T+ r�ctlm.,fir„`e �tcrrwsa =cc�mtslte;th+�faJftlia:
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
I, JA`✓f e' � r\f V� ZL'�^ as Owner of the subject
property
hereby authorize ')?Y2 A �?
C 71
to act on my behalf, in all matters lative t work a r o a this building permit application,
Signature of Owner Date
I, 2 1Jo � /E-Tr1'Q1AJE( �/� )+ .* 1�, 'A)� fin! -, as Own uthorized
Agent hereby declare that the statements nd information on the foregoing applicati n are true and accurate,to the best o dge
and belief.
Signed under the pains Wd penalties of perjury.
DA V11
Print N
Signature of Owner/Agent Date
. .
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
Setbacks Front I
Rear
Building Height
Bldg. Square Footage
Open Space Footage %
(Lot area minus bIdg&paved A�A 0,'(10
of Parking Spaces
(volume&Location)
A. Has a Special.Permit/Variance/Finding ever been issued for/on the site?
�� ��
�X
ND ^�� DON'T KNOW «_� YES �_�
IF YES, date issued:
� <
IF YES: Was the permit recorded at the Registry ufDeeds?
NO 0 DONTKNOYV 0 YES 0
'-----------1 ,--------1
IF YES: enter Book | Page � and/or Docun�pnt#� |
----------'
B. Does the site contain a brook, body uf water nrwet|ands? NO DON7KNOVV () YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained y~� Obtained �-� Date Issued:
� - --- ---!
v_� �~� ' ' /__
C. Do any signs exist on the property? YES 0 NO
r-------------------------------------
|F YES, describe size, type and location: | �
D. Are there any proposed changes to or additions of signs intended for the property? YES - NO
r-- ----------'--------------------------
!F YES, describe size, type and location:
E� Will the construction activity disturb(clearing,grading on.or filling)over 1 acre uriait part ofa common plan
that will disturb over 1acre? YEGK� j NO &�l
��
|F YES,then o Northampton Storm VVaharMunagemontPemnit from the DPW iorequired.
1 Wi r b' enty
City of Northampton ftt
Building Department Cori, "Utttrrrrve y*Perrrrtt
r
212 Main Street ew1lStoAvtltobtllty -
Room 100 1a#ec/tIWII q�a,lillty
Northampton, MA 01060w� ofrtrlrrti� �s
phone 413-587-1240 Fax 413-587-1272 tl�itehis r
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address:
Map Lot Unit
Zone Overlay District
v�-
Elm St.District CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: _
06C 36-
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Accent:
d , /
Na rint) Current Mailing Address: s ti / C/
S464214-- 79 q0
Sin ure y Telephone
SECTION 3 ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building 0 o,ow (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 5
3. Plumbing f� �•� m Building Permit Fee
4. Mechanical(HVAC) 7 J
5. Fire Protection
6. Total=(1 +2+3+4+5) / QG� Check Number
This Section For Official Use Only
,,4a7 3 Date
Building Permit Numbe r: Issued:
0a 16
Signature: 111Al2,�
Building Commissioner/Inspector of Buildings Date
J "� 9 K07
BP-2007-0723
GIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Perrnit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit# BP-2007-0723
Project# JS-2007-001103
Est. Cost: $13800.00
Fee: $69.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: DAVID A PIETROWICZ 071816
Lot Size(sq. ft.): 13285.80 Owner: KROSCOZKA JARRETT J
Zoning_URB Applicant: DAVID A PIETROWICZ
AT. 135 NORTH MAIN ST
Applicant Address: Phone: Insurance:
4 ORTON ST (508) 755-5151 WC
WORCESTERMA01604 ISSUED ON:111912007 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMOVE WINDOW & RENOVATE BATHROOM
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 1/19/2007 0:00:00 $69.001268
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
BP-2007-0723
135 NORTH MAIN ST
COMMONWEALTH OF MASSACHUSETTS
GIs#:
CITY OF NORTHAMPTON
Map:Block: 17C-237
Lot: lo PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
renovation BUILDING PERMIT
Category:
Permit# BP-2007-0723
Project# JS-2007-001103
Est.Cost: $13800.00
Fee: $69.00 PERMISSION IS HEREBY GRANTED TO:
Contractor: License:
Const.Class:
DAVID A PIETROWICZ 071816
Use Group:
Lot Size(sg. ft.): 13285.80 Owner: KROSCOZKA JARRETT J
Zoning:URB Applicant: DAVID A PIETROWICZ
T• 135 tiJORTH MAIN ST
Applicant Address: Phone: insurance:
WC
4 ORTON ST (508) 755-5151
WORCESTERMA01604 ISSUED ON:1/19/2007 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMOVE WINDOW & RENOVATE BATHROOM
POST THIS CARD SO IT IS VISIBLE FROM'THE STREET Building Inspector
Inspector of Plumbing Inspector of Wiring D.P.W. Bu g p
Underground: Service: Meter:
Footings:
Rough: Rough: . House# Foundation:
g Driveway Final:
Final: Final: � ,r c' -7 Rough Frame:D�
✓L1�
Gas: Fire Department Fireplace/Chimney:
Rough: Oil:
Insulation:
Final: Smoke:
Finai: 0�i (SS�2,5101 L&A(S
'\
THIS PERMIT MAY BE REVOKED BY THE C Y OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occu anc Sip nature:
Feel e: Date Paid: Amount:
Building 1/19/2007 0:00:00 $69.001268
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo