31A-069 (5) 206 ELM ST BP-2016-1451
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31A-069 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 I# BP-2016-1451
Project# JS-2016-002493
Est.Cost: $25065.00
Fee:$175.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: WILLIAM TUROMSHA 101722
Lot Size(sq.ft.): 8058.60 Owner: SALLOOM SIMON
Zoning: URB(100)/ Applicant: WILLIAM TUROMSHA
AT: 206 ELM ST
Applicant Address: Phone: Insurance:
P O Box 141 (413) 586-4005
LEEDSMA01053 ISSUED ON:6/15/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:UNIT# 1 - RENOVATE KITCHEN, 2 BEDROOMS,
ADD LAUNDRY ON 2ND FLOOR
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 6/15/2016 0:00:00 $175.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2016-1451
APPLICANT/CONTACT PERSON WILLIAM TUROMSHA
ADDRESS/PHONE P O Box 141 LEEDS (413)586-4005
PROPERTY LOCATION 206 ELM ST
MAP 3 LA PARCEL 069 001ZONE URB,f 10111/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORMFILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid C4c is 6.Gag 115
Tvpeof Construction: UNIT#?-RENOVATE KITCHEN,2 BEDROOMS,ADD LAUNDRY ON 2ND FLOOR
New Construction
Non Structural interior renovations
Addition,te Egistinp
Accessory Structure
B itdin Plan In luded
Owner/Statement or L'certse 101722
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION 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..^ 'lir "e :
Signr. Ira'rciai Daze
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.
a IS,- Versionl.7 Commercial Building Permit May 15,2000 tl
/ Depailment use only
City of Northampton (Status of Permit:
Building Department Curb CuttDrieway Permit
tC! t
♦ 'y ='-=+ 212 Main Street SewertSepgc Availability
k Room 100 Watermell Availability
S &Y Northampton, MA 01060 Two Sets of Structural Plans
r.9e. phone 413-587-1240 Fax 413-587-1272 PIoVSite Plans
' - Other Specify
APPL • • 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: This section to be completed by office
2o6 Elm ste,6ET Map Lot Unit
NOt,THA++p1 rr MA
Zone Overlay District
Q Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
t.Q 2.1 Owner of Record:
S1YtoN SAL,Loorn, 206 Elm ETRE B?, 11/41 MITA AP'pTou MA
Name(Print) , Current mailing Address.
Signature �s- ��" Telephone
2.2 Authorized�tAnent:
'
W1ihtim 3- tt.rrc.maMA Bcs. %oC. hit 1.EEo5, ?1A Oto53
Name(Print) Current Mailing Address.
WIZ Sit ydo5 uu 'V3S*S 3416
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COST
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1, Building jS 365• w3 (a)Building Permit Fee
2 Electricalybo e o (b)Estimated Total Cost of
_ • Construction from(6)
3, Plumbing Building Permit Fee
Seed. ^•
4. Mechanical(HVAC) I9 L"
5. Fire Protection / ••1
6. Total=(1 +2+3+4+5) 25" GIS- oo Check Number &eay
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
Version1.7 Commercial Building Permit May IS,2000
S. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to lx titled in by
Nullding Department
Lot Size T.4 76 SO FT SwotE
Frontage '?C 4H YTSever.
Setbacks Front Ig!o" i IS
Side L: 2I R: C'4" L: 22 R: (off
Building Height gq an Dir
Bldg, Square Footage 77 �'T
Open Space Footage
(Lm avec minas bldg&paved
parkinpl
of Parking Spaces
Fill: NfA
(volume&Loeaiiaa)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW 0 YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Page and/or Document It
B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO f„4
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO
IF YES, describe size, type and location:
E W»i the construction activity disturb(clearing.grading,excavation,or filling)avert acre or is it part of a common plan
that will disturb over I acre? YES O NO CD
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
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 0 Existing Wall Signs 0 Demolition IXI Repairs 0 Additions 0 Accessory Building 0
Exterior Alteration 0 Existing Ground Sign 0 New Signs 0 Roofing 0 Change of Use❑ Other 0
Brief Description Enter a brief description here. Omit owl' of Them T�� +- b...:1 ftow..atta
Of Proposed Work: itlEtoaeie krtcnera Twe Etswalaama aro`L� .a.1.007
Janine* eu Sa;(e<nP Fa�M-
SFJanine* Scope OF Waxy_ pm* Play b, NTS( Assoc/allf
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP{Check as applicable) CONSTRUCTION TYPE
A Assembly Al- ❑ A-2 0 A-3 0 1A ❑
A-4 0 A-5 0 1B 0
B Business 0 2A 0
E Educational 0 28 0
F Factory 0 F-1 0 F-2 0 2C 0
H High Hazard ❑ 3A 0
1 Institutional 0 1-1 0 1-2 0 1-3 0 3B _ ❑
M Mercantile 0 4 0
R Residential ® R-1 0 R-2 R-3 ❑ 5A 0
S Storage ❑ S-1 ❑ 5-2 ❑ 56 0
U Utility ❑ Specify:
M Mixed Use 0 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 750 CMR 345
SECTION 6 BUILDING HEIGHT AND AREA•
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
111 /8oc 5Q f^'t 15, Sae
2n° f SCA Sc Ft 211d Skin,
3 n 3re
4'"
4m
Total Area(sp 3400 Sq {t Total Proposed New Construction(se
Total Height(ft) 2 P7
Total Height ft
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public 0 Private 0 Zone Outside Flood Zone❑ Municipal 0 On site disposal system
Version?.7 Commercial Building Permit May 15, 2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) /�
Independent Structural Engineering Structural Peer Review Required Yes O No 4
SECTION 11 -OWNER AUTHORIZATION•TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
SH off See LL on K , as Owner of the subject property
hereby authorize W1II,atn -77-1R..0 Ms qA _to
act on my beh in all matters relative to work authorized by this building permit application.
X fl
signature ofOwnerDate
I, fir. )jhpin S } u/2 o ml5 H A , as Mg.e„fAuthorized
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
1
AMU lat `(—U 2 fet k A
Print Name
jr�t,..944 7 TORE Zo)L
Signature of Owne gent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Hower:_ WtU/pr+i J 14U2 nM SHq 000 Sea
License Number
58F 57-7 to. ,Brox/'/' IECcs h4 OdoS-5 _ 07-/1s/2o1P
Address ' Expiration Dale
9/3 5?5 f812/6
signature Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(ALGA_c,152,§25C(S1)
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 0
Version 1.7 Commercial Building Permit May IS,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:
4 ..,( Not Applicable 0
Name( egistrant): 5313
ttom}, N‘
Registration Number
Addles re —.
sect 6711 Expiration Date
.ign Telephone
9.2 .L. rofossional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Asea of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Nee Of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor –�
1/14•NN iAComsbs 'DES}6N t CONSTAucTroN Not Applicable 0
Company Name:
WIN/Am• T MUR ern Ana _—
Responsible In Charge of Construction
Address
:9, S}5 } y[
Signature Telephone
•
June 7, 2016
Simon Salloom
206 Elm Street
Northampton, MA 01060
DEMOLITION;
Kitchen
Acoustic tile ceiling/plaster and lath
Strip walls to studs
Remove
Wall between kitchen and dining room
Wall between entry hall and dining room
50%of wall separating basement stair
Entry from dining room
Plumbing fixtures from first floor bath
Ceiling to floor joists walls to studs
Closet wall at end of entry hall.
Framing
New opening for living room door
Door opening to basement stair
Doorway from new dining room hall to 1st floor
Insulation
Energy—All exterior walls
kitchen and bath
Sound—Interior demising walls between apartments
that have been opened on one side
Drywall
Kitchen,bathroom, basement hall, entry hall closet
City of Northampton 212 Main Street, Northampton, MA 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 150k
Address of the work: 204. FLJf .\-TE-Err NoRn4p rtta
The debris will be transported by: M f\ALrnw,L1
The debris will be received by:
Building permit number:
Name of Permit Applicant
William T TRomsHA
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
�_= Department of Industrial Accidents
sl)j]I` lOfce of Investigations
=me= 1 Congress Street, Suite 100
�l Boston, MA 02114-2017
`�'"_•�. www.mass.govldia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organixationhindividual):.....
Address: Co Foo,-sr sriz en- Re. .SaJe 14'l .1 Pens 11/A-9/0.4i
City/State/Zi : —r. J' alaS Phone#, _ _
Are you an employer?Check the appropriate box: Type of project(required):
L Q t am a employer with 4. ❑ 1 am a general contractor and l i 6. New construction
employees(full and/or part-time).* have hired the sub-contractors
2.X1 1 am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling
ship and have no employees These sub-contractors have g. Lid 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 I O.[1?:1 Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their I Lig Plumbing repairs or additions
myself, [No workers' comp. right of exemption per MGL
12.E] Roof repairs
insurance required.] " c. 152, §1(4),and we have no
employees. [No workers' 13._J 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 'orkcrs 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: –73? taarpPc
Policy#or Self-ins. Lie. #:. 7 PJ L48- 0LS-A N..If ._... Expiration Date: 6l20/Zak
Job Site Address:_.20 v tz• .... City/State/Zip:_ jyt_ j'fIALo
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 cert'V under the pains and penalties of perjury that the information provided above is true and correct.
Date: f20/hS17/.2_1' 11A7-26
- /AO S
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Penult/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#: