32C-102 (11) 44 CONZ ST BP-2017-0360
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mao:Block: 32C- 102 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Sidine BUILDING PERMIT
Permit# BP-2017-0360
Project# JS-2017-000600
Est. Cost:$50400.00
Fee: $353.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
use Group: WILLIAM TUROMSHA 000515
Lot Size(sq. ft.): 10802.88 Owner: MURPHY DAVID A
Zoning:NB(I00)/ Applicant: WILLIAM TUROMSHA
AT: 44 CONZ ST
Applicant Address: Phone: Insurance:
P O Box 141 (413) 586-4005
L E E D S M A 010 5 3 ISSUED ON:9/19/2 016 0:00:00
TO PERFORM THE FOLLOWING WORK:REMOVE EXISITING CLAP BOARD SIDING,
INSULATE BUILDING BLOWN IN CELULOSE, SPRAY FOAM AIR SEALING, WRAP BUILDING W/
TYVEK, INSTALL NEW WOOD CLAPBOARDS, REPLACE DECAYED TRIM
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 St 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 9/19/2016 0:00:00 $353.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File N BP-2017-0360
APPLICANT/CONTACT PERSON WILLIAM TUROMSHA
ADDRESS/PHONE P O Box 141 LEEDS (413)586-4005
PROPERTY LOCATION 44 CONZ ST
MAP 32C PARCEL 102 001 ZONE NB(I00)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Tvoeof Construction: REMOVE EXISITING CLAP BOARD SIDING,INSULATE BUILDING BLOWN IN
CELULOSE.SPRAY FOAM AIR SEALING,WRAP BUILDING W/TYVEK,INSTALL NEW WOOD
CLAPBOARDS,REPLACE DECAYED TRIM
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 000515
3 sets of Plans/Plot Plan
THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF MATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
D o D
Signature of Building Official Date
'Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning&Development for more information.
Version l.7 Commercial Building Permit May 15,2000
Oeparanant use only
•
yCity of Northampton Statusof Permit.
6 ‘41\////.* y a Building Department curt Cut/Driveway Perna __
., 212 Main Street Sewer/$epUcAvailability
Room 100 WaterMlellAvatiabitity
45 Northampton, MA 01060 Two Sets of Structure(Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plana
< Other Specify
r
-PLICAT��
ION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
I �� OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
id Property Address:
yy (one STREET Map 32 C Lot to Z_ Unit oo I
Nott iAYt?Iwo 111A Zone Overlay District
Elm St District CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
n,w,o ter U - . 78 -_ELM STREET NORTRAmpfor} MA
Name(Print) Current Mailing Address:
Signature Y _.-- Telephone
2.2 Authorized Agent:
What- 1: -Tueomsta _.. eit_FMX II/ LEEDS.MA 01053
Name(Prim) Current Mailing Address:
yL3_. 545 7V/4
Signature _ Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
'.. Building (a)Building Permit Fee
5090cm
. ..
2. Electrical _____..____ _. _
_
(b)Estimated Total Cost of
Construction from(6) ..._ _ _ - _. ...
3. Plumbing ^--- ---� Building Permit Fee
4. Mechanical{HVAC) --- -- -- At
5. Fire Protection35_3
fi.TTotal=(1 +2+3+4+5) 50,Lfoa.00 Check Number 7111
This Section For Official Use Only
- Butting Permit Number Date
Issued
Signature: I
1
Building Commissionernnspector of Buildings i Date
Version1.7 Commercial Building Permit May I5,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations 0 Existing Wall Signs 0 Demolition El Repairs Additions ❑ Accessory Building
Exterior Alteration 21 Existing Ground Sign 0 New Signs 0 Roofing 0 Change of Use 0 Other 0
Brief Description Enter a brief description here. %tricot Ex4snw, Clap leased xraaae, INSadaFE tastes wl
of proposed Work: tiaasa .a tttatos*a spits, Feaa. Adt alntnaf ""a+p baaawy Witink IH[Tan
_HEW 1 e._Cdup.ha8sds RCPL4CC_DEfenito_71tie_bzHres...k4.Eta8d
a
SECTION 5-USE GROUP AND CONSTRUCTION TYPE to;crs•
eat
a.. Le.w.�-...d 6y csc.iade terns
Me+L'an sarr <a,(ucna..tt agytusxl)
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 0 A-2 0 A4 ❑ 1A 0
A-4 ❑ A-5 0 1E 0
B Business 0 2A Q
E Educational 0 2B ❑
F Factory 0 F-1 0 F4 0 2C 0
H High Hazard 0 3A 0
I institutional ❑ I-1 0 I-2 0 I-3 0 —. 3B 0
M Mercantile 0 4 0
R Residential 0 R-1 0 R-2 ❑ R-3 0 5A 0
$ Storage 0 S-1 0 S-2 0 53 I 0
U Utility ❑ Specify:
M Mixed Use al Specrfy REeI(, hlt' sea Flair Net. „$eut AQESlast4 49t+d f_v .t-
S Special Use (= Specify:
.—....—__ __..._.,. _ ....—_........____....__.._.
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDRIONS ANDJOR 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)
2
2"° goo Sf. _. .gam .._
Total Area MO 2954 sj f+ Total Proposed New Construction(sS
akto
Total Height(ft) at o' _.. -.
Total Height ft 2ya oaa -_
7.Water Supply(MAI.c.40,§54) 7.1 Flood Zone,Information: 7.3 Sewage Disposal System:
Public 0 Private Zone _ Outside Flood Zone Municipal 0 On site disposal system
Version] 7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column co be Bed m by
Building Department
Lot Size 10,$43 Si ct _.
Frontage ..._ _. . ._
Setbacks Front
Side L II . . A: af - I'..:..lL R
Rear $3.'.
Building Height as- Zr
Bldg. Square Footage1114.
Open Space Footage
eami,msbldg&paved -.__.. ...._
policing)
parking)
#of Parking Spaces ----- - -- ,
Fi11:
(voluneaLocation)
N/A
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW Q YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW 0 YES Q
IF YES: enter Book Page and/or Document K
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW Q YES (3
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 NO Q
IF YES, describe size, type and location: $701 OM &tat t ot9 aat,o (pay Stgrl 3'—e x 2'4
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO t
IF YES, describe size, type and location:
E. W II the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre oris it part or a common plan
that veil disturb over 1 acre? YES Q NO
!r'YES,then a Northampton Storm Water Management Permit from the DPW is required.
Version L7 CommercfaE Building Permit May 5,2000
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)
91 Registered Architect:
Not APPliCable ❑
Name(Registrant)_.. . Registration Number
Address
Signature Telephone
9.2 Registered Professional Engineer(s})
Name Area of Responsibility
Address Registration Number �—
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiation Date
Name Area of Responsibility
Atldress Registration Number
Signature Telep+mne Expiration Dale
Name Area of Responsibility
Aad'ess Reg Region Number
Signature Telephone Expiration Date
9.3 General Contractor
Not Applicable ❑
Company Name:
` a War Rut.ms tin =rl .t. CD1J.KraW'M.t
Resat:110 a in Cham of Co struction
SSt reOM 5T. P.o Yh'r"+X_!`1_/_ sz_11i_ Q1953.
Address
Signature Telepnbne
Version I Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) �y
Independent Structural Engineering Stnwctural Peer Review Required Yes Q No 0
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I. _ T u Ibtat' . _ .. ,as Owner of the subject property
hereby authorize ._.Nara • ISVARA —... . . . to
act on m aft, in all matters rei a to work authorized this building permit application
Signature et Owner Date
I, ,.._.. .._.. _. ...__ . .. _.. __. .-.. _ .. _. ,as CwnerfAuthonzed
Agent hereby declare that the statements and information on the foregoing applicatlon are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury,_
Print Name ...___
Signature of OwnerlAgent Date —.
SECTION 12-CONSTRUCTION SERVICES 7
10.1 Licensed Construction Supervisor. Not Applicable 0
Marne of License Molder_ f/tilnae,--f+ Uc*o 7 .._ ... 000 EIS-- _..
License Number
loig
I
Address Expiration Date
fatioba
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 Attached Yes ® No
•
-� The Commonwealth of Massachusetts
— Department of Industrial Accidents
Office of Investigations
�". _�_= 600 Washington Street
77- Boston, MA 02111
-_ www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): WI)// I0onT
bAln J 1Lsha DEA DESI(N g CWJSIDtMMTin.1
Address: sa Flto$47 SrhEftT P.a. ea W
City/State/Zip: LEERS /pp O/oS3 Phone k: 1I/3 .}s 7496
Are you an employer?Check the appropriate box: Type of project(required):
I.❑ I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-fine).` have hired the sub-contractors 6. ❑Sew construction
listed on the attached sheet. 7. ❑ Remodeling
2.1Z I am a sole proprietor or partner-
ship and have no employees These sub-contractors have g. ❑Demolition
working for me in anycapacity. employees and have workers'
P ty. 9. ❑Building addition
[No workers'comp.insurance comp. insurance.
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
officers have exercised their 11.❑Plumbing repairs or additions
3.❑ I am a homeowner doing all work
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 REP/aA5 $Ievwq
comp.insurance required.]
"Any applicant that checks box#1 nasi also 611 out the section below showing their workers'compensation policy information..
'Homeowners who submit this affidavit indicating they are doing all work and then hire outside contactors must submit a new affidavit indicating such.
;Contactors that check this box must attached an additional sheet showing the nave of the sub-contactors and state whether or not those entities have
employes. lithe subcontractors have employees,they must provide their workers'cony.policy number.
l am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site
information.
Insurance Company Name: TRAo E'1FRS
Policy#or Self-ins.Lic.#: Expiration Date:TA ZWJE Zo I;
Job Site Address: City/State/Zip:
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 IT In ci,500 00 and/or nnr-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
Signature: N to .9. /r. _ Date:/5 SE/a7FrrBP4 20/G
Phone#:
Official use only. Do not write in this area,to be completed by city or town official
_ CiTy of TownC - . _ - __Permit/License-#------.__ ----.---- _ _ . _
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
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 150A.
Address of the work: yy Coat near
The debris will be transported by: 11. $rules n t
The debris will be received by:
Building permit number:
Name of Permit Applicant W beam. T. Ittn_omsl.
Date /S SEpfln4v2o/6Signature of Permit Applicant