23A-224 99NONOTUCKST BP-2019-0123
CIS#: COMMONWEALTH OF MASSACHUSETTS
Mao:Block:23A-224 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeorv:windows replaced BUILDING PERMIT
Permit# BP-2019-0123
Proiect# JS-2019-000201
Est.Cost:$8145.00
Fee:$40.0o PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: ROBERT SZKLARZ 98619
Lot Size(sp. ft.): 7884.36 Owner., BIERWERT KAREN
Zoning, URB(100)/ Applicant. ROBERT SZKLARZ
AT: 99 NONOTUCK ST
Applicant Address: Phone: Insurance:
566 AMIIERST RD (413) 322-90310 WC
SOUTH HADLEYMA01075 ISSUED ON:7/31/1018 0:00:00
TO PERFORM THE FOLLOWING WORK REPLACEMENT OF 9 EXISTING WINDOWS
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 Sienature:
FeeType: Date Paid: Amount:
Building 7/31/2018 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
41 _ s
Department use only
City of Northampton Statue of Permit
Building Department Cure CutipnwwayPenal
212 Main Street Sexer/Septic Availability
Room 100 WatedWeli Av lk&l ty
Northampton, MA 01060 Two Sets of Structural Plan
phone 413-567-1240 Fax 413-587-1272 PkA/Site Plans
OHM Specify
APPLICATION TO CON ER REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
1I
NI UNInlIne0e eU 1tl3U �rn— 10
-i13
SECTION 1 -SITE INFORMATI
1.1 Property Address: IRV 0E inr Thiss section to be completed by office
p a�/= Lot may Unit
99 Nonotuck StreetUG
D ^ ��^�a a Overlay District
•J E m St Inside CB DlsWct
SECTION 2"PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
Karen Bierwert 99 Nonotuck Street
Name(Pnnt) Cwren'�ltiMailin Adds 6ress:
nn ,L - �, -
6 TNephone
Signa[ule�
2.2 Authorized Agent:
en atr 5(,(a tgm�yrc� P�_1.Cnv+f ti.,cBr 1�, We 010- r-
Name(q Cunent k6iliog Address:
f� / O )
SignaNre Te ephonl e
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 8,145.10 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee ,(y
4. Mechanical(HVAC)
5.Fire Protection
6. Total=(1 +2+3+4+5) 1 8,145.10 Check Number �J
This Section For Official Use Only
Date
Building Permit Number: Issued:
�
Signatur . 1�40
Building Gomegmerlins,,ector of Buildings Dale
staff @ colonialinnovation.com
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
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
Frontage
Setbacks Front
Side U R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus ring&paved
dein
q of Parking Spaces
Fill:
volume&[.ovation
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO a DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO a 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 e
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 O
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 O NO e
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK Icheck all aeglicable
New House ❑ Addition ❑ Replacement Windows Alterations) EJRoofng ❑
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[O] Other[E:Q
Brief Description of Proposed Replacement of 9 existing windows with Integrity inserts.
Work:
Alteration of existing bedroom_Ves x No Adding new bedroom Ves x No
Attached Narrative Renovating unfinished basement Yes x No
Plans Attached Rall -Sheet
ea.M New house and or add@lon to existina housing. complete the fotlowina:
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?
I. Method of heating? Fireplaces or WoDdsloves 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 ChySewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS/AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, en- �c r .F1'e r we r t ,as Owner of the subject
property
Colonial Carpentry Innovations, Inc.
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
ewe--. ' f -7
Sinaature of Owner /I Data
I,1 O Ol'1 I Q 1 QYDQ(1'fYl1 �llYlAv/2j'7(lY1 S�n f. , as Owner/Authorized
Ag anl hereby declare m th statamen and information on the foregoing application are"a antl accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Print Nam
Signature of n Date
SECTION 8-CONSTRUCTION SERVICES
81 Licensed Construction Supervisor: Not Applicable 0
Name of License Hader: Robert N. Szklarz
License Number
CS-098619
Add... Expiation Date
566 Amherst Rd. South Hadley, Me 01075 10/22/2019
Signatu lephone
(413)322-9031
.Re Isteretl Mwe Imamonnament Coftactor. Not Applicable 0
I A�Ohl rkg2eJ���7"t.1 J nW2f..nP InC
Codi
an Nem. ' 1 —, Registration Number
f 5- 175091
Addre Expiration Date
Telephon 7—YO`� I 04/17/2019
SECTION 10.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(5))
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....... V No...... 0
Northampton, MA : Residential Property Record Card
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Parcel lD Name Street Name
NONOTUCK ST SearcM1 Reset
Parcel ID Card Map-Block-Lot Location Zoning State Class Acres
23A-224-001 1 99 NONOTUCK ST 101 -n/a 0.181
Owner Information Property Picture
Bierwert Karen -
99 Nonotuck St •�k
Florence MA 01062
Deed Information
Book/Page: 4795/10
Sale Date: n/a
Dwelling Information _
Living Units: 1
Style: Ranch
Story Height: 1
Exterior Wall: Frame .,
Attic Living: None
Basement: Full
Year Built: 1967
Ground Floor Area: 912
Unfinished BSMT Area: 0
Fin BSMT Living: 450
Tot Living Area: 1362
Red Room: 0 x 0
Tot Rooms: 5
Bedrooms: 3
Full Baths: 1
Half Baths: 0
Max Fire Place 0
Frame Fire Place 0
Heating Type: Basic
Valuation
Lan@ $98,200
Building: $90,000
Total: $188,200
Sales History
Document No Date Price Type Validity
n/a 1995/12/01 $110,000 rand + Bldg 0
n/o $103,300 Land +Bldg 0
Permit History
Date Purpose Price
Out Building Information
Type Qty Year SIxe1 Sixe2
Shed-Frame 1 1991 1 120
Building Sketch
Descrolar/Area
A 1 FOB
912 light
38
24 1Fr/B 24
912
38
Notice
The 1brormatlon delivered through this on line database Is or ded In the spirit of open access to government Information and is
intended as an enhanced service and convenience for citizens of Northampton, MA_
The providers of this database-CLT, Big Room Studios, and Northampton, MA assume no liability for any error or omission In the
information provided here.
Currently All Values Are Finalized For Fiscal Yr 2017.
Comments regarding this service should be directed to: Isarafirl northamptonessesser,
wv�
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
Boston,MA 02114-2017
www.massgov/dia
\\orkers'Compensation Insurance Affidavit:Builders/Contractors/Electiicians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant I t t' Please Print Leuibl
usy
Name (Biness/Organiretiontadividual): ` '
/ 61017101 rarno� Inroini—r�_t 1nC .
Address:.56(o RmhP. j 2d
City/State/Zip S Phone#: l,3)
Are yea an emvlayer?Check the.ppmpmm aox: Type of project(required):
I. am aemployer with employees(full sndurparl-time). 'i. []New construction
2.�lamesole prnpriemr orpmncrshiP and have no employees working forme,. g. E]Remodeling
any capacity.(No workers-rump.insurance me neod.l
3 I am a homeowner doin ll workm If rkers'com . eumnc dl' q. El Demolition
ga yse [Nu coo pin eregmre
4.❑1 am acontraction,ner and will be hiring contracto conduct all work on my property. I will I O❑Building addition
ensure i tall cancrincoreaseither have wmmas'compdrougld immancenr are sole IL❑Electrical repairs or additions
propnemrs with no employees. 12.❑Plumbing repairs or additions
5.[]lam ag mmI cunnecmr and l have hired thesuD-immuntors uamdon lheanaehed amen 13.�Roof repairs sub-conhactors have employees and have wonkecomp.iisconect C��
6.❑We are a corporation and its uRccrs have exercised their right of exemption per MGL c. M.t T ilder�I riACJ)�
152.§I(4),and we have no employees.[No workerscomp.insurance required.]
"Any applicant Nal chinks box#1 most also fill out the section hdow,showing Nelr workers compensation polity infunoadon.
t Homeowners who submit this affidavit indicating they are doing all work and Nen hire mande co ndarb rs most submit a new affidavit indicating such.
1Contracmrs Nat clock this box most attached an additional sheet showing the name of the sob-connectors and,,.whether or not those entities have
employees. If Ne mbmnnacom,have employees,[hey most provide their workers comp.policy number.
I am an employer that is providing workers'enmpensadon insurance for my employees Below is the polity and job site
information. _
Insurance Company Name:._f_l'QVO IV f S
Policy#or Self-inss.(.1ILiic.#: (,Iju 948IA--I I �' Expiration Date: IO 13
Job Site Address: —19 f)n-hirr- Ufre9-j" City/Slate/Zip:f-/drfn r(/, M1'} nIn(pp'L
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verificatio
I do hereby eeat the information provided above is truetand correct
S to oi!iun e s qp:d pen 'es er' hDate --T I.2 d
Phone# f
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#:
City of Northampton
Massachusetts
I DEPARTNENT OF BUILDING INSPECTIONS M
212 Nein Street *Municipal Building
Northampton, MA 01060
Debris 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.
The debris from construction work being performed at:
q q �laagl c� ��me)
(Please pont house number and street name)
Is to be disposed of at:
'56ko Amhvrc+ R�l ��oL3thi�r dlpt t '"a �umpsie t ron�_�ded b�
(Please pont name and location of facility) Tt
Or will be disposed of in a dumpster onsite rented or leased from: Q
(Company Name andsAdd�dreSS)
11�A l -50
Signature of Permit Applicant or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.