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20 Westwood BP-19-5520 WESTWOOD TER BP-2019-0055 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 35 - 135 CITY OF NORTHAMPTON Lot-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGLLcc.1144/2A) Category.KITCHEN&BATH RENO BUILDING PERMIT Permit# BP-2019-0055 Protect JS-2019-000084 Est Cost: $17200.00 Fee: $110.0 PERMISSION IS HEREBY GRANTED TO: Const.Class:Contractor: License: Use Group: WALTER MAREK III 055201 Lot Size(sp.fi.): 9888.12 Owner: W MAREK iNC zones Applicant. WALTER MAREK III AT: 20 WESTWOOD TER ApplicantAddresN: Phone: Insurance: 73 SOUTHAMPTON RD 413) 527-7667 O WESTHAMPTONMA01027 ISSUED ON.7/23/2018 0:00:00 TOPERFORM THE FOLLOWING WORK.-REMODEL KITCHEN & BATHROOM, REPLACE 3 WINDOWS & DOORS 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; FeeTvpe: Date Paid: Amount: Building 7/23/20180:00:00 $110.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2019-0055 APPLICANT/CONTACT PERSON WALTER MAREK III ADDRESS/PHONE 73 SOUTHAMPTON RD WESTHAMPTON (413) 527-7667 Q I PROPERTY LOCATION 20 WESTWOOD TER MAP 35 PARCEL 135 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OITT Fee Paid U. Building Permit Filled out Fee Paid TWeof Construction: REMODEL KITCHEN&BATHROOM REPLACE 3 WINDOWS &DOORS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included Owner/Statement or License 055201 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INT94MATION 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 ofHealth 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 olition Delay i-:natmeof rgnature ofBuildin fficial Dat Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all reguIred permits from Board of Health,Conservation Commission, Deparmisent 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. Department use only City of Northampton Status of Permit: Building Department Curb Cutlorivewsy Pennh 212 Main Street Sewer/Septic AvailabilityA Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 PloUSite Plans Other Specify. APPLICATION TO CONSTRUCT,ALTER, REPAIR RENOVATE OR DEMOLISH rA ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION J"\- ` r l tlress: This section to be completed by office1.1 ProoeM Atl ao dress: MapAll; Lot 11 Unit n' w - Zone Overlay DisMct Elm SL District Ca District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: tA i fi, Name(Prim) CuCura'lMeilirg[ress: Tolepr2le Signature 2.2 Authorized Agenic ,r/J',^hlE Name(Pant) Cunard Mailing Md. Signature TelepMone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed bpermit plicard 1. Building r i a)Building Permit Fee 2. Electrical b)Estimated Total Cost of Construction from 6 3. Plumbing Sao Building Permit Fae 11 DD 4. Mechanical(HVAC) V 5.Fire Protection 6. Total=(1 +2+3+4+5) Check Number Thls Section For Official Use Only Date Building Permit Number: Issued: Signatur . Building Coi isslunadlnspector of Buildings Date WInLyee<3 @ UVk1\Ca1-.N'- EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 8-DESCRIPTION OF PROPOSED WORK(check all applicablet New House Addition ReDplao orwnl,;Inows Aheratlon(s)Roofing ElOr Accessory Bldg. Demolition New Signs [0) Decks [q Siding[01 Other[II" Brief Des ption o p work oY ° `t ,+3atk . AA1Q Ren a- 3 wig 3 O ar Alteration of existing bedroom—Yes No Adding new bedroom Yes k No Attached Narrative Renovating unfinished basement `Yes _No Plans Attached Roll -Sheet Ga.If New house and or addition to existing housing, complete the following: 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 f 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 constrection within 100 R.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, as owner of the subject property hereby authorize to act on my behait, in all matters relative to work authorized by this building permit application. Signature of Owner ly1l, // Date I,b o 1" art as OwnerlAulhorized 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 hep/gins d penalties of perjury. PrintN U Signature of Owner/Agent Da[e Section 4. ZONING All Information Must M Completed.Permit Can M Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Q Building Depanmart Lot Sim Frontage Setbacks Front Side L: R:L: R: Rear wilding Height Bldg.Square Footage Open Space Footage nu Lot arca minus bldg&paved aur 017poking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW ® 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 ® 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 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 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. City of Northampton Q--MassachusettsI)6PAe1 S OF BOZLDZNG ZNSFBCTIONS212lYinetieat •Nml 01 HuilGiegaostnavpton, em 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 performedat: Please print house number and street name) Is to be disposed of at: UUd f Ca jj- Please print namo and l0 on of facility) Or will be disposed of in a dumpster onsite rented or leased from: y( Company Name and Address) 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. SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction S I rvisor: Not Applicable 0 Name of License Holder: G CS o + 010 1 1.1 3 So Ia R ( J vi,—* . MA n Na jr EwiraGon ate signature Telephone 9 Roulstered Home Improvement Contmetor: Not Applicable Company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT)M.G.L.e.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...... City of Northampton Massachusetts DEPARIMBML' OF BUILDING INSPNCTSONS Z 212 win atrMt • Nunieipal Building a cNorth,o n, Na 01060 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes.Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction, alteration,renovation, repair,modernization, conversion, improvement, removal, demoltbon, or construction clan addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which am adjacent to such residence or building"be done by registered contractors. Note:/f the homeowner has contracted with a corporation or LLC,that entity st be registered. Typeof Work: I-y"A N)' fly' Est Co OD Address of Work:1b e I^c.. 06ery, Date of Permit Application: 7 va- I hereby certify that: Registration is not required for the following reason(s): Work excluded by law(explain): Sob under$1,000.00 Y I1 O Owner obtaining own permit(explain): C (J"Y1VX- "( {ML( _G)'^'4r't'Ar 1 SCIT v Ot/Pttteee Building not owner-occupied II t Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: Date Contractor Name HIC Registration No. OR: No wt standing the above notice,I hereby a p y for a building pt as the owner of the Bove property: I l j6 Date Owner Name and Signature The Commonwealth ofMassaehusefGc Department oflndustria/Aecidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 wwmatassgov/diaW11twkers'Compensation Insurance Affidavit.Builders/Contnemrs/Electrldansn4 tubers. TO BE FILED WITR THE PERMITTING AUTTIORITY. Applicant Information Phase,Print Lezibly Name(Business/OrganiMfioNindividml): VIC Address: 12 tM";}" City/State/Zip: r' M6 Vu.) Phone#: 41 G,),) 9 l Are you an employer+Check the apprvprlate lona: Type of project(required): Ida]..employmwiu _employees(MI soo,m on-o.t.7. New construction 2.(anawle pmpriebrorpuuership and Mvemem loyees wohiog f6,mm g. Remodeling anY capacity.Mo wmkm'comp.in.mauce required.]9. Demolition 3.I am a hommwmr doivg ell woh myaetf.[N.wadren'nam.inuvmmrequired.]t 4.lamahomeownca.dwi Wdngwnh.aa co.d,ctaltwo onmypmpcM. lwiu 10 Building addition mama Wnau cantreama eNur Mvc wohas'co npenvtianivvmmmaesok Il.Electrical repairs or additions fietam witb m employees.12.Plumbing repairs or additions 5.lamegercrd caoaac li ivve dMv.ve o Mve hir t brmmac[ots sted m Neamehedshxr 13.RwfThesesubcoamnorsMveeloyxsandwrkers' W..1 repairs 6.We are a amp uw avd its officers have eaerei awr right ofnemptioo per MGL c. 14.Other 152,51(4),and we have no empkyxs.Mo workers'comp.iauuaaa rtqu'ved.l Any applicant dist checks brut#1 rmat dw fill an the s«am below showingtheb wvAov'coleomuon pobry infwmah. t Home..who t this affidavit indicatingdrey.m doing all workand tlen hire outride runnacmm uuM wbmit.new ef6lavit truncating such. Conhacmutut check Us box moat Luched an additional shit showing the name ofthe aab.cwtnxunsaod sere wbts m mnot throeenrities Mve employes. IftM wbcmtmcmn Mve cwploy they mut povide We'a "der - .Mlwy numbs. I am an employer dud is providing wworkers'compensadon insurancefor my employees. Below is duepolicy andjob site Insurance C L` l: 1 coInsuranceCompanyName:''(,, nn,yQPolicy#or Self-ins.Lic.#:(XC O 1LAt Sg 4D Facpimtion Date: q Job Site Address: V C. e— City/State/Trp: fvcc , " `l" J Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage m required ruder 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 from of a STOP WORK ORDER and a fine ofup to$250.00 a day against the violator.A copy ofthis statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerb)ry under rile rides ofperjwy dist due injbrmadon unue and correct S1 M: !tel/Date / phone t Official use only. Do not write in this area,as be completed by city or down of ficial, City or Tower: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityfrowo Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 71412018 Office of Consumer Affairs 8 Business;Regulation-MasaGw HIC Registration Complaints Registration 159488 p Cen "ealth or Massachusetts Registrant W.MAREK INC. f Division of Professional Licensure Name WALTER MAREK III Board of Building Regulations and standards ConstrucRon'SopeNisor Address 73 SOUTHAMPTON RD. City,State WESTHAMPTON,MA 01027 CS-055201 LAyires:06123/20 Dip 3-JExpiration042N9/2020 WALTER L MARS ...:' Date 73 SOUTHAMPTON ROAR WEBTINMPT SIA 01gV: `. Complaints Details 1.."' No complaints found for this registrant Commissioner You can also view arbitratign and Guaranty Fund hlstor .. Back ISearch Site Policies Contact Us O 2012 Commonweafth of Massachusetts. Mass.Gov®is a registered service mark of the Commonwealth of Massachusetts. 1;i2 r.,I)IROOM ry o + 1 UTILITY UVIN6 LA N DR 71CL, IN22,LM1-2 in I KITCHFN popcl-f 2 In 1 1b, 1 i2