17A-138 (3) 225 CHESTNUT ST BP-2019-0899
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A- 138 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category'Bath reno BUILDING PERMIT
Permit BP-2019-0899
Proiect4 JS-2019-001499
Est.Cost:$20137.00
Fee:$131.00 PERMISSION IS HEREBY GRANTED TO.
Const.Class: Contractor. License.
Use Group: THOMAS MALONE 055236
Lot Size(sa.ft.): 17616.04 Owner. CHOLAKIIS KATE&SEV
Zoning:URA(100V Applicant. THOMAS MALONE
AT. 225 CHESTNUT ST
ApplicantAddress. Phone., Insurance.
128 RYAN RD (413) 885-9038
FLORENCEMA01062 ISSUED ON.212512019 0.00.00
TO PERFORM THE FOLLOWING WORK:BATHROOM REMODEL
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 Occuoancv signature:
FeeTvpe: Date Paid: Amount:
Building 22520190:00:00 $131.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2019-0899
APPLICANT/CONTACT PERSON THOMAS MALONE
ADDRESS/PHONE 128 RYAN RD FLORENCE (413)885-9038
PROPERTY LOCATION 225 CHESTNUT ST
MAP 17A PARCEL 138 001 ZONE URA(IOOU
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCL REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildine Permit Filled out
Fee Paid
Typeof Construction: BATHROOM REMODEL
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 055236
3 sets of Plans/Plot Plan
THE FO LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOPMATION PRESENTED:
_Approved_Additional permits required(see below) LV ITH i-+votr�
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
Demolition Delay
/-"/z Z-19.2019
Signfisre of Building Official Date
Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all inning
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 stria standards of MGL 40A.Contact Office of
Planning&Development for more information.
Department use only
City of Northampton Status of Permit:
Building Department Curb CutfDriveway Permit
1 212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: ` This section to be compllt"office
Map J— Lot Unit
Zone Overlay District
Elm BL District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
K'\w ? !Sto CVX�titi„s Zzs c,,-e.%6 S�( -F
Name(Pont) Current Mailirg Adtlress.
t3
Telephone
Signature
2.2 Authorized Agent:
—t1,.a.rrw M.\cry— (L °L—
Name(Pont) A/��{// Cur're`nt`Mailing Address
: y�
Signet Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed bpermit so licant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee },
4. Mechanical(HVAC) ✓�
5. Fire Protection
6. Total=(1 +2+3+4+5) O }1,$1 Check Number IR
This Section For Official Use Only
Building Permit Numbs : Date
Issued: b p
Signature 14LL qq-1
Building Commissioner/Inspector of Buildings Dare
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION ti DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows, Al[sraeon(s) Roofing ❑
Or Doom El
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [O Siding [O] Olhef[Q7
Brief s tio}n;of`Proposed
Wok: % ,
a
Alteration of existing bedroom_Yes_No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement _Yes No
Plans Attached Roll -Sheet
ea If New house and or addition to existing housing, complete the following
a. Use of building: OneFari 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 consWction. Dimensions
e. Number of stories?
I. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance tone attached?
h. Type of construction
i. Is construction within 100 ft.of"tends?_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. SepticTank CitySewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, ".C. \ as Owner of the subject
property, ` 1
hereby authorize
to act on my behalf,in all matters relative to work authorized by this building penntt application.
Signature of Omer Dataky—tcl
t
I, \iyi m4 - l �. �s �M9 �c� . as Owner/Authorized
Agent hereby declare that the statements an infomiatlon on the foregoing application are two and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Prim Name
2
Signature of OwnenAgent Data
City of Northampton
Massachusetts
X
` DEPARTMENT OF BDILDZNG INSPECTIONS
212 rain Street • Municipal Builtl W
Northampton, MA 01060 �(la
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 perfomting improvements or renovations on detached one to four family homes. Prim 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"reconstmction, alteration, renovation,repair, modernization, conversion,
improvement,removal, demolition, or construction of an addition to any pre-existing owner-0ccupied building containing
at least one but not more than four dwelling unks....or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note.Lf the homeowner has contracted with a corporation or LLC,that entity must be registered
Type of Wmk: 601 mwl. 10 /k Est CosC ZUg UUU.j d
Address of Work: 225 S\o4V
Date of Permit Application: Z.' \'S— k')
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law(explain):
_Job order$1,000.00
_Owner obtaining own permit(explain):
Building not owner-occupied
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
t�permit
�as the agent off the owner:
7—l7S--\'A
Date Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
City of Northampton
Massachusetts
Z
i DSPAa14fENS OF BpZLDZNG ZESPECTZONS
1 212 Min St ea! anicipal Building m jpC1
NoitTamptoldn, W 01060 X11
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:
7zr Com. sok
(Please print house number and street name)
Is to be disposed of at:
�sG —e-, ��c-�
(Please rint name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
-z lS lc-1
`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.
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed in be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone numbers)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation polity,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in_(city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Department's address,telephone and fax number:
The Corrunonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel. #617-727-4900 ext. 7406 or 1-877-NMSSAFE
Fax#617-727-7749
Revised 02-23-15 www.tnass.gov/dia
Estimate
128 Ryan Road
Florcnvc.MA01062 Date Estimate#
1/17/2019 1722
Name/Address
Kole and Sev Cholakis
225 Chestnut Strew
Florence,MA 01062
7ertns Project
On receipt Cholakis bathroom
Oescripbm
Remove existing plumbing fixtures
3 Ea
Removal ofsmd wells
64 SF
Removal ofsheelrcek on walls and ceiling
465 SF
Stud walls 2 in.x 4 in.
24 SF `
Vertical discharge bath fan and light
I Fa \\
Fiberglass batt insulation 5-12 in.Kraft faced,R-21,walls
196 SF �6'-
Fiberglass
lass ban insulation 12-1/4 in.Kraft faced,R-38 ailing Z'
u 1S
Gypsum drywall, 12 in.moisture-resistant greenboani b
250 SF
Faucet for shower(Allowance 5200.110)
1 Ea
Shower base 60 in.long
I Ea
Shower wall stall 60 in.,3-piece(Allowance 5400.00)
1 Ea
Installation of file in thin set mortar,floors
58 SF
Tilc(Allowance 51.50 SF)
58 SF
Custom shower door(Allowance S1200.00)
1
Conan vanity tops and integral sink 25 in.long and vanity(Allowance$350.00)
1 FA
Medicine cabinets Swing door, 16 in.x 22 in,recessed(Allowance$75.00)
I Fa
Total KG
PE-mail
Signature
)885-9036 tora@
(413rainhome.net
Page 1
Estimate
128 Ry.Road
Florcncc.tM01062 Dotc Estimate#
1/17/2019 1722
Name/Address
Kate and Sev Cholakis
225 Chestnut Smect
Florenee,MA 01062
Terms Project
On receipt Cholakis bathroom
DescTWgOn
Install beth accessories(Allowance$50.00)
1
Prime and Paint walls and ceilings
465 SF
Free standing tub and faucet(Allowance$2500.00)
I Ea
Floor-mounted tank type water closet(Allowanw$225.00)
1 Ea
Plumber(Allowanw$3000.00)
1
Electrician(Allowmmm$1600.00)
1
Add new access door in wiling in hall
1
Recycle fees
1Ea
Building permit fees
1 LS
First time Home Buyers Discount
1
Pmjwt material,labor
Material,perjob
Labor,paph,
aPmjm Subtotal
Firs[time Home Buyers Discorm[
Total ec
Phone# E-mail
Signature
(413)885-9038 unn@minhume.net
Page 2
Estimate
Izx Ryan Road
Florence,MA 01062 Date Estimate#
�— 1/17/2019 1722
Name/Address
Kate and Sev Cholakis
225 Closeout Street
Florcmx,MA 01062
Tema Project
On receipt Cholakls bedroom
Description
aProjeet Told
Total $20,137.57
We propose to hereby to famish material and labor-complete in aca rdanee with the shove specifications,for the sum total.Payments to be made
as follows:halfof full total upon acceptance,one quarter of full total upon the start ofthe project and the full balance due upon completion.All
material is guaranteed to be as specified.All work to be completed in a manner according to standard practices.Any alterations or deviations from
above specifications involving extra vests will be executed only upon written orders,and will became an extra charge over and above the estimate.
All agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry fire,tomedo,and other necessary insurance.
Acceptance of Proposd will commence with the home owners signature.Prices,specifications and conditions are satisfactory and are hereby
accepted upon signature.Rainbow Home Improvement is authorized to da the work as specified and to bedal as specified.
Phone# EmailW'y
Signature
(413)885-9038 mm@rdnhome.net
Page 3
8T
Extg Toilet
(Remove?) Bathtub
(Remove)
Tile Flooring
6' 1" (Remove)
o i
Sink I
(Remove) iJ
Closet with Attic Amass
(Will need to relocate attic access)
'
Li �cv�
linen Closet
3' 7" 5'
�P7YlOv� ��
Pee cooe 193C6,L46
New Bathtub
(Shown at 5.5' x 2.5')
6- 1"
> (--o---I
I �` New Vanity
New Toilet (Dims T8D)
Turned 90 Degrees from Current Location
• � New Walk in Shower
New Fooring (5 x 3')
CPkz ,?
3'
i
I
i
Extg Toilet
(Remove?) Bathtub
(Remove)
�i Tile Mooring
6' P' / (Remove)
J � '
Sink I
(Remove) ._JI
Closet with Attic Access
(Will need to relocate attic access)
Li
Linen Closet
__3, ?, 5
ti
New Bathtub
(Shown at 5.5' x 2.5')
6' 1"
> New Vanity
New Toilet (Dims TBD)
Turned 90 Degrees from Curent Location I y
New Walk In Shower
(5'x 3')
New Flooring
Cf—g,41AIL�
3'
3' T' S'
2/15/2019 )) City of Northampton Mail-225 Chestnut St.i buiMing permit oanmilalian
Q441, qty of Kim Carson <kcarson@northamptonma.gov>
N
225 Chestnut St. building permit cancellation
1 message
Sev Kolysko <s.kolysko@gmail.com> Fri, Feb 15, 2019 at 1:08 PM
To: kcarson@northamptonma.gov
Hi Kim,
My wife, Katherine Cholakis, and I (Seweryn Kolysko) own a property at 225
Chestnut Street in Florence. We recently filed a building permit for a
bathroom renovation. The contractor on this permit was Justin Lively. We
now decided to proceed with a different contractor who will submit a new
permit. Please cancel the permit submitted by Justin Lively.
Please let me know if you have any questions.
Best,
Sev Kolysko
Sev Kolysko
skolysko@gmail.com
623-202-8243
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02/16/2019 THU 9: 58 PAX 21001/002
AGORd° CERTIFICATE OF LIABILITY INSURANCE O MYMr W1
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
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BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the cerHHc th,holder IB an ADDITIONAL INSURED,the Policy([")must have ADDITIONAL INSURED provisions or Ifo endorsed,
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ACORD 25(2018103) The ACORD nam°and logo are registered mark.of ACORD
02/14/2019 THU 9: 59 FAX 0002/002
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
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BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the Certificate holder is an ADDITIONAL INSURED,the poltry(les)must be endorsed. If SUBROGATION IS WAIVED,subject to
the tem.and conditions of and policy,certaln Policies may require an endorsement. A abtsiment on this ce ,c.te does not confer d,m to the
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