35-169 (17) 1345 BURTS PIT RD BP-2019-1024
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Bloek:35- 169 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
ermit# BP-2019-1024
Proiect# JS-2019-001680
Est.Cost:S 11900.00
Fee: $77.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Group: WALTER MAREK III 055201
Lot Simian.fQ, 19994.04 Owner: PELIS LAUREL
Zoning, Applicant: WALTER MAREK III
AT. 1345 BURTS PIT RD
Applicant Address: Phone: Insurance:
73 SOUTHAMPTON RD (413) 527-7667 0 Workers
Comcensation
WESTHAMPTONMA01027 ISSUED ON.312612019 0.00.00
TO PERFORM THE FOLLOWING WORK.REMODEL SUNROOM GLASS WALL- INSTALL
FRENCH DOOR
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 Find:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: 411; 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 3262019 0:00:00 $77.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File g BP-2019.1024
APPLICANT/CONTACT PERSON WALTER MAREK III
ADDRESS/PHONE 73 SOUTHAMPTON RD WESTHAMPTON (413)527-7667 0
PROPERTY LOCATION 1345 BURTS PIT RD
MAP 35 PARCEL 169 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
CL D REQUIRED DATE
ZONING FO FILLED OUT
Paid
Buildine Permit Filled our
Fee Paid
Twoof Constructiow REMODEL S GLAft-"LL•INSTALL FRENCH DOOR
New Construction
Non StrugAnl 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
INF ATION 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: She 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 Sued Commission Permit DPW Storm Water Management
/Demolition Delay
3- 24-Zoi9
Si 'e of Building Official Date
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 mat the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
Department use only
City of Northam ton Status Pe
' Building Depart ant MAR 7 0 C UDtl way Permit
t 212 Main SV t sewed eptic vailability
Room 100 Wow ant ilaality
Northampton, MA 10@fPT OF pU1LOMONIN of dural Plans
phone 413-587-1240 Fax -
OMer specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORNATNIN
1.1 Pmoertv Addmss: This section to be wm~by oRlcs
134S 3ur,'1�'s MA
(0 Map La I(��1 Un8
r
t' A 0100, Zone Overlay District
Elm SL Disbkl CS Diamol
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
Nemo( 1�), /� -, Cunam Mailing Address:
Telephone
Spna ure
2.2
War
wn
Slgrewre Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by pimmill applicant
1. Building / J� (a)Building Permit Fee
2. Electrical r7 (b)Estimated Total Cost of
�a Construction from 8
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number
This Section For Official Use Only
Dale
Building Permtt Number. Issued:
Signatum: 3-ZL-2o)9
Building Commissionerllnspector of Buildings Day
GJ/vlc tl o @ Cor�,ca�1 �l✓�
EMAIL ADDRESS(REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
u.'lfitkfEU ti :',EK C9 CC 0'.
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ell
Ec„ ,n,arnsw ,oA
"'.:GP . .;O14P1Nr , Si: '[FV iH -0ny tc n tl lS;c Cd 1=' • Jif: 04 t :...t
4V Aoq: a, n t;..„l e�: .:1wPa� J :nr� -
y:
Fr t J iCh ac li a iJ ..
Section 4. ZONING Ali IMonna[bn Must Be Completed.permit[an Be Denied Due 7o Incomplete Information
Existing Proposed Required by Zoning
Thu column to be filled in by
Building Depaament
Lot Size
Frontage
Setbacks Front O L_
Side L:FI R:= L:[ R:
Rear 0
Building Height
Bldg.Square Footage % -
Open Space Footage
M oma miow bide&paved U
q of Parking Spaces
Fill:
volume&Iucafion
A. Has a Special/ke
/Variance/Findin ever been Issued for/on the site?
NO OONT KNOW YES O
IF YES,date issued
IF YES: Was the recorded at t Registry of Deeds?
NO ODONT KNO O YES O
IF YES: enterok Page and/or Document#
B. Does the site conbrook, y of water or wetlands? NO O DONT KNOW O YES O
IF YES, has a pbeen or to be obtained from the Conservation Commission?
Needs to be oO Obtained O , Date Issued:
C. Do any signs exise perty? YES O NO O
IF YES, describpe and location:D. Are there any prochanges to or additions of signs intended for the property? YES ONoO
IF YES, describtype and location: 7
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 O
IF YES,Nen a Northampton Storm Water Management Permit from the DPW is required.
. 131.E .rl ui u ., S1f.C:
u
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) F�] Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs ]o] Dacha [0 Siding P:3] Other(EA
Description of Proposed!
WoAcReiff Wf\(OJM S
Off—
Alteration of existing bedroom_Yes 1 IN Adding new 6edmom Yes v _No
Attached Narrative Renovating unfinished basement Yes _-X—No
Plans Attached Roll -Sheet
St.R New house and or addition to existing housing, comolete the followina:
a. Use or building:One Family Two Family Other
b. Number of rooms in each family ung: 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 W oodstaves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
1. Is construction within 100 S.of wetlands?_Yes _No. Is construction within 100 yr. floodplain Yes No
I. Depth of basement or cellar floor below finished grade
it. 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, ' , V .as Owner of the subject
propert
hemby US A
hereby a my e
my
on
to act behalf,in all manetive W work authorized try this building permit appi ^m.
Signalu f OWW Date
I, 11( ,as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the bast of my knowledge
and belief.
Signed unger t,he pains and nalu of perjury.
Pmt Name jV 3i' _
Signature of O~Agsm e
'M4'JI -'.P"� -x f t 'L%a G'E � a7 Ei• t14Y
t
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Su erA o_ NotApp9raMe 0
No,.o}Liu / r •
nse Noldrt: Ma at Cr( 0�5J'
Uea e N er
73 6 a3 ao _
lam/ Nl3 4-;I1 25-39 E
Slpnehea TdWhone
9.[ntered Hem lainwornmentiM Not Applic" ❑
_I�✓'iart� c, ISg4�
NevM R C n Number
3 �ar J p
Address E)Oraboh Date
LkaLl� d1�l�Telew pn.y13 R�1
SECTION 10.WORKERS'COMPENSATION INSURANCE AFFIDAVIT)M.G.L e.152,§2SC)8))
Workers Compensaton Insuranoe affidavit must be completed and submitted With this eppkabon.Failure to provide due affidevt vriA Muff
in the denial of the Issuance of the building permit.
Signed Affidavit Ataded Yes....... No...... ❑
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City of Northampton
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Massachusetts
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\' oaresnae+rr or eoraorsc rxsrscrroxs
212 win St t •INnlcipl suildinq �.
9oith-wton, M 01060 ♦ - C
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 b'g performed at:
13Ns LU�
(Please print house number and street name)
Is to be disposed off at II
Uwll�� Rif ulnc
(Please name Vmd locallon of facility)
Or will IIbedis�jposed of in a dumpster onsite rented or leased from:
W, 4r- - C. ?3 jt,,. w kdR
(Company Name and Address) 17
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.
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The Con munweaUh ofMassachuseas
Deparhnent oflndusumalAccidents
] Congress Street'Suite 100
Boston,MA 02114-2017
rawvwmassgov/dia
WIV.rkers'Compeasadou insurance Affidavit:Baikkr&ConbwtorsWAtchwaos/Phtmbers.
TO BE FILED WITS TBE 1'ERM17l7NC AUTHORITY.
A ll tlno Pit=print Legibly
Name(ammea/orpnwmri n&vidaa0- _
Address: —13 S ,—
city/statalzip; �►1►4 0Y � moue#-.- Nf GN) q
Ade Yav a ?Cyd tltt appnpdam be 7ype alproiees(required):
[�IamacreploYcwf6�,___voplym(fidl aodtrpotaime)• 7. ❑Newcunshuction
l.❑Im,mkpopimraprmm4ip®d haw no mployva wdaa frmero & ❑Remodeling
mY-P.*-Mowaima•emgia®,va„garied] 9. ❑Demolition
s.[][em ahamawnm dovna0 wadcgyadE[Nv wa#ma'amp.mrmmms9aireal♦
a❑Ion ehomco.oc.,am]I be hung miurrontocaad,m.O wmkwmy a"m•"r. lwm 10❑Building addition
emae Watall avnamaa eilhcbavewvlras'mvpm•ew imwaawmeaole tl.❑Eleetriwl repansoradditiona
paprivms wti memployee
12.❑Plumbing mp®S or eddlnWa
5.Q tamageomleomscuravdrlvrtueed dmaubamauom tiwa a ma aaeiva sbaa. 13❑Raaf> a
r1®mDmmamo�alvve avpbymme N.e.adds• .iavmvm*
6.❑we ere a cspmsdao sot iu o�mv rove e,s®d dad rima afamgVm pv MG 14.00lher
153.41(4).and we Wvem® Ia Olawmaa aMoned.I
'Any appficam that chcdm box el sunt alw M wdr mtia ldw ahecaydevZi-ma';-- a lafonooda.
t Homeawnms who mbmrt rhhai5davh irdic gdny as dong 0 wnb and dm hoe aWdearaam nbmta.Minas lo,H oZ such.
tCovhucron dn[rMek tlus M1oa mat earbcdm eddirioal shaiahowina wvmed�a�aminaasadaasvetemerma Ooam'via have
rmmoYcas IFtbeaub+mtsamms bene mployeq Weynmrt pmvWc t6e'v asodi'a noraie)>sbr.
law"emp/aya 4Wirprovidingworkm'eonyensadonhrammjbrmgspiptna Belowu0upu0rymrdjubdra
infmrmmion. / ? (�/�
Insmmce Company Name' ,/i L -1. `��
Polity#mSelf-ias. Ili7a7#j rWl.(C� �y. �yO...� — l0( MVuationDma: 6 : '
Job Site Address: R City/Sietmf:. Cte. -
Attach a copy of the uoorkons?ompvowdoo pnYq declaration page(showing the policy numbs and a virwea am).
Failme to secure coverage as required under MGL a 152,¢25A is a criminal violation ptmisbable by a five up to$1,500.00
and/or one-year imprisonment,as well as cinl penalties in the form of STOP WORK ORDER end a fine of up to$250.00 a
day against the violator.A copy of this adhment mey be forwarded to the Office of Investigations of the DIA for insurance
coverage verificanon.
I do hereby rrwdardoe ofpsjvy doer are informndan p.n ddreahave is true and correct
4}gpenue' _ ___._ Dam
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Official mer only. De not wAft in do®area,m be completed by etly or moa o$rua).
City or Toon: PermitUceum,#
issutagAuthority(circle one):
1.Board of Hank, L Building Department 3.City/Toro Clerk 4.Elechim Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
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oac o CERTIFICATE OF LIABILITY INSURANCE 04701201n
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATNELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISBUWG INSURERM AUTHORIZED
REPRESENTATIVE OR PRODUCER,AM THE CERTIFICATE HOLDER
IMPORTANT: NIM MI kwADDrnOMALWSURMD,on poky(be)must M endorsed. NSUBROGATION IS WAVED,subject to
tM temuarW w.r0lbrudlM poge3r,oe1MN1 poBNMrsey reglinarsrltlneeerrlt AWdrrrlerAentldeserWfeeee doesnaft- IFVftto Mle
ceWAoete hokhr In Neu a such
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CS.K.INSURANCE AGENCY,INC. 413 527-735910,0131547-8314
103 Northampton SL tra'W'IM kskA mumnca.wm
'.O.Box 597
astham mn MA 01027 PHENIX MUTUAL INS CO
wismats.ASSOCIATED EMPLOYERS INSURANCE CO
W.Marek Incorpomt d MMMMUC
73 Southampton Rd
Westhampton MA 01027
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
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IXCLI1910NB AND OONDITIONO OF SUCH POLICES.LIMITS SHOWN MhY HAVE SEEN IN==BY PAD CLAIMS.
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CERT*ICATE HOLDER CANCELLATION
TIEMD AMY O ll! IS TI0®O'. Mt D0®BE GANCBIID MIORE
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ACORD 25(2014-837) The AGORD mss Intl logo as IsgY6red mrtu of ACORD
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AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affabs 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("IDC").
M.C.L.Chapter 142A requires that the"reconstruction,allemtim, renovation,repair,modemimban, conversion,
improvement,removal,demolition, or cronshucaon of an addition to any pne existing ownero upied building containing
at least one but not more than four dwelling units....or to shudurm which are adjacent to such residence or building"be
done by registered contractors.
Note•.If the homeowner Am contracted with a corporation or LLC,that entity must befregistered.
Type of Work: _.1v'S'7"a�j Q�X— Eat.Cost
1
Address of Work: ( qS \ 1
Date of Permit Application: 3
1 hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law(explain):
_Job under$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 ROME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 141A.SUCH OWNERS ALSO ASSUME THE RESPONSBILITES 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 permhthe agent of the owner:
�/j I W. rel(s�, 1 S9 LAn
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
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501321 10 BURTS PIT RD PARADIGM NINDOW/BURTS PIT RD 28 10TH NET EOM VA 3/19/19 2:42
ftid Te ship se
W. Marek Inc. W. Marek Inc./Mise DOC! 910913/4
73 Southampton Road 73 Southhampton Road EXPT DATE: 3/21/19 TERN#462 """•'•^"
'SPEC ORDER '
Westhampton MA 01021 Westh ton MA SLSPR: RB RICH BUIS ""`••"••"
(113) 527-0003 (413) 527-0003 TAX 040 MASS TAX
ORDR 940913
SHIPPED ORDERED UM SKU DESCRIPTION LOCATION UNITS PRICE PER EXTENSION
1 EA ZZ00494091300 RD: 102' X 50n 3-WIDE DH 50 1
PARADIGM N.C. #8300 SERIES
WHITE VINYL
LOW E W/ARGON
NO GRIDS
DOUBLE LOCK
FULL FIBERGLASS SCREEN
3/4" INT REC 4-SIDES
BRICKMOULD W/SILL NOSE
W/J-TRIM FILLER
0#225542
(U-FACTOR 0.28)
PARADIGM/49614-MAREK 3/1 VF
419782
TOT WT: .00 " ORDER " ORDER •• ORDER `• ORDER •• ORDER `• ORDER `
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501324 10 BORTS PIT RD NEUMA PATIO DOOR/BURTS PIT RD 28 70TH NET EOM VA 3/19/19 2:39
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. rek Inc. W. Marek Inc./Misc DOC4 941286/4
3uthampton Road 73 Southhampton Road EXPT DATE: 3/20/19 TERM4462 ••"SPEC ORDER
aam ton MA 01027 Neatha ton MA SLSPR: RB RICH HLAIS +•++•++++++a+
(4 3) 527-0003 (413) 527-0003 TAX 040 MASS TAX
ORDR 941286
SHIPPED ORDERED UH SKU DESCRIPTION LOCATION UNITS PRICE/PER EXTENSION
1 EA ZZ00494128600 6/0 X 6/8 IRIS HINGED PATIO DOOR SO 1
NEDRA SMOOTH WHITE FIBERGLASS
FULL LITE IOW-E GLASS
4-9/16' WHITE COMP FRAME
BMC ULTRA PVC *LOOSE*
ROYAL SATIN NICKEL HANDLE
MULTIPOINT LOCK
WHITE VANISHING SCREEN
2G 42906646
(U-FACTOR 0.251
REEB/49642-MAREK 3/5 VF
25194000
TOT WT: .00 `" ORDER " ORDER ++ ORDER +* ORDER „ ORDER ** ORDER +
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