32C-235 (8) I I WILLIAMS ST BP-2020-0188
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:32C-235 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
Permit# BP-2020-0188
Proiect# JS-2020-000317
Est.Cost: $33000.00
Fee: $215.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq.ft.): 5532.12 Owner: TUROMSHA WILLIAM J
Zoning: URC(100)/ Applicant: TUROMSHA WILLIAM J
AT. 11 WILLIAMS ST
Applicant Address: Phone: Insurance:
58 FRONT ST (413) 586-4005 ()
LEEDSMA01053 ISSUED ON:8/13/2019 0:00:00
TO PERFORM THE FOLLOWING WORK.-RENO LAUNDRY TO PANTRY/CLOSET FOR
STACKABLE MACHINES
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 Deoartment 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:
FeeTyae: Date Paid: Amount:
Building 8/13/2019 0:00:00 $215.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
City ofNorthmpt�ECEI� jWa
safermit
Building Deprtm$TTt- Cut/ nveway Permit
212 Main tree rtSe tic Availability
Room 1 0 AUG
13 2019 r/W 11 Availability
Northampton, A0, 060 Setsof Structural Plans
phone 413-587-1240 ax - 2 ite sans
DFaT of SUILDING INSFEC r Sp cify
NORTHAMPTON
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION AP cZ 0- ( 9
1.1 Property Address: '"�
This section to be complete office
Map 9, Lot '� Unit
�ll►,ltlhams S7-2*s[-=T
0,PRQ7 m a t4T ** I Zone Overlay District
uO m-Ro lwc p- o^j N)A 3 1 0' (0<3 Elm St.District CB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 +jOwner of Record:
yj 1/iar, J- d w4Arni/w'0 t. O. Link 141 4EF-QS NA O 1053
Name(Print) Current Mailing Address: �z
On, Q 11-riew"t, Telephone 3 5 s-
(Print)
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
2. Electrical A j pmo , ov (b) Estimated Total Cost of
Construction from 6
3. Plumbing 3a oo • oo Building Permit Fee
4. Mechanical (HVAC) 10, OOb
5. Fire Protection
6. Total = (1 + 2 + 3+4+ 5) a ao Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature: c. 0 f, 31 t L�
Building Commissioner/inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING Alt 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 € — - _ - _-_-� E— mm
Frontage -- _ -- _
Setbacks Front �� � �
Side L:= R:= L:= R:= j
Rear
Building Height � �
Bldg. Square Footage %
Open Space Footage _. %
(Lot area minus bldg&paved � � ,
parking)
#of Parking Spaces
Fill:
(volume&Location) —— ---- 1 A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO & DON'T KNOW 0 YES 0
IF YES, date issued: —
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES 0
IF YES: enter Book _. page., . and/or Document #�
B. Does the site contain a brook, body of water or wetlands? NODON'T KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained 0 Date Issued: 3 i
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0
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? YESO NO 19)
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows "�Roofing
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs (O] Decks [C] Siding [❑] Other[❑]
Brief Description of Proposed
Work:C,i-th...,!y r, LaL P,#Aa&,by Ataoor, Te ?n,.Ys% 10a&ry Fcm 67mkghty
Alteration of existing bedroom Yes �tocK Z k.,1" 0&4>3 5iE;: p-ITue"D MAm-&Trv'e,.
g _No Adding new bedroom Yes Y _No A*4.0 pkka—E:%
Attached Narrative Renovating unfinished basement Yes )_No
Plans Attached Roll -SheelS
6a. 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 of 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 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 City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
property as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
1 n --.kb as Owner/limed
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 the pains and penalties of perjury.
� I1-,,6, T T�,L0P"S AA
Print Name
12-1i 42 1 4,ca /r3 .UifGl.'LsSi r/9
Signature of Owne gent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: ,(,[)11lw,J o�,,,S�ti n U 0 S S
License Number '
Address Expiratiort/Date
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
l A
4 M I a r.....,a A.P �g-SJ+1H � �lU$�R tcc�Tip aS Jo) 2 Z Z
Company Name Registration Number
Address Expiration Da e
Telephone,-(/-! saps
SECTION 10-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...... ❑
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�\ The Commonwealth of Massachusetts
Department of Industrial A cciden ts
I Congress Street,Suite 100
Boston,MA 02114-2017
www mass.gov/dia
Workers'Compensation Insurance Affidavit: General Businesses.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Business/Organization Name: Urn emny4a- ESI Glia 2 colls- ply o,j
If
Address: P0 'Zpk ILII C,EI=ps MP. 0IoS3
City/State/Zip: Phone#: Y/3
Are you an employer? Check the appropriate box: Business Type(required):
1.❑ I am a employer with employees(full and/ 5. ❑Retail
or part-time).* 6. E]Restaurant/Bar/Eating Establishment
2. I am a sole proprietor or partnership and have no 7, 0 Office and/or Sales(incl.real estate,auto, etc.)
employees working for me in any capacity.
[No workers' comp. insurance required] 8. ❑Non-profit
3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment
their right of exemption per c. 152, §1(4),and we have 10.❑ Manufacturing
no employees. [No workers' comp.insurance required]*
4.❑ We are a non-profit organization, staffed by volunteers, 11.0 Health Care
with no employees. [No workers'comp.insurance req.] 12•0 Other
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
**If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an
organization should check box#l.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information.
Insurance Company Name:
Insurer's Address:`j lav
City/State/Zip: -{p24-Fpk fl -T c9(e I p ) /
Policy#or Self-ins.Lie.# I_ S P-` & - d L E44 L
_� Expiration Date: L/2,n Zo Zo
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 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. 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 of perjury that the information provided above is true and correct
Signature: I d6z ei%a s L _ Date / /�e��• -*- 20 /g
Phone#:
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.Licensing Board 5.Selectmen's Office
6.Other
Contact Person: Phone#:
www.mass.gov/dia
City of Northampton
Massachusetts �k ,�` :�• `''f��
DEPARTMENT OF BUILDING INSPECTIONS D; 2
h 212 MainStreet •Municipal Building
Northampton, MA 01060 ,1
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:
) 1 5-7�2x—r.—,r ®n l�t�o�nrafo�j
(Please print house number and street name) If
Is to be disposed of at:
Varij -KF e-b K4
(PI ase prin name a d location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
W
Signature 15f 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.