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35-134 (7) 14 WESTWOOD TER BP-2020-0460 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:35 - 134 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: GARAGE BUILDING PERMIT Permit# BP-2020-0460 Proiect# JS-2020-000779 Est.Cost: $33500.00 Fee:$218.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: WALTER MAREK III 055201 Lot Size(sq.ft.): 9670.32 Owner: WEAVER JENNIFER Zoning. Applicant. WALTER MAREK III AT. 14 WESTWOOD TER Applicant Address: Phone: Insurance: 73 SOUTHAMPTON RD (413) 527-7667 O Workers Compensation WESTHAMPTONMA01027 ISSUED ON:10/15/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT PORCH AND ONE CAR GARAGE 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: Smok : 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 10/1 /20190:00:00 $218.00 12 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner i File# BP-2020-0460 I� APPLICANT/CONTACT PERSON WALTER MAREK III ADDRESS/PHONE 73 SOUTHAMPTON RD WESTHAMPTON (413)527-7667 PROPERTY LOCATION 14 WESTWOOD TER MAP 35 PARCEL 134 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST OSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildinp,Permit Filled out Fee Paid T_ypeof Construction:_CONSTRUCT PORCH AND CAR GARAGE 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 INFORMATION 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 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 Dela} t6l�-v to Sig ture of Building Off-ficial 10Date 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 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 Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans \ �. phone 413-587-1240 Fax 41 rff ff�EC ns APPLICATION TO CONSTRUCT,ALTER, REPAI t, REI IOVATE OR DEMOLISHONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION �:j I 1.1 Property Address: t)EPT.OF 6UILDINC;INI"61�ttlflon t be completed by office NORTHAMPTON.MA 01060 Map Lot Unit MA I 1 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ( �t �- U`, Nardi e(Print) Current ailing Address: 1 , � Ok41 Telephone Sign4Ve 2.2 Authorized A e U), nt: afe.l(- Name rint) Current Mailing Address: J 0 `t-?) T,�3 / Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building ( Z)0 (a)Building Permit Fee 2. Electrical �� (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) ` V 5. Fire Protection 6. Total =(1 +2+3+4+5) D Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: 10 Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House Addition Replacement Windows Alteration(s) EJ Roofing 0 Or Doors 0 Accessory Bldg. Demolition 0 New Signs [O] Decks [Q Siding[p] Other[d] Brief Description of Proposed Work: C r-SWVV-1" PIX /I Ca ,Ih/ Alteration of existing bedroom Yes V\ No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 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 I, �e�"�� �J e.�l�}{X' as Owner of the subject property hereby authorize 1�—wTu 1�2f/L lX� l vi v� W i l4� to act on my behalf, in all matters relative to work authorized by this building permit application. tG Signatur of Owner Date I, � ar as Owner/Authorized 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 p-V and p�alties o perjury. (/ : V��✓ Print Name l Signature of Owner/Agent Date 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 I i V o Setbacks Front T/—(. 3� r Side L:�R: 1 L:J R: r� I Rear Building Height Bldg. Square Footage % Open Space Footage qV % 7�os (Lot area minus bldg&paved f lJ parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO © DONT KNOW ® YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ® DON'T KNOW ® YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained ® , Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO 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. SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Su ervii or: Not Applicable ❑ Name of License Holder: �L"I � G 1 M1— C3V�)0+ Licens Num er a313 0�0 Address Expiration Elate Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ GJ .Mtu,rzK- S9 Lin Company Name Regi trati n Number Address 13 00 Gj�1 CIJ�i�, Expirati Date Telephone��� J �`� 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...... ❑ City of Northampton ����+:►',,'ir�i ti\` sic, r Massachusetts '; t °"` r DEPARTMENT OF BUILDING INSPECTIONS �`. k S` 212 Main Street •Municipal Building J�., �w Northampton, MA 01060 �sl-f} . 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 11 c onstructs n work being performed at: Ly US� \ � (Please print house number and street name) Is to be disposed of at: (Please pint name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Z'/,X, lill- f� 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. BUILDING INSPECTOR'S PLOT PLAN IN WESTWOOD TERRACE NORTHAMPTON, MA o PREPARED FOR W. MAREK INCORPORATED 0 1 w m n - -Ile m Cl - 8 ,-'ZONE WSP FRONT SETBACK 20' SIDE SETBACK 15' REAR SETBACK 20' F f;C ,tt. II I /I I I 48'-10" 24'-2" 8'-8" 16' I PORCH GAR AGE 1 x20 8" I I I I I I I I I I I S I I I I f I Lil - Exsisting House I I L----------------- I I I I I I I I i - I ---------1 I I I FOUNDATION PLAN II II co I I I II Ii I 48'-10" LIVING AREA 127 sq R 46-10" 24'-2" -- 16, 3I 1 31 12 (ye )-V mon wall between , and Garage to be r ;rLivall corn Floor .22 3I 121"" Of &f-- 71-10",x-I 4" GARAGE 31112 ...... ............ Exsisting House .3 FIRST FLOOR PLAN ILI in 12 (vert)-V 3f 12 48'-1 0" LI\IlNr7 AREA 121 sl ft 4B'-10" 24'-2" 5. I � I t«c v I I ————— — — 31h12 I � <E2?� I �I rV1�Vn I ------------ 1 N f GARAGE "I 3 112 19 4"x 211-4' i � I I I r I I I _ _ 9 12—— ly Exsisting House I ( I I I I I FIRST FLOOR PLAN 3in12 (vert)-v I� rl m 4B'-10" LIVING AREA 121 sq R Asplalt Roof Shingles Underlayment Ice Barrier Drip Edge Ridge Vent Roof Pitch to 5/8"Zip Roof Shealthing Match House -H; En Ineered Roof Trusses 2x4-1 Woe.exterior Walls Garage Door Header to be Engineered IN I 'Zip Sheaithing ,... vl 5ldin9 rage Presure Treated 5111 Plates 4" Concrete Slab Compacted fill Poured Concrete 5'Walls w/Footing Y Gross Section s The Commonwealth of Massachusetts Department of IndustrialAccidents 0 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le 'bl Name(Business/Organ' tionM 'vidual): Wo C• Address: �3 City/State/Zip:(��� O Wa Phone#: I I� TP � 1 Are you an employer?Check the appropriate bOx: Type of project(required): 1.q!!�am a employer with _employees(full and/or part-time).* 7. New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.F1 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 E]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I L❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ p Roof repairs These sub-contractors have employees and have workers'comp.insuranceJ 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[:]Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date Job Site Address: �� 1 I'�r(T+� City/State/Zip: V-1- (� 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 verification. Ido hereby certify under tha' an nalties of perjury that the information provided bo a is true and correct. Signature: 1 Y Date: Phone#: Lc � l J 3 Oficial use only. Do not write in this area,to be completed by city or town of ficial. 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#: oATRe(INuoorrrYr) eco CERTIFICATE OF LIABILITY INSURANCE 02/2012019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES 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 holler is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). A PRODUCER K.S.K.INSURANCE AGENCY,INC. PHONE IC(413)527-7859 RAx 413 527-8314 203 Northampton St. travissias ksk-insurance.com P.O.Box 597 IMSUREIM- Easthampton MA 01027 gmugg A:PHENIX MUTUAL INS CO ASSOCIATED EMPLOYERS INSURANCE CO IMSURW W.Marek Incorporated 73 Southampton Rd y Westhampton MA 01027 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH 7HI5 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BPo�CLAIMS. LMIT rfm of I wgokMCEKIM RM 1 000,000 X CpMp�AL GOMM LIABILITYEACH OCCURRENC — DAMacE To RENrEamrom 50 000 A CI.Aws-MADE a OCCUR 5 000 3. CPP0719447 1110112018 11/0912019 EXPmwona PERSONAL&AOVI.- S1.000,000 GENEg&AGGgeQ&TE 2000,000 a TE LST APPLIES PER 1 000 000 ppiRpp.. PRODUCTS_ IOP A G X roLICY !ECT Elm S COMBMED SINGLE LIMIT S AUTOMOBILE LIABILITY $ BODILY INJURY(Per I)MM) ANY AUTO BODILY INJURY(Per accident) $ ALL OWNED SCHEDULED PROPERTY DAMAGE Autos $ NON-OWNED HIRED ALTOS AUTOS $ EAjrH OCCURRENCE UMBRELLA UAB OCCUR AGGREOA EXCESS LIAS MS•MADE L-= & - - X PER OTH- woma S COMPENSIATION AND EMPLOYERS.LwaanyY LK .L.EACH ACCIDENT S100,000 ANYpRp3RIETOWPARrNEPMMCUflVE NIA WCC-500-5014290-2019A 02/10/2019 02110/2020 100000 B OFRCERIMEMSER EXCLUDED? Y E.L.DISEASE-EA OYEE In oLSEAs -PoucYUMrr -00,000 DEsCRIPTIOM OF OPE RAMONS I LOCATIONS I VEHICLES(ACORD101,AddWonal RamwIw Schede,may be an ached if more space is"hod) GENERAL CONTRACTOR CERTIFICATE HOLDER CANCE'LATION SHOULD ANY OF THE ABOVE DESCRIBED POUCW-S BE CANCELLED BEFORE THE EXPIRATION DATE 'THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS- AUTHORIZED REPRE3ENTAIM < Q> ®1988 2014 ACORD CORPORATION. All rights reserved" ACORD 25(2014/01) The ACORD name and logo are registered marls of ACORD ,......... ... ..,,M.,,......�.,,a.«..•......u...•..,._.�...V..f«....a .....,............-...,..,."..., „� 9k:+Scar'�s��1'M't��13�?�CV�If�.►1�3�t'F�' 4�`>t;r�,�,�;,3t4�.n£,, iiilf'r ii{C i >�id�F�'Cf n ttl:;`;•3�'ffi'�tJVe,�TCd;'?£�s.'�r+v+P°s.s� �'"i"�.$�Sv�'T"�A'��.r r..:- E t iTti34a�l. ... $�:1 .fit s. M^.y1A4t7 i ttb.i' fiifCCk Ts;It t"3Ot�^�Il�6[.;r^tsz�W®n11GR:'• � i��� � V�l42S::,:L1'.6I. 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ViG.[t 3`�LH�'<3 61{�r.•� .1§ A..�nf Lrt1 12Y3!'r$1,{fm lx 1<4, 1 '.li`.<.i F�S.CUL 'i 6,vA Commonwealth of Massachusftts iviston of Prote tonal Ltcens �e E- 67 8 es. 6/2 01 S WALT L MARE SOOT MPTON O STHAM NMA 10 Co i ioner v" Commonwealth of Massachusetts Division of Professional licensure Board of Building Regulations and Standards Constwctibri`Stipervisor CS-055201 EEXpires: 06/23/2020 WALTER L MAREK,10 73 SOUTHAMPYON ROAD/ WESTHAMPT0*MA 01027't Commissioner _j;7l ` nrnrrrorunvull�n`^fr!irutrc�u�el/1 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Corporation Reaistration EMIration 159488 04/29/2020 W.MAREK INC. WALTER MAREK III 73 SOUTHAMPTON RD. WESTHAMPTON,MA 01027 Undersecretary