24C-031 (4) 76 NORTH ELM ST COMMONWEALTH OF MASSACHUSETTS BP-2021-1802
Map:Block:Lot:24C-031-
001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2021-1802 PERMISSIONISHEREBYGRANTED TO:
Project# Contractor: License:
WILLIAM J TUROMSHA DESIGN &
Est. Cost: 14050 CONSTRUCTION 000515
Const.Class: Exp.Date:02/15/2022
Use Group: Owner: MURPHY, DAVID A.
Lot Size(sq.ft.)
WILLIAM J TUROMSHA DESIGN &
Zoning: URB Applicant: CONSTRUCTION
Applicant Address Phone: Insurance:
11 WILLIAMS ST (413)575-7846
NORTHAMPTON, MA 01060
ISSUED ON:08/31/2021
TO PERFORM THE FOLLOWING WORK:
REBUILD PORTION OF ROOF
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.
Signature: � '
.5.2' )1 •
Fees Paid: $94.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
qGC //,,-\ Department use oni
- aospJ City of Northamp O�,T c0 Status rm
i
!` ti °�r Building Departmen '10�e orb curl {v�vira ermit
" 'c,,,,, 212 Main Street 'tiyG,,,,, Sr/Sept' Availability
` >> t Room 100 ��lb`;'.,, Water/W I Availability
{ �,� i;r i /So
k1.
f Northampton, MA 01060 �-9°F o is of Structural Plans
4" *-9"c" phone 413-587-1240 Fax 413-587-1272 '° ite Plans ' .
ar 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 completed by office
.' Nitscr% ST48e-r Map Lot Unit
Mel IttlAsNiihriw4 Th PI Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
xsuICy (,! Ply 42 )012m E1J1 Sr s-r AlOgraivainspihisi
Name(Print) � ) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
` libi G�ti2awisl-iaa iiie//,.v:.s s"TeraT Ucur f+ra aritni
Name(Print)/ Current Mailing Address:
hAS 9 Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item I Estimated Cost(Dollars)to be Official Use Only
_ completed by permit applicant _
1. Building %cte�. @ (a)Building Permit Fee
REh•edk or Gs►A6e Iaorsa. GG
2. Electrical (b)Estimated Total Cost of
2So . 411"' Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) # qiCt
5. Fire Protection
6. Total=(1 +2+3+4+5) - Pi/ 050.a° Check Number / ' / V
/�
This Section For Official Use Only
Building Permit Number: L a- -i 0� I T Date
Issued:
i
1 i 1 ; %
Signature: OP
Building Commissioner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
r,:n
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
i
Lot Size .+ _ _____ i I_._._-.,. ___.. _._.________i
Frontage 1 ..7. 3...!_.•_____._..1-1 1._..__ _.___.._..__.__.__ _i �w __ ,_._. _ . ..,,
Setbacks Front c-
Side L:2.1'L R:i%'.`.( L:.... ._, R: ... ._r t.__._.
Rear ri.9-4. I_.._`.... :_71
Building Height - -- - -,
Bldg.Square Footage ! % .
1 F`.
Open Space Footage
(Lot area minus bldg&paved LL,, �Y. .! #_..._ I' 7 - _,
Parking) _..... .. .,
•
#of Parking Spaces i_ _.* _...�
Fill: _.,.,_......_....___ — . .._. __ _..,
(volume&Location) __ _._._.. .�I ... i ...,_. _.`
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DON'T KNOW 0 YES 0
IF YES, date issued:; ,
• IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES Q
,....._.. .._.,_......._.__....
IF YES: enter Book Page: and/or Document#1
B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained ® Obtained Q , Date Issued: 1
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location: MURM R g LpTci stq,y
1 . RowT.e
N r-rut!louse
D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO 0
,--
IF YES, describe size, type and location: ---I
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 Q NO
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 Alteration(s) ❑ Roofing ❑
Or Doors El
Accessory Bldg. ❑ Demolition ❑ New Signs [DI Decks [C] Siding [CO] Other[O]
Brief Description of Proposed
Work:Rt,Rtuto la SYSo RooF ON TNf fb# itioa a Tlrg TlJ.RIF eiat_Gpexia THAT Rgamoua Sas 477wc 4
Alteration of existing bedroom_ Yes No Adding new bedroom Yes 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, DAuic i°f(u2PH7 , as Owner of the subject
property
—__
t
�� _
hereby authorize T1 44c5I' ,o
to act on my b , in all matters % a to work auth.Eir9d by this building permit application.
Signature of Owner Date 25 P« sT i
I, 1b/YJ -7" 1 d».sita___ , as ems"/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 the pains and penalties of perjury.
W,L1, .i T 1(L OMSha
Print Name
4/ J�
Signature of Owner/ ent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder: �ll1'sa,,. /ti II.OrtaS 4A CS — 0 0 0 5IS
License Number
/1 dr/./i,aH,: S-r•2 6 rs-t M O Z/15/ 20
` ZZ
Address/ Expirati Da
10/ ��, 1r� •� � — 1/3 S?S �8Y6
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable 0
Willmar. 3-- ti4n. .�M• "beSic,N COHSTtaCT,.44 101 7 2.7--
Company Name Registration Number
II 141,1/,Aim 3 sTREL-1- 81141 zoLL
Address Expiration Date
N0RTHAni fa13.! POI 0 1 b Lo Telephone 4//3
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 0 No 0
DESIGN & CONSTRUCTION
August 25, 2021
Commissioner Jonathan Flagg
Northampton Building Department
212 Main Street
Northampton, MA 01060
Property Location:
76 North Elm Street, Northampton, MA
Demolition and removal of two-thirds of the three-car garage. The remaining
third to have structural repairs and a new shed-style roof. This portion of the building
will be removed in the Spring of 2022 to make room for a new three-car garage.
A large tree fell on the garage, a result of the rain and wind storm two weeks
ago. The garage was totally crushed. Inside was a Ford F350 pickup truck that was
remarkably unscathed.
We supported the remaining structure as the structure was moving and would
have eventually collapsed destroying the truck and the remaining portion of the building.
The owner would like to install a new roof and retain until the Spring. See
attached photographs. I have also attached plans showing the new shed roof with
structural supports.
The permit application includes the $2,800.00 of work it took to extricate the
pickup truck from the collapsed building.
Thank you for your consideration in this matter.
Respectfully submitted,
William J. Turomsha
Wm. J. TUROMSHA • 11 Williams Street • Northampton • Massachusetts 01060
City of Northampton
-pRs A P O\.
'` Massachusetts '" •.i �!r•
,
fj r A. * ��
H1.q•- ,,z -
',.
'.. --1-1'. gt.V. DEPARTMENT OF BUILDING INSPECTIONS ;.pi,
, c
i 212 Main Street .Municipal Building ,.Ta i �b
-:, Northampton, MA 01060 j4.'W �~a
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:
76 No<" El" SIle.0 eir NO2THr;PA pie P-1
(Please print house number and street name)
Is to be disposed of at:
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
M S L1 Wirt. ?0 a box Ill Wiilr4m4hw.c MA
(Company Name and Address)
biZt bYJrmK-
Signature of ermit 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.
The Commonwealth of Massachusetts
, Department of Industrial Accidents
t 1= 1 Congress Street,Suite 100
_ .1=
Boston,MA 02114-2017
www.mass.gov/dia
rV
Workers'Compensation Insurance Affidavit:General Businesses.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Business/Organization Name: WM TTuR.ennsu. -DF_si64 2 CoH srrakeria'
Address: 11 Willi Awls s emar
City/State/Zip:Na(LTknlnp-rota,mA •ajDlie• Phone#: �f13 s'86 Yoe.6-
Are you an employer?Check the appropriate box: Business Type(required):
1.® I am a employer with o employees(full and/ 5. ❑Retail
or part-time).* all SuLc.»*awee.Rs 6. I:Restaurant/Bar/Eating Establishment
2.❑ I am a sole proprietor or partnership and have no 7. El 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. 0 Entertainment
their right of exemption per c. 152, §1(4),and we have 10.0 Manufacturing
no employees. [No workers' comp.insurance required]** 11.0 Health Care
4.❑ We are a non-profit organization,staffed by volunteers,
with no employees. [No workers'comp.insurance req.] 12.IE Other Gari*e l Z. GaKre."GTOtie.
*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#1.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information.
Insurance Company Name: —RSA.p U 6 LE KS
Insurer's Address: P. O Sax. 5600
City/State/Zip: 14 ART'Fo R o , GT 0to1 2.
Policy#or Self-ins.Lic.# F'P Ski.21- o 4 5 3 N 4 4 Expiration Date: 6 ZO' ZCZ•z
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 certifyy, under the pains and penalties of perjury that the information provided above is true and correct
Signature: li11), • )/-tim s14.•►- Date:
Phone#: 41J3 5S L Ai QO s-
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
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