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24C-031 (6) BP-2022-0952 76 NORTH ELM ST COMMONWEALTH OF MASSACHUSETTS 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-2022-0952 PERMISSIONIS HEREBY GRANTED TO: Project# BATH RENOS Contractor: License: WMJ TUROMSHA DESIGN & Est. Cost: 55700 CONSTRUCTION 000515 Const.Class: Exp.Date:02/15/2024 Use Group: Owner: A. MURPHY, DAVID Lot Size (sq.ft.) Zoning: URB Applicant: WMJ TUROMSHA DESIGN & CONSTRUCTION Applicant Address Phone: Insurance: 11 WILLIAMS ST 413-586-4005 7PJUB0653N47921 NORTHAMPTON, MA 01060 ISSUED ON:08/10/2022 TO PERFORM THE FOLLOWING WORK: RENOVATE 3 2ND FLOOR BATHROOMS 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: l inal: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Q9 „iiX1 . Fees Paid: S390.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner &Gi1AJNG rotpT i RU CFI ' : ' . M 1 , 1 The Commonwealth of Massachusetts ,1= V AUG - 9 2022 Office of Public Safety and Inspections Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling OF BUILDING INSPECTIONS (This Section For Official Use Only) NOFITHanemmnk. 01 0 Building Permit Number. -Date Applied: l Building Official: SECTION 1:LOCATION �fo itiart.-1141_ NoR'N +pTor►p 010040 No.and Street City/Town Zip Code Name of Building(if applicable) 2yc -O . Assessors Map# Black#and/or Lot # SECTION 2:PROPOSED WORK Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below Existing Building Ft Repair® Alteration ® Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other 0 Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes .0 No ❑ Is an Independent Structural Engineering Peer Review required? Yes 0 No 121 Brief Description of Proposed Work KEN ATE 3 SELicahp P4 a e9 rti•rri4 ana..% SAM AirpcN rip PLA►O% fib*. 1 ci rAiL.. sEm,304c1n4j_e F,icr Le Cn-ncr.s SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) El Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) ` 1 Zc 3 yy z o 3 Total Area(sq.ft.)and Total Height(ft.) eI►'17o Z6 mla 26:0° SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub ❑ A-3 0 A-4❑ A-5❑ B: Business I B; Educational 0 F: Factory F-1 0 F2 0 H. High Hazard H-1 0 H-2 0 H-3 0 Hd❑ H-5❑ I: Institutional I-1❑ I-2❑ I-3❑ I-4❑ M: Mercantile 0 R: Residential R-1❑ R-2■ R-3 0 R-4 0 S: Storage S-1 0 S-2 Cl U: Utility❑ Special Use❑and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA 0 lB ® IIAI] IIB ® IIIA ❑ IIIB0 IV D VAS VB 0 SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public If Check if outside Flood Zone CI Indicate municipal aA trench will not be Licensed Disposal Site CIrequired 0 or trench or specify: Private 0 or indentify Zone: or on site system❑ permit is enclosed 0 Railroad right-of-war Hazards to Air Navigation; .1.4. ' Not Applicable® Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or Noll Yes 0 No SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Does the building contain an Sprinkler System?: P1 ci Special Stipulations:: Design Occupant Load per Floor and Assembly space: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner 1)At111-% MURP4iq 7$ NatTµ ELM UOLctxaeop+eu a i•_e Name(Print) No.and Street City/Town Zip Property Owner Contact Information: awaJ€c yl? •Sst—s'h2a y(3 -moo-zz45 Title Telephone No. (business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: WI III Ate, V k(tit nm$l1A 11 d/tlli Win s ST4ART Noe ,Ailsiao NA 6/ofoa Name Street Address City/Town State Zip to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1.) If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control the a check here 0. Otherwise provide;.;•,:;._;u, _.. ,._:.,. .. (see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals) Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline lion Date 10.2 General Contractor WM I'0as trys444 `Dgsi 8 ow-4 snItcLeTi 0 Q Company Name it,/ T'u2btrasttA C L. 000sic 44IC 1101 }22 Name of Person Responsible for Construction License No. and Type if Applicable 11 Ifichikpro.s srn.11c,rr AIO RTN Am frT60 Mil 0/0`c, Street Address City/Town State Zip 'iLL- goo Nl3 -543- 71,14 WmaarrSuA Q rig- corm Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11: =_-=--'_:_<:._ .:. (M.G.L,c.152.§ 25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes■ Nu U SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs: (Labor and Materials) Total Construction Cost(from Item 6)_$ 1.Building $ 3.4200 00 Building Permit Fee=Total Construction Cost x_(Insert here 2.Electrical $ IP, 206. till appropriate municipal factor)=$ . 3.Plumbing $ 17, 30o. oo -31 0 4.Mechanical (HVAC) $ Note:Minimum fee=$ ✓ (contact municpality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ 55 l p p . o o (contact municipality)and write check number here K 3a SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT -By entering my name below,I hereby attest under the pains and penalties of perjury that all of the in:ormation ' ed in this application is true and accurate to the best of my knowledge and understanding. W/�� i2ovr%sN A GEIiER , ea CToit `./ '.-. 35- �$ 7,1/t5/Z4 Please print and sign name Tiitle Telephone No. Date //� � �1/1IA/I05 � r A10e`Thp7'1J MA t1OLo l��a10. S,4tA!164 ,i2__C_Onn Street Address City/Town State Zip Email Addr s 1,CcZ611 0 t ). Municipal Inspector to fill out this section upon application approval: �A Name Date CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD Sop' 2'0 zi Si 9 20f '4Z' 2$ Z g' 3$' SIDE YARD 98-4/ SIDE YARD 7'0„ • (�Jor&r EL STRS - { FRONT SETBACK Z`/'6" FRONTAGE )?3-0 City of Northampton o. �s' ..f s: ,�. `r Massachusetts z 'l� DEPARTMENT OF BUILDING INSPECTIONS %' t,•. 212 Main Street • Municipal Building y0j •C•� ��gF Northampton, MA 01060 'PS aiD% CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: L4hli€y KRCYLING The debris will be transported by: Name of Hauler: /,i, T AL.Diu M 1 O•171 tdilliv.,46k.41 IAA 0i0413 Signature of Applicant: ,., 1� _ . _ Date: 41251Z0 , .&\ The Commonwealth of Massachusetts �J. Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass,gov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Business/Organization Name: Wii 1' 1 u 2 c)rn S 144 Z Es 03)-tsTekem a►.� Address: I) M it/Arnim STp Fi'r. City/State/Zip: A O/z ,,A,apTeN lam) 1444 Phone#: 4i✓/3 -r,$C • oo-S- 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. Restaurant/Bar/Eating Establishment 2.0 I am a sole proprietor or partnership and have no 7. 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.❑Manufacturing no employees.[No workers'comp.insurance required]** 11.0Health Care 4.❑ We are a non-profit organization,staffed by volunteers, 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#1. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name: l RAU g L€2 S Insurer's Address: F O Bc3 X. E(Q Oo City/State/Zip: M171t T.1rt?2,Q CT 04./O ?— Policy#or Self-ins.Lic.# P Tu 13 - 04o.r 3 N Y-7 Expiration Dater M ZO • Zo Z 2, 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 Iead 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,u der the pains and penalties of perjury that the information provided above is true and correct .__. Si ature: cm= Date: 2 re i d Phone#: — .5 S G -41 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 '`�C'oR ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 07/25/2022 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 holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisio s or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsemer�t. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Kim Pages HUB INTERNATIONAL NEW ENGLAND LLC PHONE A/C No.Ext): (413)750-7110 FA,No): ADDRESS: kim.pages@hubinternational.com 1070 Suffield Street INSURER(S)AFFORDING COVERAGE NAIC# Agawam MA 01001 INSURER A: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER B: TUROMSHA WILLIAM INSURER C: DBA DESIGN & CONSTRUCTION INSURER D: 11 WILLIAMS ST INSURER E: NORTHAMPTON MA 01060 INSURER F: COVERAGES CERTIFICATE NUMBER: 797856 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 THIS 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 BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YWY) (MM/DD/YYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ - N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS N/A BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION - v PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 A OFFICER/MEMBEREXCLUDED? N/A N/A N/A 7PJUB0653N47922 06/20/2022 06/20/2023 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigations/. Sole proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN David Murphy ACCORDANCE WITH THE POLICY PROVISIONS. 78 North Elm St AUTHORIZED REPRESENTATIVE Northampton MA 01060 Daniel M.Crowley,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 1 ACORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) �� o7/zs/zoz2 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 holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,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). PRODUCER CONTACT Tina Beaulieu NAME: Borawski Insurance PHONE (413)586-5011 FAX (413)586-7973 (A/C,No,Ext): (A/C,No): 88 King Street,Suite B E-MAIL tbeaulieu@borawskiinsurance.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL# Northampton MA 01060-3257 INSURER A: Atlantic Casualty Insurance Co INSURED INSURER B William J.Turomsha,DBA:William Turomsha Design&Construction INSURER C: 11 Williams Street INSURER D INSURER E: Northampton MA 01060 INSURER F: COVERAGES CERTIFICATE NUMBER: 22/23 GL 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—HIS 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 BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INS° WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) LIMI-S X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE ` $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) • $ MED EXP(Any one person) $ 5,000 A L2050041010 05/10/2022 05/10/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER- GENERAL AGGREGATE $ 2,000,000 POLICY PRO 2,000,000 JECT LOC PRODUCTS-COMP/OP AGG- $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) _., ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) r$ AUTOS ONLY AUTOS— HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accidentl UMBRELLA LIAB OCCUR EACH OCCURRENCE $ ^— EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y I N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CA CELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN David Murphy ACCORDANCE WITH THE POLICY PROVISIONS. 78 North Elm St AUTHORIZED REPRESENTATIVE Northampton MA 01060 '--re- I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD $41'axial- .. 1-� \/ __/ ,•••*". ...-------------------.4 - 6II i \ . M. , • E / 000ts o va.x•A6 IRE.Loc4rv."0 y„_ ---- � SI St 1 , z / . \ 3-0 a N. _ 8,o„ \ • A NoRTH sx_r• STREET PLAN St, owit4G Rrc9ovE Fr6am G04s5 5N0weR -9Keetwit is Ww.., Daum 11URf411- NCB P`t"''r't'A.) SEcw4D Clit-1-_.,y,R. t''F, J. 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