31B-028 (6) 51 SUMMER ST
BP-2004-0273
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31B-028 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2004-0273
Project# JS-2004-0398
Est. Cost: $41327.00
Fee: $205.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Robert Walker 034783
Lot Size(sq. ft.): 4007.52 Owner: ROSZKO STEVEN R&KATHRYN K
Zoning: URC Applicant: Robert Walker
AT: 51 SUMMER ST
Applicant Address: Phone: Insurance:
36 Service Center (413) 584-1224 Workers
Compensation
NORTHAM PTON MA01060 ISSUED ON:9/12/03 0:00:00
TO PERFORM THE FOLLOWING WORK:REBUILD AND RELOCATE SIDE ENTRY PORCH,
ADD 1/2 BATH, MUDROOM, REMODEL KITCHEN
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:,/0/*:j�t..9tJ Rough��� 36,4 +�� Driveway Final:
Final: /0 `;,,Z- X Final: /./b`3 ` !� 1` l
Rough Frame: 0 k /D_ 3 1-05 _4
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final: /�.r /7rO 3 —Z
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOL N OF
ANY OF ITS RULES AND REGULATIONS.
Irilif�/ �'
Certificate of Occupancy / Signature:
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 9/12/03 0:00:00 1169 $205.00
212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2004-0273
APPLICANT/CONTACT PERSON Robert Walker
ADDRESS/PHONE 36 Service Center (413) 584-1224
PROPERTY LOCATION 51 SUMMER ST
MAP 31B PARCEL 028 001 ZONE URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: REBUILD AND RELOCATE SIDE ENTRY PORCH,ADD 1/2 BATH,MUDROOM,
REMODEL KITCHEN
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 034783
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
{/proved 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 Co 'ssion
o
Signature of Building Officia Da
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 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address: --� 1
5u tel.wke-y- S TVA kcf
Map Lot Unit
n1*-- --terw,(2 rJ Zone Overlay District
Elm St.District CB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
.\IC_ trip l‘434-1- N bSZ*o sal tnA- wA ST N a l''
Name(Print) Current Mailing Address: sirs
lO_ zr v�
Telephone J
•lliewature
2.2 Authorized Agent:
L`' -kvt.2 3( SrArbou-e_ Orr t N aru°�- m
Name(Print) Current Mailing
Address:
- --- ----- U� 4-U 7?
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building `t 8 7 (a)Building Permit Fee
2. Electrical ap�� (b) Estimated Total Cost of
I.
VV . Construction from(6)
3. Plumbing (_ r UU' Building Permit Fee
4. Mechanical(HVAC) � ,f
5. Fire Protection
6. Total=(1 +2+3 +4 + 5) 1 [ 3-2.-7t. Check Number 116
I
This Section For Official Use Only
it VI Issued:
Date
Building Permit Number: yJt P_Ldtlq _
Signature:
Building Commissioner/Inspector of Buildings Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED
DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size / 3 S%o 0)6513
Frontage S Z t'
Setbacks Front
iaD
Side L: i� R: L:�S R: 101 f�
Rear 2p► 20 ` 90
Building Height n?d 20�
Bldg. Square Footage ggbD1 ,L„( % (8r y•` if
Open Space Footage / %(Lot area minus bldg&paved 't.p2�2 b 21e�2 1
parking)
#of Parking Spaces
Fill: N/A NiQ
(volume&Location)
A. Has a Special ermit/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 DONT KNOW YES
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO V.-DON'T KNOW
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:
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing 0
Or Doors 0
Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other[ ]
Brief Des ri tion_oQf roposed II
Work: (€ D.Q 1. S 4 q(3 L 1 AA-CV 1-/2 \ t' U aznotv.. =�T n
v�-oiI.0 L K-'ar-tj-F-fv
Alteration of existing bedroom Yes__ No Adding new bedroom Yes ___
Attached Narrative Renovating unfinished basement Yes _ 6 ICO
Plans Attached Roll -Sheet IPS
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. Mascheck 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
L I, STEVIL) A04 KalbCr -PI CIS_,�JC ) ,as Owner of the subject
property ,W1 T k
hereby authorize -ROber' CO+`4e,r-
to ac on y behalf, in all matters r ' e to ork authorized by this building permit application.
- � 2i_ 2a0
3
beture of Owner Date
I, V6 .5C _ ,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 und�e pains and penalties of perjury.
nn ik—Print Name
Signature of Owner/Agent Date
.
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: �p,� y Not Applicable 0
Name of License Holder F2;�n ,/ 5 I. w �-'F• 0�`��v` License Number
i Rice— c .t { I z�, To,��y � 104 O 3
Address / Expiration Date
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable E
of fut . 0 7004
Company Name Registration Number
Address Expiration Date
CIAIA`PS/A/V � 1_ 4°Ielephone G�0 4'—1 17-11—
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 0
11. — Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license, •rovided that t e owner acts
as supervisor.CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside, en which there
is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use ani or farm
structures.A •erson who constructs more than one home in a two- ear •eriod shall not be considered a omeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official that h:/she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time,during a d upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of E ployers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be lia i le for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Co e,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
v
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c%AMP7'
� �4 i tti Cif Northampton•
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DEPARTMENT OP BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 010@'tl r'
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, '0'7C12-c Lkf -vs a --
(licenseeJpermittec)
with a principal place of business/residence at:
'5(o S€Clokct „„A c ci EJ (phone#) -- ` 24—
(s tl eet/ci ty/stately p)
do hereby certify, under the pains and penalties of perjury, that:
(( am an employer providing the following worker's compensation coverage for my
employees working on this job:
C AdTa4At 1S Cc) , WL ? cot ZCcI 1 ( cttod—
(Insurance Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hir
the contractors listed below who have the following worker's compensation policies:
ro u �Awc,Cr( 1/5 ✓�n�n�w r \ 4j i coi Lv Z $ , Z 20 s 3 / 3 1 1 0 4—
(Name of Contractor) (Insurance Company/Policy:Number) (Expiration Date)
R-t.ty C rz-t t cri-(1P- Itrt2 a- 1/1A.6-44 „a�Arc G• v 6 -7 :,, q -s - 5 V r t `0 4_
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional:beet if necessary to include information pertaining to all contractors)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that while homeowners who employ persona to do maim:lenaX construction or repair work on a dwelling of
not more than throe units in which the homeowner resides or on the grounds appurtenant thereto are not generally ooaside ed to be
employers under the worker's compassation Act(GL152,ss 1(5)),application by a homeowner for a license or permit may evidence the
legal status of an employer under the Worker's Compensation Act.
I understand that a copy of this statement may be forwnnied to the Department of Industrial Accidents'Office of In urine for the
coverage verification and that failure to secure covcrago under section 25A of MOL 152 can lead to the imposition of criminal penally
°onsisting of a fine of up to S 1,500.00 andlar iaaprisoameat of up to one year and civil penalties in the form of a Stop Work Order a
fine of S 100.00 a day against toe.
For dcpartmaatal use only
Pern,� Z ti � t Number Lot#
Signaturel�/e of LlamseelPetmttxee
Aug 20 03 12: 17p Steve Roszko (413) 585-1685 p. 2
--NOTE-
THIS PLAT IS COMPILED FROM DEEDS. PLANS AND OTHER SOURCES AND IS NOT
TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED,
BUILDING LOCATION ACCURACY IS NOT GUARANTEED
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TO: FLORENCE SAVINGS BANK &
FIRST AMERICAN TTILE INSURNACE COMPANY
TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF
I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING
MONUMENTATION ALL VISIBLE EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON
THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES.
EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN
A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR
COMMUNITY # 250167 `
—NOTE—
� THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
SURVEYOR:}1\ ' `1'�'` AND DOES NOT CONSTITUTE A PROPERTY SURVEY
��a oF s —MORTGAGE LOAN I14SPECTIQN PLAT—
OF .ti�, NORTHAMPTON, MASSACHUSETTS
iRANDAl 5 PREPARED FOR
IZER JANE C. KULIS
8035032 y SCALE: 1 "=20' SEPTEMBER 1 1 , 2002
etioP HAROLD L. EATON AND ASSOCIATES, INC.
suRv
REGISTERED PROFESSIONAL LAND SURVEYORS
235 RUSSELL STREET — HADLEY — MASSACHUSETT: