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24C-031 (9) BP-2023-1751 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-2023-1751 PERMISSION IS HEREBY GRANTED TO: Project# GARAGE 2023 Contractor: License: Est.Cost: 22500 WILLIAM TUROMSHA 000515 Const.Class: Exp.Date: 02/15/2024 Use Group: Owner: A. MURPHY, DAVID 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: 12/14/2023 TO PERFORM THE FOLLOWING WORK: INTERIOR FINISHES TO 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: / rThr60111 Fees Paid: $146.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner / ' - 4;14,,,, , The Commonwealth of Massach, setts t 3 2� *jv .. Office of Public Safety and Inspectio} op�, �' Massachusetts State Building Code(780 CMI '-iiii';!n, ,, Building Permit Application for any Building other than a One-or Twod" w Bing/ (This Section For Official Use Only) (�°so:Ns Building Permit Number:a? b- / 7S1 Date Applied: Building Official: ,, ,/ SECTION 1:LOCATION 1L. WocCrIA ELM VI" 14DICTI&ATWPTbN MA 01o130 GARAGE No.and Street City/Town Zip Code Name of Building(if applicable) Assessors Map# Block#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 Et Repair 0 Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use ❑ Change of Occupancy ❑ Other 0 Specify: t.f-rc lime, 8tr.•ua 04er Are building plans and/or construction documents being supplied as part of this permit application? Yes SI No 0 Is an Independent Structural Engineering Peer Review required? Yes 0 No SI Brief Description of Proposed Work: l1vrRgti>._ Ftwttst4 Wot .k wilt CawlTt&ttaF oPVANfQeHFos_ SEuR&LMew+rtat a..A♦Et + slow Fit lA war co a&. 'r o 'f'6 STlltle1 CdMsTol,innn of SAT% itaftson CSNA Fr104s14 Skop As!as C.s/+f'41. DAtria: it btam Liz Nadi RArt&M Plv MW7 ► 1 s e bel &saaLL B *arr.+Roe u m& £t1TR1 VEIT.l,a.l� a.li Gu�saT 1�cal. eta V*Jer +FLOof:- rmtm1.t csek N(i Amp Ste.N6 ea LaC1lErttwl; oueq. 144t46 S6G Amik.c.viEte PV►t.] 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) 0 Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Exisfir,o Proposed ITT'Vs. No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) 1296 sir. Total Area(sq.ft.)and Total Height(ft.) /j 14 2 y:o SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2❑ Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business ❑ E: Educational 0 F: Factory F-1 Cl F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0 I: Institutional I-1 0 I-2❑ I-3 0 I-4❑ M: Mercantile 0 R: Residential R-ID R-2 0 R-3® R-4 0 S: Storage S-1 ® S-2❑ U: Utility® Special Use 0 and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA 0 IB 0 IIA 0 IIB 0 IIIA 0 IIIB 0 IV 0 VA 0 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: A trench will not be Licensed Disposal Site 0 Public® Check if outside Flood Zone 0 Indicate municipal® required❑or trench or specify: Private❑ or indentify Zone: or on site system 0 permit is enclosed 0 Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable 0 Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No 60 Yes 0 No 0 SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: W000 'F11;lan,g Does the building contain an Sprinkler System?: NO Special Stipulations: Design Occupant Load per Floor and Assembly space: ` "I'711• "4.6' 't , • • ;I."" f.!•••• 6 • • , 11: • • .!ve 41 • • SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner DAvio M uRrN y 39 NORTH eui SrRtnZ No RT1.1ArAproe.* KA 0 la/.o Name(Print) No.and Street City/Town Zip Property Owner Contact Information: 'us -.584- 59 At 'l/3=53* 2Z;5 Dwio.pluvial, se Gor+cal2 r.pater Title Telephone No. (business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Wins lam T. TELa..w+nsa A it kis if/or s STILIVer Nao;rH#trnt'}uJ 114 010 40 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 then check here t7. Otherwise provide construction control forms(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 Expiration Date 10.2 General Contractor T Tt.ca,oatmHA Company Name IEJM r 1tic141maRA. CS—Vdo S15 Name of Person Responsible for Construction License No. and Type if Applicable yyAU Nvs 5Titeter WORT1.i%_1004 11ut MA o1o`o Street Address City/Town State Zip - oos Tutcotns HA et G tKa1iL.• cam, Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT (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 1 No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs: (Labor and Materials) Total Construction Cost(from Item 6)=$ 7 2,5 00•ov 1.Building $ 4$o p .o• Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ 9 opo,oo appropriate municipal factor)=$ 3.Plumbing $ 'Taos. o0 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ 22, Soo.oO (contact municipality)and write check number here 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 information contained in this application is true and accurate toy�the best of my knowledge and understanding. Valtwn7TucksIM+sMn VA* . 1141 ...,.L..._- 6 Vitt ROL C01.111e1AVn la_-SRL-If 0 Og 12/13/Z1123 Please print and sign name Title Telephone No. Date II W,lliAtis s`r&SET NDtr1+Ampto0 Iv►p otDt.o W'rt,.chasmM ggrnmi.- Cowl Street Address City/Town State Zip Email Address n S�1 Municipal Inspector to fill out this section upon application approval: ��� ame Date • -41 'v;*.!1? vi • 7,4. • 73 ' :77 - •••• t;•.;"‘ , : •„ ., •L':. • ri.17:•`.••;.1 * it" -7; 777.. ;z,".::•' tt::v 04,-4...;• s olt J.:: 2. •.'!A •: CITY OF NORTEAMPTON SETBACK PLAN MAP:. LOT: _ LOT SIZE: 0.93 ACRES REAR LOT DIMENSION:_ REAR YARD 35 L.Q1 9' 1 1 . 1 ---.._ ...-- ,... --, 1 ---, I • 1 ......7 1 i I , LL-------1 1 ft..______,,.__,, , . 1 . ..____„•_. SIDE YARD 36 .-0"° NEW GAN WE • I SIDE YARD___I 21 I 1 . 1 . • .1, . ..........,..,.-t 1 \ li ----1--.1 1 _ - . EL.rt silt*:E.11_, FRONT SETBACK . . I 1 . FRONTAGE_J ........ "'d7n"• The Commonwealth of Massachusetts Department'of Industrial Accidents • • 1 Congress Street,Suite 100 • _, Boston. ,i14 02114-2017 www mass.got•/dire 1140-kers'('onipensation Insurance AI1idas it:BuildersJCOntraedrrs,E:lectriciansrPluuthers. TO BE FILED SS I'1'H'1'11k PER?t1Lri'lti(:At''I'HOORIT%. Applicant Information Please Print L el:ails Name 1 Busines OntanezatiunwIndevidual►: Igt/M,r. 1-u 20 c,s E&A i)Es I G1•4 d C p.m STR&Lcm b u Address: 11 LJ t llusr�_s1 CityfState;`Zip: Flo gmi *t. Phone .1L3 58c, . tf005 Are yen in enyattrye-r?t'thcck LW:apprupriatr t,ara: 1' lx of project(required): LEI 1 not a employes with employees dull amd ur ptui-tiatw l.+ 7. 3 New construction 2.6Z 1 am r sole p.uprietur or pannarship and have atu employee-,scurking for ant in K. 5a Remodeling, nary capacity.[Nu wurketa'comp.insurance ttquired.j 3D t ant tr huttsunt nes doing all work aty•clf.JNo vein-has'corral insurance required.) 9. Demolition 4.0 I Jilt u hunanuunor and will be hirine ae•ntraa1uree CO conduct all work.on my property. I will 1 o a Building addition ensure that all contractors either base:sunken,'oterntt tsatioat ntxuruno:in awe sole {1.0 Electrical repairs or additions proprietors H lino no employees. t2.❑Plumbing,repairs or additions do 1 ant a aeriesal cunaractur and 1 Igo c hired the stab-cuntractorr listed un the attached.sheet. 1 ^ atra These sub-cuntractura lone citrpluy'tar,anti bat c worker,' cp.insurance.' u 6.0 Vic an a ewrpatrmaun anti at.,officers have exercised their right of exemption per 4k(:il_c. 14. ]Other' 11'�.ti 1141.and sec lase no ernpluyecs.[No%surkers'comp.insurance required.J •'.any applicant that cloaks bat al rnust abu fill uut tlrc,upon b:Iutt showing tlanr workers'cunrpcnsaliun pulley information_ *Ilumevawrsene who gallanit this athd tart indicating they arc dome all s.ark and then hire outside cumtnacwn Rum.submit a new affidavit indicating ng suck ;Contractor,that cheek this bey+,must altaehett an addatiunttl sheet strt,y,ink tla.:name of the suls-emetractvr,total atom N hehbcr ix not thus:aatntie,h tti+c eutpluycr. If the sub-curttratctor,have employees.they must pray a.k their +turkcrs esnnp.txtlicy number. 1 alit an employer that is providing trorkers'compensation insurance for nth entplo,'ees. Maw is the policy and fob site in farnration. [nsumnceCompaut. Name: LJAQt1,Tr Skitcosc.E. LZosooy3'I s ATLAI.ITic.. .CA_54.4t,Ta1'__— Policy or Self-ins.Lic.#: Expiration Date: Sit o 1 Zo ter lob Site Address: ° NOR'T31 ELM 5-ra EET City/State:'Zip: Immo"i6Rip P% -Olotoo• Attach a copy of the is irkers"compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under NIGL c. 152.§25A is a criminal violation punishable by a tine up to S1,500.00 and:or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine otup to S250.00 a day against the violator.A copy of this statement may be forwarded to the Ot'tice of Investigations of the DIA for insurance coverage verification. I do hereby certify under the Intht,s and penalties of perjury that the information provided above is trite and correct_ S3L'ttatun: l�M 1`u bECEinfiEt• 20 2-3 Official use only, Do not write in this area.to be completed b,y city or town official ('try tar own: PertniL License r Issuing uthorit} (circle one): I. Board of Health 2.Building Department 3.i•it!o l tswn Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.()tier Contact Person: Phone#: A DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 11/07/2023 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 NAIC# 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: 23/24 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 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 (MM!DD!YYYY) (MM!DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGETO RENTED 100,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 A L2050047460 05/10/2023 05/10/2024 PERSONAL&ADV INJURY $ 1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PET n LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y!N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ri NIA 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/LOCATIONS/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 CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Northampton Department of Public Works ACCORDANCE WITH THE POLICY PROVISIONS. 125 Locust Street AUTHORIZED REPRESENTATIVE � _ Northampton MA 01060 ti/! (� -�v _ _. I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD City of Northampton e-7177 % Massachusetts �2 ,i-*17.."f3 r-;.; Ncis; i a ' ®!\ , : S . DEPARTMENT OF BUILDING INSPECTIONS 7`= 7:` ! 212 Main Street • Municipal Building �Js k'•. a�' Northampton, MA 01060 sf „ 51‘��' 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: Vatir.r 'Rec.,. Lime, 231 e,4sThlpn Tbr.l Rows omitail MA The debris will be transported by: Name of Hauler: !✓,//,oa, Tiig.ornsria or. LEAa 5 154aLb ,1 co Signature of Applicant: / oa.,�___ Date: 121131 dow 3_