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17A-272 BP- 2011 -0557 GIS #: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON ' Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ADDITION BUILDING PERMIT Permit# BP- 2011 -0557 Proiect # JS- 2011- 000809 Est. Cost: $92000.00 Fee: $552.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JOHN ZIEMINSKI 017889 Lot Size(sq. ft.): 18730.80 Owner: ZUKOWSKI PAUL A & MARYELLEN SALA Zoning: URB(100)/ Applicant. JOHN ZIEMINSKI AT. 138 OAK ST Applicant Address: Phone: Insurance: 8 WOODRIDGE CIRC (413) 247 -9014 Workers Compensation HATFIELDMA01038 ISSUED ON :1212112010 0:00:00 TO PERFORM THE FOLLOWING WORK.- CONSTRUCT 16 X 32 ADDITION 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. Certificate of OccuRancy Signature: FeeType: Date Paid: Amount: Building 12/21/2010 0:00:00 $552.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner File # 13P- 2011 -0557 APPLICANT /CONTACT PERSON JOHN ZIEMINSKI ADDRESS/PHONE 8 WOODRIDGE CIRC HATFIELD (413) 247 -9014 PROPERTY LOCATION 138 OAK ST MAP 17A PARCEL 272 001 ZONE URB000)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiniz Permit Filled out OQ Fee Paid T_ypeof Construction: CONSTRUCT 16 X 32 ADDITION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• Owner/ Statement or License 017889 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN PRESENTED: pproved 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 Delay L2 M,�Vt /,;?- /D Signature of Building Of icial Date 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. r i)Cpar rrCentps City of Northampton Stags rifer>rit " Building Department "uiib'sY .; 212 Main Street �§ Q1N$epl�`i42F�3£Fly z ae a Pr w Room 100 y 515 t p 1 n Va$/11Va]laU111 r• x+� a`, '2rw a `R . Northampton, MA 01060 Two Sets�l"Structural P�ahs � � � �� phone 413- 587 -1240 Fax 413 - 587 -1272 I?telite Pia�ns § d 4 t 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 Map Lot Unit Zone Overlay District EfiniSt °District CB District SECTION 2 -PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record l% I& - - 1 PA' r 3 Sa c c i ST�rc i (I c 2 �7�i9c�,97 j�, Na r ( ; in t) Current Mailing Address: r - " Telephone S igp6ture 2.2 Authorized Agent: 4,Y t 71 tt PGL"` C 0C Name (Print) Current Mailing Address: Signature Telephone _ _ - - -- SECTIO - ESTfMATED CONSTRUCTION!COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by ermit applicant 1. Building J (a) Building''Permit'Fee 2. Electrical (b) Estimated Total Cost of O d� Construction from: 6 3. Plumbing S' O L Building Permit Fee i 4. Mechanical (HVAC) `F, c- 5. Fire Protection ' 6. Total = {1 + 2 + 3 + 4 + 5) �j' 2 � C> Check Number 5 r This Section For Official Building Permit Number. sue ed: Signature: Building Commissioner /Inspector ofBuildings! Date f� a ' ' ` / 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 Setbacks Front Re Building Height Bldg. Square Footage % ' Open Space Footage --------- % (Lot area minus bIdg & paved # of Parking Spaces (volume & Location) A. Has a Special Permit/Vahance/ Finding ever been issued for/on the site? �� �� �� NO ��, DON7KNOYY \�� YES �~� IF YES, date issued: IF YES: Was the permit recorded at the Registry ofDeeds? t� » NO ONTKNOYY YES '8�� ' IF YES: enter Book Pagd and/or Document# �� B. Does the �tecontain a brook, body of water orwetlands? NO t�� DON7KNOVV �~� YES IF YES, has permit been or need to be obtained from the Conservation Commission? Needs tobeobtained «�� �btaned �~� Date|ssued' ------1 m�� ' ` 'L___—_____{ ' »r� . C. Do any �gnsex�ton the prmpe�y? YES v+� NO IF YES, describe size, type and location: � ... .............. _-___�_____-__ ...... ........... .... _� ' "' =`~'~'^~' � YES x�� NO ~,p^'`, �~� |F YES, describe size type and location: E Will the construction activity disturb ng, grading, excavation, or filling) over 1 acre oris it part nfo common plan that will disturb over 1 acre? vEs 01 mo ' |F YES, then o Northampton Storm Water 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 E3 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding [oj Other [ O] Brief Description of Proposed /4''e ?Z' ' � "�v.� -7V — 'Fr� s7�TJ� ✓ « CF sC - Work: tir�D�_J�L�cnG�.u�tJ�!Cr� �FZ�!s�rri A'M,�d Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -CS heel' sa: lf.Nerlu hose and vc addition.to`ez�s�rrg:f�ouslrag; cciinpCete:the.folfowlrig: a. Use of building : One Family ?e Two Family Other b. Number of rooms in each family unit: ? Number of Bathrooms c. Is there a garage attached? & - 7^1C- d. Proposed Square footage of new construction. S ! Dimensions �3 2- e. Number of sto ries? C f. Method of heating? IA Fireplaces or woodsteves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction 4 I 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 AUTHORIZAT70N -'1 O BE COMPLETED "WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize to act o I mattter relative to work authorized by this building permit application. Signature of Owner Date 1 "- /&5-� - asAOwrier /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. Print Name 4 de 144 - - -- Signature f ner /Agent Date SECTION 8 - CONSTRUCTION SERVICES I 8.1 Licensed Construction Supervisor Not Applicable ❑ Name of License Holder : �� I _' l7 ! l/�/ C l ' License Number Address Expiration Date Signature J Telephone 9 . Rdaisferer3. lonie °Improverfent.ContracfoT3 ._3.s. r ... -. ...., ..,..'' ...' Not Applicable ❑ r e- Company Name Registration Number L % Z Address W5 Expiration Date Telephone '2 If 3i ae SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 162,.§ 25Cf6) 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....... AC No...... ❑ 1". ;�Hr�mwner���=Kmtoi _The_current_exemption.for. "homeowners" was ext ended 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, provided that the owner acts as supervisor. CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner Person (s) who own a parcel of on which he /she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached ordetached structures accessory to such- use - and/or farm structures. A person who constructs more than one home in a two -year period shall not be considered a homeowner Such "homeowner ' shall submit to the Building Official, on a form acceptable to the Building Official that he /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 and 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 Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable 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 Code, City of ort amp on r i anc a s General )Jawslnnotated. Homeowner Signature s The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washing, ton Street Boston, MA 02111 '���• www.massgov/dia - Workers' Compensation Insurance AfflidaNlt: Builders/ Contractors /Electricians/PIumbers Applicant Information / Please Print Legibly Name ( Business /Organization/Individual): ✓ F ��nJ h`. � /E�I� ti S/C/ � L lG Z��L � �� C� Address: City /State/Zip: Phone. #: c GEC ` 7, A you an employer? Check the appropriate box: Type of project (required):. i . I am a e to r with l 4.. E] I am a general contractor and I employees full d/or part- time).* have hired the sub- contractors listed on the attached sheet 7. Remodeling 2. ❑ I am a sole proprietor or partner- ship and have no employees These sub - contractors have. .g. Demo',ii'don working' for me in an ca _aci employ a nd have workers' - - y p - ty' _ 9. {- Building addition [No workers' comp c . ms,ran ompinsman required] 5. F We are a corporation and its 10,R ElectricaI repairs or additions 31 I am -a omeo-uFner Being all �vorlc -- - -_ _._ of eers�aa xercised their __.I_I P um .Bing repairs or additions myself [No workers' comp. right of exemption per MGL 12. VI Roof repairs insurance required] t c. 152, §1(4), and we have no employees. [No workers 13.0 Other comp, insuran required.}. *Any applicant that checks box #.1 must also fill out the section belowshowing their workers' compensation policy information. t Homeowners who submit this affidavit.indicating they are doingaR work and then hire outside contractors must submit anew affidavit indicating such zContractors 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: SJ CL."<ti /z 4 6' d ,,� e -7 � . Policy # or Self ins. Lic. #: SGG�D G' fir /a l / Expiration Date: �1_3zlll Job Site Address: S: ` /: "Z2% i�� ° ' City /State /Zip: 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 and/or one imprisonment; as well as civil Penalties in the form of a STOP WORK ORDER and a ane of up to $250.00 a day against the violator. • L e advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage Verificat I do hereby:_certif under the pains and penalties of perjury that the information provided_above islrue- aridcorrect -__ __ Si tune: Date: Phone #. Official use only Do nvt wrrte in this area, to be completed by city or fawn offciaL City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Iluildinb Department 3. City/Town Clerk .4. Electrial i cnsp ector 5. PIumbing Ins pector_ 6. Other -._ _ Contact Person: Phone #: Massachusetts - Department of Public SafetN Board of Building Re- ulations and. Standards Construction Supervisor License License: CS 17889 Restricted to: 00 JOHN H ZIEMINSKI a ' 8 WOODRIDGE CIRCLE 48 HATFIELD, MA 01038 k #` Expiration: 2/25/2012 t'un►mi,tii»ur Tr #: 15199 Office of Consumer Affairs & Business Regulation HOME IMPROVEMENT CONTRACTOR _ Registration: 400133 Type: A — _ Expiration: 6/9/2012 DBA JOHN H. ZIEMINSKI BUjLDER /CQNTR. i John Zieminski 8 CIRCLE DR. a�_��, HATFIELD, MA 01038' Undersecretary i 7 F 13 �-'� e '`" „ ' �"� / i C""� �� p� L::..t ��C`S(u f+.�� " "� „ ��'' � ,r 1_'� =•.:f F;pa�:. 4 � ,� +'±L' f:; ?��g T �^" 1 ` 9'� 4 � • ���" . ��.i ��; `� ' .�_ � � �a - ,x,11 i � I �1 j d ! 1�,-'V w it ,; ' 4 6TtCi.cSG�J 3 tar { yN f k 7 ' � IA k � i December 20, -2010 ' John Zieminski 8 Woodridge Circle Hatfield, MA 01038 Subject Property: 138 Oak Street Northampton, MA 01062 Mr. Zieminski The plans for the 16 x 32 addition dated 12 -18 -10 have been approved as noted; 1. Engineering for truss and LVL submitted before rough inspection. 2. Structure must conform to 780 CMR 7 th addition 1 and 2 family with 2009 IECC. a. Ceilings R -38 insulation after air ceiling. b. Walls R -20 cavity insulation or R -13 cavity and R -5 continuous. c. Existing walls exposed without insulation add R -3 per inch of wall. d. Floors R -30 or fill the cavity, but R -19 minimum. Push up rods 2' O.C. e. Basement walls R -13 cavity or R -10 continuous. f. Slab R -10 for 2' at perimeter, add R -5 at edge if radiant heated floor. g. Windows .35 U- Value. 3. Smoke and CO per code, plan and as noted. a. A smoke and CO detector at the bottom of the stairs and a heat detector in the garage. Charles Miller Assistant Commissioner of Buildings E .L F Ra i i r } i t f� \ n LU e C 9 d 91 I �� ' � £ 1p !As I�' II`� I � L I , siawl• z� a�+.+r. m+azer >uo S,.r i'6 dYOi°�AT4V Msl AlYS>.✓ _ l� -� IC � � /(-(, �? Ra,l Umt (MSibK Yry 2 <�JII• _ ��yrr� • TiL t% '6 41 1 1 1 i) wwr 2 NN o A, � � n./ f✓ti. -. Rar•. rN �_ I I • w_bMr �brl� -• _�. �,/ — - n✓ew.wq d - re• rrw. u� 'aJ' .r. aena 1 as. •,. r w a• � �"� 1 Gwsu /wars l aw ✓ww.a^ .necr 'S' 11Y� rw 0 rp'n...7 1 . .LrsS M¢.K � �� (AO) p 1 �� ���I� L•�1 ® t.a -.L -c. grwrvL .,. ,., a�� � � �• v v I (;. 'L. "'ric FVe„r rRw' a. -� ,• 1 ' —d ..� w_.. .��+ sx,c{e �N �ysti. V +MNF wa(. FCa�:: tort.. _ N.,. 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