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' DEPARTMENT OF BUILDING -INSPECTIONS s 4 , °
INSPECTOR 212 Main Street 0 -Municipal Building ' ,;`
Northa MA 01060 5�
LOCATION CX B' • e (-. 7 t 1.C1.f k Via -- n eC' ► v -Q__- -
SQUARE FOOTAGE AMOUNT
BASEMENT @ - 20 • t b 4 3-s - 7, 60
1 @ .$0 1 - 1 - f,o 0
2 FLR @ 30 - 1 C.) 3 o ,, O .
`
�
l FLOORS, FINISH ATTIC, GARAGE @ 2 ( LJ 0 ! . i q?,-,00 -
DECK/PORCIIS @ :20 - L . dC.) , ZA , ' 6
TOTAL. L 71 (o 6 o
t -� The Commonwealth of Massachusetts
T =—
T 3IV.-_-__:-P-.iiiiv – Department ofind
cl -. Office of Investigations
— = 600 Washin Street
1 �.,�= BBoston, Mass. 02111
Workers' Compensation Insurance Affidavit
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name:
l ocation:
city phone #
0 I am a homeowner performing all work myself.
0 I am a sole proprietor and have no one working in any capacity -
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ei I am an employer providing workers' compensation for my employees working on this job.
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I am a sole proprietor, general contractor, or homeowner (circle one) and have hired the contractors listed below who have
the following workers' compensation polices:
•
company name: . . • .
• address: . . . . . .. • . .. . .
city: . • • phone:#- • .. •
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Failure to secure coverage as required under Section 25A of MIGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and /or
one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
1 do hereby rtif under the pain • d • enalties of perjure that the information provided above is true and co ecL
C
Signature / l )C/ kr _ -6.9-N9 Date ' 0q
Print name Merri yn A. Gagne' — Office Manager Phone# (413) 269 -4360
F` use only do not write in this arca to be completed by city or town official ,u
city or town: permit/license # ['Building Department 5
['Licensing Board qa
` ❑ check if immediate response is required ['Selectmen's Office
['Health Department
contact person: phone #; ['Other
tre-vued19 PJAI
0
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : ZITER SALOOMEY 018780
License Number
P.O. BOX 1203, WESTFIELD, MA 01086 11/13/13
Address Expiration Date
v 413 531 - 0062
\ Signa re elephone
9. Registered Home Improvement Contractor: Not Applicable ❑
SALOOMEY CONSTRUCTION, INC. 100978
Company Name Registration Number
P.O. BOX 1203, WESTFIELD, MA 01086 6/24/14
Address Expiration Date
_f>•■� 4 Telephone 413- 269 -4360
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 ❑
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, 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 land 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 or detached 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
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
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
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg & paved
parking)
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 0 YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q ; DONT KNOW 0 YES
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO 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 0 NO Imo•
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES ® NO n(
IF YES, describe size, type and location:
E. Will the construction activity disturb (de ring, grading,, ®vation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 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) n Roofing n
Or Doors El
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [L7 Siding [D] Other [d]
Brief Description of Proposed NEW "A" STYLE UNIT, PER ATTACHED DRAWINGS
Work:
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 X Two Family Other
b. Number of rooms in each family unit: 9 Number of Bathrooms 3
c. Is there a garage attached? Y
1 i
d. Proposed Square footage of new construction. 0 Dimensions s S( ( (
e. Number of stories? 2
f. Method of heating? GAS Fireplaces or Woodstoves Number of each 1
g. Energy Conservation Compliance. y S Masscheck Energy Compliance form attached? A
h. Type of construction )X 1 "- ) eCCA
i. Is construction within 100 ft. of wetlands? Yes X No. Is construction within 100 yr. floodplain Yes X No
j. Depth of basement or cellar floor below finished grade 1 0
k. Will building conform to the Building and Zoning regulations? X Yes No .
I. Septic Tank City Sewer X Private well City water Supply X
SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, ZITER SALOOMEY , as Owner of the subject
property
hereby authorize TONY BILO TA
to act on my behalf, in all m ers relative to work authorized by this building permit application.
c O 6/29/12
Sign ure of Owner Date
1, Z ITER SALOOMEY , 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 under the pains and penalties of perjury.
ZITER SALOOMEY
Print Name
dik 'K- 6/29/12
Sig : ture of Owner /Agent Date
wr»
Th> '-_ - Department use only
City of Northampton Status of Permit
, Building Department Curb Cut/Driveway Permi Permit 211
212 Main Street Sewer /Septic Availability
Room 100 Water/Well Availability
t ECTIONS
X060 orthampton, 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
1.1 Property Address: Thiss section to be completed by office
#7 MARK WARNER DRIVE Map /( i.ot 00 I Unit
BEAR HILL ESTATES lot) 0 45;4
20 BRIDGE ROAD Zone t} Overlay District
NORTHAMPTON, MA 01060
Elm St District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
20 BRIDGE REOAD LLC P.O. BOX 1203, WESTFIELD, MA 01086
Name (Print) Current Mailing Address:
: - - - r - > ' 413 - 269 - 4360
Telephone
Stu (2:7
2.2 Authorized Agent:
ZITER SALOOMEY P.O. BOX 1203, WESTFIELD, MA 01086
Name (Print) Current Mailing Address:
413 - 531 - 0062 (--------4 `\ Sture / Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building $217,135.00 (a) Building Permit Fee
2. Electrical $ 5,400.00 (b) Estimated Total Cost of
Construction from (6)
3. Plumbing $ 11,600.00 Building Permit Fee
)777 ‘ ei Mechanical (HVAC) $ 10, 300.00
5. Fire Protection /56?.
6. Total = (1 +2 + 3 + 4 + 5) $244,435.00 Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2013 -0017 nn�
APPLICANT /CONTACT PERSON SALOOMEY CONSTRUCTION � F X�
ADDRESS/PHONE P 0 BOX 1203 WESTFIELD (413) 269-4360
PROPERTY LOCATION 7 MARK WARNER DR - 20 BRIDGE RD
MAP 16B PARCEL 001 007 ZONE SR/URC/WP
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
B uilding P rnut Filled out /51 $ 7c9
Fee Paid 6
Tvpeof Construction: CONSTRUCT 2 STORY SFH W /ATT /GARAGE/DECK
New Construction
Non Structural interior renovations
Addition to Existing_
Accessory Structure
Building Plans Included:
Owner/ Statement or License 018780 „ Q
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
_ i/Approved 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
! elay
411W pr
440K 7 9 -1 4%
Signature of Buil I ing 0 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.
7 MARK WARNER DR - 20 BRIDGE RD BP- 2013 -0017
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 16B - 001 CITY OF NORTHAMPTON
Lot: -007 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: New Single Family House BUILDING PERMIT
Permit # BP- 2013 -0017
Project # JS- 2013- 000019
Est. Cost: $244435.00
Fee: $1799.60 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SALOOMEY CONSTRUCTION 018780
Lot Size(sq. ft.): Owner: 20 BRIDGE ROAD LLC
Zoning: SR/URC/WP Applicant: SALOOMEY CONSTRUCTION
AT: 7 MARK WARNER DR - 20 BRIDGE RD
Applicant Address: Phone: Insurance:
P 0 BOX 1203 (413) 269 -4360 Workers Compensation
WESTFIELDMA01086 ISSUED ON:7/10/2012 0:00:00
TO PERFORM THE FOLLOWING WORK: CONSTRUCT 2 STORY SFH
W /ATT /GARAGE /DECK - STYLE A
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 Occupancy Signature:
FeeType: Date Paid: Amount:
Building 7/10/2012 0:00:00 $1799.60
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner