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CITY, OF NORTHAMPTON
BUILDING DEPARTMENT -
These plans have been reviewed
And approved,
Date
9'-5 3/8"
Signature }
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6-1 1/2"
EXISTING
o r IV s' ,
SCALE: 1/4" = 1'-0"
2
1 — 2'-8" x 6'-8" rear door
2 — new windows in living room
1 — new window in kitchen
New window trim, door casings, baseboard where needed.
Sheetrock entire first floor ceilings.
The narrative above makes reference to plans dated 18 February 2015.
Respe ully submitted,
William . Turomsha
WJT/djt
1DESIGN& CONSTRUCTION
19 February 2015
Building Department
City of Northampton
212 Main Street
Northampton, MA 01060
Subject Property: 15 Park Avenue, Northampton
Proposed Renovation:
Remove masonry chimney from basement to roof.
Infill floor openings and patch roof opening.
Construct new half bath on first floor, new closet in living room.
Remove existing closet wall in living room.
Remove columns and wood boxes currently supporting second floor.
Replace with 2 x 9 7/8" x 1 7/8" micro laminated beams.
Post supporting beam in outside wall to bear on the wood sill.
Post supporting beam in inside wall to have new poured concrete footing and
lolly column.
Remove existing kitchen and replace as per plan dated 18 February 2015.
Remove existing gas fired steam boiler. Replace with high efficiency forced hot
water boiler.
Replace cast iron radiators with aluminum fin baseboard and wall mounted
radson panels.
New electrical wiring entire first floor.
Install new Jeldwen insulated fiberglass door.
1 — T-0" x 6'-8" front door
Wm. J. TUROMSHA ♦ P.O. Box 141 ♦Leeds ♦ Massachusetts 01053
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 78OCMR 108.3.4 to
act as his/her construction supervisor. The state defines"Homeowner"as, "Person(s)
who owns a parcel on which he/she resides or intends 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
home owner."
The building department for the City of Northampton wants person(s) who seek to use
the home owner exemption, to act as their own construction supervisor, to be aware that
by doing so you become responsible for compliance with state building codes and
regulations. The inspection process requires that the building department be called to
inspect work at various stages, which include foundation/footings (before backfill),
sonotube holes (before pour), a rough building inspection (before work is
concealed), insulation inspection (if required) and a final building inspection. The
building department requires these inspections before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occupancy
until the work can be inspected.
If the homeowner hires other trades to perform work (electrical, plumbing & gas) the
homeowner will be responsible to make sure that the trades hired secure their proper
permits in conjunction to the building permit issued, and that they get their required
inspections. Failure of the individual trades to secure the permits'and inspections as
required.can DELAY the project until such time.as the proper permits and,inspections are
made
I, understand the above.
(Home owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date
Address of work
location
The Commonwealth of 31assachusetts
Departm ent o j in dustrial:4 cciderzts
=' Office of lzrvestigations
.r - 600 Tf ashington Street
Boston, _111A_ 02111
_.. www.nzass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers
Applicant Information Please Print LeQibiv
Name (Business/Organization/Individual): ( &fizmW0 DBA DES16M 4 C&NOLXA` 01.
Address: 5S f32owT S-rer-aY -O. Sox I41
City/State/Zip: L,,pas Mµ a jogs Phone l#: q13 -S7E -7 fYk
Are you an employer'Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4• ❑ I am a general contractor and I 6. ❑New construction
employees (full and/or part-time).* have hired the sub-contractors
2.® I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling
ship and have no employees These sub-contractors have S. ® Demolition
working for me in any capacity. employees and have workers' 9 ❑ Building addition
[No workers' comp. insurance comp. insurance.',
required.] 5. ❑ We are a corporation and its 10.® Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their I L Plumbing repairs or additions
myself. [lv o workers' comp. right of exemption per MGL 12.® Roof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [',Io workers' 13.7 Other
comp.insurance required.]
`Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
?Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such-
'Contractors 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: T-RAyELEK3 —
Policy#or Self-ins. Lic.#: PJNII 'Ob S3TVY� `9 ` (y Expiration DaterD 116
Job Site Address: /.S' &&& ayeMal f M AMIA ov?DU MA City/State/Zip: p/o L o
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$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to 5250.00 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 certtify�1under the pains and penalties of perjury that the information provided above is true and correct.
Sianature• /"1rws 4..._ Date:If fiiew Aai 26,16'
Phone#:
Of use only. Do not write in this area, to be completed by city or town offzciaL
Citv or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
SECION 8 -CONSTRUCTION SERVICES
r:N.:..i'c.f ensed Construction Supervisor: Not Applicable ❑
License Holder W1 If IQtk TtA R6 000 51 S
License Number
Pa 'Rox, 14) 58 FIR okT Lefins Ina 010rs.
Address Expiration Date
Signature Telephone ,
9.Registered Home Improvement Contractor Not Applicable ❑
141/.y.., 1' 1ura msAaa ,o isu Consz-,uereA) IDl�2Z.
Company Name Registration Number
?O. &r M LF-Ens MA aloS5 &/Zgl101to
Address Expiration Dale
Telephone la gm mi
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 OWif&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 1.08.3.5.1.
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-vear 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. . 1 ;1 . • ,
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 Erhployers 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 5-DESCRIPTION OF PROPOSED WORK{check all applicable)
New House F7 ' Addition Replacement Windows, Alteration(s) ® Roofing
Or Doors 5Z I
Accessory Bldg. 0 Demolition El New Signs [O] Decks [E] Siding[pj - Other[0]
Brief Description of Proposed REMoUE GHIMUE Geris?'oo4T. NEW K1b L( Et^4h/ NEW KIt4N6N
Work:CAVMAA M iili�ta oL 2-A Pl A� A=1A&lASQ0-, —Z uFru K]DaASh DOt.wn// AUT FM69L &Etltu
Alteration of existing bedroom Yes _No Adding new bedroom Yes _No
Attached Narrative X Renovating unfinished basement Yes X No
Plans Attached Roll K-Sheet
6a.if New house and or addition to existing-housing:'complete the fo[[owing:
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 heat places or Woodstoves Number of each
g. Energy Conservation Compliance- Masscheck 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
I, NANQ4 t A?40*EW X1 111 kE1J as Owner of the subject
property 4
/
hereby authorize Yl1 Z• A
act on my b I, all matters rel e to work authorized by this building permit application.
Signature of Nker Date
l 1�IIKM Ti,t�bMSH�. as9wmio/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
2ol
Signature of Ei /A ent Date
n
. -
^ .
' .
�
. .
Section 4. ZONING Ali information Must Be Completed. Permit Can Be Denied Due T o incomplete information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Rear
Bldg.Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
#of Parking Spaces
A. Has aSpecial Permit/Yariance/Finding ever been issued for/on thesite?
NO DONTRNO� �� YES ��
~_� '��
|F YES, date issued:
� �
IF YES: Was the permit recorded at Registry of Deeds? _ ^
NO DONTKNOYY 0 YES
IF YES: enter Book / -/ Page and/or Document#r-----------T
B. Does the site contain a brook, body of water orwetlands? NO 0(7N DONTKNOYY 0 YES 0
IF YES, has permit been or need to be obtained from the Conservation Commission? '
F------------
Needs tobeobtained 0 Obtained /—\ , Date|ssued: �
^ �~� »C>%
C. Do any signs exist on the property? YES �~/ NO
IF YES, describe size, type and location:
�
D. Are there any proposed changes toor additions of signs intended for the pnoperty? YES 0 NO 0
IF YES, describe size' type and location: �
E. Will the construction activity disturb(clearing, gradingexcavation, or filling)over 1 acre orioh part ofa common plan
that will disturb over 1acre? YES y ) NO K�k
�� ��
IF YES,then a Northampton Storm Wffe—r Man—agermen-f-P&mit from the DPW is required.
Department use only
City of Northampton Status of Permit:
Building Department -Curb Cut(Driveway Permit
fW 2 0 2015 212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
eCtric,Plumbing 8 Gas tnsen i6ni orthampton, MA, 01060 Two Sets of Structural Plans
Northampton, M�o e 4 3-587-1240 Fax 413-587-1272 Plot(Site Plaits
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:
1S TIARi. A U r=NLLE MapSAEFT *,31-J3 Lot# Unit
No irx`m^"p-ra w MIA Zone U R G Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
RAW ulkew 15 PACK A FMILLE VOMAKfMIJ 1414
�N70)(Print) Current Mailing Address:
gl a 335 S52 S'
V` Telephone
Si nature
2.2 Authorized Agent:
W,ll,orr+ S• 1 "*OMS W4 P 0. to)( 141. LEEOs 14A 01o13
Name(Print) Current Mailing Address:
&lAl.4 - JLMvisz&., `!/3 575 18flo
Signature Telephone-T
SECTION 3-ESTIMATED CONSTRUCTION COSTS'
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building • (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
6.606. Construction from(6)
3. Plumbing .o Building Permit Fee
32eo
4. Mechanical(HVAC)
5. Fire Protection 10, 600.
6. Total=(1 +2+3+4+5) L 0 oo Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissionerllnspector_of-Buildings Date
File#BP-2015-0813
APPLICANT/CONTACT PERSON WILLIAM TUROMSHA
ADDRESS/PHONE P O Box 141 LEEDS01053 (413)586-4005
PROPERTY LOCATION 15 PARK AVE
MAP 3 1 B PARCEL 314 000 ZONE URC(100)/
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: REMOVE CHIMNEY ADD 1 ST FLR 1/2 BATH REMODEL KITCHEN REPLACEMENT
WINDOWS/DOORS COLUMNS W/BEAMS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 000515
3 sets of Plans/Plot Plan
i FOL OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
ATION 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
m 'tio elay
Sig ure of Building Official 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.
15 PARK AVE BP-2015-0813
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 3 1 B-314 CITY OF NORTHAMPTON
Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:renovation BUILDING PERMIT
Permit# BP-2015-0813
Proiect# JS-2015-001577
Est. Cost: $64200.00
Fee: $385.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: WILLIAM TUROMSHA 000515
Lot Size(sa. ft.): Owner: MILLIKEN NANCY
Zoning. URC(100)/ Applicant. WILLIAM TUROMSHA
AT. 15 PARK AVE
Applicant Address: Phone: Insurance:
P O Box 141 (413) 586-4005
LEEDSMA01053 ISSUED ON:212312015 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMOVE CHIMNEY,ADD 1 ST FLR 1/2
BATH,REMODEL KITCHEN,REPLACEMENT WINDOWS/DOORS, COLUMNS W/BEAMS
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 Sisnature:
FeeTvpe: Date Paid: Amount:
Building 2/23/2015 0:00:00 $385.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner