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�^ DEPARTMENT OF BUILDING INSPECTIONS
i:NSPECTOR 212 Miun Street 0 Municipal Building
s,.
Northampton,MA 01060
LOCATIONOV B r i�a e P 0 dJ �r&e_ AD U�
SQUARE FOOTAGE AMOUNT
BASEMENT @ y :20 l 7 3G
IT FLOOR.@.50.
ND FLR @3O .
FLOORS, FINISH ATTIC,GARAGE g.20
DECKIPORCHES @ .20
TOTAL. 7r W
T The Commonwealth of Massachusetts
_} Department oflndiiu tria[Accfdents
= MIM Of 1j7Y9SLfff2fiVBS
— 600 Washington Street
Boston,Mass. 02111
Workers' Compensation Insurance Affidavit
name:
location:
city phone
* I am a homeowner performing all work myself.
* I am a sole proprietor and have no one working in any capacity
~I am an employer providing workers' compensation for my employees working on this job.
comoanvna'me: SaloOme:y _COr1=StZ'11Ct1OT1r�.=�ITC�.°.:.:;�:'• :`.. �;":; �,
:. :.
P O. -Eck 1 2 03
....:
> W e s t f i e l d., Ma (11.0 8 0
city phone:.#: -: .•:..•.
MG � ..20012.1.: 120
insurance co.. Mass Employers " Ins . _CO pniicv# C 0 0 `< -><
yI am a sole proprietor,general contractor, or homeowner(circle one) and have hired the contractors listed below who have
the following workers' compensation polices:
comany name
address:
city:
insurance co. : . .. ;. . : .•,.,. ...:-.: :,....:pohcv��" ". .�>:.•";
company name:
address: :
city: •phone#:
insurance co.
-
Failure to secure coverage as required under Section 25A of NMGL 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 rxrfifi, under the paired enaliies of perjure'that the information provided above is true and correct.
S i mature' Date
F intname Merri yn A. Gaq e' — Office Manager Phone ( 413 ) 269-4360
F? official use only do not write in this area to be completed by city or town official
city or town: permit/license# nBuilding Department
❑Licensing Board
Q check if immediate response is required E]Selectmen's Office
OHealth Department
contact person: phone i#; nOther
tr—n d;i95PIA)
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder ZITER SALOOMF..Y 018780
License Number
_
P-0- BOX 1 -0 � WERTEIRT.D., MA 01 0116 11 /13/15
Address Expiration Date
413 531 0062
Tele
9.Registered Home Improvement Contractor Not Applicable ❑
SALOOMEY CONSTRUCTION, INC 100978
Company Name Registration Number
P.O. BOX 1203, NESTFIELD, MA 01086 6/24/16
Address _ Expiration Date
` �'-- elephone 413 269 436
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....... NX 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 5-DESCRIPTION OF PROPOSED WORK(check all aualicable)
New House ,� Addition ❑ Replacement Windows Alteration(s) E] Roofing
i Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding[p] Other
Brief Description of Proposed O ®e%-
Work: NEW CONSTRUCTION OF A "
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 existina housing complete the following:
a. Use of building :One Family Y Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms 2
c. Is there a garage attached? Y
d. Proposed Square footage of new construction. LkCQ6 Dimensions C) )(CZ
e. Number of stories? C
f. Method of heating? GAS Fireplaces or Woodstoves Y Number of each 1
g. Energy Conservation Compliance. Y Masscheck Energy Compliance form attached?
h. Type of construction X(e LOnoa
i. Is construction within 100 ft. of wetlands? Yes 3 _No. Is construction within 100 yr. floodplain Yes X No
j. Depth of basement or cellar floor below finished grade g Fef,4
k. Will building conform to the Building and Zoning regulations? X Yes No .
I. Septic Tank City Sewer_ )'C Private well City water Supply `
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
ZITER SALOOMEY as Owner of the subject
property
hereby authorize TONY BILOTTA
to act on my behalf,in all matters re tive to work authorized by this building permit application.
c_ 4/9/15
Sign4NEe of_Owner Date
ZITER 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
4/8/15
'SkAature of er/Agent Date
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 ------I
Side L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage % ------
(Lot area minus bldg&paved ------
parking)
#of Parking Spaces
Fill:
(volume&Location) I -------
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON7 KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DON7 KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 0 Obtained Date Issued:
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and Location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,,Lx9avation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO A'Sh
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
it Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Ddvewa
APR 1 6 y Permit
e
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Electric, Plurnb rig&Gas Inspections Ortllam tOn, MA 01060
Northampton, MA 01060 p TWO Sets Of$tRJCtUr81 Plans- `
phone 13-587-1240 Fax 413-587-1272 PIotlSite Plans
Other Specify f
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
20 BRIDGE RD Map Lot Unit
#19 Mark Warner Drive
BEAR HILL ESTATES Zone Overlay District
NORTHAMPTON, MA 01060
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
20 BRIDGE RD LLC P.O. BOX 1203, WESTFIELD, MA 01086
Name(Print)
Curren443 nft yy s1360
Telephone
at
2.2 Authorized Agent:
ZITER SALOOMEY &/or TONY BILOTTA P.O. BOX 1203, WESTFIELD, MA 01086
Name(Print) Current Mailing Address:
413 531 0062
�ignia re Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building 170, 400. 00 (a)Building Permit Fee
2. Electrical
6, 200. 00 (b)Estimated Total Cost of
Construction from 6
3. Plumbing 9, 900. 00 Building Permit Fee
4. Mechanical(HVAC) 7, 500.00
5. Fire Protection
6. Total= (1 +2+3+4+5) 1900000, 00 Check Number a
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2015-0983
APPLICANT/CONTACT PERSON SALOOMEY CONSTRUCTION
ADDRESS/PHONE P O BOX 1203 WESTFIELD01086(413)269-4360
PROPERTY LOCATION 19 MARK WARNER DR-20 BRIDGE RD
MAP 16B PARCEL 001 001 ZONE SR/URA/WSP
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: CONSTRUCT FOUNDATION ONLY FOR SFH N LV Sew6R AVAIL _
New Construction Fort fm-t-- PF2/U1
Non Structural interior renovations
Addition to Existing
Accessory Structure -
Building Plans Included•
Owner/Statement or License 018780
3 sets of Plans/Plot Plan
THE YOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INvy FORMATION PRESENTED:
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
Demolition Delay
`f'I"Gy L,S
Signature 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.
19 MARK WARNER DR-20 BRIDGE RD BP-2015-0983
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 16B -001 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: FOUNDATION BUILDING PERMIT
Permit# BP-2015-0983
Project# JS-2015-001890
Est.Cost: $190000.00
Fee: $287.00 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/URA/WSP Applicant: SALOOMEY CONSTRUCTION
AT: 19 MARK WARNER DR - 20 BRIDGE RD
Applicant Address: Phone: Insurance:
P O BOX 1203 (413) 269-4360 Workers Compensation
WESTFIELDMA01086 ISSUED ON:412712015 0:00:00
TO PERFORM THE FOLLOWING WORK: CONSTRUCT FOUNDATION ONLY FOR SFH -
NEED WATER/SEWER AVAILABILITY FOR FULL PERMIT
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 4/27/2015 0:00:00 $287.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner