24D-118 (3) E 0 NI E
D
City of Northampton
Building DepailmeAt
Electric,Fiu^nr'l 19&Gas lnspec ions Phan RgVI@W
Nort'l --' pt_ n kAAL"060
212 Main Street
Northampton, MA 01060
A
ENSTRY RAF
ROOM•3
REMOVE EXISTING WALL
r AND RELACE WITH 2�d FLOOR
CHIMNEY \ 3 1/2'X 9 1/4'LVL BEAM
EXI5TIN5 FLOOR
KITCHEN NEW 3 1/2'X 9 114'
ROOM+I `" LVL BEAM
E]JSTW E!<TERKJR WNL
Is+FLOOR
ROOM•2
` REMOVE EXISTING WALL
DN
_ (2)PEW 31/2'CONC.FILLED
LALLY COLUMN @ EACH END
HAU,WAY BA5EMENT
E%ISTRG FpRDAT1pN WAIL J
(2)NEW 24'SO.FOOTING
LH
24 O'
FIRST fLOOR
NT5
SECTION A
NT5 �
1 � 1
LIVING ROOM/ SPARE BEDROOM
• Remove 12' of existing wall between living room and spare bedroom
• Install LVL Beam to support the second floor
• Remove existing closet doors and re-frame opening
• Sheet-rock walls
• Tape new walls with three coats of joint compound
• Sand and prime walls
• Paint walls with two coats of paint (color samples will be provided)
BASEMENT
• Install 6 Lally columns in total
• 3 supporting play room and 3 supporting 12' opening between living room/spare
bedroom
• Providing proper footing for each Lally column
ELECTRIC
• RE-locate light switch and wall outlets
HARDWOOD FLOORS
• Re-finish 550 sq.ft. of hardwood floor
• Apply three coats of polyurethane
*Dumpster and all permits included
TOTAL JOB $ 9,700
At start $4,850 '
Balance at completion $4,850
/c��:�r -.mss � � •.�.�—^,-•�'�
Tomasz Karas achel Hannel
P.O.Box 1
Ludlow,NIA 01056
Karas Home Improvement
General Contractor, LLC...
Tomasz Karas
P.O. Box 1
0 Ludlow,MAO 1056
CONTRACT
Section A:Parties involved:
This contract is dated 11`h
day of August 2015 between
Customer:Rachel Hannel
11 Church st.
North Hampton Ma
413-320-2490
AND
Karas Home Improvement General Contractor,LLC... *P.O.Box 1 Ludlow, MA 01056
Telephone: 413-374-8638
Email: Karastzc(in2mai1.com
Website: Karasgc.com
Section B: Description of work and terms:
CEILING
• Remove existing ceiling near the staircase from 1St to 2nd floor
• Reinforce existing framing
• Sheet-rock ceiling
• Tape ceiling with three coats of joint compound
• Sand and prime
• Paint ceiling with two coats of paint
• Paint walls near the staircase from 1St to 2nd floor (color samples will be provided)
PLAY ROOM
• Frame 13' of wall with a door opening and frame closet with two sets of door openings
• Sheet-rock walls
• Tape new walls with three coats of joint compound
• Sand and prime walls
• Paint walls with two coats of paint (color samples will be provided)
• Install all trim (door trim/ baseboards), (match existing)
• Paint all trim
• Install doors (play room entry doors/two sets of closet doors
• Paint all doors
• Install closet shelf and hanging rod
City of Northampton 212 Main Street, Northampton, Na 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work:
The debris will be transported by: Ak,
The debris will be received by:
Building permit number:
Name of Permit Applicant
Date Sign-ature of Permit Applicant
City of Northampton
Massachusetts
F- c'
DEPARTMENT OF BUILDING INSPECTIONS �: x
212 Main Street • Municipal Building rJI b
Northampton, MA 01060
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
[acceThe State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her
sso onstruction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which
e/she resides or intends to be, a one or two family dwelling, attached or detached structures
ry 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 any 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
1, 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 Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address:
City/State/Zip: Phone #: ��, _ 3/� �G
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
employees (full and/or part-time).
* have hired the sub-contractors 6. E]New construction
2.® I am a sole proprietor or partner- listed on the attached sheet. 7. ®Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers'
insurance.$ 9. ❑Building addition
comp.[No workers' comp. insurance
required.] 5. ❑ We area corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
tHo meowners 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: C2 Crnt
Policy#or Self-ins.Lic. #: 7/3 3�/,3a g� Expiration Date: —19
� Ciy/State/Zip:Job Site Address: C 01060
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 $250.00 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 certify under the pains and penalties ofperjury that the information provided above is true and correct.
S_ignature: f�r`s�GS-t? y 1e, Date:
Phone#: y13 371/ �6
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3. City/Town Clerk 4.EIectrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
ECTION 8-CONSTRUCTION SERVICES
/ 8.1 Licensed Construction Supervisor: Not Applicable £
Name of License Holder: I n M Z K4`Ct �xj?7/9
License Number
i
I Address Expiration Date
/-I/3 - 37// - Y6 3
Signature Telephone
- _ - ,,, .....
9 Registered Homeamprovement"Contractor Not Applicable £
Company Name Registration Number
p a . ��k �.� o�c s �= 7
Address f� ^� Expiration Date
Telephone / `3
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.Egemption
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
i
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ( Roofing
Or Doors C]
Accessory Bldg. ❑ Demoli - n ❑ New! ig s [Oj D [Cl Siding [O] Other[O]
Aft LL"_4 Brief Decr' tion of Propose
Work: s ear t TG-j t h I�
Iteration of existing bedroom Yes No Adding new bedroom Yes _No fsr
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa If Neuv:house andor add:flon to exisfna.housmg,`complete the fotlowlnct:
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 heating? Fireplaces 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
1, as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, , 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.
01 e L2 CQ S
Print Name
Qs�
Signature of Owner/Agent Date
i
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information .,
Existing Proposed Required by Zoning ?t
This columnito be filled in by '
Building Departmept
Lot Size ��
Frontage
Setbacks Front
Side L:= R:`—_ L:I I R= r�--
Rear �� l —
Building Height
Bldg.Square Footage % r-- S
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces 1-----� T
Fill: r
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW Q YES Q
IF YES, date issued:f—
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW Q YES Q
IF YES: enter Book L- �1 Pagel i and/or Document#i�'
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q , Date Issued:
C. Do any signs exist on the property? YES Q NO Q
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO Q
IF YES, describe size, type and location: ^
E. Will the construction activity disturb(clearing, grading, excavation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q NO 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
i
t
s°� Departrpent use only �n t i �i
� h
of Northampton Status ofPermtt; k� F ,
i� ttrr4 ty `� xFa?ri 4 tii l—t
Nib d
//� ing Department Ctrrb Cut/Driye�!tay Perini# � � �i3i� "ysft ,it_ ''
t7W ` �
12 Main Street SewerlSepticAvaiCa611iit 7'n a tlhi rr tity r
Room 100 UVaterlU!feltAuailability t r.
EfZ 1.' I J
IL ,'trlC, P:iJt acS in3 mpton, MA 01060 IT walSefs ofS#ructurai Plans a 1 xh'
Northamptcr., 1 U n t 7tI ,
7-1240 Fax 413-587-1272 PIo/Site Plans N t t 7 ;t riC yr� "t ki "f t
Uthe>z5pepifjf�? .... r 4
r
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This sectiort to be completed by gffice
1.1 Property Address: F
t t
�/ C/�►�1� Map Lot t r ,r Umt
i
� )9 O``-50 Zone +. Overlay D�strtct
/"1 /(/(7
...'
_Eim St District , 't CB Dlstnct
SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED AGENT:
2.1 Owner of Record: �/ ��,%�
Ralf L1t�L(?�!SeC
Name(Print) Current Maili dress:
Telephone
Signature
2.2 Authorized Agent:
iCAtIC E j�a ,s P, o. Box f l A llw ozac %
Name(Print) Current Mailing Address:
�,w�sr �,ic�s
Signature Telephone
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
7dv Construction from 6
3. Plumbing Building Permit Fee
Mechanical(HVAC)
5. Fire Protection
6. Total=0 +2+3+4+5) Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissionerllnspectorbf Buildings: Date
File#BP-2016-0243
APPLICANT/CONTACT PERSON TOMASZ KARAS
ADDRESS/PHONE P O BOX 1 LUDLOW01056(413)374-8638
PROPERTY LOCATION 11 CHURCH ST
MAP 24D PARCEL 118 001 ZONE URB(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: SHEETROCK CEILINGS ADD CLOSET TO PLAYRMAEMOVE WALL&INSTALL
LVL BEAM INSTALL 6 LALLY COLUMNS IN BASEMENT _
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 099719
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOR 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
D of ' y
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.
11 CHURCH sT BP-2016-0243
GIs#: COMMONWEALTH OF MASSACHUSETTS
MM:Block: 24D- 118 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category: renovation BUILDING PERMIT
Permit# BP-2016-0243
Project# JS-2016-000399
Est.Cost: $9700.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: TOMASZ KARAS 099719
Lot Size(sq. ft.): 7100.28 Owner: HANNAH RACHEL&PAMELA BOCKOL
zonine: URB(100)/ Applicant: TOMASZ KARAS
AT. 11 CHURCH ST
Applicant Address: Phone: Insurance:
P O BOX 1 (413) 374-8638 WC
LUDLOWMA01056 ISSUED ON.91812 015 0:00:00
TO PERFORM THE FOLLOWING WORK:SHEETROCK CEILINGS,ADD CLOSET TO
PLAYRM,REMOVE WALL & INSTALL LVL BEAM, INSTALL 6 LALLY COLUMNS IN BASEMENT
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 9/8/2015 0:00:00 $65.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner