07-019 (7) BP-2022-0783
326NORTH FARMS RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
07-019-001 CITY OF NORTHAMPTON
Permit: Demo
PERSONS. CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2022-0783 PERMISSIONIS HEREBY GRANTED TO:
Project# DEMO Contractor: License:
Est. Cost: 4000 YURI TUTKA 115442
Const.Class: Exp.Date:02/06/2025
Use Group: Owner: KREPEL, PAUL &KREPEL, CANDACE
Lot Size (sq.ft.)
Zoning: WSP Applicant: IRON HAMMER HOME IMPROVEMENTS
Applicant Address Phone: Insurance:
32 OLD POST RD 20039912
WORTHINGTON, MA 01098
ISSUED ON:07/05/2022
TO PERFORM THE FOLLO WING WORK:
DEMO PORCH
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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
0 1, ,2 Ti
Fees Paid: $30.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
RECEIVE
•
The Commonwealth of Massach ' etts
Board of Building Regulations and Sanda ds OR
Massachusetts State Building Code, 70 C R ��• 1 2022 IV'UNI IPALITY
SE
Building Permit Application To Construct, Repair, Reno lish a Revise Mar 2011
One- or Two-Family Dwelling EF T OF )IN"INSPECTIONS
r OMHAMPToN 11A R,pag
This Section For Official Use Only
Building Permit Number: Qp- 7"g 3 Date Applied:
Building Official(Print Name) Signature te
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
326 North Farms Road, Florence, MA 01062 7 07-019
1.la Is this an accepted street?yes x no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
WSp single family dwelling 4 acres 69.56
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yesO
SECTION 2: PROPERTY OWNERSHIP1
2.1 Owner'of Record:
Paul Krepel Milwaukee,WI 53207
Name(Print) City,State,ZIP
3134 S Vermont Ave 414-839-2282 pek3247@sbcglobal.net
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2:Demolition of 7'x 12'enclosed porch at the rear of the house.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
0 Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5. Mechanical (Fire
Suppression) Total All Fe s: $
Check No.tILI Check Amount:
6.Total Project Cost: $4000 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) S— / .5 zf q Z p'Z/O G�2 S
/iv IZ 1 v1 Vpc License Number Expi ation D to
Name of CSL Holder
c5A.:3) List CSL Type(see below) ()
No.and Street Type Description
A C.,1 tl Unrestricted(Buildings up to 35,000 Cu.ft.)
City/Town, State,ZIP S R Restricted 1&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
1(3—��-412.3 uviZ1 11-'(I e_ wt-1 I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
12 u,y H po-lt'Ie)l r o't" 11-'1 12.v E " t..-t'T 5 HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
'j' S, TZ--0 ecc %It 1 IV"04Pr e C4'1 C_of 1
No.and Street Email address
City/Town,State,ZIP Telephone
SECTION 6: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 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize Yuri Tutka
to act on my behalf,in all matters relative to work authorized by this building permit application.
PaCtl n2
8/27/2022
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
== The Commonwealth of Massachusetts
.
t Department of Industrial Accidents
L=tit
1.41111111111
wails -a I Congress Street,Suite 100
Boston,MA 02114-201 7
..rantrt
%LAX'
"Jk www.mass.govitlia
Workers"Compensation Insurance Affidavit:BuildersiContractorsfElectriciansiPlumbers.
TO RE.FILED Virtu'ERE PERMITTING AtrIllORITI.
Applicant Information Please Print Leoibls
Name I DusinesVOrgantzationi Indrvichnil IL HArirt 61k- 1-tor-q:
Address; "1-, G 70 cj
CitY/StatesrZirt:W01Th"rttArl t A- Phone#: 3 —3LC - el I 2- 3
Art yeti an employer?Cheek the appropriate boa: Type of project(required):
101.ent 4raltpklyer with_63' nroployeca thin aniket part-tintet.* 7. 0 New construction
"2.0 Lam a ude pruptithe or parmership tlave nu employees working forme m 8. Remodeling
any capicity_[No workera'comp natininer required.1
)0 I am a horirowner&instil watt triyielf.[No woritera'cow,mow=twin 9. Demolitioned""
I 0 0 Budding addition
la I am a homeowner and wiLl be hiring contractors to-conduct all week 41I2 uw property_ I will
tamale*sir etleirranors either have wodters4 ciallapernatain tnutmee t*Ate SOIC 1 a Electrical repairs or additions
propiiiitais with00
12.0 Plumbing repairs at additions
SO lam agenesal contractor and I have hired die niti-ciatitraetorx hated on the attaztiod dieet,
Mean slah.bariertietOrs hove tsuplOyekhmd hive*Wrier, cmnp.insittoneti, I 10 Roof repairs
14.0 Othei
AO We ate a coo:anneal and it Akers have eitematal dant tight of ex-mignon per MU
152, 100.,and we have iso .[No vourkera'tOrtici.HUM-at:lee recitiatd./
apetkint that titikla bin;I mika also fill out the section below showing their workers'poropeinati:n pulley infOrmanen_
+Horror:wow%who admit this affidavit=heating they are-Soing all work and then here outaide contractors mint s,ohntit a new affidavit indicating xiick
tCtintraretars that cheek din box row attached an additional ahem howing the:mune of the auh,contractues aad atm:whether or not thine entitio,haw.
employe**. lithe sub-contrattors have eirtplu!.i.vi,they men provide their *ot4iii omp policy number
I am an employer that is providing workers'compensation ittfarentee for my employees> Below is the policy and job site
information.
'manatee Catroany Name: IL 66:-/L-i I Ni 5 Li(2- h 6
Policy Or or Self-iris.Lic. ZQO 3 C./ C/ Z- Espiraticai Date. 6 2- 7
Job Site Address: Z--6 f-f. FikRI "5 cityistatezip: FL-A-te-ice riP, 6 1 0 6--
Attath a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure ixiverage as required under MGL . 152,*25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of*STOP WORK ORDER and a tine of up to 5250.030 a
day against the violator.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 s aides of perjarY that the information prosided above is true and correct.
Signature: Date-
Phone - LC — I
(..ffithal awe only. Do not write In this area,to be completed by city or town official
City or Town: PermitiLicente
baiting Authority(circle one):
I.Board of Health 2.Building Department 3.Cityffins n Clerk 4.Electrical Inspector 5, Plumbing Inspector
6.Other
Contact Person: Phone#: