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25C-221 (6) BP- 022-1444 50 WALNUT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 25C-221-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2022-1444 PERMISSION IS HEREBY GRANT 4 D TO: Project# REPAIRS TO GARAGE FLOOR Contractor: License: Est. Cost: 6700 GENE BOROWSKI 106527 Const.Class: Exp.Date: 12/23/2022 Use Group: Owner: GOHR GOHR FRED W JR& JAI MAR A Lot Size (sq.ft.) Zoning: URC Applicant: BEYOND BUILDERS Applicant Address Phone: Insurance: 117 SUNNYMEADE AVE 413-687-3777 6HUB-2E67637-7 CHICOPEE,MA 01020-1780 ISSUED ON: 11/03/2022 TO PERFORM THE FOLLOWING WORK: REPAIR BROKEN GARAGE FLOOR 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: 10 • • .›.2 ' Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner / r �. 1�,i. .� 1 r The Commonwealth of Massachusetts W Board of Building Regulations ands tan rds NOV . F R Massachusetts State Building Code, 78RFp R 8 <9022 I ISPEALITY T R i. Building Permit Application To Construct,Repair,�R �y44/ olish a Revi ed Mar 2011 One-or Two-Family Dwelling , ,�, �`ti':7 '/r �pIsp F This S ction For Official Use Only ��°'0 / Building Permit Number: 1 p)2" /eft/LI_ Date Applied: a 4,,_ /js, //' i I- -202.Z Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION . roperty Addr s: 1.2 Assessors Map&Parcel Num15G.1 . c iv,� 1.1a Is this an accepted street?yes no Map umber Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 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 yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 0wnerl&I RW "1/ ii;e...744,.4--1,741,1 . Name(Print) City,State,ZIP • 56 �� A ti f Sf. - Mod 6/1375VV4461‘. No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building Ci Owner-Occupied Repairs(s)ig Alteration(s) 0 Acdition 0 Demolition 0 Accessory Bldg Number of Units Other 0 Specify:4,,,, de/Pta •,'_. 412)11, Brief Description of Prop d Work': ��..ceri 4, 142.e.4) 7t `-</ /,,,I, 4-•e iA A .1-itod ' 1)1q-Ill SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ / 7 , 1. Building Permit Fee: $ Indicate how fee is determined: �P ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costa (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Total All Fees: $ Suppression) Check No.41(,(1?+Check Amoungt6 6. Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due: iiir City of Northampton * * Massachusetts - tt * e ?G A.i "t 9 t� DEPARTMENT OF BUILDING INSPECTIONS it 212 Main Street • Municipal Building %3' V%Northampton, MA 01060«tip PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS, DOORS, ROOFS,RENOVATIONS, ROOF MOUNTED SOLAR, ETC. 1. Building Permit Application signed by legal owner and filled out by o«-ner or authorized agent. 2. One set of plans and specifications of proposed work (Digital and hard copy). 3. Construction Debris Affidavit filled out and signed by applicant. 4. Worker's Compensation Insurance Affidavit filled out and signed by applicant. 5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance. 6. Energy Conservation Compliance Certificate (new/replacement windows). 7. Home owner's License Exemption Form (if applicable). 8. Note any Special Permit requirements (if applicable). 9. Energy Code —all new construction(Gut/Rehab) requires a HERS Rater Affidavit 10. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton. SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor Lice e CSL) C5/�j/2 7 / �3 › R !�J►� �t�/tP �Gt/'Dcca "wkitii1110a/1:44) License Number Expiration Date Name of CSL Holder �1/ 7Sl�74 ��'/ r / 4. List CSL Type(see below) !/ Street e Description toi atyl lC' J A ��� afvT`r� Unrestricted(Buildings up to 35,000 cu. ft.)City/Town, tate,ZiP f R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding 4,J,„_____iii, or,,_ SF Solid Fuel Burning Appliances q ).4e-7.- -7.77 I Insulation phone Email addresw1�-/✓ o-a D Demolition 5.2 Re ' ered Home Impr j emyontract‘IHIC) /7 y6 .� A/�e �3 t ��� `i, vs HIC Registration Number Expiration Date HIC CompiarfName;./...HIC Registrant Name No.and Street ./? /72 af7 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 0 No .0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PE T Ze I,as Owner of the subject pa hereby arfflt SF�� �� to act on my behalf, ' al rs elativ to k authorized by this building permit application. ///3/Pe ...— Print Owner's Name(El onic Signa re Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest under the pains and penalties f perjury that all of the information contained in this application is true an"/ y7edge st f mand understanding6e44 ii,A0z4.95•Cli. „A-4" // .3/.- _,_ Print Owner's or Authorized (Name ent Ag 's Elecre) Date OTES: 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 •- ' 11 vc, Department of Industrial Accidents 1 Congress Street,Suite 100 Boston, MA 0114-2017 4,1..-0.. .,.,.-•,•.:7;:::‘.>, WOVw.mass.govldia S' takers' C4.1[11petiSA 11011 Insurance ,t ffida%it:BuildersA-alarm ctursiElectriciansiPlumbers. i(i EIL 1-11.1-.1)\Nil II I 11/.1 I'Llt,ill I I IN(;Al 1110141 I' Applicant Information Plea Print Letilill,. Name(Business,Organizatiori liki 'dual): 4.) ,, .....,o6t.) . Address: /17 ' c.",..ii 1;44 A,i C City/StateiZip: 4_Jc. A ota.45 Phone#:i.4( Art rut as easplayte Cheek the appropritd;box: ii pe of project(required): 1.N lam a employer with '.:.. employoes k fUit andsm part-time Ls 7. D New construction 20 1 ant a sole proprietor or partnership and have no employees swotting for me m 8. 3 Remodeling ..,carsteary.[No workers'comp.insurance Tripura] 9. ED Demolition 30 lam a horni.syworr doing all work myself.[No soothers'conc.insurance retsina] ICI CI Building addition 4.0 lam a hoincorner and will be hiring arntrantors to conduct all work on my moperty. I will ensure that all Lamm-actors either bare*otters'cortipenration insurance or are sole LID Electrical repairs or additions proprietors with no employoni_ 1 2.D Plumbing repairs or additions 5C3 1 am a general contractor and 1 hare hired the rub-contraciors listed on the aninhed rheet I 3.-_11 Roof repairs These sub-contractans have employees and have workers'comp.ttesurance) 4,...,....other , f7ee, 6.0 We are a corporation and it,officers have exercised their right of etemption MG per L c. e 1 152,*101.and we hare no emplo or yees.[No wkers'comp.insurance remain:4] P. *Any applicant that checks box=1 met 36)till our the section below Aliw true their viorkers eurnpensatiom Isiis..,, in LI mit1, i f../....._ .....-.....-Toik nen who submit this atrisius3t radscatnig they are doing all is-urii and then hat ont.-ift,omits.scum,must.ribald a new affair ta insticating such. 4,:untractorr that check this box must anacbed an additionid Inert showing the name of the subscontracters and rule whether or not those awns hare employees_ lithe rob-contractors/112Nt employees.they must pnos.ide their rvorkers'comp.pa hey number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. --", Insurance Company Name: //'et ve /P/5 Policy#or Self-ins.Lie.#: ‘,6,5 --- ?2:—...— t‘.67137-7 Expiration Date: —V Job Site Address: Si--St; 4/s144.-yrk CityiStateZip: A ©/ee,,e, Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a tine up to$1,500.00 andeor one-year imprismunent,as well as civil penalties in the form eta STOP WORK ORDER and a fine of up to S250.00 a day against the violator.A copy of this statement may be forwarded to the Oflicc of Investigations of the DIA for insurance cos,era,,2e 'krill-IL:Lefton. I rho hereby certift under the in net penal ' A of-perjury that the information provided above is e an COMCI, SI2Iii:L11,..: „"Pdiretar g it- 1)1-..4'r.t. C5/r . 4g7— 3777 Official use only. Do not write in fhis area.to be completed by city or town official City or Town: Permit/License# Issuing Aathoriq (circle one l: I.Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone 4: _. _ City of Northampton „�c1sr 1 Massachusetts A.n,�'•~ -- fi ..„ o . \ ,. e'llDEPARTMENT OF BUILDING INSPECTIONS ; s �` 212 Main Street • Municipal Building 3 b Northampton, MA 01060 4 i"r CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: /7,a'{, car r G" v, ,...,, 1 The debris will be transported by: Name of Hauler: 34-,..-/—e.„ .._ Signature of Applicant: -� Date: �( -� 4._g pp City of Northampton Si Massachusetts A . and fs *{ DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 "'ATMSeSt't� HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, (insert full legal name), born_ (insert month, day, year), hereby depose and state the following: 1. I am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners' exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s) who owns 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 home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel,I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this day of , 20_. (Signature) • Number 455 8 October 26,2122 Gene Borowski Licensed&I sured General Contractor • MA lic.CS- 06527 117 Sunny Meade Ave. Chicopee,MA 01020 __ (413)687-3777 0 t. t D 9 R S _ CUSTOM DESIGNS NEW HOMES•AoornONs•RENOVATIONS CONTRACT SUBMITTED To: JOB SITE: Fred Gohr Same 50 Walnut St. Northampton. Ma.01060 (413) 584-8666 We hereby propose to finish all material and supply all labor necessary to R/R garage(20'x21)floor/jack up main carrying beam and install three(2'x2')footings with rebar. The job will consist of 1. File permit and waste removal by Associated Building Wreckers. 2. Jack up and shore center beam and front column of garage between doors. 3. Demolition of existing slab and excavate(3)2'x2'footing with rebar. 3. Set wire mesh and pour 4"concrete floor at 3,500 PSI. 4. Install(3)4"steel concrete columns with Springfield Plates. 5. Clean up and remove all debris. - Permit/Waste Removal $ 950.00 Bobcat/Operator $ 750.00 Demolition/Excavation $ 1,200.00 Jacking/Columns/Plates $ 750.00 Footings/Concrete Work $ 2,800.00 Misc./Clean Up $ 250.00 TOTAL BID $ 6,700.00 $ 3,500 Deposit with the balance of $ 3,200 due upon completion 77///2_ L