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32A-259 (7) 36 MARKET ST BP-2019-1287 GIs p: COMMONWEALTH OF MASSACHUSETTS Map:Blmk:32A-259 CITY OF NORTHAMPTON Lou .001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateaerv:window replaced BUILDING PERMIT P re nrit a BP-2019-1267 Proiectu JS-2019-002080 Ea.Cost,S4500.0 Fee:s 100.00 PERMISSION IS HEREBY GRANTED TO: Const Class: Contractor: License: Use Group: AARON PUNSKA 105542 Lot sizelsa.A.): 4268.88 Owner: SULLIVAN ANN& LINDA RAINVILLE C/O MEAAGHAN M SULLIVAN Zonina;URC(100V Applicant. AARON PUNSKA AT: 36 MARKET ST ,4ULWfAddress: Phone,• InStsrance: 11( KINGS HIGHWAY (413)626-60330 WESTHAMPTONMA01027 ISSUED ON:5/1612019 0:00:00 TO PERFORM THE FOLLOWING WORK INSTALL 12 REPLACEMENT WINDOWS 2ND FLOOR POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Mater: Foodagal Rough: Rough: House# Foumdadon: Driveway Final: Final: Final: Rough proms; Gas: Fire Department Fireplace/Chimney: Rough: M Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certifleate gj grapaney Signature: FeeTvgc; Date Paid: Amount: Building 5/16/20190:00:00 $100.00 212 Main Street,Phone(413)587.1240,Fax:(413)587.1272 Louis Hasbrouck-Building Commissioner File q BP-2019.1257 I I J SWI ) APPLICANT/CONTACT PERSON AARON PUNSKA ��/ " -r S ADDRESS/PHONE 111 KINGS HIGHWAY WESTHAMP X)N (413)626-6033 0 JL PROPERTY LOCATION 36 MARKET ST ryp� MAP 32A PARCEL 259 001 ZONE URC(100V THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST N SED REQUIRED DATE FILLEDZONING FORM Fee Paid Buildm2 PermitFilled Fee Paid TweofConstruction, INSTALL 12 REPLACEM T DOWS 2ND FLOOR New Construction Non Structural interior mnovatiogc` Addition to Existina Accessory Structure Building Plans Included Owner/Statement or License 105542 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 � al r r6 , Signature 9FBuilding 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 aro granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. 5 �wsf P kk�0 Versim i.7 Commercial Building Permit May 15,2000 ._. Lj Department use only C' of Northampton Status of Permit MAY 4 Sul ing Department Cum Cut/Driveway Permit 2019 2 2 Main Street SewaadSepfic Availability Room 100 Water/Well Availability nF-T OF Boaor�;N.IN=PFCmD rt mpton, MA 01060 Two Sets of Structural Ptans NOPTHAMr-11 -1240 Fax 413-587-1272 Ploi Plans Other specify APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING J�/ SECTION 1-SITE INFORMATION �D N'�7 " 7 1.1 Property Address: This section to be completed by oma 3� NDr�(R Map jaf{ Lot �,I /A„• .pP6D Zone Overlay District lV`.-•- ,-`-• Elm St.Mai CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: — 35 M ii z , NNn f Name(Print) Current Mailing Address: U U LM3 Ezb_-Huth Signature Telephone 2.2 Authorize1ldA nt: Aidan- Qun3C Y� . 14 kN lhra {,�vil'�v�C It^� W^✓1 Name(Pant) Current Mailing A dress: tl 413 6Zt- V 7.3 Signature Telephone SECTION 3-ESTIM ED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building - 1 (a)Building Permit Fee 2. Electrical 1 (b)Estimated Total Cost of Construction from e 3. Plumbing Building Permit Fare 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) SUO. `" Check Numbervp (IU This Section For OfBclal Use Only Building Permit Number Date Issued Signature: Building Commissioner/Impactor of Buildings Date • Verdonl.7 Coaunercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition Repairs Additions ❑ Accessary Building Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing Change of Use[I Other Brief Description Enter a brief description here. Of Proposed Work: � a SECTION 5-USE GROUP AND CONSTRUCTION TWE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 18 ❑ B Business ❑ 2A ❑ E Educational ❑ 2B ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 Institutional ❑ 1-1 ❑ 1-2 ❑ IJ ❑ 38 71 M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: ' COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: Proposed Use Group: . Existing Hazard Index 780 CMR 34)'. Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(so 2"tl 2m ._ Total Area(sf) Total Proposed New Construction(sf) Total Height(0) Total Height ft 7.Water Supply(M.G.L.o.40,$SQ TA Flood Zone Information: 7.3 Sewage Disposal System:Public ❑ Private 0 Zone Outside Flood Zone[] Municipal ❑ On site disposal system❑ • Versionl.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON iONING Existing Proposed Required by Zoning This column to b fiitd in by BuildingD brio Lot Sim Frontage Setbacks Front Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot�mime bldg&pnv 4o Parking Spaces Fill: vobme&Lociuvv A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW © YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O ]IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O 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 O NO O IF YES,men a Northampton Storm Water Management Permit from the DPW is required. • Versionl.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable Name(Registrant). Registration Number Address Expiration Date Signature Telephone 9.2 Regblered Professional Enginaer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Data Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 GenesawsI l Contractor �( I, NVol1-.�dNJ '�' - Not Applicable ❑ Company Name. Responsible In Charge o/Consnvctian 1 id �NM:, Wect6 1, M, opzl Addre� Hl8 6L( 6433 Signature 1217 ^ Telephone Versionl.7 Commercial Building Permit May 15,2000 SECTION 10.STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Pear Review Required Yes O No SECTION 11-OWNER AUTHORIZATION-TO BE COMPLETEDWNEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize (7+yM Qa'is .—... _.. to act o ^mfyy^beh f ' matters Weave to work authorized by this building permit application q p 1. .1... Sg uro f Ovmer ete now— YW1 b�''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. k'-, P'v'6t+A Prim Name Signature of OwnerlAINKe SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Su ervisar: YY,,vv�� Not Applicable ❑C 1, Name of License Holder �'` Volts" GS I 0 J � _1 Z License Number W kt t, Nj✓ 104 4T1 At, oval +I V2 I y Address E<plratlanl�Dade I 413 W - 4z33 Signature Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,125C(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 Me building permit Signed Affidavit Attached Yes No O e City of Northampton 212 Main Street, Northampton, MA 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: $ rk-yi 14 Thedebris will be transported by: l k4n �04A The debris will be received by: �l�T v Building permit number: o Name of Permit Applicant J� 1ons16rl r Date Signatue of Permit Applicant f The Commonwealth of Massachusetts Department of IndustrialAccialents 1 Congress Street,Suite 100 Boston,MA 02714-20777 www.mass.gov/dia V11ccliers'Compensation Insurance Affidavit:Builders(Cootraeors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le ibly Name(BusinesslOrganizatiowindivid:ul): ,AYN Js3(l�'h' Address: P kl 1(W) �*N City/State/Zip: low Phone#: b Arcyov m employer?Cledr Me sPPr^Prime hoc: Type of project(required): LE]l am a employer with empinyees(fdl aodlorpm-timet' 7. New construction 2.LV..enol.pic,soctm or pmmerehip and have no employees working formein 8. ❑Remodeling 1�VV�anycwrco .[No workers'com,venrince onsied.l 3,M I am n homeownerdom dl work If workers'coati.mrumme re tired 9. ❑Demolition g myna [Now9 �' 4.❑I an a homeowner act ac will be hours contrtors y w concoct all work on mpopery. I will l0❑Building addition name thatch coovocmrs either have workers,ennossadun lmurnnee or on,sole IL❑Electrical repairs or additions proprinors with no employees. 12.C]Plumbing repairs or additions 5.❑I eon a general conrtnetor and I have hired rhe sub-contractors lined on the ansched Amt. 13.❑Roof repairs Theusub-conuamra chave emri ..c:ployees sort have wwkecomp. .c: b.❑We me a coryomtion and in officers have exemsed theirnght ofnempron per MGL c. 14.❑Other 152,41(4),slid we have on,employees.[No workers'comp.vin.requonsi] 'Anyapplicmt Matchneks box#1 mutt wh fill oto the..are below showing Mev wohers'compenution policy mf tion. 'Homeowners who submit Nis affdavit indicating Nay art doing all work and then hire outside conuacmrs must submit a new affidavit indicming such. lConuuctors dut check this box must attached an additional slicer showing die name of the sub-convectors act swe whether ur not Mux entities have employees. Ifthe sub-contractors have moployces,they must provide Mev workers'comp.Oolicy number. I am an employer that is providing workers'compensation insurancefor my employees Below is the policy and job site information Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/StatdZip: 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. 152,625A 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 a STOP WORK ORDER and a fine of up to$250.00 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 cerdfy under the pains and penddex ofperjary that the fnformadon provided a bove is one and corroa Signature' eA=w ',lndDate' Phone#' 'W 6zc -- 607 ;r Official use only. Do not write in this area,to be completed by city or town official. City or Town: PermitfLicense# Issuing Authority(circle one): L Board of Health 2.Building Department 3.Cityrfown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: E Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written.' An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,¢25C(6)also states that"every state or local licensing agency shall withhold the Issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,p25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." .applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or insurances,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple pe rnitlicetrse applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in_(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof thin a valid affidavit is on file for future permits or license. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address.telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1.877-MASSAFE Fax#617.727-7749 Revised 02-23-15 www.mass.gov/dia ... .. . # b�` �. i'. d4". tea: , .a•»s" b 4 1 .*� low $u1} #**YY "-01 , I 4 Ov . . , : :< . . ma . . . . . \ ? \ } ? a � owl" 6 mp 110 2\ m . . . . . . d1111p, . . . : � ® IM, \I \ f) Ny (X n N .I n A. a r I ^ r IIXI. §I h II 7 r I a T imar.ws+,+,ktrW Ta 4a rn wMM t.P��.'�M1it tew fia T,Ybs M+n YK.Y tb �.b Yw wm..ti Naw 4A. E ��� ••. 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