32C-052 (4) Waiver file:///C:/DOCUME-1/cmiller/LOCALS-1/Temp/Waiver.html
Aaron Punska Construction and Painting Aug.15,2014
111 Kings Highway
Westhampton,Ma 01027 CSL:1055427
apunska(c)gmail com
413 626 6033 HIC:139080
1 request that you grant a modification to waive the requirement for control construction for the
project at 1 Pearl St. in Northampton because the work is of a minor nature,will not affect health,
accessibility,life and fire safety,or structural requirements and is impractical in that the cost of
control construction is considerable when compared to the cost of the proposed work.
Thank you for your consideration.
Respectfully,
Aaron Punska
Aaron Punska Construction&Painting
111 Kings Highway
Westhampton,Ma 01027
8/27/2014 8:34 AM
1 of 1
t 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
j(�� `` c
Name (Business/Organization/Individual): 11Nvc.f\ iuyk9kA,
I�k�• _
Address: w
City/State/Zip: Q e vk�.rnr, 1 Mh 0011 Phone#:
Are you an employer? Check t -appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
2.iemployees (full and/or part-time).* have hired the sub-contractors 6. F-1 New construction
l am a sole proprietor or_partner- .listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g. ❑Demolition
working for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers' comp.insurance comp. insurance.$
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
�.❑ I am a homeowner doing all work
of
have exercised their 11. Plumbing repairs or additions
myself. [No workers'comp. right of exemption per MGL 12.7 Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.l
*Any applicant that checks box;#1 must also?Ill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they W 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 are employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self--ins.Lie.#: Expiration Date:
Job Site Address: City/State/Zip:
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 of perjury that the information provided above is true and correct.
e G 9
Signature: Date: u dil
Phone#: Yd Uk6
Of 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.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER:REVIEW(780 CMR110.11)
Independent Structural Engineering Structural Peer Review Required Yes r No
SECTION 11 -OWNER AUTHORIZATION-TO!BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES` FOR BUILDING PERMIT..........-...................
.. ................. as Owner of the subject property
hereby authonze'._ `^!.?!�_ y!^.`� _. �Yl '�!!��. (1�.`_..�. _. f _a ... r_.�. ... __._____.____............
act on my behalf, in'all matters t e.10 work,arrtlibrized by this building permit application_ M
Signature of.OWnor LY" _._ _ Date
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
Print Name
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION.SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:?a'.Lw✓1u. Vl� ,�.....o .. , . _....... ... ..... . .... ....... �,- �. ,_ . 1..�._ y.. _. ._....._
License Number
Gie ��
Address �— Expiration Date
�l'✓Yit fr'W'ZrdYt+�
Signature Telephone
SECTION-'(3-WORKERS,'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.1521§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 6 ilding permit.
Signed Affidavit Attached Yes No 0
Version 1.7 Commercial Building Permit May 15,2000
SECTION 9-PROFESSIONAL DESIGN'AND CONSTRUCTIORZERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL-PURSUANT TO 780 CMR'116(CONTAINING MORE THAN 35,000 C.F.OF EIILOSED SPACE)
9.1 Registered Architect:
Not Applicable ❑
Name(Registrant):
Registration Number
Address
« Expiration Date
Signature Telephone "
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
_._._...
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
_,...._: _..__.._. ._...._._. _ .. .... ._.._....._. ........_:
Signature Telephone Expiration Date
_,.w..._ _.� r__,._...,._,....._.._,.°__°_._.__. M. ......____... _....
. ......... ........ _...._._.._..
_........ ._.__..
Name Area of Responsibility
1
Address Registration Number
Signature Telephone _ Expiration
lion Date
9.3 General Contractor
0�?_✓1 ✓M ... ......,_. ._ _ _..._.. _._.____ _....,, Not Applicable ❑
Company Name:
Responsible In Charge of Construction
Address-411 kw w YJ L 61 A,�,
Signature Telephone
Versionl.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning .
This column to filled in by
Building Department
Lot Size
Frontage
Setbacks Front ____...
Side L._... R.1..___•-j L::_._. _._3 R:.
Rear
Building Height i
Bldg. Square Footage . '"' %
Open Space Footage _ % --
- - (Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location) ....,_.._... ._._ .__ ._ _,
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW ` YES 0
IF,YES, date issued:
IF YES: Was the permit recorded at the Re istry of Deeds?
NO 0 DONT KNOW YES
IF YES: enter Book Page, Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW C YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:_
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location: Q�c�1t) / �1�h5 btirt
D. Are there any proposed changes to or additions of signs intended for the property? YES NO
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 0 NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Version 1.7 Commercial Building Permit May 15,2000
CUBIC
SECTION CES FOR PROJECTS LESS THAN 35,000
FEET OF ENCLOSED SPACE . 6fU4,
Interior Alterations ❑ Existing Wall Signs ❑ Demolition ed Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign d New Signs❑ Roofing❑ Change of Use❑ Other❑
Brief Description 'Enter a brief description here.;if
Of Proposed Work:
fi,AAA S
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
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 ❑ 213 » I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H-Hi h Hazard ❑ - _ --- 3A ❑
Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 58 ❑
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
IJo�;L q.
/ 1 St € �._
1St
2ntl _-._.. 2nd
d ....._. _ _...... 3rd
th4 h _.. _ .»_.__.... w.. _. ._ __ ». 4
Total Area(sf) Total Proposed New Construction s
Total Height(ft) F}
Total Height ft
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone _,_,.," Outside Flood Zone E-] Municipal ❑ On site disposal system E]
Versionl.7 Commercial Building.Permit May 15,2000
Departme:'t use,only
Ci' f Northampton status of Perrtt�t
�• B i g Department Curb Guf/Driveway Petrtw
ain Street Sewer/SepttcAuat(abrlrty
ape m 100 WaterMlell AVattabiltt
& mpton, MA 01060 Two Sets of"S#ruetu�a[""Plans
3-587-1240 Fax 413-587-1272 Plot/Ste Plans
wc�`��o`� Other Specify
APPLICA0111rTO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 SITE INFORMATION
1.1 Property Address:
This section to be completed by office.
Map Lot Unit
Zone Overlay District
—"-- 'Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
r rU Tc
Name Print Current Mailing Address: It
Signaturelk Telephone
2.2 Authoriz d Agent:
Name(Print) Current Mailing Address
Signature Telephone
SECTION 3-'ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use:Only
completed bv Permit applicant
1. Building / (a)Building Permit.Fee
I
2. Electrical (b)Estimated Total:Cost of
Construction from- 6' _.,_..w. ._.._., ._..
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) _... _......, _ z .. _.
5. Fire Protection
OK
6. Total=0 +2+3+4+5) Check Number
This.Sectioh For:OfficI6I Use Onl
Building Permit Number Date
Issued
Signature:
Building Commissioner/lnspector.of Buildings Date
1v
File#BP-2015-0135
APPLICANT/CONTACT PERSON AARON PUNSKA
ADDRESS/PHONE 111 KINGS HIGHWAY WESTHAMPTON (413)626-6033 Q
PROPERTY LOCATION 1 PEARL ST
MAP 32C PARCEL 052 001 ZONE CB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out godv add
Fee Paid
Typeof Construction:_REPLACE EXTERIOR GLASS PANELS
New Construction
Non Structural interior renovations
Addition to Existing
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:
—IeKpproved 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
Demo ' 'o Delay
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.
I PEARL ST BP-2015-0135
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C-052 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit# BP-2015-0135
Project# JS-2015-000113
Est.Cost: $1600.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use GroM. AARON PUNSKA 105542
Lot Size(sq ft.): 11194.92 Owner: MATTHEW GIBBS
Zoning: CB(100)/ Applicant: AARON PUNSKA
AT. 1 PEARL ST
Applicant Address: Phone: Insurance:
111 KINGS HIGHWAY (413) 626-6033 O
WESTHAMPTONMA01027 ISSUED ON:812712014 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPLACE EXTERIOR GLASS PANELS
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 8/27/2014 0:00:00 $55.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner