38B-232 (2) 60 OLIVE ST BP-2016-1055
GIs#: COMMONWEALTH OF MASSACHUSETTS
MM Block: 38B-232 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-2016-1055
Project# JS-2016-001794
Est. Cost: $20500.00
Fee: $133.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: AARON PUNSKA 105542
Lot Size(sq. ft.): 24785.64 Owner: MCGOVERN KATHLEEN D
Zoning: URB(100) Applicant: AARON F UNSKA
AT. 60 OLIVE ST
Applicant Address: Phone: Insurance:
1 I I KINGS HIGHWAY (413) 626-6033 (�
WESTHAMPTONMA01027 ISSUED ON.•3/4/2010 0:00:00
TO PERFORM THE FOLLOWING WORKi.R ENOVATE BATHROOM/LAUNDRY ROOM
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 CITE' OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 3/4/2016 0:00:00 $133.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2016-1055
APPLICANT/CONTACT PERSON AARON PUNSKA
ADDRESS/PHONE 111 KINGS HIGHWAY WESTHAI PTON01027(413)626-6033 ()
PROPERTY LOCATION 60 OLIVE ST
MAP 38B PARCEL 232 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATIQN CHECKLIST
E14CLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: RENOVATE BATHROOM/LAUNDRY ROOM
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
INFOR ON 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
on elay
J —/ —AK
Sig ure of Bu ding Mfficiar 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.
r� Deparfineht,use o'nl ' ,tis h' i
I(h ]
City of Northampton Status ofPerrntt
fia Ul
hri , iF
Building Department Curb Cur/Drlye+ ay Petml#
212 Main StreetSewer/SeptieAualla�Ilrty ate
Room 100 /V e7tAvailablltty ' t
hampton, MA 01060 Twa,Se#`s~of 5tri�ctrrab Plats r- �f; P i'n.?J- it ,�t ��-`,�
phon413 587-1240 Fax 413-587-1272 Plof/Slfe Ptans a , ti > ''' 1jj Fi,;' a , r4
N°Sr TION TO/CO TRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE.IN A ION
1.1 Property Address:
This sect�orrta be completed by office
Eli
60 Orl✓e S' Ma ' Lot Uw n
Xlov-y��
_..__.._r. ..______..__:]•'_v.]-.'vr.:__ifi.jar__`X12,:_T__vL_i__�.=-lr:(_arv:v{:T=i'i''y_a'��:'::i r...vi r�''_?_-.� � :-.!.'�
I'1 /�T'+y r'�W Zoe 1 OyerlayDisfrict
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SECTION 2.=PROPERTY OWNERSH..IP/AUTHORIZED AGENT
2.1 Owner of Record:
KaAlecg 1% G,vlel-*l 60 011k sf-
Name(Print) Currenailing Address:
Telephone
Signat re
2.2 Authorized Agent:
/10 rv'j L A
Name(Print) Current Mailing A ress:
Signature Telephone
SECTION 3'-ESTIMATED CONSTRUCTION COSTS.
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building rC " (a).Building'Permit Fee
2. Electrical �^� (b) Estimated Total'Cost of
Construction'from'(6) '
3. Plumbing ,o Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) �. Check Number
This Section For OMCial`Use'Onl
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector`of Buildings: Date
. .
^
_
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
Tliis column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Rear L--J
Building Eeight
Bldg.Square Footage j
Open Space Footage %
(Lot area minus bldg&paved
#of Parking Spaces
(volume&Location)
A. Has a Special Permit/Va riance/Finding ever been issued forlonthe site?
v�� y~�
NO ��/ DONT KNOW �~� YES \=�
|FYES, date issued:
IF YES: Was the permit recorded atthe Registry ofDeeds? /
NO � 0 DONT KNOW YES
��
IF YES: enter Book Pageland/or Document#
�� \��
Cr �
B. Does the�tecontain a brook, body ofvvateror*edt�
wetlands? NO � DONT KNOW ��, YES �
IF YES, has permit been or need to be obtained from the Conservation Commission?
�~�
Needs to be obtained Obtained Date Issued:
t_/ '0 '
�� ��
C. Doany�gns e�stonthe proper� ��.� YES NO \=�
IF YES, describe size, typeandiocation:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO ��+~
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, gradingexcavation,orfilling)over 1acre urinitpart nfacommon plan
that will YES ���� NO [^7~
' '- /
IF YES,then a Northampton Storm Water Management Permit from the DPW is required. |
^ |
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SECTION 5-DESCRIPTION OF PROPOSED WORK'(check all applicable)
New House F7Addition ❑ Replacement Windows Alteration(s) Tofing ❑
Or Doors F
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[] Siding [0] Other[0]
Brief Description of Proposed
Work: &.07 wJ"'7 00l'JtN✓f. Ate►
Alteration of existing bedroom Yes k No Adding new bedroom Yes fk No
Attached Narrative Renovating unfinished basement Yes k No
Plans Attached Roll -Sheet
sa; If New.hOuse and:or.adtllttotrfo existlnq:hous>nq corn �ete._ffie.followincF:
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'-70 BE COMPLETED .WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR.BUILDING PERMIT
. /an Vynol as Owner of the subject
property /, D
hereby authorize
to act n my behalf, in all matters relative to work authorized by this building permit application.
ilk* Zq Z�
Signature of Owner > 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 perjury.
A+'m fv" s
Print Name
Signature of Ow Agent Date'
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable £ / y^7
Name of License Holder: 1U✓) �L417S{6il Cs — [0 � l Zs
License Number
N 1017-z-If
Address U Expiration Date
Signat Telephone
9.R�e e £
is�fered H:ome.lm rovemeit.Contractor _ Not Applicable
1`�;Crv�t op lcei �Q s A-vc h,- 7 Z°I Ll Z
Company Name Registration Number
(l/
'Y 11
Address Expiration Dale
/it �lhrs t`J''Y L✓Qd/�'b('�--- Telephone �� 1
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 Qwner Egempt><0
The current exemption for"homeowners"was extended to include Owner-occupied Dwellines 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 pen-nit.
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
The CommonwealtP of Massachusetts
Department of ln#strial Accidents
` , -- Office of Inv stigations
600 Washington Street
Boston, M�4 02111
4 "f www.massgov/dia
Workers' Compensation Insurance Affidavit: $uilders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): AAInA.1 fMSK&
Address:
s ffwy
City/State/Zip: ��' �1u A, OtOV-1 Phone#: ` r!� 67� _ 60 3 3
Are you an employer? Check hie appropriate box: Type of project(required):
1.❑ I am a employer with 4. EJ I am a general!contractor and I
employees (full and/or part-time).* have hired the sub-contractors
6. ❑New construction
2.k I am a sole proprietor or partner- listed on the attached sheet. 7. ®Remodeling
ship and have no employees These sub-contractors have g• Demolition
workingfor me in an capacity. employees and have workers'
Y P tY• 9. ❑Building addition
[No workers' comp, insurance comp. insurance.$
required.] 5. F� We are:a corporation and its 10.0 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 12.0 Roof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [Nd 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:
Policy#or Self-ins.Lic. #: 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 ofperjury that the,information provided ahove is true and correct.
Signature: Date: 5� 1,9 Zilty
Phone#• Y(3 6
Official use only. Do not write in this area, to he completed by cilty or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3. City/Town Clem 4.Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
Citi of Northampton. _
Massachusetts ;;' r{
1.��yy�l�nt�c7.
y r ; DEPARTMENT OF BUILDSNG X1VSPECTIO1V,S �t ,
�t
212 Main Street • Municipal Building � 4D�>
pX,�
Northampton, MA 01066 IyY �ti .
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows'the homeowner the right under 780CMR 108.3.4 to act as his/her
construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which
he/she resides or intends 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."
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
i
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
kddress of work location
I
i
12 Main Street Northampton, MA 01060
City of Northampton p ,
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: 40 011vy
The debris will be transported by: 9 "[� cayc✓✓1
The debris will be received by: V(4
Building permit number:
Name of Permit Applicant AWS bo
Date Sign-ature of Permit Applicant
,
G DAPTot S146 Lro
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618 depot street+manchester center SINCE 1940 385 cole avenue+williamstown
802 362 1952+toll free 888 447 5645 413 458 8121•toll free 800 670 7433
88 exchange street.middlebury rk MILES z i west street+west hat&eld
8023882721.toll free 800 564 2721 BUILDING MATERIALS SUPPLIER 41324.78300+toll free 866 446 582o
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