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31A-236 (3) 35 KENSINGTON AVE BP-2016-1396 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 3I A-236 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-2016-1396 Project JS-2016-002408 Est. Cost: $32500.00 Fee: $211.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: AARON PUNSKA 105542 Lot Size(so. e.): 4965.84 Owner. REMSEN PENNY L Zoning:URB(100)/ Applicant: AARON PUNSKA AT: 35 KENSINGTON AVE Applicant Address: Phone: Insurance: 111 KINGS HIGHWAY (413) 626-6033 () W ESTHAM PTO N MA01027 ISSUED ON:5/27/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:CONVERT 1ST FLR PARTIAL PORCH TO BATHROOM 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: FeeTvpe: Date Paid: Amount: Building 5/27/2016 0:00:00 $211.00 212 Main Street, Phone(413)587-1240, Fax:(413)557-1272 Louis Hasbrouck—Building Commissioner (jig File#BP-2016-1396 tart( APPLICANT/CONTACT PERSON AARON PUNSKA tia ADDRESS/PHONE III KINGS HIGHWAY WESTHAMPTON01027(413)626-6033 () r I�''j 1 " PROPERTY LOCATION 35 KENSINGTON AVE MAP 3 IA PARCEL 236 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT /// n - �// Fee Paid !.L Building Permit Filled out Fee Paid Tymeof Construction: CONVERT 1ST FLR PARTIAL PORCH TO BATHROOM 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 INB6RMATION PRESENTED: I' 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 Demol'tion Delay ..-ee — 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. _ r�Tfi' Bt t DepaCmen(use.p fly ' City of Northampton Maros'nf-P�rmti aa. M 2.5 2016 Building Department Curb' iivDfive iggerrnl6• n a= � � j, 212 Main Street SewerlsoriaA inensii.taliaJ FM1 �� w="' ` Room 100teMg.l[avatlabllltyF is * :i pER M W rp'pt"• .rthampton, MA 0"1060 Thi i•4444 se .0., r.uc}ufal PY_asz r.. .aqi g-, phone 413-587-1240 Fax 413-587-1272 Plpf/slfe Plensx i -"}�' - Other_Specl56 r" ..._e y>,, 114t ill APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION + 1.1 Property Address: This sectmn-£o bec'ampleied by office -- 4 X€4541 /0n Ac //�� nn ,/� a a, mss. - Lott' 11.1 ICmt Wt.,,A Nn ✓Vts 0/0 L-7 Zbne ar Ov"ewrlaytDsfrcFr 1 _ =E�7 r str cf .. _ .`-CByp s[ c1";- k' SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 1 E. . lCalhkeh (Jf/15 3s- kirism9Aa '°e- Name(P.�� Curent Mailing Addres ////JJ I 113 991 719/ (t'/3 it ezYo ' - 7 Telephone Sig A2uthorized A•ent: _.4 k-dsl P4sA.4- /1/ furl() # - weifi im It Cron Name(Pent) Current Mailing dress: %3 616 - (4)3} Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS. i1. Estimated Cost(Dollars)to be I - Of tial Use Only completed by permit aoolicant - uilding 2c o o.,� '(a) Building Permit Feb - - i leCrical �G' _(b)Estimated Total Cost cf Construction from(5) 3. Plumbing So J Building Permit Fee 4. Mechanical(HVAC) 1 \' 5.Fire Protection / v,Q/ 6. Total=(1 +2+3+4+5) t Z 'lo :J Check Number //‘ '/ I This Section For Official Use Only 7 Dale Building PerrnitNumber. - Issued: Signature: - - - Building Commissioner/Inspector of Buildings Date r 'r" Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Infgrmation Existing Proposed Required by Zonipg '442 Building T'is cob=to be 51 d in by Building Departmen* Lot Size l I `; Frontage 1 Setbacks Front Side L.' ; R:I I LIZ =7; I �1�, r ` EI Rear Building Height I I F-- E Bldg.Square Footage ( i % j - 1,, 1 ; - Open Space Footage � % --� (Lot areaminus bldg&paved parking) 4 of Parking Spaces Fill: —„ (volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0' in DON'T KNOW YES 0 IF YES, date issued: IF YES: Was permit recorded at theRegistry of Deeds? NO DONT KNOW YES 0 I Page; I and/or Document#1 IF YES: enter Book ; g I / { /�( Q YES 0 B. Does the site contain a brook, body of water or wetlands? NO o DONT KNOW ., IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained let Obtained 01 Issued: 1 C. Do any signs exist on the property? YES NO C 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 IF YES, describe size, type and Location: 1 E. Will the construction activity disturb(clearing,grading, exc ation, grilling)over I acre or is it part of a common plan r that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition Q Replacement Windows Aiterationfs) J Roofing n Or Doors Eli Accessory Bldg. D Demolition n "r uew Signs (MI Decks trz Siding EC]) Other IP] 1 7,otAcp�� rxT........_ _......_ir o—n Brief Description of Proposed pi f t' -`' Work: /tfks fort of €4/3A feeble Irh A beir<wvn-n / / ' t7o:— Alteration of existing bedroom Yes No Adding new bedroom Yes No / Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ¢a, If:New-house-and or'2dditidn f'o existfnq-Fotfsinq, cprnpfete the}bllowinct 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 atstories? I Method at heating? _ Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. —Massoheck 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 Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR-CONTRACTOR APPLIES POR BUILDING PERMIT ff I, LJn ilen]Sf✓1 / /r.1/i/eerf /•ilrn S ,as Owner of the subject property pp hereby auth. /✓0514-00 to sat .ehelf,I -. ers relative to war, -ethos-iced by this building permit application. onIre / //lath/� /5_ 7.1 . Signet y'of• er Gate ,t ryq 1, /ix ei4 A SGS , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing appiicatian are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. � rrnG great/ _ Print Name -I —. icy.. /S /we _ I Signature of Owns pent Date SECTION 8.CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable E Name of License Holder: ._ L5— Ier 12 License Number ! to 17 %/k- lr- .. __ z ff �U'C Address I 1 Expiration Date Ea et33 Signature4000r Telephone BeRevistered Horneimprovergent Cnrirator. = Not Applicable f /fyvcn RnsA✓t l+ssif-whi t/ ir-" 112-992.Company Name / U - Registration Number Jll knS; itt - 16 Address� I // iA^ Expiration Date WC6Y knit 1'h Dea Telephone Lit —c a33 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M,G.L.e.152,§25C(S)) 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 E 21 CHame 6wucr total port The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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 1883.5.2. 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/Cr farm structures.A pers nu 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 sucb work performed under the building:permit As acting Construction Supervisor your presence on the job site will be required from time to tune,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 permit. 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 • - The Commonwealth of Massachusetts Department of Industrial Accidents a i [ Office of Investigations ----:e7�l �'. 600 Washington Street Boston,M4 02111 (4,"_..,,,e www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information r] /J Please Print Legibly Name (Business/Organization/Individual): /(yr.,vn loni il- _ Address: Iii 16iIty City/State/Zip: _ - L.� 6. / Dia 2-7 Phone #: 103 EZ/ - 4 e33 Are you an employer? Chec. the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction ployees (full and/or part-time).* _ have hired the sub-contractors 2. am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractor have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Buih'ing addition [No workers' coma. insurance comp. insurance.: required.] 5. ❑ We are-a corporation and its 10.0 Elect-icai 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. [No workers' 13.E Other comp. insurance required.] *Any applicant that checks box,t1 must also fill out the section below showing their workers'compensation policy information. tHo meowners who submit this affidavit indicating they arc doing all work and then hire outside contactors must submit a new affidavit indicating such. IContractors that check this box must attached an additional sheet showing the name of the sub-contactors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. Iam 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 line 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. Ido hereby cerhfy under the pains and penalties of perjury that the information provided, �+abbove is true and correct Sim /- ature: Date: v /f y 7.1q,du Phone#: AA3 —(Ii '6033 Official 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#: City of Northampton >. s Massachusetts $r� r ` I' ' `1 I�� �,' D£PARTPTcNT OF BUZLDPNG iNSPEC_T:MS 11 C 212 Main Street • Municipal °2 S 1'Nne `C.,- r Northampton, MA 01060ry % INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT I 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, understand the above. (Home owner/resident's signature requesting exemption) will call to schedule all required building inspections necessary for the building permit issued to me. )ate address of work location • I City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Aiadar-it 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: 3t horstob c. The debris will be transported by: L w The debris will be received by: b<%- Alt Building permit number: • Name of Permit Applicant — _thdy15 2a,4 i Date Signature of Permit Applicant te): , ei-i.- ,r` I 7 refer( ofwit-4;A() ,,{' t�o/rlei' . !� 1-,c- f, 'y tkj ';--7-!� Pi-elk � r Al- t Ire..... 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