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31B-228 (3) File#BP-2016-1393 APPLICANT/CONTACT PERSON AARON PUNSKA ADDRESS/PHONE I I1 KINGS HIGHWAY WESTHAMPTONOI027(413)626-6033 0 PROPERTY LOCATION 32 BEDFORD TER MAP 3IB PARCEL 228 001 ZONE EU(I00)/URC(I00V THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid /i6 9,1407) Building Permit Filled out Fee Paid Typeof Construction: REBUILD FRONT STEPS 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: rlinproved 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 Dela o of But ding Off. f 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. aI ILcc;V L4./ Department use only I City of Northampton Status of Permit MAY 5 ?n' i Building Department Curb Out/Driveway Permit 212 Main Street Sewer/Septic Availability DEPT ora �rva insoanoes Room 100 WaterNVell Availability nonrnnmroN,MA oIoeo 'lorthampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 PIat/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOV SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office 31 Mtj"t ? 'v. Map Lot Unit Alf y,_/� � AA 006L Zone Overlay District �V �LZ Elm Et.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ^` 4/ /i - Si p.c�i'0me 3 "&„,5.,fsl: Name(Print) In � Current Matting Adpreis: �� - ��8C- ✓� ' -- Telephone Y!5 Signature 2.2 Autho ' A ant:,'� u ''''•• ///'W� ' / �/ ,/� �yay i.M$/vs- 111 n//� 5 : " a WPt/h.�ae7n� Al�- Name(Print) Current Mailing Add ss VAS 614 —6a 33 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only corn rated b ermit a licant 1. Building -4 000 (a) Building Permit Fee 2. Electrical (b)Estimated Total Cast of Construction from (6) 3. Plumbing Building Permit Fee 4 Mechanical(HVAC) 9,rn 5.Fire Protection 0O,�.... ///r/ 6. Total=(1 +2+3+4+5) I So �' ,Check Number kUf This Section For Official Use Only Date Building Permit Number. • Issued' 51—Signature .....;: 0, aJ( J / 1 Building Commissioner/Inspector of Buildings Date 5.(1)0./Y1 5ka 0 0/ Section 4. ZONING AIL Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department' Lot Size Frontage Setbacks Front Side L: RI L1 R .. Rear _. .. Budding Height + - Bldg Square Footage Open Space Footage % (Lotareamnusbldg&paved • • —_ parking) • of Parking Spaces Fill: (volume&Locedon) A. Has a(EY' Permit/Variance/Finding ever been issued for/on the site? NO (E/ DONT KNOW Q YES Q IF YES, date issued:: IF YES: Was the�permit recorded at the Registry of Deeds? NO ' J DONT KNOW Q YES Q IF YES: enter Book Page and/or Document ft B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW (1) YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Q , Date Issued: C. Do any signs exist on the property? YES Q NO IF YES, describe size, type and Location D. Are there any proposed changes to or additions of signs intended for the property? YES Q 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. SECTION 6-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) L{ Roofing n Or Doors Q Accessory Bldg. ❑ Demolition ❑ New Signs [01 Decks [0 Siding[0] Other[0] Brief Description of Proposed /.. -(. Work'. 01��� wr 51/44 Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Sa. If New house and or addition to existing housing, complete the following: 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 ftof 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-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT � I. foii / 4/o( — p t - I e 4-4 ?ir(t I_L , as Owner of the subject property µd hereby authoriz- %coq tts K.N} to act on my bit If,in II m tters r I ie to work authorized by this building permit application. 2ffrLL y Z`j ZJ(6 Signature •t • AOw'et (QJ Date O I, /fb✓/u Y✓NSk-Mh , 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. /kink Rift MAN" Print Name / /1 i� Z f 17.44, Signature of Ow r •gent Date 0f SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable E Name of License Holder: goun,k, Ante cc la 5-t— License Number pl lets dz'/']/'� ide247 h bbVi b/v,] « Address V Expiration Date �`/ t} 6Z 33 Signature / Telephone 9. Registered Home Improvement Contractor Not Applicable E Arra. 'Lake" lnsi-u</z,, /� P: /7171 2-- CompanyName {f, Registration Number (i/ /6ys 41/4Y/ (4,� Address U o Expiration Dat Telephone 6z4, -(oh?3 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§250(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 Owner Exemption 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 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/sire 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 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 s The Cownnonweajth of Massachusetts • # om, Departnent©fIndustrialAccidents Office of Investigations I Ji 600 Washington Street ' '- gi‘ Boston, MA 02111 ''a -ss'- www.mass.gov/dia Workers' Compensation Insurance Affidavit: ThuiIdells/Contractors/Llectricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individuaal): wLL P✓N4h✓r Address: /1/ /ems>/ /may " a City/State/Zip: Wta fk � � -b14 Rime #: 4?6 "(63)Are you an employer? Check the a propriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I loyees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling These sub-contractors have ship and have no employees 8. ❑ Demolition working for me in any capacity. employees and have workers' comp. insurance.] 9. Building addition [No workers' comp. insurance required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions m self. [No workers' comp. right of exemption per MGL Yp 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.D 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. tContractors 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 foe 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 DLA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjuty that the information provided above is true and correct. Si_ attire: Date: 71 O/[o i Phone#: - 6a33 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 uar 45 T4 - t ) r Massachusetts t , 6 v L it DEPARTMENT OF BUILDIVG INSPECTIONS 5555,,,, 212 Main Street o Municipal Building J '. Northampton, MA 01060 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 Jbefore 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) _ I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location City of Northampton 212 Math 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: 3z. &.tin T rr The debris will be transported by: 4• (Ansi-0 The debris will be received by: Vel,- Building permit number: 0 Name of Permit Applicant gene k04- ( ?jZ/b Date Signa re of Permit Applicant Aaron Punska Construction&Painting Commissioner Hasbrouck Aug.6, 2016 Subject: Request for Waiver I request that you grant a modification to waive the requirement for control construction for the building of a set of stairs on the front of 32 Bedford Terr. 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.All work will be completed within the prescriptive requirements of 780 CMR.Thank you for your consideration. "Mass Amendments, sections 107.1 allows for an exclusion from control construction for this project" Respectfully, Aaron Punska Aaron Punska Construction & Painting 111 Kings Hwy, Westhampton Ma