31A-236 (4) 35 KENSINGTON AVE BP-2018-1093
GIs 4: COMMONWEALTH OF MASSACHUSETTS
MaRBloc :31A-236 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category:KITCHEN RENO BUILDING PERMIT
Permit# BP-2018-1093
Project JS-2018-001967
Est.Cost:$174800.00
Fee:$486.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: AARON PUNSKA 105542
Lot Size(sa. ft.): 4965.84 Owner., REMSEN PENNY L
zoning:URB(100)/ Applicant: AARON PUNSKA
AT. 35 KENSINGTON AVE
ApplicantAddress: Phone: Insurance:
111 KINGS HIGHWAY (413) 626-6033 Q
WESTHAMPTONMA01027 ISSUED ON.•4/25/2018 0:00:00
TO PERFORM THE FOLLOWING WORK.KITCHEN RENO/ EXTERIOR SIDING
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 ft 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:
FeeTvoe: Date Paid: Amount:
Building 4/25/2018 0:00:00 5486.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Filet:BP-2018-1093
APPLICANT/CONTACT PERSON AARON PUNSKA
ADDRESS/PHONE I I I KINGS HIGHWAY WESTHAMPTON (413)626-6033 O
PROPERTY LOCATION 35 KENSINGTON AVE
MAP 31A PARCEL 236 001 ZONE URBt100V
THIS SECTION FOR OFFICIAL USE ONLY
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid r
Building Permit Filled out lP
Fee Paid
Tvueof ConstructionKITCHEN RENOMX1ERRNrSIDrNG
New Construction
Non Strucmral interior renovations
Addition to Existing
Accessory Structure
Buildine 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 Variancex
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
emolition Delay
a[ureof emici Official Da�
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.
City of Northampton Status of Permit Department use only
Q-A
Building Department Curb CWDriveway Permit
212 Main Street Sewer/Septic AvailabilityRoom 100 WaterWell AvailabilityNorthampton, MA 01060 Two Sets of Stnxtural Plans
phone 413-587-1240 58� pg —r) Re Plans
-
-------- he Specify
APPLICATION TO CONSTRUCT,ALTER, RE AI TEAR EM LISH A ONE OR TWO FAMILY DWELLING
e'� NB
SECTION t -SITE INFORMATION _ /O� i (0q
1.1
VrC" ].:Z LG
7.7 Property Address:
""7'`*"' ^ ww�- hhis section to be completed by office
Int
°JS �iPrysh/_� A//t'„n Map 3R Lot 3� Unit
/E� C Zone Overlay District
Elm St.District LB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record://
f�E7t�'siiJf��.l:' Ir' ."iE c--
Name(Print) 1.14 ,) Cunent Mailing Atltlress'.
Teleph�
Signature / Z
2.2 Authorized Agent:
Ifaro Q✓�ska Lll kikr< d G✓ra� � �
Name(PdnQ Current Mailing ress:
� y/3 Bad - 6a33
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item EstimatedCost(Dollars)to be Official Use Only
co leteit b emit applicant
I. Building 2 arz) W (a)Building Pemit Fee
2. Electrical „� (b)Estimated Total Cost of
/�-6Construction from 6
3. Plumbing Building Pennit Fee Ply SteJ
4. Mechanical(HVAC) F/��� F/ ��/
5. Fire Protection r ! 6 I
fi. Total=(1 +2+3+q+5) 7`/� Check Number
This Section For Oficial Use Only
Building Permit Number. Date
Issued.
� _ p
Slgnat ��/
Builtl' Commissionerlllnnspeclor of Buildings Date
dA�Oin, @ �(A/'4 r ij 9eN1
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This colamu to be fined as by
Bufldine Depamnent
Let Size
Frontage
Setbacks Front
Side L: R: 1.: R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage ye
(I.atarea minus bldg&paved
parking)
dofParking Spaces
Fill: —
(,emm..&Loemiou)
A. Has aSigei;pid Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry If Deeds?
NO O DONT KNOW Q YES O
IF YES: enter Book Page and/or Document N
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES O
IF YES, has a permit been or need to be obl airnsd from the Conservation Commission?
Needs to be obtained O Obtainea O , Date Issued:
C. Do any signs exist on the property? YES I:) NO G)'-
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions or signs intended for the property? YES Q NO
IF YES, describe size, type and location:
E Wit the construction activity disturb(clearing, grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over I acre? YES NC C)�
IF YES.. then a Northampton Storm Water Manager ent Penn it from the DPW is required.
SECTION&DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing E:]Or Doors
Accessory Bltlg. ❑ Demolition ❑ New Signs (O] Decks [q Siding[ Other[C]
Brief Description of Proposed
Work /P /r,;"? lSyU r
h
Alteration of existing bedroom_Yes ✓ No Adding new bedroom Yes ✓ No
Attached Narrative Renovating unfinished basement _Yes ✓ No
Plans Attached Roll -Sheet
ea. If New house and or addition to existina 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?
J, 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-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, lYNl2b ,f'{ah?iliG7 as Owner of the subject
property
hereby authorize "k ✓'1?d�/�
to act on�behalf, l mtters relative to work authorized by this building permi ppli tion.O Da
I, All41N P14 , 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.
PnM Name
SignatureerlAgent Dale
R
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction So is Not Applicable ❑
Name of License Holder'. I IL4n� PU115 (5 10�� F
License Number
llt 1cw � D Aw t IO
Address Expiration Date t�
� ZG
Signator Telephone
9 Registered Home Improvement Contractor: Not Applicable ❑
Rv Pdh� , uv en — 112 �h Z
Company NameI Registration Number
u� 11 �� 1�eY f S�Z9 � �d
Address / Expiration Da e
Telephone. Z'b — J
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT (M.G.L.e.152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
io the denial of the issuance of the building permit. _
Signed Affidavit Attached Yes....... ❑ No...... ❑
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS s
212 Main Street • Municipal euiltling Ji b
\ North®pton, MA 01060 bp-.�.jlyJ
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes. Prior to
perforating work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L. Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing
at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered.
Type of Work: LN Jtv�x I Est. Cost � �uj
�—
i VII,
Address of Work: j5 llivlw\
Date of Permit Application: Yi�wJ (J
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law(explain):
_Job under$1,000.00
_Owner obtaining own permit(explain):
Building not owner-occupied
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM[OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed order the penalties ofperjttry:
I hereby apply for a building permit as theagent of the owner: 'J
." /?U II iY / -- `,1 ("N kt9 i// ?L / "!
Date Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
City of Northampton
.s
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal .0 Id ng
Northe pton, MA 01060 by t
Massachusetts Residential Building Code
Section 110.85.1.2
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 to o family dwelling, attached or detached
structures accessory to such use and/ or farm stru,;tures. A person who constructs more than one
home in a two-year period shall not be considcreca homeowner.
Section 110.R5.1.3.1
Any homeowner performing work for which a bu.Iding permit is required shall be exempt from
the licensing provisions of 780 CMR 110.R5, pro vided that if a homeowner engages a persons)
for hire to do such work, then such homeowner sl.all act as supervisor.
Such homeowner shall submit to the Building Oficial, 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 inju-ies 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.
0 City of Northampton
a
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street •Municipal Build-1
Northampton, . 01060
Debris 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.
The debris from construction work being performed at:
1�k
3� keu�
(Please print house number and st et name)
Is to be disposed of at:/`
iN
(Please print nam nd loca}ono acility)
Or will be disposed of in a dumpster onsite rented or leased from:
lueN f r01l o ff
(Company Name and Address)
Signature of Permit�7icant or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
Boston, MA 02II4-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit:General Businesses.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
q n 1
Business/Organization Name:
} A Eh'l I"✓v1' q �,n yd( - lli1'
Address: lit WAk5 ( alj
City/State/Zip: we,rL A, !c _ .'hone#:
Are you an employer?Check t to appropriate box: Business Type(required):
L❑ 1 am a employer with employees(full an& 5. ❑Retail
orpart-lime).* 6. ❑RestaurantHar/Eating Establishment
2. 1 am a sole proprietor or partnership and have no 7. ❑Office and/or Sales(incl. real estate,auto,etc.)
employees working for me in any capacity.
[No workers'comp.insurance required] 8. ❑Non-profit
3.❑ We are a corporation and its officers have exercised 9. ❑ Entertainment
their right of exemption per c. 152 dl(4),and we hate 10.0 Manufacturing
no employees. [No workers'comp. insurance required]*' 11.[]Health Care
4.❑ We are a non-profit organization,staffed by volunteers,
with no employees. [No workers'comp.insurance req.] 12.❑ Other
'My apph,.le d atcheek,box kl must ado fill..,the wetiou below showiag in rrworlers'emnichasicion policy information
""It the coryoate offeers have exempted themselves,but the corporation bu oda rcimloyee,o workers compensation policy is required and such an
organization should check box p1.
I am an employer that is providing workers'compensadon insurancefor my employees. Below is the policy information.
Insurance Company Name:
Insurer's Address:
City/State/Zip:
Policy:or Self-ins.Lic.# _ Expiration Date:
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 IAGI a 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well a.civ I penalties in the farm of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a cop t 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 above is true and correct
Signature: 4 Date
Pluneh': �3 624 --4h33 t
Official use only. Do not write in this area,to be completed be city or town official.
City or Town: Per mit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.CityrFown(lerk 4.Licensing Board 5.Selectmen's Office
6.Other
Contact Person: Phone#:
www.,re ,,cv der
s
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 bean 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 your insurance company's name,address and phone number along with a certificate of insurance.
Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members
or partners,are not required to carry workers' compensation insurance. If an LLC or ITT 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 pent iclicense number which will be used as a reference number.In addition,an applicant that
must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary). A copy ofthe affidavit that has been officially stamped or marked by the city or town
may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. 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
1 Congress Street
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax#617-727-7749
www.mass.gov/dia
Fmm Rcn.N 02-23-15