31A-236 (5) BP-2023-1580
35 KENSINGTON AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
31A-236-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2023-1580 PERMISSION IS HEREBY GRANTED TO:
Project# bath reno 2023 Contractor: License:
Est.Cost: 38000 AARON PUNSKA 105542
Const.Class: Exp.Date: 10/22/2025
Use Group: Owner: COLLINS REMSEN PENNY L&KATHLEEN
Lot Size (sq.ft.)
Zoning: URB Applicant: AARON PUNSKA
Applicant Address phone: Insurance:
220 NORTH WEST RD (413)626-6033 •
WESTHAMPTON, MA 01027
ISSUED ON: 11/09/2023
TO PERFORM THE FOLLOWING WORK:
BATH RENO
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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
Fees Paid: $247.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
1 Ei 1
. / .
NO% - 8 � .
2023
he 1 ommonwealth of Massachusetts
W. Bo; d o i Building Regulations and Standards FOR
. MUNICIPALITY
';,,aFFcr►;csssac setts State Building Code, 780 CMR USE
�6o
Building •e . ..li ation To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: SA- .1*3- /6 f 0 Date Applied:
4/0 a:I .> //4Z-- 11- 9-2oz3
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property,Addres • 1.2 Assessors Map& Parcel Numbers
, itS)til >1 Otte
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(II)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public C� Private❑ Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2. Owner'of Record:
4M l fl152v1 C Ku. (,� I� 4\5 v., Ln oNko
Name( nnt) City,State,ZIP I� h-
5 tt5N\Ib. 14 4(3 /9t•�1it/ litni(enctli nic61 Vkfllg (i th 5Watt 1YI_l 1
No.and Street Telephone Email Address I
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 11 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2:�' (ay�l, �ao( 0w (Qittl `a(I. — Pb.,t 190-11 fit b )1ULJ jlh 1C i
liked .
- ' -t — 14,561 huLt I- ozps - rt. i 1 l t rmv-V- -Iv iiTt �1.t eo15 ovn
_Wilt
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 31) 90 W 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ pv. 0 Standard City/Town Application Fee
0 Total Project Cost (Item 6)x multiplier x
3.Plumbing $ 1610. W 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
$ Total All Fees: $2 = }{
Suppression) � °1 D t, / 0
Check No. A heck Amount:
6.Total Project Cost: $
;B/Oi)U, 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
.0,17,T'r4r
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building94,
Northampton, MA 01060s"_ 11'
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS,ROOFS,RENOVATIONS,ROOF MOUNTED SOLAR,ETC.
1. Building Permit Application signed by legal owner and filled out
by owner or authorized agent.
2. One set of plans and specifications of proposed work(Digital and hard copy).
3. Construction Debris Affidavit filled out and signed by applicant.
4. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance.
6. Energy Conservation Compliance Certificate(new/replacement windows).
7. Home owner's License Exemption Form (if applicable).
A 8. Note any Special Permit requirements(if applicable).
s
9. Energy Code—all new construction(Gut/Rehab) requires a HERS Rater Affidavit
10. Please provide the appropriate fee in the form of a check made payable to: The City of
Northampton.
4.
4
• SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 41,CC-(A 1i.L ( u ZS
.6yv uOt II4 License Number Expirati n Date
Name of CSL Holder
IN )(� nList CSL Type(see below) tk
No.and Street Type Description
` 11 �• U Unrestricted(Buildings up to 35,000 Cu.ft.)
W��` W R Restricted 1&2 Family Dwelling
City/Town,St ,ZIP M Masonry •
RC Roofing Covering
WS Window and Siding
'1 t )()1)) �\u SF Solid Fuel Burning Appliances
U7 t )()1)) kootSti.0 gIwo •(,J'\ I Insulation
Telephone a Emaii1a ess D Demolition
5.2 Re rstere HItiome Improvement Contractor(HIC)
KSYlktHIC RZeg%i�tr tion Number Ex at on ate
HIC Company Name or HIC Registrant Name otil
VA *I IA Q IOW'
No.an tree Er ail address
City/Town, tate,ZIP Telephone
SECTION 6: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 Issuan of the building permit.
Signed Affidavit Attached? Yes No .0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize f\Offi\ (L \(4'
to act on my behalf,in all matters rela've to work authorized by this building permitpermit application.
ve4 1,141, 1 1 -
Print Owner' ( ctro r Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
containedin this plication is true and accurate to the best of my knowledge and understanding.
LA i)rt 6 MbJ. '1 7k?L
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms _ Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
-,...
4
The Commonwealth of Afassachusetts
PI
) Department of industrial.--lecidents
.. .....7.0.1 rw R / Congress Street,Suite 100
4.,SI Ithigir# Boston, MA 02114-2017
voinv.M US'S.goridio
xiiii,
1441.[-kers'Compensation Insurance AMdaiiit:Builders./ContrattorstElectriciansePlu[fibers.
11)BE FILED W1111 THE PERNIIIIING AtITHORITV,
Annlicant Inforniation Please Print Leailits
Name 4 tittsiness:Organ i zillion;t ndi victual i: AV/4/1 fiJ VI. t13.
Address: laa Ikiliki Et
City/State/Zip:VA- \t/v* I\ fiCk sat'Ll. Phone i4: kto it7A -igt.5.) _.... . .
fla-r yea au employer?I h,c1..ilit apprupriate boa: Ty pe of project(required):
I cJ>aa1.134:16•Yer with. _ _ e71101.1}1. (fail and-or part-tiirei.' 7. 0 CV4 construction
l, .trri a sok proprietin or itartnership und have 1113 employees v4 orking lin me in 8. Remodeling
1111i capacity.[Nu workers'comp,insurance required i
9. 0 Demolition
3.0 I am a horracownm doing all work myself frs'o%miss's"comp_31111.1=111:1:requires]]''
r.cm.oult-that all einitrarturs e
10 0 Building addition
id eh
II
a Electrical repairs or additions
;1111uprtetom with no employers.
11E1 Plumbing repairs or addititnis
Ica I...,a ip..c...,al contractor arid I have hired the sub-contra:tots.-listed on the attached sheet
I 3.0 Root repairs
Tbes42 sub-Lunn-ay:urn haw employees and have workers'enatp.insurance.:
I 4.0 Other tis%siblsfil (42.A9
6.0 iiVe arc a corporation arid its officers ha se eservised elven.ngle of cuing:Mort pet MU c.
151.§1f41.,and we bast no angloyees.[Nu workers'comp,insurance required.'
i.- .
*Any applicant that.isx.-Ls.has a 1 maxi AIM/till 4/1.1 111C t.A.Z10111%-111,1 AO%mg their workers'compensation puls..-y eriformatrint
*Homeowners who stalwart this affirlawt inalscating they Arc dsling all work and then here outside contractors most sutural a new affidas It indicating suk:h
Ituiltractors that check this Kr,:must att..s.iwil an additional sheet show My the mume of the sub-contractors and itili11 wilettior or not those entities lime
onplo)ces IX the sols-comr.1,[1,1,11.3,i,114.11.1ya:CI,1.11..:) must pit .' 11-1,-i wurkm ctnr 14:y 111.11Mber.
I am an employer that is providing work ' ttonVitatiklt ny.eirrphlyees.....khill,ils: obit und job sae
1tollk -
Information. - 0,
10
•
Insurance Company Name:
—
Policy#or Self-ins. Lic. #: Expiration Date:
Job Site Address: CityStatelZip:
Attach a copy of the norkers*compensation policy declaration page(shossing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation ptirnshable hy a fine up to S1.500.00 '
andior one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a line of up to S2.50.00 a
day against the violator. A copy of this statement may be forwarded to the Office of Investigation,of the DIA for insurance
•
, over..t.2,.. ,.c n 11,:atiOrl
I do hereby u'crrify under pains and penalties of perjury that the information prorideil above is Inre and cm-rect.
Signature: Date: IbsS 1 &Z.,
Phone s r: $ Lit, (4013
Official use oak Do not write in this area to be completed b) city or Iowa official
fCity or Ton n: PermltlLicense#
Issuing Authority (circle one):
' 1. Board of Health 2.Building Department 3.City/Tonn Clerk 4.Electrical Inspector 5. Plumbiiii: I ilspector
6.Other
Contact Person: Phone 4:
. ._......,
City of Northampton
MassachusettsA.
*
Jo
DEPARTMENT OF BUILDING INSPECTIONS t
W 212 Main Street • Municipal Building
Northampton, MA 01060ht
ss 1r�11
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of
in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
Location of Facility: uk �G1L1U\3
The debris will be transported by:
i C
Name of Hauler: fthot4-
Signature of Applicant: Date: ADJ 7 �3
City of Northampton
� ` Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 11
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (insert full legal name), born_(insert
month, day, year), hereby depose and state the following:
1. I am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the
Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or
work on a parcel of land to which I hold legal title.
2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'
exemption, does not involve the field erection of manufactured buildings constructed in accordance with
780 CMR 110.R3.
3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2:
Person(s) who owns 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 home owner.
4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I
qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of
the project or work on my parcel, I am not engaged in construction supervision in connection with any
project or work involving construction, reconstruction, alteration, repair, removal or demolition
involving any activity regulated by any provision of the Massachusetts State Building Code.
5. If I engage any other person or persons for hire in connection with the aforementioned project or work on
my parcel,I acknowledge that I am required to and will act as the supervisor for said project or work.
Signed under the pains and penalties of perjury on this day of ,20_.
(Signature)
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