39A-052 (2) BP-2023-1529
86 LYMAN RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
39A-052-001 CITY OF NORTHAMPTON
Permit: Demo
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2023-1529 PERMISSION IS HEREBY GRANTED TO:
Project# DEMO GARAGE 2023 Contractor: License:
J BURNISKE LANDSCAPING &
Est. Cost: 3500 EXCAVATION 105935
Const.Class: Exp.Date: 03/31/2024
Use Group: Owner: L ARNOLD KENNETH D&WENDY
Lot Size (sq.ft.)
Zoning: SC/URB Applicant: J BURNISKE LANDSCAPING &EXCAVATION
Applicant Address Phone: Insurance:
5 MATHEWS RD (413)378-8868 WC2-33S-B20B62-013
SOUTH DEERFIELD, MA 01373
ISSUED ON: 01/11/2024
TO PERFORM THE FOLLOWING WORK:
DEMO GARAGE
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.
1491
Signature:
Fees Paid: $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
2 K
File #BP-2023-1529 V" q
APPLICANT/CONTACT
C PERSON:J BURNISKE LANDSCAPING &EXCAVATION
5 MATHEWS RD SOUTH DEERFIELD, MA 01373 (413)378-8868
PROPERTY LOCATION 86 LYMAN RD
MAP:LOT 39A-052-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $50.00
Type of Construction: DEMO GARAGE
New Construction
Non Structural Renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans/Plot Plan
Driveway Grade%
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 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
7� Demolition Delay
I �
Si!' :ture 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.
RECEIVED
_ E_
PPT 0713U1TLD2ING7:NS°2P:CTI.
• The Commonwealth of Mass ch
Office of Public Safety and Inspe tionR Nom. oNs •
HAMP
Massachusetts State Building Code(7' v TON.MA 01060
Building Permit Application for any Building other than a One-or Two-Family Dwelling
(This Section For Official Use Only)
Building Permit Numbers 15 -9 Date Applied: Building Official:
SECTION 1:LOCATION
1.4 Al A 60 51— /V01-7?-07P727WW
No.and Street City/Town Zip Code Name of Building(if applicable)
Assessors Map# Block#and/or Lot #
SECTION 2:PROPOSED WORK
Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below
Existing Building 0 Repair 0 Alteration 0 Addition 0 Demolition gi•frlease fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy E3 Other El Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No 0
Is an Independent Structural Engineering Peer Review required? Yes 0 No 0
Brief Description of Proposed Work:
Cenc_CL__1770W
•
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0
Existing Use Group(s): Proposed Use Group(s):_
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 El B: Business 0 E: Educational 0
F: Factory F:i.0 F2 0 H: High Hazard 1-1-1 0 11-2 0 11-3 0 1.1-4 El f1-5 0
I: Institutional 1-1 0 1-2 0 1-3 0 1-4 01—M: Mercantile CI R: Residential R-IQ R-2 0 R-3 0 R-4 0
S: Storage S-1 0 S-2 0 U: Utility 0 Special Use 0 and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA 0 IBCI IIAD 11B 0 HIA 0 111B 0 IV 0 VA 0 VB 13
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: . Debris Removal:
Public 0 Check if outside Flood Zone 0 Indicate municipal 0 A trench will not be Licensed Disposal Site 0
required or trench or specify:
Private 0 or indentify Zone: or on site system 0
permit is enclosed 0
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Rt-view Proces:s:
Not Applicable Cl Is Structure within airport approach area? Is their review completed?
OT Consent to'Build ervriosed CI Ne%0 orNoCI Yes 0 No 0
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY —
Edition of Code: Use Group(s): Type of Construction:
Does the building contain an Sprinkler System?: Special Stipulations: _ _
Design Occupant Load per Floor and Assembly space:
__..........____________
•
SECTION 9: PROPERTY OWNER AUTHORIZATION
N •.anJ Ad ress of Property Owner
/ ,...pial. 46'y i_viiii4g ST plo I-7 frti if ofFDA) ii)A
---
Name(Print)' No.and Strcvt City/Town Lip
Property Owner Contact Information:
tti 5-9, :.
faiL
-
Title Telephone No.(business) Telephone No. (cell) e-mail address
lf applicable,the property owner hereby authorizes:
Name Street Address City/Town State Zip
to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL fllease fill out Appendix 1)
If a building is less than 35,000 cu.ft of enclosed space and/or not under Construction Control then check here 0.
Otherwise provide constrursiop control form...(see section 107 in the code)as required.
10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals)
- -
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date •
10.2 General Contractor
J g-6 -0/5,e 5 ki„ I_ S cliA0-1-)c) 3
Cog,'pang Nam
fj-V/M) Ail Ai if/0)7)3 tiii3)6?6151111 CS 10 561)
Name of Person Responsible for Construction License No. and Type if Applicable
5 fr4.4:714EL,6 44 S 7DA-0 ytt A 01575
Street Address City/Town State Zip
- _ i fire jib DieVatift. , eenvt.•
Telephone No.(business) Telephone No.(cell) e-mail address
SECTION 11:WpRKERS'CONVEN5Ark.,- • IrAYIT(M.G.L.c.152.§25C(6))
A Workers'Compensation insurance Affidavit from the MA Department of Industrial Accidents must be completed and
submitted with this application. Failure to provide this affidavit will result in the denial of the'p‘uance of the building permit.
Is a signed Affidavit submitted with this application? Yes vr No 0
--
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
-
Estimated Costs:(Labor
Item
and Materials) Total Construction Cost(from Item 6)=$
..,
1.Building $
— , — Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ appropriate municipal factor)=$ .
3.Plumbing S u.,_,30
4.Mechanical (HVAC) $ Note:Minimum fee=$:JUL (contact municipality)
5.Mechanical (Other) $
Enclose check payable to
6.Total Cost $ 600'c4 (contact municipality)and write check number here 14179
IL
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
_
By entering my name below,Thetehy attest der the pains and penalties of perjury that all of the information- -rcC-intained in this
application is true and accurate to the best in, knowledge and understanding.
owner LIGRa_..._.12)p) 3
Please print and sign nanae s Title Te170,oinel\lo. Date
.5nl,irt)1/2pos yz.d , D Fa #.7.4- 0)313 €1 )116-P4S-'1d.511-2..6
t-r
Street Address City/Town State Zip Email Address
. i P 1 Il ;11
Municipal Inspector to fill out this section upon application approval: - 4
L Name ate
ASBESTOS REMOVAL
All residential, commercial and institutional buildings are subject to Massachusetts Department of
Environmental Protection (MassDEP) asbestos regulations at 310 CMR 7.15. Therefore, owners
and/or operators (e.g. building owners, renovation and demolition contractors, plumbing and
heating contractors, flooring contractors, etc.) need to determine al asbestos containing materials
(AGMs), both friable and non-friable, that are present at the site, and whether or not those
materials will be impacted by the proposed work, prior to conducting any renovation or
demolition activity.
Examples of commonly found ACMs include, but are not limited to, heating system insulation,
floor tile and vinyl sheet flooring, mastics, wallboard,joint compound, decorative plasters, window
glazing, asbestos containing siding and roofing materials and fireproofing materials.
Failure to identify and remove all ACMs prior to its being impacted by renovation or demolition
activities, can result in significant penalty exposure, and higher clean-up, decontamination,
disposal and monitoring costs.
A DOS certified asbestos consultant must be contracted to determine if asbestos is present and
whether removal/repair is necessary. If the building is a state owned facility. contact DCAM and
DOS. DOS provides a list of licensed asbestos abatement contractors and consultants. You may
wish to inquire if a contractor has any history of violations. Only DoS licensed and DOS certified
asbestos abatement contractors and consultants may be hired to perform asbestos related work
in Massachusetts.
Received by: J efft
Pr' t Name Title
P-1.0 to/i7/1,
Sig a re Date
City of Northampton
f�' Massachusetts
. 1. %,),,ft
DEPARTMENT OF BUILDING INSPECTIONS
�'.� 212 Main Street-• Municipal Building
_..;+' Northampton, MA 01060
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, 554, 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: N o 'mein, r r,LL L'/ +l ( C y t- ii N ty
The debris will be transported by:
Name of Hauler: j (L 6 J) / 5 /
Signature of Applicant: 6.0
Date: l0) 11 ) .
4s'‘
.'ii,...;., The Commonwealth of ifitSSOChtl8eftS
Department of Industrial Accidents
I Congress Street,Suite 100
&Aron. ti,4 02114-20I-
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I do herebi tiertifyunder the pains and 1 Ihnlaitiet of pernin that the information provided tilso .e is nor and,orreir
SlInaturs:- Ct'
ti1/4'1"0 1).i'i..
413 31)1
. Official ate only. Do not write in this area.to be 4.ompleted by t lit or town official ls
4 14t or loon: Per snit I.icenae a
loosing Autborit (circle line): I
I.Board to(Ileakb 2, Bisikling Department 3.t'it,4•'I on n t lerli 4.Lleri err al Inapector 5.Plumbing Inspector
, 6.(biter
Contact Permit: Phone a:
1IS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLUttt. I n
TIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORCED BY THE POUCH
SLOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S). AUTHORIZI
=PRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IPORTANT. If the certificate holder is an ADDITIONAL INSURED. the policy(iesl must have ADDITIONAL INSURED provisions or be endorse
SUBROGATION IS WAIVED. subject to the terms and conditions of the policy. certain policies may require an endorsement. A statement
ns certificate does not confer rights to the certificate holder in lieu of such endorsement(s(.
CONTAC`
OUC£R TAME
ATRICK M SHIPPEE PkoNE ,
BA MIRICK INSURANCE AGENCY 3'
8 BRIDGE STREET ADDRESS
,HELBURNE FALLS. MA 01370 itySURER=S AFFORDING COVERAGE NAIG
tNS:SRER A L.pert)" Qt.gta Fere Ir`s ra.nce
JR ED < INSURER 8
BURNISKE LANDSCAPING & EXCAVATION LLC t�SURERB
)BA JRB DISPOSAL I
, MATTHEWS ROAD INSURER D
;OUTH DEERFIELD MA 01373 I INSURER E
INSURER F
)VERAGES CERTIFICATE NUMBER: -.: REVISION NUMBER:
ADDL.sixtR POLICY EfF POLICY EXP LIMITS
TYPE OF INSURANCE yN POLICY NUMBER MU 00 YVY'Y. =T,ANI OD-YYYTI
COMMERCIAL GENERAL LIABILITY
AUTOMOBILE LIABILITY
•
UMBRELLA LIA$
EXCESS Luxe ---
WORKERS COMPENSATION WC2.33S•B2 B62.013 5 28 023 5 28 2024
AND EMPLOYERS LIABILITY Y N ,(
YN r A 10�t0,l4`V J0yy�:"^0
Mandatory,(!NH « Lv
ESC RIP TION Of OPERATIONS LOCATIONS VEHICLES ,ACORO 101 Add4eonal Remark Schedule may be attached rt more Yoace es fritU red/
WORKERS COMPENSATION INSURANCE COVERAGE APPLIES ONLY TO THE WORKERS COMPENSATION LAWS CIF THE STATE OF?,tA.
This Cemficafe Cancels and superseoes Atli orev:ou's[y€SSutdd Ceti€`cates only the.,, re:ate to workers CL1tttPe"`allOn coverage
PHYSICAL ADDRESS
VA7 AMHERST GROVE THE SOCIAL AMHERST ATTN MELANIE LUTZ 279 AMHERST ROAD SUNDERLAND MA 01375
:ERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Bt
THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERI
ACCORDANCE WITH THE POLICY PROVISIONS
AUTHORIZED RE PRE SENTAT'VE
City of Northampton
Massachusetts
1*.,1
DEPARTMENT OF BUILDING INSPECTIONS '
- 212 Main Street_ • Municipal Building
Northampton, MA 01060
APPLICATION FOR DEMOLITION PERMIT
Attached are the forms required for a Demolition permit. Please tilt out all theattachedj forms
and submit them to the Building Department with the appropriate fee. Please make checks out to
the City of Northampton. (Cash not accepted)
Please be advised that disconnect signatures from the following departments must be submitted
with the application•
1. Eversource (Gas division)
2. National Grid (Electric division)
3. Northampton Department of Public Works - Water
4. Northampton Department of Public Works — Sewer
5. Northampton Department of Public Works — Storm water Management
6. Northampton Department of Public Works —Tree Warden
7. Northampton Historical Commission Review (if built prior to 1945)
Proof of extermination is required to be submitted to the Health Department for all Commercial
demolitions and all abandoned residential properties. (Extermination may be required at the
Health Inspector's discretion if evidence of rodents exists).
Other required documents:
• Massachusetts Construction Supervisors License
• Copy of Workers Comp Affidavit
• Asbestos abatement report
A Demolition Permit will not be issued, and no demolition is to commence until ALL required
documents are submitted to the Building Department.
For further questions or information, please contact this department (413) 587-1240
BUILDING DEPARTMENT
DEMOLITION PERMIT SIGN-OFF SHEET
Date:
Address: Building Use:
Owner: Phone:
Owner's Address:
UTILITY CUT OFF
(Signature of Authorized Representative of Utility Department required)
As required by the Massachusetts State Building Code (780 CMR), a permit to demolish shall not
be issued until a release from the utilities is obtained, stating that their respective service
connections and appurtenant equipment have been removed or sealed and plugged in a safe
manner.
Eversource(Gas)
Signature Title
National Grid (Electric)
Signature Title
DPW(Water)
Signature Title
DPW (Sewer)
Signature Title
DPW (Storm water)
Signature Title
DPW (Tree Warden)
Signature Title
DPW Director
Signature Title
Historic Comm. Review
Signature Title
Health Department
Signature Title
De-TXrit:d Ni
..aMoro CITY of NORTHAMPTON
r.:07,��,�s PUBLIC HEALTH DEPARTMENT
��i !'sir' Public Health Director-- Me+ridith O'Leart, RS
'7�J Cart r Municipal Building-212 Main Street --Northampton.MA 01060
�`�`� +y Phone(413)587-1214-Fax(413)587 1221 Public_JHealth
hiip:-:hwrnr.northamptonma got,-245r1eahh Prevent Promote.Protect
WITNESS OF EXTERMINATION
Date 101 i 9 I -3 Time .e-hUQQ 9` /O Q
Property Owner: &1 CL 1 r)i-nip'Cc f 1 I t h O l c
Property Address: SS LOyM 0-r1 c t l�`c \C vo'r) kA d\(XQt
Exterminator: J c cL )QI3Q: Q 0u\-\--
Company: M %(-N L- -kt.Mar1 —P2 S �.-CNl),CI- b \ Co, t\f C.
Company Address: go e Dc\L slc- su.*C \(Dz., 1�Of- CL MA 010(00
Rodenticide/Chemicals Applied l (1aQ B/c)(-
Reason for Extermination: Pl(e- - Qte-rn0 / i�h b n 3CJt a3t-e.
Comments: I lrl ad-a.I I P d 2 p ro4-e c+Q. L P b a-k S --1`l o n S
I r S 1 . ,. CCU' 3co, 9 t - ck t to 0
F! ClTYO!!ORT!MPTON
i . .`t t. PUBLIC HEALTH DEPARTMENT
'al ; •, puhLr Health Director-Merrrdah 0Teat7.KS
yam, Municipal Building—712 Main Street—Nurihampum.M1 01060
phone 14131 587-1:14—Fax/413i 58'-1221 Public Health
http:i 4eHw.norihamptunma gov,'?45,11ealdr r,,,,,,,
Proxa,t.Pro,ea.
WITNESS OF EXTERMINATION
Date 11.4M) ---
Time 441
Property Omer: hl t 11 k-Pjy) it ✓j p l v
)k
Property Address: lb n U Cx t4 10 0 trkl. /v 4: `"'0`'lv1 r.(-17--Vs
Exterminator: JA4. D{Otil(A)Jr 1
Company: WI i to IC-t Mho tr t 7\..( Thy,t
Company Address: 616 (,6,, 2 4t 5v 1 10- Net , f
Rodenticide'Chemicals Applied i/10.' 6t67\
Reason for Extermination: �( e'— I�e It(6 \t fin, c-A-✓� )e µ
Comments: I s t' g.llt.a ) p li.c.A i p ( ant k 5 L��t� (�/ , t
,,,.1
usi
5,.A.,r61 ( `r._•f t_-- i(14_6t40 -.- _ . . . ..,. ..
•
I hereby certify, under the pains and penalties of perjury,that Ito the best of my knowledge
and belief,have applied the above noted pesticide in accordance with M.G.L.Chapter 132B
and any other applicable law or regulation.
P .
y Water ❑Well ❑Septic System
( _
If applicable ❑Y s. ❑No \ I /
1 iAW Pi [I 1(1g1vD
Board of Heal t Representative Si na f erminator •
E
*Demolition best practices relating to fugitive dust and debris must be adhered to in accordance
with MGL Chapter 111, Section 122.
i SERVICE SLIP / INVOICE
murytgN •integrated Peat anagement
INUTEMAN •Problem Wlldl/f Removal �7111
.. EST CONTROL
S.
i r:rl,' .0 Conz StreetLAD ,, i , ',"..�"'.: . A. 's -
orthampton,MA 01060
13-586-1009 800-586-1009 Providing a personal int grated approach to pest management since 1976"
w.minutemanpest.com
Work
Bill To: Location: /
/V Xiy..""4 A tom, /
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/jay >1 A,-t,P t,c A/4
WORK DATE TIME TARGET PEST ROUTE NO. TECHNICIAN TIME IN
PURL IASE ORDER TERMS LAST SERVICE MAP CODE CERTIFICATION TIME OUT
SERVICE DESCRIPTION PRICE
� u r o c 4 r (6-,-`i-a-c— — l (ati ,2'a4-114--C, 4, 90
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•
today a Pest Vanagement Professional from Minuteman Pest Control serviced your property.To maximize our service and reduce
:onducive pe conditions, the following problems were noted.Your attention to these areas would be greatly appreciated.Please
:ontact our office if you should have further questions.Thank you.
!.:-`r m-- : EXTERIOR
3 Screen open does and,vm0oves 0 Walt/floor function must be sealed ❑V:.:tauon(Tree branches,shrubs,plants) 0 Damage I-
s Clean up act ttne'bons of grease,waste and moisture. ❑ .wdust 0 Soil(very high against property)
Drams must be Qaan and free fWwrng ❑Repair notes.cracks and loose tiles. ❑ .isture problems ❑ Pets
3 coae garbage c*Inners. ❑Door sweep required 0 Other 0 C•reenter bees/damage 0 Other
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.-v acres z pay t'a�t of sMM oss ae specified arrove
DATE , PEST EMENT PROFESSIONAL L1C•
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