24D-317 (17) 149 ROUND HILL RD BP-2017-0618
GIS#: COMMONWEALTH OF MASSACHUSETTS
:B
Maplock:24D-317 CITY OF NORTHAMPTON
Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: window replaced BUILDING PERMIT
Pennit# BP-2017-0618
Project# JS-2017-001000
Est. Cost:$4000.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: AARON PUNSKA 105542
Lot Size(sq.ft.): Owner: BARBARA CYMROT
Zoning: URC(100)/ Applicant: AARON PUNSKA
AT: 149 ROUND HILL RD
Applicant Address: Phone: Insurance:
111 KINGS HIGHWAY (413) 626-6033 0
W ESTHAM PTO N MA01027 ISSUED ON:11/2/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE BATHROOM WINDOW, REPLACE
SIDING &WINDOW TRIM
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 if Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: O1: 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:
FeeType: Date Paid: Amount:
Building 11/2/2016 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0618
APPLICANT/CONTACT PERSON AARON PUNSKA
ADDRESS/PHONE III KINGS HIGHWAY WESTHAMPTON (413)626-6033 0
PROPERTY LOCATION 149 ROUND HILL RD
MAP 24D PARCEL 317 000 ZONE URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid I/O yds
Building Permit Filled out r`�U
Fee Paid
Tvoeof Construction: REPLACE BATHROOM WINDOW,REPLACE SIDING&WINDOW TRIM
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 F LLOW ING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF RMATION 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
Si: . re of Buil'ing • ictal 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.
.2410'- '5/7
_Depanment use only
City of Northampton Statusof Permrt' ; _
- -- -------Building Department Curti'Cuf/DrlveWay Permit
- -- -_! j 212 Main Street Sewer/SepticAvallebIlit¢
��II Room 100 WateRWellAvailabIlity
NOV — 'HAG Northampton, MA 01060 Two Sets of Structural Plans
phone f ll3-587-1240 Fax 413-587-1272 PIOUSIte Plans
r s Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
Map Lot Unit
I9 24mA (i) '
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
avb' va CliMrDf '1 441 , trSl- _ 1-&. . _ clot(
Name riot) Current Mailing Addres _ /
t, 1r (k13 if - 7753
0 2.'Ii , 1s-. Telephone )
ignature :--/nit OC 1141 1—® S�CG.(. Ittl
2.2 Authorized Agent: / yf l A
A AA]oN.f ��( �7 � r tth lLf Lwt OtRd
Name(Print) Current Mailing dress' /)
b7& 01)3
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building G�OD17 cu (a) Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection 1/ 6(06. Total=(1 +2+3+4+5) yU'JJ. w Check Number ,/30 /�
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
Section 4. ZONING Alt 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
Ii i
Frontage 1 __..__ I I ____II 1
Setbacks Front 1i LL I
Side L iR . _L� _IRI _. .]
Rear
- 1 L. 1
Building Height 1 i I — �
Bldg. Square Footage 1 I % 1 I
I
Open Space Footage _ %
( rt area nlmabwg&wyea r l
parking) _ �. .
#of Parking Spaces I -I I. - .I L ...
Fill
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 6 DON'T KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
g
IF YES: enter Book I Pae II, and/or Document U
B. Does the site contain a brook, body of water or wetlands? NO LJ DON'T KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Nees to
e oained
C. Do any signs exisbtton the propeOrty� YESObtained O NO , Dateued: i— _.
e
IF YES, describe size, type and location: 1
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO 07
IF YES, describe size, type and location. ,
E. Will the construction activity disturb (clearing, grading,exc anon or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) ,�, /
New House n Addition LI Replacement Windows Alteration(s) I - Roofing ❑
Or Doors 0 V /
Accessory Bldg. Demolition CI New Signs [O] Decks [q Siding[E Other[O]
Brief Description of P,,ropposed ) ` /
Work: aPtla� Maris, t✓ln i ✓I/6-.r 5/Ity wL IrOWt' hit.,
Alteration of existing bedroom Yes --No Adding new bedroom Yes ✓ No
Attached Narrative Renovating unfinished basement Yes ,/ No
Plans Attached Roll - Sheet
6a. 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 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, AAVbAvu t •
4i rip , as Owner of the subject
property ,At� {q/ 1�
hereby . thorize Ri-Rrot 'WI SrtA
to act m my beh.lf, in all alters relative to work authorized by this building permit application.
I
iii ignature of Owner Date
1, TN✓W'1 f(H.S t , 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 painsand penalties of perjury.
� m4vi
gig(k4
Print Name
Signature of 0 r/Ageir Date
•
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder'. IiA W✓1 �V h 4;1( CS t �—Y/i
License Number
Iii klkuJ 0 U{'�wy W e sfu.� -p ./f4, of z 7 /0%ZZ/ /7
Address Expiration Date
674 - (eo33
Signature )Telephone
/ rna, - ar,„ka,6 ?in aj[ Com
.9.Registered Home Improvement Contractor: Not Applicable ❑
p 34o $0
� �k 5�L cOnfl vcna, P4.kf„�
Company Name � Registration Number
/1/ k4O. fly Stiff %tc PL } Stn lv-G
Ad ress 3 Expiration Date /
7 }} A /ken
S . `('fS
ri Y hrobi-) Telephone b 26 -GO 3 3
ba w Jn Yhs 7
SECTION 10-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 issuance of the buildin permit.
Signed Affidavit Attached Yes C3' 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 acceltable 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 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 tie State Building Code,City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
City of Northampton 212 Main 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: 1 N'7 / u,t J Ail /d
The debris will be transported by: n Q -1 --
The debris will be received by: VcJ/t. ) ,c,
Building permit number:
Name of Permit Applicant Ake fcka
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
Department of Industrial Accidents
$— Office of Investigations
� � 1 Congress Street, Suite 100
Eta—=
' Boston, MA 02114-2017
�,: