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18-041 (2) City of Northampton ? 0 .0, - t � M ro S , S X S ;C Massachusetts ���' * ) 'c1 t : ' � DEPARTMENT OF BUILDING INSPECTIONS } � °4 \ - y' 2 12 Main Street • Municipal Building ' ,`� ^a 'a Northampton, MA 01060 N WD Property Address: `CeL/ eke Ave Contractor Name: Pool Cr YYl u ll t Address: 39 we U -S feet City, State: it' 'Y 1 e 0, 41.4 C IRO I Phone: (L 1 )77 .a - eeA Property Owner Name: 1/1il':hF Tt)rn ° r Address: I do (O _ ,4vc, City, State: A br rvir /OA C 1 066 I, Pao I Sf.ilmj I' (contractor) attest and affirm that the building I intend to insulate does not have any open air (knob and tube) wiring in the spaces to be insulated and that I have provided the property owner with a copy of this affidavit. Contractor signature .._ Date The Commonwealth of Massachusetts *; Department of Industrial Accidents Office of Investigations „ E- i 60() Wo.. hington Street ml"I Boston, MA 62111 4 wwY..mass.gov/dia Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers Applicant Information lease Print Le l- Name nsinessiOrganiazord ti ndividut]): 1. CO 6 ei -{. ..1 f-1 c Address: '3 ) t{ Gil &( (s S City /State/Z,ip: a`"rt C (c _ l one #�, t " � " e� � 1 Atreeyou an employer? Cheek the app. I trial( boa: Type of project (required): - i. Ll'�3 I am a employer with f t) 4. [ 1 a a general contractor and I 1 , employees (fcli andlor part - lime).' have laircd the sub- contractors t 6. New eon.. coon 2.0 1 am a sole proprietor or partner- listed on the attached sheet. 7.] Remodeling ship and have no employees These sub - contractors have 8. [) Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. [] We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs _ insurance required.] t c. 152, §1(4), and we have no LL� employees. [No workers' 13.5, Other s (A, ( Gt.T 4 -d }ti. comp. insurance required.] Any applicant that checks box ff I must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ( contractors 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 are employer that is providing workers' compensation insurance for my employees. Below is the policy and job site iafiirnratlntt rte ■ Insurance Company Name: t W ( . � t F[ C& -1- "v S 'Y' R C Policy # or S e l f - - i n s . Lic. #: 5 / e. c. L C. & S` (p 7 Expiration Date Pt -� [ —2- er 12— Job Site Address: 1 &9 COOK' ' AV e Cit /Statelr1p: f YO 1 mA O i 060 Attach a copy of tke nor cers' en upeasatioa policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required unri -r Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $ I,500.00 andlor one -year imprisonment, as well as civil penalties in the forn of a STOP WORK ORDER and a fine 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 DIA for insurance coverage verification. I do hereby cer • , under the :: ' , d p i ' of perjury that the information provided afro a is true and correct. / Si ature• -- -- - ° Date: If iz Phone #: - 4 (. g 7 7 2------ - -g-c • 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 #: \ ,' . 0/ • • 4 ' f 4 ' k u ; Office of Consumer Affairs and. Business Regulation _- ' 10 Park Plaza - Suite 5170 0'' Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 165217 Type: Corporation Expiration: 1/21/2014 Tr# 220702 CO -OP POWER, INC. PAUL SCHMIDT _ 324 WELLS ST GREENFIELD, MA 01301 -- Update Address and return card. Mark reason for change. ❑ Address 0 Renewal O Employment ❑ Lost Card DFS -CA1 Cl. ECM- 04/C4- G1C12 g 7G09,2w2.64 - 67,/iiaiaachwel/ Office of Consumer Affairs & Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ( 9ti�= Type: j Office of Consumer Affairs and Business Regulation j �I _ Registration 165217 p, Expiration: 1/21/2014 Corporation 10 Park Plaza -Suite 5170 Boston, MA 02116 CO-iFPPOWER INC. PAUL SCHMIDT / 324 WELLS ST GREENFIELD, MA 01301 Undersecretary r Not v. # without signature _ 40 Massachusetts - Department of Public Safch Board of Building Regulations and Standards Construction Supervisor License License: CS 103635 Restricted to: 00 PAUL SCHMIDT 24 CHESTNUT ST HATFIELD, MA 01038 , c "= --- Expiration. 5/20/2013 C'ommisxnrnrr Tr#: 103635 R D � CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YWY) 11/22/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: Shannon Palazzo James J. Dowd & Sons Ins PAWL. No. Ext1:413- 538 -7444 ( FAX , Na):413 -536 -6020 14 -lo ! yoke la Road MA 01040 E-MAIL alazzo dowd.com -lyke P @ INSURER(S) AFFORDING COVERAGE NAIC #I INSURER A Safety Indemnity Company INSURED COOP INSURER E :Great American Insurance Companies Co Op Power, Inc. INSURERC •U S Liability Insuran Company 324 Wells Street INSURER D : Greenfield MA 01302 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 1050225280 REVISION NUMBER: THIS IS TC CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM CR CONDITION OF ANY CCNTRACT CR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY EE ISSUED CR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, • EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR T YPE OF INSURANCE D/ ADDL SUBR POLICY EFF POUCY EXP LIMITS LTR ' INSR WVD POLICY NUMBER (MM/DYY YY) (M M' M/DDYY) GENERAL LIABILITY CL1566148 11/8/2011 11/8/2012 EACH OCCURRENCE $1,000,000 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $100,000 CLAIMS -MADE OCCUR MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY _ $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPUES PER. PRODUCTS - COMP/OP AGG $2,000,000 POUCY JEST X LOC $ ■ AUTOMOBILE LIABILITY COM6212701 123/2011 3/23/2012 ( E s ac NEU SINGLE LIMI I (Eaacadent) $1,000,000 ANY AUTO BODILY INJURY (Per person) $ ALL OWNED X SCHEDULED BODILY INJURY (Per accident) $ AUTOS X HIRED AUTOS X NON -0WNED PROPERTY DAMAGE $1,000,000 AUTOS (Per accident) UMBRELLA LIAR _ OCCUR EACH OCCURRENCE EXCESS UAB CLAIMS -MADE AGGREGATE $ DEO RETENTION $ $ WORKERS COMPENSATION WC STATU- I OTH- AND EMPLOYERS' LIABILITY Y/ N TORY LIMITS I ER ANY PROPRIE.TOR/PARTNER /EXECUTIVE ' E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N / A (Mandatary In NH) EL. DISEASE - EA EMPLOYEE $ If yes, destibe under DESRIPTION OF OPERATIONS beL,w E.L. DISEASE - POLICY LIMIT $ Directors & Officers Liability EPP111 T553 5/2/2011 5/2(2012 1,000,00(1 5.000 Deiu t iMe )ESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ADORE/ 1)1, Additional Remarks Schedule, K more space is required) Vaiver of Subrogation Applies. CERTIFICATE HOLDER CANCELLATION • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Honeywell Utility Solutions ACCORDANCE WITH THE POLICY PROVISIONS. 65 Shawmut Road Suite 4, 2nd Floor AUTHORIZED REPRESENTATIVE Canton MA 02021 -1461 0 19BB -2010 ACORD CORPORATION. All rights reserved. t,CORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD E) ° CERTIFICATE OF LIABILITY INSURANCE DA's`' °D! ) �.. ---� 11/29/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER N ° Jos Judd Blackmer Insurance Agency Inc. PHON .EXIT: (913) 625 - 5527 FAX N ol: (419)825 -8210 1147 Mohawk Trail A op Ess:j @blackners.com ry INSURER(S) AFFORDING COVERAGE NAIC Shelburne MA 01370 -9707 INSURERA :Twin City Fire Insurance Co 29459 INSURED INSURER B: CO -OP POWER, INC. INSURER C : PC BOX 688 INSURER D PC BOX 688 INSURER E: GREENFIELD NA 01302 INSURER F : COVERAGES CERTIFICATE NUMBER: Master 11 -12 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE IV AY BE ISSUED OR' MAY THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POUCY EFF POUCY EXP UMITS _ LTR WAR WVn POLICY NUMBER (MMIDDNYYY) (MMIDDIYYYYI GENERAL L[ABIUTY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PR S ( RENTED PREMISES S (Ea occurrences $ CLAIMS -MADE I I OCCUR MED EXP (Any one person) $ _ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ _ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPOPAGG S 7 POLICY 1 1 E ra Il LOC S AUTOMOBILE LIABILITY ( C F O O BIKED SINGLE LIMIT ANY AUTO BODILY INJURY (Per person) S — ALL OWNED SCHEDULED BODILY INJURY (Per accident) S HIRED S AUTOS NON -OWNED PROPERTY DAMAGE � $ AUTOS (Per accident) $ UMBRELLALlAB — OCCUR EACH OCCURRENCE �$ EXCESS LIAR CLAIMS -MADE AGGREGATE S DED RETENTION $ S A WORKERS COMPENSATION I WC STATU- 10TH - AND EMPLOYERS' IJABILITY TORY I IMI7S I FR ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N EL. EACH ACCIDENT S 1,000,000 OFFICER/MEMBER EXCLUDED? ( N ! A (Mandatory in NH) DINTEC.T.C68 66 11012011 11/1/2012 EL DISEASE - EA EMPLOYEES 1,000,000 Um describe under DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT 5 1,000,000 DESCRIPTION OF OPERATIONS ( LOCATIONS! VEHICLES (Attach ACORD 1D1,AddItlnnal Remarks Schedule, If more space Is required) Operations usual to energy efficiency services - energy audits, air sealing, insulation and solar hot water system installation. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Honeywell Utility Solutions 65 Shawmut Rd, Ste 4, 2nd Fir Canton MA 02021 -1461 AUTHORIZED REPRESENTATIVE .t J Deneault, CISR/BLAJ — �� ✓ ACORD 25 (2010105) ©1988 -2010 ACORD CORPORATION. AU rights reserved. INS025 (zotoOS).D1 The ACORD name and logo are registered marks of ACORD SECTION 8 - CONSTRUCTION SERVICES Licensed Construction Supervisor: 8.1 Licensed Construction Supervisor: Paul Schmidt Name of License Holder : 24 Chestnut St. Hatfield, MA 01038 CS # 103635 U Address Exp. 5/20/2013 413- 772 -8898 Si. • ;,�!'� Telephone Home Improvement Contractor: Co -op Power Inc. / Paul Schmidt 9. Registered Home Improvement Contractor: 324 Wells St. Greenfield, MA 01301 Company Name # 165217 Exp. 1'21/2012 Address 413- 772 -8898 T @cooppower.coop 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 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 (1) 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 /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 the State Building Code, City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding [0] Other [0] Brief Description of Proposed Work: IvS lit 4Ar7 .4 S14t1,1 Peir Alteration of existing bedroom Yes X No Adding new bedroom Yes 2 ‹ No Attached Narrative Renovating unfinished basement Yes X 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, Gy U art u ---.� I.- /\'J .' / ,1 , as Owner of the subject property hereby authorize 6% I i fl G4 - lam - to act on my behalf, in all matters relative to work au orized by his bidding permit application. Si gnat a of q er Date I, Pa 0 . h (A 1 , 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 s of perjury. Pool &i.-)111;r1 Print Na /nature . I er /Agent Date • . - Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning ,,,, This column to be filled in by ' "' C. a Building Department Lot Size I I I I Frontage I II II I Setbacks Front I I I I I Side L:I I R:I I L:I I R:I I I I I Rear I I I I I I Building Height I I I I I I Bldg. Square Footage I I I I% I I I I I I Open Space Footage ( , I I % (Lot area minus bldg & paved parking) # of Parking Spaces I I ( I I Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW O YES O IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES O NO ;,y 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 O NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only '= City of Northampton Status of Permit: '�. Building Department Curb Cut/Driveway Permit t 2 ©,Z„ 212 Main Street Sewer /Septic Availability 33‘- - 6 ' Room 100 Water/Well Availability s7ec \0 - lorthampton, MA 01060 Two Sets of Structural Plans An °i0 one 413 - 587 -1240 Fax 413 - 587 -1272 Plot/Site Plans 0 NpR,PMF,, ., 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 1"I i ,r C-fr Z Map Lot Unit (loll CrtrD r % A e Zone Overlay District Pt)VL/WAr►u ( Dtt&n n� + Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Cc-et c F,T Feu , .... A- m tt,Ld c 1.i ./L.x.✓ - - - / - (... ,_,, L 1,,, At lv • �') M � oic c c Name (Print) I Current Mailin Address: A,i, �� ? ,• i; SgS ti i � i'/L�'w�`-� Telephone Signature 2.2 Authorized Agent: Pa() ) Schm; d f P 0. ' 6£sg' 6-(e-e4 le kt, NIA c51.3o I Name (Print) Current Mailing Address: (q) 3)77) g u Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building °("11\/3 (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 6. Total = (1 + 2 + 3 + 4 + 5) 4k L I Check Number ‘2,3 $3 This Section For Official Use Only Permit Number: Date Building Issued: Signature: Building Commissioner /Inspector of Buildings Date 4 File # BP- 2013 -0026 APPLICANT /CONTACT PERSON PAUL SCHMIDT ADDRESS /PHONE P 0 BOX 688 GREENFIELD (413) 247 -5739 PROPERTY LOCATION 164 COOKE AVE MAP 18 PARCEL 041 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE / ZONING FORM FILLED OUT Fee Paid Buildin: Permit Filled out 4 I . IA Fee Paid l " t — ' i' F 1 /I Tvpeof Construction:_INSULATE & AIR SEAL 1 I New Construction Non Structural interior renovations \ Addition to Existin• I allia 1 1 Ila I Mriii. I I iff /j Accessory Structure Building Plans Included: Owner/ Statement or License 103635 3 sets of Plans / Plot Plan THE FO ING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON I ATION 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 De ition Delay ' , 7? 7-/d-/7- :nature of B ' d g O icial 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. 164 COOKE AVE BP- 2013 -0026 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18 - 041 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit # BP- 2013 -0026 Project # JS- 2013- 000041 Est. Cost: $418.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PAUL SCHMIDT 103635 Lot Size(sq. ft.): 26353.80 Owner: BERNHARD MICHELE TURNER Zoning: Applicant: PAUL SCHMIDT AT: 164 COOKE AVE Applicant Address: Phone: Insurance: P O BOX 688 (413) 247 - 5739 WC GREENFIELDMA01301 ISSUED ON:7/11/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:INSULATE & AIR SEAL 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: 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: FeeType: Date Paid: Amount: Building 7/11/2012 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner