23A-129 (3) %jarsachusetts i)aparlrnent of Public 5atelty
Hoard of Building Regulations and Standards
f unatreirtiitn Salyer.r,ur Speri�+lt}
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License:CSSL-1"318
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JOHN APURJEW
39 EAST MAIN ST
STAF 0RD SPRIM 6
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Expiration
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xpi i atinn: 8/27/2018 I r tiividui�!
JOHN PERRIER
JOHN PERRIER
STAFFORD,CT 06076 Undersetri:trry
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CERTIFICATE OF LIABILITY INSURANCE *AT#l+fftxv.rYr,
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THIS CERTIFICATE IS ISSUED A.$ 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
BEL.OW..' TNIS CEOPICATs or INSURANCE,DOES NOT CONSTITUTE A CONTRACT SEMEN THE ISSUINOIN-WRER(S).AUTHORIZED
REPRMNTAWN OR P*WOCM AND THE CERTIFICATE HOLDER.
IMPORTANT; B uw ;;wflcat0 holder an AD01potiAL INSURED,for pDIL-Y(lw)rout bs ondotsad. lf$U8ROGATlQNJSWAjvwwqWto
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COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSU90'TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOrMTIWANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED"OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE Pt c*4 DESCRIBED HEREIN ISSUBJECTTOALLTHEYEFWA
EXCLUSIONSAND,CONDITIONS OF bUdk POLICIES.WITS SHOWN MAY HAVE SEEN RECUCEO BY PAID CLANKS.
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SECTION 3: CONSTRUC'T'ION SERVICES
3.1 Construction Supervisor License(CSL) 10T31 1 ?Z 1 JZ1 t5
t�41-�N t_f l ioense Number FApirallba Dais
Nsme of GSL Holder '�
S q E^6 M,c l N „�� List cs> Typo(see t>GtoW)
No.Wild Street Type Description
.. 1�pr,pV g7 U Unrestricted Burldi up,to 3S 000 cu,1)
Citytrown state,ZIP R Restricted 14:2 Family Dwelling
M M
RC Rood Covetin
WS Window and Siding
SF Solid Fuel Ruming Appliances
*A?g30-qa 5 4 h�w�y�i t tnsutation
Tee one Email&Wress D Demolition
&2 Registered Tome Improvement Contractor(HIC)
R3 GZ1 fie
" HIC Regisuation'Numbec EUpiiMi
RIC Comporty N HI �R t Name a a
NO.And'stivot Q FM
Qi 1Town,State �ZIP Tile hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(Nt.G L.c.tbt 0 2SC(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...........0
SECTION 7x:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT.
I,as Own the sub jectp ,hereby authorize �1A1 �.t- fi13
to my, hatf,in matters ative to work authorized by this building permit ap lication.
f,
er's Name nic Signature Daft
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
contained in this application is true and accuaat to the best of my knowledge and understanding.
Print s or Authorized is Name(ElecironicSigniuure) Testa
NOTES:
1. An Owner who obtains a building permit to-do hislher own work,or an owner who hires an unregistered conractor
(not registered in the Home Improvement Contractor(HIC)Program),will of have access to the arbitration
program or guaranty fated under M.G.L.c. 142A.Other impomm information on the HIC Program can be found at
fflYw:mass gpovtoca informa6on on the Construction Supervisor License can be found at www.mass.¢ovldos
2. When substantial workis planned,provide the information below;
Total floor arts(sq,ft.) (including garage,finished basomendattics,decks or porch),
Dross living area(sq.ft,) Habitable room count
Number of t3replaeft Number of bedrooms
Number of batttirooms Number of halfRraths
Type of heatingsystem Number of docks/porches
Type of cooling system Enclosed Open _____
3. "Total Projoct Squaw Footage"may be substituted for"Total Project Cost'
The Commonwealth of Massachusetts I. .�
Department of 1'ndustrial Accidents
0►,ffice of Investigations
I Ceaygress Streets Suite 100'
Boston,MA 02114-2017
wow,Ows.govidla
Wo rkers' Compensation Insurance Affidavit: Builders/Contractors/ElectriciasnOlumbees
A »Ican�t In[ormxtioa 'lease print Cannily
NAMO(busioc"rganizatioNtndividuai):New England Green homes
Address.-O East Main Strsept
Ci /$tate/Z% ;Stafford,CT 00070 Phone#:000-830.7794
Are you to employal Check the appropriate box: Type of project(required):
1.0 1 am a employer with 4 4. Q I am a general contractor and i 6, ❑New construction
employees(full and/or part-time).' have hired the sub-contractors
2.❑ I am:a sole proprietor or partner- listed on the attached sheet, 7. ❑Remodeling
ship and have no employees These sub-contractors have S. Demolition
%vddli far me Itt any a;i employees and have workers'
8 Y p tY' 9. Q Bulidrngitlon
[No Wo*ets'comp,insllrallt a cottip,irtsurancN.•
5, We area corporation and its IO.Q EleCiri�!'tepalry or sbiditiott>E
3.❑lam a homeowner doing all work or icem have exercised their i i.❑Plumbing,repah or odditiotls
myself.[No workers'Comp. tight ,91( ,wrid per MGL 12.[J Roofre trs
imt;trance;required.j' 152,§1(4),and we have no t"t � /
employees.[Noworkers' (3.( Other l
comp,insurance require d.j
'Any oppiltaM that cheeks box N 1 must aiso:fell out the section below showing their worke W compensation policy inromution.
t Homecwaers whoaubmit this affidavit tndicsting they are dome all worl,and then hero twtaidn coturectotx moat submit*,now atff vit Wicau"11.aach.
:Contraottim,dwohook`thit box must attached an additional sheet showing the name of the subcontrecton and sWo w1wher or tbota enfid"have
employees. If am tubpcontnectors have employees,they must providt their workers'camp policy number.
t aan stn saiplvye�tb�is provldiLtg workers'eo�atsattlort lns,8ranee for racy ctl+playatrs. Btrlrrw/s ttitrPolky.waa►Jeb s�ti
Wermattnn.
insurance Company Name:Inte?go
Polloy .NewC424991 Expiration Date:-
#ar Self-fns.Lie.n. P
Job site Address:All Stoats In city/statelzip
Attach a tupy of the workers'compensation policy declaration page(shoring ttre pallicy number and esxpirstion date).
Failure to statue cov;imp as required under Section 25A of MCL c. 152 can lead to the imposition of criminal pertttlticlt of 4
ftno up to 11,500.00 amffor one-year imprisonment,nt,as a;H::S civil,pcnxltios is the f0ml of a VOP WORK ORDER ttttd Olm
of up to$250.00 a day against the violator, tic advised that a copy of this statement may be forwarded to the Office of
Investigations ofthe DIA ter inauranco vu-ecrega voritivacu»i.
�r��eeeeA '
l do hMby car Matter r tJt6 palm and tittltrs qf1por that the information provided above'&mere knd coned;
Ewa.'
a
O,f}'letat we only. Do not write In this area,to be corrtpteted by cJty or town oRkIaL
City or Town: _ Pcrmit/Lkense M
Issuing Autbority{circle,one):
1.Board of Haellb 2.sullding'Department 3.Cityfrowa Clerk v. Flevtrical'inspector S.Plumbing laspetctor
1+06or
comet hm's.
LElectric, 302015
The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR.
MUN
Massachusetts State Building Code,7$pCMR '09E ITY
USB
Building.Permit Application To Construct,Repair,Renovate Or'Demolish a Revtsed'Mar 2011
One-or Two-Family Dwelling
Ibis Section For Official Use Only
Building Permit Number: Date Applied:
Building Official(Print Name) Signature bate
SECTION 1:SITE INFORMATION
I.I Prope 1.2 Assessors Map&Parcel Numbers
Ia Is th a an A%c d street?yes no Map Number Parcel Number
1.3 do itag Informatiom 1.4 Property Dbucusious:
Zoning District Proposed Use Lot Area(sq ft) Frontage(A)
]:S Building Setbsoks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(NLC.L c.40.§34) 1.7 blood Zone lnformiition: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone?'
Public t] Private[7 -- Municipal D On site diosal system
Check if yesL7
SECTION 2: PROPERTY OWNERSHIP,
2.1 Sbvaort of Regord,�7 CQ ,
Name(Pr Ci state.LIP
ITo,and Street Telephone Email Address
SECTION$:DESCRIPTION OF PROPOSED WORJO(check afl that apply)
New Construction 0 Existing Building❑ Owner-Occupied O Repairs(s) 0 1 Alterations) O Addition
Demolition 0 Accassory Bldg.0 Number of Units Other 13 Specify.
Brief Description of Proposed Work
r7 lap
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Labor and Materials Official Use Only
1.Building 1. Building Permit Fee:k_Indicate how fee Is determined:
2.Electrical 0 Standard City/Town Application Fee
0 Total Project Cos?(Item 6)x multiplier x
3.Plumbing $ 2, Other Fees: S
4.Mechanical(HVAC) $ List:
S.Mechanical (Fire S Total All Fees:S
S sign
Check No.,0211 Check Amouer Cash Amount:
6.Total Project Cost ' a Paid in Full o Outstanding Balance Due
File#BP-2016-0122
APPLICANT/CONTACT PERSON JOHN PERRIER
ADDRESS/PHONE 59 EAST MAIN ST STAFFORD SPRINGS06076(860)930-7794
PROPERTY LOCATION 46 MIDDLE ST
MAP 23A PARCEL 129 001 ZONE URB000)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: INSTALL ATTIC INSULATION
New Construction
Non Structural interior renovations
Addition to Existing-
Accessory Structure -
Buildiny Plans Included• -
Owner/Statement or License 105319
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO MATION 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
Demolition Delay
t
Signature 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.
46 MIDDLE ST BP-2016-0122
GIs 4: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23A- 129 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categoa: INSULATION BUILDING PERMIT
Permit# BP-2016-0122
Project# JS-2016-000211
Est.Cost: $3009.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOHN PERRIER 105319
Lot Size(sq. ft.): 19602.00 Owner: WALMSLEY CATHERINE A
Zoning_URB(100)/ Applicant: JOHN PERRIER
AT. 46 MIDDLE ST
Applicant Address: Phone: Insurance:
59 EAST MAIN ST (860) 930-7794 WC
STAFFORD SPRINGSCT06076 ISSUED ON.713012015 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL ATTIC INSULATION
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 7/30/2015 0:00:00 $55.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner