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11A-005 (9) 1 46 CHESTNUT AVE BP-2016-0991 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: I I -005 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-2016-0991 Project# JS-2016-001676 Est. Cost: $1800.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PAUL SCHMIDT 103635 Lot Size(sq. ft.): 22041.36 Owner: MCNALLY MAUREEN F&MOLLY SENN Zoning: URA(102)/ Applicant. PAUL SCHMIDT AT. 46 CHESTNUT AVE Applicant Address: Phone: Insurance: 24 CHESTNUT ST (413) 247-5739 WC HATFIELDMA01038 ISSUED ON.-21512016 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: FeeTyne: Date Paid: Amount: Building 2/5/2016 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner h File#BP-2016-0991 APPLICANT/CONTACT PERSON PAUL SCHMIDT ADDRESS/PHONE 24 CHESTNUT ST HATFIELD01038(413)247-5739 PROPERTY LOCATION 46 CHESTNUT AVE MAP 1 I PARCEL 005 001 ZONE URA(102) THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildin Permit Filled out Fee Paid Typeof Construction: INSTALL ATTIC INSULATION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Buildin Plans Included: Owner/Statement or License 103635 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IlSlFO,4MATION PRESENTED: pproved 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 D a op . Sign 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. E7phone C. o� City Nora ampt�n "FEB •4 Bu" #� � Room 100 75F--13-U7_-L,,7 orthampton, MA 01060 3-587-1240 Fax 413-587-1272 APPLICATION TO CONSTRICT,ALTER,REPAIR,RENOVATE OR DEMIOUSH A ONE OR TWO FAMLY DWELLING '5 V yy 1.1 PrODWW Address: c✓ c -a s 1 � v C._. `ter SE��a 21 Ownwofcs Record: Name 'nt) Current Mailing Address: 1► a-- S-P_ � C �S� Telephone 2.2 Audwrmed Agent: j�f_ c y-�P�27S IZ In rn i' -t- fie Name(Print) Current Mailing Address: Sig Telephone Item Estimated Cost(Dollars)to be C3 ly;; com) Soo . ' it a cant 1. Buildirxg � (a Fee 2. Electrics{ 3. Plumbing .' 4. Mechanical(HVAC) 5.Fire Protection 6. Total=(1 +2+3+4+5) ¢ g00 . Ct c. c)2Yj 1,5 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 Building Department .......... Lot Size Frontage Setbacks Front Side L. _ R: R:,. Rear Building Height Bldg.Square Footage Open Space Footage % (Lot area minus bldg&paved parking) A of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Fincinover been issued for/on the site? NO 0 DONT KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW � YES 0 IF YES: enter Book Page. and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 11<Q YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 Date Issued: C. Do any signs exist on the property? YES NO 0 \Z7 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO IF YES, describe size, type and location: E. Will the construction ac"disturb(clearing,grading a vation,or filling)over 1 acre or is it part of a common plan that will disturb over I acre? YES 0 NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all agg_lcA;bie) New House ❑ Addition ❑ R Doors Q Alteration(s) ❑ Roofing ❑ Accessory Bldg. ❑ Demollbon ❑ New Signs [C]] Decks [M Siding ], Other[ la�hge, Brief Despiption of Pr ,r Work: Se��-i n aj It s Alteration of e)asting bedroom Yes No Adding new bedroom YesNo Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet M ft.'If i +et�r labs ttitiotrng: 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 It of wetlands? Yes Na. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grime 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 8E COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIESFOR BUILDING PERNT 1, a U as Owner of the subject property hereby authorize �> -ev'1+ �S to act on my behalf,in all matters relative to orkWith0ized by this building permit application. 5.4 e Dt Signature of Owner Date I, �2l.L �In[d-7�"" 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 of perjury. 7i'I a�f - Prfrrt Name LP Signatdre of Date MINIM 8.1 Licensed Constriction Su visor: Not Applicable ❑ / _ Name of License Holder: Irl( C�l�/1/YL� 10 � (—P,3 w J k�a Il 5+, i4a+�gct ' 0, License Number Address Expiration Date -1// - a� - ignature Telephone r Not Applicable ❑ Company Name Registration Number Address 2 � . Expiration Date , mfg Qt 0J5QTelephonc�l/3 aay 1-,5/39 5 ' AIDE I�' 1 11 E (MMI.-L.c.45Z 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...... ❑ 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 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations U1 600 Washington Street Boston,Mass 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/individual): Address: eG City/State/Zip: :1 g 4 l-,,—L d 01 D4ne#: Are ygu an employer?Check the appropriate box: Type of project(required): 1.Ul am an employer with- 4.©I am a general contractor and I 6.❑New construction employees(full and/or p me).* have hired the sub-contractors 2. 1 am a sole proprietor or partner- listed on the attached sheet. Remodeling ship and have no employees These sub-contractors have S.❑Demolition working for me in any capacity. employees and have workers' 9.p Building addition [No workers'comp.insurance comp. insurance. � required] 5.®We are a corporation and its 10.❑Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers'comp. right of exemption perm MGL insurance required]t c. 152,§ 1(4),and we have no 12.0R re ' s employees. [no workers' 13.: er comp.insurance required.] ".Any applicant that checks box t#1 must also fill out the section below showing their workers'compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contactors that check this box most attach 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 an employer that is providing wo ers'compensatio 'nsurance for my emplo ees.Below is the policy and job site information. Insurance Company Name: U, t Policy#or Self-ins.Lie.#: . (> — 0 _ t/o Expiration Date: Job Site Address: f _ �� City/State/Zip: 1. )4e Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration(date). Failure to secure coverage as required under Section 25a of MGL 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 250.00 a day against violator. Be advised that a coPe of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certifr— Signature: der the pains d penalties of perjury that the information provided above(is true and correct. Date: Print Name�� SU 1(Y1 t�t' Phone#; 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 Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#: City of Nort�ton : .t = 212 Iftla Its..t . llnotcdaml skLt1Aing vardumrtm, ML 0106 Property Address: v L"-d s rte: 46me - 1+ � c Address: 4; '4 - CRY, state: „�-�a.�--�� MA 4 tck--)' Phone: -7 Property ower iWne: 4W4-ep- r) Seca MCEWIlU Address: Jl{ C S�nu+�1-e City, State: L -ff A`,N ._.�`'1i n i 4A.4-- (=*Scw)attest arw aim that the butt t mterw to insulate does not have way open air 0mob and toga)**M in the sus to be insured acrd that i have provided the prop"owner wiM a try of V,&stfidevit Conoactor s%r e 14:::� Date � , ar OWNER AUTHORIZATION FORM (Owner's Iarnb) owner of the property tooted at w(0 (Property Address) (Property Address) hereby authorize (Suboontrador) an authorized subcontractor for RISE Englneering,�to ad on my behalf to obtain a building pennit and to perform work on my property. Owneff Signature Date