29-395 (6) 116 SANDY HILL RD BP-2017-0036
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:29-395 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: woodstove BUILDING PERMIT
Permit 4 BP-2017-0036
Project it JS-2017-000061
Est. Cost:
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RICHARD SCOTT 83108
Lot Size(sa.ft.): 12196.80 Owner: ROSS MILTON R
Z,on2> Applicant: RICHARD SCOTT
AT: 116 SANDY HILL RD
Applicant Address: Phone: Insurance:
20 BULLARD AVE (413) 478-6306 O
HOLYOKEMA01040 ISSUED ON:7/12/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL BRECKWELL STOVE
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 7/12/2016 0:00:00 $40.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
RECEIVED
City of Northampton
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ins Massachusetts
fr'T. I
DEPARTMENT OF BUILDING INSPECTIONS ,
ANG WSPECngya 212 Main Street • Municipal Building �. .0
PEON MAOlOSa Northampton, IM 01060 r," '1
SINGLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
FOR WOOD, COAL, PELLET, CORNSTRAW OR SIMILAR STOVES, OR FIREPLACE INSERTS
,y000
Permit Fee:Y O Check # X40 87/01
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant/ Pit r: I L 1 b� I O c p
Address: 11 e g AAD'/ /4IL( 17.19 Telephone cpr— I2C
L d item G e,
2 Owner of Property. S Pr NC
Address'. Telephone:
3 Status of Applicant Owner Contractor
4. Type or Brand of Stove: S CL K t..csQCL
If applicant is not the homeowner. JJ
y ( id
Construction Supervisors License Number et 3 ) �b Expiration Date b "/ 10
Home Improvement Contractor Registration Number 16 O 62 ]7 Expiration Date E " b ) b
All Applicants must complete a Workers Compensation Insurance Affidavit before we can issue a permit
5. Certification: I hereby certify that the information contained herein is true and accurate to the best
of my knowledge. {1/,�/
DATE: -/—2/ / APPLICANT'S SIGNATURE /Y/ .
DATE: `// HOMEOWNER'S SIGNATURE IT y l/�,, 3'
APPROVED
DATE: 2 /— /( BUILDING OFFI ' L
The Commonwealth of Massachusetts
'4 Department of Industrial Accidents
=— !t
_77)J��a Office of Investigations
• _MB ;
_[:a_ - 600 Washington Street
='r. r Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): / { CH tai 210 nn 5e..o L 1
Address: HOC
13 OL L
City/State/Zip: j�JOL '2'D t ( V l (SS Phone#: f 113 -.C3 3 6 3'/O
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
^Employees(full and/or part-time).• have hired the sub-contractors 6. ❑New construction2.Lf I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling
ship and have no employees These subcontractors have 8. 0 Demolition
working for me in any capacity. employees and have workers' 9. addition
[No workers' comp. insurance comp.insurance.[ ❑BuBdmg
required] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ 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 120 Roof repairs
insurance required.]t c. 152, ¢I(4),and we have no
employees.[No workers' 13.0 Other S it V e
comp.insurance required] J /ISTAt—L—
'My applicant that checks box al mat also fill out the section below showing their workam'conawasatien policy information.
t Homeowners who submit this affidavit indicating they am doing all work and then hire outside contractors mat submit a new affidavit indicating such.
[Contractors that check this box must attached an additional ship showing the name of the subconmclos and state whether m not those entities have
employees. If the subconnaeton have employes,they mutt provide their woken'comp.policy number.
Jam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-Ms.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
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 c.152 can lead to the imposition of criminal penalties of a
fine up to$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 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.
/do hereby cern .under.the pains and penalties ofperjury that the information provided above is true and correct
ce.dSignature: , v 1/l IAV/ Date:
Phone#: 1-11.3 S Y3 trip D
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):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
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: ) Sit A t>,-/ LL re,D
The debris will be transported by: M sls e.C.
The debris will be received by: RD a rl 6 Pcri} fl- N d gr.
Building permit number:
Name of Permit Applicant
c�Lvl
Date Signature of Permit Applicant
C 1N,,i c li,
LLJ ; CENTER FOR 31 / -
U -4 EcoTechnology-
we make green make sense-
Post-Construction Duct Leakage Testing Report
Site Information
Date of Test Tuesday, July 05, 2016
Client Orchard Valley Heating and Cooling
Project Address 65 Kensington Ave, Northampton, MA 01062
Test completed by Miira Gates
Duct Leakage Test Results
Conditioned Area #1 1568 isq ft Conditioned Area #2 1568 sq ft
Duct System 1 - Leakage to Outside Duct System 2 - Leakage to Outside
Leakage to Outside 47 'CFM25 Leakage to Outside 15 iCFM25
CFM25/100 sq ft 3.00 CFM25/100 sq ft _0.96
Pass or Fail IECC 2009? Pass Pass or Fail IECC 2009? L Pass
Notes:
Post-Construction Duct Leakage Requirements
IECC 2009 - Leakage to Outsrde Test for Renovations <4 CFM per 100 sq ft of conditioned floor area