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23A-130 50 MIDDLE ST BP-2016-1514 GIS rt: COMMONWEALTH OF MASSACHUSETTS Map:Block:23A- 130 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: INSULATION BUILDING PERMIT Permit# BP-2016-1514 Project JS-2016-002580 Est. Cost: $3000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PAUL SCHMIDT 103635 Lot Size(sq. ft.): 14287.68 Owner: DESMOND LINDA M&DENNIS C Zoning:URB(100)/ Applicant: PAUL SCHMIDT AT: 50 MIDDLE ST Applicant Address: Phone: Insurance: 24 CHESTNUT ST (413)247-5739 WC HATFIELDMA01038 ISSUED ON:6/21/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:INSULATION IN ATTIC AND AIR SEALING AS NEEDED 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: FeeTvae: Date Paid: Amount: Building 62120160:00:00 $65.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck- Building Commissioner File#BP-2016-1514 APPLICANT/CONTACT PERSON PAUL SCHMIDT ADDRESS/PHONE 24 CHESTNUT ST HATFIELD (413)247-5739 PROPERTY LOCATION 50 MIDDLE ST MAP 23A PARCEL 130 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid 14065 Building Permit Filled out Fee Paid Tyoeo£Construction: INSULATION IN ATTIC AND AIR SEALING AS NEEDED New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owned Statement or License 103635 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 e , I ,,r/% el-aa-"/6 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. f•C% � City of Northampton s au 4 c'i v1 - .es 212 Main Street L \� Room 100 , Northampton, MA 01060 0,,,<:,,,_,T%r one 413587-1240 Fax 413-587-1272 . _.. . _ _: APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMe.Y INVELSR4G 1.1 Pewees Address: M s Li-V.) MiOldti Ort Jn m r -, „ > saanettx-hiSeammeleerMS 1 Oenxer of Record: nn r S SmurrI SD (b 1ad6. S + mTeiephone ade 216aft{a.A Awn- SSL-. of t>3 eev (-�-{- -� Nine ei t I O mn1 + LI tt Ch erns a+ 5'.--c-afi�e c d 1 Current Mailing Address: Telephone Item. _ .... _ Estimated Cost(Dollars)m be ONISEFIENROMY completed by permit applicant 1. Building .e11 ��d . u 2 Electrical (tI 3. Plumbing ENSINNINS 4. Mechanical(HVAC) 5. Firs Protection gg ( ' B. Tatffi-{1 +2+3+4+5) ., )O )[}. cit.) IQO(p s -. fO , .. nate tamed . v. Section 4. ZONING All Information Aust 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: _ L:. _._: R...___. . Rear _. Building Height Bldg.Square Footage :__ - Open Space Footage (Lot amaminusbldg&paved ming) # of Parking Spaces Fill: • (volume&Location) A. Has a Special Permit/Variance/Findin ver been issued for/on the site? NO 0 DONT KNOW YES O IF YES, date issued:. IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW YES 0 IF YES: enter Book Page and/or Document P. B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW 0/ YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained ® , Date Issued: C. Do any signs exist on the property? YES O NO ®� 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 IF YES, describe size, type and location: E Will the construction activity disturb(clearing,grading, ation,or filling)over 1 acre or is it part of a common plan that will rfisturb over 1 acre? YES 0 NO C IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION o-DESORPTION Or PROPOSED WORK 1Nsc1a a I ecsicatls) New Name 0 Addition ❑ aRplawnMDoors O AlMeaon(s) 0 rq�pRooNg ❑// Accessory Skip. ❑ Demolition ❑ New Signe IDS Decks )D Skil ` 4/ weak:y of t i lgyti (�'N9 �In7lor( Akl-w c.pie Mic Sea :T �/6 fli Attention of existing bedroom_Yes 4j No Adding new beMlan Yes `� Attached Nemetive Renovating unfinished basement _Yes 'V No Plan,Attached ROY -Sheet ga.H New house and..or addfkct ttl tdatina Aouslas.cawwletetfteioNairina: a. Use of buiklirg:One Family Two Family Otter b. Number of rooms in each family int Number of Bent, c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? L Method of heating? Fireplace Woodeaves Number of each g. Energy Conservation Compliance. Meau3wde Energy Compliance form attached? h. Type of construction I. Is construction sewn 100 - .t wetlands?_Yes _No. Is construction within 100 yr. floodplain_Yes NO j. Depth of basement or•= floor below finished grade k. WiII building mnform to the Building and Zoning regulations? Yes No. I. Septic Tank_ Cay Sewer Private well City water Supply SECTION Ta-Owls AUTHORIZATION-TO BE COMPLETED MEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, _,a e :7 . _ as Owner of the subject property (( 11 II � -- hereby authorize 3}S 44/2 YI.��/!��/011-ail+ i(preS,1 CJ' to act on my behalf,in al metiers relative to by this budding permit application `}t2 6rN'0.[.Ja-4--- la-/S' / Sanwa of Owner orae I. 'Vac/ .5hm id'' - as Owner/Authorize0 Agent hereby declare mat the statements and information on the foregoing application am true and acwrss,to the beat of my knowledge and befef. Signed under the pains and penalties of perjury. / Prim Mane of. Dew - ys f � sa1- - Not Applicable C N1m.aft.ie.na.Nsim _ .. .._ _ J. X0.-1- (} , i1 �- rr License Number Address Expiration Date lac%�`,oE5 411 - a4 -5 �gnature Telephone {� ^=eiS ` -'.?_M,, sem' �_ aica NotAPble 0 S t " " •'�l�uait taa±a .tea _04012.- a . 17_1'7 / 5 Comnam NameRegistration Number a. r-ee.-� . 1 111 .... ess Expiration Date {-f a4J1i el d YYn,4 CN O381 TelephonWi3/4141i'573 somewmansteotemostaseagritt.G.Lc.seZS25010 Workers Compensation Insurance affidavit must be completed and submitted with this application Failure to provide this affidavit vfil result in the denial of the issuance of the buildlnngpermit. Signed Af davitAttached Yes t9' No O 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,CMB M. Sixth Edition Section 108.3,5.1. pefnid.n of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there M,oris 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 ht 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 bundle&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 City of Northampton c.enSIS or soara. atm 212 111,112 $EZML • Ilindayei a IA4 q .OSEl+eca• le nolo Properly Addle..: L 'St /Y1 t'cL U S+ Cort }lad! 5c fimi�f Name: Soh - -&4�c `n-e_�I�rn�rcn�reinen C,nnharikur� ;lane- • Address. G9 Li l ,YlY7i' L& J1'(cth cdy, State: PoA-f;ud ma oil Phone JL4) 5. , i'k 1-67,39 Nome': ! JPnni5b?'fcmonc( Address: 57) nn i"ad La. S+ ciy, stale: r 1 rn c /4 O l©( o 7-- 1, rad l 1-mn i a.F- (caa.dor)at atd.flirn Via the building i mend to instils dos not hammy opal N(Mob aid tube)wig Si the spaces to be insure and that I have provided the property muter sal a copy al this uRd.vlt u` y RISE 2=_ , Cordon,M,a „ OWNER AUTHORIZATION FORM 1, tavt> c $ MOwork (Owner's Name) owner of the property located at 1b N•cUk 5—r (Property Address) iy ) C IM r O UO(Propert Address hereby authorize (Subcontractor) en authorized subcontractor for RISE Erglneedng,to act on my behalf to obtain a building permit and to perform work on my property.This form is only valid with a signed contract. \ �V� l� II� � II `l pals IN JUN 1 0 2016 The Commonwealth of Massachusetts —+—,— a__.��� Department of Industrial Accidents Congress Street. Suite 100 Boston. MA 02114-2017 =v y www.mass.gm✓die Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legiblv Name(Au ness'organiationdndioideal): SDL Home Improvement Contractors, Inc Address: 24 Chestnut Street City/State Zip: Hatfield. MA 01038 phone 413-247-5739 Areyou an employer?Check the appropriate box: Type of project(required): I-Q l am a employerpl with _8 emoyees Ifni]and Or pan pane �! � - 9 New construction I am a soie proprunor or partnership and haae emeesk -s_. I R. ❑ Remodeling any capacity [No orkers comp msurance required 3.❑l am a homeowner doing all work ml Nworker, re ancc oa III 9- ❑Demohbpv 491 am ahomww and will be Inning c O� Bulldingaddtion ensw-e that all contractors eto have kerscompo.. ! I 11.9 Electrical repairs or additions proprietors with no employees 12.0 Plumbing repairs or addition., '❑I general contractorand I have h h : b - d A . """ 13. Roof repairs These sub-contractors pl havep v. ' 14 E Other Insulation arc vnrpo anditt oofficersofficeexercised vv:Lc. -- b? x]]41 and he have no employees ¢ workers comp an - d. *Ana applicant.that checks box-I must also fill our the soct:mbean . _Moc tintsa nation Homeowner,who submit this affidavit indicating they are du a OrS and the: c.ut-me:ors must submit a new affmaiinduanng ucts =Cotrs that check this box must attached an additional sheet and stare whether or not those entities wu employeesIt the sub-contractors ha'e employees. , vac thee worker, number I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name. Selective Insurance Co Policy=or Self-ins-Lie. n: WC9024456 Expiration Date. 2/23/2017 lob Site Address: c.)0 (YU&ILL S*re_a * _. Cin'State Zip: 1"1111 4ri!' a YY1R OILYo 2-- Attach a copy of the workers' compensation policy declaration page(shooing the policy number and expiration date). Failure to secure coverage as required under MGL c. 52254Is a_:minal violation punishable by a fine up to 51.500 OU and or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 52250.00 day against the violator.A copy of this statement may he forsxarded to the Office of Int estieations of the DIA for insurance coverage verification. I do hereby certii'a r th ains and penalties of perjury that the information provided above is true and correct Slananue: Date: L5-1 CO Phone p. 413-247-5739 Official use only. Do not write in this area,to be completed be tin'or town official City or Town: Permit/License Issuing Authority(circle one): I.Board of Health 2.Building Department 3.Cin'/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone h: �� NYM AcoRDe CERTIFICATE OF LIABILITY INSURANCE M"°" Ler' 1/15/2016 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: I the certifIcata holder Is an ADDITIONAL INSURED,the policyfies) must be endorsed. H SUBROGATION IS WAIVED,subject to the terms and conditions of t a policy,certain policies may require an endorsement A stetemeM an this certificate does not confer rights to the certificate holder In lieu of such endomement(s). PRODUCER An Cynthia Henderson, CISR Webber a Grinnell RHONELer wg,1 (413)586-0111 Net ic,N SSE 6401 8 North Xing Street E*WKS1 cbendersoneembberandgrinnell.cam INSURERIBI AFFORMNGCOVEMGE num0 Northampton .... NA 01060 i Nausea ASelective 19259.. INSURED I INSUMRis SDI, Home Improvement Contractors Inc. �WSOAERC. 20 Chestnut Street ','MURES o: NSURERE..._. Hatfield MA 0103$ NSURERF: COVERAGES CERTIFICATE NUMBERXeaster 2016 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN SSSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERF INDICATED NOTWTHSTANDING ANY REQUIREMENT. TERM OR CONORION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED SY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHO1M4 MAY HAVE BEEN REDUCED BY PAID CLAIMS use MX CM_ _. . 'Pyy _.. _.. Lie WIPE OF IN6'UMNCE WPC MS WAXY NUMBER I Y...F /Y -�Xp Ulan X CGMMER0AL GENERAL Laskin M'MyYWY1'EACH XCCURRENCE $ 1,000,000 A CAMS-MACE X tcCUR DniflP dR€M.ISf.§ R !$5ai 1 100,000 82204065 2/1/2016 2/1/2017 MED 3X IAnr ire Ervin) 1 10,000 PERSONAL a Wv{nJUav__... ... _._ __... 5 1.0__.0_..0,0_D0 GEN GRE3A'ELMrt ao?DESPER GErv6RLLeG9PWTE S 1,000,000G _ _.. . X GUTa-Cv. � _OC PRODUCTS COMP/OP AGO 5 3,000,0000 AUTOMOBILE UASILITY COMBINEDp (SINGLE LIMIT 5 . 1,000,.000 ANY AUTO EOIXIY MJilRY(Per 9.4303; 5 _ . Aa .rCI+E➢ULf-G K9100328 2/1/2016 2/1/2017 8033LY F3tiuRY(SMacctb4) 5 3.X 44440 AUTOS AUTOSX MON-OWNED PR�EPTY DATIAGE 1 AUTO fframTrla _... UrgMnnPeem9ImMBINAI S 100,000 X UMBRELLA WB X OCCUR EACH atURRENCE $ 1,000,000 A EXCESS WAS CU MSMtSE +liGRFGaTE i DEC X 14E1EMIpN$ 10,000 82204065 2/1/2016 2/1/2017 5 WORKERS COMPENMMW X rr�'R X 0tH ANO EMPLOYERS'UABRRY/N Y $TATETE, ER .. :NPRInta Y PROoR, TNER?EKEcuTv£ E I. EACH ACCIDENT $ 500,000 (WAGER/MEMBER EXCLUDED' Y NIA 2/23/2017 A Obsestory N NH) M09024436 2/23/2016 EL GSEASE EA EMPLOYEE 1 500,000 :XESCRIF'IONOF'WERATONS tax" E.01SMIISJ.POLICY uMR 5 500,090 Ot3CMPTMIN OF OPEMYl0Ma r LOCATIONS/VEHICLES UWRD 101.Ad Oral RMIMIW Sr-Mau*.Try 0*431103441 M more Well M noses* The Workers Compensation policy does not include coverage for Paul Sobaidt, Rendrick Dempsey and Douglas Schmidt. Columbia Gas of Massachusetts as hereby named as Additional Insured par written contract with respects to General Liability & Auto Liaiblity, for work performed, and per the terms and conditions of the policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY Of THE MOVE DESCRIBED POLICIES BE CANCELLED BEFORE Columbia Gas of Massachusetts THE EXPIRATIOt DATE TNERE0f, NOME WILL BE DELIVERED IN d Technology Drive Ste 250 ACCORDANCE WITH THE POLICY PROVISIONS. Westborough, MA 01581 AUTHORIZED REPRESENUTNE rr M 001988.2014ACORD CORPORATION. Al rights reserved. ACORD 25(2014/01) The AGGRO name and logo are registered marks of ACORD INSO2S-2in aw,