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35-254 (3)
59 SYLVESTER RD BP-2017-0932 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 35 -254 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-2017-0932 Project# JS-2017-001593 Est. Cost: $2000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: PAUL SCHMIDT 103635 Lot Size(sq. ft.): 60112.80 Owner: RYAN WILLIAM I&NOREEN MCGIRR Zonin Applicant: PAUL SCHMIDT AT: 59 SYLVESTER RD Applicant Address: Phone: Insurance: 24 CHESTNUT ST (413)247-5739 WC HATFIELDMA01038 ISSUED ON:2/7/20I7 0:00:00 TO PERFORM THE FOLLOWING WORK:510 SQ FT 7" LAYER R-27 ADDED TO ATTIC FLOOR OPEN BLOW 51 SQ FT 2"THERMAL BARNER POLYISO ON KNEEWALL, 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 if 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: FeeTvpe: Date Paid: Amount: Building 2/7/2017 0:00:00 $65.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File it BP-2017-0932 APPLICANT/CONTACT PERSON PAUL SCHMIDT ADDRESS/PHONE 24 CHESTNUT ST HATFIELD (413)247-5739 PROPERTY LOCATION 59 SYLVESTER RD MAP 35 PARCEI 254 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT;APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONINGFORM FILLED OUT FeeeePaiddaid FILLED Building Permit Filled out Fee Paid Tyneof Construction: 510 SQ Fr 7"LA` _t ' ADDED TO ATTIC FLOOR OPEN,BLOW 51 SQ FT 2" THERMAL BARNER POLYISO ON KNEEWALL_AIR SEALING AS NEEDED New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner?Statement or License 103635 3 sets of Plans/Plot Plan THE EO4LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INV n ATION PRESENTED: 2 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 jolliii.dt • P- 7- �/J/�' o B Sig o re uilding 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, Cit of Northampton _fatif'fDep event j 212 Main Sheet Room 100 Off Northampton, MA 01060 H phone 413-587-1240 Fax 413-587-1272 1111116, - .. TION TO CONSTRUCT,ALTER,REPAIR RENOVATE OR OEMOU R1 A ONE OR TWO FAMILY DMgaLJNG 1.1 ftrataAua t lye S gd Ra all an-) et_iov ,JET �v?t-{w.r' CO (—1 Natu Conan Maims . raMpnare Stream —yam 22Auekalss Aas t -SC—* ,.�— `, rz?s edv}2 r\± -, `-PO f flJ'tnYi r f Q C evc7i-ne; - 1 ‘U>.t--7 k II Nara(PMtt) 4/ GnbrR Malang Ag 4� f 2 Toephone Item Estimated Coat{Dollars)to be orad t7 camHt eDCaCart . 1. Building c(7 MialtS,ASEIPPI c� WO' 2. EleCVkal "E , . 3. Plumbing 4. Mechanical(HVAC) 5.Fire Protection 6. T� (1 +2+3+4+5) 0210,0“/- ta.� OP/SIRSIEr.7/!./1 • Section 4. ZONING Att Ian at on mat Be Completed.Dentin Can Be Dented Due To incomplete tnfamatton Existing Pmposed Required by Zoning This column to be titer in by Building tint Lot Size Frontage Setbacks Eat Side Building Height __ .... _ Bldg.Square Footage Open spateFootaga ._--- --_ % _ ... ._ _.. :.—_-_. (Lot arm mina Nig&paid wring) #of Parking Spaces _.... __... Fill: (volume&la;auan) __.._._._._._., _.. ... .__.._—_..___ ....... ._.._____�.._._. A. Has a Special Permit/Variance/Finds r been issued for/on the site? NO 0 DON'T KNOW YES 0 IF YES,date issued: IF YES: Was the permit recorded at the Regi try of Deeds? NO 0 DON'T KNOW YES IF YES: enter Book Page. and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW a' YES 0 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 0 no d' 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 cy- IF YES,describe size,type and location: E. Wil the construction activay disturb(rearing,grading, or filkng)crier t acre or is it part of a oxnmon plan t atwir disturb over I acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. sEcnot45.1)1ESCROMONOFPROPOSBOWORICidletticall aeefpeeWef New Howe 0 Addition ❑ Rapiatefasnnindows Alteration(*) 0 Reefing 0 Or Doom Accessory Bldg. 0 Dmwelion D New Signs 101 Decks PM ) Other Thief Description of-- /6 s -Ft 14 /Asper ier- at1 added' to the /cr,. Work a# a • • . �/ .. i1 Ai' Ade i_ in a'. !4✓i30 tri <t Alteration of sleeting bedroom_Yes No Adding new bedroom Yes No /�Y S41.02.0 n AttachedNamadve Renovating unfinished basement Yes ✓�/_No Pans Attached tag -Sheet a. Use of Siding:One Family Two Family Other b. Nhsnber of rooms in each family unit Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction a Number of stories? f. Method of heating? Ft -..:.._-_ a Woptlstoves Number of each g. Energy Conservation Compliance Masscheck Energy Compliance form attal.sf? h. Type of construction I. Is construction within 100 ft of*stands? Yes _No. Is construction within 100 yr. floodplain Yes No j. Depth Wbasementorcawtear. _. .grade k. Wil bulM§ig conform to the . end Zoning regulations? Yes No I. Septic Tank_ City - - Private well City water Supply_,_,,,_ SECTS?*-OWNER A,Ui}pp24T$ON-1013ECOMPIETED WIN MONEYS AS IT MR ttatAPPLIESFORSNRDINOPEOMIT as Oster of the subject Ply '7 � , her%ry aWmize SrSLa 1' C . y1 v A/2.%✓'?f_rl�' ezart/ru&tre,S, 'E., to act on my Waif,in aaul matters relative to wortitatilhofized by rile building permit application. .. t ��A-.cL_ (X-f�} cfComer Dec as OanedAulhaiied Agent hereby declare that Ifs statements and WMarmaton on the foregoing apokcaeon are true and accurate.to the best of my knowledge and belief. Signed under the pains and penalties of pedury. `Tat &-AFF1,14-1— dOtte :..t ,... •«.,.. <�•�.. Not Appraawe ❑ License Number • _ , �" -'t'�lGl. A •GI0 ; , S 9—)0 0) 9 Expsaton�e ��.rw.! .� asi . a�t •.nature - Telephone _. T~ _ _ a.•..,:.:. . =. Not Applicable C S ta t e Verfliilf cunni ,co,es, / 7"41 i pompano Name Registration Number rens Expiration Date 1-+a JIctd , MA Gt 03S1 Telephone//3d41-573' 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 buildlr4 Permit Signed ANidevitAttadted Yes @` No D The current exemption for"homeowners"was extended to include Owner-oecunied Dwelt/Ass 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 saps vtser.CMR TM. Sixth Es§tion Section ll ,S&; Definitten 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 snucnues.A person who constructs more than one hose in a two-year period shah not be considered a homeowner. Such"homeowner"shall subunit to the Building Official,on a form acceptable to the Building Official,that halm SO be yemoSble for all sea work performed under the h permit, As acting Copetraedou Sasteervbor 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,vyl amv 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 _ _ MPryaagp6isnoaquo0 VFW Imo moo aauaaaMo dadcedappapYwd a.aq Ig Pus PolliPsul 040)fat ap utlikes taaB pus aw**ado .q$0a tetlasul 03 PLAN I gullirel a8 SR WOO Pie la 40wa4+00) -F9'1 wil-4> rya,1 -P- a)0/Q (7LU a d U a-° jL was AO Fea7 ->alCVIiA� £ -) :mow wb / w72,101lr' I seams ilagetud c. 4-1010 t+w ' pntS-FIN ams 'A -rnms -+amu tc M 3 17e measpv • a ` sti°frrtv{tivJen `a`"a:31} --'cks ate, CA QaaiW+aaa+a p- -vo-y -aQf ` OHM el to:-/-ilrepTa:red-- c. a F i wino taaeara asame aazasraa sares s •. Ser afaspaaaap Undallninen o A?3 Permit Authorization `'g `� mass save Form SwgM.dwayh'oflotw rdoese. Site ID: S00050249916 Customer: WILLIAM RYAN I, WILLIAM RYAN ,owner of the property located at: (owner's Name,printed) 59 Sylvester Rd FLORENCE (Property Street Address) (City) • hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building;lit t perform insulation and/or weatherization work on my property. /A Owner's Signature: Ate //• - Date: /G 30, �6 FOR CLEAResuR OFFICE USE ONLY CLEAResuR has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Og'O CIFAResult • 50 Washington Street,Suite 3000 • Westborough,MA 01581 . 18002804472 Oj t I15r481ii.44i hsy Rev.102015 . .\ The Commonwealth of Massachusetts 41._ Department of Industrial Accidents c -= 1=�' ; 1 Congress.Street, Suite 100 `fi=-P•_ Boston, MA 02114-2017 www.mass.gov/dia __ W urkers'Compensation Insurance Affdacit: Builders/Contractors/Electricians/Plumbers. TO BE FILED ti ITH THE PERMITTING tl7HORITA'. Applicant Information Please Print Legibly Name I Business ation indn,dual l: SDL Home Improvement Contractors, Inc Address: 24 Chestnut Street City/StateZip: Hatfield, MA 01038 phone a: 413-247-5739 . re sou an emplo.cr?Cheek the appropriate box: Type of project(required): ❑ .Amb 8 t e.._i. lc 7. ❑ Nev. construction ❑ n.ifineHrn H ❑ Remodeling ip inorance regnirno I I _ ❑ ter. d. ,_ ii Mrcn....r [No w. a n... ., 9. El Demolition t❑I hu; . .,cid hen .r ,,, r,r, IIS IL❑ Huilding addition .a.. . . r Aim._ e worker.c .y . .n.,4: r e. c 11 Electrical repair or additions proonnton.nnh no ninolo‘.o> I_'.❑Plumbing repairs or additions and I d o r 1 ..I>ne... I' Roof repairs ❑1 ha,eeapit.,. and har arke . ' ❑ P c❑n. .: eory .c nnl ,ed h n v erAI d,, _ 11.❑✓ Other Insulation .cli],.and 4. , mnl A aurkcrs p _, ri: I n 'An>.pp.kanun:u eks ho‘nn mu,t also inl out 1.seep _ .k+{comp.nsanon prq innyznaflon H re wbo alda. _.hey rcd I ,. _ o,_ s:b:nw atYdact Id a Iii Co . aere hate Contractors thatchock: url by e, pWnaW 1. mil tnp. o and care vnothos.e4(es hm I _ ,. Cthe Nub-contractor.nu.ee p ,h.p mac . .. ,cork nP rest:v nnnrc. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site infornwtion. Insurance Company Name. Selective Insurance Co Policy=or Self-ins Lie WC9024456 qq Expiration Date: 2/23/2013 Joh Site Addresd: ,j9 •—.5/4",a5-01062-- r'd _ C ty State.Zip:_arOLUle a mA Attach a copy of the workers' ompensation policy declaration page ishoning the policy number and expiration date). Failure to secure en'erase as required under MGL c. 62. ¢25A is a criminal violation punishable by a fine up to 51.500 00 and or one-year imprisonment,as well as ci'it penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day ains:the violator.A copy of this statament linr. be:hruard d-- the Office of Investigations of the DIA for insurance coveraee verillcation. I do hereby certify uner the p s and penalties of perjury that the information provided above is true and correct. %, d/ Sig aturc: / :74"-- I Date: r9- Lp' 1 /y Phone-: 413-247-5739 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.Cin/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ACO® CERTIFICATE OF LIABILITY INSURANCE DATE(MWDNYYYYI `i 1/29/2017 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 NA : Cynthia Henderson, CISH Webber s Grinnell Due Ro EM). (913)586-0111 FAXlAdh N ) Ui3)se6-6451 8 North King Street E-MAIL chender song webberandgrinnell.com IN SURER(S)AFFORDING COVERAGE NAICA Northampton !fA 01060 INSURER Selective Ins Co of S Carolina INSURED INsuRERa:Selective Ins Co of Southeast 39926 $DL Home Improvement Contractors Inc. INSURER C: 24 Chestnut Street INSURER D: INSURER F: Hatfield MA 01038 INSURER P: COVERAGES CERTIFICATE NUMBERSIaster 2017 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 MAY BE ISSUED OR 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. )LTRIDOL SUER -IMMJDDYEFFMWDDYE%P - - - LTR TYPE OF INSURANCE )NSD WVD POLICY NUMBER (MWDOMYYj (MMIDWVVVYI LIMITS X COMMERCIAL GENERAL LIABILITY --_ —_ DAMAGE TO RENEE g 1,000,000 DA CLAIMS-MADE X OCCUR PREMISES(Ea RENTED ) S 100,000 52204065 2/1/2017 2/1/2018 MED EXP(Any one personl5 10,000 _ -PERsoxAL aADV INJURY a 1,000,000 GENL AGGREGATE LIMITAPPLIES PER_.. GENERAL AGGREGATE E 3,000,000 JECXPOLICY T LOC PRODUCTS AGO 8 3,000,000 _ OTHER 5 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 6 1,000,000 (Ea Sinden(—_ A ANY AUTO BODILY INJURY(Per person) S ALL OWNED K SCHEDULED A9100328 2/1/2017 2/1/2018 BODILY INJURY AUTOS AUTOS (Per accident) 5 X HIRED AUTOSX CN-OWNED -PROPERTY DAMAGE E _ AUTOS (Par.accident)) _ Underinsured mains el split $ 100,000 X UMBRELLA LIAe X OCCUR EACH OCCURRENCE $ 1 000,000 A EXCESS LIAR _ CLAIMS-MADE AGGREGATE S 1,000,000_ DED X RETENTIONS 10,000 52204065 2/1/2017 2/1/2018 E WORKERS COMPENSATION PER 0TH- ANDEMPLOYERS LIABILITY V N '4 STATUTE R ER ANY PROPRIETOR/PARTNER/EXECUTIVE — EL EACH ACCIDENT $ 500,000 OFFICER:MEMBER EXCLUDED? Y NIA B (Mandatory In NH) WC9024456 2/23/2017 2/23/2018 EL.DISEASE-EA EMPLOYEE$ 500,000 DESCdcrOuOOPERATIONS below EL DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS)VEHICLES (ACORD 101.Additional Remarks Schedule.may be attached If more space is required) The Workers Compensation policy does not include coverage for Paul Schmidt, Kendrick Dempsey and Douglas Schmidt. CLEARe9Ult, Ever source and National Grad, NSTAR, Boston Gas Co. , Colonial Gas Co. , Essex Gas Co. , and Western MA Eelectric are named as Additional Insured per written contract with respects to General Liability for work performed and per the terms and conditions of the policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CJ FAResult THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Contractor Services ACCORDANCE WITH THE POLICY PROVISIONS. 50 Washington Street, Ste 300 Westborough, MA 01581 AUTHORIZED REPRESENTATIVE _ � C :endersor, CISR/CIN -/,�'—,., �^- Alc-.....e.- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS0251cn)mn