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29-517 (4)
22 TARA CIR BP-2017-0920 GIS g: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29-517 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 It BP-2017-0920 Project# JS-2017-001571 Est. Cost: $700.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: PAUL SCHMIDT 103635 Lot Size(sq. ft.): 6882.48 Owner: O'BRIEN BOBBE A Zoning: Applicant: PAUL SCHMIDT AT: 22 TARA CIR Applicant Address: Phone: Insurance: 24 CHESTNUT ST (413) 247-5739 WC HATFIELDMA01038 ISSUED ON:2/6/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:INSULATE BACK OF BASEMENT DOOR, 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: OM 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 2/6/2017 0:00:00 $65.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-0920 APPLICANT/CONTACT PERSON PAUL SCHMIDT ADDRESS/PHONE 24 CHESTNUT ST HATFIELD (413)247-5739 PROPERTY LOCATION 22 TARA CIR MAP 29 PARCEL 517 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMI • ION CHECKLIST CLOSED REQUIRED DATE ZONING FORM FILLED OUT _ Fee Paid Building Permit Filled out Fee Paid Tvpeof Construction: INSULATE BACK O' : -MENT DOOR,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 FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO TION 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 Dee J �r: o/r-r Sign. c Building 0 tcial 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. rkt .2 -2 City of Northampton Butlifmg Department 212 i Street Room 100 ` Northampton, MA 01060 phone413-587-1240 Fax 413-587-1272 1.1 PtmrW 8Jdrs: `r -rirs , 0.4ky f / Sze m of o� a— _... 21(iwBardP- d: � (9 4 RDAA tr--) r-Q a taxa-, (moi rc(�. Y- e)rene c MICIr Name(Print) Current Maiig Address: ' -Cl Telephone `i/2,- �RU953R USiamiYadAarttf_ J�1— papiti"lervf- 'u ! l-Inm --- Q (' `rnrt1 4ec\--=iCIC� Mit None(PriN) Comm Mae Address: ✓ `� 274 47'x739 Tetchy e Item Efaned Cad{Dollars)to bB x'Ts. wedby p9l,,Wtl it 1. Building 4 {IIJ 7UU� 2 Electrical § r 3. Plumbing 4. Mechanical(HVAC) 5.Fre Protection 6 Tri (1 +2+3+4+5) 170 6 a19 s, 1 . airS Section 4. ZONING Alt Information Must Be Completed.Permit Can Be Dented Due To Incomplete information Existing Proposed Requited by Zoning This column to be Mel in by Staling rent Lot She Frontage Setbacks Fropt - -- " -- Side L - Rr-. .. L . $fat ......_ Building Height ,—..._ - .__ -- Bldg.Square Footage ...—. —._.... a� . ,.__.. .....__. ..-___. Open Space Footage perking) k of Parking Spa's Fill: A. Has a Special PermitNariance/Findi r been issued for/on the site? NO 0 DONT KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the rry of Deeds? NO 0 DONT KNOW YES 0 IF YES: enter Book Page _..T : and/or Document IP B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW ©' YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO 4 IF YES, describe size, type and location: _. _..,. _... ....�.. -__...__ . . .... D. Are there any proposed changes to or additions of signs intended for the property? YES © NO e' IF YES, describe size, type and Location: E. WE the construction activity disturb( rg,grading, a'•on or aging) or ng)over 1 aaeis it part of a cannon plan that will disturb over I acre YES 0 NO V IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5- TIONCE UfaedcailaeeIaacie) New Name ❑ Addition El RRs�pla ewerd ANsnhon(a) ❑ Roofing D Or rs Accessory Bldg. 0 Omwltilon El New Signs [W Decks [O Siding i. OterRI217 Wank &id of Proposed a-nr ,p+altalac.1L ,ta bo mR . � Ssa�.Liq a$ n doAlterationAlterationAon of existing bedroomn_Yes ✓/No Adding new bedroom Hiesi'VNo //,, Attached Narrative Renovating unfinished basement _Yes V No Pans Marled Roti -Sheet a. Use of bugling:One Family Two Famey Other b. Number of rooms in each family unit Number of Bathrooms c. Is Mere a garage attached? d. Proposed Square baage of new oon struction. Dime e. Number of stories? f. Method of heating? - , orYYoodstoves Number of each 9. Energy Conservation Compliance. Mases heck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft of wetlands _Yes _No. Is construction widen 100 yr. floodplain_Yes_No j. Depth of basement or cellar floor•- • finished grade It Will building conform to the a . • and Zoning regulations? Yes No. I. Septic Tank C - . _ Private well City water Supply SECTION Ta- .,. a UTHORCATION-TOSEOOMPLETED WHEN owes AGENT OR OONIRAOTORAPPLIES FORatku*SenssraR as Owner of the subject ProPenY hereby authorize 5e 1.• --eN/ men+ h iC-S, v' to act on my behalf,in all matters relative to by this building permit application. 2 l t-7 &Wagsef, Daae Slim/dr& as OwnmrfAuttorized Agent hereby declare that the statements and information on the foregoing wtnAcl^eh are true and accurate,to the best of my knowledge and belief. Signed under the pains and permit/es of perjury. "Pan/ chm rda Print Nmne a. "--- •ms..-:•r.�. a.,•--,i Not Applicable 0 N.ao of L atfiir da: a. _ J e/.-1— t�/ { ' �+G(c� License Number / TraC'f"•Kf Oow : .� 1 Addresss / or Expiration Date .0/2 41/ - air -5 e nabae Telephone _ _ '-" Not Applicable ❑��(( 6 L.. a eta Corrroanv tip CJ!(J Registration Number _ , •_ ren - Emanation __ ao 9 ate Na-- i'e(d I' \4 01 038' Telephony/ 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 buil lg'permit. Signed SignAffidavit Attached Yes dam/ No 0 The current exemption for"homeowners"was extended to include Oweltlaaa 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. Steffi Edition Section 101E3.5.1. Diu 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 peneu who constructs more than one home in a two-year period shall not be fired a homeowner. Such"homeowner'shall submit to the Building Official,on a farm acceptable to the Building Official,that he/she shall be rammed.for all such work performed ander the bulbs permit. As acting Contrast em 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 way 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 • 7! DPIPI MPMOSatar*na Mead ag-PalWald Wall 1Pig PPP a4 09Oak 8UPP$gnPeSeeeFpdo/aaa4 Ptaaapa ! 09 Pang t%MPIl•4 all PLR wePa•>aeae("PUP* +.172 .r ,`' C e--)o I c) btt,f r-aurru l :sags'Avo iJrJ -b4-01 CZ" ansippy ua,VvCa U awe nalatiti 6CZLS'-1-•f(C -elf 9L tj1C brw ' pn -pati :ems MIO '' -s -yrury j (IC sseippv . -) tt_' ,,,ZZrrj ,(c re-tArd"1 Q . ,.ati r i ,7 q,3 Japaquao -!=f'"t'y 1 hed- 090TO !1 So. eamtma VPITDIfl . Waal .sw t2 swismpusire utxtdiatrtzein r4TO RISE60 Shawmut Road, Unit 21 Canton,MA 02021 339-502-6335 ENGINEERING' www.RlSEengineering.com OWNER AUTHORIZATION FORM I. L „24 - 1f COQ fc,,i (Owner's Name) owner of the property located at: C'/,ec 7-c_ (Property Address) %Xe 1?ce /, ,4 (Property Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering, 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. The Permit will be secured by the insulation contractor, at no additional cost. It is the homeowners responsibility to close out this permit by contacting their municipality at the completion of this work. Owner's Signature Date 6.2016 The Commonwealth of Massachusetts Department of Industrial Accidents I —1vh I Congress Street, Suite 100 '—;; Boston, MA 02114-201" www.mass.gov/dia porkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING Al THORITI'. Applicant Information Please Print Legibly Name IBasincs.ornanlzauon maividaao: SDL Home Improvement Contractors. Inc Address: 24 Chestnut Street City/State'Zip: Hatfield, MA 01038 Phone a: 413-247-5739 Are.uu nn emploaer'Check the appropriate bog Type of project(required): 0I entrae et n int $ _ enal Iet,uad Q Neu construction • 2❑ e _ N_ ❑ Remodeling 0 h rye. gel snort.me Ii r nae �ee 9. ❑Demolition 10 Q Building addition 4 E I ant ah tib '. A 011 n7,. nt oh I ,t n 9 r.:Otter' "orke . .n, r - 1i.Q Electrical repairs or additions pr�opoemo,Wb no errgloe ec. 12.Q Plumbing repairs or additions 'l l': d tile NIth- d triV .e...e... loe rple haeeu, 13.Q Roof repairs o Qss _ r- .e ph er VW.I c2 . N.�✓ Other Insulation tip 4i_and ice In,e no cm7ie_ IA vsorne_. r' etetesta. e hire arpin no hat cheeseh .e I ante,,I tion '<ean _ .e, eeripeneenon intonnotton H Thb.fi doe J nee ared r;d rh so..ac:ore ntuet eutenut a neee affidavit athictae it trohoating:uch. kontrootom that ghee:,tht,e, a.ached n addil sheet s]e - rthe and slue eshetne,at not those entities hose emploseee if the enh-contractole hese employee..Lacy mum pees loo acts eorketesump .ma.. /am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Naps: Selective Insurance Co Polies n or Self-ins. Lie. WC9024456 Expiration Date 2/23/201 lob Site Address: (.�a. Aati,n -C4SC j T- C'its State Zip: I [(Qp p Pf Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152. +25A is a criminals iolation punishable by a fine up to Si 500.00 and or one-year imprisonment,as sell as els il penalties in the form of a STOP R ORK ORDER and a fine of up to 5250.00 a day against the s iolator.A copy of this statement inase he toms baled to the Office of Investigations of the DIA for insurance coverage serif cation. I do hereby certify unayr the p r s and penalties of perjury that the information provided above is true and correct. s nature -�fi% Date: c.7 1 ' 17 rff Phone 413-247-5739 Official use only. Do not write in this area.to he completed hi city or town official City or Town: Permit'License F Issuing Authority(circle one): I. Board of Health 2. Building Department 3.City l own Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone 4: