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31A-081 296 ELM ST BP-2017-1145 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:314-081 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGLLcc.1144/2�A) Category: INSULATION BUILDING PERMIT Permit# BP-2017-1145 Project# JS-2017-001942 Est.Cost: $2500.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: PAUL SCHMIDT 103635 Lot Size(sq. ft.): 7840.60 Owner: LOMBARD JOHN&LILLY Zoning: URB(I00)/ Applicant: PAUL SCHMIDT AT: 296 ELM ST Applicant Address: Phone: Insurance: 24 CHESTNUT ST (413) 247-5739 WC HATFIELDMA01038 ISSUED ON:4/72/20.17 0:00:00 TO PERFORM THE FOLLOWING WORK:68 SQ FT, 14" LAYER, R-49 TO KNEEWALL FLOOR 132 SQ FT, R19 UNFACED FIBERGLASS BLOCKERS TO SILL AREA IN BASEMENT 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 4/12/2017 0:00:00 $65.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck- Building Commissioner File#BP-2017-1145 APPLICANT/CONTACT PERSON PAUL SCHMIDT ADDRESS/PHONE 24 CHESTNUT ST HATFIELD (413)247-5739 PROPERTY LOCATION 296 ELM ST MAP 3IA PARCEL 081 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid 4 b6 Building Permit Filled out Fee Paid Tvpeof Construction: 68 SQ FT, 14" LAYER, R-49 TO KNEEWALL FLOOR 132 SQ FT,R19 UNFACED FIBERGLASS BLOCKERS TO SILL AREA IN BASEMENT 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 INFORMATION PRESENTED: ved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ _ Intermediate Project: Site Plan AND/OR Special Permit With She 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 __ I. . Y. Dela Ate Sig re of Budding 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. __ manisitd UOPPInekt e+ld'S (VMS)PLOW.4090A '6 &M tunid rx tingioaa co we mmtt (ssIaU ovapeteuips 41aU :stoop,/ if }�17 {� {d tq,twaana *7077:6,1.1I r� n {,aau �+ s.N , % G� � Ua scvC}wat � CSSlatiant nabs antidotal 4 6,8--Y - -L�re �� wawo t � � �a ootid,as ar Wart CO - VIC -v 9NRHM8AitYICAt NO340 v iniriOas LO 3LYAOHMI'Imam VallY`1.1 NOOOS NOLLYofaa un-L99-£L4 XSj am-Les-et,suctqd 0901.0 VW 'moi 00L woos PEAS tifeW wauweciaci store Section 4. ZONING All Information West Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Regdneel by Zoning This column to be Mai in by Buildingngterimen Lot Size _ Frontage Setbacks Front _-- --- Building Height Bldg.Square Footage .___._.. Open Space Footage --_.._. ..,.__... ,..__.. —.,. (i.ot area minus bids&paved _.__... '--- wd•iog) #ofParking Spaces _._.,.. ...___: FLU: (votmae et Location) A. Has a Special Permit/VariancetFindf been issued fortoi the site? NO 0 DONT KNOW YES 0 IF YES,date issued:': IF YES: Was the permit recorded at the ry of Deeds? NO 0 DONT KNOW YES IF YES: enter Book Page and/or Document if: B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW G YES 0 IF YES,has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 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 9' IF YES, describe size,type and location: E. Wit Bre constriction activity disturb(oaring,ceding,f� or filing)overt ace or is it pan of a common plan that Will disub over I ace? YES NO V IF YES,then a Northampton Storm Water Management Permit from the DFw is required. SECTIO&- RBIIUFPROROSOM BRKt aBaoeIpatetr) New Howe ❑ Addition ❑ allt amalk AN.Miaye) ❑ Roofing ❑ / Accessory Safi. C7 DemoMiw 0 New Sign pm Pete Sdy�j o BO K/ wfalla..koti >' 8tia 0aaaglddn of Proposed �o -' .5q F" I Iv" Cacf€r 2-'/ `� t) r""�vizr c: rt 4(c)o2. Was,: . - /ll• Li .. �J./ . �E7.1J ti .! , - Amon of existing bedroom res No Adehg nen bedroom Ves /1,- 4/1 c Attaded narrative Renovating unfnished basement Yes J No jrue_cs '-4 Plans Attached Rafl -Sheet a Use of building:One Family Two Panay Otter b. Number of rooms in each family unit Number of Bathrooms c. Is too a garage atm? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of betting? Fireplaces or Woodstoves Number of each g. Energy Conservation Comeiawe Manche& Energy Compfiaca form attached? It Type of construction L isc netuction within 1.r R of wetland.? Yes _No. Is construction within 100 yrfiooWn Yes No j. Depth of..,._- •. cella flow blow fmisied grave k. Wit building.. to the Balding and Zoning regulations? Yes No. L Septic Tate_ City Seam Private well City water Suppty OrMIERS ARM ORIfetiffteitfOReiniffSFOR OBdMfr , Liu/ 1...,rxn e rd as Omer of the subject hereby authorize Lw�✓he-rt-f- k/CAYT ( iniekNC,S, �1C� to act an my behalf,in aft manes rdadve to by this building permit application. Ste., ! 'u --•' -LJr- J`7 1 tom G� r Olde t. r 2c�1 ., !h,n/Of4- as owmat,WBwrized Agent hereby declare that the statements and im&JR4Rhm on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed undm the pains and perelaee of perjury. 7A1l &-.Arnif C1-14— MintName . . ���. // 7 -of♦ Dao $.1 lJmm�ad Not RppFrabie O ({baa of Monis Hokkw: Put &.hM.i d+ I C ACR 35" License Number Address � ke64-r7i�-I- S4'. Paf:CCE Al'nag ono ' Date 7t2d)/t ---2U)Expiration s Tatwhone a - 941-57.E g :: Not Applkable A"n �--" P"' 1111111,161Allr ari 1111 ... : . ti{Igtw / Regio1Numbe/rt -f'a.4r�fctd t YYZr4 Cl 0381 rm `/ Oaoaphone03-aill.573 Waters Cin Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit will result in the denial affix Mauna of the rttemat. Signed Affida'tMarched Yea No 0 The current exemption for"homeowners"was extended to include Owner-occupiedDweafmo 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 saoervieer.CMR 78t Stith Edition Section 198.35.1. fiefinitien of Homeowner:Person(s)wbo 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 Demon wise eek mere than tee home is a two-mar period shall not be considered a homeowner. Such"homeowner'shall submit ba the Budding OffciaL on a form accaptabk to the Building Official,that bedaha MO be responsible for all Mil wort performed amier the Matins permit. As acting Comtrnclien Semervbor 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,von an be Balk 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 .^ - -,h. ao -11,74r/usisubisassus0 IMPIPIIIIPMaoacpwarnMSdaSdaBP assmstp Pus papqnsufaQandswp4Sum(s4,.pus waassommusePP?J arw'iiSuIPPKIsqla■m wee pin was Ocacesiool -�" ` m cr) O1Q FdLc :ems• Atio +s (-kJ ° ) b awio :ma S4b10 ' Pn+1 au ,I, +-nt-tis l-nu y t kC SitiPPY tlWcThl u�c��v i +9 c.u13 0266° :...mwrk+.d,+a aaem .. . 1101 • . 10. UntX0MmAra RISE60 Shawmut Road, Unit 21 Canton,MA 02021 1339-502-6335 ENGINEERING' www.RlSEengineering.com OWNER AUTHORIZATION FORM I. -"11 --ikAn ,._ VANS Owner's Name) owner of the property located at. )-Qc, -EI_ovc I .— )--" (Properly Address) -r tcSN w1 ft"lL 'J K 0 t-O t-7% (Property Address) hereby authorize 5T (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. c- T-1`"` /� �� wner's Signatur-)/ -c/-y/� 15 - t1 Date The Commonwealth of Massachusetts -- Department of industrial Accidents `4TH`>I�_ Office of Investigations *= ' 600 Washington Street zio= i` - Boston. dfA 01111 www.mass.gov✓din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers .Applicant Information Please Print Letibic Name Ili:amm.Organiiation Indo'dual): SDL Home Improvement Contractors, Inc Address: 24 Chestnut Street City"State'Zip: Hatfield, MA 01038 Phone=: 413-247-5739 Are you an employer?Check the appropriate box Type of project(required): I.© I am a emplover with 8 _ J. 0 1 'm a !cner 1 contractor and I employees{fool and'or pan-thnel- h't }sled the euh-contractors 6, New construction '.1.=; I am s sale proprietor or partner- pied on the;urachett sheet i f '. 0 Remodelinc ship and hay e no employees In 'Ib.; it ri. half11 S. 5 ikmol ii on 11 corking for me in an) c ac[O. mt t 1 '.and ha+ workers' tip 9 r n Building addition comp insurance ' eo workers. comp insurance r—r 5 7 Wearea corporation and its 10.1„2 Electric l repairs or additions required.1 r' !am a homeowner doing all urs+rk officer has ea rinsed choir 11 5 Plumbing repairs or additions ink self [No workers comp, right of cce nonan per MGI. I2.5 Roof repairs innuratme requh ed.1" 52. 4 1(4 1 and we ha+c no employ ces IN t workers 13.(] Other compinsurance required.l t app!Ga n 0m check:b4,x a must abk1 rail out the ecu tt a tl rken _rnnm - m policy inhmmarmn. .rAho,tbmh Oh ratIda ru inriaamng they arc Sena an r 1,t.!i are outaidc mntracma must:almt a new affidavit indaatmg such lrecron that click th a ho*must:maenad an additional,lea t a, rano a The nae icamon and awn'x licher Cr not thirst entitim We entioaees Il the sub-a tnracton hacc empin)CO_the n tnl p:rs Idc It ICH uorkU', nip notti number 1 ane an employer that k providing workers'compensation insurance for my employees. Below is the policy and job site information. insurance l ompam Name: Selective Insurance CO .. .. Polk, -or Self-ins.Us: '_ WC9024456 Expiration Date: �(/( x^2/23/2018 \ Job Site Address. . ......_ _/ to th-r) '^3�._. . _-__._... city:State/Zip:. f•(�r_ t'V{ ';C7�J Attach a copy of the workers' compensation policy declaration page(showing the policy number sad expiration date). (allure to secure coverage as require4 under Section 25x1.of Moil. c 1522 can load to the imposition of criminal penalties ora fine up to$1.500.00 and/orone-year imprisonment.us well as cis ii penalties in the form of a STOP WORK ORDER and a tine .0 up to$'_511 tin a day against the violator. Be ads iced thei it copy ofthis swiement may be forwarded to the Office of Ins esti:ations of the 914 for insurance coverage veri tic aeon I do hereby c ' ruler pains and penalties of perjury that the information provided above is true and correct Nig llaturst,i _ _._ Date: !=11—117 Phone= Official use only. Do not write in this area,to be completed by cite or town official I City or Town: Permit/License# Issuing Authority(Sc!.one): t.Board of Health 2.Building Department 3.City:Town Clerk 4.Electrical Inspector 5_Plumbing inspector 6.Other Contact Person: Phone#: A ® CERTIFICATE OF LIABILITY INSURANCE D T MMtDn 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 NAMEALT Cynthia Henderson, CISB Webber & Grinnell eNN mo Ertl: (413)586 0111 uc xol (413)536-6481 8 North King Street nonasss:chenderson@webberandgrinnell.com INSUREKS1 AFFORDING COVERAGE NAILtl Northampton MA 01060 INSURER 3@leCL1V@ Ina CO of S CdZO1ind INSURED 5V E0.8 SeleCtlVe Ina CO of Southeast 39926 _ SOL Home IIDpLOV@IDCRt Contractors Inc. INSURER C: 29 Chestnut Street INSURER D: INSURER : _..... Hatfield MA 01038 INSURER F: COVERAGES CERTIFICATE NUMBER4aster 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 BF 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. LT - -- -- - - -ASUER -- - -- POLICY EFF POLICY ESP - - - - LTRTYPEOF INSURANCE INSO MDPOLICY NUMBER IMM/DDIYIYYI IM WDDIYYYYI LIMITS X COMMERCIAL GENERAL LIABILITY DAMAGE OCCURRENCEO5 1,000,000 DA CLAIMS-MADE X OCCUR PREAGES l RENTED l .. 5 100,000 - -._ MED_DTP5(Any one person) y. _ 92204065 2/1/2017 2/1/2018 MED DTPµiry une person) 5 10,000 PERSONAL BADV INJURY S 1,000,000 GENT AGGREGATE LRrt APPLIES PER GENERAL AGGREGATE 5 3,000,000 X POLICY PRO. LOC PRODUCTS-COMPIOP AGG s 3,000,000 _.. OTHER AUTOMOBILE LIABILITY COaaBINEDSINGLE LIMIT 5 1,000,000 ANY AUTO BODILY INJURY(Per person 5 - - - A ___ALL OWNED i AUTOS x AUTOS SCHEDULED A9100328 2/1/201-72/1/2018 BOOurINJURY Peramaenp s x HIRED AUTOS A AUOS NON-OWNED PROPERTY DAMAGE 5 AUTOS (Re,accsienTs Undernsured mmowl Sr spin 5 100,000 A UMBRELLA LIAB X OCCUR EACH OCCURRENCE 5 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE 5 1,000,000_ DED X RETENTIONS 10,000 52204065 2/1/2017 2/1/2018 5 WORKERS COMPENSATION X SPER TATV TE X OERH AND EMPLOYERS'LIABILITY YIN _ _ ANY PROPRETORPARTNER/EXECUTIVE -- NIA BEL EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED, y mandatory inNH) WC9024456 2/23/2017 2/23/2018 EL.DISEASE-EA EMPLOYEE S 500,000 IDESCRPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT 5 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD101,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. Columbia Gas of Massachusetts is hereby named as Additional Insured per written contract with respects to General Liability 6 Auto Liaiblity, 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 Columbia Gas of Massachusetts THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 4 Technology Drive Ste 250 ACCORDANCE WITH THE POLICY PROVISIONS. Westborough, MA 01581 AUTHORIZED REPRESENTATIVE • C HeRQeeaoc, Ci3F/CI6 L .Meds—f4z.ay ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INSO251folenn