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29-033 (5) 32 PIONEER KNLS BP-2017-1310 GIS#: COMMONWEALTH OF MASSACHUSETTS Mao:Block:29-033 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: WATER DAMAGE BUILDING PERMIT Permit# BP-2017-1310 Project# JS-2017-002175 Est. Cost:$1300.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: RAYMOND PAOLUCCI 063572 Lot Size(sq. ft.): 11979.00 Owner: SCHNEIDER DAVID&HITOMI Zoning: Applicant: RAYMOND PAOLUCCI AT: 32 PIONEER KNLS Applicant Address: Phone: Insurance: 308 BRIMFIELD RD (774) 200-0419 WC WARREN MA01083 ISSUED ON:S/12/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE WET INSULATION &SHEETROCK ON SUN ROOM CEILING AND 1 WALL 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 5/12/2017 0:00:00 $65.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-1310 APPLICANT/CONTACT PERSON RAYMOND PAOLUCCI ADDRESS/PHONE 308 BRIMFIELD RD WARREN (774)200-0419 PROPERTY LOCATION 32 PIONEER KNLS MAP 29 PARCEL 033 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Paid Fee dai Fee P d Permit Filled out t.4 Fee Paid Typeof Construction: REPLACE WET I t. ON&Sf1EETROCK QN SUN ROOM CEILINCl AND 1 WALL New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 063572 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: 1./Approved_ Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan ANO/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 D y '. -- Signature of Btu din i icial Date Note: Issuance Ma 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, Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Rot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address:�np/ (� This section to be completed by office 32_ Pioneer nD l / Map / Lot 033 Unit Florence) 71')A- { Zone Overlay District Elm St.District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Schei cleft. 32 "Pater fr io1/ Florence 7111,4 Name nnt) / J� Current Mailing Address: 56k VAN K /4h orc Telephone Signature 2.2 Authorized Agent: p n� /� ez CIeao j t 4c-irtdi/ 139 6-S/e//urne 94^nnGsdr nheid Na Print ly Current Mailing Address: ,441 , O(30 ( es p ,i 1-113- 77cl-rJ737 Signatu s 1 Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building IVO (a)Building Permit Fee 2. Electrical /'D 0 (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 1/ 6. Total=(1 +2+3+4+5) 1 3 o p Check Number 336,0 ('J This Section For Official Use Only Building Permit Number: Date Issued: Signature:Signature: Building Commissioner/Inspector of Buildings Date hSection 4. ZONING AU Information Must 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 area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Sp tat Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW 0 YES O IF YES, date issued: IF YES: as t permit recorded at the Registry of Deeds? NO DONT KNOW O YES O IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES © NO )15- 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,gradin exc vation,or filling)over I acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION 8•CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: J�/(3 sY -/ Not Applicable(/bb ❑�r}"/�'} Name ofLicenseHaider: I a. Ad -P4 y.iti of CS-04352g- .3° S-("- 4^`�"�`' ` g- Lic .3°V 3r(4(id r� • , , iO �� O�/J�C✓ //g address Expiration Date vlarrrn J MR. Olio 3 Si ure / Telephone P - 77q mob-DW9 9.Renistered Home Improvement Contractor. Not Applicable 0 26514 Company Name Registration tuber Raw %hz'luee/ /hp dun Addres /q Expi tion Date 2 • 13r i/ ' r e/• 1 , Telephone Telephone 77d -Qy// SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(Mal.c.152,§25C(6)) 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 building permit. Signed Affidavit Attached YesNo El _j 0 11. - Home Owner Exemption The current exemption for-homeowners"was extended to include Owner-occupied Dwellings of one(I) 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, Sixth Edition Section 108.3.5.1, Definition 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 person who constructs more than one home in 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 building permit. As acting Construction Supervisor your presence on the job site will be required from rime 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 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 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing E Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding 10] Other[CO Brief escription f Proposed CPI �p'✓•' Wo 12-)C• 9� tc OC).Ce- We+ inSuladlo)1 tS�ieefrock onJSu(✓ �oDM+�Wa7t Alteration of existing bedroom Yes X No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa. If New house and or addition to existing housing, complete the following: a. Use of building :One Family Two Family Other /Aty b. Number of rooms in each family unit: Number of Bathrooms /( c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTORCAPPLIES FOR BUILDING PERMIT I, /�'e�\ I;VQdK t.1�l evizan�Jl It ,as Owner of the subject propeYty �p,�// Clea/11181-4- (-�'/I�, /Y i ,T, yl hereby authorize �-T ua/nv eV J ra I ,v/ l to act on my beha in,all mattes relative to ork authorized by tilding permit application. RO { 1ioC ct 1 Q0� 5 (7 /7 Signature of I ner Date I, ,as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name Signature of Owner/Agent Date 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: 3a T 1 hfEer j1✓IQI' S The debris will be transported by: n�Ain bets/ TRctk�oy The debris will be received by: _7rVQ/?Thant J7 Aar7S cik1/2 Building permit number: Name of Permit Applicant QUa j -Res/ ya-00171 " 51121/7 rRo-k192,0 (7‘ - Qpn, Ata r Date Signature of Permit Applicant The Commonwealth of Massachusetts - I _ Department of Industrial Accidents k L'i:: Office of Investigations illk / II 600 Washington Street � Boston,MA 02111 C leo www.mass.gov/die Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(BusinavOrrganizationInnddiividual):GQ✓a I/ 1 y C IPG Nl/ I� t ' \eJ I t/�rct I l eh Address: /3t( /'soot(, _5/0bAw'/�len Rd '7 City/State/Zip: Get n euvi f pal Phone a: z/�3" / 9r 7737 Are you an employer?Check the appropriate box: Type of project(required). I.IN lam a employer with f 4. ❑ I am a general contractor and I 6. 0 New construction ' employees(full and/or pan-time).• have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.f Z ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] -. officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption perMOL 11.9 Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.0 Roof repairs insurance required.]t employees.[No workers 13/ `Other 9 comp.insurance required] 3 *Any applicant out decks box NI mutt also fill out the section blow showing their workers'compensation policy infotn atioa t Homeowners.4w submit this affidavit indicating dcy pi doing all work and then hire outside coma ton must submk a new affidavit i dicating such teem:actors that def this box must anschol an additional shat showing the Ram;ofNc sub-wanders.d dick workers'comp.policy intonation. fain an employer that is providing workers'compensation insurance fanny employees. Below is the policy and job site information. [ ley/+ ,�/� Insurance Company Name: �gT2PFVe/d?5 i5 res'te- Covnl Q li y / / %r Policy a or Self-ins.tic.a: V 81) & D 15 7 y--Y-/L.'- Expiration Date: 4/1 Cl/1 / lob Site Address:_ • City/State/Zip.. / _ ✓ tit .. . Attach a copy of the workers'compensation policy declaration page(showing the policy number and exp ration date). 'Failure to secure coverage as required under Section 25A of MOL c. 152 can lead to the imposition of criminal penalties of a fore up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form ofa 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. I do hereby certify u der the pains and penalties of perjury Menne formation provided above is can correct. Signature: !�ack ainGf.(Z(p.�t�' I/,/t7(� Qt KE�Date: `�7Z/7 Phone a: i 1`7 " �cQ -V-t �-i Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License If Issuing Authority(circle one): L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other • Contact Person: Phone a: t(Arm(cric(f/i/r; M,u,,4,,.,,, Office of Consumer Affairs&Busing s Regulation 7)= r HOME IMPROVEMENT CONTRACTOR TYPE: Individual Registration 0x 12019 16 106016601/1812019 Ray Paolucci Ray Paolucci 308 Brimfield Rd. P.O.Box 1226 W arten,MA 01083-1226 Undersecretary ®, Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-063572 Construction Supervisor RAYMOND C PAOLUCCI 308 BRIMFIELD ROAD PO BOX 1226 - WARREN MA 01083 Expiration: Commissioner 0611512018