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29-093 (2) 17 HOLLY CT BP-2018-1065 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-093 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeorv: INSULATION BUILDING PERMIT Permit BP-2018-1065 Project# JS-2018-001925 Est. Cost $3000.00 Fee: $65.00 PERMISSIONIS HEREBY GRANTED TO: Const Class: Contractor. License: Use Grouu: PAUL SCHMIDT 103635 Lot Size(so.ft.): 12980.88 Owner: Trevor Powers zonine: Applicant: PAUL SCHMIDT AT: 17 HOLLY CT Applicant Address: Phone: Insurance: 24 CHESTNUT ST (413) 247-5739 WC HATFIELDMA01038 ISSUED ON:4/18/2018 0:00:00 TO PERFORM THE FOLLOWING WORK:960 SO FT, 13"LAYER, R-45 ADDED TO ATTIC FLOOR, OPEN BLOW CELLULOSE 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 sienature: FeeTvpe: Date Paid: Amount: Building 4/18/20180:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner City NdW ton,....:: Building - " ment 212 Main Street Room 100 Northampton, MA 01060 phone 413587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH AONE OR TWO FAMILYD�WELLING SECTION 1-SITE NJFORMATION Jv^ O'1 oa{ 1.1 ProoerNAtldnse: as- SECTION 2-PROPERTY OVINERSHIPIAUTHORED AGENT — — 2.1 Owner of Record: LVD fL / u✓JP1S �� e '{- Name(Prin[) `` Cumen .AtaAmg Acj(a. ^ OQll� Tel ns �r �/ Signature 2. Mrtrad Aeent: SbA. �- P✓n1%�°L-M-4�j' ��5.�'G Name Cwrent Melling mcinesys: 6)6. 8- nature Telephone SECTIOU 3- Item Estimated Cost(Dollans)to be Offidal Use Ordy compliated.by parmit applicant 1. Building ` b`x�a (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Censvuomfmm 3. Plumbing Bulding Permit Fee s/YY'�/r0es- 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) (' ." Check NumberaJr.) ly r.&ft,0w±?EMMldfn Gelb Date Building Permit Number Issued: Signatu �/� l� Bull" Bob EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING Alt Infarrrra m M Be completed.Penmt Can Be Dented Due To Incomplete Infometlon Existing Proposed Required by Zoning T am anwbelf dmby sWkbm OcpsAvmt Lot Sia Semacls mit Side L=R_ L. R: Rte Building Height Bldg.Sq—Footage % Open SpaceFomp .___. ___ % (Ida amimebldgRpwe ___.. —._ PwIdum #ofpwking SPwes Fill: A. Has a Special Permit/Variance/Flbeen issued for/on the site? NO Q DONT KNOW 0 YES O IF YES, date issued: IF YES: Was the permit recorded at the Regi ry of Deeds? NO © DONT KNOW YES IF YES: enter Book page. and/or Document# 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 © Obtained © , Date Nsued: C. Do any signs exist on the property? YES © NO Q-- IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES © NO Cr IF YES, describe size,type and locatlon: E. Wdl the wWjucdon a"dirgtab(^�rg,gratlatg, m fUWV)over t acre o is K pan of a common plan that vdB d igurb over i acre? YES( NO IF YES,then a Norlhempam Storm Water Management Penna from the DPW m requeed SECTION s DEScsernWOF agROg") New House ❑ Addition ❑ Replacement Windows Afteratlon(s) ❑ Roofing ❑ Dr Doom ❑ --'' Accessory Bldg. ❑ Demolition ❑ New Signs [O) Deeks [171Siding // �Othor[ Brief Desc tion of Pro ose¢—, {A�• � c"C'� 1 Work: f(o0 S4 Yrt Alteration ofexisting bedroom_Yes No Adding new bedroom Yes o Attached NaRRenovating unfinished basemen[ V/ No Plans Attachedhed Roll -Sheet a. Use of buildingOne Family Two Family Other 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? In. Type of construction i. Is construction within 100 ft,of weti s?_Yes _No. Is construction within 100 yr. floodplain_Yes_No I. Depth of basement or cellar d below finished grade k. Will building conform to th wilding and Zoning regulations? Yes No. L Septic Tank_ ity Sewer_ Pnvatewell_ Citywater Supply_ SECTION 7a-OWNER 7d7FHORDfATKM-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BURJ MiG PEfMR7 I, .as Owner of the subject property hereby author¢e .��l.. -l'K1I'Yl.� h'L�YJJJ'E/y-y/'S�' L h✓l�Y0.c.'/Zo/'S -LIl to act on my behalf, in all matters relative to work autlilorized by this building permit application. 4"—"— Sonatas Owner Date I 14aI S M/ d-4 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. Sig under under the pains and penalties of perjury. F6auI ,')0-AM1'14-- Print Name U- y3 -/8 siglo of M Date SECTION 8-CONSTRUCTION SERWCES 8.11- n nmmiEmS r: ( Not Applicable)❑ Name of License ,,r d/T - 163CL�J License Num 77P6 a2o � y Atltlres sExpiation D to S Mure A, Telephone .._ A - " Not Applicable ❑ SSL- -40ryw �n,an,,re,r>p.�f cfvcs, � h'S�/s CoN/nI /I Registatlon mbeN r Address y�� /L Expiration to i� I r ✓ Irf ��Q'�� Tell �UT /��� SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.O.L.e.182,§25C(6)) Workers Compensation Insurance affidav;m t be completed and submitted with this application. Failure to provide this affidavit will resuk in the denial of the issuance of the buddin emit. Signed Affidavit Attached Ves.._... No...... ❑ City of Northampton / - Massachusetts LIEPAN'14$ffl' OF BNZZDZNG ZNBFSCTIONa 212 Main Sircec •Munic>pal BuilEing NorthYYpton, MA 01060 Debris 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. The debris from construction work being performed at: zu (Pleaseriot house nughber and street name) Is to be disposed of at: nn 7V��eXn s �7 VY- 6t (Please print name and location of faci ty) Or will be/disposed of in a dumpster onsite rented or leased from: -A 14:p 4hAddre� v tz/o, bnCi (Company Name and ss) 'gignature of Peffinit pplica or Owner Date If,for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. City of Northampton i Massachusetts 5.." DKPAR1 OF BOILMM INSPECTIONS 212 lYin ip • [Lnicipal HuilQ3vq Northampton, !e 01060 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes.Prior to performing work on such homes,a contractor most be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction, aherefion,renovation, repair, modernization, conversion, improvement,removal, demolition, or construction of an addition to any pre-existing ownerbccupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence cr buiding"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered 1 a Type of Work:_ a.-('ION Est Cost: 3tLXcz) Address of Work- / )acd ( n� i— Y O1Zn L� m i4 Date of Pemut Application: I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): —Job under S 1,000.00 _Owner obtaining own permit(explain): Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITIES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building PM.t as thea agentof the o c V� L4 L xhrvu Date Contractor Nkrie Ckc,&5,ZfY—HIC Registration No. OR: Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature RISE60 Shawmut Road. Unit 2 Canton, MA 02021 ENGINEERING OWNER AUTHORIZATION FORM Trevor Powers (Owner's Name) owner of the property located at: 17 Holly Court (Street) Florence, MA 01062- (Town, State, Zip) hereby authorize 0000 t_ (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 homeowner's responsibility to close out this permit by contacting their municipality at the completion of this work. 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N:a _ .OVFRAGES CERTIFICATE NUMBER" 'xy - HEVISIONNUMBER. 4 n"tl- A +]azu r, if o .M;a .,a ;'. Mus E F.aet[a - .•.. a_ . �. � au..a: CERTIFICATE HOLDER C.ANCE,TA'SON N' ABOYI D 4GK1'l ops„gF68E JV^ FFTFO^ )PTF THEREOI NOTICE W4_ H1 ]FNERED M 2C T- SYN 'NO 'JR)A4C> ry nf-§JIIC�PROV1310N5 '988 102E ACORD CORPORATION AU*gets reserved ACORD 25 f201e101; The ACOR. ..am. n.1.i no. .,IN,.F rnsxa of ACORD 'NS025 - -.