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42-102 (2) 262 WEST FARMS RD BP-2018-1390 GIS#: COMMONWEALTH OF MASSACHUSETTS Man:Block:42- 102 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-2018-1390 Proiect# JS-2018-002468 Est Cost$2000.00 Fee: S65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group PAUL SCHMIDT 103635 Lot Size(sp.ft.): 23130.36 Owner: DURYEE CHARLES C&VIRGINIA E zonimc Applicant: PAUL SCHMIDT AT: 262 WEST FARMS RD Applicant Address: Phone: Insurance: 24 CHESTNUT ST (413) 247-5739 HATFIELDMA01038 ISSUED ON:612712018 0:00:00 TO PERFORM THE FOLLOWING WORK:ADD 8" LAYER OF R-30 TO GARAGE CEILING; 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# 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 627/2018 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck-Building Commissioner - Iasi+ File#BP-2018-1390 APPLICANT/CONTACT PERSON PAUL SCHMIDT ADDRESS/PHONE 24 CHESTNUT ST HATFIELD (413)247-5739 PROPERTY LOCATION 262 WEST FARMS RD MAP 42 PARCEL 102 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED Oil"!�� Fee Paid ��- Building Permit Filled ou Fee Paid TvueofConstruction: ADD 8" LAYER OF R-30 TO GARAGE CEILING: AIR SEALING AS NEEDED New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 103635 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOIYMATION PRESENTED: _Approved_Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:$ 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 Demolition Delay �Sgna re of Building Oj/p/�) r Dat NWe: Issuance of a L�a�dg permit does not relieve a applicant's burden to comply with all zoning requirements and ob n all required permits from Board of Health,Conservation Commission, Department of public works and other applicable permit granting authorities. r Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. V E D 1ty of Northampton wilding Department 212 Main Street 18 Room 100 N hampton, MA 01060 412 -587-1240 Fax 413587-1272 DEN INS CION! NORINN.tPTON,MA 01 APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR WAONERDWELLING SECTION 1-SITE INFORMATION 1.1 PnooeMAddreas: rids,sawassival,be gemwombw4o- �Lca s -n..4 ,., 1 L tit I oZ t rniq g C) 16 CP � Elm&.DW1e CB DBtrkt 1 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Ownero Record 11rnI me(Pn ) `;Ll fir . Ly Tebphone Signature 02horiedA a /' 1 L/ (�ssNn st Sttxf�er d n?r9 Name Current Mailing Address'. Cj/V3bi nature Telephone SECTION 3-ESTIMATED 0aWALMMIM COSTS Item Estimated Cost(Dollars)to be Official Use Only comaktild by permit applicant 1. Building gr (a)Building Permit Fee 2. Electrical (b) Estimated Total Cost of Carekusgon from. 3. Plumbing Building Permit Fee n dj4. Mechanical(HVAC) S 5. Fire Protection 6. Total=(1 +2+3+4+5) MO. Check Number Tkft alleges FarDdiphl Was 01* Dab Building Permit Number. Issued Signature: Building Com ofBWtliogs Data EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONE] ONING All Information Must Be C"teted.PemNt Can Be Denied Due To Incomplete Infonretion Existing Proposed Requbed by Zoning Thisrulumv m 1,ad in by Bm'Idig ilcpmmmt Lot Size Fronualle Sethacks Front . _. Side L_R: -_ L: R. . Building Height Bldg.Square Footage ....__. _... .._ % Open Space Footage __. % (Win arta minus bldg&pevrd 4 ofParking Spaces _... . ._.... A. Has a Special Permit/Variancs/Findi ver been issued for/on the site? NO O DONT KNOW YES O 1F YES, date issued:. IF YES: Was the permit recorded at the Regi ry of Deeds? NO O DONT KNOW YES O IF YES: enter Baric Page - and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW a YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained © Date Issued: C. Do any signs exist on the property? YES © 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 ©' IF YES, describe size, type and location: E. VAI the mrNlruction activily disturb( hg,grading. or filling)wen t sure or is it pan of a common plan that will disturb over lam? YES � NO IF YES,then a Northampton Storm Water Managernerd Pe rnb from the DPW is required SECTION 5-DESCRIPTION OF PROPOSED WOW teheek all applirakl.l New House ❑ Addition ❑ Replacement Windows Alteration(.) E:] Roofing Or Doors 1 ��/��/ Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Sitting�Other[ / U' BriefiDescription of Proposed/� �/ SCi /�A'/o/� s ( i L iS �/i O�' fM1T(1D eratioe4zis ing ro Ves No Add ne bedroom Ves ✓ No Attached Narrative Renovating unfinished basement Yes ✓ No Plans Attached Roll -Sheet a. Use of building '. One Family Two Family Other b. Number of rooms in each family unit Number of Bathrooms c. Is there a garage attached tl. Proposed Square footage of new construction. Dimensions e. Number of stories? t McNod of heating? Fireplaces or Wootlstoves Number of each g. Energy Conservation Compliance, Masscheck Energy Compliance farts attached? h. Type of construction i. is construction within 100 ft.of well s?_Yes Nc. Is construction within 100 yr. floodplain_Yes No I. Depth of basement or cellar 0 below finished grade k. Will building conform to th wilding and Zoning regulations? Yes_No 1. Septic Tank_ Ry Sewer_ Privatewell City water Supply_ SECTION 7a•OWNER AUTHORIZATION•TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 11, as Owner of the subject property ' I hereby authorize )_ 44—ol R- -1M�/!i✓'E/Yy/7'�' to act on my behalf, in all matters relative to work aut onzed by this building permit application. Signature of Ovmer Date 's 1, 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. Signu�pQ under the pains and penalties of perjury. Fra ct 50 )M1114-- Print Nam�e //) Sig ure of I Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supmli Not Applicable "❑p Name of License Holder: d J ,3i J License Num S� Lfthi yTR-r�121 / .r� U p�3� ba / ,S pO 42 og Addres Expiration Dlike 5 azure Telephone 9. Not Applic`ablle ❑ S}�LMe. Omf2 rry nf- C�tDGS; Tii � �'�7YfS Company Na Registration mbar Adtlress Expiration Date g+ aid M,4 Dlb3� Telephon ��7 �3 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(S)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial ofthe issuance of the building permit. Signed Affidavit Attached Yes...... ❑ No_.... C City of Northampton Massachusetts c IZPlla19ffi!T OF BpZLDZNG INSPECTIONS 212 Min st—t eMunicipel suilaing `' . NOrthe tcn. N.e 01060 Debris Disposal Affidavit In accordance of the provisions of MGL c 40, 554, 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: � nn n PGZrMS (Pleasseeprint houseenumber and street name) Is to be disposed of at: (Please print name and location of fa lity) Or will be disposed of in a dumpster onsite rented or leased from: Al- �o'V �40=1aC', o (Company Marne and Ad rass) I �!1 1-g�GCT7�7C191 OCL §ignatue of Peffinit Applicaff 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 Massachusetts a ➢SPARTd9:NT OF BUILDING INSPECTIONS 212 Win Street • Naninipal auiidi, , Northampton, W 01060 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation f'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 must be registered as a Home Improvement Contractor("HIC"). M.G.L. Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, ocnversion, improvement,removal, demolition, or construction of an addition to any preexisfing owner-occupied building containing at least one but not more than four dwelling units._.or to structures which are adjacent to such residence or building"be done by registered contractors. ,Note:If the homeown r has contracted with a corporation or LLC, that entity must be registered oC� Type of Work: -� Est. Cost: �[`Y7 Address of Work: [Q of �, rY Crvl-S Imo. Date of Permit Application: I hereby certify that Registration is not required for the following reason(s): —Work excluded bylaw(explain): Job under$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 RESPONSIBILITES 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 P931M.I as the agem of the o�tt�r yN it 5cV1Mia--h Date Contractor N me +yZLckvf-5, HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building perrim as the owner of the above property: Date Owner Name and Signature Permit Authorization mass save Form Site ID: 3416878 Customer: CHARLES DURYEE 1, Chna IeS DIj R�e e. owner of the property located at: W Q R`r I(7et,i Neme,PrOted) r�0 262 F.torenca.8t� � MA 01062 (Proven,street Address) latvl hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherbation work on my property. (J Owner's ^,aafi1,l Signature: d� O,QJ Date: ;} /�I; FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Name: CLEAResult Phone. 800-480-7472 Email: Fe,Ciff—uie a my Rev.102015 The Commonwealth of.Massnchuselfs Department of lndarstrial Accldem.% Office of Investigations 600 Washington Street ' Basion, MA 02111 Sa n�_•'� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/( antractors/Electricians/Plumbers Applicant Information Please Print Legibly Fame nwzmc.,urea.uat lndl,,J,W,: SDL Home Improvement Contractors Inc Address: 24 Chestnut Street ds'Statei7.ip. Hatfield, MA 01038 _ Phone »- 413-247-5739 Are you an employer?Check the appropriate bov. Type of project(required) ', 1 am a emplo,cr ,nh1. E] I am a u.ncral nlractur Had I -� ha,e hired the uh ,onnacmrs o. L7Sew conslrucnnn emplo}cu(full and or part-lintel.' _❑ I am a sole proprietor or pannei- ti led on the a11ached sheet '. Q Remodeling ship and have no employees I h,,,- .oh-contractor, haw a_ ❑ Ikniolition working for one in any capacity. emplu,ee,and hu,r i,k,,, t lNo,sorkers' :onto. insurance ml imuranee. Budding addition reyunedl S. ❑ N r ,�ogn,retiun and u. 19.❑ P.h tncal repuus or additions �.❑ l an a homeow ner doing all cork of7iccr, ha,ceycraud their 11 E] Plumbing repairs or additions m nelC Nu worker' col )gin (ry<mpb Ir M n , iil. I P I_❑ Root repair, insurance required` I -ItJrand have nn mol x,. VSs ,rken 1i.[2Inher IneUlatiOn . coni insurance required] '4r,. at,hca i nua imak,IN,a I na,l ahu hll nal dhc u-a..m dnlmr 'l— ms lho,..... ., inrcn.alna Iv.hc, marmauan 4,tne-1, dsit, in",hllldmd.,id,nlmy tKn ale dome all e.. ml@en Lucy"".d, of wd.ubmnemx alh"'a d,.a, 11 d. m '' nm t.,mruetnrz,aaells.thuMmints onpkl,an a0w,00 +' .Lyn.pre ' mdm.ofthewGhon wlm.anA.mm wRJv sirm4dMrw emiuu,hate mnlntW Irlhc arh-comractnrn M,campin3as.lhe> musl'—d'0"" .,.dc. . m0 lwh.rn mhe, I am an employer that is pmvldwg workers'eompeasation insurance for mr•empMrees. Below is Ike polier and job site information. Insurance Compan; Name: Selective Insurance Cc Policy '+or Self-insLic +. WCr9024456 I.ypiranot Nate 02/23/2019 ' ' \ iob � 4-Site Address'.arf[. ._ ,"LL.f�r 1, K-�k _ t'ity State:Lip'. ,- ard1(�r� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 35A of MGL c IS'_can lead to the imposition oferiminal penalties of a line up to 51,500.00 and or one-year imprisonment,as W eil as:i,,I penaltias in the form of a STOP WORK ORDP.R and a fine of up to 5250-00 a day against the violator. Be advised that a cope of this gatenient may be forwarded to the Office of Investigations of the DIA for insurance ccoereg,verification I do hereby leen, si/ster I Pak"a el pesiahrcs of per/un'that the information provider/aboree_is true and carr ect Sint Phone° . .�.✓� _7_.5 /`3/_._- . Offkial ase only. fM nm wrhe in this area,m he completed hr.in sir mow oJjklnl. Citv or Town: _ Permit/Licease n Issuing Authority(circle am): I. Board of Health 2. Baildhig Department 3.(:'ity/Tuwn('lerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone 0: AC De CERTIFICATE OF LIABILITY INSURANCE el�isi o B `� 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 Me cenlNcate holder IS an ADDITIONAL INSURED,the policy(")must M endon wl. H SUBROGATION IS WAIVED, subject to the terms and condllons of tM policy,canal,polktes may require an endorsement A staeement on this camflcate does not confar rights to the cartill holder In he.of such endorsements. FOeTACH ooucER IXAaF. Cynthia Handerson, CISR Hahber c Grinnell 1 .. Ea9 (0131586-0111 plUwc owl uvlsa S-1/i[ 16 North King S<raetfKAIeae.chenderacn8wabbarandgrinnall.com INBURERIeI AFFORONG CWERAGE 4a1CA Northampton NA 01060 RauRERA:Selectrve ins Co of S Carolina IxauREO NSURER11:94010ctive Ino Co Of Southeast 39926 SDL Home In,rov,mant Contractors Inc. ,NSURERc. 24 Chestnut Street NSUREa0 NSURERE 'Hatfield NA 01038 ,IXSuaERF COVERAGES CERTIFICATE NUMBERNester E" 2019 REVISION NUMBER: ! THIS IS TO CERTIFY THAT THE POLICIFS OF INSURANCE III BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOp THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REWIREMENT. TERM OR CONDITION 01 ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY IHE POLCIES DESCRIBED HEREIN IS SUBAC' TO AIL THE `FRMS. FXCI USIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED HY GAIO C'�AIM9 TSR PE OF IXEUMNGE AWl9V9R PM`.CY NVNRER POLICY Eff PoIYY EIP LIMnS R X COMYERCAL GENERAL LIAMLITY .i IN Nl, I 1,000,000 VAGE TO I11110 100,000 A AIMO NAII X 11117 NE.,I,B L --._e 9R10W 6S ./'✓2019 LR/x019 ♦r_.% ,<nr aw wrto _ 10,000 HEON,,..s ADX .,OH. s :,000,000 - AGUIIIa ,0M711111C1 PER GYVI IA 0.,U.1,-. 1 S 3.000,000 A X 'O=Cv JEC ,0: IH.v_..LS 1111`01 All 1 3,000,000 R F roulDNEONNIAUTOAI LAsuny it..1 F 1,000,000 A ATO ROnIIV NjlRy Iv AL,11.111 X 11T.1DllI, 493003]8 1/:,2019 :1112019 ✓O1/. .i .. vd n[... S X I-.RCCA'-TOS X NON-0rxEf. PO'4d O MAGE y W E 100,000 X JWPEUAWe X . OG^i,R n,'. 00LURIINII S 1,O0O,D00 A ERCEfa LIAR (;,pIMS MAGE no,.._;A*L s 11000,000 OEU X NEiENIIONf :0 000 1220065 l/1/20:8 1/1/2019 - N04ERaCOYKXYTIOX X X f9H AND EM LOYEW LNYILRY �rl-F.CEO EF9ER� 6w0RKFT1I , yr YyNLN IA [A .1 Pre 1 500,000 B IpaPWpOMNN) EC902110E "IV"-e ,''9 OC 9 :I F VP,O1EL'; 1 500,000 OX CNGnaN OOP IgN5 mox DISE S_ 10 CJMn 3 500.000 i OEECRIPigN Oi OPERAndla/ear. . Vcl.c Ido. Im,bbl it Ruch [OeWa,mry Mror<NM tlmon Scheidt, l �i'he Norlwra Companaation policy does net include covecage for Panl 9chmldt, Kentlzick D.mpaey and Douglas SOM1dt. !CLEAR...It, Evazaourca and National Grid, NSTAH, Beaton Ga. CP. . Colonial Gas Co. , Xaaaa Gas Co. , and `Western NA Eeleetric are navlad as Additional insured per written contract with rupaets to Cenral Liability for work parforned and per the terms and conditions of the policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CLEAReeult THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Contractor Service. ACCORDANCE WITH THE POLICY PROVISIONS. 50 Washington Street, Ste 300 RUTN Westborough, MA 015181 ORIZEO PR REEaENTAiIVE C 19362014 ACORD CORPORATION. All rights reserved. ACORO 25(2014101) The ACORD name and logo are registered marks of ACORD INI:,