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38B City of Northampton Massachusetts DEPAR27MVT OF BUILDING INSPECTZONS 212 Main Street M Municipal Building Northampton, MA 01060 Property Address: r + i Contractor 1 Name. `� )x- C',-- . Address: " City, State: t �r Phone: Property Owner Name: t 1 - Address: - 00 City, Mate; .. . � fvo 6 (contractor)attest and affirm that the building I intend to insulate does not have any open air (Knob and tube)wiring in the spaces to be insulated and that I have provided the property owner with a copy of this affidavit. -'" Contractor signature , x r Date DATE JNWD[)fYYVY) CERTIFICATE OF LIABILITY INSURANCE — 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 AL-TER 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 MOLDER. ............ IMPORTANT: If the certificsits holder Is an ADDITIONAL. INSURED. the Policy(ies)roust 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 endorsornsings). PRODUCER NAME Cynthla Henderson, CrSR Webber & Grinnell PHONEFrac ijw, �No,P-X 111, (4111'?0586-01111 (AX,"j, 56 9 North King Street EMAIL AD"Ess che.-idersonC4webberandgrinn*ll.cos. AFFORDING COVERAGE NA4C 11 .Northampton MA 01060 N8URFRA:SQlQ(-:.1ve Ins Co of' S Carolina INSURED NsuftRb Seie-wive Ins Co of Southeast 39926 SDL Home Improvement Contractors Inc, dNSURER 24 Chestnut Street INSURER I,1 4SURER L Hatfield MA 01038 NbUREitr --COVERAGES CERTIFICATE NUMBER:Maeto EXp 2019 REVISION NUMBER: ................. 118 IS 'TO CERTIFY 7HAT THE POLICIES OF INSURANCE ILISTEC,"SEL,"'WHAVI5 BErN, !SSLJ;l P, I'll �'HF INSURFC)NAMED,ABOVF FOR�HF PC)I,ICV PfRJO(', ft;)CAVV ) KJOI ;;`�q$,ANOIING ANY REQUIREMENT E'RM OR (,()N�A�1(),N lllli: A,,k,,v CONTF2A�- OP OTHER DOCUMENT W11H )211'1,;PFC1 1 0 WtA!Cl' C'ERTJFi(.ATF MAY BE !iSlJ,7D OR MAY Pi RlAiN, ;,,+ NSUF-(AN(141 /,! ;'OkOf i DESCRIBE[) "FREiN iS SUBJEC�' 'C' A��., THE I!IRM,S i XC;U'SiONS AND COND:TIONS OF SIUCH PO;LiCIES LIMITS SI-,'(lVVN t,0,AWfi,BEFN RFI)W, l)B PAID CLAIMS $ TR .TYPE OF INSURANCE, AU17. 11110 4C y E$Vf C V fXP POLICY NU OMITS X COMM ERClAl.GENERAL UABILI TY 1 0 0 01 0 0 0 A A MIS x DAMA(C PC-NTED 4 100,000 V11 r. A, "A', c l;U x PRO Ali tOMORILE t1A6ILI1Y A X A, A.9 X At, x W)N(I VI^E X UMBRELLA LIAO X U'RkENC A Excess LIAB XQ 000 COMPENSATION AND EMPLOYERS OABILiT I X TTU x NA fMandatory io NH) WC902445650r, 000 A��,; tA i''C'WC Y s,.ir1V300 0.00 DESCRIPTION OF OPPRATIONS LOCATIONS i VEHICLES IACORD 101,Aadl-1,nnai 'lay r4 The Workers Compensation policy does not incholo, :.-overagIe for Pali St,,hmidt, Kendrick Dempsey and i)ouglas Schmidt. Columbia Gas of Massachusetts a.a hereby named as Addit -onai Insured per written contract with respects to General Liab.ility b Auto Liatiblity, for work performed, and per, the terms and conditions of the policy, ——------------ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANrELLEID BEFORE Columbia Gas of Massachusetts THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 4 Technology Drive Ste 250 ACCORDANCE WITH THE POLICY PROVISIONS. Westborough, MA 01581 AUTHORIZED REPRESENTATIVE 191118-2014 ACORD CORPORATION, All rights re"ryod. ACORD 26(201"1) The ACORD name and logo are registered marks of ACORD INS026 The t"witmonsrealth raj :Ifaysachosetts Departmew q/ Industrial 4c•cidents C) Jic°e q/Investigations : . 600 t4"ct8hingtrlrr Street flostom MA 02/11 www,mas,8.gov1dhj Aortcers' (.'otnpensation Insurance Xffitiaviv ftttilders.4 t)ntraetrx 3 ,lectrici ns/Piuttnbers Anpli;cont into onPlum P I —exikk SQL Name Improvement Contractors Inc 24 Chestnut Street £t•4 �t tt 1� Hatfield, MA 01038 _ 413-247-5739 _..__,_._......r��,....._ ?. ..<:_,.� sry Nou an employer"Check the appropriate ho Type oft>rojr(required) tT 3�,'1ti*# #iRs iia r,ti"l7iirt Itriic' ,et"t 1 rtrt;i letter err partner, iit tt Iit: .Yah '. f ltet'llodel, . her,.?flat haV #ifs tmirilo) ce, ._••.. ...., t ',nTfil itla'tit z i'.$ Nw4fing addition j''4,U x�ilrA.a.'#"`� Ci3rtlli_iii'it.9rxi€3t,'t . -ti9; .: I'lectric°al rcpa ,of ;idd'ttion, z �1 !�1tbi lc 41 ic'tl<ttrig,a l9 %%or'k 9c'T b Plumbing repairs or Atit�TtaMs , tghl i '+E.fi£pli,ii per \4, ry 5. { 7i ei i`` �wrker', Ci76nr`� Roof repairs a ivuoircci •. % �, �.; ;.� tsnl� 'r2i'. (0er Insulation ,.a...r.,v hx Jw:k tN,Nwk im4st retutc.iu;J an aKWAiwi4w, k ..,. and'faii v0wtfwr or Mot th='Vv:°3Y3ttkt;,ics'stc i zi% tib—.raiwf,W,htikt::.01,eacc,,tries,inivo pi, I am utr errt�lrtexr�is Isrrt��worlitrx`t°f:�nr�rrrv�z ir�.�r�rurrc r fc�r rpt°t� l�r� I�w�� tc�� d►s ittlarrr�rai�,rt. ln,e}rarwc tz'tintpwl\ carne: _ Selective Insurance Co WC9024456 �,Plrafic>ti Date 02/23/2019 ,ti sifts Ad�tres f_�.x,.e C'lt }C�C}� ��. (jt C`_s tL'�tts�?� li� O���✓� Attach a copy or the (showing t1w policy numbier Mull tx irati 4*1114 I ii funs tee secure Dov ragge as required under Sec;tto;. 1"' ,av tc<id to the ttrmetsition of criminal perialties of si line ilp to �1. t3fl.ttfi aridhir ttt�-ti°�:tr int�rr�tanrtict �.;. :• ft attt� t;?lae rttt'tia cif a`�'1`<�I'tt4'(:7 1�c.)Pil)f;It Ari t t li 3 against #„ l'l y1 3tt the t1t tray he foti* rd I to the Office M ,,>t�tip to�S_�"t)€H>a cla���sf,�tr+,�t thr ktc>tatear. Be13c cac3�l;es�; <. netts igretiown of Jit DIA for insurortu 1 do heretic°ce oder porins andpienalriet of joerjorl that fit. i1jorwation provi*d above is irme amd cr re€i. .. ....._.. .. __.. I'lx>rc — c;2 t)�In;ial rase ojiq , Do not wr X14 area,to be cs)mpteted hi'cif or tr wo gfft t f C,tt%err 1 own _._ i't rr»itft icer r# Issuing!Authority tcirtlt t ea: 1. Boars!of Htaft 2. bulifttg Mpartawal 3.t its:'t trotn t lork 4. Electrical Insowtor 5, f%wibift Inspector 6.Other f t_(intact Perm: Phone#, RISS. ENGINEERING' OWNER AUTHORIZATION FORM 1, Rachel Schneider (Owner's Name) owner of the property located at, 1 Ed2ewood Terrace (Property Address) Northam p Ion, MA 01060 (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. Owner's'Signature Date RISE Engineering,a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 1 Canton, MA 020211 339-502-6335 www.RISEengineering.com City of Northampton f. Massachusetto .rBWARTAMT LSF` Br XZDXM XNSPACTIONS 212 Main Street w Municipal Building Northw*ton, MA 01060 AFFIDAVIT Rome Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("t ;AIIR")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 CHIC"). M.G.L.Chapter 142A,requires that the"reconstruction. alteration,renovation,repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-oxislrng owner-occupied burg 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 regkftw#d contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered� e� d yN of Work:._......�.2.�4�.Ui'�.,....___...._ ,,__ ___._. _ . _ Est.Cast:_ ���L./ Address of Work:--/.� , �j_ ... Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s)- Work excluded by law(explain). _­_._._.__. _ Job under 51,000.00 Owner obtaining own permit(explain): __„_........._ Building not owner-occupied Other(specify)_..-.... ... ...................... OWNERS OBTAINING THS OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE ROME IWWVEMENT 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 RESPONSIBII.,ITES FOR ALL"WORK, PERFORMED UNDER THE BUILDING PERMIT.SEE NEIN PAGE FOR MORE MFORMATION. Signed under the penalties of petjury: I hereby apply for a building t as thea nt f the o r: WL& (- �I IT //- - 5 Date Contractor Nimei 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 City of Northampton Massachuzotts MWAIRMINT OF BVILDZM ZMWSCTXONS 212 Main Stre*t *Municipal Building Northampton, M 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; E -4c4e2L dQ P_lt Doc-)r-4 (Please print houte number and street name) Is to be disposed of at* ci (Please print name and locationoff lity) Or will be disposed of in a duf22ter onsite rented or leased from: A- ompany Name and Address) %igna"turiof Peffig*Ap&, or Owner-Date If,for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall noW the Building Department as to the location where the debris will be disposed. SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Con&Uvcdw / Not Applicable Name 91 Lie=Hold- M j License Numbe' Addres Expiration Dke S ature Telephone s _.,. .. Not Applicable 13 " Address Expiration ._ _ _" SECTION 10-WOM(ERW COMPENSIATM01WRANCE,AFFM*ff CM.G.L.c.182, 25C(6)) Workers Compensation Insurance affidavit ,St be completed and submitted with this application,Failure to provide this affidavit will result in the denial of the issuance of the buildiriepermit. Signed Affidavit Attached Yes..,..., EVIdo...... 1 New House C] Addition Replacement Windows Alis Vdon(s) Rooting ❑ j J Or Doors 17 1 l Accessory Bldg, ❑ Demolition ❑ New Signs (©) D+rcks (Q Slding�tkis+tr[M1, ! I Brief Description of Proposed Work: (' Q � Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes ✓ No Plans Attached Roll -Sheet 60. i a. Use of building: One Family Two Family Other b dumber of rooms in each family unit: Dumber of Bathrooms 1 c Is there a garage attached? d. Proposed Square footage of new construction. Dimensions j e i e. Number of stories? y I €. Method of heating? Fireplaces or Woodstoves Number of each g Energy Conservation Compliance. Masscheck Energy Compliance form attached? I h. Type of construction I Is construction within 104 ft, of wetl s? Yes ___..No. Is construction within 100 yr. floodplain Yes No Depth of basement or cellar below finished grade i t k. Will building conform to th uilding and Zoning regulations? Yes-No . 1. Septic Tank ity Sewer Private well City water Supply StECT*N 7a-OVIMIR AMPa,", -T`01- COMPLETED I as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to worts a orized by this building permit application, 5 ure of 0WW Date 1 1 ! as Owner/Authorized Agent hereby declare that the stoWments and information on the foregoing application are true and accuraise,to the best of my knowledge and belief. Sign under the pains and penalties of perjury, Prin,Marne sig of Section 4. ZONIPGU All IrrfwMartion,Wart Be cam*ted.Pem k Can Be Mwde+d Due To lrrr npletts Warrrration Existing Proposed Rid by Zbairt This o*mma to be SlbW in by BW1dingDqwt"ft Lot Size Fron a Sed*&s Front sideL ._,. _.. R: _. L: R:, Building Hei& _ Bldg.Square Foofage _ /o Open Space Footage °la (Lot ares my=bldg&paved #4f Pairing Spaces Fill: v kme&[ocwtian A. Has a Special Permit/Variance/F r4fingAw been issued for/on the site? NO � DONT KNOW YES (� IF YES,date issued:' IF YES: Was the permit recorded at the Regi ry of Deeds? NO C) DOWr KNOW YES IF YES: enter Book Page and/or Document#' 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 o wed 0 ObtWwd 0 , Dabs Issued C. Do any sigm exist on the propmV. YES 0 NO S IF YES,describe size, type and location: D. Are there any proposed changes to or additions of sigma intended for the property? YES 0 kitl NO IF YES, describe size,type and location: E. VW the c onshx on activity tilkrb{ ng,w, or 9)over 1 acre or is It part of a oammon plan that wM b over 1 acre? YES UNO IF YES,ttw a Nordwa ion storm water Merragernerft Permit from the DPW Is rte. City of Northampton Building Department 212 Main Street Room 100 t Northampton, MA 0 1,9 phone 413-587-1240 Fax 44:687-1272 APPLICATION TO CONSTRUCT,ALTER,REP R,i vAT�t?fdWluroLlstl A£1AiE OR TWO FAMILY DWELLING SECTION 1-SITE ~TION 1,1 PrOt16i tY�ddrm: --�--' NORTHAAAPTON.MA o t ,�c;✓ e- vimars.W46*A l { SECTION 2-PROPERTY OWNEI~SHtPIALITHORIZED AGENT � 2,1 ©wn Nam Print) Current M*AWg Addys: Tone Si store per /rt &dbgrkM Mot, Name Current Mailing Address: i Telephone S Item Estimated Cost(Dollars)to be Official Use Onty by miit applicant Building 1 (a)S+ildirl P'ern*' 2. Electrical tJ (b)Elated TOW Cost 4f 3. Plumbing ll3uRAllifte PwwAt Fes 4 Mechanical{HVAC) 5. Fire Prowtlon y( !X 6. Total=(1 +2+3+4+5) Chock leer A Dade Building Permit Nunmser lard: Signature: 2 �� EMAIL ADCMSS(REQU#RED; EITHER HOMEOWNER Oft CONTRACTOR) I EDGEWOOD TER BP-2019-0672 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38B-041 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-2019-0672 Proiect# JS-2019-001093 Est.Cost: $1500.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: PAUL SCHMIDT 103635 Lot Size(sg.ft.): 3223.44 Owner: Rachel Schneider Zoning:URB(1001/ Applicant: PAUL SCHMIDT AT. 1 EDGEWOOD TER Applicant Address: Phone: Insurance: 24 CHESTNUT ST (413) 247-5739 WC HATFIELDMA01038 ISSUED ON.121512018 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSULATION TO ATTIC FLOOR OPEN BLOW CELLULOSE, RIGID BOARD TO CRAWL SPACE 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 Dmart1gent 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 12/5/2018 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner