23A-126 (4) 30 MIDDLE ST BP-2019-0683
GIS#: COMMONWEALTH OF MASSACHUSETTS
M&Block:23A- 126 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
Ega] t# BP-2019-0683
Proimt-# JS-2019-001115
Est.Cost: $4000.00
e: 5.Q0 PERMISSIONIS HEREBY GRANTED TO.
Q At.Class_ Contractor: License:
s r 0: PAUL. SCHMIDT 103635
Lot Size(sa.ft.): 15463.$0 Owner: DEQQU EM
zoning:(IIW(100)/ Applicant: PAUL §g H M I QT
AT., 30 MIDDLg ST
Xgcant Address: Phone: Insurance:
24 CHESTNUT ST (413) 247-5739 WC
HATFIELDMA01038 ISSUED ON:12/10/2018 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSULATE ATTIC, 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: I&ARAilment Fireplace//Chimney:
Rough: 7: Insulation:
Final; oke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy signage:
FeeTyne: Date Paid: Amount:
Building 12/10/2018 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587.1272
Louis Hasbrouck—Building Commissioner
::j7NSU61gr10A1
City of Northampton
Building L3 #rnent
212 Main Street
Room 100
t Northampton, MA 01060
phone 413-587-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT,AL R, "-46&OLISh A ONE OR TWO FAWLY DWELLING
SECTION 1-SITE lNF*fttAAT4ON DEC 6 018
1.1 Prtar adv Vis: .
��� �� NORTHAMPTON,MA 01060
..�.�.r
C 1 0 Ln
zow
611111s OL WAAPW
SECTION 2-PROPERTY OWVERSWPIAUTHOR2ED AGENT
21 QWpgr of R gr6, J
` 1 vr� �► e
Name(Print) Current Mla&V Address:
Telephone f `�
Signature
4" M4
Name Current 0siting Address:
gnature Teiehone
Item Estim =Cowst(Dollars)to be Of ti Use Ot taorrtrmit icant
1. Building 7 C"o (a)Iui P"44 Fft
2. Electrical (b)Es#imsked Tod CoM of
3 Plumbing Suilldit Pwrnk Fee
4 Mechanical(HVAC)
5, Fire Protection
5. Total=(1 +2+3+4+5) Cl"Nut 7
Building Permit Number D&*
Issued:
Signature:
EMAIL ADDRESS(REEK) ECO; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING Alt nsformation Mst Be cotmteted. Permit Can Be DenW Duero twe tnfwmtian
Egg Proposw Rapbld by zonmg
7bir oaiurms to be MW in by
DWI&V Depousaw
Lot Size _... .
Fina ..._... ._.. .... ... ___ ...... . _ __.. _
Sys _.... . _._...
L_......__. lt:-- L:_ ....... R:.
...............
Building Height
Bldg.Sguam Footage ala
Cwt Speoa Fookage %
(144 area mum bldg&paved
#of _ ..
Fill:
. t &z _.... . .. _.._
A. Has a Special Permit/Varianceff been issued for/on the site
NO 0 DOWr KNOW YES 0
IF YES,date issued::
IF YE'S: Was the permit recorded at the Iiiry of Deeds?
NO 0 Down KNOW YES
If YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DOPff KNOW YES �}
IF YES, has a permit been or need to be obtained from the Conservation Commissim?
Needs to be obtakwd t"N ObtaUwd 0 DaW iswsel _..
C. Do any s4m exist on the property? YES { NO "
IF YES,describe size,type and location:
D. Are there any proposed changes to or additions of s*ns Intended for the property? YES 0 NO '
IF YES, describe size,type and location:
E. VISI ft own4ruallon air dWArbC or )am 1 acre or Is It par'!of a=nmon van
tM&will+#MA over 1 acre's YES NO
IF YES,#on a Nortwmpton Storm Water AiMarsoement Pormit from DPW is nxpjWW,
SECTioN 5-
New House ❑ Addition ❑ Repleceawnt Windows I Alterationisj ❑ RoofitV ❑ I
(ir Doors D
Accessory Bldg, ❑ Demolition ❑ New Signs [01 Decks (Q Sidirtp(! O= .. p�
Brief Des ri tion of Proposed „
S� F , / " a c ter ' - c��, tl oe
Work: ! S
Alteration of existing bedroom Yes No Adding new bedroom Yes No No
Attached Narrative Renovating unfinished basement Yes
Plans Attached Roll -Shut
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? r i
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? E
h. Type of construction
I. is construction within 100 ft.of wet[ ds? Yes No. is construction within 100 yr. floodplain Yes No
Depth of basement or cellar below finished grade i
I
k. Will building conform to wilding and Zoning regulations? Yes�No.
1 Septic Tank �ity Sewer Private well City water Supply
i
SECTii?N 7a-OWNER "-T
Tf G LET�tIN
OWNERS�� T
i
1, as Owner of the subject
property
hereby authorize iz, 1
to act on my behalf,In all matters relative to work at prized by this building permit application. j
Swriature of OVWW Date
as Owner/Authorized
Agent hereby declare that ft stats and information on the foregoing application are true and accurate,t$the best of my knowledge
and belief.
i
Sign under the pains and penalties of perjury.
Print Name
/c;l g' I
Sig e of Date
SECTION 8-CONMUCT i-SERMES
8.1 Liceand Conabuwtkm
/ Not Applicable
Nance of License Holder: C�� Z!2,,,3-&-.
License Num
be1.2c
Adores Expiration Dite
e-
S ature Telephone
i
Not Applicable
C-om2gov Na Registration4mbar
e) ,
7
Address Expiration Date
'� "5X
Tele � e
SECTION 10-WORKERV COWENli$ATIOM FRANCE AFFM T OA.G.L,c.1&2,*25CM
Workers Compensation Insurance affidavit ust be completed and submitted with this application,Failure to provide this affidavit will result
in the denial of the issuance of the buildl rmit.
signed Affidavit Attached Yes....... No.,.... 0 j
City of Northampton
Massachusetts
DEVARTINAWT OF BUIT*DrNG XXSPZC7r0KS
212 Main street *Municipal building
NarthwWton, M 01060
Debris Disposal Affidavit
In accordance of the provisions of IVIGL 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:
(Please print house number and street name)
Is to be disposed of at:
C-U nc
(Please print name and location facil
r
Or will be disposed of in a dumpster onsite rented or leased from:
ry\A C) D
44
f(Company Name and Address)
g1nature of F1~App#caW or Owner Date
If, for any reason, the de"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
212 Main Street * Municipal Building
Northampton, MA 01060
massachus*tts
DWAR7T OF BUXZDXNG XNSPACTZONS
AW
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 must be registered as a Home Improvement Contractor("HIC").
M.G.L.Chapter 142A requires that the"reconstruction, alteration,renovation,repair, modernization, conversion,
improvement,removal,demofton, or construction of an addition to any pre-existing owner-occupied bu#&V containing
at least one but not more than four dwaffing units-.or to structures which are adjacent to such residence or building"be
done by reskiih"yd contractors.
Note:If the homeowner has contracted with a corporation or LLC,that entity mast be registervit
Typeof .................... ....................... Est.
Address of Work.
rf-UA -(:L�
Date of Permit Application:—— -------
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law(explainj:__.........
Job under 51,000.00
Owner obtairting 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 ROME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Ckqvur 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 per ury:
I hereby apply for a buildingt as the agent f the oWnpr:
W IL4 L I
Date I Contractor rite Ctrv�y�c4-of-5 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
RISE
ENGINEERING'
OWNER AUTHORIZATION FORM
I, Erin Decou
(Owner's Name)
owner of the property locatedI at:
30 Middle Street
(Property Address)
Florence, MA 01062
(Property Address)
hereby authorize :!:—:>� I
(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
XDate
RISE Engineering,a Division of Thielsch Engineering, Inc.
60 Shawmut Road Unit 2 1 Canton, MA 02021 j 339-502-6335
www.RISEengineering.com
7hc� ��c�r�r «�►��t*rr/�� ��j.1��rs,+;�tc°l�us�tls
Deptrrtmert,t rrl lrtrlustrirtl.4ccident?t
sligations
.,.
00 W"rtshin t°on Street
� a
Rosu,rra> :4.4 112111
svtvw,mus.8.govIdia
Workers' C ompertsstion irtsursnct Vtirtavit. Ruiiciltrs t t,rttract€rsl ;ic tricians/Plumrer
iictu t lnf p6AMO Pt it
SDL Horne improvement Contractors inc
Addrt s: 24 Chestnut Street
Hatfield, MA 01038 a iR# tlt' 413-247-5739
1rc vrau an emplet,.er. Check the appropriate lttrx;
Type rw1 prajtect(rtyuiretlt
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"ids t {7t"ICG*r^; GC)TrI ?. , rx , ? e.31,(fl.t 31 1M M(3i .� -,
ll
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aas�sirtee�.�,Ra,rtl # ;. Insulation
.S,SSt33ca,a ?t,.v��,.3t.tx+��. .,,,anr•, i,S1,s,l:ijts .,.._ _ „z �~rr� l�:.r,•,At„ylRrii+#iu> �l,t;,.r,;d11;4+€ ,i
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f,MrA0o'f,05. i 1t%xa...ti, !yak must Attdi+;i.ir.t"M aWuw4 4,0'k,.
,.J sSRti-u rera tit'; hast;empkccs,.tic 4S ,,,i - "O,, nc�r
I rrt»u»erlr��ker thupr Ir ItrarrT nrlcer�'c°rr�n�rtticrrr in.t�trrtrrz'N 1l)r rttt�c=�� ►ja. l�frri��;t'�►4r/ t#c�•� b she
inJvrtmlrticrrt.
1w,aranee Compattg :Marne: Selective insurance Co
llohc, of self.ins, l,ic. ;.. WC9024456 �piration Lkit_cj._ 02/23/2019
.<)t)site;Adcire,s� 130._ cru' -a-LizS� it, Staic lip
Attach a copy of the workers'c peasation policy cfrcluration page-(showing thepokey attataNaer sad txts *tiatel.
I iilure to wcure ccrwrapt«as reyui ed under Sectir)y. .... A ° '+;lt:i l_ #; 1 :.ts. : tii to the imposition itiwn ctt`criminal penalties c, r,
fiiie tip to'S1.500,00 and"or orte-YT kr imprisonntert; :;, #.. 4 .i peiiahic-, w fire fttrrn of aS`iU*A`ORK ORDF R kind u 1;m
,.St tip tea S'250.(tt)a day against tyre violator, € aLxL i i qi ti,s 3 f # !tis`+tatelfwrit Ina; tx:forwarded to the O fioc `?
;rT>r ri aifcarts of the DIA trwr inswr*uv cove
1 do hereby cert x4er POM€ndpenalrits s,l perjurt aster Me iqjormwfion rook"above it true twd e(weea.
(�fi ittl u:i,e rsttdt' lei not Wrke in this urets,try he omjlietefj hr, 411,or town 10MO,
C;ir� err"fawn etratitil-ifte'"stu i
Issuing Authors(eiirele ate);
1. Board of Heafth 2. Mpartftat 1 C-ite,%"l e)"if "lrrk 4. Electrical lssWtor PlastbWg taectnr
6.Otbier
AC"R CERTIFICATE OF LIABILITY INSURANCE
1/15/2018
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION QNLY 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 he endorsed. It 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 ondors"r i!).
PRODUCER 1.a Henderson, CTSR
Webber & Grinniall P f (41:1)586-0111 FAX
0.1p,tel (AC,-I
R North King Street IMS,,chenderson0w*bborandgrinnoll.con;
A
INSURER(S)AFFORDING COVERAGE NAIL 0
Northampton MA 01060 'N9URFRA:8Q16Ct1VQ Ing CO Of S Carolina
INSURED 1N$URER 0 SSI QC t,LVQ, Ing Co of Southeast 39926
SDL Home improvement Contractors Inc, INSURER C
Chestnut street "NSURER T)
Hatfield MA 01,035 NItURERr
-——---------- ............
COVERAGES CERTIFICATE NUMBER:Master Exp 201.9 REVIISION NUMBER:
HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED SEIJI)",;,�iAVE. BC�N .HE INSURED NAMED ABOVE FOR T1111F POLICY PF R- 101"
iNJ17CA`F10, N0111+1ITHSrANOING ANY REQUIREMENT TERM 0,,P ',ONA`,()N 011 ANY CONTRAC T OR OTHER E)OCUMENr WITH RESPECT TO WHICIi 'HIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, 'HE. NSURANCE A ,`()RDW(; 8 tP01, IF.S DESCRIBED HEREIN IS SUBJE, r AL., THE ?SMS
FXQ USLONS AND CONDTIONS OF SUICH POLICIES.LIMITS SH(,WN V.Ae HAVF,BEEN RE[XJCi�'
DBY PAID CLAIMS
'NSA :At SUIW
LIP.......... "'YPE Of INSURANCE LIMITS
................
X COMMERCIAL GENERAL.0AW7TY
A X
)WAG '0 RENTED
E ka,i S C. C a WAo rw""a",
'1,1 'Any`nor,,
A,,%,�?,::"A UA: e?-„. k w, i 3,:10313 00
PRO
X
........... ..................
AUTOMOBILE LIABILITY NG",C
0 i.
ANY A,0
A A�
A, x
A',l 06,
X 0R�1`A L, x W)N,0,AN011
-000
X UMBRELLA LIAR x
A
EXCESS LIAR
A
U
x 8220406,� i 2019
..........
WORKERS COMPENSATION .......
AND EMPLOYERS`LIXASILITY Y'k
SLA J11-114"fy,
8 -In NH) W,90 34 6
50"; ',)00
D�Ep,
51rL0
DESCRIPTION Of OPVRATtONS LOCATTOW VE141CLES (ACORD 101.AddWinnaL Rerrsatkx St33rstlule,.may be Attactwo t more W"e 4,0quir*d)
sThe Workers Compensation poli does not inc.-,Itide �_overaae for Paul, Schmidt, Kendrick Dempsey and Douglas
�Schmidt.
Columbia Gas of Massachusetts is hereby named as Addat,onai Insured per written contract with respects to
General Liab.,,Iity & Auto Liaibiaty, for work performed, and per the terms and conditions of the policy,
CERTIFICATE HOLDER CANCELLATION
ANY LiF THE ABOVE DESCRI[SED POLICIES OF CANCELLED BEFORE
Columbia Gas of Massachusetts THE EXPIRATION DATE THEREOF, NOTICE WILL BE OFLIVERED IN
ACCORDANCE WITH THE P(XICY PROVISIONS.
4 Technology Drive Ste 250
Westborough, MA 01581
AUTHORIZED REPReSFNTATIVE
C,1"11-2014 ACORD CORPORATION, All riot"noterv0d.
ACORO 25(2014101) The ACORD name and logo are registered marks of ACORO
?NS025,?w«r,.
^I - 2018 '�. EAT'HERIZATiON
mass
e' .. ., E.R INCENTIVES
?.4tx"d an y:*tar Energy reccrrrmendattc ns, yaw kat mi,r ar benefit ander a'" a-eei np
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CUSTOMER INSTRUCTIONS
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�4aned a,rad com'plened c o e s of is tarn;ars;as try of t r'':'a.a Withas c:: don of Y.. w Em"y
y
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mll:be in`he c+"zent rMar,a'gF2`it'9%Mt exrPedis t:`e C;A.€4t w-mss r.<<,�:�" C:e-a.},Py"a[ss<�1 Y"�€Y;..':,'��'•..:
4 €ete thc=re t_rnnmended i aairivaa ation erntsr �.*y'frp,'
t rrttdt`° : Erin Decoti 'Client 9 o, Site ids° 452866
Sm r„ 0 Middle Street Florence {06
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fa)ne N •nein 267 254-41 f ry .,N� € ��.
Cte twn �S 19 n 4u 0 a Datat%
,o dire are€t theme is any trove k ars tube Waring tht, 04";. j wM evaOne the foll"wiing areas Whwe+ l ie Mau save :
w eaat'ea ate` a C9df rr€ tl latPt ffU masse been made
M Attic Floo 0 Attic Wall jittad 6t3 J �tericr Wall ��€rr at
have oei'forrned my€€smMan and deter"uned there, i.+ ';: o t vc,k,*""min tur-e granp.r?ties ar(+as below.
wall l�atttc Slo I XtF a i,rr Vat8 jai-er-e
rt<§:.+.,fea:a ani a r ,`; e i'-rm +ar=;