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22B-048 (7) 15 RYAN RD BP-2021-1387 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:22B-048 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: CHIMNEY RELINE BUILDING PERMIT Permit# BP-2021-1387 Project# JS-2021-002311 Est.Cost: $2246.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JAMES WALLING 105507 Lot Size(sq.ft.): 12980.88 Owner: DOYLE CLAIRE Zoning: WP(99)/WSP(99)/URA(66)/GI(32)/ Applicant: JAMES WALLING AT: 15 RYAN RD Applicant Address: Phone: Insurance: 62 SUMMER ST (978) 880-8772 BARREMA01005 ISSUED ON:5/25/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:RELINE CHIMNEY FOR WATER HTR 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. • Ir �LI . Certificate of Occupancy Si�lznature: j ' 1 low FeeType: Date Paid: Amount: Building 5/25/2021 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner ____l __ S. - l EC ") The Commonwealth of Massachusetts FOR y�: B B..rd Building Regulations and Standards Ma.sach sett MUNICIPALITY State Building Code, 780 CMR USE . 0 4 2021 it tng Permit A plic4ion To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 TroNs Ole-or Two-Family Dwelling �T�r3 t�A0,os43 _ i This Section For Official Use Only rcpT OF 6UI1D11`IG iNSf'E1�• �. Building P. im umfil ber: �,"d i /r3 9 7 Date A lied: C-Oht, 5 // Z-- 5-25-zozi Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.i Prop ty Address• 1.2 Assessors Map&Parcel Numbers Y i.la Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' ,r1n,/� l 2.LOCkte- 0 I.1 1 1[JY'LV�CI 1 p-tent 1 • `f� 0 I b lQ Name(Print) City,State,ZIP I'S 12..q a.r Q...c 624.)2t3-tit cs c 4 04( YA . conr-% No.and Street Telephone EmY1 Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other lit Specify: clnlrn.r VrerS Brief Description of Pr osed Work': t_ot ura SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ OA to,W 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ CI Standard City/Town Application Fee 0 Total Project Costa(Item 6)x multiplier x 3. Plumbing $ (lJ 2. Other Fees: $ 4.Mechanical (HVAC) $ s List: 5.Mechanical (Fire $ 0 Total All Fees: ►, C Suppression) Check No.r Check Am..•/. Cash Amount: 6.Total Project Cost: $ aa/t I ..e co 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) J5 b. I I Jzc a 5jrkks V()Dati.y•Q. License Number Ex iration Date Name of CSL Holder o rb � List CSL Type(see below) Sp No.and Street Type Description Y \ rc. rn iq O l m 1 U Unrestricted(Buildings up to 35,000 Cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry V( �r.ecnS,ccl`V kt^QI f laSr RC Roofing Covering "-�'/ `�^;` ` ' `�V V Window and Siding 0//� l �r ,�l Solid Fuel Burning Appliances l�I C1361 11yL I Insulation Telephone . Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 18 ! ' Q I tire's- ` C' `t y ���0 S IC Registration_ Number E irati Date I��mp4ny�1amYeQIj�CMrant amees i fr� and,Street ( ` {�' / q CoSSardibi r`._airi -uncle)/ )/ �JL.OJ`I � OA r c th b a ( Li 13)43 u-1 l L (�) Email address j(`�ICQS.l��'1 City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE A}'FIDAVIT(M.G.L.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? Yes No .❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR'�" APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize E-tre-S� CJW er\Qy titcp S to act on my behalf,in all matters relative to work authorized by this building permit application. CSC DOLQ Si 19 Print Owner's Name(Electronic Sinature) ate SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. ` !comes Zeki lIciPoci Print Owner's or Authorized Agent's Name(El onic Signature) ate NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" City of Northampton S,s SAC Massachusetts Ail. '<<, G Si.DEPARTMENT OF BUILDING INSPECTIONS i t '.w 's 212 Main Street • Municipal Building J6,r �L .1,6 n Northampton, MA 01060 s6ryy^ j�1 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: a 71 rvi-Q-V' L e_, (NAP 61O The debris will be transported by: Name of Hauler: Glee-S SQ. C (S-S Signature of Applicant: Date: __� The Commonwealth of Massachusetts Department of Industrial Accidents 111111 55 1 Congress Street,Suite 100 ) Boston,MA 02114-2017 www:mass.gov/d1m takers'Compensation Insurance Affidavit:Builders Cantraeto ....>bers_ TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Busincss O nizationandividlual): Ft resaAt CanUvw\Ly Qtr,1l c.LS Address: all 'Pea vivvIr 'C d City/State/Zip: of1r\ G .C ? Phone#: 011 -13— l Le.14.0 Are yrs as enuplayerf Cheek die.pperprirte bast Type of project(required): Lig 1 am a mpbyer with_..� employee(full ard+'orpaet-tiou)-' 7. New construction 201 am a mole proprietor or parmeship and bee no employees working far me is S. El Remodeling any may-[No workers'comp.romance re.ri-] 930 t a a homeowr doiag an went myself.[No workers'comp.inherence requital Demolition m ne 10 Buildingaddition 4.0 1 inn a homeowner and win be hiring contractors to tonnes all vc uric on my property. I rth71 assure drat all emrsacteea either hive watltles'compensation im„nr roe or ate sole 11.0 Electrical repairs or additions ptoprie ens with so employees. 12.0 Plumbing repairs or additions 50 I am a general coasracior and I have hired the stir-cmaractoss listed an the wed sheet. 130 Roof airs These urherwaracwrs haw employee'and have workers'comp.oranneee: reP r,� ti We are a and its officers have exea,ised their 14. Other CY l (f'Y)r-y*corporationsight of exemption per AWL e l 152,41(4).and we have so employees.[No warless'comp.insurance requited.] ( , ,rS •Aay applicant that decks boa RI non alto fill out the section below shanties their workers"compensation policy infarnueine. -�-C py�1 Howeoweers win submit this affidavit iaacatiug they ate doling all went and thee hire outside.catroractoas mind submit a new affidavit indicating Suck :Canractots that check this bolt tryst attached ass additional shed showing the same*Me sub-cmrracmrs and state whether ar rot drama:amities have employees. If the subcontractors have employees,they most provide their waders'map.policy Number. 1 ear an employer that is providing workers'cwnysrresa(itrn insravnslase for airy ensphiyees. Below ls the policy and Jars site lnformatloa. Insurance Company Name: Ve Q_y^S j/ _ Policy#or Self-ins.Lie.#: / PJ W C�38 L t LN Expiration Date:q [ 2 G I 9O Job Site Address: ►-J WE\ act_ City/State/Zip: rlO1 f T V 1p ) f T Attach a copy of the worker0 compensation policy declaration page(showing the policy number and expiration date)0 10(1a Failure to secure coverage as required under MGL c. 152.§25A is a criminal violation punishable by a fee up to$1,500.00 andfor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verifica' I do hereby cent re. the and penalties of perjury that the lnforisadom provided}�- I abovee is trace and correct / Signature: / � Date: ) " )c2Oc2 Phone#: ( 1113)3LC- [ LL Official use only. Do not write in this area,to be completed by city or town g(jidai City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector . 6.Other Contact Person: Phone#: i Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards • Construction Sup4Msor Specialty CSSL-105507 = Expires:01/19/2022 JAMES J WALLING• 40 HIGH STREET P.O.BOX 40 _s • SOUTH BARRE•MA 01074 - Commissioner " --- • • / 2W/M0eaI�(/l�i 02-4 ii(:/arM iatMecj-eZ .- Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation FIRESAFE CHIMNEY SERVICES INC Registration: 182449 277 PALMER RD UNIT 2C • Expiration: OB/25/2021 WARE,MA 01082 • Update Address and Return Card. 3CA 1 11 201ii•05/17 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: Reaistration ._ Expiration Office of Consumer Affairs and Business Regulation 162449- =z 08/25/2021 1000 Washington Street -Suite 710 FIRESAFE CHIMNEY SERVICES INC Boston,MA 02118 JAMES WALLING JR ;. 277 PALMER RD UNIT 2 C �,i�.-..arl• s/. WARE,MA 01082 Undersecretary vaii ithout nature ' ®C O• A R CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/VYYY) 05/19/2021 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 the certificate holder is an ADDITIONAL INSURED, the policy(ies)must 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 endorsement(s). PRODUCER CONTACT NAME: Jessica Pierce BRABO INSURANCE uu"c°.No.Extl: (508)830 3800 FAX No): E-MAIL ierce braboinsurance.com ADDRESS: IP 65 Cordage Park Circle INSURER(S)AFFORDING COVERAGE NAICB Plymouth MA 02360 INSURER A: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER S: FIRESAFE CHIMNEY SERVICES INC INSURERC: INSURER D: 277 PALMER ROAD INSURER E: WARE MA 01082 INSURER F: COVERAGES CERTIFICATE NUMBER: 656942 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IFF POLICY EXP NSR ADDLTYPE OF INSURANCE INSD SUER POLICY NUMBER (MPMIDD//CYYYYY) (MM/DD/YYYY) LIMITS LTR INSD WVD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS N/A BODILY INJURY(Per accident) $ AUTOS NON OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER H STATUTE ER AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 A OFFICER/MEMBEREXCLUDED? N/A N/A N/A 7PJUB0G03354621 05/12/2021 05/12/2022(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Northampton 212 Main Street AUTHORIZED REPRESENTATIVE Northampton MA 01060 x P I Daniel M.Crowley,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD �.14 FIRECHI-01 JPIERCE A Ro. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDmm) 5/19/2021 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 the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or 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 endorsement(s). PRODUCER CONTACTNAME: Brabo Insurance Agency PHONE FAX 65 Cordage Park Circle (NC,No,Ext):(508)830-3800 ( No):(508)746-1540 Plymouth,MA 02360 ADDRESS:info@braboinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Northfield Insurance Company INSURED INSURER B: Firesafe Chimney Services Inc. INSURER C: 277 Palmer Rd INSURER D: Ware,MA 01082 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE MD WVD POLICY NUMBER (MMIDD/YYYYI,(MM/DD/YYYYI 1,000,000 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE X OCCUR W5420788 7/15/2020 7/15/2021 DAMMISEAGE TOEa RENTEDoccurtencel $ 100,000 PRES( MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT OTHER: $ AUTOMOBILE LIABILITY Ea aBccideD SINGLE LIMIT $ — ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED _ AUTOS ONLY — AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE _ AUTOS ONLY _ AUTOS ONLY (Per accident) $ $ — UMBRELLALIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N OFFICEW RIETOREMBER ARTNEED?ECUTIVE N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. Puchalski Municipal Building 212 Main St Northampton,MA 01060 AUTHORIZEDREP•RESENTATIVE I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD City of Northampton `S si Massachusetts ff 'f DEPARTMENT OF BUILDING INSPECTIONS 1. 212 Main Street • Municipal Building vs:,, Ca Northampton, MA 01060 s6 "' PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW 1 & 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES, FENCES, GROUND MOUNTED SOLAR, ETC. I. Building Permit Application signed by legal owner and filled out by owner or authorized agent. 2. One set of plans and specifications of proposed work. (Digital and hard copy) 3. Site plan with location of proposed structure(s) and set backs. 4. Construction Debris Affidavit filled out and signed by applicant. 5. Worker's Compensation Insurance Affidavit filled out and signed by applicant. 6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance. 7. Energy Conservation Compliance Certificate (new / replacement windows). 8. Home Owner's License Exemption Form filled out and signed by Homeowner (if applicable). 9. Note any Conservation and/or special permit requirements (if applicable). 10. Driveway Permit (if applicable). 11. Proof of Water and Sewer entry fees paid (if applicable). 12. Trench Permit - public land by DPW / private land by Building Dept. 13. Stretch Energy Code - all new construction will require a HERS Rater Affidavit to be submitted with permit application before issuance of permit. 14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton.