06-057 . route 9 B P- 2011 -0640
GIs #: COMMONWEALTH OF MASSACHUSETTS
47 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- 2011 -0640
Project # JS- 2011- 001040
Est. Cost: $1694.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: PAUL SCHMIDT 103635
Lot Size(sq. ft.): 550162.80 Owner: BIERWERT KIM G & LOU ANN
Zoning: SR(100) Applicant: CO -OP POWER INC & NORTHEAST BIO DIESEL
AT. 297 HAYDENVILLE RD - Route 9
Applicant Address: Phone: Insurance:
P O BOX 688 WC
GREENFIELDMA01302 ISSUED ON :112012011 0:00.00
TO PERFORM THE FOLLOWING WORK.-INSTALL ATTIC & HATCH INSULATION
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 Siinature:
FeeType: Date Paid: Amount:
Building 1/20/20110:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner
File # BP- 2011 -0640 ,
APPLICANT /CONTACT PERSON CO -OP POWER INC & NORTHEAST BIO DIESEL
ADDRESS/PHONE P O BOX 688 GREENFIELD
PROPERTY LOCATION 297 HAYDENVILLE RD - Route 9
MAP 06 PARCEL 057 001 ZONE SR(100Z
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: INSTALL ATTIC & HATCH INSULATION fit
New Construction 1
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
INFO ION 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
Sig6trffe Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health, Conservation Commission, Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning & Development for more information.
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
5 1 0 A 212 Main Street Sewer /Septic Availability
,Q,�► y' Room 100 WaterNVell Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413 - 587 -1240 Fax 413 - 587 -1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address ii This section to be completed by office
j e r V d Map Lot Unit
c C Zone i' Overlay District
L J Elm 3t. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record
tA
tt !
NI STL4- "?ZS'�
2.2 Authorized Agent:
Name (Print) Current MailindAddressA
Signatirre Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by ermit applicant
1. Building (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee d ,q j
4. Mechanical (HVAC) a�/ 0
5. Fire Protection
6. Total = 0 +2+3+4+5) 1 r' Lo Check Number
This Section For Official Use Onl
Building Permit Number. Date
Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg & paved
p arkin g)
# of Parking Spaces
Fill:
volume & Location
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO Q DONT KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Re istry of Deeds?
NO ® DONT KNOW AN
Sa
YES 0
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 obtained 0 Obtained 0 , 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 Q NO
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors 1
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding [E:3] Othe
AJ
Brief Description f Proposed
Work: L J ol
Alteration of existing bedroom Yes No Adding new bedroom Yes o
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
6a. If New house and or addition to existing housing, complete the following:
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?
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?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject
property /� l ('
hereby authori V t �J G
to act on my b all afters relative to wM authorized by this building permit plication.
I, L as Owner /Authorized
Age Kt he eby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed unde the p ins and penalties of pe Lry.
( 'rG
Print ame
17 b
Sign ure of Owner/Age Dat
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor Not A pplicable ❑
Name of License Holder
License urn er
2- u
Address b piratwn Date
Signature Telephone
9. Renistered Home Improvement Contractor: Not Applicable ❑
6b -6le 16S - Z1 2
Company Name Registration Number
,,3 Z �„_l 57` 1 - �I
Ad/dr'ess�,1 Expiratio Date
V! L�Ir/o Telephone Z 1
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (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...... ❑
11. - Home Owner Exemption
The current exemption for "homeowners" was extended to include Owner - occupied Dwellings of one (1) or two(2) families
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor. CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner Person (s) who own a parcel of land on which he /she resides or intends to reside, on which there
is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm
structures. A person who constructs more than one home in a two -year period shall not be considered a homeowner
Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official that he /she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
^ `
CERTIFICA"IFE OF LIABILITY INSURANCE 11/23/2"0-1)o
1 z iS ;SSUEL PS A MAT TIER OF INFOF',MATiC)N ONLY AND GONf NO RIGHTS 1 ,.JP0jN THE. CERTIPICAIE HOLDER THI-�
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFO�DED BY THE POL
DELD'Al rAIS CEIRZ IFI,'/,TF-, OF INISUPANIC"I. DOES NOT C�nN!, A CONITRAC7 . BETWEEN !HE ISSUING IN5tJVLRfS), AUTHORIZED
if file Is ar ADD!1IONAL. INSURED, tW� pollcy(i�-s) rniust be endorsed, V SUBROGATION IS VVAIVE-u, suoitict to
the torms and conditions of the policy, certain policies may require an endorsernent. A statement on this certificate does not confer rights to the
IN
INSURED
inNSUR Amer�,ca ins
INSURER B:Commerce Insurance Co
;324 Wells St
- INSURER D :Twin Citv Fire Insurance Cp
INSURER E
lGreenfield MA 01301
AN) RLOUIRLMENT, IERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECI 'TO WHICH THIS
IFOKI E MAY ISSUED OR MAY PERTAIN, THE INSURANCE AFP-QRDFD BY THE PCIUMES DESCRIBED 4EREIN IF, SUBAEC7 To ALI TVIF TrRmLl�,
SUCH POLICIES. LIMITSSHOWN MAY HAVE BEENI R BY PAID CLAIM'--
PO WITS
LICYNUNISER
EACH OCCURRENCE S 1,000,000
8/2010 11/8/2011
IVIED EXP (Any one oemon)
GENERAL AGGREGATE. S ( "Ool
$ 1,000,0001
URY (Per person)
PROPERTY DAMAGE
(Per amtdi!nl)
FACH OCCURRENCE 1,000
10 011
L CC�ific ,- Ato issuec subject to the terms, conditions, exclusions, and endorsements attached thereto.
CANCELLATION
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN'
ACORD - 25 , 2009!09) 1988-2009 ACORD CORPORATION. All rights reserved.
The t ;trire1monweaaith cj 'lilaa-vsac husetts
- Department of Indatstrial Arcidenty
Office oflnvestigations
600 Wavhingian .street
Ott stt�62p lll`r� 02 111
www.mas €.govldia
Workers' Compensation Insurance Affidavit Builders / Contractors /Electricians/Plumbers
Apyliwnt Information Please Print Legibly
Name (Business /Urbanization/ Individual): ( ( / U VJ ey—
r
.Address _ �-
Phone
CAre You an employer? Check the appropriate box; 'hype of project (required). 9
1. l am a employer with � 4. {� I any a general contractor and I i
havt; hired the sub- t_.ontractors h° New construction M
f�Trtploy�.es Gull aree�,'os' past ua��e) -�
2. n l am a solt., proprietor or partr,er_ listed on the attached sheet. 7. E] Remodelin g
j ship and have no employees These sub - con#. tors have 8. Ej Demolition
v'trtx ItT tC3r r1 "a< Ill 1i °t' L;etpilc te:y' employees and have workers'
insurance.* wilding addition
(No workers comp comp. P-
T ytjirt d_] 5, E] We art, corporation and its 10,[1 Electric ai repairs or additions
3. r .: i Ilt�na r.� a tsa r doh a ;ill �v >r k officers have exercised their 11.7 plumbing repairs o ad �itir�Y�s
myself. No workers' com right of exemption per MGL
Y P' e_ l i2a . 1(4), and we have no 12,E] Roof repairs
rreleirec'. �3
employees. [No workers' 1 Other--_ • l ✓1 /
comp. insurance required.]
*Awr applica ;a :Feet ci;ecakcs box f11 must akx) f°ilt out the section below showing their workers' compensation policy information.
T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
it ortraf c dl +t < hexk this Wx muA ;!.ttac.he.d are additionat sheet showing the name: of the sub - contractors and state whether or not those entities h ave
employees. if the sub - contractors have employees, they must provide their workers' comp. policy number.
Jam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
cxm
�F'�fe�rldlll�E) /1.
YtSttSiile -4'; 7FY7l7Tt4' .f'.ri'.T'ifP
�1 r
?'i61t4 } ;,Y. �,cS -3I4:. 1_t.. .__ • .) ...; j _.. _. ., uxptr'atioD Date: L..-
.lab Site Address. City /Mate /zip:
AttAch a copy of the workers' compensation policy declaration page. (showing the policy number and expiration date).
Failure to secure coves, a required tinder Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties of ,9
lane up to $1,500.00 0.00 and /or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
f tTt 2t7 4, tt.c�e1 ,€� w<.1 ? pl w 'rir�latefr. Be advised shat a copy of this statement may be forwarded to the Office of
Inve of the DIA for insurance coverage verification.
1 do hereby certi"der t Ains and penalties of perjun that the information provided above is true and correcx M � +
m ate s _
8 fl /fr. drat use onip. Do not write in this area, ti) he Awwrpfettd by city or town official
(' Cit) or Town. PI'1 TSl= IELD Permit/License #
f, Issuing Authority: Enilding Department
Contact Person:, Phone #: (413) 499 -9440
ie
.Office of Consumer Affairs and usmess Regulation
_
10 Park Plaza - Suite 5 170 _
Boston, Massachusetts -
Home Improvement Contractor Registration `
-_ —_ - -- - - = Repistration_ 165217
Type: Corporation
Expiration: 1 1212012 Tr# 292798
CO -OP POWER INC. — - _
PAUL SCHMIDT
324 WELLS ST
- GREENFI MA 0
_ Update Address and return card - Mark reason for change -
-- j_! Address Renewal = Employment Lost Card
1 v 50M- 04104- G7o7216
,. ` ✓f� -�ao�w,rufevllf °,� �,aeoful�u�a - -
Office of Consumer Affairs & Business TLtanlation License or registration valid for individul use only
' HOME IMPROVEMENT CONTRACTOR before the expiration date If found return to:
' Office of Consumer Affairs and Business Regulation
RegistraYlan_,_.. -165217 °
Expiratiow__A M12 Tr# 292798
10 Park Plaza - Suite X170
...: =- - - -= - Boston, MA 02116
Type:::;: == aDrion
10-0P POWERYINQ: _
'AUL SCHMIDT`_
124 WELLS ST �.-
3REENPIEL MA 01301 ry
Dndersecreta Not valid without signature
iMassachusetts- Department of Public Safety
Board of Building Regulations and Standards
co?s�Ictjon Supervisor License
License: CS 103635
Restricted to: 00
PAUL SCHMIDT
24 CHESTNUT ST
HATFIELD, MA 01038
- !y/ Expiration: 51202013
Conunb�;inner TT-,: 103635
1