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15B-021 (2)
101 CHESTERFIELD RD BP- 2011 -0037 GIS #: COMMONWEALTH OF MASSACHUSETTS Map.-Bloc 15B - 021 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Bugg[! DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2011 -0037 Proiect# JS -2011- 000065 Est. Cost: $2100.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: URBAN & SONS INSULATION CO INC 101878 Lot Size(sq. ft.): 32365.08 Owner: HOUCK GEORGE F & HEATHER G Zoning: URA(100) / Applicant: URBAN & SONS INSULATION CO INC Fi`il: Ili 1 13, 1'lCJTLi`t1`IELD l-,i-i Applicant Address: Phone: Insurance: 385 LIBERTY ST (413) 732 -3922 WC SPRINGFIELDMA01104 ISSUED ON.- 711912010 0:00:00 TO PERFORM THE FOLLOWING WORK.- INSTALL FIBERGLASS INSULATION POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Serviced . Meter: Footings: Rough: Rough: House # Foundation: _Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Ifnnjjsulaation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NO HAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REG 6,* # ' Mo tZM44 Certificate of Occu anc nature: FeeType: Date Paid: Amount: Building 7/19/2010 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo BP- 2011 -0037 GIs #: COMMONWEALTH OF MASSACHUSETTS i4la Bloc 15B - 021 }. CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildil DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category BUILDING PERMIT Permit # BP- 2011 -0037 Project # JS- 2011- 000065 Est. Cost: $2100.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: URBAN & SONS INSULATION CO INC 101878 Lot Size(sq. ft.): 32365.08 Owner: HOUCK GEORGE F & HEATHER G Zoning: URA(100) Applicant: URBAN & SONS INSULATION CO INC AT. 101 CHESTERFIELD RD Applicant Address: Phone: Insurance: 385 LIBERTY ST (413) 732 -3922 WC SPRINGFIELDMA01104 ISSUED ON. 711912010 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL FIBERGLASS 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 Sisnature: FeeType: Date Paid: Amount: Building 7/19/2010 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo File # BP- 2011 -0037 APPLICANT /CONTACT PERSON URBAN & SONS INSULATION CO INC ADDRESS/PHONE 385 LIBERTY ST SPRINGFIELD (413) 732 -3922 PROPERTY LOCATION 101 CHESTERFIELD RD MAP 15B PARCEL 021 001 ZONE URA(100) THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid AM Typeof Construction: INSTALL FIBERGLASS INSULATION New Construction Non Structural interior renovations Addition to Existin Accesso1y Structure Building Plans Included: Owner/ Statement or License 101878 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION 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 m . tion Delay Signature of Building Offi6al 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. !Al a �Dep,rtment�lse�pnly City of Northampton b ��� <� Bul {ding Department xk x A �Ci� 2�2 Main Street l5ep�caa�Iabtltty 'n Aoom 100 atefitell Atiiatiafi�lty Northampton, MA 01060 Tie 56"f4,tt�da PI An phone 4'13- 587 -1240 Fax 413 - 587 -1272 P #xtCS�te Ptass < der APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING fSECTION 1 - SITE INFORMATION Property Address This section to be completed by office (�� Map Lot Unit Zone Overlay District Eta* St District CB District SECTION - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record - -- - - -(- 10" E C. -P c� y e� �� - i �I c 6N er r `( ( � Name (Print) Current Mailing Address: Se AN ckdi Telephone - gt 0 Signature 2.2 Authorized Agent: '!1 U fASee,V SUv►55�, 14(ca4� Ua �� Lf �� S H Name (Print) Current Mailing Address: Signature Telephone SECTION 3'= ESTIMATED CONSTRUCTION COSTS Item Estimated Cost {Dollars) -to -be Official Use Only completed b permit applicant 1. Building�� y � �(�� (a)Building'Permitfee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total= (1 +2 +3 +4 +5) a(oC - ;;I �CheckNumber - This Sec'ion Fob Of#iciaE CCse Or�y' 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. _m._ ... L _.._....._ R Rear �... .. Building Height Bldg. Square Footage _ __ __. % Open Space Footage % _ - -- (Lot area minus bldg & paved p arkin g) # of Parking Spaces _...__ , __._....__ _...... Fill: i volume & Location —_. , . _ _ _ _ ._ . ._ _.... _...__..... .._._ A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT K NOW YES IF YES, date issued:x IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONTMKNOW 0.., YES w IF YES: enter Book 5 f Page and /or Document # M1N B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained - Obtained , Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: i D. Are there any proposed changes to or additions of signs intended-for the property ? YES 0 NO 0 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 YFS, then a Northampton Stomi Water Management Permit from the DPW is required. w SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition Replacement Windows Alteration(s) Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [M Siding [01 Other [C� Brief Description ,pof� Pro ose Work: C �� e!`G� RSS ��1� ( (A t'J Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes _ X No Plans Attached Roll - Sheet sa lf'l e�iv ltoase ar>rd ar:acitlttlo toi6x l� iiliii rg-° 66MWiate .the 6fl6 ing: 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? 0 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 APPLfES FOR BUILDING PERMIT I, as Owner of the subject property a q� hereby authorize �+ >^�� v\ Q i� ... `I Vu V' a �� Cl V / l kkV �J r�Q V\ to act on my behalf, in all matters relative to work authorized by this building permit application. n Signature of Owner Date I 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. Signed under the pains and penalties of perjury. Print Name Signature of Owner /Agent Date r SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction S upervisor : LL Not Applicab Name of License Holder i� \ U`� V rJ G c) License Number Address Expiration Date 7 3Z,3 T Z Z Signature Telephone 9.. Registered. Enamel "mnrovemen #:.Car�tracfor: Not Applicable ❑ r G © SY Company Name Registration Number ef Address � Expiration Date SV . uy Telephone SECTION 10- WORKERS' COMP ENSATION INSU RANCE AFFIDAVIT (M.G. c. 452, §- 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...... ❑ trL� 11I11 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 buildine permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion -off the - work— for - which- this- permit-i &-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 saws Annotated. Homeowner Signature The Commonwealth of Massachusetts Departinent of Industrial Accidents - Office bfInvestigations k: ' 600 Washington Street Boston, MA 02111 www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name (Business /Organization/Individual): y T_\_Yzt v -S O►'is Address: City /State /Zip: !` � ' ` � Gk to 1A_ Phone #: Are you an employer? Check the appropriate box: Type of project (required): 1. [54-4-am a employer with Z 4. ❑ I am a general contractor and 1 6. ❑ New construction employees (full and/or part- time).* have hired the sub - contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub - contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.7 Electrical repairs or additions re 3. ❑ I qu a homeowner doing a11�veFk - - -- -- officers have exercised their _ _ _11_❑ Plumbing repairs or additions myself. No workers' comp. right of exemption per MGL 12. ❑ Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box #1 must also fill 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. +Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have employee's. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: ` n zw\ VY\ Policy # or Self -ins. Lic. #: �,'M Z--Y O .S �� l Z. C29 Expiration Date: e)/ t _ I CD Job Site Address: C c �1 e�- � ( d y� CA 4f City /State /Zip: q vcc;s, ell ('0 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 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500:00 and /ot one- yearimprisonment, well -as civilpenxlties -in- -the - form of -a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: ��Gs'� / i Date: / 7 Phone #: O fcial use only. Do not write in this area, to be completed by city or town official City or Town: - Permit/License # Issuing Authority (circle one): - i. rtl ofl e !{Ii— ?�t1 #IdI Beparttnetil 3. City /Tuyva Clerk__.4_Tlc-c-t Inspector 5. Plumbin Inspector 6. Other Contact Person: Phone #: HOME OWNED EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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 home owner." The building department for the City of Northampton wants person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become - responsible for compliance state buildingcodes -and r egula t io ns. The, inspection process requires that the building department be called to inspect woi vanous stages, whicirde fomrdtion/footiu�s(before bacfrll), sonotube holes (before your), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupaney until: tt a work can be ins ectetf _... P _ If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. .(Home owner /resident's signature requesting exemption) I will call to scledule a71 require uil inspections necessary for the building permit issued to me. Date Address of work location DATE 7 l C PHONE - CELL r ®� FAX CONTRACTOR STREET l C I CITY ��� L� L ZIP JOB STREET -- CITY AREA FOOTA THICKNESS TYPE O.C. MAIN CEILINGL CATHEDRAL CEILING GARAGE CEILING V) 0 BASEMENT CEILING Z � U 2nd FLOOR SLOPES �� '� � a Q w ; ✓S u per` 2nd FLOOR KNEE WAILS 1 st FLOOR EXPOSED CEILING GARAGE EXTERIOR WALLS EXTERIOR WALLS GARAGE HOUSE WAILS WOOD 1/2 WALLS (WALKOUT( CATHEDRAL WALLS ' J Q CONCRETE FOUNDATION WALLS BASEMENT BLOCKERS & RUNNERS l f �L V �S . P q l nc>�r�VN �YN nW Chu k STAIRWELL WAILS C w� Q,� 9 " � R / BATH WALLS t"Ce_ (� G n V O ( / c- A PARTY WALLS OVERHANG C 0 W V\ ti v-(cjS ► � Q, '� Q ' p � (P� CEILING ENDS O v� �\ V\ G L U V\ C �f'S 1�1` �'` 1 st FLOOR BLOCKERS & RUNNERS PROPER VENTS c PRICE TYPE OF STRUCTURE �- r v� v(C►�`� c,c D6 6� I �'e e v z, v` C I o F DIRECTIONS: ESTIMATOR DATE ❑ FAX EST ❑ JOB 4c ti O.C. 2ND R PES O.C. CATHEDRAL CEILING O.C .0 I 1 I 1 I I I 1 Z 1 1 1 I I I GA GE CEILIN © ; O.C. 2ND FLOOR KNEE WALLS ; O.C. BASEMENT CEILING ; O.C. 1 1 1 I 1 1 I 1 1 I 1 1 1 1 1 1 1 I 1 1 1 1 , 1 1 I O.C. 1ST FLOOR EXP. CEILING O.C. ; 1 I 1 1 I I 1 I 1 I I 1 I I 1 I I 1 1 I 1 1 1 1 I 1 I I 1 I EXTERIOORAWALLS ) O.C. GARAGE HOUSE WALLS O.C. WALKOUT WALLS O.C. 1 I 1 1 1 I I 1 1 I I 1 I 1 1 I CATHEDRAL WALLS ; O.C. FOUNDATION WALLS ; O.C. STAIRWELL WALLS ; O.C. 1 1 I 1 I 1 I I 1 1 1 I I 1 I 1 I I 1 I I I I I I AOW A 1 1 1 1 1 PARTY WALLS O.C. BASEMENT BLOCKERS- RUNNERS O.C. I I 1 I I 1 1 I I 1 1 I I 1 I 1 I I 1 I 1 1 I 1 1 I 1 1 1 1 1 OVERHANG O.C. 1 ST FLOOR BLOCKERS O.C. BATH WALLS O.C. & RUNNERS Oak 1 1 1 I 1 t I I I I 1 1 I 1 I f � I 1 I I 1 I 1 1 I 1 1 I 1 I 1 1 I FFF���JJJ C I I I 1 I I 1 I I 1 I I 1 I 1 I 1 1 1 1 i 1 1 1 I 1 1 1 1 I 1 1 I I 1 I I 1 I 1 1 1 I 1 1 1 I 1 1 I 1 I 1 1 I 1 1 I 1 I 1 I I 1 1 1 1 1 I 1 I 1 1 1 I 1 1 I 1 1 I URBAN & SONS INSULATION CO. INC. E6 385 LIBERTY STREET SPRINGFIELD, MA 01104 (413) 783 -0701 • (413) 732 -3922 MASSACHUSETTS FAX (413) 525 -8116 REGISTRATION #100590 Proposal Submitted to Phone Date George Houck "Purchaser" 896 -4906 7 -7 -10 Street Job Name 101 Chesterfield Rd. Same City, State and Zip Code Job Location Leeds, Ma 01053 Contractor hereby submits to Purchaser specifications and estimates for: 2nd floor above garage. Main ceiling 2nd floor - 12" Unfaced batts with fire poly R -38 (1) 2nd floor Slopes - 10" kraft batts with proper vents & fire poly (peel paper) Exterior walls - 6" Unfaced batts & fire poly R -19 Proper vents - Installed in slopes complete (1) Insulate past open kneewall. Options; If 10" High density R -38 installed in the slopes add: $250.00 61ef to contract price. Urban & Sons INsulation Co. will pull the permit. 1L - �� �/� 1 - /sue � „ -7� WE PROPOSE to furnish material and labor, complete in accordance with above specifications, for the sum of: One Thousand -Fight Hundred & Fifty dollars ($ $1850.00 l payment due upon receipt of invoice. NOTE: This proposal may be withdrawn by us if not accepted within thirty (30) days. I AO Contractor les 7 /' Accep nce by .r aser, Title and Date YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. Payment in full due upon completion of work. Accounts owed over 30 days are subjected to a finance charge of 1 �% per month (18% annually). After 60 days buyer agrees to pay all collection fees including a reasonable attorney's fee. URBAN & SONS INSULATION CO, INC. 385 LIBERTY STREET SPRINGFIELD, MA 01104 (413) 783 -0701 • (413) 732 -3922 FAX (413) 525 -8116 I (� d 9- C e UCH , N�4t,4 eld 4 � of f D Custom e r� N Address I -e'e v give permission to pull a permit for my City or Town home to do insulation work to be done by Urban & Sons Insulation Co., of Springfield, Ma. Any questions please call me. 413- 783 -0701 Salesman for Urban & Sons Date 1ta bavr--