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18C-117 (5) 4 / lu 1.0 100 85 I al.. -U0 73.75 151 18C -067 18C- 097 100 75 18C -092 140 104.5 100 75 151 18C_091 co 18C -098 100 SO. 75 151 • 18C -066 65 100 2 100 18C -099 150 107 18C -121 100 75 100 75 75 18C -100 75 100 4t./.49(.1 A/ O 95 100 18C -120 75 r 50 18C -101 147.7 75 100 18C -119 100 95 18C -102 75 100 8C -118 105 , 75 95 75 065 75 75 100 75 18C -103 18C -1 108.7 75 k`/ s o 48.85 105 95 18C -104 18C -122 so 18* 116 75 95 2.9 102 206.5 75 18C -123 110.5 64.5 75 18C -124 28 99.49 102 / 75 18C -125 45 100.21 101 18C -126 18C -115 95 124.11 112.5 54.53 18C -132 185 65 102 190 100 32.87 18C -127 % / 100 / 130.58 379.9 j 95 r. A� °® CERTIFICATE OF LIABILITY INSURANCE ! ✓� "'...,'..__,..., !3/18/09 'RODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Prouty Ins. Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 188 Main Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO Box 116 Spencer, MA 01562 -011 INSURERS AFFORDING COVERAGE ( NAIC # NSURE° INSURER A. Providence Mutual Ins. Co. P. G. LANDSCAPING, INC. INSURERB: UNION INS CO OF PIT P. 0. BOX 389 INSURER C. - -- --- -- - -_ - -- SPENCER, MA 01562 INSURER D. _ i INSURER E COVERAGES _ 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. VTR ADD GENERAL LIABILITY POLICY NUMBER D —__ - -_- I I Q�TE Y EFFECTIVE POUCY EXPIRATION LIMITS ,TR NS TYPE OF � �DATE(MM1DD'YYW1 POLICY EFFECTIVE 1 EACH OCCURRENCE 5 500,000 DAMAGE TO RENTED A I IX COMMERCIAL GE NE RAL LIAB ILITY I CPP 0061684 04 I 4/15/09 4/15/10 i PREMISES (Ea occurrence) IS _ 50,000 i 1 i CLAIMS MADE I X I OCCUR I MED EXP (Anyone person) I $ 5,000 — 5 , 000 i l j PERSONAL& ADV INJURY $ 500,000 _J ! GENERAL AGGREGATE S 1 000,000 -_ GENII AGGREGATE LIMIT APPLIES PER I PRODUCTS - COMP!OP AGG S 1 , 000 , 000 - -- j POLICY ? F LOC AUTOMOBILE LIABI UTY I COMBINED SINGLE L IM7 ' S I - ANY AUTO j (Ea accident) i ALL OWNEDAUTOS BODILY INJURY SCHEDULED AUTOS ' (Per person) ■ HIRED AUTOS BODILY INJURY $ NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO - --T -- -- OTHER THAN !ACC AUTO ONLY: AGG 1 $ $ I EXCESS / UMBRELLA LIABIUTY EACH OCCURRENCE $ OCCUR — CLAIMS MADE AGGREGATE $ ' — — $ DEDUCTIBLE I $ RETENTION $ I $ WORKERS COMPENSATION 1 WC STATU- ' I OTH- AND EMPLOYERS' LIABILITY j I TORY I NITS F R B ANYPROPRIETOR/PARTNER/EXECUTNE t r I WC00675 -6770 4/16/09 j 4/16/10 E.L. EACH ACCIDENT_ $ 100,000 OFF ICE RrtNEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $ 500,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT 1$ 100,000 OTHER • I , DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS LANDSCAPING CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFT HE ABOVE DESCRIBED POLICIES BECANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILU 0 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INS ER, ITS OR REPRESENTATIVES. .. AUTHORIZED REPRESENTATIVE _CHARLES N PROUTY % ,/� ACORD 25 (2009/01) ©1988 -2009 ACORD CORPORATIO / AI fights reserved. The ACORD name and logo are registered marks of ACORD . SECTION d CONSTRUCTION SERVICES $.1 LicensedS,Op tdgeti t3uaarvisart Not Applicable I License Numb=er Address Expiration Date Signature Telephone 9. Re istered Nome Im ovem4rlt,j s rt!ltdtgr • dust App1ic bla 7 P G Z—l9 A _ DS / fin . may J--. / � G �._ CvmOatl,Yl4.et2 t V Reglairation Number Address Expiration Date r elt'phonr' ��3 = a9' 'i// & ,Ion 0 ;SECTIO ' COMPENSATION INSURANCE AFFIDAVIT (M.0.L, c. 152, § 25C(8)) Workers Compensation insurance affidavit must be completed and submitted with this application. Failure to provide this affda'it wig result ! in the denial of the issuance of the building permit. _ --__ - -- - - - - - - 1 ragned Affidavit Attached Yes....,, 1. Ne ❑ „ -"Home (vvner ]Cx att The Current as e.nptior for "Dome ,uTrc.r ” was extended to include t), caner -arc trpied T. lereliin s pf ono (1; or tA and to allow such homeowner to engage an individual for hire who does not possess a license, gualded that the laragLag.th as aupen•ispr. C114 7 1.3Sixth, titlon Asian. 1O8.33.L Deflydtiott.ef HotpcovagE: Person (s) who own a parcel of land on which he /she resides or intends to reside, or •r<-l there is, or is intended to Pe, a one or tvty family dwelling, attached or detached structures accessory to such use vndr ra structures. A.uersue ,h�o,rarr9 r g nnc hatnejjt: two-vcar ►tc lat r a taiLag a,S a Imtrtcownrr. Such 'homeowner" shall submit to the Budding Official, on a form a ^ro.pt:able 4.o the Building (?Cit;ial rhsct hCGS1rC_ shall be responsible for all such work performed under the baildlaR permit As acting (nnscruetios Sttn erviaor your presence on the job site will be required from time to time, during and _Do, completion of the work for which this permit is issued. Also b advised that with reference to Chapter 152 (Workers' Cornpensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws .Annotated, matt be liattlt for person(s) you hire to perform work for you tinder this permit_ The undersigned 'homeowner" cernEes and as W1'S responsibility for compliance with the State Build :.rg Code, Gil Of Northarorcr Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotate Htrincewnt:w Signature ht10( Gt�CLB�f:Tt �d :1' i 600Z.6T:ni. - , Ail44,,` The Commonwealth of Massachusetts r - n--- - .. - z= Departerge.,n of Industrial Accidents PI- tr• ii .M Office of Investigations 600 Washington Street k. ..01 IPT Bostott„ 2114 02111 14-wwanaSS„govidia W orker!' Compensation Insurance Affidavit: BuilderslecintractorsiElectriciansiPlunabers Applicant Worn:lotion — --- - —7— SIgase.PALiti ----- E)— ---- -- Name (Blziness/OrganimaionAndivichia!) ( - : r . 4 1 1 ------ Address: 1... I - -- __- Are J.° u an employer? Check the appropriate box: r ,..i. a etuployer with _ _ Type of project (required): r' 4. 0 I era a general contraercr and I 1 -------:-----------7 - — i employees (fall =Wax partlaine).* /MIT hired the sub-‘....ontractors I 6: D New °Ii.sIllicti i — Fisted on the annebrki sheet I I 7. D Remodelino; 2. Li I am esote ploprietor or partner- ship and bavezio entployees The suh-contactors have I 8 ai] Dealcution ; w o r k i n g for Me in any oity. empicy=aenCi baye vital:ars' , 9. El SuBtlini eddi4Orn [No woriceo' ‘,..44). insurance - cramp. rammed. . L , . ' ,...1 - I required.] • 5 - 0 We are a O. COIrOatiOla alid iZ 1 E. =Pain OS additions i 3. LI I am a homeowner doiri! art work officers lierve4mrclsea. thetr i 11.0 ram:king repairs or additicras 1 myself Nolvorbrs' comp. insurance re quired.1 1 riga of eXCI4litai per MQL LI 1 EL c. 152, §1(4), and we bave sio 1 Roof airs Itp 1 employees: No workers" 1 13.0 Other L....... ----- -- conELMsatanect reeittited..] I I _ *Any applicant that c:hecks tem Oft mut atx . .af out th e. sectioct beivve4boarkiT ihdr wit ims. corapt‘urition p id orzna si oa . . 1 Horneovencre who suhmt this zfEdiish. Erik-4a thrY azt dorinZ au wet aed the= Eire mantle ctrtraaors must subilit 2 IICW alf.dmit incttattg rah. k.ont-actors (bat raCx,1c this ticgt taust =1=1 ay adititimal &beer shaving the r of tives0.anniirakturr, ra3d nue who:btu orr wt. ton =Nes bave erriplipyers. 1 1 the Silbm.11111/=75 LEVC =plery.ftt, they laic provide ther works& 00 , 74 ,_ poi rrmun h, cr. i am an employer tital ts pivol‘fing workers compensation insarancofor my einployees. Below is the polity and job aye information, losuranet Copyavy Na2tie; ' •-• e° L. ' 9 0' C. PP Doc./ 5q1-0 vic..g _Q,c,_,QD.17,c-6770 • Not) 61) -ikc.. 1-kituni -A)A . Policy # or Self-ins. Lk i . ef:_ J _____ Expiration Date:_ 91457/0 7oh Site Address: 3 0 /ii/ i SoA) _____L___cityistoizip; Nok77 .4".1.Tiu HA ........___ --- Attach a copy of the workers' compntim policy &titration. page (showing the policy irtunher and expiation date). Flame to sernir: Coverage ii.,. required Tuadci SettiiiiiltA Of MG-1.. C.;•152 eat lead to the fainositien of efirtinalliensiltles i ga. fine up x S1,500.00 =dim on ear impriaonment, ea well as civil penalties in tb.e form of* ST31 WOK GIRDER and a fiac oinp t s250-00 a daY:against the 'relator. Be f4visedIst a copy aft} statement tttly In fon.vareedto the Oetce of . triveititintioni - of the r_g&Itit_____ veLiffca;* . -__ - - . - - . „ . . . . Moth ezeity c tiler the patns , - pfi - of perlittythert the information providri above .i.viii.oraZ correct. ___. - v 4 41 . T) ci._ /6_:)- caiL___ - • • ._ :,.......•_ . - ;Wjir only. Do not wrke in this or town ,rwid • City Or Town.: Permit/License 0 Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. CitriTown Clerk 4. Electrical,rnspector 5. Plarehing aspects:- 6. Other _ • _ ________ ColtnaCt Person: — — Phone #: ---- 7..1Zii.Alleft: XV1 9t ,- Zi 6007.61 VIOIZ . . .,... , ra — 8,BULQN.j• OUBJIP_TION Qf PROPOSED WI,RK (cheek art aoollea.bei New Rouse 0 Addition 0 Tia.m .nt Windows Altereitionfa) 2 Roofing Or Doors Ci Accessory Bldg. 0 Demolition ri leew Sign [C31 Decks [ Siding g:0; Other [CZ Brief Description of PropoSed , Work: - 0_12 ik- 6 .11a_a_di , , ‚Z Alte4allon of existing bedroom yes , it_ No Adding new bextroom Yes Attached Narratve Renovating unfinished basement _ Ye's. Piers Attached Roll .. Sheet — aa. If N'-iii no ' ,• - an .' or a • • 1 '1 t I.• 1' ,, -; ;II. I a t- I. • °mien) the follawinn: a. Use cf bui:ding One Family _ 1 two Family Other , b Number of rooms in each family unit: Number a Bettroorra_ / c Is there a garage attached? __XII iv! IrAeiP d Proposed Square footage of new construction., /V /4 Dimensions ____..... ...._ e. Number of stories'? / _. f Method of heating? Fireplaces or Woodstoves N.rnber of each ,r,., Energy Conservation Compliance. .. Masscheck Energy Compliance form attached? _ r . Type of construction i. Is construction within 100 ft of wetlands? Yea ___ No. Is construction within 100 yr. flocdplain Yes _ Na P / i. Depth of basement or cellar floor befavv fi,lished grade k. Win building comforts' to the Bulld,ng and Zoning regulations? _ Yes No . I, Septic Tank City Sewer _____ Private well City water Supply ------- sEcitoN Ta - OWNER AUTHORIZATION - 70 BE COMPLETED WIrIP.N OWNERS AcFNT OR CONTRACTOR APPLIES FOR BUILDING PERMIT . — , — I, ___ A9 t/ Re.-"s>'0.,/,,...e , w Owner of the subiect property .., \ hereby authorize e 7 ,.._„......4/p. i Cit,/ 4/ 9 , .. I ' A/ C to act on my behalf, in all matters re ve to +so - Ian by ' building permit apolcation - --a2:---- . Slt mature of Omar Date Ar ..1 ' . . . . 1 / ViI2L_______ , as Owner/Authonzed Agent hereby declare that the star,pments and int . aeon on thr foregoing application are true end accurate. *,o the best of my know;edge and belief, Signed under the. pains end pen a . es of perigy Print Name / ..,.....i , ' Ionatere of Owner/Agent I Date — . . COOT] ZIZTLVX Xti Of"-Zi 6POZ.6T)or ■ ■ ! Section 4. ZONING AR Information Mug Be Compteted. Permit Can Be Denied Due To Incomplete IntormatIon Existing Proposed Requirod by Zoning This cowe, in be filled in by Building Dm:nu-nem -- --- _ — 1 tp l_t_ot So7e I _: ------_______ I Front4ge, . . . I Setbacks FTOnt Side L: - j-.+.1-. R.: t_CL L: tf, 1 ' ittar ___ Swirling Height ------- - - f 7 — • -- -1 . _. -- i — Bldg, Square Footagc 13 , r o --- % i - 0 ' 1 r ap - en Space Pootagm • ......., % i ---.. rtim alma minus bldg & paved 1.... earicrst1 I . t ------1 Ai of Parking Spaces _ ..... Fill A. Has a Special eermitiVararice/Finding ever been s.sued tor/on tie site? JO 0 DONT KNOW 0 YES 0 IF YES, date issued:. IF YES: Was the permit recorded a the Registry of Deeds? NO 0 DONT KNOW GI YES 0 IF YES: enter Book ------- Page ariiiior Docurnent # • -- B. Does the site contain a brook, body of water or wetlands? NO it, DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission' Heeds to be obtained 0 Obtained 0 , Date Issued: C, Do ary signs exist on the property? YES 0 NO 0 IF YES, describe sue, type and t0Cation: ' D. Are there any proposed changes to or additions of signs intended for the property ? YE$ 0 NO „,..., IF YES, describe size, type and location: G, Will the construction activity disturb (.mein, grating, avation, or nwng) over 1 acre or is A pr of a co'nmon plan that mil distut nvar 1 acre? YES Ci NO '. it YES, than a Northarnpton Storm Water Management Permit from the DPW ia required. Z1.7:12f Xv3. gt:;.:r 6007.,idi. 'OT Z002] ' , • 1 )( . r 7— ., City 'of Northampton Stati..WorPrecitit:. .' - : • ... .. - .. . , ,:•:_ r. ,‘ BuildIngpepartment turt4o1/1) - - : , " 212 Mn Street G Owi ri b fip t RoarA 100 Noriktmpton, MA 01060 , • , TY‘. ofEtri,iatiir PI, phOne 413-587-1240 Fax 41a-ss7-1 272 .. , oi• PIM/tile 'Mark . , - •-' : • ' . . . . . ' Other Specity .., I APPLICATiON TO CONSTRUCT, ALTER, REPAIR. RENOVATE OR DEMOLISH A ONE OR 'IWO FAMILY DWELLING . __ SECTION 1 - SITE INFORMATION _ __, This section to be compfeud by office 1.1 property Address: 3? 9/fijoi/ S'71-'' Ma p --- — L Zone Overlay , Elm 9t District CB nintritt , SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT ---1 i 1 _ — --....•■••■•••••■1^ . ---...------ ---.--- &1__Oeiner_of Record: 1 N ante (P Current Mailing Addre31 ------ ' Tral@phofie , ,...3192ye_____ ' — ------- , 2 2 Authorized Aunt ' - 1/ 4 1 ■/ ,e_i_ e 4 ch9Iplicek•X4,- N,rne Current Mailing A ddress 3 43;i7/9 . --- .. -- — , Signituto --. ,.. t . t .„,r,„ 7. ,......", , Telcuhime _ 3 - ......1 —12-- vf "?----P—e--------- i sEorION _ESTIMATED CONSTRUCTION CO ' T._ ----- 1 ltern — I — Estimated Cost (Dollars) to be Official U•te Oily . . . 1 permit eti.licant 1. Building 7 (a) Budding Permit Fee ----- V V V — - - --- 2. Electrical (b) Estimated Total Cost of ----- Construction from (8) i I Plumbing Building Permit Fee I • _ - 1 4 Mechanical (HVAC) 1 5, Fire Protection ______ 1 6, Total , (1 4' 2 3 4. gi. 5) ... _ _ Check Number ItilSition Far Official Use Only _______ _ Building Permit Numioe;•.__ __ $iin Attire: uldng c Issued: . _ Dorninic3loneribuvectpr & Buildings Nit —17-1------ ---7 __ _.,.. TO 0 l'n iTZT,T,LinClt ri'd firg,:r 600Z.61:01 r File # BP- 2010 -0480 APPLICANT /CONTACT PERSON PATRICK GALANT ADDRESS /PHONE 61 BROOKS POND Spencer (508) 885 -2985 PROPERTY LOCATION 38 ALLISON ST MAP 18C PARCEL 117 001 ZONE URB(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 Typeof Construction: INSTALL BULKHEAD New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans / Plot Plan THE F LOWING 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 Demolition Delay ��I� / .. 260 Signature of Building 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. Ate it BP- 2010 -0480 GIS #: COMMONWEALTH OF MASSACHUSETTS • _ CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -0480 Project # JS- 2010- 000663 Est. Cost: $4000.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PATRICK GALANT Lot Size(sq. ft.): 9452.52 Owner: REDSTONE PAUL Zoning: URB(100)/ Applicant: PATRICK GALANT AT: 38 ALLISON ST Applicant Address: Phone: Insurance: 61 BROOKS POND (508) 885 - 2985 WC SpencerMA01562 ISSUED ON:11/9/2009 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL BULKHEAD 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 Signature: FeeType: Date Paid: Amount: Building 11/9/2009 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo A5 0 75 ?5* x 0N- ne e Qty \,) '� �` Q ,.(< 95 A 75 95 . ?5 50 7 p 50 c..A2(3 .:\A 9 ...AA 1 t ' -1 1 a ?5 1pp -, 1 p5 �� 5 °2 — __ 48 85 90 ALLISON ST 64.5 2a p 5 5 1 1 1 13 2 �� 1 ' �A2 01 - °5 1 p2 - gg 3 1 12.5 B? AB- nt zit toe( /Id c't. y lacheme ...._ _ Board of Building Regula ions and Standards ill CI One Ashburton Place - Room 1301 A' 1 } Boston. Massachusetts 02108 Construction Supervisor License License CS: 76123 Restriction: 00 Expiration: 5/23/2010 Tr# 24726 WILLIAM R LAMORE 724 GREENFIELD RD DEERFIELD, MA 01342 Update Address and return card. Mark reason for change. Address Renewal Lost Card DPs CA1 Ca 50M-0707 PC:64g° ■ . ( 1 6M0142.14M7aag Ott: #42,14(4,41460e6 Board of Building Regulations and Standards Construction Supervisor License License: CS 76123 Expiratiat 5/23/2010 Tr* 24726 Restriction: 00 WILLIAM R LAMORE 724 GREENFIELD RD q., _...---- .....–*e DEERFIELD, MA 01342 Commissioner . . 4 i r ' STATE OF CONNECTICI'T DEPART.1J1.1'7 Of COA PROTE C'T10 HOME IMPROVEMENT CONTRACTOR WILLIAM R LAMORE 724 GREENFIELD ROAD DEERFIELD, MA 01342 ■ LIC. / REG NO EFFE TIVE t II EXPIRES HIC.0572771 12/ 1/2008 11/30/2009 SIGNED Viit'e"a'6"iiN R •.'•.1. , 7.4 :. . Vd* Y I/ 1 .... • 1 S '' .:::::::04: . .. � .. t w r. j ✓ i . t t '.4 .'4 V .. t. �..+� �t • • - tqw . ybM {t ,' . t . ti �' 71 i V r $, :10: , . ; .. ;t„ s s • e1 t t .en t r4: kM1 N t �'A t k s .t .tit. '.'2 • s•, s, is r :,?,lttn, s 1 . °.t, t , r ,.� ` 1�,J ,u 3�, .. } t,. °t, 1/ ..?., ,.,�': �.� `: by s .t i•,1,. r r. .M1 .• '. M 'rt r h rtJ: �Ra AV.. ,1. ,At. r yy fj'% . e f, 4'. Art: Y, l. .� 6. l y i ' g 't r. ..M1 ..� . � 1 t � ' Al q q y Y !,{ � � i,. ' lf f �t', fig ff ,�.... , fF,.,,. ",� -61:: '4, 'f�` alt,,,,... � .,. .. Rte.,.. ,tJ f �.. r ? ^ .. �,, { � 1fR fif jft� fj� S R 1, �• /0-"I'' � ;i� � , � S TATE OF CONNECTICUT ._ _ rICU1 # DEPARTMENT OF CONSUMER PROTECTION '° - . „ . S A,. r ,5':';',-: .d.. B e it known that ,' • WI LLIAM R LAHORE f > A1.4, i 724 GREENFIELD R OAD ' t DEERFIELD, MA 01342 f \- is certified by the Departrrient of C`o Protection as-a registered '� ' ,; yam F HOME IMPROVEMENT. CONTRACTOR ' • � Registration # I:I � 572771 h sy f * i LAMORE LUMBER CO ' ; e ."r Effective: 12 /01/2008 ` ' ' Expiration: 11/30/2009 -_' p Jer ry Farrell, Jr., Commissioner ?� > s t -0 ll +T i ti s t s �10 " f . " ift s , r vt , s }t ; :. i , }?'. t ,4*;'t 11/ ii N @ -f t' t ° v.,�,, F;f p t , ••• �s1 t y )J . ig s , a4 �(f(t J f ff 1 �{ t Vj ,s r x , ,Zk h i 4 i rs} '' e .4" t S 7„t. ,. ,tl . BJ. 4d ,, - 3 ..3 q ! — ,,, '` 4 �, - .I �r� y',; p ( :. 0 :' �, ;, � �� .f ..t 3 r �� r h . n ,r. rM1 4 s r 7.. w 4,a r , Y f� •,,, ,.r „ y r- >. ' • Z; ^ • - „, f ! }t ii G f t ti {f � • a i t ,. . s { !� q • , ,t : ; s. 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I AMORE 1.,10 cc, ..., , Ri..',0111L :i; & 10 MA (i! 7 14?. i 1 -- ;e.,!efri - 15 --- > ( ,) , 0 , a ..-- 1 ;.--'-') F „:0P.0' Cit PORATION, A11 rigt 7e;;Eff1. (ti ..AC4 1-ta.(7 , i,,;" ■17r7' 7.: 1,' AMINIIIIIIIIIINIIIMP*- SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: c ,Q J�J Not Applicable ❑ Name of License Holder : k /f /0 ' . i/ r O� e 9 L/ '4,62 P e/ t/ /5 /J / ?/ License Number r � Q�� P�� /y fit m13� � t' -�' 'k? 6 / 5 Address Expiration Date 7 Signature f - lephone 7 ;)4 %' , 3 7 7353(5s-- 9: e�4iste to 'm�ertmi�rci�iement :r, P Nr. Not Applicable ❑ t/l/f/ 77/14,47 ,� f /7f) ' /f Company Name Registration Number AA/7()A e �rr c, OS 7 P" Address E x Expiration Date �����, p�3�?� p i Telephone P/50/9 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 S. No ❑ t '' "' 111 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 1083.5.1. 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 ,w, 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 t -CA Frontage Setbacks Front Side L: /2 R: 3 0 L: R: D Rear v ' i` Building Height f / Bldg. Square Footage -��jj pi) Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /finding ever been issued for /on the site? NO 4, DON'T KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO ► DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 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 ® NO et 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 ® NO ► :t 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) Roothg ❑ Or Doors 0 Accessory Bldg. Demolition ❑ New Signs [0] Decks [Q Siding [0] Other [C]] Brief Description of Proposed ,..•,._- / ,Ft / x I y / � f �� St/'i Work: .,,« -*lb; l� / Alteration of existing bedroom Yes / No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes Plans Attached Roll - Sheet . J e1N , 'OU$�' C��I�d<(�f]ItlOf1 ji4 N1 �111 ®;]10t1S1O • 'COI11 �]g�a, fl @'fi0�]t�W�11.` 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 hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date t/ / e D r , 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. fr9" I/ Re).-)_c)-0,44P Print Name • % ///7 6 p F Signature of Owner /Agent Date City of Northampton . ' ` ' ° Building Department ,. 212 Main Street � -, 'Room 100 = • °`' � c ' ' Northampton, MA 01060 � • ,,(`,\. ; �' p hone 413-5w-1240 Fax 413- 587 -1272 . APPLICATI T CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: 'This section to be ' ffice : t ,"///$ OA( S T : Map Lot Unit /VDiQ /t 1�� 0 / Q 6 Zone Overlay Distri Eim'St.DIs"irtct P { , w C1 lst t � r SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Name (Print) Current Mailing Address: Telephone Signature X ook ,q 2.2 Authorized Agent: , itoj ,c c>,-, cif? Y5 Name (Print) Current Mailing Address: p 3 n v/1/9 L° ,� //ii / '/ J 4 �6 6f Pi Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 9 3/ 0 (a) Bu Permit Fee 2. Electrical (b) Estim Total Cost of Constriction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total= (1 +2 + +4 + 5) Check,Numi r ` a ,`" This Section For ff ldlal Use O Total date Sottdtng Permi l umber c Issued, Signature ti",-;:!,::,']''':' _ . ding ommiss�it nerll pector o Bltl s " Date , g , • File h BP- 2010 -0548 APPLICANT /CONTACT PERSON REDSTONE PAUL ADDRESS /PHONE 82 CLAYBROOK RD SUNDERLAND (413) 665 -8914 O PROPERTY LOCATION 38 ALLISON ST MAP 18C PARCEL 117 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Paid Typeof Construction: ERECT 10 X 14 SHED New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF RMATION 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 e. 7" / (;;;/____ / Signature of Building 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. 4 Y£ .. BP- 2010 -0548 GIS #: COMMONWEALTH OF MASSACHUSETTS ..hl :z r ` ''' CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -0548 Project # JS- 2010 - 000773 Est. Cost: $3100.00 Fee: $28.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 9452.52 Owner: REDSTONE PAUL Zoning: URB(100)/ Applicant: REDSTONE PAUL AT: 38 ALLISON ST Applicant Address: Phone: Insurance: 82 CLAYBROOK RD (413) 665 -8914 0 SUNDERLANDMA01375 ISSUED ON:12/10/2009 0:00:00 TO PERFORM THE FOLLOWING WORK: E RECT 10 X 14 SHED 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 Signature: FeeType: Date Paid: Amount: Building 12/10/2009 0:00:00 $28.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo Demolition 1. Removal of paneling, insulation, ceiling tile and other debris to make the upstairs ready for insulation and/or other work. NOT responsible for removing windows, wood trim or material that may contain pre 1978 lead paint without change order. Customer did sign Opt out Agreement for lead just in case. 2. Customer will supply dumpster. Insulation Portion 1. Installing 6+ inches of dense pack cellulose (aprox R21) in slopes of second floor from first floor wall plate to ceiling cap. 2. Installing 1 -7/8 inch polyiso board (R12) to inside of slope rafters, taping each seam with foil tape. 3. Installing furring strips over polyiso board for sheet rockers, dimension to be determined. 4. Installing R -38 or what is possible to ceiling cap with loose blown cellulose. Hatch will be provided. If hatch is needed to be installed a change order is will be issued. 5. Installing dense packed cellulose (aprox R13) to gable end walls, using reinforced plastic. The Commonweakh of Massachusetts Department of Industrial Accidents Office hivestigations 600 Washington Street Boston, MA 02111 www.massgov /iris W Comps Insurance Affidavit BoilderviContractors/Elechicians/Plambers Annficant Information Please Print Iry Name (BosisessfolganissamiharkissiX co — O Pp j ,,, W ,- Address: 37. c,14 ajv S -"' cit e : Greg/6M mA • 01361 r>> #: (PS-- 77 ;- 4 s X Are yen an mpivyer? (Meek the a piaptiate bore Tsreof r ( k 1 .4. ,/ram as empiayer with 8 4. _ I am a general contractor and 6_ New Cansandian Epees (fdl and/or Pert -fit)* have hired the sub-contractors 2 7_ _Remodeling . _ I am►a sole prnpaetrear partner- listed on the attached sheet: i Ship and have no employees These Irrtve 8- Demolition Wari®g for me batty capacity. wows' camps insurance. 9. Bantling Ashram [No 'madras' comp. insurance 5 We are a corporation and its 10. Electrical agars or additions required.] officers have mrercised their — 3. _ I am a homeowner doing all rood( right afesempdon per AWL 11- — Plumbing repairs or addaions myself [NoWadoers'camp. C. 152,' 1(4), and wehaveno 12 _Roofrepaas t ,�s� insurance re9eired.] employees. [No ' 13_ (,)0� :I &.1/ '14 Uit1 camp. ilffindOCC requited] API)eb * carry applicant got checks box in mwtabo till outdo section Wow abaci* their madam' oompanscim palm' r information. *Homeowners vriso submit titis affidavit indicating tiny are doing all cock and then bins outside caductors must sate& a now affidavit indicts* such. *Contractors that check this boot mmt attach an addgiood duet showing the same °fibs sab.comn,tors and their workers I omen employer OW s providftworkere for m► employees. Below is the policy a djrabthe in hmurance Company Nam= ehiC,K 1Y1 P o l i c y # o r S e l f - i n s . Lk. O vd eoL C 6 /1' Expiration Dram H. 1 CI l u 1 Job Site Adder .s y AThs Attack a copy of the workers' compensation policy declaradiea page (showbrg the pokey amber eapirairon dale). Belpre to secure coverage as regaaed under Section 25A afMGi, C. 152 can lead to the imposition oforiminal pennies afa fine up to $1, 500.00 and /or anoyear as well as civiilpeoaities the form afaSTOP WORK ORDER and a fine of uplo S250.00 a day agate the violator. Be advised that a copy °£this statement may be forwarded to **Office oflnaos ofthe DIA for iliSIXIMCC coverage verification. Ido hereby catfra the alpwJpy that the iirfonootion prouder aboveisirreaedconactt Signo a = D 1 7// i_i_Zaa? Phone 0: 1 1 l3 poi Oificied asew Dr:neitw>ulclred% am, isle coolploisi bely*tom City or Town: Pearvittiasaed: Issuing Authority (circle anek 1. Board of Health 2. BunrImg Department 3. City /Town at 4. Electrical Inspector 5. Plumabing Inspector f. Other Cotes Pie& ACa DATE (MMIDDNYYY) r`„ C OF LIABILITY INSURANCE 1/22/2010 PROnucER (413) 625 -6527 FAX: (413) 625 -8210 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Blackmer Insurance Agency Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1000 Mohawk Trail ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Shelburne MA 01370 -9737 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Landmark American Ins Co Co -op Power, Inc INSURER 5: Hartford Insurance Group 324 Wells St INSURER C: PO Box 688 INSURER D: Greenfield MA 01301 INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR pA ' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE D N I LTR INSSRD DATE IMMlODiYYyy] GAATTE E IMMIDD!YYY Y) LIMITS M(DDNYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY PREMISES Ma occurrence) $ 100,000 A X CLAIMS MADE OCCUR 05599600 11/8/2009 11/8/2010 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT. AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 X(POLICY IJECT ILOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO 1,000,000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Person) 1$ A HIRED AUTOS — BODILY INJURY X NON-OWNED AUTOS 8A05599600 11/8/2009 11/08/2010 (Per accident) $ PROPERTY DAMAGE $ (Per accident) G AR A GE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS !UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE 5 RETENTION $ $ B WORKERS COMPENSATION I WC STATU- ( OTH- AND EMPLOYERS' LIABILITY Y TORY LIMITS FR ANY PROPRIETOR/PARTNER /EXECUTIVE I 108WECLC6866 11/01/2009 11/01/2010 E.L. EACH ACCIDENT $ 500000 OFFICER/MEMBER In EXCLUDE y E.L. DISEASE -EA EMPLOYEE $ 500000 H C deacdba under SPECIAL PROVISIONS babes E.L. DISEASE - POLICYLIMiT $ 500000 OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS! VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS Certificate issued subject to the terms, conditions, exclusions, and endorsements attached thereto. Operations ususal to alternative solar energy resources. Berkshire Gas is listed as additional insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Berkshire Gas Company DATE THEREOF. THE ISSUING INSURER WALL ENDEAVOR TO MAIL 10 DAYS WRITTEN 115 Cheshire Road NOTICE TO THE CERTIFICATE HOLDER NAMED TO 11-10 LEFT, BUT FAILURE TO DO SO SHALL Pittsfield, MA 01201 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 26(2009/01) ©1988 -2009 ACORD CORPORATION. All rights reserved. INS025 (200901) The ACORD name and logo are registered marks of ACORD *9 10/102/,;494t ec'eta&A Office of Consumer Affairs and usiness Regulation 10 Park Plaza- Suite 5170 �t Boston, Massachusetts 02116 Home Improvement Contractor Registration ' Registration_ _ 165217 __ . _ - Type_ -CorPoration - ` ' - _ - Expiration: 1/21/2012 Trd 292798 CO-OP POWER, INC. ^-- - PAUL SCHMIDT 324 WELLS ST _ ` GREENFIELD, MA 01309 _ Update Address and return car-AL reason for change.. _ — 0 Address ❑ Renewal ` fl Employment D Lost Card 9 k 46 s.Q �,, f/ // - Office of Consumer Affairs & Business Regulation License or registration valid for iadividui use only ii HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to 5 Office of Consumer Affairs and Business Regulation 7 b -- Reg 165217 10 Park Plaza -Suite 5170 Expiration_ ; -112 (2012 Trd 292798 Boston, MA 02116 Type i CO-OP POWER,1NC�: _ PAUL SCHMIDT = _ -- . 324 WELLS ST _ - 4.J- -. �� GREENFIELD, MA 0130 Undersecretary Not valid without signature Massachusetts - Department of Public Safety Board of Building Re'g'ulations and Standards \ I Construction Supervisor License License: CS 103635 Restricted to: 00 Paul SCH 24 CHESTN ST ' HATFIELD, NIA 01038 Expiration: 5/2013 t'onankstanner Tilt: 1 1 A SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : J2 /'Y�I / 1 0243S- Lice se Number q c ):4 i mf , - - "� — 'zz5 ) Address Expiratio Date natu e Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Co Or° PO 2 ) Company Name stration Number r &411,. _ ) 2-- Ad•'-ss � f . ' j v� (J/� .,,, t �Z) Expira n Date r 6 Telephone 7 77 -OD p� I(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 00 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 -rear 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 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing n Or Doors 0 — 1 Accessory Bldg. ❑ Demolition 3Z1 New Signs [0] Decks [EJ Siding [0] Other [0] Brief De cription of Propose. Work: ri •, ,A t so la 4 t l , Al 1- / A 6 . (;,.# ' C _ it' /✓ W - �,, St l Ar ✓ i N '�( % / Alteration of existing bedroom ` Yes _o Adding new bedroom _ Yes No Attached Narrative (l 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 . 1. 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 - X I. /` (r _ %V — _ as Owner of the subject property hereby authorize Q 00 C J ) 4 e ( ✓ V I I' d' rl rt. , C r to act on my beh n attmatte� t flck thorized by this building permit applicati n. Signature of 0 er Date I, __ ') J C/4 � . as Owner /Authorized Age t hereby declare that the staterrfents and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed der the pains and penalties of perjury. / . C PttN..•- Ari %/ ..,i 21) ---2,69b Srgnatur. w o • Agent ate .a Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to he Idled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building height Bldg. Square Footage °0 Open Space Footage 00 ( Lot area mints bldg & paced parkins) # or Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO O DON'T KNOW °ESL YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES O IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO jg IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES O NO Q' 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 O NO iec IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Adoommummummomminumook Department use only • `' • City of Northampton Status of Permit: Building Department Curb Cut /Driveway Permit 2 ^ �� 212 Main Street Sewer /Septic Availability t �� U �0 Room 100 Water/Well Availability Nprthampton, MA 01060 Two Sets of Structural Plans phone 413- 5871240 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: This section to be completed by office ) A � Map Lot Unit 3 Aiii Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: ]� r J /)/v �_ � l / / f r (r . 5 iP� J Name (Print) Current Mailing A dr T elephone ,` ` 7 — 3 / ` *Signature y J V 2.2 Authorized Agent: Na I int) FG /4/14 / 1 f - t1 6 - °/ f) Curren ailing Address: PArr - igna� --. ------------ - - - - -- Telephone _ — _ - -- j SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building L� (a) Building Permit Fee 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) Check Number /97 This Section For Official Use Only l►�`� Date Building Permit Number: — Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2010 -0954 APPLICANT /CONTACT PERSON PAUL SCHMIDT ADDRESS/PHONE 24 CHESTNUT ST HATFIELD (413) 247 -5739 PROPERTY LOCATION 38 ALLISON ST MAP 18C PARCEL 117 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 6 �/ Fee Paid Z 5 V Typeof Construction: REPLACE INSULATION New Construction 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 INF91 MATION 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 / Al 1 Signature of Building 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. k.4AONS BP- 2010 -0954 GIS #: COMMONWEALTH OF MASSACHUSETTS it g , tt " = , Ii r CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -0954 Project # JS- 2010- 001413 Est. Cost: $4850.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PAUL SCHMIDT 103635 Lot Size(sq. ft.): 9452.52 Owner: REDSTONE PAUL Zoning: URB(100)/ Applicant: PAUL SCHMIDT AT: 38 ALLISON ST Applicant Address: Phone: Insurance: 24 CHESTNUT ST (413) 247 -5739 WC HATFIELDMA01038 ISSUED ON :4/29/2010 0 :00 :00 TO PERFORM THE FOLLOWING WORK: REPLACE 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 Signature: FeeType: Date Paid: Amount: Building 4/29/2010 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo