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17A-173 (3) '`--- City of Northampton Massachusetts * ' " `�c f � W v 1 ( t DEPARTMENT OF BUILDING INSPECTIONS Sv ' � �• *>°` 5:' 212 Main Street • Municipal Building k3 ,��' \ , - -+ � Northampton , MA 010 60 sE h` ‘ Property Address: 40 Howe Street, Northampton MA Contractor Name: Paul Schmidt (Co -op Power) Address: 24 Chestnut Street City, State: Hatfield, MA Phone: 413- 247 -5739 Property Owner Name: Beverly Shaw and Thomas Bassett Address: 40 Howes Street City, State: Northampton, MA I, Paul Schmidt (contractor) attest and affirm that the building I intend to insulate does not have any open air (knob and tube) wiring in the spaces to be insulated and that I have provided the property owner with a copy of this affidavit. Contractor signature 1 ):4 Date 3 , J' I ..2-- co -OP di' 1 L /7 POWER BUILDING COMMUNITY -OWNED SUSTAINABLE ENERGY Affidavit of Waste Disposal 1, Paul Schmidt, Energy Efficiency Program Director of Co -op Power certify that Co- op Power will remove all waste from the job site located at:_ lM QS £4f ' A ' f1 I��'✓ Owner Name Street Address Town /State • Waste will be disposed of at our dumpster at our facility in Hatfield, MA. Our removal service is Waste Management. Paul Schmidt Da'- Co -op Power, 324 Wells St., Greenfield, MA 01301 or Mailing Address: Box 688, Greenfield, MA 01302 ph: 413.772.8898 or 877.266.7543, fax: 413.517.0300, info @cooppower.coop, www.cooppower.coop A CERTIFICATE OF LIABILITY INSURANCE 011 M 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 t AE: CONTACT Shannon Pala77o James J. Dowd & Sons Ins 14 Bobala Road moo. Ems) 413 538 7444 FAX No :413- 536 -6020 Holyoke MA 01040 ADDREssspalazzo @dowd.COm INSURER(S) AFFORDING COVERAGE NAIL f'1 INSURER A Safety Indemnity Company INSURED COOP mama B :Great American Insurance Companies Co Op Power, Inc. INSURER C :U. S. Liability Insurance Company 324 VVQIIs Street Greenfield MA 01302 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1740136959 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 'MAYBE - ISSUED OR"MAY PERTA1f4,- THE INSURANCE 'AFFORDED EY DESCRIBED HEREIN IS SUBJECT -TO •ALL-T.HE-- EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AbDL SUER POLICY EFF POLICY EXP LIMITS LTR INSR M/ WVD POLICY NUMBER (MDD/YYYY) (MM/DD/YYYY) C GENERALLIABIUTY CL1566148 '11/8/2011 11/8 /2012 EACH OCCURRENCE $1,000,000 DAMAGE X COMMERCIAL GENERAL LIABILITY PREM (Ea RENTED $100,000 CLAIMS-MADE I 1 OCCUR MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POUCY ,IFJ - X LOC. A AUTOMOBILE LIABILI Y COM6212701 1 3/23/2011 3/23/2012 t:UMttINtU SINULb LIMI I (EaeccideM) $1,000,000 ANY AUTO BODILY INJURY (Per person) $ ALL O ED X AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X NON-OWNED PRRrraER.TentDAMAGE $1,000,000 UMBRELLA UAB _ OCCUR EACH OCCURRENCE _ $ • EXCESS IJAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPEMSATIDN I WC STATU- OTH- AND EMPLOYERS' UABIUTY Y / N TORY I IMITS ER ANY PRDPRIETORIPARTNER/EXECUTIVE I N / A E.L. EACH ACCIDENT $ DFFlCER/MENBER EXCLUDED? (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ If yes describe uer DESC nd RIPTIDN OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 8 Direcinrs & Officers Liability EPP1117553 32/2011 5/2/2012' 1,000.000 5,000 Deductible DESCRIPTION OF OPERATIONS 1 LOCATIONS r VEHICLES (Attach ACORD 101, AddItionel Remarks Schedule, If more spar* Is required) Waiver of Subrogation Applies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Conservation Service Group ACCORDANCE WITH THE POLICY PROVISIONS. 40 Washington Street Suite 3000 AUTHORIZED REPRESENTATIVE Westborough MA 01581 � �� © 1988 -2010 ACORD CORPORATION. MI rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD A CERTIFICATE OF LIABILITY INSURANCE DATE i2oii) 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 N A C NTTACT Joseph Judd Blackmer Insurance Agency Inc t Fm: (413) 625 -6527 ( Not: (413) 625 -8110 1147 Mohawk Trail ADDRESS: ] oeeblackmers . com INSURER(S) AFFORDING COVERAGE NAIC 5 Shelburne MA 01370-9707 INSURER :Twin City Fire Insurance Co 29459 INSURED • INSURER e CO — OP POWER, INC. INSURER C: PO BOX 688 INSURER D: PO Box 658 INSURER E: _ GREENFIELD MA 01302 INSURER F: COVERAGES CERTIFICATE NUMEER aster 11 -12 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 REOUIREMENT, TERM CR 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 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADM . POLICY EFF POLICY EXP LIMITS LTR INSR 1tND , POLICY NUMBER , (MNVDD/YYYY) , (MMIODA'YYY) GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES lEa occurrence) $ _ CLAIMS -MADE 1 1 OCCUR X MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE _ $ GENII AGGREG APPLIESPER PRODUCTS - COMP/OP AGG $ _ 7 POLICY 1 ( l JFRr�,T I LOG AUTOMOBILE LIABILITY COMBIN SINGLE LIMIT _ ANY AUTO BODILY INJURY (Per person) $ A LL O S OWNED ----' SC U BODILY INJURY (Per accident) $ NON - OWNED * PROPERTY DAMAGE S HIRED AUTOS _ AUTOS (Per accident) _ UMBRELLA LIAR OCCUR EACH OCCURRENCE ! $ EXCESS LIA CLAIMS -MADE AGGREGATE $ DED 1 1 RETENTION $ $ A WORKERS COYIPENSATIDN 1 TORY S I AU 1 O ER AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE N E.L EACH ACCIDENT $ 1,000,000 OFFCERAAEMSER EXCLUDED? , NI 11/ 1 /2 D11 11/1/1012 (Mandatory In NH) OSIVECLC68 66 E1. DISEASE - EA EMPLOYEE s 1,000,000 If yyeess dcnbe uncle DESCR OF OPERATIONS below E.L DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS! LOCATIONS 1 VEHICLES (Mach ACDRD 101, Addttionat Remarks Schedule, tt more space Is required) Operations usual to energy efficiency services - energy audits, air sealing, insulation, and solar hot water system installation. As indicated above where an "S" is shown in the ADDL INSR column the Certificate Holder is an additional insured organization. • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Conservation Services Group ACCORDANCE WITH TKE POLICY PROVISIONS. Suite 3000 40 Washington Street AUTHORIZED REPRESENTATIVE Westborough, Mk 01561 J Deneault, CISR /SLAJ — ACORD 25 (2010105) • ©1988 -2010 ACORD CORPORATION. All rights reserved. INS025 (2oloos)01 The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts ...rile Department (I/Industrial Accidents ,, ` . 9: ` c 4` Office of Investigations ::M '` 600 Washington Street '" Boston, MA 02111 ��z wwx.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information Please Print Lely Name { BusinessiOiganizationiimiividual ): 1...� �+ (°" 6 ' . C14 .: --i'1 C Address: '3 q to ((S s C-- (7 s y... City /State /Zip: �' '�-\- • (J. Phone 44: i ( 3 — 1 7 . 2— — 0` c Are you an employer? Check the appr 1 I riate /box; Type of project (required): 1. DE 1 am a employer with ( t) 4 . 0 1 ern a general contractor and 1 - * have hired the sub- contractors New construction employees (full and/or part�inaej. 2.01 am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub- contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' 9. 0 Build ng addition [No workers' comp. insurance comp. insurance'# required.] 5. 0 We are a corporation and its 1 0. ❑ Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MOL 12.0 Roof repairs _ insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13.0, Other .�-� r --1=- i' (� , [ A.41 UY comp. insurance required.] *Any-applicant that cheeks 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. xContractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have employees. 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 np employees. Below is the policy and job site information .--•" �, Insurance Company Name: (N (¢' C. i f / F ` f r & - - Y' ^ stiv avv\ & , 0 ' Policy # or Self- -ins. Lie. #: 5 R^ k C 1r (0 & (p 4 Expiration Date: V — i — ! & 1 ' "" Job Site Address: HO (r/�L J ,f CityfStatelzip' ---ii lY — o 1l A- Attach a copy of the workers' compensation policy declaration page (showing the policy Dumber and expiration date). Failure to secure coverage as requited under Section 25A of AML c. 152 can lead to the imposition of criminal penalties of a fine up to $ 1,500.00 and/or 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. Be advised that a copy of this statement may he forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer ' under the. , : ' , rid p , , ies of perjury that the information provided abo a is true and correct. signature: ---,- ' Date: D II Phone #: .4 [. — 7 Z° -,,c- O Official 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): 1. Board of Health Z. Building Department 5: City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: (�! Not Applicable ❑ 7 Name of License Holder : fig VLF i ,' 7 Jo 3 L7 I Jc License Number I 1 1 G irtrAi , b 60/ ) 0A S zc 1 l.r Addres , J Expiration Date 2, tfl Z Telephone Signature Tele p 9. Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number 3 z L w�' /if cv- eg,1/6 J . 1 )1 >�1 Address l Expiration Date � Telephone t / /S� ?Y 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 A SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) a6 Roofing ❑ Or Doors l] Accessory Bldg. ❑ Demolition ❑ New Signs [0] ecks [❑ . Siding [O] Other -'�q /∎ , A .. rj lc f Brief Description of Proposed � ,�l ,�g Work: - fr ts . 1A / 1,/t ✓.�j Ale t ,,0.1 r 1 T 5 ) c eim - Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes No 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 6- .mot .i-r� S� subject �� , as Owner of the sub property � hereby authorize 6a or f'/,if" (J -740 ) GM � �t -- to act on m ehalf, in all matters relative to work authorized by this building permit application. i Signature of Owner Date 2 )5 1 ) 1--- I, P4 1 �-JL- J47), /P1 ( 60 aLv, `� as Owner /Authorized Agent hereby declare that the statements an informatio on t fo regoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. M f 10 ' Vi i r Print Name . I %. �� 2 fir Signature • Owner /Agert, Dat- • / Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To complete . `6,..tion Existing Proposed Re uire4 by Zoning 41 ` " This c n to be$llcd in by i Building Deparunent , t Lot Size 1 1 I 1 ^,.∎... yc' f v ` Frontage 1 11 11 1 Setbacks Front 1 1 1 1 1 1 Side L:I 1 R:1 1 L:1 1 R:I 1 I _ 1 1 Rear 1 ( 1 1 1 1 Building Height I I ( 1 I Bldg. Square Footage 1 ( 1 I% 1 I 1 I 1 1 Open Space Footage % (Lot area minus bldg & paved 1 I I 1 1 1 I I I parking) # of Parking Spaces 1 1 1 1 I 1 Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO O DONT KNOW Q YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW O YES O IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW O YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO \ e( -- IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, exca on, or filling) over 1 acre or is it part of a common plan O that will disturb over 1 acre? YES NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. t � r Department use only CJ l Ild g Department Cit of Northampton Status of Permit: 0 Curb Cut/Driveway Permit 7. X 021 - ain Street Sewer /Septic Availability o � Room 100 Water/Well Availability • orthampton, MA 01060 Two Sets of Structural Plans . , , ,,,..0 - 0 413- 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: This section to be completed by office I 9 0 1q0i/irES i*OW1 Map Lot Unit Zone Overlay District Joy vc Y Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Tfriti SRAw fiJ A �o hiti x .57- Na �° lel Ma iling A�ldr s «t A ' 111) z4Z j 8 ' ' 3 l / Telephone Signature 2.2 Authorized Agent: Name ( J i! 1W� Current Mailing Address: ` s: < Signatur Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building / f'» (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 '1 6. Total = (1 + 2 + 3 + 4 + 5) �� Check Number .` 3 f�� This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date y<>. i F‘IN , ..----- (1 :...) File # BP- 2012 -0809 APPLICANT /CONTACT PERSON PAUL SCHMIDT ADDRESS /PHONE 24 CHESTNUT ST HATFIELD (413) 247 -5739 PROPERTY LOCATION 40 HOWES ST MAP 17A PARCEL 173 001 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 L10 7 Typeof Construction:_INSULATE ATTIC 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 FO OWING 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 e - D-la Signature o Cuilding 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. 40 HOWES ST BP- 2012 -0809 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A - 173 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- 2012 -0809 Project # JS- 2012 - 001414 Est. Cost: $1600.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PAUL SCHMIDT 103635 Lot Size(sq. ft.): 14984.64 Owner: BASSETT THOMAS A & BEVERLY A S Zoning: URB(100)/ Applicant: PAUL SCHMIDT AT: 40 HOWES ST Applicant Address: Phone: Insurance: 24 CHESTNUT ST (413) 247 - 5739 WC HATFIELDMA01038 ISSUED ON:3/20/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:1 NSULATE ATTIC 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 3/20/2012 0:00:00 $50.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner