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32C-241 \ p BUILDING COMMUNITY -OWNED SUS7AINAELE ENERGY Affidavit of Waste Disposal I, Paul Schmidt, Energy Efficiency Program Director of Co -op Power certify that Co- op Power will remove all waste from the jot^ site located at:_ Jason Traver / / r )14witot 4 ;72 I Owner Name Street Address / Town /State/Zip Waste will be disposed of at our dumpster at our facility in Hatfield, MA. Our removal service is Waste Management. "7/.1 ifs;72 Paul Schmidt Date Co -op Power, 324 Well 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 ,i -6-34. 0," , , 4 ' 1'4 k glia___. ---- ' _ Office of Consumer Affairs and Business Regulat _— e 10 Park Plaza - Suite 5170 - Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 165217 Type: Corporation Expiration: 1/21/2014 Tr# 220702 CO -OP POWER, INC. PAUL SCHMIDT 324 WELLS ST GREENFIELD, MA 01301 Update Address and return card. Mark reason for change. 0 Address 0 Renewal ❑ Employment f l Lost Card DPS -CA1 sa ECM- 04/C4- G 10121E lie Zr07YNI9NiiuUe da -Wamaccuaaetta `.` \ Office of Consumer Affairs & Business Regulation 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 ,_, t ' Registration: 165217 Type: g r __ ,- : , Expiration 1/21/2014 Corporation 10 Park Plaza - Suite 5170 i i Boston, MA 02116 COP POWER, INC PAUL SCHMIDT i 324 WELLS ST - GREENFIELD, MA 01301 -. ti► Undersecretary Not v. without signature laSSachusetts - Department of Public Safeh P� Board of Building Regulations and Standards Construction Supervisor License License: CS 103635 Restricted to: 00 PAUL SCHMIDT 24 CHESTNUT ST HATFIELD, MA 01038 r' . y c �'� ` Expiration: 5/20/2013 C'ommis,cioner Tr#: 103635 The Commonwealth of Massachusetts -� -. Department o Industrial Accidents. Of. face of Investigations ° - 600 Washington Street Boston, MA 62111 *err * www. mass govitlia Worker' Compensation Insurance Affidavit: BuilderslGomtractorsiElecti i €ians/Plumbers Arinlieant Information Please Print Legibly Name inessiOrganizatiordJndi— a1): CO r ' Address: . 31:-.' ,( 4 (,l &( (s '' City /State/Zip: .-' C-tc . Phone 41: 3 7 — 8" ti ' 1 f Arty.ou an etmpioyer? Cheek the app. rime Type of project (required): 11. E I am a employer with (f; 4.0 1.Gm a general contractor and I b. 0 New constructor. employees (full andior part-time).* have hired the sub- contractors 2. I am a sole proprietor or partner- listed on the attached sheet Remodeling ship and have no employees These sub - contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' y 9. ❑ Building addition [No workers' comp. insurance Comp. insurance $ 10.0 Electrical repairs or additions required.) 5. (1 R e are a corporation and its 3. ❑ 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. MI Other AG (t, ( (+i -Ul'v. 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 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 my employees. Below is the policy and job site information. Insurance Company Name: VV f i'[ C1 � F � [ C & I St w'ti. e 'r c Policy # or Self -ins. Lie. #: 5R" ) e � C . . L (6 13- c � Expiration Date: "' [ .2- .( �J - / � �y Jab Site Address: __ 4'iilll e y ��` o`er City(Stateellip: �" lf Gf . ii la M14 (7/ V 6 + ,j ' AtAttach a copy of the workers' canzp�satiot€ paled declaration page (showing the policy number and e i rateotr 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 51,500.00 andtor one -year ixnprisotrtnent, 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 be forwarded to the Office of Investigations of the DI A. for insurance coverage verification. I do hereby cer ' J under the. - : net p ' of perjury that the information provided afro e is true and correct. Signature: Date: 2 Phone #: (. g f - 7 Z--- - 8 Official use only. L)o not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): I. Board of L. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector • 6. Other Contact Person: Phone #: 05/03/2011 13:58 FAX 4135871272 0 t4 r ,,,pf- G 3LU t ��M C `x001 Property Address: ( l 1 afrit' 51_ 4, . Q Contractor Name: i 4 _4 /i // Address: (P I t4 5j- City, State: ,. ' - if 4 Phone: 4 q - 4 5 Property Owner /1 Name: (1 K5 ') /7 .ermtve r . l i e 1 at a , - City, State: 4 r ail etm . A * 1, 4 4 1, al < ti ►4 (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 / Date . _ f/:" . ,ff. .....„-- 5 , r4- i • . SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: table D Name of License Holder : ` Licensed Construction Supervisor: Paul Schmidt fiber 24 Chestnut St. Aid � Hatfield, MA 01038 , &ate _ CS #1 103635 U Exp. 5/20/2013 - - " — Signature Telephone 413-772-8898 s. Registered Home Improvement Contractor: Home Improvement Contractor: licable L Co -op Power Inc. / Paul Schmidt Company Name 324 Wells St. ' lion Number Greenfield. MA 01301 Adaress 16521 ti n Date Exp. 1/21/ logy 413- 772 -8898 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 34 -- No ❑ f . - 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. ChM 780, Sixth Edition Section 108.35.1. 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 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House n Addition ❑ Replacement Windows Alteration(s) I + Roofing n Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [E] Siding [D] Other [D] Brief Description of Proposed Work: (NJ t, All m IL ( 1 2. 'L c c. ( NS> , t v 4 n Al w .01t1- 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 I, fASUV� 5-r4 dQr, , as Owner of the subject property hereby authorize 1- i4 ter t Fio c- - i� to act on my behalf II matters relative to work au by t his • ilding permit application. � � Si ure of Own r / rte Date I, PL .<444,107- , 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. (fit C� (htl Print Nam - < . Signat of Owner A gent Date Z• j. 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 S Lot Size . Frontage Setbacks Front Side L: R: L: R::- Rear Building Height Bldg. Square Footage 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 0 DON'T KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Regi try of Deeds? NO 0 DON'T KNOW ( YES O IF YES: enter Book Page. and /or Document #! B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW C) YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained Q , Date Issued: f J C. Do any signs exist on the property? YES O NO I / IF YES, describe size, type and location: i s D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO CJ , 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 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. (e/1) 0 Department use only City of Northampton Status of Permit: uilding Department Curb Cut/Driveway Permit 1 AUG 2 7 2011 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability N rthampton, MA 01060 Two Sets of Structural Plans �-- 0 R 7 Hp^F t41 - 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: c} This section to be completed by office +ufo) i E y Si APT 2. Map Lot Unit /4 U 17t Pr�ien iv f } 0 i G, r0 Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: r Name Prins Current Mailing Address: _ - Telephone Si• ature 2.2 Authorized Agent: A IL c -t 71 t ©f' 3i- av�Lt S ST: —n L=IP 0 1 3 I Name (Print) Current Mailing Address: / 3 — 4i t ? Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only 4. completed by permit applicant 1. Building &O �j (a) Building Permit Fee I / 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) 4 33 q Check Number . 5o'? This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2013 -0215 APPLICANT /CONTACT PERSON PAUL SCHMIDT ADDRESS/PHONE P 0 BOX 688 GREENFIELD (413) 247 -5739 PROPERTY LOCATION 118 HAWLEY ST - #2 MAP 32C PARCEL 241 001 ZONE URC(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 U `�, n '2 40 Typeof Construction: INSTALL ATTIC 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 INFORMATION PRESENTED: VApproved 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 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. 118 HAWLEY ST - #2 BP- 2013 -0215 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C - 241 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- 2013 -0215 Project # JS- 2013- 000357 Est. Cost: $3309.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PAUL SCHMIDT 103635 Lot Size(sq. ft.): 7797.24 Owner: GRAVER JASON Zoning: URC(100)/ Applicant: PAUL SCHMIDT AT: 118 HAW LEY ST - #2 Applicant Address: Phone: Insurance: P O BOX 688 (413) 247 -5739 WC GREENFIELDMA01301 ISSUED ON:8/28/2012 0:00:00 TO PERFORM THE FOLLOWING WORK :INSTALL ATTIC 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 8/28/2012 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner