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32C-083 � � e too rn ivit r nw1 ea ✓r l� o/ t ial lac %€th d o O ffice of Consumer Affairs and usiness Regulation �.. a 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 1-lome Improvement Contractor Registration Registration: 121178 Type: Private Corporation Expiration: 4/12/2012 Tr# 294082 D.P. CARNEY CONST INC DANIEL CARNEY 34 HORSESHOE CIRCLE WARE, MA 01082 Update Address and return card. Mark reason for change. Address Renewal I I Emplo) ntent ! t.ost Card s -�Ai C, ,t44 04;04 1.2 7 /te r " P/re /II f ?IIU4'f /.1lll Li ((hl.lae 6eJetd License or registration valid for individul use only t Office of Consumer AITiirs & Business Regulation " HOME IMPROVEMENT CONTRACTOR before the expiration dale. If found return to: Office of Consumer Affairs and Business Regulation Registration: 121178 10 Park Plaza - Suite 5170 Expiration: 4/12/2012 Tr# 294082 Boston, MA 02116 Type: Private Corporation D P CARNEY CONST INC DANIEL CARNEY 34 HORSESHOE CIRCLE j WARE, MA 01082 Under secretary t •ot vali rthoul sign. ire rr__,= jo, 0 4? vi:t..achu.ctt• - l)clt: intent OI Pull!;; - k 1. Board of Building Regulations and Standard. Construction Supervisor Specialty License License: CS SL 99376 Restncted to: RF DANIEL CARNEY f t 34 HORSESHOE CIRCLE 7'7,1 „ , WARE, MA 01082 ,,',4.;:p,:,..,:' «ice- _---- _-- Expiration: 8/1912011 (unuOi,vi,aier Tr#: 99376 s. SdQMo9•S% AI AtMM :o1.iajaN •asuaatl sR11 Jo UOgK onal .IOJ asnni s! apoj 1 u!pl!nfl amn7S sa)aSnypnssuw alp Jo uo!)!pa )ua.t.tn3 8 ssassod O) a.inl!ti ,luo uo!1!lotuaU - W0 saa!naQ ;lu!UJ nd land p!loS - AS iu!piS pun ssopu!M - SM iuuanO3 JooH - A21 ,Chin ,UUOS8W - V1 f 1 :o) pa)au)saj • blie Safet Restricted B g t i t :t1 i7: i 7 ni n I) ::_ R o L f ; i s P c ili u e t e7n : sit t e .in st t:::is 4)ni , 1‘ ' •'EY DANIEL ‘ ARN DA .01.,E CIRCL 0 34 HORSL1711'''.0 WARE MAb1082 , WA.,-, 8/19/2011 Trg: E x pi r a t ion: 99798 ......t...4._ ..._,,,. _----''.. ( viiiimt r i ,, , .. -, ?' -- ' .,,,,''' ',.'7,,':•'-d,',,,,;::;., :-", . ' ''':.'''' - ‘ 1 ''' ''',::.:- .1: ;:',,ilin'-':',4'4';''''.1',Cr4;-...,;',,,,Y14,,,,:. . - RECEIVED JUL 0 3 21106 LO1)1lnoi1R'enll/l of/Yfassnchuselts 1)r:1prrr•1llren1 of Intluslriul Aceirlents ir, r ()Bice of Investigations 1 I i 6(1(0 11'u.\•iringlon ,S reel I hostnn,Al:1 02111 fvmlv.nrass'.gov /din 11'ot ers' ('trnrlrcrl sit lion Insurance AlTidavit: Builtlet• s/ Coulraclors /1?lectriciau.ti /l'lullthrrs 11)ltlit'anl I111millalilll► 1'Irasv 1'!1 tI 1,t illly• (I;,, i„ ,��:,i,l ;,Ilu „!lu�ltr D.P. Carney Construction, Inc. ltlless 34 Horseshoe Circle (',ly•til:,H!y.I1) Ware, MA 01082 Phone ll: 413- 967 -7124 tic inu an t dIIf Il 'rt - : ' ( the upprnpriale huz: ' hype of 1trujerl (r(iluit crl) 1 I I ;u a 11111:111 y u l i lh 6-10 l L l 1 am a general contractor and 1 G. L� Ncw cons(( of to u rnildl�dyci s (lull antUurMarl line) * have hired the sub- contractors I L a s dlc pit I,I i_ I1,i (n I :lt l u r _ listed on the attached sheet. 1 /. [ l c,nu lciinl 1•hesesub- contractors have 8 [_1 1 cI1l ltl d�ut 1,0 tut �I� :ul�� ra , �ctl workers' comp. insurance. c I � )'� �. Ll Building atl .dolt ,'t�odil in;tit; ti. 11 I rd ,I 1 ul -hccrs have exercised Ihcir lo.[_ llcc Ii_al I c'I �:IIr�; ul a�ldliu,�n; 1 Mil :d luun_own•I (10111r all work right of exemption per MCI, 111 1 d'luutbiii rcpaus 111 :n1Ju10[1.. , -II 11 r�:' c��Itll� c. 152, §1(4 and we have no 12 j 1 employees. [No workers' comp. insurance rcquiled 1 la Olhcl 1 y pl,;, w il,.ii i . i. , 1„ 1; 1 nni,t ul . (ill t ut the . clum bclu r showing Ihcir workcis' CndnllrlttialinrI puldcp inlni nwliuu L, .ul,uni 1111, nlli,l,r,u niJieadnii lhryaledoingallwild, wdthenhireoutsideconoaclorsnualsubmil anrs alli.Li a nulu.uuil ua. i a'• Ih.0 rin, 1, ilu . 1..., unt,t ;�ll.icldc11 an :ut1►IIIUIYII sheer showing Ilse name of the s�h- cuntractoes and Ihcir svoi keels' annp IwIIi \ oitoun:uoln ( dun (1/1 end /' /dir ((dill is l,ropiilini; men hirs' compensation insurance fin- nry employees. Melon ix the poll, r until iuh sin' 1 di1VINd,lfdd lu;w;uli_e t'Innl1,ulV l Char tls Company I, II, yr,t'1 `HI H., 1.1 li WC00 9930624 Expirationl):Itc: 11/ 15/11 30 Wilson Avenue City /Slate /Z.ip:Northampton, MA 01060 1(:icli a ro of t he worl:crs cuInpelISM1on pulley declaration page (sho»'ing the policy number and expiration LI:tle). Mule h. L i ue t t�vei;t)�c ;Is retluitetl under Section 25A of MGLc. 152 can lead to the imposition of rriutinal I1rnaltu:, of ;t 1111,. up to ,1,`ili11 H1t ;mil /to one -year intl)risonrnenl, as well as civil penalties in the form of a S'I O1' \V'Oi:h )1:1 )1:.1: and a line L.(up 105, ?`.0 oil ;d (l,1y ;tp,,•tiusl the violator. Ile advised that a copy ofthis statement may be forwalzlccl to the ()ft ice of ,tl);itior, id ill,. 1)1A fot itdsurunce coverage vetilicalion. 1 JO h certifi' :inner the n.'pnd penalties ofperjury that the iajoruurlion provided above is triter and correct. li d ' pale: March 22, 2011 III,,L� iI: 4 967-7124 UlJiriui 11,■ onit. I ro not 11.riter in this urea, to be completer( by city or town official. cit ni 1101\ 11: Permit/License 11 Is�uinl; Audio' ily (circle one): I. ito;ud of IleilliII 2. Building Department 3. City /Town Clerk 4.l lectrical Inspector 5. Plumbing Inspector (Wirt t •olat I crson: Phone ll: • SECTION 8 - CONSTRUCTION SERVICES - r r r 8.1 Licensed Construction Supervisor: Not Applicable ❑ y Daniel P. Carney (eached sheets Name of License Holder : 34 Horseshoe Circle, Ware, MA 01082 Address '\ Expiration Date 413- 967 -7124 of 0 Sire Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ D.P. Carney Construction, Inc. 121178 Company Name Registration Number 34 Horseshoe Circle 4/12/2012 Address 413 Expiration Date Ware, MA 01082 Telephone 967-7124 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 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) El Roofing Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [EJ Siding [0] Other [0] Brief Description of Proposed work: Re-shingle house. Alteration of existing bedroom Yes >( No Adding new bedroom Yes X 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 Jean LaPlante , as Owner of the subject property hereby authorize D.P. Carney Construction, Inc. to on my be , in all matters relative to work authorized by this building permit application. �, �.�,�� : = March 22 , 2011 Sill= of Owner Ali Date Joann Carney (D.P. Carney Construction, Inc.) ,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. Joann Carn Pri • k ame All k).:, A te , March 22, 2011 S'4 of Owner /Agent - Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW ►~I YES 0 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 Q 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 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 c& IF YES, then a Northampton Storm Water Management Permit from the DPW is required. ' t I , tOtt C 1 ;114 . , R C O . j Department use only 1 City of Northampton Status of Permit: ,4 Building Department Curb Cut/Driveway Permit r 2 Q 212 Main Street Sewer /Septic Availability • Room 100 Water/Well Availability 010 , 1 40414 'I .- ■ o MA 01060 Two Sets of Structural Plans phone 413 587 - 1240 Fax 413 587 - 1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office 30 Wilson Avenue Map Lot Unit Northampton, MA 01060 Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Jean LaPlante 30 Wilson Avenue, Northampton, MA Na (PnAlp u ent a i g A ress: 01060 T $ l ephone - + 12 2 ; t Telephone Signatu ```"�`�� thorized ' gent: CL AtiCEC '-__) D.P. Carne nstruction, Inc. 34 Horseshoe Circle, Ware, MA 01082 Na • : (Print) Current Mailing Address: l....A_,. — --- 413 - 967 -7124 Sig - Telephone SECTION 3 - ESTIMATED CO ST UCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building /roofing $ 6 , 0 7 6 . 0 0 (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) $ 6,076.00 Check Number /5 7 9y 43t- This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date 30 WILSON AVE BP- 2011 -0761 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C - 083 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: roofing BUILDING PERMIT Permit # BP-2011-0761 Project # JS- 2011- 001257 Est. Cost: $6076.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: D P CARNEY INC 99376 Lot Size(sq ft.): 5096.52 Owner: PLASZKIEWICZ -PULC IRMINA L Zoning: URC(100)/ Applicant: D P CARNEY INC AT: 30 WILSON AVE Applicant Address: Phone: Insurance: 34 HORSE SHOE CIRCLE (413) 543 -4803 WC WAREMA01082 ISSUED ON:3/24/2011 0:00:00 TO PERFORM THE FOLLOWING WORK: RE- SHINGLE HOUSE ROOF 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 3/24/2011 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner