11C-017 f 1 " 6n/moa)eath 0 / i joa
Office of Consumer Affairs and Business Regulation
41 = f ' 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.
Li Address Li Renewal Li Employment ri Lost Card
C'FF CA CI IC -C'4/C - C1C7"iiF'
�' � O "' "� License or registration valid for individul use only
, \ Office of Consumer Affairs & Business Regulation 8 y
r HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: 165217 HOME Office of Consumer Affairs and Business Regulation
i , �
ti � Expiration 1/21/2014 Corporation 10 Park Plaza - Suite 5170
Boston, MA 02116
CO 6P POWER, U 1 }
d
PAUL SCHMIDT
324 WELLS ST �—
GREENFIELD, MA 01301
Undersecretary Not v without signature
M11`tx�:t� ° Oe'tt'tme pf c S#'
f3ttrtrtl ta� [3ttif� ild%rrg 1 tc:l;tti atr ati nt t►nx ani) Publi Standar d etti s
Construction Supervisor License
License: CS 103635
Restricted to: 00
PAUL SCHMIDT
24 CHESTNUT ST
HATFIELD, MA 01038
---- Expiration: 5/20/2013
t'omm i rsiuner'
Tr#: 103635
3
CO -OP j1
1 L
A POWER
BUILDING COMMUNITY -OWNED SUSTAINABLE ENERGY
PERMIT AUTHORIZATION FORM
I, Ise �' I '' , owner of the property located at:
(Oufner's Name)
be cnA 4-Ite 57 ,, 41
fr
/
(Property Street Address) (City /Town)
hereby authorize a v - f` 0 '�'e�
/ (Contractor)
to act on my behalf t obtain a building permit and to perform insulation and /or
w: • • - ' ation wor property.
v a - /
. _ f/
(Ow er' :i• na ur`e'
// /3
(Date)
Co -op Power
15A West Street, West Hatfield, MA 01088
phone: 413.772.8898 or 877.266.7543, fax: 413.517.0300
Email: info @cooppower.coop Website: www.cooppower.coop
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : Paul Schmidt 103635
License Number
24 Chestnut Street, Hatfield, MA 01038 05/20/2013
Ad. ess Expiration Date
(413) 772 -8898
nature Telephone
9, Registered Home Improvement Contractor: Not Applicable ❑
Co -op Power 165217
Company Name Registration Number
15A West Street, West Hatfield, MA 01088 01/21/2014
Address Expiration Date
Telephone (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 )!CI No ❑
11. - Home Owner Exemption
The current exemption for "homeowners" was extended to include Owner - occupied Dwellines 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 he 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 fl Addition fl Replacement Windows Alteration(s) E Roofing E
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [E] Siding [0] Other [IN
Insulation
Brief Dess[iRtron of Proposed C� /� �! i 1
/ J r � � ` g ���
Work: L � `! � f� - T't �` VU�fi'lr 1 i'1 SLtIGf� 1:�✓1 f> (� - 4 -
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: 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 AGNT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, j3ep/- i / d c 1 , as Owner of the subject
property
hereby authorize Co -op Power
to act on my behalf, in all matters relative to work authorized by this building permit a plication.
SEE /lief -i 2'»7 - wiV i 6 /ivl. 5 f// 3
Signature of Owner Date
1, Paul Schmidt _ , 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.
Paul Schmidt _
Print ame
1/43/
Si ature 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 /Findin ever been issued for /on the site?
NO 0 DONT KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW ige YES 0
IF YES: enter Book Page, and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO . f,d0 DONT KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained
, 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 0 NO
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, ex or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
YES, then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
-_,:f...2.____2---1 City of Northampton Status Of Permit:
Building Department Curb Cut/Driveway Permit
5 20 13 212 Main Street sewer /Septicpuailability
Room 100 WateriWWeil Availability
T ! Dit i cp T!ONS orthampton, MA 01060 Two Sets of Structural Plans
prP
NORT.OF HBUiAMPTON, MA o U• ° one 4 13- 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 A ddress: �,,� This section to be completed by office
1 N1 Hi VIf` '-Y Ma p -- Lot Unit
LffE / vt�l �Jl 4 /► ��, ' Zone � Overlay District
Sts.: it. District __________ VB District _ - .
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT L_ �
2.1 Owner of Record: 1 p �/�4
J S� f'1 ,4 /1 �,1 &r/1Qlt� e 7` /t1I7 010
Name (Pr t) Current Mailing Address: / /cI ] �
5� -4�1'V1' / ?,qT -10 oW s2 Telephone I1�� l /(O /(r?
Signature
2.2 Authorized Agent:
Paul Schmidt / Co -op Power 15A West Street, West Hatfield, MA 01088
Name (Pr t) Current Mailing Address:
%/...-,.... (413) 772 -8898
Signa ,fie Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS 1
r
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building
3 (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from i61_
3. Plumbing -------- .3uilding Perm „it Fee
4. Mechanical (HVAC)
5. Fire Protection _
6. Total = (1 + 2 + 3 + 4 + 5) ` / 053 Check Number �/ #(56
This Section For Official Use Only
Building Permit Number: — Is
Issued:
_i__
Signature: ____ -
Building Commissioner /Inspector of Buildings Date
File # BP- 2013 -0801
APPLICANT /CONTACT PERSON CO -OP POWER INC
ADDRESS/PHONE 15A WEST ST WEST HATFIELD (413) 772 -8898 Q
PROPERTY LOCATION 1 BERNACHE ST
MAP 11C PARCEL 017 001 ZONE URA(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out �j�� eh ./56 Fee Paid /
Tvpeof Construction: INSTALL WALL 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
INFO ON 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
j ern 1 ° lay
3 - ,5-r3
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.
1 BERNACHE ST BP- 2013 -0801
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 11C - 017 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 -0801
Project # JS- 2013 - 001370
Est. Cost: $2053.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: CO -OP POWER INC 103635
Lot Size(sq. ft.): 8755.56 Owner: ASHTON JOSEPH D
Zoning: URA(100)/ Applicant: CO -OP POWER INC
AT: 1 BERNACHE ST
Applicant Address: Phone: Insurance:
15A WEST ST (413) 772 -8898 0 WC
WEST HATFIELDMA01088 ISSUED ON:3/6/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL WALL 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 3/6/2013 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner