23D-002 (10) 43 NONOTUCK ST BP-2016-1162
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23D-002 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-2016-1162
Project# JS-2016-002006
Est. Cost: $3300.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: PAUL SCHMIDT 103635
Lot Size(sq. ft.): 36938.88 Owner: HARDING MARY J TRUSTEE
Zonint4: URB(100)i Applicant: PAUL SCHMIDT
AT. 43 NONOTUCK ST
Applicant Address: Phone: Insurance:
24 CHESTNUT ST (413) 247-5739 WC
HATFIELDMA01038 ISSUED ON:4/6/2016 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 4/6/2016 0:00:00 $65.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2016-1162
APPLICANT/CONTACT PERSON PAUL SCHMIDT
ADDRESS/PHONE 24 CHESTNUT ST HATFIELD01038(413)247-5739
PROPERTY LOCATION 43 NONOTUCK ST
MAP 23D PARCEL 002 001 ZONE URB(100)
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid 16
Building Permit Filled out
Fee Paid
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
INFO ION PRESENTED:
pproved 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
De olit' D y
Signa of Buil ng 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.
F -_� City of ri tthamptan
Cent
s 212 Iain Street
APR 5 '` 16 3 Room 100
4
Niampton, AAA 01060
41 587-1240 Fax 413-587-1272
APPLICATM TO CONSTRWT,ALTER,REPAIR,RENOVATE OR DEMOUSH A ONE OR TWO FAMLY MELLING
1.1 Property Address:
A/3 /lot
SW
2'.
21 Owner of Record:l/
Name(Print) Current M " ('0 )
Telephone��'A� / U
Signature L
2.2 AUlhedwdArent:
Name(Pant) Current Mailing Address:
sigrmturev Telephone
Item Estimated Cost(Dollars)to be .
corn it apiplicant
1. Building c,
2. Electrical ( al "
3. Plumbing
4. Mechanical(HVAC)
5.Fire Protection
6. Total=(1 +2+3+4+5) c,
Ste:
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/Varianceffincinover 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 � 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,::Q YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 Date Issued:
C. Do any signs exist on the property? YES NO
0
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 n,or filling)over 1 acre or is it part of a common plan
that will disturb over I acre? YES 0 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK falteck all geda§lsl
New House ❑ Addition ❑ Replacenerrt Windows LAftmtlon(s) ❑ Rooting ❑
Or Doors 13
Accessory Bldg. ❑ Demolition ❑ New Signs [07 Decks [[] Siding J Other[
Brief Description of Pr ��' �j ji as_ d `�,o
work: r aim
4"
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Pians Attached Roll -Sheet
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?
r
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. %`� Masschedc Energy Compliance form attached?
h. Type of construction Z/I
L Is construction within 100 ft of wet*16s? 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 r City Sewer Private well City water Supply
SECTION 7a- AUTHORiZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR 13t1iL01ING PERMIT
I, as Owner of the subject
property
hereby authorize +
to act on my behalf, in all matters relative to vvo 'zed by this building permit application.
Signature of owner pate
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.
cL-f—
Print Name
Sig of Ager Date
t .8',O
8.1 Licensed Construction Stt . or: Not Applicable ❑
Name of License Nolder: rru ar�– 10 �R
3 15—
License Number
��2 -nuc-�-- Wil-, - -�a��r'c� ,V►r)�9 c»v38' 1
Address
Expiration Date
I - 3 -5 7A q
ignature Telephone
a V PR Not Applicable ❑
y-y 5�
Company Name Registration Number
_ A4 +r-ee-�
AddressExpiration Date
mA Q1 Telephone'q/3'ray�J�739
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...... ❑
s
The current exemption for"homeowners"was extended to include Owner-occupied DweflinQs 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 1
Defnzition 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 Hable 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
The Commonwealth of Massachusetts
Department of Industrial Accidents
h 1 I Congress Street,Suite 100
,� la
Boston, MA 02114-2017
www mass.gov/dia
«'orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): SDL Home Improvement Contractors, Inc
Address: 24 Chestnut Street
City/State/Zip: Hatfield, MA 01038 Phone#: 413-247-5739
Are you an employer?Check the appropriate box:
Type of project(required):
1.F✓ I am a employer with 8 employees(full and or part-time).* 7. F1 New COriStrUCtlOn
2.n[am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling
any capacity.[No workers'comp.insurance required.]
9. El Demolition
3.01 am a homeowner doing all work myself.[No workers comp.insurance required.]'
10 Q Building addition
4.01 am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.F-1 Roof repairs
These sub-contractors have employees and have workers'comp.insurance.
14.E]Other Insulation
6.0 We area corporation and its officers have exercised their right of exemption per MGL c.
152.§1(4).and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box i*1 must also fill out the section below showing their workers'compensation policy information.
r 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: Selective Insurance Co
Policy#or Self-ins. Lic.#: WC9024456 i ' Expiration Date: 2—/23"/2017
Job Site Address: o A / n -(J �T City/State/Zip: C�U(�
Attach a copy of th workers'compen'sation pollicy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00
,=_ell a�r-ivil nennitie- in the form of a STOP WORK ORDER and a fine of up to 5250.00 a
coverage verification.
Ido hereby certify u e:rl*painy and penalties of perjury that the information provided above is true and correct.
Si nature: Date 3`- �� " f (CJ
Phone#: 413-247-5739
Official use only. Do not write in this area,to be completed by city or town official
Citv or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Permit Authorization ,,
mass save Form
PARflCIPAnNO
s•rtrgrth ulo•natty etwom CONTRACTOR
Site ID: S00050153427 Customer: MARY HARDING
1
I, MARY HARDING ,owner of the property located at:
(Owner's Name,printed)
43 Nonotuck St FLORENCE
(Property Street Address) (City)
hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed
below to act on my behalf and obtain a building permit to perform insulation and/or weatherization
work on my property.
Owner's Signature: ,
Date:
FOR CSG OFFICE USE ONLY
Conservation Services Group has assigned the following Mass Save Home Energy Services Participating
Contractor to the above referenced project:
Participating Contractor Date
Os O
0
For Office Use Only
Conservation Services Group • 50 Washington Street,Suite 3000 • Westborough,MA 01581 • 1800.480.7472
Rev.062015
City of Nor' tou
ZNWAIEammw Or
212 Baia street . Wanicdpd ddb q
Nartt=lptm, 10 01060
Property Address:
Contractor -Pact t nuIJ* �t
Name.
.)' �---
Address: -Q-
Grty, state: MA
Phoras:
Property Owaff
Name:
Addreew
City, State: -- t ..P e-) c 0 �� � CD )
1,TA41 xl ._...�. (mWadv)Wed and aftm the bum 1 h0m to
e ase does not hese any' al-? U*Wft to the sales to be hmiated and#W 1 have
provkled the property owner wKh a copy of fte aMdoWL
Gorr�`twsigna�rre
Date