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17C-140 (7) 46 NORTH MAPLE ST BP-2016-1261 GIS #: COMMON, WEALTH OF MASSACHUSETTS Map:Block: 17C- 140 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-2016-1261 Project# JS-2016-002170 Est. Cost: $1500.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PAUL SCHMIDT 103635 Lot Size(sq. ft.): 9931.68 Owner: PREER STEPHEN "Zoning: URB(100) Applicant: PAUL SCHMIDT AT. 46 NORTH MAPLE ST Applicant Address: Phone: Insurance: 24 CHESTNUT ST (413) 247-5739 WC HATFIELDMA01038 ISSUED ON.51312 01 6 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL SLOPE & FLAT CEILING INSULATION & REPLACE CLAPBOARD 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 5/3/2016 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2016-1261 APPLICANT/CONTACT PERSON PAUL SCHMIDT ADDRESS/PHONE 24 CHESTNUT ST HATFIELD01038(413)247-5739 PROPERTY LOCATION 46 NORTH MAPLE ST MAP 17C PARCEL 140 001 ZONE URB(100)/ THIS SECTION FOR OFFIjCIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: INSTALL SLOPE&FLAT CEILING INSULATION&REPLACE CLAPBOARD New Construction Non Structural interior renovations Addition to Existing Accessory Structure Buildine 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: L--'�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 Demo ' io la 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. RECEIVED 2=7 City of Northampton Binding Department 212 Main Street DE N OTHAMPTON!MA 0106BUILDING 0 3 Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOUSH A ONE OR TWO FAMILY DWIELLMIG 1.1 ProDeft Address. ' 2.1 owner 91 Record: 1 Name(Print) IFC nt 0T—' ��Ir ft_ tT�=( ✓' c� Telephone Signature 2.2 AAorized Agent: pa:>j e -'10— w i' -t- Name(Print) Current Mailing Address: 4'�e�/—Z- i— �- a�7-S73� Sig Telephone Item Estimated Cost(Dollars)to be D com~by perryfit apOicant 1. Buildivrg 00 2. Electrical 3. Plumbing 4. Mechanical(HVAC) 5.Fire Protection 6. Total=(1 +2+3+4+5) Ste: �; ,. bete 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 ffiled in by Building Department Lot Size Frontage Setbacks Front Side U.- R: L: R:,. Rear ------ Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) of Parking Spaces Fill: (volume&Location) I A. Has a Special Permit/Variance/FincLing"ver 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 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 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 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 or filling)over I 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&DESCRIPTION OF PROPOSED WORK(check all aon(i abl®) NOW House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors M Accessory Bldg. ❑ Demolltlon ❑ New Signs ([7] Decks [Q Siding ] Other CM5�" Brief D 09on of Propos� n 7 Work: S o Nt' "v5 © r (� bLa tl7 c�.... GL-�_. ►'L�S�LC_s�..,. Alteration of existing bedroom Yes No Adding r> bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a.If NW "- A—e :h It iii e u tit>W nq: a. Use of building:One Family Two Family Other b. Number of rooms in each family unit: Number of,Bathrooms Y!-- 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 v�peti`F ands? Yes No Is construction within 100 yr. floodplain Yes No r j. Depth of basement or cella below finished grade k. Will building conform t Building and Zoning regulations? _Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION TO 8E COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property hereby authorize � + 4'S e-, to act on my behalf, in all matters relative to worft0tholized by this building permit application. Signature of Owner Date 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. ` Tom'/ t ,-a:i-- Print Name Signatdre of Owner/ Date SECTIM8- 8.1 Ucensed Construction Sucervisor / , �, �,- ,• Not Applicablesem❑ / Name of License Holder: c3LL( �(�U►lit 10 J C g,3 5— Ucense Number 6 zc,�Lt4- 44a+��ct,j,mtq 01 Address Expiration Date J � a� ignature Telephone r�:." �77' 1301 �� Not Applicable Comoanv Name I Registration Number clLf n�v-47v-ct . -,-2 L7 Address Expiration Date �J@,44',e-( d , m14 01 b 33 Telephone4h3 of-V J�739 SE llF- 1 -AVFM_ (l1 aL.c.tom,$M;C1' 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...... ❑ The current exemption for"homeowners"was extended to include Owner-occupied Dweltings 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 788, Sixth Edition Section 148.3.$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 homg 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 City of Northa�ptoa �tsssasetts s { nwARUMM or 212 stain stmet • !=kips WAUM W NafthaMpbm, m► 01060 Propetly Contractor Name: Address:city, stow stoe: M A Q l Q 6& ice: Name: n prcl Address: 4CQ Lam- h rn L,2- ------------ City, state: �L cD i G (-0 �- (cordractar)attest and affbrn that the bukHng p kiterid to wwjkft does not have any open a r and time) in the Spam to be kwilated and#W i have provided the property owner wNh a copy of this aMdsr*t. C nbmctoc some" Date The Commonwealth of Massachusetts Department of'Industrial Accidents 1 Congress Street, Suite 100 (� Boston, MA 02114-2017 r www mass.gov/dia �M Workers'Compensation Insurance Affidavits Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aaolicant Information Please Print Le2ibly 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): I.r✓ 1 am a employer with 8 employees(full and%or part-time).* 7. ❑ New construction 3.7 1 am a sole-proprietor or partnership and have no employees working ?u.me in $, ® Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.F-1 I ant a homeowner doing all work myself.[No workers'comp.insuranet required.]' 10 ❑ Building addition 4.F1I 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 l l.❑Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.r7 I am a general contractor and I have hired the sub-contractors listed on the attached sheet_ These sub-contractors have employees and have workers'comp. 14insurance.; 14.�✓ Other Insulation 13.[]Roof repairs 6.r_1We are a corporation and its officers have exercised their right of exemption per MGL c. 152,g 1(4),and we have no employees.[No workers'comp.insurance required.] IL *An}applicant that checks box�l must also till out the section below shoH ing their workers'compensation policy information. 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. 1 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 Expiration Date: 2/23/2017 Job Site Address: ,-z:i4 City/State/Zip: LD Lc?� � d n� Attach a copy of the workers' compensation policy claratipn 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 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify yAv*r the p s and penalties of perjury that the information provided above is true and correct. Si,,mature: ,o� Date: Phone#: 413-247-5739 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 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: RISE60 Shswmut Road;Unit 2(CRntAn:tlqA 020211339-M2-M, ENGIN EERING' www.PJsfngineering.com OWNER AUTHORIZATION FORM (Owner's ame) owner of the property located at: (Property Address) (Property Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE trgineering,to act on my behalf to obtain a building permit and to perform work on my property.This form is only valid with a signed contract. ,� .4A I OvAner's Signature 0 Date 2 O �P