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24A-117
18 CALVIN TER BP-2016-1501 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24A- 117 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-2016-1501 Protect JS-2016-002562 Est.Cost: $2322.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JOHN PERRIER 105319 Lot Size(sn. ft.): 7971.48 Owner: STEINBERG GERALD S&MARY T Zoning: URA(1001/ Applicant: JOHN PERRIER AT: 18 CALVIN TER Applicant Address: Phone: Insurance: 18 BROADWAY POND RD (860) 930-7794 WC STAFFORD SPRINGSCT06076 ISSUED ON:6/16/2016 0:00:00 TO PERFORM THE FOLLOWING WORIGADD R-38 INSULATION TO OPEN ATTIC 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 Sienature: FeeTvpe: Date Paid: Amount: Building 6/16/2016 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2016-1501 APPLICANT/CONTACT PERSON JOHN PERRIER ADDRESS/PHONE 18 BROADWAY POND RD STAFFORD SPRINGS (860)930-7794 PROPERTY LOCATION IS CALVIN TER MAP 24A PARCEL 117 001 ZONE URA(1001/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid C,� Q5 - Building Permit Filled out Fee Paid Tyneof Construction: ADD R-38 INSULATION TO OPEN ATTIC New Construction Non Strum rat interior for renovations Addition to Existing Accessory Structure BuildingPlpns Included: Owner/Statement or License 105319 3 sets of Plans/Not Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 Deo. itit% y Sig 411.1111S ud•ing iffcia 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. • 0 The Commonwealth of Massachusetts 1l,1s Board of Building Regulations and Standards FOR '� r— (: Massachusetts State Building Code, 780 CMR MUNICIPALBY USE 0 Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 Ili One-or Two-Family Dwelling cc I• This Section For Official Use Only ging Permit Number: Date Applied: .,,,,, Building Official(Print Name) Signature Daze _ SECTION I: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers -- I.1 a Is this an accepted street?yes no__ _ Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Di nag Proposed Use 1 La Area(NW frontage(ft) IS Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply;(M.C.L c,40,§54) 1.7 Flood Zone Information: J 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? 1 Municipal 0 On site disposal system O Check ifyes0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record; \i'01111nmCri "-A— OCK N e(Print, State.ZIP No,and Street , C a \) 1Y1 . v" Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check alt that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) O Addition 0 Demolition 0 Accessory Bldg.O Number of Other 0 Specify:,, Brief Description of Proposed Work': To Add R-38 Insulation to open attic SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: item Official Use Only _ (Labor and Materials) I. Building S 1. Building Permit Fee:$ Indicate how fee is determined: 2. Electrical $ — 0 Standard City/Town Application Fee 01'otai Project Cost'(Item 6)x multiplier _x_� 3.Plumbing $ 2. Other Fees: $ — 4.Mechanical (HVAC) $ List —.. — 5.Mechanical (Fire — $ Su., ession) Check _ All Fees:$ Check No.4 Ca)- Check Amount: 05. Cash Amount: ,_ i 6.Total Project Cost: $ �"--))�A 0 Paid in Full 0 Outstanding Balance Due: NEGH 28 Spellman rd Please Submit Stafford Springs,Ct Permits to: 06076 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) John Perrier 105319 12-12-2015 License Number Expiration Date Name of CSL Holder List CSI..Type(see below) I__ 18 Eradway Pond rd - Type Description No.and Street U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted I&2 Family Dwelling City/Town,State,ZIP - M Masonry RC Roofing Covering Stafford Springs Ct 06076 WS Window and Siding SF Solid Fuel Burning Appliances Insulation 860-9307794_ jperrier06076t&yaloo.com Tele. one Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Company Name or MBC Registrant Name 173021 8-27-2015 HIC Registration Number Expiration Date John Perrier No.and Street IS Bradway Pond rd jacrrier0607600.com Email address Stafford Springs,Ct.06076 Ci /Town, State,ZIP Telephone 860-930-7794 SECTION 6: 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,.....,.._El SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize New England Green Homes to act on my behalf,in all matters relative to work authorized by this building permit application. John Perrier 5/3) /2016 Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,1 hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Lynn Ford 5/ 3) /2016 Print Owner's or Authorized Atent's Name(Electronic Signature) Date NOTES: S. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will rLor have access to the arbitration program or guaranty farad under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.pov/ocg Information on the Construction Supervisor License can be found at www,mass,gov/dos 2. When substantial work is planned,provide the information below: - Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.)` Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Numberofhalf ,aths Type of heating system Number of decks/porches Type of cooling system Enclosed Open_ 3. 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Install Date: , , .,. . % % _ . Er=Pgake Refer to the Home Energy Report fora detailed description of work to be preformea /—. yfG. SY: ---) TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE The contractor agrees to perform the above described work,furnishing the materials and labor specified above for the total price listed above. Payment of the full amount is expected upon completion,by check,cash or credit. The customer agrees to pay Me ba)anc oft - . upon completion of the job. ! V Customer Signature: - Date: 'TR() f Nl) ' " _. Panel Via M1 L CERTIFICATE OF UNARY INSURANCE MAIM TARMAIMQANI*11*Al AkkArT(R OF OOORYRTMIi OW AMOOMAMM 10 MORA Man Nil CVRMgATO HOMO IMO OOOVIOAS 0S Jr A010MWNLY el MnAMlQ1TLOW OA MN 118 OTIOSE AMMON OT NI OO( MS MR flRllMAU O0 MMRWWO NMI MM Ot fRQ}i A 000MAC1 HM R 1111*WO M011MM11 AVM= WOOS OR :•,;.`.AMNMOMOMICAHIAIMOA ,r.::r rs.�rpeny*pa St5MM_YY6 Ason AMA*...MMJIA SAOA S MM .xtiMAYMR W amp xR. 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I O/W I, OC.\ v 'tib' (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 c-11 __ 1-7