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30C-059 369 FLORENCE RD BP-2017-0390 GIS#: COMMONWEALTH OF MASSACHUSETTS Mao:Block: 30C-059 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-2017-0390 Project# JS-2017-000643 Est.Cost:$2600.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: PAUL SCHMIDT 174415 Lot Size(sq. ft.): 19994.04 Owner: Lisa McCray Zoning: URA(l00)/WSP(I00)/ Applicant: PAUL SCHMIDT AT: 369 FLORENCE RD Applicant Address: Phone: Insurance: 24 CHESTNUT ST (413) 247-5739 WC HATFI ELDMA01038 ISSUED ON:9/12/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:1,000 SQ FT 11" LAYER R-38 ADDED TO OPEN ATTIC SPACE, AIR SEALING AS NEEDED 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 It 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 9/22/2016 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-0390 APPLICANT/CONTACT PERSON PAUL SCHMIDT ADDRESS/PHONE 24 CHESTNUT ST HATFIELD (413)247-5739 PROPERTY LOCATION 369 FLORENCE RD MAP 30C PARCEL 059 001 ZONE URA(100)/WSP(1001/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid -�{'I 16 Building Permit Filled out C(�J Fee Paid Typeof Construction: 1,000 SO FT I I"LAYER R-38 ADDED TO OPEN ATTIC SPACE,AIR SEALING AS NEEDED New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 174415 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF R N 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 Demolition De y 7 Signature of Building a fficial 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. 1i°hk Svc car of ton S(Gp 41° 2z1 Street ppA.,,...�,.�.,'. HG„oSs.0( mini 100 0t off o” Northampton, MA 01080 n""orv°"tP4phone 413.587-1240 Fax 413587-1272 APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR Dpi A OtE OR TWO PAYE.Y OW9JJNCb 1.1 MESJE,Ad9te E. F 3 a_09 UL:C✓1 GQ _ C�1OCOa— � wY 21 Oros(. ;, : .�-�; , mcC� ra�J a9 t` lr�ne.c, Kc!. Menu(Pira? tl Cunnx MaIg Aaasss: F- 1 ., Al A ."--LP n . Ik C jl t( T"ka"° i..�r6-0S, — 6, -71 8- 2 Sloan I gablibliketEMAILSQL.*-�c 1 o27)elvmQ.R'"(' Mei:(P �' <'� Covent etyma steres` Telephone ttem Estimated Cost(Dollars)to be WaNikCg1l''} dbgpeltStatl6Jr e. ENASErAe 1. Builder/ Z Electrical 3. Plumbing 4 mechanical(HVAC) S.Fite Protection +5 / B. Tt� (1 +2+3+4+� Cc[ �R OD °(-) �� rp . . Section 4. ZONING Nt Infa+,w.ia sat Be Completed.Permit Can Be paned Due To Incomplete aroma—ion Existing Proposed Required by Zoning This mnomf robe filled in by Building Department Lot Size Frontage __ _—__ _ ___-..,_ "'�_ Setbacks Front Building Heim --- -- '— Bldg.Square Footage Open SpaceFootage (Lot mmammnNdg@WaW '.....__.: `.__._ • .__.J Parking) #of Puking Spades _ ___ (volume&Wmben) A. Has a Special Permit/Variance/Findi r been issued for/on the site? NO 0 DONT KNOW YES 0 IF YES, date issued:: IF YES: Was the permit recorded at the�Reg/i5�ry of Deeds? NO 0 DONT KNOW l:l YES © IF YES: enter Book Page: ! and/or Document B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW Ra? YES O 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 of the property? YES © NO �f 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 Q' IF YES, describe size,type and location: E. W11 the consbu cton activity disturb(clearing,grading,/�P'1 vaa�on,or tilling)over 1 acre or is it part of a common plan that will disturb over I acre? YES© NO V IF YES,then a Northampton Storm Water Management Permit from the DPW is required. New Nose ❑ Attrition 0 Replacement Windows Mtaragoo(s) © Railing ❑ Or Doors 0 Accessory Ssdg. ❑ DernoWSon 0 New Signs jag Decks 10sk y I Other[ f BDescription of fl {)1Y� �-era..i,'ynv..a c� 2� r - e. - _, f' Eat Description _ Work r 000 -�-- f l Ll/ r K-38 fH�e.ci -:o O n 4 he- ✓ s c Adding new bedroom No Attached Narrative bedroomMention of waft Yes No Renovating unlashed basement YesYes V' No Plans Attached ROA -Sheet a Use orbua ng:One Family Two Family Other b. Number of roans in each family unit Number of Bathrooms d. P,tposed Square footage of new ca istruc fon. . , ... e. Number of stories? f. Metol of Nosing? Fireplaces or Wooclstowss Number of each_____ C. Energy Cin Compliance. Masediedc Energy Compliance form . • h. Type of construction i. Is construction wain 100 tt.oflee: ande? Yes _No. is construction within 100 yr. ftoodptain,Yes_ j. Depth of basement or cella'floor below finished grade k. Wa building conform to the Buidag and Zoning regulations? Yes No. i, Septic Tank arty Sever Private wen_ Ca water Supply_ sEOynoNTa«OMjEitMl'7NONi TION-TOejDfiEPLEfED WHEN OWNERS ASIENTOR001~ORAPPUES FOR81E.0ffief$ton 1---t‘ ji_ rY)c ( atci as Owner of the subject property �p hereby authorize A...• -1-4011A- ,y�.�}.��tyD�ynv + ectni ielkne-S,11 N.� • toad on my behal€,in ay m attrs Seta to woiaLt teed by this permit appikason. Sop cHw,,. Q-t 9--1{v a Dere 5thrnrd* as OwnertAudwrized Agent hereby declare that the statements and h,f,meson on the foregoing application are true and accurate,to the best of my knowledge and Slot Signed under the pari and penalties of perjury. `-- fccffPrint Name Date 8.7 Lioenwd ConebuctIon Suoenths ,, ' 7 Not Applicable/�❑ .i� c Name of l Hindu: act c 7akinU CI± ! U 3 s license Number Address Expiration Date � .�--- '/13 - a%1�5��� Telephone Not Applicable 0 f•-• 11 ._ l of ebR- . , l /171/S Cmnq Registration Number a4t chPtut rene7/ '7 {4a--%'ct I tail.} Cl 038' Telephone4/3ad475731 Workers Compensation insurance efficient must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance ofthe?permit Signed Affidavit Attached Yes 6T'/ No ❑ The=rent exemption for"homeowners"was extended to include Owser-oemsied DweJgan 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. Si,W Edition Seedon 108.3.5.1. Dem 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-vear period shad 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 removable fir a8 asci welt oerfermed under the building penult. As acting Coostracdon Saoervlsor your presence on the job site will be required from time to time,daring and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Wnkers'Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,von 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 all City of Northampton asseageseets s or a�� 21111111111121901111 r/.2 nm Stars .a.+eya suew ate, IS moa - f- Property : .x(09 * l uv nec_. 2 d Center I . chanck -( Name: la e--. a. ...Leeibee tat..' ar .•-/n ! ,t _ h .lne'_. • Addrest 9 L4 CS-vesl-nu--- SI-re.e,-I- city, t : PaAcia , MA ora > 44)3 . a$r7-617.39 Nemec: Owne` t,r Sa , 1 f c r vtcf< J Address: ‘. Nsq PI Gl R +.0 JL _ C Ply,Stott `— ( fnar�c _ \ IY�R O101oa- I:7*A .5C`tors LA:7' (contractor)attest and alke that the bad&+g I intend to PS.dabs gottasaraRy.eye eft*nab and tube)wiiigitthe spaces tobeensilaged and that Ihave provided the pnaperW thtmar VIPM a copy ofttkal6dwlt. Contractor signature,iii___, Date 9 - I9 - I (.0 RISE55 Shawmut Road,Unit 21 Canton,MA 02021 133&502-6335 ENGINEERING www.RlSEenglneering.com OWNER AUTHORIZATION FORM I, `I) 5-As Rc--C- y (Owner's Name) owner of the property located at: Property Address) 2r--.vJ - M 6 LO 6 - (Property Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering, 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. TECEDVE er's Signature JUN 2 1 2016 Date 6n - b - 1;0 � s � S • The Commonwealth of_ifa.ssachusetts � Department of Industrial Accidents ... t Congress Street.Suite 100 " . r Boston. 114 02114-201" ,v a-s� www.mass.gov/din — Workers' Compensation Insurance,lftidas it Builders-Contractors/ElectriciansiPlumbers. TOPE FILED Xs ITH THE P€R,\IITT6lt At:THORITS. Applicant Information Please Print Legibis Name Ismsme Organization Tilde dozh: SDL Home Er-provernent Contractors, Inc \ddress: 24 Chestnut Street Citv'State Zip: Hatfield, MA 01038 phone 4132475738 are.ou an empiovere Check the appropriate boa: Type of project(required): soh 8 Jr.,: ' F e. 0 New conitruction iii n n?p•TOOsn e. . - s _ _ 1i 1 A. Remodeling ..,e r r s _. 9. ©Demolition Elie n o 10 [] Building addition h .e .a an p_ii2r .neen _ 1 t l.0 Electrical repairs or additions elPithI .. it . n a. n o 12 D Plumbing repairs or additions Clot' r I-not e tened .. .c,ha. I o h 13.D Roof repairs cos thorns-Pap cerceern ape h4.00ther Insulation ,c a :a[. . '.an hat,:ro_Tat .,_ '� e11,171,11.. .. _ .�. i ... .t anneeantksive oi nolo tetne 1311o _ _ er intension_ u mi One aetdeca innicanne:h_: Pe et nee ci - .. --, n. ' -2 —11,1.1e . "'117.1.C.11151,MU:Es:NMI=lewsubmit aftdahn]a u. vb d. cue inn;chinch nonan.. 1atscasenadot, a: - .-- h .n- and on, anther o._rnhm , nve . em erenia>egn If me 3nb-contrielors have e crappie po en PP ember_ I am an employer that is providing workers'oompensation rmurarrve for no employees. Below is the polies and job.Site information. Inserance Company Name. Selective Insurance Co i it or Self ins_ Lie, Vt+C9024456 _ �7_ _ _ Expiration Date: 2/23/2017 lob Site Address:ti, O( 0 —I 1 (A s ✓tip ¢ RC\ Cit State Zip. Iasat.in( 0t fn .Attach a copy of the workers' compensation polish declaration page(showing the policy number and expiration date) . ealfite to secure Coverage as required nder7+161 . ____.. ;elation punishable by a fine up to SI.500 ad orene-}car imprisonment.as null as she Nriainea in.nam `a SFOP A ORK ORDER and a fine of up to 5250.00a da}against the violator.A copy of this statement that be tare ark the Office of Intesbgations of the DIA for insurance coverage verification. I do hereby cenif u r the p s and penaltiesofperjury that the information provided above is true and correct .ed �(�„, � date. p' 9' Ste/ Phone�i:-413-24 5� '1 __.... J T 1 Official use only. Do not write in this area.to be completed hr linar town official Cin or Town: _ Permit license Issuing Authority(circle one): I. Board of Health 2. Building Department 3. Cites Town('lurk 1.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone=: --I' ACOROe CERTIFICATE OF LIABILITY INSURANCE DATEme2Dic THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER. IMPORTANT: If the reiterate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the Certificate holder in lieu of such endorsement(s). PRODUCER NAmo, Cynthia Henderson, CISR NAME. Webber & Grinnell Firmbwfatl. (413)586-0111 1 ,Not...(413)506-6411B North King Street nIRa:chenderson@vebberandgrinnell.com " "--- INSURFA(BI AFFORONG COVERAGE NACF_ Northampton MA 01060 INSURER•Selective 19259 INSURED 'INSURER e_ SDL Home Ielprovement Contractors Inc. (INSURER C: 24 Chestnut Street :INSURER O i INSURERE __.. Hatfield MA 01038 INSURERI. COVERAGES CERTIFICATE NUMBER3faster 2016 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED aELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. AMR UB TYPE OF INSURANCE ADOL3R. POLICY EFF - POLICY EXP -.... _..-._.. LTRINSn WYo POLICY NUMBER IMLVOOYYYN IM*'OO'YYY1 LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 bAMPNTENDENTEN ACLAIMS-MADE X OCCUR PREMaESEaomrrena)" 5 100,000 _. . _ 52204065 2/1/2016 2/1/2017 MED EXP(Any one person) S 10,000 PERSONAL 8 Dv INJURY 5 1,000,000 _. _ . GM AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 5 3.000,0000 ._X POLICY PR6 _. _ _. JECi _.. LOC PRODUCTS COMPrroP AGG S 2,000,000 OTHER AUTOLpWLE LAWLITV COMBINED SINGLE LIMIT 5 1,000,000 ANY AUTO BODILY INJURY(Par ppEml A ALL OWNED SCHEDULED AUTOS 't NON- A9100328 2/1/2016 2/1/2017 BODILYMJURY(Per a2,pen0 5 X HIRED AUTOS S AUTOSO EO PROPERTY DAMAGE AUT06 (PLA accieen0 UrCwmwrMS motorist&sdil $ 100,000 X UMBRELLA LAO X occuq EACH OCCURRENCE S 1,000,000 EXCESSWB A CLAIMS-MADE AGGREGATE OED T- RETENTION 10,000 5230/065 2/1/2016 2/1/2017 WORMERS CDMPEXSAl10N X PER STATUTE X E � R ANOEMPLOYERO'NABLRY Y/N_ ANY PERIMEMTOR EXCLUDR:EXECUT VE -- EL EACH ACCIDENT S 500,000. A DFFICEcMEMSER EXCLUDED? Y NIA _ Ir Mads eMS — NC9021456 2/23/2016 2/23/2017 EL DISEASE.EA EMPLOYEES 500,000 IONCI wrCN OF OPERATIONS _ SE- DESCRIPigN OF OWIow E L DISEASE-PoGCV LIMIT 5 500,000 OESCMPTON OF OPEMTtNSI LOCATIONS/VEMCLES IACORO 101.Ad6Mwu1 RMMM&IM¢uIR may be attached I more Map M requited) The Workers Compensation policy does not include coverage for Paul Schmidt, Kendrick Dempsey and Douglas Schmidt. Columbia Gas of Massachusetts is hereby named as Additional Insured per written contract with respects to General Liability a Auto Liaiblity, for work performed, and per the terms and conditions of the policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Columbia Gas of Massachusetts THE EXPIRATNIN DATE THEREOF. NOTICE WILL BE DELIVERED IN 4 Technology Drive Ste 250 ACCORDANCE WITH THE POLICY PROVISIONS. Westborough, MA 01581 IAUTHOMIEDREPRESENTAnVE �0Henderson, CSR/CI: .i_ ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 ommrr