11A-007 (6) 35 CHESTNUT AVE BP-2017-0514
GIS 4: COMMONWEALTH OF MASSACHUSETTS
Map:Block: IIA-007 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cate2urv: IN$ULATION BUILDING PERNIIT
Permit# BP-2017-0514
Project# JS-2017-000841
Est. Cost:$969.00
Fee: 565.00 PERMISSION IS HEREBY GRANTED TO:
Const.Cass: Contractor: License:
Use Group: URBAN & SONS INSULATION CO INC106062
Lot Size(sq.ft.): 11325.60 Owner: CHALMERS LESLIE
Zoning:URe',(t01}7 Applicant: URBAN & SONS INSULATION CO INC
AT: 35 CHESTNUT AVE
Applicant Address: Phone: Insurance:
385 LIBERTY ST (413) 732-3922 WC
S P R I N G F I E LD MA01104 ISSUED ON:
TO PERFORM THE FOLLOWING WORK BASEMENT RIM JOIST &AIR SEALING
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector f 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:
FeeTvpe: Date Paid: Amount:
Building 565.00 /4/7/(/
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File g BP-2017-0514
APPLICANT/CONTACT PERSON URBAN&SONS INSULATION CO INC
ADDRESS/PHONE 385 LIBERTY ST SPRINGFIELD (413)732-3922
PROPERTY LOCATION 35 CHESTNUT AVE
MAP I IA PARCEL 007 001 ZONE URA(101)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OU
Fee Paid
-4 )
Building Permit Filled out J
Fee Paid
T .eofConstruction: BAS:MENT '01ST&AIR SEALING
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 106062
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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 Pemrits 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
Dena '4n Delay
Signa e it ui ding : ial D to
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.
a
�4.--,
I I` '2D- ar us n r s:1
<' ."r of h1orTampton IS Oec k'efi s. �
C✓ '" - Furley D_pailmen � ar_ �u��n� spy= 'ut <�
Vp \ Z 21 Main it 't S m�'S P}t ad J zahi
�� Room 100 ,! t ;N lei v lamlry r=
Northampton, (tA ILLS /o-o ata`mi TPI c -+' .
Lc) phone 413-587-1240 Fax 413-7;87-1272 1 odSYtPia - -
Ctr-— }r _ ._. r y
\ APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OP TWO FAMILY DWELLING
W SECTION': SITE INFORMATION
I
It111s eGr otf to be bonpisrad tyoffice, _ :I
11.1 Prover 'Address: , -
I l �relCC-S� V, -; �� MP - La r.- Lcd
Tanen Overla961 not I
(.. Sr'r,OS I
:_Elm St D trir _ - OD D s.r a -�
' SECTION 2-PROPERTY OWNERSHIFIAJTHORIZED AGENT
I
2.1 Owner of Record: � ,�
I L-.`N_�\ i_ --\.' 1�_ as C. NL.S fl \\S1 .\%s
Lame Want) 1.k2V:�4ul -Adcress.-^�-�c.* `` `c
Ts:echos):
9g m varu
I _2 Authorized Acen 14 \\\l(
Curren'Malang Address:
I
Signature Taiessaas
1 SECTION 3-ESTIMATED CONSTRUCTION COSTS i
Item Es ria d Cost(DCll )to be I Onici6 Use Only
IcomoieLed by oerrn ao ii ant (i.
I Building I WI'Lasing Perms)Fee I
I
i 2. Electrical I Id)
EEs:mated Total Cost of
i Censtruction Isom i3) 1
1
3. PWmbing I Eullding Pernit Fee
4. Mechanical(HVAC) I
j5. Fare Protecl,on II
5. Totaa=(i «z)-s+4-s{ C1bC)k -Socn®ek Number 7 & to r
This Section For Official Use Only
I
Ds!
Building Permit Number:
Issued: ,_
1
I Buald:ng Cnmmi__lane:r'nspector of Buildings Date
EMaii5 ^-max^-..�..i ...4-4 ............ ..-+ Wig._
i
5eEilor 4. ZerENO si. dnrmecicr Mos de arraPorrered.Per :Coe Be Dead Sue Tr lvnmr ote r c rabn.
Etztatobz Proposed !Required by Zon n I
Ybas aerranE be EILINby
?adding D9yatmon
Lot Size ...__, .—< �.� ,._.
IFrontage di i
Settacks From - - 1
h.
G e 1 1. _ . ...._
' ear 1 .— I - . ._
B'ilcinz Thighs _LLi. _. I ---_
E;dg. Squire .atage - 1g
i O n Spat o tage I % I
(Lela, m bldg&pared I I
_ 1
earearega
i „
1 l I
t Fa
A. Has a S eoiai PermitiVe:lance;Finding ever been issued `or/on the site?
NO 0 DONT KNOW & YES 0
IF YES, date issued;]
1=YES: Was the perm recorded at the P gisiry of Deeds?
NO 0 DONT KNOW C+ YDS 0
IF YES: enter Book - i PEE=-_. . and/or Document Ei
E. Sees the site contain [brook, body of r cr neua __? NO 01 DONT KNOW M YES 0
IF YES, has a perm;been or need_e be obtained from the Conservation Commission?
._
Needs to be obtained 0 Obta! ed 0 , Dates Issued:
C. De any cars exist on the propeerty? YE5 0 NO K
IT YES, tfescHee size, -type and location: __
D. Are there nh proposed changes ngs to or additions of sighs ine nded fort e property 7 YES 0 NO
-- -
IF YES, describe size. type and rogation:
- _ �_
E. MI the construe-nth actio!} Sirtorb Mearre, grading, excavetian, orfilling)over t acreo it it pan of a common plan
that will distut over 1 acme YES tO n0 D
YES,tour,3 Northampton Storm'Wat_er M1 r P tat Pe-mii from:he DF1V Is r cuire;.
I
SECTION 5-DESCRI=TION OF PROPOSED WORK(check all aco;lcable) I
1
New House ❑ Adpirion ❑ RepJacement Windows ) Altera-Canis) I Brno.
Cr Doors El l
Accessory Bldg. ❑ Demcittion ❑I New Signe [M] Beers ED Siding(Di OtheitoBj
3�1
Erie'Description of Proposed (� �j (.�. ,� R
Work V .� � SA,..jr.,. s'S\� —r ..mss.\�'ti,1
1 At lte atio of existing bedroom Yes No d inch newt doom Yes Na
Attached ttached Narrati e Renovating gr. ni h d basement Yes No
Plans Attached Roll -Sheet
Gorr If New house ane-'or edrr' .Ie; re cxis Inc heesVte. c roli_te the foUbiefinet
a. Use of buliding:One Family DC. Two Family Other II
U. Number of rooms in each family unit'. Number of Batirocros_,
c Is there a garage attached?
d. P,000sed Square t>tae cf new construction, Dimensions
e. Number of stories?
t. Method of heating? Fireplaces or Woadstoves Number of each
a. Energy Conservation Compares. _ Massoheck Energy Compsance form attached?
h. Type of construction
is construction within 100 ft of wetlands? Yes Nn, construction within 100 yr. iloodplain Yes No
I e oil of basement or City er below Bilis tvote
grade
A Will building :enteral to the Building and Zoning re_gulatJons? Yes No
I. Septic Tank SewerClryPrivate well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT J
t, ,as Owner of the sanest
ProPerty r'—.-.^-'
hereby authorze � �J - \ -S- <y;�S S ' C V t\\ _
to
to act on my behait, in ak matters relative to work authorized by this building permit cocPcation
I
as - —\
Signature of Owner bale
t, �4A a, r s Ob ner(Au h .iz d
I Agent hereby oectare that the statements and information on the feregoino spplfeabon afe true and accurate, to the bsteat of my ko wedge
I and belief.
_Signed under the tains an : tilt ic\i p=_,I,l:ry I
b \'\0
` "ii9nr•ura 0(Cwc5r/lrgen Date
SECTlChi S i CONSTRUCTION S-R:'VICCS
... Li.Cansn:Constr.-action Surceniior: ``\j
\71
Name tense Hope.
Lla;nse` T.per
\ i
`amu
Address EyL3t. Care
siSn cre Telephone
9: F. ms Bred Home Imprmvemeni C n _tor: -_ t wolisa tie -s
(�,.
—
" Registration Number
Company iilan= \s)1 tri _ `ig
Expiration Date
Addr s
elepra,,'13 ^
SECTION 10.WORKERS'COMPEENSATI0N INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6))
Workers Compensation Insurance affidavit must be compl_tted and submitted with this applioatign. Failureto provide this affidavit will result
in the denial of the issuance 0f the bending permit
Signed Affidavit Attached Yes SE
1.E - 3Ntie Ovv er ��e ntdf
The cuweat exemption for`homseame. was mended to giciude Owner-oc.unid Dwellings of one 1) or t o( i families
and to allow such Homeowner to ensaaaze an individual for hire who does not possess a hc_ose.provided that Theowner acts
as supervisor. CPoLR 780. Sixth Edition v$eetion 1083.51.
Definition of Homeowner:Person(s)who own a parcel of lend on which he/she resides or intends to reside,on which:hers
is, or is Intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
,stnctres.A person who constructs more than one home in a two-year period shall not be considered a homeowner.
Stich Anomeo"ter"shall submit to the Building Ofticiai,on a 1o:n acceptable to the Building Official.that he/she shall be
responsible for ail such work unformed under the building vermin.
As acting Construction Supervisor your presence on the job site will be required from time totime,dining and upon
completion oftbe work for which this permit is ied
Also be advised that with res ,me to Chapter 152(Workers' Compensation) and Chapter 153 (Libilin o:`Employers to
Ern,loyees for injuries not rsulting in Teeth)of tha Massachusetts General Laws ,A—notated,vau may be liable far person(s)
you hire to perform work for rna under this permit.
The undersigned"homes-wet'certifies and assumes responsibility for compliance i the State Building Code,City of
Northampton Ordnances,State and Local Zoning Laws and Stare of Massachusens General Laws Annotated.
,Homeowner Signature_ -........_
A 'The �C-'m nciEwe lth ^"/L tags'k ✓seas
epan^ rf of I 5 i 4C &= d
edo- or
Office Cf I' c5 a trts
F,ys ddla=� = 600 6d swlrgr,.rStreet
''�.�.w_ s!; scStr P, .TvT400211,
Workers' Comperssaten deacearerese Andz cat: reeslidersiaordrecOradoetEecracholanseFaatsrthera
emsreUcceant.Fnlotr¢lara atm "� ,dense Print " olbly
Name PumessiD ga zat;orretadi•ddual):.'Qe y_.y�� teeS\)\ '�(� —
Address: ��...... 1---1�ti�*� 1 S\
CitylStatelZip: . Phone#fl *D„ :.
[
Are you an empiayer? Check the appropriate bet: i I Type of project (required):
`.S 1Iamaemployerwith10-11- . EJ} - 4I am ageneral cent:acior and I I �'
6. ^1 NeV construction
employees (full ands:Hart-t,inre).* have hied the sub—contractors
2. I am a sole proprietor or pander- listed on the attack d sheet. 7. CJ Remodeling
ng
ship and have no employees These sub-contactors have g. LI Demclitica
crafting tom me in any capac3i3' employees and have workers'
9. LiBuild addition
I [No workers' compinsurance comp msurance,-
required.] 5 j We are a corpora:ion and its 1 id-7 nt cTUal repairs or additions
officers have exercised their 11.0r or additions
3.�,,,- I am a homeowner doing all work id
Plumbing repairs
myself. 'o workers'coca. -igh f exemption per IvIGi
r i2.L Roof tepaa,
insurance re u rand c plc ees. [ and weowork n' no r—'
H 13Oth_r„S,y�i �
employees. [ho wn�kexs'
cA
comp. insurance required.]
`.Andanplmant that checks box#1 roust also bill out the sector below o leg their workers'compensators policy rh mate:1
tHo meownen vino submit this athdavit ind'.catug they are doing all work and then tine outside consactnr Trust suborn a am aThdaelt indicating such.
=Contractors that check this box must trached an additional sheet showing the nam of the sub-contractors add state whether or not those entities have
employes If thesab-concacnrr_have employees,they roan pronide their workers'comppolicy 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: ��\U C- -\`
Policy
Self-ins
ins.Lic ?1
c\) X/ o'D \ .\
r
Job Site Address: ) CL . � �, .+ C: Sia^ Z �` `,- tnoo"n.. ki\t-4
,-may'
Attach a copy of the workers'compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MOT, c. 152 can lead to the imposition of criminal penalties of a
fine up to 51,500.00 and?or one-year irnpasonment as:veli as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office,of
Investigations of the DLA for insurance coverage verification.
I do hereby certify unde . an. nalfies of perjury that the information provided above is cue and correct.
�' : \o - 'o - \`b
$12n31Lre: - - -� Date
Phone 0: ) a _ rinoon. _
i
Official use only. Do not write in this area„ to be completed by city or town official
I
City or Town: Permit/1f cense 0
1 Issuing Authority(circle one):
II
1. Board of Health 2.Building Department 3. City/Myra Clerk 4,Electrical Inspector 5. Plumbing Inspector II
i 6. Other_noon '
Contact Person: Phone 0: 1i
City of Northarftcril
Hain sCrinik
'`- `% •
eft nesechusszts
aLTNT ? Eh
S33CPOi
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OWNER E X'y2TION ACKi\QWL,PDGEM NT
i The State of Massachusetts allows the homeowner the right under 780C1MR 103.34 to ad as his/her
construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which
he/she resides or intends to be, a one or two family dwelling, attached or detached structures
accessory to such use and/or farm structures. A pedon who constructs more than one home in a too-
1 y
wo-
( y ear period shah not be considered a home owner."
The budding department for the City of Northampton wants any person(s)who seek to use the home
owner exemption, to act as their own construction supervisor, to be aware that by doing so you
become responsible for compliance with state building codes and regulations. The inspection
process requires that the building department be hayed to inspect work at various stages, which include
foundation/footings (before backfill?, sonotube holes (before pour). a €ouch buildino inspection
(before work is concealed), insulation inspection (if repulsed) and a final building inspection.
The building department requires these inspections before the work is concealed, failure to secure
these inspections can result in failure to obtain a certificate of occupancy until the work canbe
inspected.
if the homeowner hires other trades to perform work (electrical,plumbing & gas)the homeownerwill be
responsible to make sure that the trades hired secure their proper permits in conjunction to the building
permit issued, and that they get their required inspections. failure of the individual trades to secure
the permits and inspections as required can DELAY the project until such time as the proper permits
and inspections are made
understand the above.
(Home owner/resident's signature requesting exemption)
I will call to schedule all required budding inspections necessary for the building permit issued to me.
Date
Address of work location ..... _...—
Cite of Northampton .212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
in accordance of the provisions of MGL c 40, S54, 1 acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit small be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: aS c,,-\\Tr°1 cf \) 6
The debris will be transported by:
The debris win be received by:
Building permit number:
Name of Permit Applicant u
Date Signature of Permit Applicant
Property Address: ?,S. C - �� J \ k"'yi T
Contractor
Name: ' &Y \ ��5� �� `A
Address: �` j \ ��SC ,-y. < t
City. State: S \�
Phone:
Property Owner
Name:
Cy, State: \\\, r\'44 /4A `JK S3 _
� y
I,
NO �/ (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.
Contractors'. - :
Date \\(--.<:.>
� -�b
RISE60 Shawmut Read,Una 21 Canton,MA 02021 3395025335
ENGINEERING www.RISEanghrarrn0.com
Erf::.-. z- -
•
OWNER AUTHORIZATION FORM
LSItit_ CAVGArset5 (2-Atik
(Owners Name)
owner of the property located at
c 5 (1ncsr•oT f1/41.)1P---
(Properly Address)
Lccet5 I - O t O 5 1
(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.
rIGEOVEDs i
AUC ?. 1 20'9
Date