36-122 (3) 517 WESTHAMPTON RD BP-2017-0499
GIS#: COMMON',' .3A _TH OF MASSACHUSETTS
Map:Block: 36- 122 C I . Y : NORTHAMPTON
Lot:-001 PERSONS CONTRACT H . .. 'J REGISTERED CONTRACTORS
Permit Building DO NOT HAVE ACCESS TO T. E C.JARANTY FUND (MGLc.142A)
Catenary: INSULATION L M? . � ;�il� V PERMIT
ERMIT
Permit# BP-2017-0499
Project JS-2017-000820
Est. Cost:$2000.00
Fee: $6/00 PERMISSION/.. .. Y GRANTED TO:
Const.Class: Contractor: License:
Use Group: PAUL SCHMIDT_ _ '03635
Lot Size(sq.ft.): 67082.40 Owner: GONTARU:
Zoning: Applicant: PAUL SC1 ;. )1-
AT:
TAT: 517 WESTHA1.1 V f
Applicant Address: Insurance:
24 CHESTNUT ST '5739 WC
HATFIELDMA01038 ISSUED ON.:10/17/21!-. '. .,
TO PERFORM THE FOLLOWING WORI " layer, r-15 added to attic floor air
sealing as needed
POST THIS CARD SO IT IS VISIBLE FROM TII i:_-
Inspector of Plumbing Inspector of Wiring P.It' - Building Inspector
Underground: Service: Mel.
Footings:
Rough: Rough: Hou, Foundation:
Dri'
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: OI: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE C1_..'.. HAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy
FeeType: Date Paid: Amount
Building 10/17/2016 0:00:00 $65.00
212 Main Street, Phone(417 (413)587-1272
Louis Hasbrouck- - :sioner
File#BP-2017-0499
APPLICANT/CONTACT PERSON PAUL SCHMIDT
ADDRESS/PHONE 24 CHESTNUT ST HATFIELD (413)247-5739
PROPERTY LOCATION 517 WESTHAMPTON RD
MAP 36 PARCEL 122 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid CA-4 (qai (16
Building Permit Filled out
Fee Paid
T •eof Construction: 872 s. ft 4" la er r-15 added to attic floor air sealin d as needed
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
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
__Deft• ition I-
Sig . e of Bui ding 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.
, ,
a Northampton
s''' `3 VJ z�z
�\ ��Pa
ASSN Street
ikO� o � Room 100
4‘5,,,cr4 Northampton, MA 01060
4,-e-- phone 413-587-1240 Fax 413-587-1272
- TION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DENOLl8N A ONE OR MO may OMI BRIG
1.1
5/7 it,v 2d
✓ICY • / I h✓I4A-)LCL/c ,bil�7 � / la/�'1�Yr0'` r /`-�
e(PMe) l'I %Eng""m'm.:Gt� RCo2_ 9 g / /-
SQ A. zC.-Gfaa-L A L Telephone
Sigralure
atediatiandes Sb-- n przD eme (ye-
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Nana(P- �// Current MaltingLi Aeb h
f Li i.-=,- �47-5 73 9
Tebphcne
item Es meted Cort(Doers)to be
by t
,. Buildings 000 ' " f
2 Berme
e
lgp�
3. Plumbing
4. Mechanical(HVAC)
5.Fire Protection -
6. Total=ry •2+3.4+5) -f`"t".—
rDOG 0 ' , !9'9 - 0�
_„ � .
Section 4. ZONING Att Infonnadon Akan Be Completed.Permit Can Be Dented Due To Ukom ptete allormation
Existing Proposed Required by Zoning
This cot to be Fled m by
Building Deportment
Lot Size
Frontage
Selbael¢ Fro t
Side L _ R:--- -: L:._.. _ R' ___ .___:
Building Height .—_. ..__.,._
Bldg.Square Footage -.__. ____. % .,.___ _._._.. --.
Open Space Footage
Not mea mina Ndg&pasta '_...._.. L._._..: -..__._ ._.�._ ._____
#of Parking Spaces
Fill:
pottue ex LOOM*
A. Has a Special Permit/Variance/FI r been issued for/on the site?
NO 0 D0447 KNOW YES 0
IF YES,date issued::
IF YES: Was the permit recorded at the Regi try of Deeds? ((��'�
NO DONT KNOW Y `✓.___.
IF YES: enter Book Page:. and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW (2 YES 0
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 0 NO Q�
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 42'
IF YES,describe size,type and location:
E. NAI the capon activity disturb(dealing,grading, • ,or tilling)over 1 acre or is it part of a common pian
that we dsltab over I acre? YES 0 NO
IF YES,then a Northampton Storm Water Management Pero from the DPN is requimd.
SECtititit4 5-DESDROWISNIWPRalckekliatil.aea/aWq
New Home ❑ Addbon Replacementendows ANeslon(s) ❑ Roofing ❑
Or Doors G77 /
MOSSaarf ❑ Demwlwn ❑ Wainjo} Decks fp ie. on�[�
Brief Description of • „ r � • n ✓ C'4
work
Agate of existing bedroom Yes No Adders new bedroom Yes F7o�,,.. '"�''�
MaleAttachedAttached
Nan** Renovating unfinished tmnenwnt ,Vas Na
Plains Alatlmtl flag -Sheet
a. Use of btldi g:One Family Two Family Oyer
b. Number of rooms in each tinily unit Number of Bathrooms ___......_——_-......
• Is there a garage attached? ..--
d. Proposed Square footage of new contenecto.t ;' Dimensions
e. Number of shares?
t Method of heating? Fireplaces or Woedstoves Number of each
g. Energy Conservation w. . 0.iahlnedt Energy Cornplance fern attached?
h. Type of construction
L is mor -.,.; 100 ft ofweba,ds?_Yes _Nu is construction whin 100 yr. floodprain Yes No
i. Oec h of basement or cellar floor below finished grade
L. Will building cordon,'to the fkticting and Zoning regal/Sons? Yes No.
i. Ser:Taal_ City Sewer Private weir City water Supply______
SECTItiplasiOWNERAUTHOPPAIKIN-SOBE•fAUPIEfE Wei
Mad SOLI T ORIDDN* C1-tAfl'UES FORUMS**PERMIT
r, as Omwr of the subject
prMmrtY
Nifty authorize *5 1%.. -F brew.. r7A/efatel+ r!'�kres,Tr,Cr•
to ad on my behalf,in a makes relative to by this blkffng permit.gq 5vn.
Sez
OL-14-a . _ci__—r J 0. ( f_ j
5chmr
Agent hereby declare that the statements and it ifis an on the foregoing application are true and a7curate,to the best of my kriowiedge
and belief.
Signed under Me pains and penalties of perjury. •
�sks! &Jwr c1*
Pt Nave
;l. Date
awaea
Not Applicable ❑
N.a.&LtntH r_
tin Number
Date
� � t / - tilt -5
sun - Telephone
'-- ,, t Not Applicable, /❑
Cemoana lltaae Registration Number
e2 _ 7 /'Z
Expkation
n �J
J—f,+4G(4 , !Y\A til o3Q Telephony/Aay7573•
Workers Compensation hindrance affidavit must be completed and submitted with this application.Failure to provide this affidavit will result
in the denial of the issuance of the breed permit
Signed Affidavit Melted Yes No ❑
The current exemption for"homeowners"was extended to include Owner-oceimied Dwelling"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?8B. Sb* Edition Section 108.3.5.1.
Definition of Romeowns[: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 as ee strac s mere than ate home in a two-var period shad not be considered a homeowner.
Such"homeowner"shad submit to the Building Official,on a form acceptable to the Building Official.that hwahe shall be
renewal*for ad seek work oedonned nyder the biildaoe 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 Northampton
a...aeea..tta
NIS a►a. SDE119 SPICI601111 .
21.2 Stu INS • ass Railding
leezelluraptca, r auw
Vad Mick
Contractor
Name: s`b� . nee.%m rnvear e.t4 .n17 racAtcs ,Znc., •
Padang
/4/1.17•44A a C'.�es� nut SA-ree,-�-
My, staSOW , rni oL
Phone: -4i3- a 7-67.)9
ficepaty Name:
owner � � CS U-� r��c�
car.state et-e-n Le . it✓f nr r) (-.0
a—
i,-Tag' l thiel.-1 (cotmaae)Meet and Serra that the tamIIntend to
inset Snit Sonny ape at demo and tube)sting i the spaces to be in:~andthat have
prodded the prepatrraeterated a copy etrikandadt.
Connector eignstureap....-
Date
Per-mit Authorization
mass save Form V.
t.f ourenemy..CK.,Y ooxl
RACTINI
'gar
Site 1D: 0 Customer: David Gontaruk
David Gontaruk ,owner of the property located at:
(owner's Name,printed)
517 Westhampton Rd 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 Signatu cwerreas
Date: D ?A 6A0 /6
•
FOR CLEAResult OFFICE USE ONLY
CLEAResult has assigned the following Mass Save Home Energy Services Participating Contractor to the
above referenced project:
Participating Contractor Date
•
act
•
CLEAResult • 50 Washington Street,Suite 3000 . Westborough,MA 01581 • 1800-480-7472
ForOfice Use Only
Rev. 102015
The Commonwealth of Nassaehusetts
Department of Industrial Accidents
- I Congress Street, Suite 100
Boston, .if4 02714-201-
www.mass.goc/dia
-- R orkers'Compensation Insurance Affidasir Builders.'Contractors/Electricians!Plumbers.
TO BE FILED W ITH THF: PERMITTING AL THORITY.
Applicant Information Please Print Legiblv
\allle ,Roriners01.2anizimen lid:idvalC SDL Home morevement Contractors, Inc
Address: 24 Chestnut Street
City State Zip: Hatfield MA 01038 Phone a: 413-247-5739
tie you an emplo.ere Check the appropriate hoe
Type of project(required):
plu 8 _ '. ❑ Nev. construction
❑ '° p p `^ t -- - S. 0 Remodeling.
..
Ola , nc cue e k �. ❑Demoti on
Jr� and be h 10 Building addition
a.e that al :She:eatz ,rke - t i.Q Electrical repairs or additions
proan _as.. - 1?_0 Plumbing repairs or additions
❑1 I. d - ny .c_.. � 1
13Root repairs
(❑ic cora r _.. 14.❑,. Ocher Insulation
e hea II .. � po inlonfla -
a h t.. o _ =I �subma atfidaea. e..
4 I_rees Icheck th attached eell the — 7. and ae o n�1 rc ..e thouose entities ...
thc so btors have emp ar rthethat: mhe:.
lam an employer that is providing workers'compensation insurance f r my employees. Below is the policy and job sire
information.
insurance Company Name: Selective Insurance Co
W09024456 2/23/2017
P I s Sert-in Li . Expiration Dated
Jeb Sao Addrsss: rrta /iso Silty Stare Zip: J- /6/(,c.7 e,('
Attach a copy of the workers' compensation pot ce declaration page(showing the policy number and expiration date).
I secure coverage as required under AIG. _. . ., d,ti Son punishable by a fine up to Si00.00
u
and or ones:,ear imprisonment.as v.ell as civil penalties t lc inn Or a SI OP\\ORE ORDER and a fine of up to S250.00a
day against the violator_A copy of this statement may be fors_._m!n;:he Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify par the p sand penalties ofperjurr that the information provided above is true and correct
St ,tue. / v /i��- l) /6 —//s-/ <o
Phone413-247-5739
Official use only. Do not write in tha area, to be completed bi'city or town official
City or Town: Permit I icense=
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.Cin-:Town Clerk 4. Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone 9:
ACOR d CERTIFICATE OF LIABILITY INSURANCE DATE lits 0"i M
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 certificate holder is an ADDITIONAL INSURED,the pollcy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the polity,certain policies may require an endorsement A statement on this certificate does not confer rights to the
certificate holder in Ilse of such endorsementls).
CONTPRODUCER LiammcT Cynthia Henderson, CISR
Webber & Grinnell No,P (413)586-0111 FAX
k\S.NoL :413)586-6481
8 North Ming Street ME" chenderaon@webberandgrinnell cor
NI6VREWHI AFFORgMe[MEM4E tam
_.
Northampton 10, 01060 _ yINSURER A 9electIVO 19259
INSURED li INSURER B:
3011 Boma Improvement Contractors Inc. I INeuRFRc[_.
24 Chestnut Street L ENSURERD:
'.,INSURER E: _... __.
Hatfield NA 01038 ;INSURERF:
COVERAGES CERTIFICATE NUMBERddaster 2016 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTMETHSTANDING 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
:NSR 'Ada SOU _._. . POLICY UP POUCYEXP _. __...
LTR TYPE Of INSURANCE ,,INN WYD POLICYNUMRER 0,0NOOYYYYI IMWDWryYYI. ULYTS
X COMMERCIAL GENERAL LIABILITY ', EACH OCCURRENCE S 1,000,000
A
CLAMS MAGE X OCCUR GAVAGE JHENLEO--
MffDEXS1Eewtamnay. ,3 100,000
S2204065 2/1/2016 2/1/2017 MED EZP.Any pN pima S 10,000
y
PERSOrvu e:.pViNJURY $ 1,000,000
GENE.AGGREGATE MET ARP, ES PER GENERA_AGGREGATE 5 2,000.000
PR
X POTCY JE=j LOC PROO,LTS COMP/00 AGG $ 2,000,000
OTHER _. .. 3
AUTOM0thLE UAINUTY CON&NLC SINGLE LIMIT 5 1.000,000
EE.PmI1 ,..
A ANYADTO 000.LTINJURY PMp:am: S
AGTD OWNED ZSCHEDJTED A9100328 2/112016 2/1/2017 800 LIIN1URY r Pmao;Iex S
E nRE0AP.05 E N
NON.
OWNED PROPERTY DAMAGE
_. . AUTOS LPn F[oNm_
UnCMWSW Cm0Mnet mm 3 100,000
X UMBRELLA LMa X 00CUR EACH OCCURRENCE 5 .1000,000_
A EXCESS CAS C.AMEMADE AGGREGATE , ,
S
OD E RETENTION10,000 81204065 2/1/2016 2/1/2017WOR
PEMASCOMPSAOON
AND ELOYERSp
WLJAAeLRY YIN x_STATUTE E ER
ANY PROPRETORRARTNERIEXECUIVE , E..EACH ACCIDENT 5 500.000
A Mandatory In
EXCLUDECT YNIA
...
NatwyMNNI wc9024656 2/23/2016 2/23/2017 E. DISEASE EA EMPLOYEE 5 500,000
flea dSSCme urger
DESCRIPTION OF OPERATIONSEmmy E.OrSEASE-POJCY LIMIT IS 500,000
OESCISPIIN OF OPERATIONS Jr LOCATIONS/VEHICLES(ACORD 101.Ad&YMu1 Romans Schedule,may 6e attached If more apace enquired}
The Workers Compensation policy does not include coverage for Paul Schmidt, Kendrick Dempsey and Douglas
Schmidt.
CLEARmsult, Eversource and National Grid, NSTAR, Boston Gas Co. , Colonial Gas Co. , Essex Gas Co., and
Western NA Eelectric are named as Additional Insured per written contract with respects to General
Liability 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
CLEAResult 114E EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Contractor Services ACCORDANCE WITH THE POLICY PROVISIONS.
50 Washington Street, Ste 300
West orough, MA 01501 AUTHORIZED REFSESENTATIVE /,a �_�`�
O -S , =PUN
Td
®1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
INS025 onion