16B-053 (3) 197 NORTH MAIN sT-2ND FLOOR BP-2017-0520
GIS COMMONWEALTH OF MASSACHUSETTS
Mao:Block: 168-053 CITY OF NORTHAMPTON
Lg:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Ninth: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Caiegonn INSULATION BUILDING PERMIT
Permit BP-2017-0520
Proict# JS-2017-000851
Est. Cost;$2000.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const Class: Contractor: License:
Use Group: JAY BOLAND 101880
Lot Size(ya.tit: 17685.36 Owner: WHITLEY RICHARD G
Zoning: URB(100y Applicant: JAY BOLAND
AT: 197 NORTH MAIN ST- 2ND FLOOR
Applicant Address: Phone: Insurance:
12 PISGAH RD (413)203-2454 0 Liability
H U NTI NGTONMA01050 ISSUED ON:10/24/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL I I LAYER R-38 INSULATION TO 804'
ATTIC SPACE INSULATE HATCH &AIR SEALING
POST THIS CARD SO ITIS 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 Firepiace/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 10124/20lb 0:00:00 $65.00
2 12 Main Street, Phone(413)587-1240, Fax:(413)587.1272
Louis Hasbrouck—Building Commissioner
Filen BP-2017-0520
APPLICANT/CONTACT PERSON JAY BOLAND
ADDRESS/PHONE 12 PISGAH RD HUNTING TON (413)214-2414
PROPERTY LOCATION 197 NORTH MAIN ST-2ND FLOOR
MAP 16B PARCEL 053 001 ZONE URB(I00)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
INCLOSED REQUIRED DATE
ZONING FORM FILLED OUT r{
Fee Paid / `
Fee Paid
Permit Filled out (/
Fee Paid
TvpeofConstruction: INSTALL, 11" LAYER R-38-(NSULATION TO 804'ATTIC SPACE INSULATE HATCH
&AIR SEALING
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 101880
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS.APPLICATION BASED ON
INFq ATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Projectli, 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
ft oittt s-
Signature of Building I rteial • 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.
r n .. Department use only
I. City of Northampton Status of Permit:
Building Department Curb cut1Driveway Permit
j 8 . 212 Main Street Sewer/Septic Availability`
4 4:',0, - / Room 100 Water/Well Availabirdy_,,,
"'a o / ortttampton, MA 01060 Two Sets of Structural Plans
°"Hi':7: ne , 13-587-1240 Fax 413-587.1272 Plot/Site Plans
Other Specify_.
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOUSH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION J
1.1 Property Atldress -�,,i A This section to be completed by office
q9A M'1�(') circa- ZrMap Lot Unit
00066 1( a)4 Q( p411� Zone Overlay District
Om St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1er of Record:
t rd c4/17 1619 n ST- 2
Name(Print) Crtmd Og Pess: Mp- FJ }pc"
^v_/
Telephone `` l3 5
8
4 ( k3
Signature (J '2LeC- 16/(a
2.2 Authorised Agent: /t (� y r ,,1t
_e( t��,<'1T�� ( rre- Pt Shy ss: �G=+
NameName(Pont) ;; Current Mailing Ad ss
Signature Telephone
SECTIO!3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building
3 000, 00 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(B)
3. Plumbing Building Permit Fee
4. Mechanical(HVAG)
5.Fire Protection � ,/[{//� _
6. Total=(1 +2+3+4+5) o�OW> . t3) Check Number /ie Q 0 " eib
This Section For Official Use Only
Budding Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) El I Roofing 0
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs (D) Decks (O Siding[0) Other(0)
Bnaf De '.-- Propos tl h 204 t ff spbt Instill. +L
wax: `l 11"t.Ayof 2`�1tts luTon
lf�d ¢rar5�tsaltnk
Alteration o existing be room J Yes No Adding new bedroom Yes X NoA.,
Attached Narrative Renovating unfinished basement Yes ./l. No
Plans Attached Roll -Sheet
6a.If New house and or addition to existing housing,complete the following:
a- Use of building:One Family Two Family_ Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a gara•- attache..
d. Proposed Square footage of new • .motion. 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 wetlands? i Yes No. Is constructio r hin 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Wilt building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank_ City Sewer_, Private well City water Supply—
SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, 1 (♦/ . . . .
+ . . . .. , as Owner of the subject
propertyh
Ss_
to atyn my authorize Imo. �'�veto wor
to�/a�ca+t.{�o''fn`�m�y'b�eh�att,in all ma -rs elative to work authorized by this building permit application.
Signature of Owner -'Dale —j --
I, _....� � (tl^c..p Y �.. . ,as Owner/Authorized
Agent hereby d dare hat the statements and information on the foregoing application are true and accurate.to the best of my knowledge
and belief-
Signed odor the pal s and penalties of perjury.
--F.aisis A PrN/ X _..
Print Name
Signature bf Qvrtrer/AQent Date
SECTION 8•CONSTRUCTION SERVICES
8.1 Licensed Construction St4 ervisor::/� \ Not Applicable
Name of License Holder: J Ay C3 \a.. n A t d 11 b L` (Th
License Number
—
\a--piSach D_A-. -i-}'t-,r1-V+rW#bf\ ma 27th&O iaa\ a---1 .2,0( kr
Address J t Expiration Date
Signature` .•-„ Teiepnone
14 ,.r 4t3 1 -a1-Ftc
9. '.:pistoned Home Improvement Contractor: Not Applicable ❑
Al / n/ et Le1/2-10Th S 1 LetVEC 3
Company Name ` t77 Registration Number �/
t PIS an"T 1 rap DIc 1ace d l
Addressr �I,r �; (1, f Expiration Date
NI�j
" Telephone 1 t
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(8))
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 0
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) or two(2)families
and to allow such homeowner to engage an individual for hire who dr..s not possess a license,provided that the owner acts
as supervisor.CMR 780, Sixth Edition Section 108.7.5.1.
Definition of Homeowner: Person(s)who own a parcel of land on which heishe resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached stnictures accessory to such use and/or farm
structures.A person who constructs more than one home 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 be/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,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
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150k
Address of the work: 19 9 ,-ni17n S 1 n'aipfl ce
v� cc
r
The debris will be transported by: Yt,__ ) Co 11.,t,-1-tac,S
The debris will be received by: WA-Clc (✓altar r
Building permit number: 0y rYl o-tet
Name of Permit Applicant / / ISI [he-a 0� ry
int
10 I ?ii . I :1/4 c ct
Date Signature of Permit Applicant
•
RISE60 Shawmut Road,Unit 21 Canton,MA 02021 1339.5026335
ENGINEERING wWrearI g.com
OWNER AUTHORIZATION FORM
I, ley
( '.N c flvt
owner of the property located at
IV?
(Property Address)
MA— U cO(7)-N.
(Property Address)� c
hereby authorize e ` 1 3 4 SDI IL+ a >
(Subcon ar]ur/)
an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building
permit and to perform work on my property.This formm is only valid with a
signedcontract
Owners Signature d
Date i
•
Vit , 121
The Commonwealth of Massachasetts
Departmewt ofImiaabial Accidents
lona: ;re Office of Investigations
1 Sake 100
Bassler,MA 02114-2017
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rc' wwwtafspsgow'dia
Workers'Conapeusatifm loarance Affidavit Builders/Coat acton/Electrieiam/Ple°ben
Applicant Laforantion Please Print Legibly
Name masanstorassiesenosivahant r?)011V0a - rnQ ..11 cr)1u+ler:
Address: 1 .2 ') syq�aL R Oa_
City/Stated �'L(j�-1'i11Q 611, (Y) A- OIDSb_ Phone 41: ).13- 0)17. 31_3x_ _-----_.
An you a employer!Cheek thiappropriele but TyPe of project(rogand):
1.❑ 1®e with4. ❑ lam a general contractor red l ❑
aoNar Pmy�).v
have hued theorb-cmn'acnas 6. New construction
2 I am a aoM proprietor or partner-
Them
die attached silo. 7_ ❑Rerooaemag
flip and have eo employees 1Leae silo-aoUaUwa have a. 0 Llemnlmm
mates for me in any capacity. employees andbare workers' 9. ❑Bdldiog addition
comp.insurance;
[No ) insurance
requiced. 5. 0 We e a corpormm and its 10.0 Electrical repairs or add'moa
3.❑ I hhomeowner doing all wadi offices ham rammed their 11.0 Plumbing repots or additions
myself[No mem. comp. right of exemption par Ma 12,0 Roof repairs
ra4nied]t c.152.§1(4),and we haw no 13❑Other
employees [No leadoff?
comp.insurance required]
•Act spetloamr ale boa II mumbo®I as theavtim Wow Awdtaa mese'mpoa>m policy mformnien
Room Bas whoatmh this ander*.mraina.y wsots ail met eau mm bhe made mroaemm moa submits ere.alive:B ori
ams clad are boa me aaamS'm adlamm atm denim Deme cite mtrmm®ml stem wbm>ba es ea Woe mien ham
mPdRa ace st-mennen levicereloyen they mom provide mm oaten'men.policy acne
l0 s employe limn b pm"Ye wrier'wrpeaerkm teemsfor sty flyby's,. Below Is the policy amijab she
beffiNIIIMIL
insurance cnm pmyr+�c p1.11 �`Cc.� ' I �11�rzllCsL (Amp din
Policy#°Self-ha LLic.Y: .� frcf/ (r tel 15`11 1 Expiration Da k1 - 1 - 2b % (1:7
lob she Address- Ili 1 M mr'l, (� 5f ? f \ CUy bteI2ip:- goszn, t 11A 6i
Meade a topy of the workers'eampeafbu policy dwcdratba page(.towing the policy number and'avionics date).
Tame to(erne coverage as required ode Seaiow 25A of MOL c. 152 en lead to the imposition of criminal peakin of a
fine up w$1,500.00 aaNe ono-year imprisonment,as well as dvil penalties in the form of a STOP WORK ORDER and a fine
of up to 7:250.00 a dry against the violator. Be advoed that a copy of this Bust nmy be forwarded to the Office of
hiveatigatims of the DIA far insurance coverage vengeance.
IIo hereby wader Aepsa u/pemit ofpef .y*4ekbraaoriauprovide Horeb arae rod alma
Sim eon .mi a *�= � Disc 1i21 13I cb VO
Phone ft. y I 4(l1-3 130
Official off ay. Do out write be Iib mew,to be anapdmdby dry or town rfdat
City er Tows: Permit/Lien=#
bas/bas/wg Authority(ode one):
I.Boned of Health 2.e.mkrj apartment 3.City/Town Bek 4.Electrical Iapeetor S Ple mhug Inspector
&Other
Co.tact Pan: none#:
�L Wo vir C ?g/ aee
i Office of Consumer Affairs and Business Regulation
,,i 10 Park Plaza-Suite 5170
Boston,Massacligsetts 02116
Home Improvement CetorRegistration
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HOME ENERGY SOLUTIONS - -. x1
JAY BOLASGAH R 5�-_ - vim
12 PISGAH RCL -.
HUNTINGTON,MA 01050
'Ir':`- '''II@idrAddress ad nava wt.Stark vats far char
0 Adams 0gamma 0 liaplarniat O Lott card
YE•astox omniao '.,. /aroarraZ
11, Oahe ettapsomarr ABWt&Roches aeesiada ties.r.epaM.aoeaSl for tediidd s*sly
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qSA 10PaakYh �
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MassachuscJa,OOWibherd of%bac safety
ffi erwd of 8141k7oy3 Raga/at/a=sad Standards
:,smtsacOao Supervisor l sem{p
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frotip.....4tare 1.3114 Expiration
Corncissioner 12Q7120I0
City of Northampton
;, ws
p� - Massachusetts
LT n a
t u o
•i , DEPARTMENT OF BUILDING INSPECTIONS ry
'�' 212 Main Street • Municipal 3vilttnq
Northampton, MA 0106D M' 80C'
t. 1 r2G(
_
Property Address: l cti _ .'a U ,: A S 1.... i 6bferye r m i l
Contractor /
Name: _ i► 'moi. : \ • de' _: . lu i. b r. S . b :r
Address: ^ . _a,__ -7� .—..
City, State: 4AU rtk1f/its .nr MA D I O O
Phone: LUZ . I Ptn1 -1i13b
Property Owner (----
wner
Name: d\Q,,CA V3\-\ 14A i kj
Ici`lii tM c s1
Address:
City, State: _r___Lt,0i n( m.___.. D
10(e D
_'f ``
I, " tt 6')1 (contractor)attest and affirm that the building I intend to
insulate do-. of 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 }()t31'c`�01Cn