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24A-106 (3) 28 PROSPECT AVE BP-2017-0515 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block:24A- 106 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-2017-0515 Project JS-2017-000842 Est.Cost: $3798.89 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: URBAN & SONS INSULATION CO INC 106062 Lot Size(sq. ft.): 16509.24 Owner: BIG WOOD PETER&ELIZABETH A Zoning: URA(100)/ Applicant: URBAN & SONS INSULATION CO INC AT: 28 PROSPECT AVE Applicant Address: Phone: Insurance: 385 LIBERTY ST (413) 732-3922 WC SPRINGFIELDMA01104 ISSUED ON:10/19/2016 0:00:00 TO PERFORM THE FOLLOWING WORK ATTIC & KNEE WALL CELLULOSE & THERMAX 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 Signature: FeeTvpe: Date Paid: Amount: Building 10/19/2016 0:00:00 565.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File k BP-2017-0515 APPLICANT/CONTACT PERSON URBAN & SONS INSULATION CO INC ADDRESS/PHONE 385 LIBERTY ST SPRINGFIELD (413)732-3922 PROPERTY LOCATION 28 PROSPECT AVE MAP 24A PARCEL 106 001 ZONE URA(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT, Fee Paid len t* Building Permit Filled out ..J Fee Paid Tvpeof Construction: ATTIC&KNEE WALL CELLULOSE&THERMAX 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: ✓Approved Additional pennits 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 •.n Delay ev,vt"- /D/7/I( S g- re of Buildi ffic 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. c 888-8 D2o388nen838on8/ City br blarthamO 71' Stat(Is dfParmn _ UtA \,t uitllYllC D parthent Curt)cut/Driveway Permit 217 Main 8e3tctSeo6cAv nab ify: Arailablli oFA P'nctr 100 dda eNVell tr ro"tNoa`"E hlorth2P'Itlioq VIA 01080 TvcSgts of Srrumural Plao pnarlU 413-587-1240 Fax 4 3-587-1272 IP otl Ete-Plans keit- rt. rct; 1 rbe 5¢zcie __ _ APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE CR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 .SITE INFORMATION 1.7 Property Address: m Thit ecuUn to Eel completed by office \� ( lv loge Ovetayt0 rc4 .' -Elul LDstrct� CRDstrct. SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.t Owner of Record: Ckti� toWt7c� \)11 Nose ferric Current Mailing Address: . •�--") q Telephone Signature 2.2 Author_ i eat N r-�� ost „" �c \ am �ISCrAk ` i S 1 _ CU:r91.Mainng Adtets- ‘ 9 Sion-arra Telephone LECTION 3 -ESTIMATED CONSTRUCTION COSTS ,Sem Estimated Cost(Doears}to be Official Use Only 4 completed by permit apphcent 1. Building (a) Building Permit Fee 2, Electrical ( (b) Estimated Total Cost of Construction from(E) J 3. Plumbing h Building Permit Fee n. Mechanical(HVAC) 5_ Etre Protection 1 E_ Total=(1 +2>3+4+6) This Section For OfficChel Num Use '71 l7� 'r 2'^'Sg �,Check Number70 Only Date Butrdina Permit Number: ivied: Signature _ aNJding Conunissicnerlrnspeeloc et Buil[ngs Date Erna,' LSection ¢. ZONING All information Must Be Coin pteted. Pa rmlt Can Be Denied Due To Incomplete Information Existing Proposed Requirediy Zoning This column to be filled in by Building Department Let See Frontage Setbacks Front --"- Side Rear -- Building Height Bldg-Square Footage r"" r-- % . Open Space Footage % (L tarea minus bldg&p v d .--- narlanA) #of Parsing Spaces --= Fill (volume&TamafiEnt — _. -- - - - — A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW ® YES O IF YES, date issueda IF YES: Was the permit recorded at the Registry of Deeds" NO 0 DONT KNOW YES 0 IF YES: enter Book Page I. and/or Document#. I B. Does the site contain a brook, body of water cr wetlands? NO 0 DONT KNOW YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained C , Date Issued: C. Do any signs exist on the property? YES 0 NO 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 IF YES, describe size, type and location' E Will the construction activity disturb(clearing, graces, excakation, ar sling)over l acre ori it pad of a common plan that will disturb overt acre? YES 0 NO SZ IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 6-DESCRIPTIOI1 OF PROPOSED WORK(check all acailcable) New House Addition fl Replacement Windows Alteration(s) I Roofong Or Doors 1 I Accessory Bidg r Demolition U New Signs 101 Decks [I Siding 1� Othe ) LI�SJ -h�[��� Bdef Description of Proposed WorkL " \Z� -2\— j \ �G��Vcj.t+ dt Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 5a If Flew house and oraddition 4o e;iistdrra Caousomas-cotmceVc-te tuhefoP9ow¢mq: a_ Use of building:One Family Two Family Other b. Number of rooms In each family unit: Number of Bathrooms c Is there a garage attached, d. Proposed Square footage of new construction. Dimensions e. Number of stories, Method of heating, Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Massoheck Energy Compliance form attached, h. Tyne of construction i. Is construction within 100 ftof wetlands? Yes No. Is construction within 100 yr floodplain _ Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT DR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize ) 1��\ to act on my behalf,in all matters relative to work authorized by this building permit application. Ste nature of Owner Date ���. O�rare �t��V as bestOwner/Authonzea myknwle and b hereby declare that the statements and :ocmafion on the foregoing application are true and accurate, to the best of my knowledge and belief Signed under the pains a ,d pEnaltes of perjur _ Pont Name " Stenah¢e of Owner/Agent Dale SECTlObs 8-CONSTRUCTION SERVICES 8.1 Licensed Construcion Sumervisor: /J"�-�\ Not Applicable E o� Name os License Homer: �u\�\ \ ^ _ \cpb License Number Addr `� Expiration Date uHs. i — — — Signature Telephone 9 P.edistered Home Improvement Contractor Not 4pplicable £ S'\ � ��--t�SJ\d'rrt \r� 'i1 \t S`V �J Company Na e Registration Nu her Address Expiraiio Date Telephone SECTION 10-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 E No E 1; - Home ®sones Exemptionn The current exemption for"homeowners"was extended to include Owner-occupied Dwellings 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 780. Sixth Edition Section 108.3.5.1. Definition of Homeowner Person(s)who awn 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 deached structures 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 he/she shall be responsible for all such work uerformed under the building permit. As acting Construction Supervisor your presence cn the job site will be required from time to tme,during and upon completion of the work for winch 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,vo a may be liable far 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 222 • h The C oT'i /bfr naztomveLfasse'e✓I sef.'S ehhe _ ,ei7Pt:rs,SePa.cj[✓tt strird Aeciderds 1 Office ofInc s`igadom.s ^t 0 Jt ,d.16o 00 °;ytn5;#1?s�'v s Street Becton, MA 02111 Workers' Compensation Lacaurance r.dasmi: .'9,si lriecs/ ,'rntrack®rs/Eleeilsnei2ns/Plumbers Applicant Information Pease]Print 7Legilorq Name (Business/Organizationtlndividual): <C City/State/Zipl� - c\c Phone #:- °\. Are you an employer? Check the appropriate box: Type of project(required): 1C.N I am a employer with \' 4. I am a general contractor and I employees (fall and/or part-time).* have hired the sub-contractors 6. Q New construction 2. 1 I am a sole proprietor or partner- listed on the attached sheet, 7. Remodeling shipand have no employees These sub-contractors have o. H Demolition wodang for in any capacity. employees and have workers' 9. [1 Building addition [No workers' comp. insurance comp. hrsnrance.t 5. n We are a corporation and its 10.H Electrical repairs or additions required.] 3.LJ I am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself [No workers' comp. right of exemption per MOL 12. Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' lOther v.5 comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. rHo meowners who submit thisoutside affidavit indicating they are doing all work and then hire contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have empioyees- if the sub-contractors have employees,they must provide their workers'comp.policy 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. Policy#or Self-ins. Lie.1:\i‘ Qy.<2...%��y .Gaxpuation Date:\—,�`�J� \ � ,�r b hob Site Address 446 ���.-.]A 1=- ' 'Jt, City/State/ZipV\C. I et'�c rE)(5--\ t`a$f" 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 MOL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well 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 DIA for insurance coverage verification. I do hereby certify rude • - --.'is ,- enalfie erjury that the information provided allove is true and correct. Sivnature: A\�3-'•��� Date: AK)— \\ \\Cr Phone #: ��-� 3°t Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City-fovea Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone ft: City Northampton Mo.ssochHoetks f 'F 1 &:NT 0. BUILDING 1 C Jt a r U 212 Street o Municipal ➢ _1oina ��5 . i Northampton, *MW OlobC INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER E ErvWTION ACKNOWL EDGEivmNT The State of Massachusetts allows the homeowner the right under 780CMP, 108.3.4 to act 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 person who constructs more than one home in a two- year period shall not be considered a home owner." The building 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 called to inspect work at various stages, which include foundation/footinas (before backfill). sonotube holes (before pour). a rouoh buildina inspection (before work is concealed), insulation inspection (if reauired) 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 occu©ancv until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing &gas)the homeowner will 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 building inspections necessary for the building permit issued to me. Date Address of work location 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 150A. Address of the work: g•-z. The debris will be transported by: �c` :\\ The debris will be received by: Building permit number: • Name of Permit Applicant \ -\ \` Date — ,1 \° .—.Signature of Permit Applicant 9;/S 7/6 949/3 Gurvls ammo 1P3m AW W oopspuno eW F AlgOolumu J!eW dgPsN+oo Aq yam P,W Yeo eeo o W AUFIsuudoeu sJewnoewou eta e!71 Ism IevoPIPPe ou Ifloloequm weepy'eW Aq'non eq 14M P.ueed m41 Vellum peu0!e a Wm PIRA A!uo e!wig s!'LL'Apedwd AW uo Nom uuol»d of pus INurd o7 B WRY GI l!ale9 Aw uo too o 'Oupeeu!Ou3 nal Jo;cpaqumgns pentapne ue OCIOS4UOCIMS) (esePDVd) • atm � r� 1.44, oN iscv 744/ `in " 'o-0 n ae mem ANedoid eW sono (seen Valeo goon-91 73-PS ! NRIOd NOLLYZWOH111V 2I3NMO w»•,eeentar•e�•, IP133NIENp > > I win elwasto es 3SIU Th\oCCPm-$•cilt%4 Property Address: Contractor Name: -S-V� Address: y A � '�� A / City. State: c-SWA-=-\ . �z� �\:%.* Phone: Property Owner Name: ----- -Address:- -- -- - - - --- City. State: `..N \� 1 � (contractor)attest and affirm that the budding 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 signatureC - Date \�