17d-051 (4) 98-100 STRAW AVE BP-2017-0679
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17D-051 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-2017-0679
ProjectJS-2017-001111
Est.Cost:$6422.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: URBAN & SONS INSULATION CO INC 101877
Lot Size(sq.ft.): 11282.04 Owner: MOLLOY JAMES F&KATHERINE R
zoning:URB(100)/ Applicant: URBAN & SONS INSULATION CO INC
AT: 98-100 STRAW AVE
Applicant Address: Phone: Insurance:
385 LIBERTY ST (413)732-3922 WC
SPRI NGFI ELDMA01104 ISSUED ON:11/15/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:EXTERI OR WALL INSULATION
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: OI: 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 11/15/20160:00:00 $65.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
116_(
- -... Pepartriertuseorly
Clop or Northampton eta ua of PErmn - -
r .Building Department Curb CuuDnveway Perms-
15 - i I 212 Main Street Se e/SenticAvallabt ty -
Room 100 Water/Welt AvaAablllt/
L ,-,,,Ns hl.RhemD'.on, MA 010E0 Tuo Seto af-Structural PanS=
"o' p::• 4. --587-1240 Fax 413-587-1272 Plot/Ste Pla�l -
Other Spemr
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR GEMOL'SH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1
Property Address,.
^ This section to be completed by once' `l
1 \'Cp S' \/ .1 .1/4\ft Lo: L-it
Zone Overlay District -I
Elm Bt .anct = CS District-
I
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Nlziling Address
moo\ ..--5
43 cs\ ;3\o
Si ture Telephone
9na
2.2 Auth orizeed Agent✓
��� tZt\y S .\-\ y x� S'
Name Print Current Mailing Address:
Signature ----tommiiii. Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
1 Item I Estimateo Cost(Dollars)to be Oficial Use Only
completed by permit applicant
1. Building � (a)Building Permit Fee
2. Electrical I ' (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee I
4. Mechanical(HVAC)
5. Fire Protection
6 Total=(1 +2 +3 +4+5) \) ).t.t-- -- LO , Check Number 77c/9 1
This Section For Official Use Only
Building Permit Number _ Date
Issued: C
Signatu ' S / //! 7
Building Commissioner/Inspector of Buildings Date
I/
i o
E pal ' a
et
Section 4. ZONING I AT Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning I
This cotumn to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front """—"" """—"'-1 —"'"
Side L R-- � L '.._ R I .�
Roar
I
Building Height I
Bldg. Square Footage
Open Space Footage _— %
(Lot area minus bldg&Paved
poking) _
d of Parking Spaces _ —
Fill. I _._
(volume&Location) .— __— ... ____ . r _.. .
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW 2 YES 0
IF YES, [ate issued:',
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW YES 0 I
IF YES: enter Book Page '.. and,'or Document rY
S. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW e YES 0
IF YES, has a permit. been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained 0 , Cate Issued.
C. Do any signs exist on the property? YES 0 NO E§
I
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(dear;rg grading, excavation, or filling)over t acre or is it part of a common plan
that will disturb over t acre YES 0 NO
IF YES,then a Northampton Storm Water Management Permit from the DEIN is required.
9
•
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aholicabie)
New House H Addition Replacement Windows Aieration(s) Roofing I
Or Doors C
Accessary Bldg. n Demolition New Signs ID] Decks I= Siang [DI Other[J
Enef Description of Proposed `` ..---**,, _'`` \\
Work: ZII \ \11 ✓1aSv 4- \ r>
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a If New house and or addition to existuna StoUshio. con]Ctatte the followina1
v� '.
a. Use of building :One Family \ Two Family Other
b. Number of rooms In each family unit Number of Bathrooms
C. Is there a garace attached?
d- Proposed Square footage of new construction. 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? Yes No- Is construction within 100 yr. Poodplain 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 OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject
property \\(�� ` `` `\ A
hereby authorize \�\ � ± c �` `yj V1}-��\
to act on my behalf, in all matters relative to work authorized by this buildingYpermit apoilcation.
\\ — CI-- \ \n
Signature of f Owner �S y'q r�, ,q� !-. Date
W rt-.r N K»11 i.-tLk4' '')rx t hifire K? '3A`S.t'f.w'f3 i*
0 t—ice \---. V\ as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Sionej under the paircilaed genet° of opt
Print Name \�
.-�! ftlek. � oats \-- 9 — \�
Signature of Owner/Agent
SECTION$-CONSTRUCTION SERVICES
S 1 Licensed Can tructicn Supervisor: „so-•+ Not Applicable £
Name ;mesa Holder fly". h , 1 1T-\' ,
license Vumber
Z%-pc
`l--ac3sza. '> -- sly
Jreiration Date
Signature Telephone
9.Ren'nPnred Homelmnrovement Contractor � Not Applicable F
. s al 7) \0
Compare Name egi traiaon Number
--s ST __- 42 �� C
Address Expiration Date
ielepione
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G L.c.152.§25C(5))
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 YesCbZ. E No f
, ; - Home ®a raex xeS HTDfLO
The current exemption for homeowners"•was extended to include Owner-occupied Dwell/nes of one(1) or two(2) famai s
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acs
as supervisor-CMR 980, Sixth Edition Section 103-2.5.1.
Definition of 7domeowuer: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 rv.o family dwelling,attached or detached structures accessory to such use and/or fann
smactnres.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,en n form acceptable to the Building Official.that lielshe shall be
responsible for all such work nerformed under the builyline[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 ofEmployers to
Employees for int es 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 Annotateed.
Homeowner Signature!„
',.. The f't;w:mer;rtarealtdt (y h§%a:ssac nese .s
Tip mA 0jr Thd001.0ial a c'.ide.010
Int h� �.�d G¢ oj p✓a m,un 6"✓.Db¢r
� 1'' 6001„ ✓inggonSize_d
1 R :.,;' &stony MA 02111
Workers' Company-tarn Lox llnnice A11rdlaavit, iRra:lyers/0'useiesa 4c,rs/:'d➢e Qroxfiaars/;D]wmafoanra
Applicant Infform int don name Tait Le:ai sly
Name(Business/Or nizatiorJtu3ividuaO: ' !t►; t-� L tiN`j"'1\ ...
Address:htg---S L—_,S-3hay 157-
City/Statel7zp6 Sit � Ar Phone fl p
Are you an employer? Check the appropriate box: Type of project (r „_
1. I am a employer With
N�. 4. H I am a general contractor and I ° p (required):
employees (fuel and/or part-time).*
have hired the sub-contractors 6. ,,,]New construction
2.7 I am a sole proprietor or partner- listed on the attached sheet, I. _ ;Remodeling
ship and have no employees These sub-contractors have o. Li Demolition.
working for me in any capacity. employees and have workers'
t came.insurancet 9. ( Building addition
[No workers' comp. v'.tsurance
required.] 5. El We etre a Corporation and its 10.-3 Electrical repairs or additions
3. — I am a homeowner doing,all work officers have exercised their 11._ Plumbing repairs or additions
myself [No workers' ci,unp. right of exemption per MGL 12. Roof repairs
insurance required.] t c. 152, §I(4), and we have no �..
employees. [Noworkers' 13. Other .
comp. insurance required.]
*Any applicant that ohecics box#1 must also fill out The section below showing their workers'compensation policy information.
tln meowners who submit this affidavit indicating they are doing all work and thenhire outside contractors must submit a new affidavit indicating such.
tCoe raetors that check this box mint attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employees. If the sub-emu-actors have employees,they mustprovide 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: \'''•55...‘"N‘Ct_
Policy#or Self-ins. Liu #:N4N52z 517( QGL+.S,,,, -0Ait.1 N Expiration Date\ \I CI 1 1
Job Site Address' 5 vy S rRtJ\IN.] Cit'y/State/Zip:: .A L " $
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 MGL 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.
Ido hereby certift undera Rieso'rfnr that the irrltirmafioDn a provided istrue and`correct.
Signature:
Phone#: , 6-2
_
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/Town Clerk 4.Electrical Inspector 5. Plumbing inspector
6,Other
Contact Person:, Phone _
Ci s.y at ticattitamp tan
f �, < .
tird-� /.'s
Massachusetts ?
212 :Bain Streeta Municised P _ldm5Biilk, J
derthamotrid 2BA 01062 'Ps
INSPECToii
Locals Hasbrouck Chuck Miller
Building Commissioner As&.ant Commissioner
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 708.3.4 to act as his/he:
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 percents)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 regula€ions_ The inspection
process requires that the building department be called to inspect work at various stages, which include
foundation/footings (before backfill), sonotube holes (before pour), a rough building inspection
(before work is concealed), insulation inspection (if required) and a final buildinn 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 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 1
1, 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:
The debris will be transported by:
The debris will be received by:
Building permit number:
Name of Permit Applicant
Date Signature of Permit Applicant
r
RISEso Shawmat Road,Unit 21 Canton,MA 02021 13396024335
ENGINEERING vninv.RISEenginearittg.com
OWNER AUTHORIZATION FORM
I, Gregory Schweitzer
(Owners Name)
owner of the property located at
98 Straw Avenue
(Property address)
Florence, MA 01062
(Property Address)
hereby authorize V Vl1Ska% j,.-eM��, � --p� 'CJV'"1C
(Subcontractor)
an authorized subcontractor for RISE Engineering,to ad on my behalf to obtain a building
pent and to pa twin work on my • ,..- wearrs only with a signed contract.
dief
Owner's Signature
10/16/16
Date
Property Address: g$ \ S—Crkl:AN\ 1J
Contractor t �l
Name: ��� �� `h\ S S \ qi\'0
Address: -- T .\[ \\
city, state: AIN) 'C)
Phone:
Property
Ty Owner c
Name: a� G S9 4
---Addrr3ss:--
cxr,
State: k'1— Ck
\\ (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.
Contractor signs ..
Date \�