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35-077 (14) 842 RYAN RD BP-2017-0764 GIS#: COMMONWEALTH OF MASSACHUSETTS Man:Block: 35-077 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGLLcc.1144/2�A) Category:INSULATION BUILDING PERMIT Permit BP-2017-0764 Project# JS-2017-001276 Est.Cost:$1300.00 Fee:$55.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: use Group: DONALD PELLETIER 101876 Lot Size(sq.ft.): 19906.92 Owner: GEHA THOMAS Zoning: Applicant: DONALD PELLETIER AT: 842 RYAN RD Applicant Address: Phone: Insurance: P O BOX 5020 (413) 538-6002 WC HOLYOKEMA01041 ISSUED ON:12/12/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:KNEE WALL 2" POLYISCO RIM JOIST 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: FeeType: Date Paid: Amount: Building 12/12/2016 0:00:00 $55.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-0764 APPLICANT/CONTACT PERSON DONALD PELLETIER ADDRESS/PHONE P O BOX 5020 HOLYOKE (413)538-6002 PROPERTY LOCATION 842 RYAN RD MAP 35 PARCEL 077 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT / Fee Paid C Building Permit Filled out Fee Paid TyoeofConstruction: KNEE WALL 2" POLYISCO RIM JOIST New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 101876 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 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 i) Bon 13 m //1a/..,y ' Signature of Building 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. • Depamtent use only City of Northampton SBO S al permit nt r" Building Department Curb Cuebivesey Permit h1' 212 Main Sheet Sewer/Sepik Availability c / ;� Room 100 wemnwel Magadan/ / Northampton, MA 01060 Two Seta of Structural Plans_.. \ phone 413-587-1240 Fax 413-587-1272 Pln7Pine stbi Ple `v; 'v Omer Speedy.111111F ' Tlpl TO C RISTR11CT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION 1.1 ProbMr Aridness: TMs section m competed be cometed by office Nap Lot Unit Zone Overlay District ._ (Th 2 C . Elem SI.DI rt ce District SECTION 2-PROPERTY OWNERSISPIAUTHORIZED AGENT 21 Oeef.al Rscad: C' \ Rn OKti.GS -c -c� _ `t Tr�T t q(1 SQcj . Nene(Print) • tJr \MsP E t i C)e d o r I o a9-/s Te",„,„ Signature UM/NSW—An - - � A\d W \ l\e-k er t o o l vv—G \ n kt- . (P^ml Current Metre Addams: )rvn 0_b 1 _C Co }- S 3S 6( ;>°---2-- Signalise Tetplys SECTION 3-ESTIMATED CONSTRt1Cf10N COSTS -- Iten Estimated Cost(Dollars)to be Official Use Only completed by Ponca applicant 1. &MWirg (a)Boning Pemit Fee 2 Inimical �..— (b)Estimated Total Cost ofo-uu .—..�\�\ r-) .__ Canson awn(e) �IJCJ 3. Plumbing Behring Permit Fee 4 Mechanical(INAC) b. Sae Protnpon -qi'AS 1Y�m 1 & total=(1 +2+3.4+5) Slit JJ ,O (/J Check Number Lir / /O 4/55 TIW Section For OMNI Use Only Date Building Permit Nunber, see auld g Cammink t nrNar of&aldrvs Once SECTIONS-DESCFIPTIO/1 OF PROPOSED WORK Ionia ill tadic.Ns Mn • MMasa ❑ Addition ❑ Or Doolim Windows Albelatforl(a) 1±1-1 Roofingnf[,;lrg /' Or Doan ' Accessory Bldg. 0 Demolition ❑ Mew Signs ICO Decks [fl Sidingp[CJ Other WaiiltDesaiPtron Prnpaeed knP4 to n k 3,` h \Poly ISO `I? I w. TO tsk Alteration of misting bedroom__Yes_No Adding new bedroom Yes No Attached Narrative Renovating unhnislle0 basement Yet No Plans Attached Roll -Sheet Is If New house and or addition to existing housing.complete Me following a. Use of building:One Family Two Family Other b. Number of mans in each family unit Number of Bathrooms c Is mere a garage attached? d. Proposed Square footage of few amsmrlion.. Dimensions e. Number of stories? I. Method of heating? Fireplaces or Woodslaves Number of each g. Energy Conservation Compliance. Masscheck Energy Complierform attached? h. Type of construction i. Is cawtrumon within 103 R.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No J. Depth of basement or cellar floor below enished grade k. Will building conform to be Building and Zoning regulations? Yea 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 PERIM —F- \ (y, I, \ O ,rS 6 '�- �^` as Owns W the subject W _oOenY `` hereby eahhaue I—) a\"(S_ lCJJo to act on m n mattersrelative to Walt arter� de d by s building pemnit appfaabon. S Srel'CInc � ar. Iar aG- 1 . of Darer ^n ogle 1, 'r V `u \N w eC es O..nM/AWhorw:d Agent hereby derive that the emtencrta and kdametion on the ion goirg application are true and aaairate,to the best of my knowledge and belief. Signed under the pains and penalties of PeiMY. ✓ 7crAW _ (AJ i IIetle ( Signalise of Omer/Agent Daly Secti i 4. ZONING NI Information Mat be Compered.Permit Can Be Dented Cue To Irmmplete Intonmlion Existing Proposed Required by Zoning The miwan to tc filled in by Building Names Lot Size Frontage Setbacks Ensit R.: I Building Height Bldg.Square Footage sb Open Space Footage % (W ear mune bids a paned Mina/ x of Parking Spaces Fill: (rot ac&la rim) . A. Has a Special Permit/Variance/Finding ever been issued for/on the site? HO O DONT KNOW O Y6 O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O Y6 O IF YES: enter Book Page and/or Document B. Does the site Contain a brook, body of water or wetlands? NO O DONT KNOW O Y6 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date issued: C. Do any signs exist on the property? Y6 0 NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or oddities*of signs intended for the property? Y6 © NO O IF Y6, describe size, type and kation: E V11B the construction atbvity disturb r ing,Brading,excavation,a fins filling)over 1 acre or is it pert pof a common plan that will& erb over 1 Bae? YES NO O IF YES,then a Northampton Storm Wale Management Permit Iran the DPW Is required. 05/04/2016 11:40 14135071272 NTON BLD DEPT PAGE 01/01 City of Northampton t , IsasaacbuwtG .11 ei o212Ml1a S Q wr) nsc INSPECTIONS f \. .. - 212 Male Street . MWc>020 Building ,�' yortbabsptent, Mk 40 alii7ardr Property Address: " 6 c7 I2-\-i cAr\ ?_•d • Contractor Name: ^ � Address. ) \ O J ccC& i (-) t�, City. State: I V a 11/41 P-x_ cek • Phone: S 3Z\6 DL) (;--- Property Owner ---- Name: \ `^(D ry-O , -E. v Address: C;54a 2y C4 (- Rd • City, State: E— k t yp> C v° 0^4 t, l>aina Vd u)Pe k)e-1- i e ((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 Amer with a copy of this affidavit Contractor signature i rmoke , ) / /C V\--5----. Date 2-_�— ( 6 lVY Affidavit far Home L..... - .b caner.Parma Ap*i'aaia rot as Us Only Peal N. De B.a.impreawN Oessr.LPs Iia coyc '-( sgplea a rant Appiratia \M8, l IAGL c.11]A w*i.a art r. ,. v_lalir b d..y raped anis,wilt anis am.pr..+Wag..ilb aa.TSI+ . Adis float ova Z in 943,_ . over Nay' ( y\o rna. ._CQ itP _ Devat IndAmen ,T-- a- / _. 1 rwy pally! p.d.rd_floc wild Or r hisrdwg ww.rc.k Wick=del by r. _iii p� bwr _afwD ii0 I) 01iiSC ?) ) -Lr1>1/41`r±IDV"- Nubby a Iwip si.a rt OWNERS PULLING 11E3Yt OWN MOM OR DEA1110 WITH taeroermllD aONIRACTORB POR AnucAEIE HaS BellOYEBIENT fl&DO NUT HAVE AOCEIN TO TI ARBITRATION PROGRAM OR GUARANTY nRU UNDER MOI,c ICA Sawed ver moll=d_____ 1Iw r 4 argaiba r♦wdr 1 Oa Cimw tit R.♦Ywdw N.. Notweemag V Wow as,I re err R...sdl w t.ewe of Is above astir Dir _ - Owe ib.P■ g r..J ._ cM CERTIFICATE OF LIABILITY INSURANCE DAMS 1018 - 71ES O'ER KATE W WOAD AS A MOM OF WPOMATMI ONLY AND CONFERS NO ROOMS UPON ME CERTIFICATE HOWIE THE CFIR.7CATE DOES NOT ARrERATWE.Y OR IEGIA1WfY ANBD. EXTEND OR AUNT TIE COVERAGE AFFORDED St TUE POLICIA MOW. 71AA CE EFICATE OF tM1 MICE DOM NOT OONAIYIVTE A CONTRACT SETYYEEN THE ISSUING INSURERS AMTIONZED#SINWdRATIVE OR PROOOCEI,AID TME EERTW LATE MOLDER. MPCRTANT: W the C11110.011.MAW AOIRIONAL MIMED.the F°EH'P{N met Is_lost REJIROOATION IS WANED. MST IN Ile Ins MI mils NM Nam_tS P_—.__ T._ Jn.al.Ida.mMt A M__Pa.*MBE emlleala dos not aPMYdpMtb Wa mioe WPM %WDM et atM adaY{MR(ij. mown __,. .. winKr _....- _.. .._ MSM INTER LL EN wrt NEW oPAa BHVEROAD R ROAD [u�,.cwaw aown .__.._.._ .�.— EAST LONGEADOW.MA O10 JIBIROINSIMFORIEM6ncv.9WN ...wits a� O A:N£wencv EwrlMrfR ratMO —..— IRLRC 11010116es: PSE E�2 OSA I ETIONND O {MIAs t: PG —.._. IETER INSULAR/ON ARON 1107 MAIN ST HOLYOKE,MA 01010 NMAEtE: W IND F: GC NEAAEIES ATE ISS* MMES.MASER TIES IS TO t$tTFY THAT THE POUCES ES OF SEMRAM£LISTED BELOW HAVE PEEN SSIJED TO THE INSURED NAMED ABOVE FOR TME POLICY POO[O INDICATE NOMTINSTMEN3 ANY RECKAREMENT. TERM OR CONornoN OF ANY CONTRACT OR OTHER DOQA1ENT WITH RESPECT TO WICI INC CERRRCATE MAY DE MEMO OR MAY PETTAN. THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HERE* IS SUBJECT TO N1 THE 'LBWS. E%CLUS/ONS AND COEDITORS OF SUM FUMES.RANTTSSSSHINN MAY HAVE SERI REDEEM NY PAID CLAYS. IAIM IOULT NW P t!O LTA TYPE Of MNaWCE IR Ply NR%TMMM9 MNWaWYY1 OppAY}yH. MON 430MIAL MINIUM E IaalmeG c (aaaV.}Y IM.LM 11Y (nY{afY°IBITtD $ -la ADwilliatv — Ip61K NiaaWaTF c GE WL NX.£wiI LIST APPLES PEA PACOUCT -COMPOPKU PE N _ Loc _AIDNOINN wan ... anxf riff ANY MOO KQY SMART PaPep —Namato — :=tko BODILY WOW pier rwerq HOW ALTOS ponce ffintElltr..CE _...- mPa.Ata. OCCUR _A_,atcasac¢ Era UM 6M.ilaOF .lnv�xre ' MOI i OIETENTIONs _.. NN/MNOEEii3NNRT a tCaY Si oswoNweMPT�F>mlioAm nRAMEM 07-25-2016 °I-754017 u.alolAc�an tbOS.000 y Nw.www ww 911D0019 61.°MrN.-EAac+aala 0800,000 at..Ai aNam EL omFAce-SOUCY WI S500800 01.1101.1.11110F 0•1040101011,wawa mecum ymsSa.wr.rr.rwYmplarArr•wpmvo mods* -_ TME WORE03t8"COIPEGATTON POLICY GOES NOT PROVIDE COVERAGE MR PELLET/ER DONALD CMICEUAROM OCANNOA PATRNOAPEt.i.EIIER SHOULD ANY OF THE move DLA POLICES 1E 1107 MAW sr GAVELLED LBEFORE THE EXPIRATION DATE THEREOF, NOI.YOIE.W 01010 NOTICE WEL SE DEANE® N THE ACCORDANCE WITH E NWTPROWaOTW. ANIII.BP NMIO*tATIvE � JOHN S WIG Plwbwa . ACOED 2Spone) TMM ACORD nw ad lOyo s MM__.4 mksswam;� __ The Commonwealth of Massachusetts Department of industrial Accidents i� -_.-- Office of Investigations l.4 600 Washington Street -. >- . Boston,MA 02111 www.mass.govldia Workers' Compensation Insurance Affidavit; BuitdcrstContractorslEleetricians/Plumbers Applicant information t i Please Print Legibly Name tousimsgriagan;nuoNtndividual): t^cr- 111; ` t e Address: 144,3 $1.)fb\ City/State/Zi.: •_01l 6 Phone a: (41 S36OZ) ? Are you an employer?Check the appropriate box: �," ' f 4. I am a general contractor and I Type of project(required): Lly[lamoyees( di withy ❑ employees(full andior pan-time).* have hired the sub-contractors 6. Q New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition waiting for me in any capacity, employees and have workers' 9. 08uilding addition [No workers comp. insurance comp.brsurance. required.) 5. ❑ We are a corporation and its i0.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself.[No waiters'comp- right of exemption per MGL 12.QRoo pairs insurance required.]' c. tit.§1(4),and we have no employees.(No workers' 13. r—__�__..... comp.insurance required.] 'Any applicant That checks boa p I muse also till out the snetroa below showing Keit workers uompensaipn polies information. 'Nomeownen sine sdtmit avis endavil iatha*g they arc doing all work and then hire«aside;isometrics mica submit a new affidavit indicating Such. K'omractws that cheek this kw muse anaked an additional sheet showing Ow name of the suarina acmrs and sate whetMor not those entities have employees. If the sulsvmntracmn have employees they must provide their workers'comp.poivy number. I ant an employer that Is providing workers'compensation Insurance for my employees Below a the policy and job site information. ((�� } Insurance Company Name: r1 C e p'f�1 i11 eft-i C le7t.,p Policy*or Self-ins Lie.a:( ,le^S� di.,/7/��{Ulq'1-33((3__9��.1 i Expiration thre':��_ _S ,,/�a17 lob Site Address: .'y�J c7 -rias\ ',It.f`• City/Stttee/Zip_tvostN..Le � Attach a copy of the workers'compensation licy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGI c. 152 can lead to the imposition of criminal penalties of a fine up to 61.500.00 andior 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. /do hereby r�een1dfy ander the �pains (and penatfes of perjury that the information provided above is nae and coned.J _ Signature:(/oU MCCIKJ._cl,)�j7'1, ,nom DatS- - .._ r / 6 Phone aC7l( S3 56W-D t eio/satmdv. Do not write in this area,to becalm:deted by city or town ofciai City or Town: ___ _ Permit/Licensea Issuing Authority: Building Department j Contact Person: C?-he �pomurnonweah latadi6aCkideia N' ' Office of Consumer Affairs and Business Regulation y_ 0 10 Park Plaza - Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 150319 Type: Individual Expiration 3242018 Tit 419291 DONALD PELLETIER DONALD PELLETIER 1107 MAIN ST HOLYOKE, MA 01040 -- Update Address and return aird.Mark reason for change. scnr G .05/11 ^ Address ri Renewal 0 Employment 0 Lost Card lip, MassachusettsDepartment of Public Safety -- Board of Building Regulations and Standards License: C85L-1011376 ConstructionnSpecialty Specialty DONALD INPELLEItR 1107 MAIN STREET a 1 HOLYOKE MA 01/040 r---i CA_:— Expiration: Commissioner 10/082018 Permit Authorization I mass saver • Form E:tT Site ID: . 50239904 • Customer: - Thomas Geha I, Thomas Geha ,owner of the property located at: - t0 nwt Name,minted) _ - 842 Ryan Rd - - Florence (Provenyatreetnddress) ICM) 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 Signature: t /Q Date: /7 Vie 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 . • • CIEAansul[ • SOWashington Street,Suite 3090 • Westborough,M,103583 . 3800-180-]4]2 For Otte Use Only Rev.702025 _