31A-175 32 MAYNARD RD BP-2016-1205
GIS a: COMMONWEALTH OF MASSACHUSETTS
Map:Block:31A- 175 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-2016-1205
Project JS-2016-002072
Est.Cost:$3043.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Coast.Class: Contractor: License:
Ise Grou :_ JOHN PERRIER 105319
Lot Size(sq. h.): 7492.32 Owner: WELCH EDWARD J JR
longe:URl'tf i0011 Applicant: JOHN PERRIER
AT: 32 MAYNARD RD
Applicant Address: Phone: Insurance:
18 BROADWAY POND RD (860)930-7794 WC
STAFFORD SPRINGSCT06076 ISSUED ON:1/4/20170:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL ATTIC 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: 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 1/4/20170:00:00 $65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Filed BP-2016-1205
APPLICANT/CONTACT PERSON JOHN PERRIER
ADDRESS/PHONE 18 BROADWAY POND RD STAFFORD SPRINGS06076(860)930-7794
PROPERTY LOCATION 32 MAYNARD RD
MAP 3IA PARCEL 175 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT '�r., / 1O/
Fee Paid �7
Buildirm Permit Filled out
Fee Paid
Tv e f Cpnstruction: INSTALL ATTIC INSULATION
New Construction
Non Stmctural interior renovations
Addition to Existing
Accessory Stmcture
Building Plans Included;
Owner/Statement or License 105319 q
3 sets of Plans I Plot Plan � C c c. t lq d J
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOR ATION 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
N Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Depen ,la
r
/2/-71
Signature of Building O cml 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 oilier 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.
FieCiz/VCt)
APR 14 2016 /0My(,ntyU
1 The Commonwealth of Massachusetts
Ryj 1— -
� -- Board of Building Regulations and Standards FOR
Massachusetts State Building Code,780 CMR MUNICIPALITY
USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied: _ --
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
' 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
1.1a Is this an accepted street?yes no ' Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone:_ Checke Flood Zone? Municipal 0 On site disposal system 0
if yes0
SECTION 2: PROPERTY OWNERSHIP'
2.I�sy‘.04/4
e(i2 e ,
1 /� ,L'�G/Z _ 2 this of yr , iii Iii '1
Name( rint) ,State,ZIP
3,q a� id qi - y- 33a3
No.an Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units I Other 0 Specify:
Brief Description of Proposed W ork2:
To Add R-38 Insulation to open attic
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: I Official Use Only
(Labor and Materials)
1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) $ Total All Fees:$ (e
Check No. 977heck Amount: Cash Amount:
6.Total Project Cost: $ 20 I/A /Y) ❑paid in Full 0 Outstanding Balance Due:
NEGH It/
28 Spellman rd
Please Submit Stafford Springs,Ct
Permits to: 06076
SECTIONS: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
John Perrier 105319 12-12-2015
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)_I
18 Bradway Pond rd _
Type Description
Na,and Street U Unrestricted(Buildings up to 35,000 cu,ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
Stafford Springs Ct 06076 WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
860-930-7794_ Jperrier06076@yahao.com
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
MC Company Name or HIC Registrant Name 173021 8-27-2016
John Perrier HIC Registration Number Expiration Date •
No.and Street
18 Bradway Pond rd jperriEmail 6ddress tom
Stafford Springs,Ct.06076
Email address
City/Town,State,ZIP Telephone 860-9307794
SECTION 6: 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 , No ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize New England Green Homes to act on my behalf,in all matters
relative to work authorized by this building permit application.
John Perrier
3/31 /2016
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in,this application is true and accurate to the best of my knowledge and understanding.
Lynn Ford
3/3//2016
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program), will nor have access to the arbitration
program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dos •
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basemenUattics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of hal£/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
A The Commonwealth ofMassachaseas I Print Form
�, l 9 Department ofInds:trialAcc dents
� A __ ; Office ofInvesttgattons
a�'r`_: 1 Congress Smser,Suite IDD
„. Boston,MA 02114.2917
www matgovfdia
Workers'Compensation Insurance Affidavit: Ruttders/Contracton/EleetriciandPiumbers
AnyReant Information Flew Print Legibly
Name ween uthem ranowtemee ey New England Green Homes
Address:IS BradwaY Pond rd
City/State/Zip:Stafford$punas CI Phone#:06076
Are you an employer?Check the appropriate box: 'type of project.(required):
1.6 I oras cmph yu with 4 4. 01 am a general contractor and J
employees(IVO and/or pan timmeek. have hired the sub-cou!ractore e. 0 New oomtruction
2.0 i am a sole propitetor of partner. listed on the attached sheet. 7. 0 Remodeling
ship and ban no employees These subcontractors have g, 0 Demolition
working for me is any capacity. employe and ban workers'
{No worsen'comp.instance camp.insurances 9. ❑Building addition
required.) 5.0 We arc a corporation end its 10.0 Ekctrical repairs or additions
ID I am a homeowner doing all work officers have exercised their 11.0 Plumbing remain or additions
myself.(No wanton'comp. right of exemption per MOL 12.0 Roof repairs
ineutwce required.]1 C. 152,§1(4).end we have no Inauleaon
employees.[No workers' 13 0 Other
comp. insUrenc0 required.]
•Anyappifrat eat Oak.lex al mx
uaim nn ore ms section below slowing their worker.'compensation pocky information
Homeoween whose:mit thh amdavitisdiesting they are doing ell work end then hire amide mouton mutt/Omit a new amdsvlr laillestiog soda
bometera tett check this box, at etnchad an additions!that Mewls:the stmt of Lb.mb'metna'en and area whether or not dice mails Mw
empkrw. 1(1k eu6mmncmn Mn empkyser,they aunt pmvke gait w«aore c v p.policy amber.
lam es saepfuyer that isprawdtng workers'compensation hence for my employer. Below ls tee policy and job site
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Job She Address:All S!reste In City(StatesZip: , 0 "4 ..,Jt ' M�0/0 bO
Anglo a copy of the warden'compensation poncy declaration page(showing the policy number sod a It bunion date),
Pathan to occua covnagel AS required Under Saltine 25A of MGL c. 152 can teed to the Imposition of criminal penalties ohs
fine up to$1,500.00 andior one-year imptiSonment,.e wo71 ere civil penalties in the form of a STOP WORK OFD8R Ando Pone
ofup to 3250.00 a day against the violator. Be advlsed that a copy of this statement may be forwarded to the Office at
Investigations of the DIA for insurance coverage verification.
I do nemb cern, Harr the "aina and. stat- .s o , a thanks . nylon provided above fs true and sorrect
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