The URL can be used to link to this page

24D-307 (6) 18 HILLSIDE RD BP-2017-1128 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24D-307 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-2017-1128 Project# JS-2017-001914 Est. Cost: $3000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: PAUL SCHMIDT 103635 Lot Size(sq. ft.): 21257.28 Owner: BROWN HENRY Zoning: URA(l00)/ Applicant: PAUL SCHMIDT AT: 18 HILLSIDE RD Applicant Address: Phone: Insurance: 24 CHESTNUT ST (413) 247-5739 WC HATFIELDMA01038 ISSUED ON:4/I0/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:INSULATE 1632 SQ FT, EXTERIOR WALLS, CLAPBOARD SIDED 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 4/10/2017 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File 4 BP-2017-1128 APPLICANT/CONTACT PERSON PAUL SCHMIDT ADDRESS/PHONE 24 CHESTNUT ST HATFIELD (413)247-5739 PROPERTY LOCATION IS HILLSIDE RD MAP 24D PARCEL 307 001 ZONE URA(I00E THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUTb. / Fee Paid (yl-tel• Building Permit Filled out Fee Paid lypeof Construction: INSULATE 1632 SO FT,EXTERIOR WALLS,CLAPBOARD SIDED New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 103635 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOJMATION PRESENTED: Approved 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 c, De .y / Signat� - u Bui mi. Date 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. \ 11oZ ! - adtl city yoofyNoorthemgtoonLaMy L---- 212 Main Street - Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 1.1 prooaetrA_._c ": S•` 1-11/tS, -1 a '� iVul \am '/0, MK} Otaco C 418,t7iLL4F ,.l 02 30'7 sa- ; ,,/ ? 1A'1 o Nme 14131: ae.aMangAddeo'.9).3• �37 //(cc. (--Va i�d T 77 arta asatialdtafft slit -Srv,papi tor* n- - uI rn t cg LI Cho�r,�a-f S- -tn�t;e18 Ma ro(PriN) Current Man)Mows: ✓"‘� y i1- (RE17-5739 Telephone Kern Estimated Cost(D )to be ccn* eo by Pont aoPScant ,. sem "SI 2. Electrical — 1 .- - 3. Plumbing ... .:. a. Mechanical(HVAC) 5.Fire Pro(BNon eased seed _.;Ta"e„,C,S1:3;44: ,.-.,g'. PSA..-..- Section 4. ZONING All Information Haat Be Completed.Permit Can Be Honied Due Ta Incomplete Information Existing Proposed Required by Zoning Ibis cohm=to be filled in by Bwidnglkpvmaa Lot Size Frontage Setbacks Frons _ ___ . _.__. ___ —.. Side Building Height .—_._ ._..__. . _ Bldg.Square Footage OpenSpaceFootage ([upon mimabkg&Feud _. I_....' _ _ --_ Puking) __�. #of Parking Spaces FDL (vo3ane do Location) A. Has a Special Permit/Variance/Finds been issued for/on the site? NO 0 DONT KNOW YES 0 IF YES,date issue&, IF YES: Was the permit recorded at the Regi ry of Deeds? NO 0 DONT KNOW YES 0 IF YES: enter Book Page and/or Document X B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW elf YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date issued: C. Do any signs exist on the property? YES O NO IF YES,describe size,type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES © NO (9 IF YES,describe size,type and Vocation: E. Will the construction acbvily disturb(clewing grading,/�� aa'" or hPalg)over 1 acre or is it part of a common plan that wig disturb over 1 alae? YES Q NO 4.+ IF YES,then a Northampton Storm Water Management Permit from the DPW is required SECTIONS-DESCRIPTION OFPROPOSEDWOR kemokall aaNpble) New Home ❑ Ado 0 Or Doors ort Windows Atn&n(s) ❑ Rooting ❑ El Accessory Bldg. ❑ Demolition El New Slee IOD] Decks [Q Siding i+) Other(4 Briat Desaq>iian of Proposed/(93,Z s - Ex- o - i.LJa i[ s cia_eboetrcs Work Alteration of existing bedroom_Yes ✓ No Adding new bedroom Yes �No Attached Narrative Renovating unfinished basement Yes No Plans Attached Rag -Sheet 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 a Ntmt&of stories? f. Method of heating Fireplaces or Waodaoves Number of each g. Energy Corhsavedon CompNence. - Ma schedc Energy Compliance farm attached? h. Type of construction i. Is construction within 1W ft of wetlands?_Yes _No. Is construction within 100 yr. floodplain_Yes No i. Depth of basement cellar flop below finished grade k Mil building codon to the Budding and Zoning regulations? Yes No. I. Septic Tank_ City Sewer_ Private well City water Supply SECTION7s-t 71N1ERAUTIONSSATION TO13ECONINEED Ma OVESE MOE DROOKTFECTORAPPUESIrcereuteltesessmorr I, as Owner of the subject Property `� hereby authorize 5)1._. —�tSYiRpmJeArenf �� fl4M,+LS,�iC� - to act on my behalf,in all matters relative to by this building pent application. I, Pati S!k at th"+ as Owner/NNorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my kniusAbdee and belief. /Signed under the pain`s and penalties of perjury. Sint &1• s� _ _.Jl s...._ _. Not Applliicablelh�❑ Nanao YMifilan Flotdar a. . — cense �, 2/ITrtl�"l'fCl� uNumber sI_ as _ 1q ow : _ 4 Am m/ a4-1 6 Expiration Date : nature - TelepMne -- - . Not Applicable ❑ Cmttoev Nne Registration Number 24 P,hp t5+r� - ca '7' otExpiration9 ' I p ITr.1--"-4G(d t mf} 0! 038/ TelephonWy).rag75V3 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 build, permit Signed Affidavit Attached Yes No 0 The current exemption for"homeowners"was extended to include Owner-occupied Dwdpaaa of one(I) 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 sets as supervisor.Gird[781. Sia4 Edition Section 11&3.5.1. Definition of Homeowuer: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 two family dwelling,attached or detached structures accessory to such use and/or farm structures.A Demon wire constructs more than one borne 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 helshe shall be resooasile for all anal work oerformed.der tee.building permit As acting Copirnetion.S,ervbor you 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,you may he 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 itinrY Ibileaanntts saaaae.aar Q aa =11 WOOS zu Nola .art . rNorwu a.•••".a Norelnspea, a 01060 Prom"Addnon: /s -4l/s/cc. fComforter .c1 tlrn Sh . �tn pmfem-errl• rr,rr}rarfivcs ,T1e, • Ada.. r 4;91.1 ( CJ- sl-nu.+- SI-see* ay, Stals t7Car ic.ld Mt4 LetaltcY Pham )113• a47-57.39 NenvePe•.•a oras -/-k y / Address i /l Si e-i sly, Simla AUl n � ) 1 r4 O i C Li i, PftLj 5r�tr,idd- (cr+eme). of rd darn lar tfm itddI rt I blond to Moder der not Wan ant Mori ridtie)ring"nthe armee tob.batdabdanent*1her poNded the p only owner et•copy ettdaalidart • RISE60 Shawmut Road,Unit 2 Canton,MA 02021 1339-502-6335 ENGINEERING" www.RlSEengineering.com OWNER AUTHORIZATION FORM Henry Brown (Owner's Name) owner of the properly located at: 18 Hillside Rd (Property Address) Northampton , MA 01060 (Property Address) hereby authorize S (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. This form is only valid with a signed contract. Ther Permit will be secured by the insulation contractor, at no additional cost. It is the homeowner's responsibility to close out this permit by contacting their municipality at the completion of this work. Lc�y Owners Signature 2-17-2017 Date /72&? ues I- S!� L ��-- 6.20f6 • The Commonwealth of Massachusetts Department of Industrial Accidents 21- Ofce of Investigations oc 600 Washington Street 3 _, ,c; Boston, MA 02111 liar hscT www.mass.gov/did Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name{Business organisation mein]iduall: SDL Home Improvement Contractors, Inc Address: 24 Chestnut Street CiridState/Zip: Hatfield, MA 01038 Phone #: 413-247-5739 Are you an employer?Check the appropriate box: T- I am a general contractor and I Type of project(required): L® I am a emplg4.xr with 8 ❑ employees(full and/or part-time).* have hired the soh-contractors 6. ❑ New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors has S. ❑ Demolition working for me in am capacity. employees and have corkers p comp. insurance= 9. ❑ Building addition [No workers' comp. insurance required.) ?. n We area corporation and its 10.❑ Electrical repairs or additions officers have exercised their 11.❑ Plumbing repairs or additions 3.❑ lam a homeowner doing all work myself. [No workers' comp. right of exemption per MGL 1' ❑ Roof repairs insurance required.] c. 152.41(4).and we have no employees. [No workers 13.0 Other comp.insurance required.' 'Div applicant that cheeks Mss=I must also lilt ma ate sewn hely», OW mg their%turkey r.nnpensation r dp inbo nation 'I lnmcow ter,who submit this alTidat n indicating tho arc doing all wood,and then hire outside contractors must submit a nem ai idat it indicatine.uch. -Contractors that check this Mn oust attached an additional sheet shun Ing the mane of the cob-contractors and state n hither or not cootie,hat it emplokecs lithe subcontractor.hate anpionts.the must pros ide their uurkco comp polE' number I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site inf rmatinn. Insurance Company Name: Selective Insurance Co Policy :or Self-ins. Lie. _: II WC1n9024.4566 Expiration Date: 2/23/2018 • Joh Site Address: / $ 4-h OSI C?;-- F-- _ Cit. State-Zip: tjl4Ha rykOkAtsi 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 MGI.c. 1522 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification_ 1 do hereby cello, nder t pains and penalties of perjury that the information provided above&true and correct. Si'nature: / Date: Phone a: Official use only. Do not write in this area,to be completed by ei0 or town official City or Town: Permit/License# Issuing Authority(circle one): I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: ACCPRE, CERTIFICATE OF LIABILITY INSURANCE DATE I61MAC1YYYY` `%• 1/24/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcylles)must be endorsed, If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER AmCONTACT Cynthia Henderson, CISH mem-4.r a Grinnell 'E ti Esse, {413)5$b-0111 (axt,. (413)306-6aai $ North Atng Street N 4 Ess.chendersonewebberandgrinnell.coat. INSURER(5)AFFORDING COVERAGE NAICp Northampton NA 01060 INRURSRA:selective Ins Co of S Carolina INSURED INSURER e 3e1@Clive Ins CO of Southeast 39926 SDL ---- Home Improvement Contractors Inc. IxmRERc: 24 Chestnut Street INSURER O: INSURER E'. __ Hatfield MA 01038 INSURER F: COVERAGES CERTIFICATE NUMBERMaster 2017 REVISION NUMBER: THIS I5 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT IMTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INR TYPE OF ADM SUER-- - POLICY EFF -POLICY EXP LIMITS LTR pmWOPOLICY NUMBER IMM'DDIYYYYI IMM/DDTYYSI X COMMRRCIAL GENERAL LIABILITY EACHOCCURRENCE 1,000,000 A AMS-MADE X OCCUR LOAM D 6E5 ERENT ` ._Lryn5 .. TO C.' .. 100.000 Cs 62205063 2/1/2017 2/1/2016 MED EXP lAny onn person, 5 10,000 PERSONAL&ADVINJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER'. GENERAL AGGREGATE 5 3,000,000 X „try .7Pf LOG PRODUCTS-COMMAAee s 3,0000,000. OTHER...... . -5 AUTOMOBILE LABILITY DOMBINEO SINGLE LIMIT 5 1,000,000 IF'a INJURY A ANY AUTO BODILY V P 'parson, 5 AALL UTOS OWNED X ASOtIM.I}OLEO 59100328 2/1/20w 2/1/2010 BOO JJ accident) S 'Y HIRED AUTOS % NON.CMNED PROPERTY DAMAGE _ A TOS (Pararswen4. Undernsure,mnonn Fl wit S 100,000 X UMBRELLA LIAR X OCCUR EACH OCCURRENCE S 1,000,000_ A ExcESG LIAR GAImS-MADE AGGREGATE _ s 1,000,00_0 DEO X RETENTIONS 10,000 52204065 2/1/2017 2/1/2018 WORRERSCOMPENSATIOrc R ANY EMPLOYERS RIETOR ARTNEr E + AC 'N ER ANY VERNEMTDWPARTUDED'? G,YIIVE Y EACHELACCIDENT 5 500,000 OFFICENMEn NIS EXCLUDED'? y NIP - B {mandatoryinNH WC90244$E 2/23/201"( 2/23/2018 h..l_DISEASE-EAEMPLOYEE $ 500,000 D ESCRIPTION OF OPERATIONS below EL DISEASE-POLICY MIT S 500,000 • DESCRIPTOR OF OPERATIONS I LOCATIONS I VEHICLES SWORD 101.Aaepienal Remarks Sclleaule,may be attached II more space is received) The Workers Compensation policy does not include coverage for Paul Schmidt, Kendrick Dempsey and Douglas Schmidt. Coltambia Gas of Massachusetts is hereby named as Additional Insured per written contract with respects to General Liability 6 Auto Liaiblity, for work performed, and per the terms and conditions of the policy. CERTIFICATE HOLDER CANCEI I ATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Columbia Gas of Massachusetts THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 4 Technology Drive Ste 250 ACCORDANCE WITH THE POLICY PROVISIONS, Westborough, MA 01581 AlinigfZEO REPRESENTATNE IC Ileatle=On CTSR/CIN 'L' � a -- — ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS$25nor4Yr,