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23B-069 (9)
114 SOUTH MAIN ST BP-2017-1198 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23B-069 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-2017-1198 Project# JS-2017-002029 Est.Cost: $2000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: use Group: PAUL SCHMIDT 103635 Lot Size(sq.ft.): 20821.68 Owner: PORTER ALEXANDER Zoning: URB(l00)/ Applicant: PAUL SCHMIDT AT: 114 SOUTH MAIN ST Applicant Address: Phone: Insurance: 24 CHESTNUT ST (413) 247-5739 WC HATFI ELDMA01038 ISSUED ON:4/25/2017 0:00:00 TO PERFORM THE FOLLOWING WORK 498 SQ FT, 10" LAYER R-37 ADDED TO OPEN ATTIC SPACE, AIR SEALING AS NEEDED 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 4/25/2017 0:00:00 $65.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File tt BP-2017-1198 APPLICANT/CONTACT PERSON PAUL SCHMIDT ADDRESS/PHONE 24 CHESTNUT ST HATFIELD (413)247-5739 PROPERTY LOCATION 114 SOUTH MAIN ST MAP 23B PARCEL 069 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: 498 SQ FT, 10 AY -37 ADDED TO OPEN ATTIC SPACE,AIR SEALING AS NEEDED 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 I OR ON 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 51' .02X i7 Si_ atu : . :uildr g ml 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. T-- ' r^P 2A nli �ofNorthampton Belding Deptatrnent 212 Main Street Roan 100 Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,ALTS,REPAIR,REWWATE OR DENOLSR4 A CME OR IWO FANCY61lB4AY8 2✓6 - o (.41 1.1 batatialtat /% l 5%6141 al(1.-1I) "1" �lPnnlJv�zvrke . 'CurrentA4e () ttn3t , rI��u �.�... 5_e.e. Bbl-t c„--b—c-d- t. Telephone Co'�(o r -0- / �j 0C 3- 22.609dialigiatJ 5S- e.`Sm(72 ems-n-F -, Name r)) I 01-Inn l tonal Address:en - 54-, I c:itii e c d rY'ar- Ty4773�j elephtme ItemI. Building c2 t 00 0 cl) EatlaaleC ccat(oog a)mbe a xed by pant aor it � 2. Electrical 3 inward 4. Mechaian(HVAC) 5 Fire P,VMCtlon S. Total (1+2+3+4+5) '' c) 00t-r _ "� •' •. l� x Section 4. ZONING AB Wsnerouh Must Be Caripteted.Permit Can Be Noted Due To Inde Information Existing Proposed Required by Zoning Ibis ocbwat to be Stitt in by Betiding Department Lot Size Frontage Setbacks Front _ _ _-- Side BOK Building Height ____ .._.._. __ Bldg.Square Footage -___. % __. __.__. Open Space Footage (Lot atomism bide&payed . '..___ , : .___. l__.' wrong) #ofParking Spaces Fill: seise&Loses* A. Has a Special Permit/Variance/Find' been issued for/on the site? NO 0 DONT KNOW YES 0 IF YES,date issued:: IF YES: Was the permit recorded at theRegi ry of Deeds? NO 0 DONT KNOW YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW G 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 Q NO IF YES, describe size,type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO (, IF YES,describe size,type and location: E. Will the corslltcDon activity disturb(cleating,grading,f1 or ting)over ave or is It part of a common plan that wtil drawn over t acre? YES© NO U IF YES,men a Northampton Storm Water Management Permit from the DPW S required 1 le e et4 —t'-p! I fl&d .ArWad n sagleuad Pee steed WPWein Pau6I$ !e!fee Pee apostate Mop Peg sgtw'a7aimoe Pte ane we"C we ;4144,476 Pee SWeenee eP Nee amneP Agaat WA( Pe2IJOUVIVP8tWO se -pP t'uttr- • t ( era p L. ! - I e " gyp s5 'uageo CIde Waled 6u.PPng sue Aq w CARPI cmoSt u ye to 'Wueaq Aw uo pe w Ste' . i �.. - , TOT, r.. TOWS .- ez!eotPne Mime fwecked POWs WRev,AWe°ea I .S .tNE}3-�iddhG Lb BOW s 4M° tea 3801-N IESQ'4640 33S Nddna ea¢em A@0 eBeb4d _-.-_JenS w —**loptles '1 ON se), ,suogen6a(Su!uoZ pue • . : w e w uuwuoo reeetwq IRM 'N ON—"—SEC u!eldpooe 'IAoo 46W;Iw!pngsuoo sl 'ON SSA Menem W'U Odt weer*ugnrWsuoo sl ? uogonesuoo p edAj 'q iPatnePe uuo;sote#dwo0 mmw3 .-. -._„ '^' 3 oogemesuO3 A6eu3 6 _"..tpas PwiewN _,. . . . . osBasNM+L 06uWO4 is Maori '1 ysauwsp regumN 'e sugWwWIG 'uoPon4suoo•r UJO a6%X4 aeMS pesadmd 'P Lpetpeee cause e 6ie4 SI a weewelSSS Io wewriN Wpm AWue}Wee w swan$+aWWN 'q 40410 Aeue9 with hewed 1010:6u nq Ya wit 'e ONWNW- IPS PeNweee weld SSA eeaeeq PeWPNun 6usewusN e I paPNet saA wuaoipeg NalpBtgppy oN IAA tuooAeq Flo tn�sGV �'-ri / Y,--eY3-ff'lel 7u �y-tr / !�.�. ft JWasoW '" thy), L „o+E' - f �a� �v5 e8 ti ra dm �ePe � v irwitr ow I�wo tta s CO epw tol aspen ❑ W>talaveq ❑ boo konactov o/❑ 130#00b1 041(ak eelrf WP*UWW0 Y ❑ CPPV 0 efwN aI$ *WOWS gatl7aNmm31 ceigoin d golielN0400'9 NOLLE Not Applicable 0 ta.a.ofblaerrattaldw: S. . ../LLc.— U • Lkrerne Number .— O 91ct) cP-0 Expiration 0aAndre!�� se.•/ , , a, { - nature Telephone S 6 I-- tiCriamr+ Ccn-k-ae zs, No AA/ 7L/5 / 5" Conmenv NM* Registration Number Ad1q ( ryas 3 rye �^ __ rens 1-4-a-'el d 1 ne)/4 Dl DS$f Telephoneeh3 dg7-573' Workers Compensation Insurance affidavit must be onmpheted and submitted with this application.Failure to provide this affidavit will result in the denial of the issuance of the?permit Signed AffidevltA+tadted Yes..._.. No 0 The current exemption for"homeowners"Wag..xt ted to include Owseap-oee,mied Rwe8laes 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 ,es savervhar.CMR 1St. Sieh Edition Sect en if8.3.5.1. Paleition of Homeowner Person(s)who own a parcel of land on which he/she resides or intends to reside,on with there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm sttuumn.A wren who cattettncts men then eat home in a two-year Period sbalnet be • .:. a homeowner. Such"homeowner"shall shit to the Building Official,on a form acceptable to the Building Official,that helve dull be dry tar all seek week uafarmedteener the bSdse permit, As acting Construction Smonvisor 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 of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be habit for person(s) you hire to pe foam 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 L "/ el? ata 41,7,yeametas- muumuu° P fPat EpMooiwaAwroAtledajt d 8PaPMQ O1W*PUB Piwadi yAS Sus&44.41011411444 sae s! 03 WINt& g406 v>aRPia iaeRaHagoeyma) 1171uM°X ga_'i -2as !Q U `.0 lL4 / UIt am Ivo 1-S vwuJ hlf ce7LS-1...kc -Qf rmow eg4b'Q VW ' F"3`p'tf 'tr, _Fiats ru m J Frer mummy -frrayx I red- f S v rtk-Li NQS / . �7 ale/ ++a aaom et '_. —as+a. 3RRf4 t en• ammo nut cm s asaaa•� eeauaaJO W swmanionaMM -014,00: • ucciderincizoit flt - RISE 60 Shawmut Road,Unit 21 Canton,MA 02021 1339-5024335 ENGINEERING' www.RISEengineering.com OWNER AUTHORIZATION FORM (Owneirs Name) owner of the property located at InkAIUJ S 1 �✓ (Property Address) �(02c- u)Ce_ IN4 01049.) (Property Address) ` hereby authorize C uL (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. Owner's ignature Date C"..‘ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 " --•s- www.mas5.govidia Workers' Compensation Insurance Affidavit: Builders/f ontractors/FAectricians/Plumbers Applicant Information Please Print Legibly Name ldiusmcs.urea»itaiion mdn iduak SDL Home Improvement Contractors, Inc Address: 24 Chestnut Street City'State/Zip: Hatfield, MA 01038 Phone 413-247-5739 Are you an employer?Check the appropriate box Type of project(required): L® l am a employer ah 8 - I o» 'eptlyaiintraclorand l emplmces(full and or parnimeV. h frail the !I m ue:ors 6. ❑ Ness construction -.❑ I am a sole proprietor or partner-, ;listed or the n uitetl sheet '. ❑ Remodeling '[h s sub-contractors have ship and have no employees A ❑ Demolition working for me in an) capacity. emphoees and have workers' 9 Li Building addition [No workers' comp. insurance comp- insurance required 5 A r e cen tratten and its 10.❑ Electrical repairs or additions 3 El I am a homeowner doing all work officers face exercised their I I.❑ plumbing repairs or additions myself (No workers-comp. right of exemption per MGL I'.❑ Roof repairs - o 3 c! '1(A and we hese no 1 Insurance required . I of Hees.jxi workers' 13 r'( Other eolnp insurance required i 'ppl r!tlml click lot-1 mom aty Ail out the mans R .,. xnl<wdion poiTc inlbmuu..n. it he suam mho it da.it tnthdat mg that arc deing ! 1/4. .. teak attraction must mbm!anew afhdai!%new:li a such omram n*thin click thu Mt most attached an additional theet vima mg lou can:r.1 the tub-camp-actors and gale whether or not!Mae amities hate vmFliot civ. If Me cuMaimnmura have craplo,50Cl tfiey mast pro.idr!heir aerAat ;imp pato number. 1 am an employer thin Ls providing workers'compensation insurance for my employees. Below is the policy and joh site information. Insurance compan. Name. Selective Insurance Co Polic) _or Self-ins LW WC9024456 Expiration Date.- 2/23/2018 Doh Site Address: If4 .�011±41_L10,_t,7__.SI> ( m StateZip: flaunts_ _. n_ma Attach atopy of the workers' compensation policy declaration page(showing the policy number and expiration date). (oto failure to secure coverage as required under Section ?S\of MCiL c 1522 can lead to the imposition of criminal penalties ofa line up to 51.500.00 and/or one-year imprisonment.as well as ch penalties in the form of a STOP WORK ORDER and a fine ,r up to S250.00 a da} against the violator. Be advised that :! :opt kith's statement ma_' be forwarded to the Office of investigations of rhe DR for insurance coverage verifcadon. I do hereby cen' nder t pains and penalties of perjury that the information provided is true and correct. Signature: Cate: Phone Official use only Do not write in this area.to be completed by city or town official Cin or Town: _Permit/License Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City-Toon Clerk 4. Electrical Inspector 5. Plumbing Inspector 1 6.Other Contact Person: Phone k: AcoRo CERTIFICATE OF LIABILITY INSURANCE DATEIMWDDNYYY) `i- 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 policy(ies) 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 CONTACT Cynthia Henderson, CISR NAME' Yn Webber 6 Grinnell PPHHONNn EFm- (413)506-0111 (uq xdp 1413)586-6481 8 North King Street ADORE55.chenderson@webberandgrinnell.com INSURERSAFFORDING COVERAGE NAICI • Northampton 1A 01060 INSUaFRA.Selective Ins Co of S Carolina INSURED INSURERB'.SeleCtive Ins CO Of Southeast 39926 SDL Home Improvement Contractors Inc. INSURER C: 24 Chestnut Street INSURER D'. SURER E Hatfield MA 01038 INsuRERF. COVERAGES CERTIFICATE NUMBERMaster 2017 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVWTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH 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. ILTADSL SUBR POLICY POUCY LTRTYPAL GENERA A iINSD WJD, POLICY NUMBER IM WODIYYYYI IMMND'YYYYI UNITS X COMMERCIAL LIABILITYGENEMLEACHETO RENEE S 1,000,000 A CLAIMS-MADE X OCCUR PREMISES ORENTEO b 100,000 PREMISES A,Any onemrsom 52204065 2/1/2017 2/1/2018 MED E%PIA^Y one perwn) $ 10,000 PERSONALfl ADV INJURY $ 1,000,000 0 GENLAGGREGATELIMO-MPLEBPEP. GENERAL AGGREGATE S 3,000,000 Rd % POLICY JEST LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 1,000,000 A AN"AIfiO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED (Perewldent)�S AUTOS % AUTOS 2/1/2017 2/1/2018 BODILY INJURY X HIRED AUTOS % AUTOS (Per PROPERTY Underinsured motorist 81 split $ 100,000 X UMBRELLA LIAR % .00CUR EACH OCCURRENCE_ S 1,000,000 • A EXCESS LAB CLAIMS-MADE0 AGGREGATE 5 1,00000 DEO X RETENTIONS 10,000 22204065 2/1/2017 2/1/2018 WORKERS COMPENSATION X PER x DTH' AND EMPLOYERS UABIUTY YIN STATUTE ER ANY PROPRIETORIPARTNERIE%ECUTIVE EL EACH ACCIDENT b 500,000 �MOFFILEREMBER EXCLUDED.) B Y NIA - - (mandabryinNHl - WC9024456 2/23/2017 2/23/2018 EL.DISEASE-EA EMPLOYEE 6 500,000 OE90RIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD tm,Addianal Remarks Schedule,may be attached if more space is required) The Workers Compensation policy does not include coverage for Paul Schmidt, Kendrick Dempsey and Douglas Schmidt. Columbia Gas of Massachusetts is hereby named as Additional Insured per written contract with respects to General Liability s Auto Liaiblity, for work performed, and per the tens and conditions of the policy. CERTIFICATE HOLDER CANCELLATION 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 AUTHORIZED REPRESENTATIVE C Henderson, CLsR/CIN fi A {ate. ©1988-2014ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025 xiann