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17A-074 (4) 14 CAROLYN ST BP-2017-1393 GIS#: COMMONWEALTH OF MASSACHUSETTS Mao:Block: 17A-074 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Pennit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit# BP-2017-1393 Project# JS-2017-002321 Est. Cost: $4000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Grouo' PAUL SCHMIDT 103635 Lot Siae(so. ft.): 11630.52 Owner: KASUNICK HEATHER&JASON PERRY Zoning: RI(I00)/URA(I00)/WSP(100)/ Applicant: PAUL SCHMIDT AT: 14 CAROLYN ST Applicant Address: Phone: Insurance: 24 CHESTNUT ST (413) 247-5739 WC HATFI ELDMA01038 ISSUED ON:6/1/2017 0:00:00 TO PERFORM THE FOLLOWING WORK419 SQ FT KNEEWALL SLOPE, R-19 FIBERGLASS, THEN FIRE RATED THERMAX FOAMBOARD. 90SQ FT 14"LAYER, R-49 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 ft 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 6/1/2017 0:00:00 $65.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-1393 APPLICANT/CONTACT PERSON PAUL SCHMIDT ADDRESS/PHONE 24 CHESTNUT ST HATFIELD (413)247-5739 PROPERTY LOCATION 14 CAROLYN ST MAP 17A PARCEL 074 001 ZONE RI(100NURA(I00)/WSP(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED t OUT Fee Paid (e1F_Ije.Building Permit Filled outFee Paid TypeofConstruction: 419 SQ FT KNEEWALL S9 FIBERGLASS,THEN FIRE RATED THERMAX FOAMBOARD.90S0 FT 14"LAYER,R-49 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 INEOS�IIATION 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 Signature of Builain.3 rcial 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. FSE . -- , �rof� 212 Main Street Y ? i Roan 100 {(later, MA 01060 ��- - phone443-587-1240Fax 413587-1272 APPLICATION TO CONSTRUCT,ALTER,IMPAR,RENOVATE ORDBIOUS(AONE OR AMO PAI ILYINELAVG R 071 ,., _ I 9392E/Lan /17/ 1/ ‘S* 77auncx, /Y) oiO(02 Liss c utak. c-r, PLY-et P�yilyti cS-I-, / LC.�� GL-Crit Termegableanat ?/o ,SgC���7 � 3 I_ Shl-.TTc I.e. vl papi /tene rf- C� I -, ,.�,,I� 'i/lu I 0J IYYt -h cg / rhhSHla'l- �J� ,-tat-1 t I8 I c Name(Pipe) fy Come Wing Arrest Telephone Item Evanston Cost(Oollere)to be 1. carmleba bg_Peanit am�oent Building 21000 2. ElectiElectrical 3. Plumbing 4. Mechanical(HVAC) 5.Fre Protection r� 'CPC �` 6. Tfl (1 +2+3+4+5) lir 000 OU - 'g1_4vA:1 (1P assioglit r Section 4. ZONING All'intimation Must Be Completed.Permit Can Be Denied Due To Incomplete Idonnation Existing Proposed Requited by Zoning This cdaem to be sand inby TheldmsDeportment Lot Size Frontage Setbacks Frgpt Egg Building Height '— _ __ _. —_ Bldg.Square Footage Open Space Footage (UR area minus bids parol L._..._: - F sera) a of Padden Spaces Fill: --- _ - (volume&Inmion) .___, A. Has a Special Permit/Yariance/Fi been issued for/on the site? NO 0 DONT KNOW YES 0 If YES,date issued: IF YES: Was the permit recorded at the Regi ry of Deeds? NO 0 DONT KNOW YES IF YES: enter Book Page.. and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW fare YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? — Needs to be obtained C0 Obtained O , Date Issued: �...__._ ___.... C. Do any signs exist on the property? YES 0 NO F "" 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 fa- IF YES,describe size,type and location: , E. WJI the construction activity disturb( ng,gradag, or fang)over 1 we or is K part of a common plan that a1N disturb over 1 sae? YES NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTIO{5-DESCRtrillielOFFROPDSEWANNtielvisecisail.aee94ble) New Haws El Addition ❑ Replacement Melon AMwaSn(s) ❑ Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [Cg Decks OCISaIIg Oth.r( / of its/"s -Fl- Kntaua.i.l C./93-C,C./93-C, ?�-1 R"VI s5.. 'Phan `e!Brief a AcV Work 9'6 ^s� -{%1' /' P Lt . ,. �i-'1 Q !open tnd1'1(' 4 c-Ln ) •p'�,'`��'�`'�y�'''��as / I2J' m beari Alteration of Swing bedroom_Yes n/ No Adding new bedroom Yes At fed Narrative Renovating unfinished basemen —les ✓No Plans Attached Roll -Sheet a. Use of bulking:One Family Two Family Other b. Number of rooms in each family unit Ndanber of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction.e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Cnergy Conservation Centigrams. Maesdedc Energy Compliance form attached? h. Type of construction I. Is construction within 100 ft of _Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of meant or cella floor •-• finished grade k WWI building conform to the • • and Zoning regulations? Yes No. I. Septic Taft_ City Sewer Private veil_ City water Supply DEMON Ta-OMABR4MANONDMION-TOW ____ ova SOR' APPM Srocest S16titrFHt11i as Owner of the subject ProWN hereby authorize to actor my befeff,in matters telato wcrl�d•An(Ioslme-Sh N� by this briding pepermit Stal --" ef owe I, �2ch-1 S-1117/./ as ownerfAwwraed Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the paps and penalties of perjury. — eCki &J halt Pot Name ' a. :_ Date nwttawerntalamtVil .. . __m... �...._._._..�. r_.._ss.._.. Not AppfiwNe ❑ Name oft gegesdw: e". _. .1 IL ' 8,4- U •License Number 0 --�! J is a4"-CCL 010 � tet - ON -5 Evinton Dee "eranae - Telephone . � Not APpFirahie :...:u.: Registration umber _ • r-eL-E-- . 1 ' r / Address Expiragon i4a4—%'ct d i VYV4 01038Telephone// t/7573� 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 bI permit Signed Affidavit Atm Yes No CI The current exemption for"homeowners"was extended to include Owittranautied Branum of one(1) or two(2)families and to allow such homeowner to engage an individual for hive who does not possess a license,provided that the ismer acts as supervisor,CMR 788._Sixth Edition Seaton 18833,1. #ea ofllemeawaer: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 Derma who caaehaem more lire one home is a twe-vest'buried Moll set be emitted a homeowner. Such"homeowner shall submit to the Building Official,on a form amenable to the Building Officials that helee shall be rettromdblefar a8 Ari west Derma seder the Maisie permits As acting Cossenretiea Srmervboryour 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,von s tav be U.N.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. Bonitowner Signature MPlyeases SlaWaJ ipapipenstaMooastanLysedad441PQPMatl a1wigPIN P4P14414a401saaade all 4&4,•4•4=4p444-AWOO+iueaeINM eglor WPM 44114411 SWIM 44414414411P tiOreSICK4 fwd., - l J ,1/271 cura-icri_i- Ass 4v niC2(2.7723 ht :444APPY J� fl V os 7 :OUP* -gift muotid c io vw ' pn14-»1 WeiS 'Ac +' 'As 1m1. y fC zsalPPY -? _ 4 r j eV." - W. (4,3 red- 4 r i on) ) // neuppv swam NM IN ' �/// a a®:as ZINISIIME lOrIOIMUOMOOON undrzogia° fli RISE60 Shawmut Road,Unit 21 Canton,MA 02021 1339502.6335 ENGINEERING' wv.w.R1SEengineering.com OWNER AUTHORIZATION FORM 1, A-StE _) e-A2 (Owners Name) owner of the property located at: (Property Address) (Property Address) hereby authorize Sl"" -�� (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. gig Owner's c77— Date l � Date f, 3. L . 2hv (?rmenaencua air .)7 tic;ar Innen% Deparnneni of inaearuei it indents 17h_. rf irr� x[ima8oen !WO ti re.h(rayon n Stree; let Barton. tl I 6311; int u.n]u9..Jfrn' din N orhers ( om pensa tion I°surdne: 411ida. it'. Builders t ontractors;Flectriciansl Plum here applicant Information Please Print Legiblx SDL Home improvement Contractors, Inc \,:,!ri< 24 Chestnut Street %);a /ip_ Hatfield. MA 01038 413-247-5739 Are Nom an emplt.cr7 C heck the appropriate bl. '1 pe of project requiredl - - �e•in_ _ .. i r•:.den.• _ i run lin em/do,er/hut i.pru.4din2 - rF. . ,sur. .u�-_ `r. ex. dmp/aree. gailk n the puller and jafi silt infnrma:tom .... �,;..,,_ Selective Insurance Co WC9024456 p,,,, 2/23/2018 CrQ/73( ry'N 'St' _nc /In —�' ,¢j1,ts�. 11 A xttacI, a cop% if the Nkorker,' ccmpeAa non pylic flet.lac uln. liagt ,'howls he polisl number and expiration datel. f do beret,' ter/ruder flit,pains Lindpena/rh '2,r' IOw-matron provided ahnre it true and correct. I'. O/hdial uec..nl _ IM not rd;i Arlt dr()11 if hi. _nenp/ih, r rot,a olrciad C in or 1 u..n: _ermit; m rn,e h'uino Authority ?circle lint?: r L Roard of Health 2 13uiltling Dcpaibnen ... ., , ti .. tkctrical In.pecior I lumbin_ Inspector h Other_ �� Contact Pernm ACORD CERTIFICATE OF LIABILITY INSURANCE DAOD/IM ` Laerr" /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 INSURERISI, 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 C this Henderson, CISR NAME: YR Webber 6 Grinnell taps NNo E.ou (413)586-0111 xDI M13)586-6481 8 North King Street poDRIE55:chenderson@webberandgrinnell.cora _ INSURER(S)AFFORDING COVERAGE NAICIf Northampton MA 01060 INSURER A:Selective Ina CO Of S Carolina INSURED INSURERB Selective Ins Co of southeast 39926 _—0000 0000 - 0000. SDL Home Improvement Contractors Inc. INSURER C: 24 Chestnut Street INSURER0: _ _. . INSURER E' 0000 Hatfield MA 01038 INSURER F'. COVERAGES CERTIFICATE NUMBER4aster 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. NOTWITHSTANDING 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. W EFF POLICY EXP INSR AODL SUBR MMLICY LTR TYPE OF INSURANCE INSO POLICY NUMBER yMWDWYYYYI IMWODIYYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 DAMAGE TO RENTED 100,000 A CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) S 32204065 2/1/2017 2/1/2018 MED EXP(Any one person) 5 10,000 0000.._ 0000 0000. . _ _ __000_0. PERSONAL E.ADV INJURY s 1,000,000 GEN AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 5 3,000,000 X POLICY �PO- LOC PRODUCTS.COMP/OP AGG 5 3,000,000 -ECT 0000. 0000... OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 1,000,000 ER accident) A ANY AUTO BODILY INJURY(Per person) 5• _ . ALL NEO x SCHEDULED A9100328 2J1/201 2/1/2018 BODILY INJURY(Per acciaenn S - X , HIRED AUTOS R ND -ON LED PROPERTY DAMAGE 5 .per accident) UndeMeured motorist Bl split 5 100,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE 5 1,000,000 A EXCESS LIAB CVJMS_MADE AGGREGATE 5 1,000,000 DED X RETENTIONS 10,POO S2204065 2/1/2017 2/1/2018 5 WORKERS COMPENSATION X ;MUTE X OTR- AND EMPLOYERS LIABILITY YIN _T_ ANY PROPRIETOR/EXCLUDTIVE -- E.L.EACH A(Vi)IDEM S 500,000 ORndaRMEnBER EXCLUDED',ED'+ Y A B (tysatloryN NH) WC9024456 2/23/20172/23/2018 ELDISEASE-EA EMPLOYEE 5 500,000 IDESCRIPTION OF OPERATIONS below -E.L.DISEASE-POLICY LIMIT 5 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101.Additional Remarks Schedule.may be attached 1m more space is revered, The Workers Compensation policy does not include coverage for Paul Schmidt, Kendrick Dempsey and Douglas Schmidt. CLEAResult, Eversource and National Grid, NSTAR, Boston Gas Co. , Colonial Gas Co. , Essex Gas Co. , and Western MA Eelectric are named as Additional Insured per written contract with respects to General Liability for work performed and per the terms and conditions of the policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CLEAResult THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Contractor Services ACCORDANCE WITH THE POLICY PROVISIONS. 50 Washington Street, Ste 300 Westborough, MA 01581 AUTHORIZED REPRESENTATIVE ....3 V /_ F12nB21 soq C-J'3/GH ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025mm4ov