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35 WINTERBERRY LN BP-2017-1530 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:36-200 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 44 BP-2017-1530 Project IS JS-2017-002564 Est.Cost: $1000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: PAUL SCHMIDT 103635 Lot Size(sq.ft.): 68389.20 Owner: SHEFFIELD MARY KATHERINE Zoning: Applicant: PAUL SCHMIDT AT: 35 WINTERBERRY LN Applicant Address: Phone: Insurance: 24 CHESTNUT ST (413)247-5739 WC HATFI ELDMA01038 ISSUED ON:7/3/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:INSULATION ADDED TO OPEN ATTIC 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 7/3/2017 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 • Louis Hasbrouck—Building Commissioner File N BP-2017-1530 APPLICANT/CONTACT PERSON PAUL SCHMIDT ADDRESS/PHONE 24 CHESTNUT ST HATFIELD (413)247-5739 PROPERTY LOCATION 35 WINTERBERRY LN MAP 36 PARCEL 200 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMI LICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building.Permit Filled out Fee Paid TypeofConstruction: INSULATION ADD OPEN ATTIC 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 INF*MATION 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 Demolition Delay �Gt " 6f30017 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. 0310 Bullring/` % 212 Main Sheet Room 100 Northampton, MA 01060 phone 413587-1240 Fax 413-587-1272 1- - a✓ • • -.1 _ ,_..c- 4_ • • c= . a.:_ A • . s.- • • : Y . _II c 1.1BiStatagna4" vLA�7t-C--L^ O[ , a— ' ) ) om¢ - < act — 2CV515— air I Name(Print) / akkuLk,iJ Mang it - ; J Telephone U r' Signature anitgbantagalt4C -e-T-rv&proi e rt- 'i n u I j1rn t a l C'h nr u-1' S� --�-ektA e c d rc Name(Pint) / / CurrentMeitq Addie' ab„»r. Item Esaimated Cost(poen)to be canekeec byDami[aayawm _ awwerg �% Dvo. vv 2. EleWiaal 3. Plumbing 4. Metlrenical(HVAC) 5.Fire Protection G 6. Total=(1 +2+3+4+5) `I, DLO ou . . e7ra��d tea. ��._ Section 4, ZONING All Information Aust Pe Completed.Permit Can Be Denied Due To Incomplete Information Required by Zoning his mhmu to belled In by Bmf Depmtmax BallialMINEMERIMMIE Setbacks Front Side Rear a let 11.111111.1111=1111111 Open Space Footage (Lot arta minux bldg&paved A. Has a Speciat Permit/Variance/Findi keen 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 O DON'T KNOW el YES Q IF YES,has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained C ) Obtained C) , Date issued: C. Do any signs exist on the property? YES © NO IF YES, describe size,type and location: . . .... _... _ ___..._ D. Are there any proposed changes to or additions of signs Intended for the property? YES O NO a s IF YES, describe size,type and location: E. WS the consbucton& iviy disturb(bearing grading. .,^',�,�, iM or n9.)over 1 we or is ft pad of a o0Mmen plan that will disturb over I acre? YES 0 NO V IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTIONS.O TISITOFFROROREDWORI(/etecS,aa anagaa.) New House p Addition ❑ Re mer; Atbration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. 0 Demolition ❑ New Signs [0) Decks [0 Siding kaI Otter[4 ore Brief Description of Proposed Work: , . • /i'n P. i . . afire aerie. ice Attre etion of existing bedroom_res No Adding new boded Yes No 6w Attachep Narrative Renovating basementunfinished Yes Plans Attacted Rag -Sheet y2 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. .imensions e. Number of stories? f. Method of heating? Fireplaces or Woorlstoves Number of each g. Energy Conservation Compliance. Messchedc 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 basement or cellar floor •- finished grade k. Will building conform to the : .,.• .and Zoning regulations? Yes No. I. Septic Tank_ Sewer Private well_ City water Supply SECTION-Fa-OY NERNUTfK# RTtoN-.TO:HE::COMPLETED VeEN onessA ORenedrosses is FoRHi1tl.DM61'Le I. as Cattier of the subject properly hereby authorize 1•-•• UZ�✓Aled en+ CCn4,a&kCS, t to act on my beha-lf, inaf, mattersre'lebve to by this building permit application.SGS !d' 'na-C..kft eg - ra 8 t a Date • C rki/TIr's-i-- as OwnedAmorized Agent hereby declare that the stated and intonation on the foregoing application are true and accurate,to the best of my knowledge and M f. Signed under the pains and penalties of perjury. - rami 5ahf?t.fd± Print Name of• Date S.1 �_.�_ �. • . - _.�. _ Not Applicable ❑ Nmapol—W24/ oHokfit .a— i{ ' rf� License Number D i q Az_. , 4'�d,FCl d to 010 i Ott Address Expiration Data �..�,.. e2 2/i - a� -5 !nature - Telephone ❑l[ Campo,Name Registration Number 14ak.('tl d t rn,4 Dl 038' Telephoner//.2raN'/'573' c 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 bun permit Signed Affidavit Attached Yes No 0 The current exemption for"homeowners"was extended to include Owner-occupied Dwethns 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 as supervisor.CMR 7W. Sixth Edition Section 198.33.1. Definition of Homeowner: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 person wipe ceuaacfs more them sae home int a two-year period shall met be moldered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official.that he/she shall be responsible for all sack work performed under the b®Idire permit As acting Construction Supervisor 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 be 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 LI- 8e- 67 a.a ---14/Veininks au* rape InPMooctip no arsiodoici pawn MSI Ina a{a wads sin 4 BLS ion Pa inn Man drtard loll lisqD Won w Pal I pan w n vie P■Isne baw l -f-P!ua'- a rr4 w . � � SS '40 4 ^c �� u r snippy > }?tis v v v r t -r CIA hrit :MON Arno A, om 6� �'s -��•� -s� rk r34XJ+0 &+w pr-itrvH es An 17C misuppv • -duff` senr.fativvi .w-d-wW V -a`"K - -'ck3 r . wyx neet 1 in net -11 SMIPPOP14104) Oti7TO m• ---- a sNeQ e MIS Rn uotuurpatomxoara ; OWNER AUTHORIZATION FORM �hJ Mari cauiic.ine Sheffi=_Ld (Owner's Name) owner of the property located at _ win[ea =a.._ 'Luc.. (Property Address) E tcceit r -' Sane ..__ _..o_ (Property Address) hereby authorize S TJ L- (Subcontractor) an authorized subcontractor for RISE Engineeringto act on my behalf to obtain a building permit and to perform work on my property. E-SIGNED by Kathy Sheffield Owner's Signature June 21 , 2017 Date —- z 0,,,,ii.41h4 1 f . 4'4. el‘4.4.1 , eICIIIS )444 , .- % • ,i-44.)410-1041 I a-I ,MI Ii .1,. ..11ta:irl \t/4)- .. r .130•44..4 3 d I IC H ' n. -4.1,• 4, ala \\ orker,. 1., ,nlptn‘‘Illi/n in‘u:,.r“ , .^-ii. ,, ., lt,thi. - ,. .ifird,tr. I. te,_trician% Plumber, 1.pplicam Inturniation Please Print Leeihi‘ SD._ Home improvement Contractors. inc 24 Chestnut Street Hatfield MA 01038 413-247-5739 xre %Oil an emplo“,.) ( heck I lit appi opt hitt . , I 'lx 01 pl 01(0 rtqUit ra elm an emplen er Mal 11 rim trim:, +f vrAen .',nip A N en. + j ., e.i. , ''2' ,71 'frlp it..I eel 'idol. s flu polin am;ivb sit' .a;nomenon. Selective Insurance Co VVC9024456 223/2018 D - ( 3'8 tki:\it nk-e---r" L.n.....p___ Iockhycr he \,nrker.. cost os.,a mil pi si:t Ilt•':1`4:1' rf flaLlt `till)\lirps; thi.. olit.. manila r and txtHra Bun date JC)(31P --—_--- _---- —__-- (Iv herein ,en'th-li Met tin pal w. eflu)pc nu ut; e 2 •1 2 f . '‘,.prat -pr,,Met: ihen t)r‘ fru t and 4 rirry‘t. ....- . .... ,_ '9.- ..!! ,.. -....." &r-C: g r I —7 I.IIIIL we"'c"lij I.io mil 5t nu ,J-1441.. arell , l). "ill i t in or I on n _ . r 1‘‘nin2. tailimrit ,..Iiiii . Board ol Ficalt), 2 Rudd 1112 !)CILI)E nit P: • ' ••• .....i }irtt t Piumbin2 .,. 00te; < intact BLINOn AC RO o® CERTIFICATE OF LIABILITY INSURANCE OATS IMMindYYYYI kr./ 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). CONPRODUCER NRMFCT Cynthia Henderson, CISH Webber & Grinnell �PENp.S No,EMI: (913)SH6-0111 FAX No ):(413)586-6481 B North Ring Street ADDREs9:chenderson@webberandgrinnel 1.com INSURER/SI AFFORDING COVERAGE NAIC6 Northampton MA 01060 INSURER A:Selective Ina CO Of S Carolina INSURED INSURER Selective Ins co of southeast 39926 SDL Home Improvement Contractors Inc. INSURER C'. 29 Chestnut Street IxsuRERD INSURER E: • Hatfield MA 01038 INSURER F 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 NOTWITHSTANDING ANY REQUIREMENT, TERM CR 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. RASH ADDL;V01Y--- POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INR) WVn POLICY NUMBER IMWDDIYYYYI (MWDDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE DAMAGE TO RccED 100,000 A O 6afA0E R OCCUR PREMISES(Ea occurrence] 5 S2204065 2/1/2017 2/1/2018 MED EXP(Am'one person) 5 10,000 _ __ .. PERSONAL aADV INJURY 5 1,000,000 GEN LAGGREGATE LIMIT APPLIES PER'. GENERAL AGGREGATE S 3,000,000 X POLICY JEC LOC PRODUCTS-COMPJOP AGO 5 3,000,000 OTHER 5 AUTOMOBILE LIABILITY COMBINED SINGLE LENT $ 1,000,000 A ANY AUTO BODILY INJURY(Per person) 5 ALL O6 OWIED X SCHEDULED A9100328 2/1/2017 2/1/2018 BODILY INJURY[Per accident) S X HIRED AUTOS X AOOOWNEO (Per acccident)DAMAGE $ Undenneured motorist BI split S 100,000 X UMBRELLA DAB X OCCUR EACH OCCURRENCE S 1,000,000 EXCESS LIAB A CLAIMS-MADE AGGREGATE $ 1,000,000 DED X RETENTIONS 10,000 52204065 2/1/2017 2/1/2018 S WORKERS COMPENSATION PEROTH- AND EMPLOYERS'LIABILITY YIN '4 STATUTE _ X ER ANY(CERMEMBOERFF0.NER/E CmNE -y- Nip - EACH ACCIDENT S 500,000 FFUDEDB (Mandatory in NH) W89024456 2/23/2017 2/23/2018 EL DISEASE-EA EMPLOYEE S 500,000 If yes,decmpe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101.Additional 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 & Auto Liaiblity, 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 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 < I- lC139, � erdelsCD1, C.H 6 e. f/_ _ _ P1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD IN6025 mm4nn