Loading...
17D-019 (15) 117 STRAW AVE BP-2018-1018 GIS a: COMMONWEALTH OF MASSACHUSETTS M=Block: t7D-019 CITY OF NORTHAMPTON Lot -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateaorv: INSULA ICON BUILDING PERMIT Permit# BP-2018-1018 Project# JS-2018-001847 Est. Cost:$3000.00 Fee: 565.00 PERMISSION IS HEREBY GRANTED TO: Const Class: Contractor: License: Use Groom PAUL SCHMIDT 103635 Lot Size(su.ft.): 12632.40 Owner: SALLES FELIPE W Zoning URB(100)/ Applicant. PAUL SCHMIDT AT: 117 STRAW AVE Applicant Address: Phone: Insurance: 24 CHESTNUT ST (413) 247-5739 WC HATFIELDMA01038 ISSUED ON.41912018 0:00:00 TO PERFORM THE FOLLOWING WORK 360 SO FT KNEE WALL SLOPE,R-19 FIBERGLASS, THEN RIGID BOARD 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 N 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 Occuoancv Signature: FeeTVDe: Date Paid: Amount: Building 4/9/2018 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner RECEIVED i yh s.t,l.lc�t-o� 7 111 Ci lof Northampton 9u(Iding Department 212 Main Street Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413587-1272 APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION t-SITE INFORMATION Kjv" !J— C) 1.1 PrmeMAddrus: 1 110 tet - jut�d Y� 01 ova EL^^:.St.DieYict CBO'~ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Rewrd: -e 7 R e t l ce—s . S{ � e� 4/4— Name�� cumentM ng Atldnee.: NaTelephone 9i7- Pia? �� SV Signatu e 2.2 orlaxed Amealt, Sb�- M2. F7✓H�'ei''>.-f iifi e �S,TnrG N tit M+4 Name Current Mailing AEdmss: Q)03C 9 now. TelepM1one SECTION!3-EST11tATE0(`Q {MIM CUSTs Item Estimated Cost(Dollars)to be Otfidal Use Only completed bv Permit applicant 1. Building v (a)Building Permit Fee 2. Electrical (b) Estimated Total Cost of Ccmfru+tior tram 3. Plumbing Building Permit Fee // �S 4. Mechanical(HVAC) /fir�^ 5. Fire Protection S. Total=(1 +2*3+4+5) (J . Check Number Soel6ee-Fermi Mw ' Building Permit Numbe Date Issued: Sign re: 0/—ZD Willing of Buildings Dem EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Infematbn AYat Be Completed.Pernrc Can Be Denied Due To inromplete Infenanon E,dslmg Proposed Required by Zoning "i.Wm13m'Id D to6embd iv by iva Tit Lot Sia —. -- - Frontage .. _Fro Setbendm Fron[ ,..__ Side Lw---.— R: L: R:. Rear Building Height Bldg.Square Footage __..—.. % _._. Open Spatz Footage .. __ _. % __.. —.. (I.a a mmtnwtokigapead #of'Parking Spates Fill: A. Has a Special Permit/Variance/Fndi r been issued for/on the site? NO 0 DONT KNOW YES O IF YES, date issued:.._- IF YES: Was the permit recorded at the ry of Deeds? NO © DONT KNOW YES O___. IF YES: enter Book Page. - and/or Document# B. Does the she contain a brook, body of water or wetlands? NO © DONT KNOW (�)' YES O IF YES, has a perrnit been or need to be obtained from the Conservation Co nmission? Needs to be obtained O Obtained © , 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 O NO (D- IF YES,describe size,type and location: E NFII the oonstr zaan ac9vdy disturb( aft,grading. or filling)over l acre or a g Partof a common plan that will disturb over 7 acre? YES NO IF YES then a Northampton Storm Yvaler Management Pennd from the DPW is required SECTION S DESCRIPT M OF PROPOSEDWOM Wasiak all aoWioable) New House ❑ Addition ❑ Replacement Windows Afteration(s) Roofing Or Doors ❑ __--'' // Accessory Bldg. ❑ Demolition ❑ New Signs [E3] Decks [O S)dingOther[ Bnef Descnptio o Proposed UUi Alteration ofexiting bedroom_Ves No Atlatinnew bedroom-Yes No Plans At Narrative Roll Renovating unfinished basement Yes ✓ No Plans Attached Roll -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. Proposetl Square footage of new construction. Dimensions e. Number of stones? f. Method of heating? Fireplaces or Woodstoves Number of each_ g. Energy Conservatlon Compliance. Masscheck Energy Compliance form attached? h. Type of construction Is construction within 100 k. of well s? Yes No. Is construction within 100 yr. floodplain Yes_No j. Depth of basement or cellar flo below finished grade k. Will building conform to th uilding and Zoning regulations? Yes_No. Septic Tank_ ity Sewer_ Private well DO water Supply SECTION To-OWNER AIJTHOR17ATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR B1/1LDWG PERMIT I. as Owner of the subject property herebyauthorize �� l.. -f+y!'Y1,2 �Y✓1DY7JJ'2+rYi7�' l i rs to act on my behalf, in all matters relative to work autli0nzed by this building permit application. Signature of Owner Date I. J S M 1 Cr.� as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Sigr under the pains and penalties of perjury. Print Sgjwfiireofownel7nt Dale SECTION 8-CTION SERVICES 8.1 Li C NotApplicsblo ❑ Nam*of license Makler: 44- --A>,3 � License Num f s�'Ylct'f' "Y�,,,TI�fi�1e(GY�_t-7� y iG9 -5,726 x.20 I ,_ Addres Expiration D to S stere Telephone . . ... �a — Not Apokable lYI.4� )/'Y10t11✓ .+1' 1!' ! G'tOGSa -/.' .' �1=7I..'� G yName Registration mbar Address /, � J� F�iretion Dole }�tt �aetd� M�} D1d38 Tel/ef�fi/one s/ SECTION 18-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.6.L.c.552, 225C(8)) Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this afSdavit will result in the denial of the issuance of the building permit. Signed A`fidavR Attached Yes .. ❑ City of Northampton Massachusetts ! DEPART!ffilT OF BDZLDZB6 IBBPSCTIODS 212 Dlain Staaet •Municipal Hvvlding ` NortAemp[on, !A 01060 Debris Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from construction work being performed at: �/ � i[J 2 (Ple((�ri t house number and streeLname; is to be/diisposed of at: (Plea st?print name and location o acility e c(, . C-J Or wiilll bedisposedof in a dumpssttter onsite rented or leased from: H � rk" 10 1"1y`e- l� Cr JN Cr'r o (Company Name and Address) 5ignature of e itpplican or Owl If, for any reason, the debris will not be disposed of as indicated., the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. City of Northampton i Massachusetts tlEPAR1alENr OF BUILDING INSFBCSIONS 212 Hain Street • M—cipal Building Northampton, Ha 01060 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor must be registered as a Home hnprovement Contractor("HIC"). M.G.L. Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement,removal, denic0on, or construction of an addition to any pre-existing owneroccupied building containing at least one but not more than Pour dwelling units....or to structures which are adjacent to such residence or building"be done by registeried contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered. Type of Work // sLq ) r-4-7D Est. Cost, Address of Work: Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain):_ _Job under$1,000.00 _Owner obtaining own permit(explain): Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building Pmt as the agent,of the oV'n�r �1--�/-/ � SbL �rn�. 1✓xnnalJ�n e/ti-- / 7 �/'�/ 5' Date Contractor Nime ,�t(,C{-oKS� HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature i tdumbla C;as <,t \'[8S52C1]USCtB 60 Shawmut Road, Unit 2 Canton, MA 02021 A NiSouire Compmy OWNER AUTHORIZATION FORM Felipe Salles (Owner's Name) owner of the property located at. 117 Straw Avenue (Street) Florence, MA 01062 (Town. State Zip) hereby authorize S I (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. The 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. -Customer Si nature f -Sign Date 03/09/2018 The ( to,turronwealth of ttassathtnens neparrmeni of lndastrial It cidentt is OIlteeof Inesttgmions 600 Bbshingtoa Street Y Ruston, 51.-1111171 �. ww v.mass.gowdia N orkers' Compensation Insurance Ilftidat it: Built i( antractorJElectricians/Plumber.+ >nnlicant Information Please Print Legl \dmr Is , -�,,,,;,,n;,n,��� :t,t _moi,. SOL Home Improvement Contractors Inc \ddrcss 24 Chestnut Street l j, Swie /if) Hatfield MA 01038 Puna' :: 413-247-5739 are wu an empkls.r Check the appropriate Mts: 1T'spe at protect(required) 6 _ 1 ].U l anr-t s.le pap iuor,r{won". . . Rr ,odef i, ,hip and .I,, �h— ,uh-r,nn � ra,.., % '. Uemolnnm . nu rr.. n nn, rnpsc h, � I , ."':m• �c. .^• — 'd, 'Jinn sddinoc i It tical renwr.of Adibon, r �j . ,, name / , ::� swd. 'I ll PI-m�biug mpau'a addidam .Ir �Au r6 � ary,, til rM1N � I � C.0 Rwl repau. n � l � .>.®l cher Insulation ��—_ n � .,�•. yin.,.. __.' ,IIs I am an employer that is providing workers'enmprnorr orr insurance for tipemplgceet. Below is the policy and job she information. In.urnncc c on.pan Narne Selective Insurance Cc WC9024456 LspcuwnDmc 02/23/2019 ��S-f+z��✓ /� , l'J, s,, Nddre«. �l/�/ r(V Q– it, date zip attach a cop of the harken' compensation polies declaration page(shooing the pnlip number and expiration date). Failure to secure coeerage its required under Section '_SA IG W d I_2 can lead to the imposition of criminal penalties of v we upros(.;(in o1_ trior nn; .en, 'nrr'aa I I,, _n .,,:, p,ralr., II ;,h lnau oto TOP'A ORK ORD):Ranj a fine IT up 1,1 S'^0.1x)a Js, nEmna dm ,iolamr_ If,ad, 1,,J th, my ;.I mmmrnt mas he fonsenled to the OfTicc of ?n,eslignnom of the DI A for insurance cm erage,erJicai „n I Jn herehs ctrl" ' oder l pauu an, penahirs of perjun that lh information provided ubove a/true(a�nndaarrect. Plane Offichd ase only. Do nat write in this area,to he rnmpieled 1, de'or roup affh'iul i (ih or Toa n: Permit/License n Issuing .Authorin (circle one): I 1. Board of Health 2 Building Department 3 e asown ( lerk 1. Lleetricnl Inspector 5. Plumbing Inspector i h Other Contact Person: phone#: --mow A`CJKO CERTIFICATE OF LIABILITY INSURANCE lilsi2DleI' 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 At THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERIS), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT If the certhcate holder is an ADDITIONAL INSURED,the policy(es)must Be endorsed If SUBROGATION IS WAIVED,subject to the terms and condi[iam of tM1e policy,certain policies may r9euire an.endorsement A statement on this certificate doss not confer rights to the CEr,ho.ta holder in lis.of BUCK andonermor ). >n000CEP �yA —Cyn[h 18 HBnderBOn. QSR Webber 6 Grinnell tui D Ent (413)586-0111KAL igiC xon r.a,EE s-s<E. 8 NOIth Krng Str9et A...Es5 Oherderson,webberandgrinnall.c00 'R...FINSI AFFOag4G orwrA E 'Alco Northampton MA 03060 NS`s RERA Saias¢.va Ins Cc of 5 Carolina IN 're. n'.FRR IF 9alaccvve Ins Co of southeast 3992E SOL Home Improvement Contractors I.._. 11unH1 24 Chestnut Street rvsvnERo E Hatfield MA 01036 yupEnr COVERAGES CERTIFICATEOTNSHRANCF BTELa FtC Exp 20:9 REVISION ABOMBER: '41515 TO cNO W, 'THAT .HN ANN RE O= EMEN'NCr RS EL BF.CW �-AYr \ SS HF ITER E) NAMED ABOVF FOR T4E 'CLIC, ul.glCf, 16C.CA' a 4JAn S-2lAN'31NG AN, HECUIREMEN' =RM Ju CC' WON ORF _ V nTgA^' On OTHER DOC.k1.N I v ❑N EC- 'l -- THE C- 11 S �pRT-1I - a• 9c-_1 _ G4 _T .11 -1 1 i 'zz_1,..F M-CRDEC IF +Cuq!5 DESCRIBED HERE IS EU6JEC"C AL_ THE TE.:vS JA11 _ .__ d `Ota^- h _ '_Cu nn 4,TE5- l o. �4YEB V �G— C CLAWS eE OFrvBU9w 4po=5OBA uMecn pyggryvr` ROUOV ERP I R X COMM ACA=GENE4A LARlul - l.DOc,Doo 11 A X l0C-0^0 � .a"9^O 409,990 X An TOMORtf 4AIFu - -"- .. u. 1 000 L•J ''.. A X % r' A X UMae -A. X --_— A ESCE55una R il. X :19r B22C<Od_ - L2C:5 w OC 5 e TON X ♦ ._, A BL T V X - y ­An cOC 0000 y B NAHAI, 11, uC3te<<c.. p'a. A'111 'Fi5 1...."y3 eJ'..000 poet .vl Inc 0001 I DESC Rwn NDFDRERAorS LDuam rIONS,YEHiES rumirlA a na.R,IF "t',w,mo..r �m�.w=• . The Workers Compensation policy dav oB not n4lude coverage for Pave Schmidt, Kendrrek Dempsey and Deug:as Schmidt u :u:Mia Gas of Massachusetts _s hereby named as Addy G_onal Insured per written contract with respects to 1 General Lvabcl Rcy 6 Auto LvavbGty. for work p formed. and o rhe terms and mrdr U.ons of the pRlrcy CERTIFICATE HOLDER CANCELLATION SHOULD AN,OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE COl UObia Gas Of Ma58achUeatts THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN 4 Technology Drive Ste 250 ACCORDANCE WITH THE POLICY PROVISIONS. Wo.t3horough, MA 01581 THOwrEOaEPAESENTATIVE -- y '-:1918-2014 ACORD CORPORATION. All rights ntwrved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD �N5025 ,,, <