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23D-099 (3)
22 NUTTING AVE BP-2018-1127 GIS s: COMMONWEALTH OF MASSACHUSETTS Map.Block:23D-099 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A) Cateeocv: INSULATION BUILDING PERMIT Permit BP-2018-1127 Proiect# JS-2018-002029 Est.Cost: $1500.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: UseGrouo: PAUL SCHMIDT 103635 Lot Size(sa.ft.): 10628.64 Owner: SAMSEL JOSEPH A&CECILIA A Zoom—URB(100) Applicant: PAUL SCHMIDT AT. 22 NUTTING AVE Applicant Address: Phone: Insurance: 24 CHESTNUT ST (413)247-5739 WC HATFIELDMA01038 ISSUED ON:5/1/2018 0:00:00 TO PERFORM THE FOLLOWING WORKAIR SEALING AS NEEDED - 175 SQ FT SLOPES, 6 INCH LAYER R-19 FIBERGLASS THEN 2" 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 p 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 5/1/2018 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner NAONE City of Northam tonjd g,�ggatrt entAPr` N( d°SRoom 100oEPT 1087-1272 APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR yyJ�� FAMILY DWELLING SECTION t-SITE INFORMATION rbP l y— //oZ 7 1.1 Prownry AddressAsia x�an to 6sellse da � ✓e D Lot Oqq a- Elie,St.Dobfut ( 13DiWiC_ SECTION 2.PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 ner of Ree rd, LC Yom/ dam? /1 Name(Prim) T _ Telep one l� Signature 2.2 Aurthorized ent SA/.. lYL2- nYL'y�e./✓LQ-/t'f' C. �,Tf�'G �lzyf�etd M4 Name P' Cunent Meting Address'. QI p3� gnature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building O (a)Building Permit Fee 2. Electrical (b) Estimated Total Cost of Capon from 3. Plumbing Building Perrnit Fee 4. Mechanical(HVAC) 5. Fire Protection Veil 6. Total=(1 +2+3+4+5) v . Check Number This Seetlon For 061eW Use Only Building Permit Number Date Issued. Signature: Building Comm 6newarspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING Ali Information Naci Be Completed. Pennit Can Be bemed Due To Inc«nplete IMomlaton Existing Proposed Required by Zoning Tbls cupsae a be Piller in by BuildingLgp t Lot Size Frontage Setbacks From Side L_R: __ L: R: R� Building Height Bldg.Square Footage - _... % Open Space Footage _. __ % (La.coin-bldg&PsvM #of S wlume tiaucndon b Has a Special Permit/Variance/Findi r been issued for/on the site? NO O DONT KNOW YES O IF YES, date issued:: IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW YES O IF YES: enter Bolt page __ _. . .. and/or Document B. Does the site contain a brook, body of water or wetlands? NO. O DONT KNOW G YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES © NO Q-- 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 IF YES, describe size, type and location: E Will the construction ac"disturb(dearing. grading,w4abon, wilting)overt acre or mit pan o a common plan that Vail disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required_ SECTION&DESCRIPTION OF PROPOSED WORK[cheek all aoNicablel New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Dr Doors O — / Accessory Bldg. F-1 Demolition ❑ New Signs (0] Decks [p Siding f' Other / �. Brief Description of Propos ) Work'. /!Zti 4 /� •S l0 rf C/r<-7P/ /l.'! 1l /.]/i q�QSS Me Alteration of existing bedroom_Yes No Adding new bedroom es No �+{ Attached Narrative Renovating unfinished basement Ves ✓ No Plans Attached Rall -Sheet 6a.#Mage i a. Use of building. One Family Two Family Other b. Number of roams in each family unit Number o`Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? I Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance forth attached? h Type of construction Is construction within 100 t. of wet[ da?_Yes No. Is construction within 100 yr. fiootlplain_Yes No Depth of basement or cellar Flo below finished grade k. Will building conform to th uilding antl Zoning regulations? Yes No I. Septic Tank_ ity Sewer_ Private well City water Supply SECTION 7a•OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMfT I as Owner of the subject property t I / _ / hereby authorize _tel[, l.. -l"hC7y'Vl2 .J.1Y,Q fG J'�'-+702/7f' C J)/1t<Y0.c.'fGl'.5 -L7f1 e-- to to act on my behalfin —all matters relative to work out onzed by this building permit applicattiioon. .lam Signature of Owner Date I S r M I 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. Sig/n��p untler the pains and penalties of perjury. F 6Y.�( 11 Print Name Sig ure ofO , he Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Su isor. / Not Applicable 0 Name o/License Holder -/7— /0,J 6-3 License Number Atltlres Expiration D [e Siloature y Telephone S.RmifY[ed.Home Not Applicable ❑ Company Name Registration mbar Address Expiration Data A+field rn D/638 Tal �p3 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(i 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 building permit. Signed Affidavit Attached Yes.._... ❑ No _... ❑ City of Northampton ' - Massachusetts r- .y DEPARTMENT OF BUILDING INSPECTIONS 212 Main street .Municipal Bui_ding Northampton. MA 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: (P—rase p''rn7St her and street name) Is to be disposed of at: ;l-fCir nt name ��CcJc_LC/1G (Pleaasese pome and ocation of facility) Or will be Idis�posed of in a dumpster onsite rented or leased from: AL-1e/vn,7fye 160-toU" Company Name and Address �— �gnature of Pe it pplioa or Owner Date 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 Massachusetts F � G LEPAET!ffiNT OF BUILDING INSPECTIONS 212 Hain Street • Municipal Building Northampton, .N 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 most be registered as a Home Improvement Contractor('RIC"). .M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any preexisting owner-occupied building containing at least one but not more than four dwelling units....orto structures which are adjacent to such residence or building"be done by reeistered contractors. note:If the homeowner has contracted with a corporation or LLC,that entity must be registered oV Type of Work: '11 o Sq Com/ _p Est. Cos[: / y Address of Work: � j7I`j V �- Date of Permit Application:_ I hereby certify that: Registration is not required for the following reason(s)_ Work excluded by law(explain): __ _lob under S 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 RESPONSIBH.ITES 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 buildingt as thea ent of the o L .�-chrnic�npr �tti -} zlay 5b� ItnrY��Lrr,ora,,e��n+- 17 y`�l 5 Date Contractor N me �C?1 "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�htmhta Cr,t, rel M,ISSflCIIIJNCLIL 60Shawm_ Rrac. o :anion MA )2021 AN3ra-C-""' OWNER AUTHORIZATION FORM Ryan Stefiuk iOwnei s Name•. owner of the property located at 22 Nutting Avenue ;Streeu Northampton, MA 01062 (Town, State. Zip, hereby auihorize Li (Subcontractor) an authorized subcontractor for RISE Eilfjmee '.q - a' rr 7ehalf to obta n a cuiefnc permit and to perform work on my prop r�y it rain with a signed contract. The Permit will be secured by the nsulapnr l o add conal cost. It is the homeowner's responsibility to clos' out this permit b n^rar'*�.p t mucicir:aiity at the completion of this work. i s mer S3'Patcre bion 'Date i 4i3?20 7 5 ]he ('otnmonweedth of,11assachuseni Department of Industrial Accidents IOffice aflm•estigatiom 600 Washington Street �+. .._ Boston. 191 02111 wwr.mass.gnwdin )Aorkers' Compensation Insurance Amdasrita Builders/( ontractors/Electricians/Plumbers Applicant Information Please Print Lezill arta;ul.,,m��ltrcan;<ad��:lne;t�a,at;; SDL Home Improvement Contractors Inc Addles,: 24 Chestnut Street Sidle Zip: Hatfield. MA 01038 I'honc =. 413-247-5739 Are you an employer?Check the appropriate box: — 7 Tse.at protect(required l' �7 I :un cMtlowr"I'll a. ❑ II naa .Ln , nt Lyp aI 8 � — \ um.uuninn -nt1 _ a� _ r1 ur pa;1-time • ih� h- vai;. n - -.,_i tmrlc pr 1 nu +,er partner_ I J Jm an h J Fee; ' ` Kamuleling ,strand hascno rmplo)ca Iha csuit-c.nnra,tor`h,, I . K Ucrnohn"'i din hart nu capaoin. npi ant nt .nrl.r ` y —,.. fi ildim•addiune I Asn ,. np m,uranct ILMIJI repan+or.lddihuns ❑ 's h •umcolto Al ,.or;. �� u thea - ❑ Plomhmg r pao,or addaiun. kcr-cors n; apt tic �i(l 11❑R ml repmi anc'c rco d rd I , .wd< , I-.ER(nher Insulation Dirty i;l.urencc rcgmrcJ_JIL_ - .�. I um an employer that is prnvidinX workers'oampeasadan insurance lar mr emylgrees. Belau,is the polka and job site attartmmon. Insurance( omparq Name. Selective Insurance Cc i'olicc - It Sell-m,. I.i, WC9024456 i.vpiralmn Dal, 02/23/2019 ;oh V o,Addrtnc.��_ LTIt /�_./ "�. t iI' stale Anach a copy or the workcn' compensa is polii declaration page(showing the policy number and expi /tion date). failure to,ecure covar io'as required under Secriun 2s3 of M(SI_ c .:'_nun lead to the imposition oicriminal penalties ota fine up to sl,ilg OO and'or one-year fmpi isonmenl. as stall a,I,,; penalne, in the (ono ofa STOP WORK ORM Rand a fin, „t up to sZ�o DNI n da, against the s o lmor- 0,ads,sed that a -op, of this sratcsnent ma) he tbnsarded to the Office r.l Im estigaoons ofthe DLA for insurance ro%erage.erific woe, /Jn hoeAl sen' nde�I pain and prnaldes of perjun-that un-informraion provided above is true a(nndd correct. pitons=, �"""YYY� Official uxe only. Orr not write in this area,to he completed hr I it, ar town official. j it, or Town: PermidLirense x Issuing Authority(circle one): 1. Born or Finish 2. Building Department 3. ( it, I own( leek J. Elie rlcai Inspector 5. Plumbing Inspector h Other Conlact Person: Phone h: �� " PATE law A`ORo CERTIFICATE OF LIABILITY INSURANCE 1/15120� 1BY' 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pdicyliea)must be endorsed. If SUBROGATION IS WAIVED, subj.-to the terms and conditions of the policy,certain policies may require an.endoraemam A sunmenl on toll o r"ifipb tlw.not cooler rights to the Certificate holder in lieu of such endonemenRa). PaopuceR N— %r 'CyntM.a Henderson, CIBR .Webber a Grinner' reORS.y rat 1413)596-0111 Mµc Nai .e.sse <as: 8 North King Street ea—Lee ch ART der nreon@abberandirinnell. NBURNSID AFFORpNG COVERAGE N.C. ,Northampton NA 01060 NUDAERA:Selective Ina Cc Of S Carolina weuREp .SURER 5Saiact.ve :ns Cc of Southeast 3=926 SOL Home Improvement Contractors Inc. INSURER 24 Chestnut Street Names. NSURERE Hatfield MA 01038 2019ISIONER E COVERAGES CERTIFICATE N CT ;ES'DSaetcr amp 20.9 REVISION NUMBER: -111 5 i0 LEFT F1 STA THE =ONOILS UI IEMEN' CP ISEC BR O I HAVE PI x N ISSU-D'C THE INSURED NAME,ABOVE FOR THE POLICY PF RI00 INDICA..ONOIWT-BSSN_DGANY T E ;R All -c RM OR CONJ-GRI,ON A Ct NL,, _T OROTHERJOCuMENI WIFHECS�F- 'ITO WHIGN`1 CATE 11 -CI "ri AES N5u ClN'N A -- G'E rt i Cit 'AID CLAIMS n[HEi4 5 BJZJECT T.. ?ME -4Na ' R II! 1 �I IAC.-S CIS h50-9..C4 001 ES rM455� PNnmrrWVE9 NRECUCEC 9'nAID CLAIMS - of UFIYSVal A.=SUBR vnVLelR ROCKY Ei: PprCY E%P xl'. X CORREROALGENEEM�LIAEILITY _ _ - 1 OOC_OLOj A .n .._. X Y_ � n .. 100.0001 A _0,000, , ,,. 1.Goo.Goo` - F 000 0001 x .,Y�'a. . ... . GDo 0I:O .R AuraND.LE EuwL rw ' I.Ooc,uoG A % X .i•.i..-.., x u. . a.. % U .Aa X RCN Circles IA , A a �..I J X _CG s2E0a Us5 ¢us ANN RAafCOx E ON OR E o s x ex.000 . N B q y RCNG2aa5A_ 2 u._- e29/9G15 FINI - L:. 5 500.000 PRECRIPTpNOFOPFRATONE LOCAnces,VBRICLES ACORDIO1Ge a ne ue say ouNmat tyle crtRU,Uv The Workers Compensation policy does not Ni nclude£coverage for Paul Schmidt, Kendrick Dammey and Douglas Schmidt. i Columbia Gas of Massachusetts _s hereby named as Additional Insured per writtoo, contract with respects to General Liabaity 6 Auto Liaiblity, for work perforneed ill per the terms and condition. of the policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Columbia Gas Of :30tts THE ERPIRAT49achu5ION DATE THEREOF NOTICE WILL BE OELIVERE3 IN 4 T2ChrulOW Drive Ste 250 ACCORDANCE WITH THE POLICY PROVISIONS. Weatborough, MA 01501 umoRlrEo REPRESENT%rnE I C:2998-2014 ACORD CORPORATION. All right reserved. ACORD 2512014101) The ACORD name and logo are regislersd marks of ACORD WS025 v-,;-