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17C-145 (9) 28KEYESST BP-2018-1367 CIS 4; COMMONWEALTH OF MASSACHUSETTS Man:Block: 17C- 145 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeorv: INSULATION BUILDING PERMIT Permit# BP-2018-1367 Proiect# JS-2018-002426 Est Cost $200000 Fee: 565.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor., License: Use Gmuo: JAY BOLAND 101880 Lot Size(so.ft.): 11238.48 Owner: BARTENSTEIN ANNA Zoning: URB(100)/ Applicant. JAY BOLAND AT. 28 KEYES ST Applicant Address: Phone: Insurance: 12 PISGAH RD (413) 203-2454 O WC HUNTINGTONMA01050 ISSUED ON:6/20/2018 0:00:00 TO PERFORM THE FOLLOWING WORK:BLOWN-IN INSULATION AND AIR SEALING 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 Shmature: FeeType: Date Paid: Amount: Building 6/20/2018 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Departawrt uses City of Northampton status W Permit Building Department Curb CutlDnvmw Permit 212 Main Street SewedSeptic Availability Room 100 Water/Well Availability �\ Northampton, MA 01060 Two seta of Structural prone phone 413587-1240 Fax 413-567-1272 Plwlsite Pmas ( tberspetl(y APPLICATION TO CONSTRUCT.ALTER REPAIR,RE A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION ?�1 P�1OBft"��, JUN 2 0 2018 rnfs:eaorr- lisp �w�pl pq.byomu d dld�3 y�yg �kj nit -�'IC1dZh(L M� oEVNORTNauvioN�snoi'SS6" Overlay District. Sm St.Diehiat cs Dbatct SECTION 2-PROPERTY OWWNERSHIPIAMORIZED AGENT —. Record: ,7y3ac t ;�� Kcg S4. Ven ,) a& V1IA OIG Neave(vmrc) Dvaent Nmilag :yl 9�-3 -i' -aacl fpr) Tebp are Silywmm 2.2 Auaartwd Agent S wA' 4.k/ /A Name(Pdm) Melrg�� Signehua Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Coat(Dollars)to be Official Liss Only cormAelsal by Parmit applicant 1. Building 0 0 (a)Building Permit Fee 2. Electrical (b)EsIlmeted Total Cost of Construction from 6 3. Plumbing -- Building Permit Fee 7(y/ 4. Mechanical(HVAC) S S.Fire Protection 6. Total=(1 +2+3+4+5) Check Number This Section For Official Lisa Only Data Building Permit Number. Issued, Signature: r7 ' O 11,q ammrmpaebr of nuiltlhgs Data 911 EMAIL ADDRESS(REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-OFACRIFTION OF PROPOSED WORK(elwek ad ) New Nana ❑ Addition ❑ Replacemand Windows I Aharafionm ❑ Roofing ❑ er Donna ❑ A—ry Bldg- ❑ D.M. ❑ New Signs = Docks [❑ Siding(p) Other 13`4 w"e`ad° m= lv"4,,A art) m `!381.Il'ra4 Alteration of wasting bedroom_Yes_No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll --Sheet Saw If New heu to and or addlflonto ex"nO hoOSIRO.conedlBM the followln0: a. Use of budding:One Family Two FamilyOther b. Number of rooms in each family unit: Number of Bathrooms__ a Is there a garage attached? d. Proposed Square footage of new construction. D"wensions e. Numberofstaies? I. Method of funding? Fireplaces or Woodstoves Number of each_ g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction I. is construction within 160 R of wetlands?_Yes _No. Is construction within 100 yr. floodplan_Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank_ City Sewer_ Private well City water Supply SECTION Ta-OWNER ADTNORQATION-TO BE COMPLETED WHEN OWNERS AGENTORCONTRACTOR APPUES FOR MLDR7G P60RT I. fNnncA 1 JA✓ � �Ifn as Owner of the subject properly L hereby authorize 1� 'g J A to act of my behafkin all matters relative to wok MMalzed by the budding Penne applraboo. NIA6 d S�aue of Owner 6> Dare I, A un M I-.e,ba I .as OwnedAuthoRed Agent hereby declare that the stalerawnts and information on the foregoing application are true and Wanes.to the best of my knaMedge and belief. Signed under the pains and permitted m ury. Shaw �) P�� �IN l Signe en,of OwneditlemDae SECTION 8-CONSTRUCTION SERVICES 8.1 Ucamed ConatruGi nSy rWaor. Not Applicable ❑q Nana of liwue Nobler: Q I6lll Liceme Number a 11 , Im n Mfg /,� wll5i- Address Eveetlon Dais a Sig Telephone 9,Registered Home n 12 Not Applicable ❑ Sl &WA MI c+� 1 MIN Regbustion Number cH vne. ��v Fav SC)J'0 V^5 ln[_ I /3 /1 q Address E*mfon Date bddryJ C.11 , �ITelephone SECTION 10•WORKERW C0LWENSATION 01SURANCE AFFIDAVR(M.GL c IS2,$28C(8)) Workers Compensation Irhsurenoa affidavit must be completed and submitted with this application.Failure to provide this affidavit will result M the denial of the issuance of the building it Signed Affidavit Attached Yes...... IX NO...... O City of Northampton Massachusetts S ,O j tx aaanamer or nougats zasPscrzons o 212 n.in S x t . temicipai amidiog 26 as nurtaaptee, ea 01060 -- � AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABIV�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 Improvement Contractor("MC"). M.G.L.Chapter 142A requires that the`reconsovcdon,alteration,renovalWn,repair,modomiration,convetaan, improvement removal,demolition,oroonsauodon of an addaicn to eay pre-eziating awneroccupiad nuxmrg contarung at least one but not mors dran fwudneft rsuts....or to sWcturea nitkh ere adjacent to Such residence or bt kW'be done by ret contractors. Note:Ifthe hosrle�ocsarer has contracted whh a carporadon or LLC that enaily mast regrrtered Type of Work:111,Y) Q'1'(�1� f �^ Est.Cost. l Address of Work, J)/ pJ Date of Permit Application:�n 1 H / s 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 ARBTPRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMrf.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner. �Shaam M,ckoU Ids u Date Contractor Name MC Registration No. OR: Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above properly: Date Owner Name and Signature City of Northampton "! Massachusetts a=5.•' '!f D Alt SPL OF aG=NG INS WTX01iM ; 2U Ir10 8t t •YmiviI+al avlldi g aeztbmpl , 101 01060 `^0C Debris Disposal Affidavit In accordance of the provisions of MGL c 40, 554, 1 adknowledge 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 (9< L�, s4 (Please prim h6uwkber and street name) Is to be disposed of at � kh' l lnll(hV1A.pmj .�Yrin ei-�-11? Q _ (Please print nipe and Watton of radw Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Signature of Permit Applicant 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. Columbia Gas- of Massachusetts 60 Shawmut Road, Unit 2 Canton, MA 02021 A NISo.Co ., OWNER AUTHORIZATION FORM I, Anna Bartenstein _ (Owner's Name.. owner of the property located at: 28 Keyes Street (Street) Florence, MA 01062 (Town, State, Zip) hereby authorize _. (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. -C er Signature -Sign Date 5130(2016 - awlAociJaKs OfficsOfINFA04NI"Is 4w WA ldfmw,MA 02111 Walifels' 1iaiaemAM NameI � +, . A A Addfesa ('AlltSr t iouar U cam: Ms% �/ 1fiw# LJ►3 - �e�- ��1 Atr�eyaaa sopkTeav fm.*the bee Type ofproject(tre k 1.ay Iamaaapigmrv� a. © lmoel�atse I�ainedse maemraodl pilaw an amgbyme{�.saa�orpac-tea}• 2.p l ataselepeopcidwarpaefiftdondwaBrBeiab= $ 7. pig ftaedlavaaaoempisyces T6emsebboonimMubave & [I DcmoMoa wadig foraaainaaycigod w. w 'CMR hummace. 9. p addition [WawaskesecamiLieaaeace 5. p Wasmaeoepmadonandits mgake l ofeessla<veasaemad8m ID-pl mpaysaad One 3.0lama,atewmrdoing atiwak zwofeamapdonparmM tl.pPloMbimempaosoradMios >ys lr[liowodoea'c®p. c 1R 4l(�.mdwabavem DO Pmts its kagemace ]t employess.[%�' 'gstluralaiaharitastaLoffia�aeaetmu6obrlnr's8ti�vdas ma¢atimpaW.7rfia► 19a.pa.ees.iaaidNaINN.liis:i{aeyoAdsaaasedc eai6mhneaebaemo.eooaaoaedwRar+ad.ami�.rh rC�4a�e3.dc�uaceape.r.alit.Yfi..aa3eoerwisaei.afiaaetimemertnadaic.adm'a.a.p,6gid�sfm. r s.r6�gn:igAs�era'espesi6a.�nrfa//r��sred�ww. ,e.�.:.a.,�.a,.sr•oc lakeCmapasyl Ail &M. J;l V 'Gwfi- �.Ow1bw Play#wseI&ioalie.#: whwCsqIwJEspuaficaDaiC I ' �i9 Job Sib,Ad — (� f� e1/eS 5 a a✓�1ce lS1l� Olnr�;7 Albeit qP9 oftLe "FINE eaa*satlsa PlydOdWradimpowe(irwhs8apeatya®Lerareapralw daft) FMIMto aecmaaamuge asmgmed order See6m25A efMGL c 152 cost land tothe impositim ofainisal peasities ofa fifeapIDtLSOMSUdAroseyeuk*kmamMaswenascivUlwao iesintimfiverofaSTOPWORKORDERandafine 3fvptoS2%M&dWsge- d:vi hMn Beadvised9mta oopyaftbia smfemewmaybe ibtwardodtotheOffmea WvaepVtiosafdwD!Aforiu eoverapyarM tim iyiand7 yw¢eyor md—p:rsaiaial isarsodeawsei 1 , p, i/aaeswb. $aaesdasileaa[d.•orq ar k osospdaaedbyuy mom View fsq.rrer # leaner a.+ti.�ar«�Y ante C7Klc 4.Ekeldeatlampefsr iPlaLiglaqwfor LD>•eiatHaaYY &Banc Jay Boland ID#2011.854 I 'l impN,Iw I Ito, rrn x I n ra d l,. W44111x,tvalxflt 1wn114 of I'll.10,404 'eldwww"KI All, Nc,Nrtxf lt11j •�• M 1 �y_ Mrtrghuallo !of Public Y 1�[� #autS of BUNd11t+0�eul�Ian><fie' WoenwlOrbL«itl1B11 . caimtruaXon au{Mrvlmcspoomalky i i 4A;AMAW 10 1 AMAlNItl� w Affm 14006g O� nt eApledit qmm bnr ON"" nT norrrrrzT,ru��a�l�i on v[aauxc��usel/3 Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 6170 Boston, M usetts 02116 Home Improv tractor Registration Type: Corporadon ReQMredon: 788724 Home Energy Solutions Inc „^ - Ezp Tenon: 011=2019 68 Russellville rd Southampton, MA 01073 Ih Updeta Adtlnw and return card. Mark rsewn for change. -+.ni C. mM UM1,I C] Addrc+s 0 Penevnl f1 employment ❑lest Card OM HOME-I eume OMelnt CONTassistRACTOR n HOMEIMPnly TYPEMEHrabon CTOri sego ths*fflon MlM forduts. tlound un . TYPfi:CapareW before taecnsu b dNe am Bu nNm to: 1Ed lop N Coneum+r $1aln erW Business eepulNon - ' 01!031'1018 10 Pne PMtl -suft02116 6170 awlon,MA 02718 Home EnergyshowebylYii 68 Ru MEolhsll eErd, tnunputN rd SouNempton.MA tiN173 Undersecretary v Not valid without signature t