Loading...
30A-064 I HIGH MEADOW RD BP-2019-0201 GIs#: COMMONWEALTH OF MASSACHUSETTS Mam lock:30A-064 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categorv: INSULATION BUILDING PERMIT Permit# BP-2019-0201 Proiect# JS-2019-000332 Est.Cost: $2000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PAUL SCHMIDT 103635 Lot Siu(so.R.): 28226.88 Owner: BERENSON RONALD&HANNAH Zoning: URA(100)/WSP(100)/ Applicant. PAUL SCHMIDT AT. 1 HIGH MEADOW RD Applicant Address: Phone: Insurance: 24 CHESTNUT ST (413) 247-5739 WC HATFIELDMA01038 ISSUED ON.8116/2018 0.00:00 TO PERFORM THE FOLLOWING WORIG434 SQ FT 10"LAYER R-38 ADDED TO ATTIC FLOOR, OPEN BLOW CELLULOSE 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: FeeTvoe: Date Paid: Amount: Building 8/16/2018 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner z,vsoc ATror� City of Northf mp:n— 1 Building Ment 212 Main Street AUG 1 5 2018 Room 00 Northampton, MA phone 413-587-1240 ax 4� APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OOR TWO FAMILY DWELLING SECTION 1-SrrE INFORMATION ✓• 10 / 1.1 Proeerty Addrass: >P1i► sit - Bee m..etrstpl Cbamllm SECTION 2-PROPERTY OWNERSHMIAUTHORIZED AGENT 2.1 / Name(Pant) Cunent MaVXng ra—as: �J✓-�� Q'T�tiAGa . Telephone 'd Signature 2.2 64horticad Agent, prne/senzCnt c�v�s,T.r� Name Cunent Maill Addeas: DIV3Si nature TZphone Item - Estimated Cost(Dolan;)to be Official Use Drily oom leted bvoemnitabiblicant 1. Building DO (a)Building Permit Fee C210 2. Electncal V V (b) Estimated Total Cost of Gassle,tyiop,fwct. 3. Plumbing Buda Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) , o0o Check Number .Fae.OMt *VM efft Building Permit Number. Dale Issued: Signatu //19 swam Fk@ EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All udanratim Met Be Completed.Pemt Can Be Dented Due To Incomplete Information Existing Proposed Requited by Zoning itis Ml wtwfie mby am'ItivgDr Lot Size Frontage SetbsclaSidc L:-- R:—.. L: R._ .___... ._ Rggr _ Building Haight Bldg.Square Footage __.__ Open Spa-Footage _. _ % (LawminvstidgRwwd ____. ._— #ofP _____.— A. Has a Special Permit/Variance/Find been issued for/on the site? NO O DON7 KNOW YES O IF YES,date issued: IF YES: Was the permit recorded at the Regi of Deeds? NO © DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW 0 YES O IF YES, has a pennit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained © , Date Issued: -__ C. Do any signs exist on the property? YES Q 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 Qt IF Y5, describe size, type and location: E. YWI the mMWrEon acfift dibxb( ng,grsdkg, or flia g)over 1 acre or Is n pad of a common plan that vafl disturb over 1 acre? YES C NO IF YES,then a Northwnptw Storm YWEer Management Penna from the DPN is required. SECTION S•OESCRVJM OF P.RBPNMNEB,YWRI((WrYall aamlinhMl New House f7 Addition ❑ ReplacementWindows Akeration(s) Rooting Or Doom 0 —' Accessory Bldg. EJ Demolition F-11New Signs [0] Decks [[] Siding[I� Ofher[ U Brief Descr�ptlon of Proyyosed r��, r A NA� fel /�IX-� work:_��'�� 6 C' ice, /0 " /�-3 c� �1cAc� "�'6 -fes/ Alteration of exlstmg bedroom Yes No Adding new bedroom Yes No Attached Narative Renovating unfinished basement Yes ✓ No Plans Attached Roll -Sheet Ba 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. Dimensions e. Number of stories? f. Method of heating?7Zoning Fireplaces or Woodstoves Number of each_ g. Energy ConservatioMasscheck Energy Compliance form attached In, Type of construction i. Is construction withis?_Yes _No. Is construction within 100 yr. floodplain_Yes No j. Depth of basement elow finished grade k. Will building conformg and Zoning regulations9 Yes No. I. Septic Tank_ Privatewell_ City water Supply SECTION 7a•OWNER AUTHORIZAT"•TO BE COMPLETED IAglEN OWNERS AGENT OR COMMRACTOR:APPLIES FOR BUILDING PEi7MR I as Owner of the subject property ,,/ hereby authorize -{-�O/Y12. 1-WIQYI}�'C�Y�e_m/' to act on my behalf, in all maltem relatlw/to work au oMod by this building permit application. Si ature of Owner Date 1. _ as OwnedAuthonzed 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 nu�pp under the pains and penalties of perjury. lJau t .`xsi,m r d.�-- Pdnt Name Siglisfure of Own / t` Dat SECTION 9-CONSTRUCTION SERVICES 8.1 Licensed Construction r: / / Not ApplicableElName of License Halder: -N- 16,36,3 ,5- ucanae Num sh, f 5l ufi "�1 via38' 3be.2o o2o / Addree Expiration Cite S eture Telephone 9•' ' I ... Not Applicable ❑ SbL Y' A, 'i!, Co Nam Registration mbB� Adtlress Expiration Pass A+ �eidl r ✓ I� 0630 Telehoa / / � SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAWT(M.G.L c.15Z$2W46)) Workers Compensation Insurance affic"itpoist be completed and submitted with this application. Failure to provitle this affidavit will result in the denial of the issuance of the buildi permit. Signed Affidavit Attached Yes....... e No...... ❑ City of Northampton lalfassaahusetts, DBPBR2f6NT OF BDILDINO INSPBCTIONS 212 qin Sticet •Municipal Building N—the ton, M 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: 1 4-�' Ql P iAi� ppcr ) (-- (Please print house nurtilber and street name) Is to be disposed of at: (Please print name and location of fa rty �� `� Or will be disposed of in a dumpster onsite rented or leased from: r (Company Name and Address) §ignature of Peffinit Applil 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 L1¢PAR1I0ENS OF BOZLIJING ZnapYCTIONa 212 nein atrwt • Municipal Building eortham n, 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 most be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation,repair, modernization, conversion, improvement, removal,demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units...,or to structures which are adjacent to such residence or building"he done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC that entity mast be registered 1 a0 Type of Work:: I nS�.wr�C'l–�"l O� 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 buildingpyqntt as the aggeentpf the o r (-NLL L✓1ryki 913 - t 8 S� ROM-#, Date Contractor N e 4,, c#vf_5 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 RISE ENGINEERING OWNER AUTHORIZATION FORM I, Ronald Berenson (Owner's Name) owner of the property located at: 1 High Meadow Road (Property Address) Florence, MA 01062 (Property Address) hereby authorize CS -- (Subcontractor) SG—(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. Owner's Signature 7 — I v Date RISE Engineering, a Division of Tmelsch Engineering, Inc. 60 Shawmut Road Unit 2 1 Canton, MA 02021 ( 339-502-6335 www.RISEengtneering.com The C'omrmsnw,ealth at.Wassaehusetls Department of Industrial.4eridenty Office of Investigations 4. 600 W'askdngton Street Y -',? Boston, 34A 02111 wpm,.mas.i.gov1dia Workers ('otnpensation insurance Affidavit: Buildernit ontnetors/EleetricianstPiumbara Applicant Information Please Print I..ihk $true utn:im..ureanl.an.... indn:dtahtl SDL Home Improvement Contractors Inc .. _. \ddress:,.,_.. 24 Chestnut Street t Ity 'SWIC-lip: Hatfield, MA 01038 Phcn c :: 413-247-6739 %re you an employer"Check the appropriate hos 'type al'projecU required) I mn a empit ver aitll 8 3- !an ve nrd n¢act and ! 1) Aew construction cmlloleesllidl and er part-timer" htL Pir ' ed ih the neranuc 1Q l am vaole proprietor or partner- Ji,,,I r. the ith achei 'et ❑ Rs nodding ,hlp and has e no employees ih. ub-omenhole g ^ Uelnr titian, tnpl . dpi h,,, crAzr� v eking fix me in an> eapacM � 9. �Fstnd¢rg atAiitinn f o+{ l vran V'o vamp, insurance It; LE f le'vical to n,or additions tegwred i - AA a ux r U i and 1, u pa lo csr addiFion. Ism a ham vuner doingait uutA tt ' r fury t 't- i�h.,- 11� Pmmbing re{la ti ,elf (Nr workers'cutup, ugln d setup..of ler MCu 1Roufrepairs .-.Uat IwImlanu i haumnm nquircdl' N I} I)„Egtnher Insulation unpi nece. to den comp m+trance required.I 1.i—tit 1h 1 .11 111, i pc at t i '. i mm*n N"ll IA ultdmn ad,."'v vaL. cd a it "I” h . ntyl mui.ubnnd li ardaul mAt 't E•,V.h e is v. lhy 11 i N,My..It'whsd un a nk't t a h hswlrc'ate.vni.ta4 I t d¢r no's Ilmw mf hxL� ny .m0im v, It 111,cnit¢0',t..o..I., mpioyfA.thc}mp.(M"Tia iMu...vkv— ... t",+tooth )an on euglaper than is pmvfdbrtt workers'compensation insurance fix rm'empiv r j. Below is the path and job site information. Insurance Compan Name. _ Selective Insurance Cc Polk' =or Sell-ins 1 Ic - WC9024456 Inpiraliou Date 02/23/2019 )oh Sint Address: Ln 2� t it State Zip --�—� 6f)-^L r'VcQ_r Attach a espy of she workers'comp oustion policy dretaatiou PORI(showisR the poll number and expirmian dale). Failure to secure coverage as required under Seciam?gA of MGI.c IS'_can lead to the imposition oferiminal mndl cs ofa fits up to Sl,200,%1 andior one-pear imprisonvent. aL.yell as.,,t!Nnalties in the form ofa STOP WORK OROLR and a fine of up to S2?d,06 it day against ilhe violator Be advised rem a J,op� nt this etatenrent may M^!awarded to the Office of _ Inresligations of die DIA for insurance coverage verification I'd o kerrQr<er% oder t polus and penalties of perjure float rite information provided above is true and correct. tiro r' ,. _ Date. j Offkial use owl). Do nm write in rkis arm,to to romp)ered hr.in or town official City or Town: Issuing Authority(circk am): I. posed of Haub 2. fluildutR Department 3.Cityflbwn(lerk 4. Meelrksl Inspector S. Plumbing Inspector 6.Other Contact Person: Phone a: `��& CERTIFICATE OF LIABILITY INSURANCE i15i201e THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS j 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 1 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: H the certlflcats holder is an ADDITIONAL INSURED.the policy(ies)..at M endorsed. If SUBROGATION 15 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 cartMcata holder In Saw of such to donemenl(s). EOx PXE4 PRODUCER pNAxoMxE, Cynthia Henderson, CISR j Nebbar 6 Grinnell SLs ri Eo1. (413)586-0111 �I. uvlssA-sae: 'iB North King Street Ao.mLae.chenderaonOwebberandgrinnell.cost IWUREMaI AFFORDING COVEMOE NAIL/ Northampton MA 01060 ewRERA:SeleecaVQ Ina Co of 3 Carolina IMIAEP NSURER B'Belcc[1Ve Ina Co of Southeast 39926 SDE Home Improvement Contractors Inc. IXBwRER C. 24 Chestnut Street Ix60BEao '.NSURER E Hatfield NA 01036 IHeuRERF COVERAGES CERTIFICATE NUMBER:M..ter lisp 2019 REVISION NUMBER: -HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUF0 TO THE INSURED NAMED ABOVE FOR THE POLICY PEN OR INDICATED NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIRCATE MAY BE ISSUED OR MAY PERTAIN, THE: INSURANCE AFFORDED 9v ]HE POI(CIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE -FRMS. FXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS I�qDIE OF INBUMMCE AOOL 9UM p0.6y XU FOLSY EIi poLN(YMYL Erp MIrB X COMMERCIAL GENERAL LIABILITY onJLCVRMkn':F ♦ 1.005.000 A ..+.mc-vA,l % _ w1_.RCN11D .F..cJa nnrw¢E5-,LR art,,.— ISCO,OCO 6220406] 1/1/1U1E _..iY19 LF%� r,m 11— � , 10,000 1.11TIA IAn.V.,,RY 1.000,050 G -I VII 1L111Ef3 laYNr.�rk 3.000,000 %N'o rry YNC .� _BCUV_i_ 3.000.000 CHUM AUTN ILR UMMUTYIV- .LLJ y ' a.DDO,coo A wo of ] A.A,1101 FC % FILL',�F-L-1: AIUVt2fi ,.F 2 L ., l e_a... . 'NON9ANE0 A.. % IREC ALOE % .TOG 100.000 % VNMI LIAS % Cc,,, ±gcnYweuaaH.Ce s 1,000,000 E..UA. AYs wALxF ,VCO A L' 4SR[tiAlt , 1.0V0 UkJ % �N.JEry VUNi IO.DPD . 81004065 `.Y.e 1/1/6019 VICRRHLSCMPEXLiION _ TN p EMPLOYER3'LIA91LIiv YIN % STATUTE X -- a11pp REvR' ENi ,T.. IF i 500,000 SME 3 E --ILEO k Y NIA B (..mAR NNI K9)10156 1/13/20:6 2/23/RO19 I F1 15. - A 1M­YrL S 500.000 'M vrieT40 pLRA-IUN,ti eemn L- OM1LAEE-pOUCY.IMI' 3 500000 TE] Workers s Compensation Polk (does not inalludet oo7 r , G or INIImon oh IInyl,bl 'The Rorkera Compensation policy does no[ inClatle coverage for Paul Schmidt, Kendrick Dempsey and Douglas I Schadtlt. Columbia Glia of Hasasehusette ie hereby named as Addational Insured per written, contract with reapecta to General Liability b Auto Lialblity, for work performed, and per the terms and condition. 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 PRDVISIDNS, Westborough, MA 01581 A.RHN IO AEMnExTATIVE V 019862014 ACORD CORPORATION. All Fights re md. ACORD 25(2014!01) The ACORD name and logo are regiYared marks of ACORD INU25:vD eD