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17B-013 (7) 384 BRIDGE RD BP-2019-0685 G15#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17B-013 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# BP-2019-0685 Proiect# JS-2019-001117 Est.Cost:$1000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor., License: Use Group: PAUL SCHMIDT 103635 Lot Size(sg.ft.): 9408.96 Owner: VANDECARR DOROTHY Zoning:_RI(100)/RR(100) Applicant: PAUL SCHMI_T AT. 384 BRIDGE RQ Applicant Address: Phone: Insurance: 24 CHESTNUT ST (413)247-5739 WC HATFIELDMA01038 ISSUED ON:1211UI 018 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSULATE EXTERIOR OVERHANG, AIR SEALING AS NEEDED 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 Deaartment 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: Feellipe: Date Paid: Amount: Building 12/10/2018 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner LN CA 7 City of Northampton Northampton, MA 01050 I V BuiWing Department 2'12 Main Stmt dy, Room 100 phone 413-587-1240 F 41 - APPLICATION TO CONSTRUCT,ALTER,REPA IR,RENOVATE OR DEN O SN ONE OR TWO FAMLY DWLL"#G UEU SECTION 1-SITE N *RVATON t I Property ACti DEPT OF BUILDIN2018 G INSPFCTIO` NORTHAMPTON,PAA 01060 g45Aj rrl �4 0/oLo a— zolaw aim at D*trw SECTION 2-PROPERTY OWNERSH JAUTHORIZED AGENT 2.1 owalf Name(Pri ) Curreaat Address: �—C. Q� Telephone Signature Name Current Iu oiling Address: Knature Telephone item Estimated Cost(Dollars)to be Omcial Use permit avOicant I. Building © o J (a)Ikkv Pew Oss 2, Electrical (b)Esfimsbad Tod Cry of 3. Plumbing Setlfding Pwndt Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) atZ 000. _ Ctc Ntubsi Date Building Permit Number: Issued; Signature: /2-7—/0 EMAIL ADDRESS(REOWRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4, ZONING All hdomiatft l Be Meted.Pem*Can Be Denied Dw To h orf gAa#a Information Existing PmPosed RmpAmd by Zoning This robe to be Wed in by �t Lot Sim _.. ...._. . . Frontage Seeks e L:.............: R: _ ... . L:. �R.. PAX Building HeW _. Bldg.Square Footage % Open Space Footage °fo (Lot arca minus bMS&paved #Of Fill: vol mte&tin _. w..::_. _,._. .. . .._. A. Has a Spector Permit/Variance/Fi been issued for/on the site. NO 0 DONT KNOW YES } IF YES,date issued:: IF YES: Was the permit recorded at the ry of Deeds? NO DONT KNOW YES C) If YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wettwWs? NO 0 DONT VJ40W YES IF YES, has a permit been or need to be obtained from the Conservation Ctxmnisslon? Needs to be arced � Obtained 0 , Dae C. Do any sWu wdst on the property? YES NO IF YES, describe size, type and location: D. Are&ere any pr%)o$ed dwlr n to or additions of sites intended for the property? YES � NO IF YES,describe fie,type and location: _. E. Va the co a'tx0on****dWsb(ding,Wig, ion,or )over I acre or is it plat of a common planwM tib ower i am? YES NO IF YES,thw a Storm VVOW MwwSwnert Panni#from the DPW is rem, SECTIll New House ❑ Adder ❑ Replacement windows Ail#erartion{6) Rooftg Or Doors Cl I I Accessory Bldg. ❑ DemolMon ❑ New Suns (01 D [M SidingfLLOIIih [ Brief Descri tion of Proposed/CD� S9 S'; �� 19 .� t� � �n Work: ' rl cx l-fc� Alteration of existing bedroom Yes No Adding new bedroom Yes No� f�-S Attached Narrative Renovating unfinished basement Yes ✓ No Plans Attached Roll -Sheet 61t a. Use of building: One Fancily Two Family Other jb. Number of rooms in each family unit: Number of Bathrooms 1=1 c is there a garage attached? r r' d. Proposed Square footage of new construction. '� Dimensions f' e. Number of stories? _ r f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance, _Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft.of we s? Yes No. is construction within 100 yr. floodplain Yes No I j. Depth of basement or cell�uifdirnq below finished grade 1 k. Will building conform to and Zoning regulations% Yes No. i. Septic Tank ity Sewer Private well City water Supply SECTION 7a- TQ LE7t0 Off.` = � - . � ,. " 1, as Owner of the subject property hereby authorize _ to act on my behalf, in all matters relative to worm authorized by this building permit application. _,/-/ � ure of Owner Date 1 i s t.d — as Owner/Authorized Agent hereby dedere that the slatemeft and Information on the foregoing application are true and accurate,to the beat of my knowledge and belief. j Sig under the pains and penalties of perjury. s. ;� Print Name Sig a of Date SECTION 8-CONSTRUCT10h 3ERMES 7 8.1 Licertiml Gmsbyofim, j Not Applicable/0 Name of License I License Numb Addres Expiration Dite S &lure Telephone Not Applicable 0 V— Registration N mber 71 1 ' i Address Eapira ate 'e� leis ` ' i�eie a SECTION,l)-til M'COWMM TIO VIMI E AF1=DAD i 0,G.L.e. 152, 2 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 buildipen-nit. Signed Affidavit Attached Yes..,.,.. No.,..., 0 City of Northampton Massachusetts nWAR21ONT OF BUZLDZM INSPSCrZONS 212 Main Street *mmiclp*l Building MeiNorthampton, M01060 Debris Disposal Affi vit 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: 3g� t ---------- (Please print house number and streetYame) Is to be disposed of at: (Please print name and location of facility)t Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) AIL/ gnatw6 of PeM*Apoi6W or Owner bate If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shag notify the Building Department as to the location where the debris will be disposed. City of Northampton xass achux.tt: _..a ZWFAXTJONT OF BMZDXMG ZBSPBCTXONS 212 Malin Straat • Municipal Suiiding Northampton, ass 01050 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Busyness Regulation("()CABR")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 Horne Improvement Contractor("HTC"). 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-exisdog owner-occupied bum containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building'.°be done by r contractors. Note: irf'the homeowner has contracted with a corporarivn or LLC,that entity mssst be registered. Sbr Type of Work:,.___. �i Est. Cost: Address of Work= Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s). --Work excluded bylaw(explain).---­ Job �_ _.._1ob under$1,000.00 _ Owner obtaining own permit (explain):--- ­. Building not owner-occupied Other(specify):__._.. OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE ROME IN+WItOVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT RAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Cir 142A.SUCH OWNERS ALSO ASSUME THE RESPONS'rIBILITES FOR ALL WORK PERFORMED CINDER THE BUILDING PERMIT,SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of petjury: I hereby apply for a buildingt as the agentof the oymFr WA Date Contractor N me HIC Registration No. OR: 'notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property: Date Owner Nara and Signature ("Dlurnbia C1aS of MaSSdChLISCM 60 Shawmut Road, Unit 2 Canton, MA 02021 A NiSoume Company OWNER AUTHORIZATION FORM l Dorothy Vandecarr (Owner's Name) owner of the property located at: 384 Bridge Road (Street) Florence, MA 01062 (Town, State, Zip) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. This form is only valid with a signed contract. The Permit will be secured by the insulation contractor, at no additional cost. It is the homeowner's responsibility to close out this permit by contacting their municipality at the completion of this work. 1c -customer Signature ' t _ -Sign Date 51$!201$ The t, t.+onntotaweaalth ra/ 1p'uxsac'hu.*etts Depaxrtmew of Ir dn.*tria1.4cc°lden �,�Jjke I#In vesfigath)ns ` tilV ll isltrrtgtrast Sfreei www,m a.ss.gowdita Nkorkers' Compensation Insurance =UYidaviu Builders/( t►rstra tor*/E.Iectriciansi lu bvrs lr Nant ,ta Im:" SDL Home Improvement Contractors Inc Aeit.ir w,�;: 24 Chestnut Street _.a v, isl atelio Hatfield, MA 01038 ,fta .� 413-247-5739 „._ . Nrt %ou an employer,!Check the appropriate 4ov: Type of project(rerlaatrEd 33 j .4 432 ,f{,xACtt ' ' 3 b�t�rt ft 4'.'t3l}'�1{3wy(,( Yh'Sth .,} #full .aridof "part-tnwl" � ., Iur . .. at,4 lst.:1 ,..,c- v crtt:>ilclitu, x�l��;,cel t ictc,r parTract- 114 ;tial have iii?etripit14ees- I} ai>e3, r ; 's lc t3it) 4I}3l 1 . � � tt!liti�:�sdcfttlnt: }\oikon er, 4;0r?'1 af, .2.f:.Yf I O ",ttS 33t sii 1 t?€t3#w aSl �Stt�3t)3f. x}3 t3t57i,.7%k�tcta<33rid #f4'.°faarM 3 M_ 1 lrattb# r�p`ir �e�sti,iittt,;}'- 7txi`5 } t'4i'f 5d)rIC4r; 1t?"('. t lit';.)x xsl jli'C4s i x . ...fix j 12, ci4itir°, �i re 1 �.�()the insulation ��;rlw t � , .. _ ag�yzii�ns. ,..,.���;lx �ra, r,., a..}, sail 3;,o tt c ..,. . . . ._, , _, .,✓e,,,.z S�.�I�z�, tf2t.,,.xfAfzx-}'2 Ytresanci ,.,.,�, t3htzzzt tt315 ztttx .th tt t3ad+`zt;t. x1sz. ,.., _ ,"a',.i � x.i-,trs� t�.aabrr t a irc�alaidakt,,f,fxWax„.a3, rv., i130;ra.,t.;,-.i.Ifi Ow, .!2x5 NO 3}.u:,t 414CIV,.i eLq iKhJIW MWI I it:„. W3? f1t �.i;r - P,tw afii3'laii,%4,ftSowf"r Y3:N`Ills",: 1t�t1 a Zile kra,have emtsiag cr_thvy zrffs.}- 1 a apt ea lrr er that is pnividhox worltera'c'r atpen.srttir rr ira,1 a rerrtz,a Jtrr Wit'enq4twses. 4dow is tkepe&y and#A she i�r�tara�iera. Insurance Compsxi� Na e. Selective Insurance Co WC9024456 02123/2019 � itv;laiclrc� : Vim$ ...... t.c �W)-Idecls _ t ;t,ate'lip utJ nCA� Attach a copy of the workers'compessa poration page(showing the palbey number mW expiration date). Failure to wCure wveyage as required under Section _. ;. `vtt: I y,,w:c'as3 to the imposition oferitninal peetialti (f#a finc tip to S1,50.tfi and`or one-year irrt sonnievt ,s�, "',ii .. .: ,4;}alti £t,ijw R)nrs (if a SP`41%f()RK t:)RUN”R ars:>F , n;, :at tap to S'2­0,00°sa day Eal;pi si the violator. W ad”s,,eil lll'i' -. ov',._ , t f.h."�,�tzit�,.}tsr r":t 2nay he lonvareied to the(_)?0'xo i,avcytigations of!her DIA tsar inswr&iix cover e 1 Stu lreretit cera paws aad penaltlel� a,1 periur, that,rlr:" information prvo*datove is irme aNdcorrett. Did Official me mqfiy, not w tis area,1t,he completed ht°.-ill,or town qfclial, l City car"{owu; ,. _ .._.._.� _ ._w..w__.,..._.... Ver it/L; 0 Issuing Aar rlttt(circle ou): 1. mrd of t eanft 2. BaNding Department 3, t:it% "!€far n t lerk 4. Electrical Inspector 5+ Inspector €i.C}tht t oanttatet Persiow Phone�: