31A-018 (2) 4 SANDERSON AVE BP-2019-0926
GIS 0, COMMONWEALTH OF MASSACHUSETTS
MamBlock:31A-018 CITY OF NORTHAMPTON
Lot -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2019-0926
Proiect# JS-2019-001543
Est.Cost:$4000.00
Fee, $65.0 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Group: PAUL SCHMIDT 103635
Lot Size(an.ft.): 9016.92 Owner: LESLIE CONSTANCE
zoning:URB(100 Apolkant. PAUL SCHMIDT
AT: 4 SANDERSON AVE
ApalicantAddress: Phone: Insurance.,
24 CHESTNUT ST (413)247-5739 WC
HATFIELDMA01038 ISSUED ON.212712019 0.00:00
TO PERFORM THE FOLLOWING WORK INSULATION ADDED TO ATTIC AND EXERIOR
WALLS, 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 Department Fimplace/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 2272019 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
G.Cil" of No am � we o Permit
Building a ant r Peann
212 Main tr FEB 26 2019 oAvaae fity ---
Room 0 Availabilay__ "
Northampton, A 0 060 _ o;Stnxturat Plans
phone 413-SB7-1240 x 4 A ,t".,:>
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEIIOLISII A OIE OR TYPO FArILY OYfi[t1.1110
SECTION 1 -SITE INFORMATION
1.1 E[222M AWrrA
: /1 -
sq�/erso�/ v-e rlr�, a2 rill Pill
Fan a ilaMat caaalbeq
SECTION2-PROPERTY OWIi IAUTHORRED AGENT
2.1 ?j�ftgwd
same ami Ginn ms" cjJ f j�
2.2
Signaeae
j /YL�. P✓L`JY/vLC il-I' C:Jv�S,T+YC
f7,4
name IM
Current Weq Address,'.
F.W. TIMPIWW
BECTIOM3-�CAWTRIICTION COSTS
Item Estimated Cost(Dolle s)to be Official Use Only
mm leted bv mmut applicent
1 Building .r DOOM (a)Building Permit Fee
2. Electrical (b)ESbmated Total Cost of
Construction from e
3 Plumbing Building Permb Fee
4. Mechanical(HVAC)
5. Fire Protection
6 Total=(1 +2+3+e+5) Q its, ChsA Nultber
Building Permit Number Oak
Issued.
Signature: / _ Z-Z4-ZQ19
Buie"C4mmnsionernnspeceir of Buldrge Dm
EMAIL ADDRESS (REQUIRED EITHER HOMEOWNER OR CONTRACTOR)
Seetioo 4. MNW1 All Mormwtm Mut Be Cp VWW.Penmt G Be MmW Due To mcmpkte inform,non
Bidding Proposed RNA by Zoning
ttss cMumo m ee mea e M
Siukim,D oaaaae
La Sine
Flonow
Saduelu F=
a& R: . .. L:_-_R:_ ...
5N[
Btdldmg Haight
Bldg.Squami FootW _ ... .. - % _..
Open Space Footage - %
#ofP S
Fill:
A. Has a Special Permit/Variance/Findin ver been issued for/on the sited
NO O DONT KNOW YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Regt of Deeds?
NO O DONT KNOW YES O
IF YES: enter Book Page and/or Document #
e. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW a 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 O NOs�-
:F 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 acavlty disturb(Vi grading,exp6abon or filing)over 1 acre or is it part of a mmmor plan'
Mat wll aewm user t acre? YES o NO (-j
IF YES. tMn a Northampton Stone Water Management PermR from tM DPW is requires
SECTION S.DE_WArT=OF.PAWOMEMMMM talloaaaad saaOcahlsl
New Nouse ❑ AdMBon ❑ Replacament Wirdava ANarallWIN
Or Door D orl[y O � �'
Nr
Accessory Bldg. ❑ Damolltlon ❑ Naw Signs [0) Decks [0 SldinplpY Otl [ /
Brief Deacnption of Proposed��D 9 `" C �pD(LJ
Work O -, �/ Cn
_ C( d zea
Alteration ofrratt" bedroom—Yea; No Addi new bedroom Yes No
Attached Nhed Ro Revoeel no n.�is�ed base�een• -Yes
No
Plans Attached Roll
On ��M Of✓M>AiliM f@fYIBiW&b aiM. COINM[lg! (GIOWIn4
a Useofbuilding:One Family Two Family
b Number of rooma in each family unit. _ Number of Bathrooms _
c IS there a garage attached?
d. Proposed Square Iootop of new oonstruction. =Dimensions
e. Number of stories?
f. McOwd of nesting? Fireplacas or Woodotovaa Number of sai
g Energy Conservation Compliance. Masscheck Energy Compliance torn,atteohel?
n Type of construction
Is consMucoon within 100 R of well 7_Yes _No. Is construction whin 100 yr. floodplain_Vaa_No
l Depth of beswnent or oN1, below flnNhad grade
k Will building conform to uildmg and Zoning regulations? Ves_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 PERMIT
as Owner of the aubleCt
Property
hereby authorize -t*CJ/Y72lU �� '/»`' ( iu'yfYn G91a/•S .(-n '� _
tc act on my behalf, m all matters relative to work aut prized by this building permit application.
Signature
of
ture o/Owner Otla
SL'-(7/✓1/ d.'�'� as OwhenAumoriz b
Agent hereby declare that me statements and information on the foregoing application are true and accurate. to the best Of my knowledge
and belief.
Sign under the pains and penalties of perjury.
r
Pont Neme __- -
a -as- ( 9
Sp a o, m _ Does
SECTION 8-CONSTRUCTION SERVICESI
8.9 Licensed Constrygtiorl 119m,
Not Applicable/0� c--
Name of Lienee Hai chml 44— J03
, / � , Lienee Numbs
s Hii f 5>• 7Y�a 4 D
AdM Expiration Date
S um Telephone
. __.. Not Applicable ❑
SSL. 44p1VLGU�r1 DYII f�_�y�/�{=-� .�ya G'IDL.�Si In Commy Nam R /7'1mber
S
eo"on
Address EapeatlM ^ Oa
Ai�eid Mit O/63£f ,e,��eT3"�?�l7 5"�,3 JJ I
SECTION 14 WORKERS'COMPENSATION VWAtANCE AFFIDAWT«/.6.L,c.M f2w4ft
_ll
Workers Compensator,Insurance affidavit must be completed and sumitted vest this"Icaeon.Failure to protide this affdevit will resuh
in the denial of the issuance of the buiWln k.
Signed Affidavit Attached Vea._.. C
City of Northampton
s
tdas sacllusetcs
D MTNLNY JF BUILDING IN$VE,=ONS
313 W:c SGr®ec eminacaP Bua.i e'.q
xoaNupeon. t9. 01060
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40. 554, 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 facilityas defined by MGL c 111. S 150A.
The debris from construction work bang performed at.rm /
(Please print house number and street name)
Is to be disposed of at
( ase print 7measel or racility7- y--/rt1C4
Or will be disposed of in a dumpster onsite rented or leased from:
s _.-f k ct
(Company Name and Address)
02 as/ 9
Ignature of Peffnit Applicaff 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 •. .i_
i
➢BPARTAmor Or BBILOINO INNPBGTIONa
21H Main att.t a lWieap.l Wa1dLq
NetNuptnn, M 01060
AFFIDAVIT
Home Improvement Contractor Lew
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 hnprovemem Contractor("HIC").
M.G.L.Chapter 142A requires that the"reconatrucoon. alteration,renovation, repair,modernization, conversion,
improvement,-removal,demolition, or construction of an addilion to any preexisting owner-occup+ed building curtaining
at least one but not more than four dealling units....or to structures which are adjacent to such residence orbuiWing"be
done by contractors.
Note:If the homeowner hos contracted With o corporation or LLC,that em*maw bbe'regivered
Type of Wbrk:_. SR,{1U r1—......._. . _._...—.-..�._/ Est,Cost: Q
� 7< 1O _
Address of Work:_ c Cde-, n_
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 pemrit(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.C.L.Chapter 142A SUCH OWNERS ALSO ASSUME THE RESPONSIBILITIES 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!�5q±�t as the aggeenntp f the oWnF r:
YHA L �Cr1Mi a F
a aS j4 S�iL }}n a. SirlOrn�em�t1 Il -41416—
Date
ly4lS'Date Contractor N me CtriNxc4cotS, RIC 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. Constance Leahe_
i Owner s N "w
owner of the prvporly IacOkb at.
4 Sanderson Avenue
i Propnm'Au&e,i,;
Northampton. MA 01060_
jPrpl�erty Arninrs�,
�
hereby authoriza �
�
fSleDrwibactwl
an authoruea subconuadw for RISE Enginearmg. to act on my behalf to obtain a buwding
pOrmit and to perform xwk an my . This brm is valid wft a signed contract.
Ownwa S
-if - 19
naw
RISE Engineering, a Division of Thielsch Engineering, Inc.
60 Shawmut Road Unit 2 1 Canton, MA 02021 339-502.6335
www.RISEengineering.com
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Department I!/ Industrial Accidents
I Congress.Slreef, Suite 100
Boston, H.4 01114-1017
www.nmrs.gor/dia
\l orken'Compensation Inset ince\f8dln it: Builderv(onlnetors/F leclricianvi'lmn ,ers.
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Anolicsot Information MAN Print Ltaibh
Nwne tih,an,..rogani.eliolrindn id®Ib:SDL dome impromsensnt Contrecliam. Inc _.
;Address:24 Chestnut Street
C i(Y'Slatc;/ip Fkltro . MA 01038 pilules. 413-247 5739
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Job Sile Address �j �la✓L�s r -% �_ 1' n slat,zti ��4-0-,np-{ ,.p�J
Attach a copy of the workers compensation p,dle) declaration page(showing the polies number and elpiralion dales.
failure to wa v mr,ragc as myu ,l,d under 1161 . P � 11,.,.: urinal ,lolnlrm poni.haht,h, lin,up u.81.,00 uu
and of on,-tun inlpdsonineN.as well as o,11 lbnulnes .n Ib, duel.of a S I(W Vk OR K ORDI'.k and u lin,of up w$_Spl u 1 I
da, wu(n I lh„i,lfa.. A dopy nl this slaloo'ra nn1, h, .. n,:n,k,i m the(r0i(e ,, In, In,ut the Its l 161 In wren,,
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Issuing Aulhorit., (circle use):
1. Rotted of Health 2. Building Department S.<n, low.( Jerk 4. Electrical Inspector 5. Plumbing Impecaa
M1.Other ... __.
( unwcr Person: _. .__.. _ Phone a:
ACv Dp CERTIFICATE OF LIABILITY INSURANCE °AIT'""°°
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLOER.THIS
CERTIFICATE WES NOT AFFIRMATIVELY OR NEGATIVELY AMEND.EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW THIS CERTIFICATE OF INSURANCE ODES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING NISURERSH,AUTHORIZED
REPRESENTATVE OR PRODUCER AND THE CERTIFICATE HOLDER.
IMPORTANT. H rile caNlldri hoMx Is an ADDITIONAL INSURED,the Polkylbsl must have ADDITIONAL INSURED Provisions or M esdon,N.
If SUBROGATION IS WAIVED,tubi to the temp eM EonNNlnor of Ma odic, cal"idreem re,uire ad andonalrem. AeMMllam on
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COVERAGES CERTIFICATENUMBER: Md%WExp2020 RFVMWN NMMRBR;
'GCTRTF: TEl THE POI.�CES OF INSURANCE I SYED SEI OWHAVE BEEN ISSUEDTOTIE INSUREDNAMEDA FMTFE POLICYPERIOD
S EC NOT W LHS1,FNl ANY REOUTREMENT TERM CR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WFOCH THIS
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