38B-243 (2) 226 SOUTH ST BP-2020-0657
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map.Block: 38B-243 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categoory: INSULATION BUILDING PERMIT
Permit# BP-2020-0657
Project# JS-2020-001114'
Est.Cost: $7000.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: PAUL SCHMIDT 103635
Lot Size(sq.ft.): 9191.16 Owner: MARTINEZ JOE
Zoning: URB(100)/ Applicant: PAUL SCHMIDT
AT: 226 SOUTH ST
Applicant Address: Phone: Insurance:
24 CHESTNUT ST (413) 247-5739 WC
HATFIELDMA01038 ISSUED ON:11/21/2019 0:00:00
TO PERFORM THE FOLLOWING WORK:INSULATIONANEATHERIZATION
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 Signature:
FeeType: Date Paid: Amount:
I
Building 11/21/2019 0:00:00 $65.00
i
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
City of Northampton
..
Building Department /
x 212 Main Street �$
H Room 100 "
Northampton, MA 01060
hone 413-587-1240 Fax 413-587-1272 '
APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY
SEGT,ION 1 SITEINFO R1 lATION; I i IALA TION PERMIT
� n
7.1 Property Address. v ;s `saottr y�� / / � � 1
c2a a 5_xt� 3
( 'Elttt�t.I�LG Cl3
SECTION 2 PROPERTY'OV ERSHIPJAuT :AGENT
2.1 Owner of Record:
lam, ✓' tee_. LQ ,
Name(Print) Current Mailing Address:
�. Telephone ��� 9 a
Signature
2.2 thoriaed<A en _
Name(Print) Current M Iling Address:
4/� X617. 5 7135-
Signature Telephone
sECTION _E§jLMATEDbj TR j+ j_ N!co
Item Estimated Cost(Dollars)to be OfiaYtlseOriy',
com p leted,b.permit applicant
1. Building 000� { 3uitcrP�rrrutee
2. Electrical (b)�,Estimated<Totai:Cost of
ZiOrI.S�d'11Ctlr3ttzfi't3t'fl. < ,,.
3. Plumbing BU0, tg P i li F,
4. Mechanical(HVAC) iy(�
6. Fire Protection
6. Total,4-0 +2+3+4+5) DDD c' Cl ec c plumber o19 2X
TflssSion For.��3f#Ialral Use.Oi
.. OT� Date
BuildingPemt`l�lurriber_, Issued:
Signature:
Bu�ldrng, mmisslanerllnspectorot6uatdtngs . Bate:__..
EMAIL ADDRESS(REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTI ' 4 CONsTRtJGTION 5�t tICE3
8.9 Licensed4cinstructlo u ervisor: Not Applicable ❑
Name-of Llcedse Holder: C C<1�1- 1 D 3 S-
License Nu ber
e l 0 CJ
AcTdreis EVIratio Date
gnature Telephone
Not Applicable ❑
Com an Name,
egistration Number
Address
�i Expiratio ate-
,,.. ��- r�k , 1t3 Telephonejc °��
SECTION i5 :;Vlft?iZKER3'CPE NSATWN INSURANCE�AFIt3AVIT{M.t3L.c 15 „§
Workers Compensation Insurance affida t must'be completed and submitted with this application,Failure to provide this affidavit will result
in the denial of the Issuance of the build' g,permit.
Signed Affidavit Attached Yes....... No.,.,.. ❑ y�+�, �,
Brief Description of Proposed Work 'a INSULA TI >]�f/
LYJ
goo 'S ; -��,�
as towner/Authorized
Agen#hereby,ded.are#hat the sta_gnl nts an
.4 tion on the foregoing application ire,true and accurate,to the best of my knowledge
and belief:
Signed under the pains and penalties of perjury.
ywe
Print Name
Signatur of Own r/Agent Date
Is 1 ,as Owner of'the subject
property
hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application,
Signature of Owner Date
DocuSign Envelope ID:IF934255-2300-464E-AF68-ECE9DC40E933
R I S _ 489401
ENGINEERING
OWNER AUTHORIZATION FORM
I, joseph Martinez
(Owner's Name)
owner of the property located at:
226 South Street
(Property Address)
Northampton, MA 01060
(Property Address)
hereby authorizeIJ�
(Subcontractor)
an authorized subcontractor for RISEEngineering, 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.
Docuftned by:
' Owner's ftn _ 1E3841E543D4EB...
10/30/2019 i 11:20 AM EDT
Date
i
RISEiEngineering,a Division of Thielsch Engineering, Inc.
60 Shawmut Road Unit 2 1 Canton, MA 020211339-502-6335
www.RISEengi.neering.com
City of Northampton
Massachusetts
" DWARTI.MT OF BDZLDZNG ZNSP.BCTZaNS
212 Main street *Municipal Building `
Northampton, MA 01060
DebrI'LS D30.spo- -1. 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 911,, S 150A.
The debris from construction work being performed at:
(Please print house number and street name)
Is to be disposed of at:
-t- -St
(Please rint,n meand coca n of facility)
Or will be disposed of in a dumps r onsite rented or leased fr9p: �
CD L
(C.ompanyName 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-&bris vuiil''lJe disposed.
City of Northampton
Massachusetts . ..
DEPdlItOMT OF BUXZDZNG ZNSPZCTXONS
212 Main street • Ymniaipal Building r ,H
Northampton, MA 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 must be registered as a Home Improvement Contractor('UC").
M.G.L.Chapter 142A requires that the"reconstruction, alteration,renovation,repair, moderniiation, conversion,
improvement,removal;demolftn, or construction of an addition to any pre-existing owner-occupied building containing
at least one but-not.more.than four,Owelkng.units....or to structures:which are adjacent to such residence or building"be
done by reiistered contractors.
Note.If the homeowner has contracted with u corporation or LLC,that entity must he registered
C,
Type of Work: Iti 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$1;000.';00
Owner obtainingown permit.(explain):
Building not owner-occupied
—Other(specify'):
OWNERS OBTAINING TI1M.OWN PERMIT OR ENTERING INTO CONTRACTS'WITH UNREGISTERED
CONTRACTC3R8.OR SLiBCUNTRACTOR§FOIL AI"PLICABLE HO'yIE IMF'RO'VEMENT'WORK ARE,NOT
ELIGIBLE.FORAND DO.NOT HAVE ACCESS TO T$ ARBITRATION PRt)GRAM OR(; 1 NI Y FUND
UNDER M.G.L.Chapter 142A.,SUCH OWNERS..ALSO-ASSUME.THE RESPONSIBILITES,FOR.ALL_WORK
PERFORMED UNIDER-TK BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the.penalties of perjury:
I hereby,apply for a building peruit as the ent of the o� r:
Date Contractor Name = 'HIC Registration No.
OR:
Notwithstanding the.above notice,I hereby apply for a building permit as.the owner of the above property:
Date Owner Marne and.Signature
City of Northampton
x
Xassachusetts
DEPAR22aWT OF BUSLDZNG ZNSPECTXONS �
�b $fib
212 Main Street • Municipal Building
W., Northampton, MA 01060 �
MANDATORY FF-01"R HOUSES Btl1L r BEFORE 1945
01 O( � �
Property Address: .
Contractor
Name:
Address: 4
City, State: L)
Phone: ii ' "" q
Property Owner
Name:
Address: Lp
City, State: I f�-� (DI d.j
I C (contractor) attest and affirm that the building I intend to
insulate oes not.have any open air(knob and tube)wiring in the spaces to be insulated and that I have
provided the property,owner with a copy of this affidavit.
Contractor.signature
Date
I
The Commonwealth of rassrachusetts
Department of Industriz>l Acci dents
1 Congress Sheet,suite 100
Bosion,MA 02.1142017
www.mass.l;orldia
Workers'Compensation Insurance Affidavit:Uttilders/Contractors/ lectricians/Plumbeis.
TO BE ITMEl3'1'VY'l'lI'(`UE l'l*RMl`f'I IMG'AUTHORI Y"Y.'
Applicant Information, Please Print I gibly
Name(tiusiness/Or ani7xiowil 'li,iduat):SDL Home Improvement,Contractors, Inc
Address:24 Chestnut Street
City/State/Zip:Hatfield,MA 01038 .Phage 413-247-5739
Are you an employer"Check tate appropriate.porta Type,of project(required):
1,[Z]I am a cmployer with 8 ��employees(full and/or part-thue).* 7. New construction
2,o l am it sole proprietor or partnership and have no employees working for the in S.t 0 Remodeling,
any,capacity.[:No workers'comp.insurance required.]
9. ❑Demolition
3.Q I tun a homeowner doing all work myself.[No workers'comp.insurance required.]t
10 Q Building addition
4,01 ata a homeowner and will be hiring contractors to conduct all work on my property. l will
ensure that all contractors either have workers'compensation insurance or acre sole 11.0.Electrical repairs or additions
proprietors with no employees, 12.Q Plumbing repairs or additions
5Q I,=a genctal contractor and l have hired the sub-contractar.s listed on the attached sheet.
These sub-canaaatars have employees and have workers'cotup.insurance.
t 1.3.❑Roof repairs
14.[�]✓,Lather Insulation
S.❑'We are a corporation€rnd its.ofiicers have e*�rcised their right of t%emption per MGL 0. --
152,S](4),and we have no erployees.N'o workers'comp.insurance required.]
''Any applicant that checks box#i must litlso fill,.aut the.section below showing their workers'cornpensation'poliey information.
t ITomeowrteh;NvhI a submit this affidavit.intlimting they are doing all work'and thin hive outside contractors must submit a new affidavit indicating such.
*Contractors that check'th is ttox must aftactied an additionail sheet showing the name of thesubcontractors and state whether or not those entities have
emphoyee& if'the sub-contractors have timplayces,they must provide.their'workers'comp.policynumber.
I rrnr tilt atraTlaygr flint i s providing workeW eempeusadou insurance for tray employees, Below is the policy and job site
in orrmrtion.
.lnsurarice Company Name:Stilt otive'Insurance Co _ —
Policy#or Self-ins.lwic.# WC 024156 _ __�___ __ 5xpiration.Date:,021231202i�
_�
Job Site Address:_ City/State/zip:
Attach a copy of the' 'workers" satetin.poli�y declaration page{shows owing
policy uumber and expire inn date).
Pallors to secure covera;e as re ltlirul under MGL c. 152,§25A is a critrlinal`violation punishable by a fine up to S 1.500.00
and/or ons-year imprisonment,,�.s well as civil penalties in the form of a STOP NVORK ORDER and a fine of up to$250.00 a
day against the violator.A copy,,of this:stateirtent may be forwarded to theOfficeof Investigations of the DIA for insurance
coverage verification.
t rlo hereby> ei'fJy � W4 11 e.pdi f tete infer analis provided ubr ve' is yrue anti Correct,
Si nature: Date:
Phone#:41 �2A7-57 9
Ojjizinl used idy. Pb.nol wire iri this iirea,'tii Ire!oowpleted by city or tirw a Vieial
City or'l own: Permit/License#
Issuing;Autho lty(circle oris):
1.Board of"Health 2.Building Department 3.Cityffo vn Clerk 4.Electrical.Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone 4: