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06-031 (11) 61 LEONARD ST COMMONWEALTH OF MASSACHUSETTS BP-2021-1941 Map:Block:Lot:06-031-001 Permit: Alts Renovations CITY OF NORTHAMPTON Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2021-1941 PERMISSIONIS HEREBY GRANTED TO: Project# INSULATION Contractor: License: Est. Cost: 4000 SDL HOME IMPROVEMENT 103635 Const.Class: Exp.Date:05/20/2023 Use Group: Owner: CHIAMIS DANNY & MARIE DELUCA-CHIAMIS Lot Size (sq.ft.) Zoning: URA Applicant: SDL HOME IMPROVEMENT Applicant Address Phone: Insurance: 24 CHESTNUT ST (413)247-5739 WC9024456 HATFIELD, MA 01038 ISSUED ON:09/24/2021 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHERIZATION 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. Signature: � t • , "9 , O CO I Fees Paid: $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner / / / 6) ,....., City of Northampton Building Department . , 212 Main Sieet 1 Sei, . Room 1700 , _a Northampton. MA cr+.: , -, phone 413-587-1240 Fax 41 ; 4 / APPLICATION FOR INSULATION FOR A ONE OR TWO FANI * - LINO ONLY SECTION 1 -SITE INFORMATION INS ULA TICLIN PERMIT This section to be completed by office 1 1 Property Address 6 Map Lot Unit ,1_,_e onct.--ci I Zone OverlayEttstriM Eini St District _ CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT net of Recorit / _fz,a Name(Print) I Current Mailing Addres5:.,0L3_ 5—ee 3__, g '7' if Telephone Si J i‘S....12_,,,,,ure 2.2 Authorized Agent: 10Gt,i 86-1A&._(.. S+ /Itifg-t 4. Name ) tio Current Mailing Address: ,----------- qi - o?c-17 --a.-- 1, 4 Signa re Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building OL, (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of — Construction from(6) 3. Plumbing Building Permit Fee 4614 4. Mechanical(HVAC) 5.Fire Protection 6. Total=(1 +2+3+4+5) 1- CYCD c'4-) if Check Number 34/3 This Section For Official Use Only i Building Permit Number. 4 I'ri ftliti i Date Issued Signature: 9'.gq" Zd2) Building Commissmerilnspector of Buildings Ottls EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION./ ��.,�.. s ,: Yx •�:;..�.> Not Applicable Ca 4/ tnci t- C.S- 1© 3 S license N ,.ber rea r - 5-� e - �l c1, ni of c� h' ��5" .7 d/a 3 Date gnature Telephone Not Applicable �� ,,�4 i 7 IN/ l..[,)ri Ciegistration Number Address c}-S-�-Y + E>± L.� Expiratio A Cal ta3 Telephon /13 zKi-s 9 SECTION 5-%NORMA,COISPENSATN:41tO PACE AFFIX O.G.L.c.112,§MOW Workers Compensation Insurance affida must be completed and submitted with this application, Failure to provide this affidavit will result in the denial of the issuance of the b permit. Signed Affidavit Attached Yee....,.. No O Brief Description of proposed Work NOTE: INSULATION ONLY / ate s� � 11 - 1 � -d c ��>� oar, �lLAcos.IZ_ . }�r- s 5 ct'-T 'c)n,14. [ a- Qk ,as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. CytkettC•bc-S, PLud 6- Print Name sign Date I, own l A r�-1 S , as Owner of the subject property hereby authorize to act my behalf, in all matters relative to rk authorized by this building permit application. (S�-c . a � c� 9- a-/ - �--/ Signature of Owner Date City of Northampton Kas sachusetts 4 , t 4? -(41, DEPARTmENT OF BUILDING INSFBCTIONS • k ; . -22 Main Street •DiunIcApel Building "rn:? Hcrthampton, MA 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: I (.._e +- (Please pri(enouse number and street name) Is to be disposed of at: cL4 c 4 -cKAAN- k- nA (Please print n4me and leceOfof facility) Or will be disposed of in a dumps r onsite rented or leased fr9in: 1, , L. AtcV Sk-i-Nk.,k--k- "\-\-CL fs-) ‘ta 'ItY\ ‘. (Company Name and Address) - c)-1. 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. City of Northampton Massachusetts ,i) L.. DEPARI26DIT OF BUILDING INSPECTIONS :t; A 212 Main Street go Municipal Building ,!".i ' ,:.• '4 Northampton, MA 01060 -47.1169: AFFIDAVIT Home Improvement Contractor La 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 CHIC"). M.G.L. Chapter 14ZA 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"be done by registered contractors. Note:if the homeowner has contracted with u corporation or LLC, that entity must be registered Type of Work: ,---- akLa {::K_D__n________ Est. Cost: t Address of Work: Date of 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 I42A.SUCH OWNERS ALSO ASSUME THE RESPONSIBIL!FES 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 peculL:i a;theg::)(Lera,kotre‘ille owa_TT: i / Y i-/ / S k 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 Name and Signature City. of Northampton .... Massachusetts / e ,;, „.4 DEPARTMENT OF BUILDING INSPECTIONS 4111 .': '`, •••• 212 Main Street 0 Municipal Building Northampton, MA 01060 MANDATORY FOR HOUSES BUIL r BEFORE 1945 Property Address, (-°/ Lec,no ,--c-4 +- _ Contractor Address, (-0 4 CIAO.(41-v‘..1—.k-- . k-- City, State: Phone: )4t,5- aql - .A5- 1 Property Owner r."._, Name: r-‘rAl C :k i 0 Address: (D I L-ec)rmn -----ct 4- City, State: i\JO-?-14-)0. --N p- ,), m A I, a i oi-)r\k:i di- (contractor) attest and affirm that the budding I intend to insulate does 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 j 1: /Date - Date 9 - I - <D-1 Permit Authorization Ti mass save Form of4Tcv.tro4 Site ID: 4306904 Customer: DANNY CHIAMIS Danny Chiamis , owner of the property located at: (Owner's Name,pr)nted) 61 Leonard St Northamptoii, (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. 19a4<ay Cgatu& Owner's Signature: Date: 09 / 19 / 2.„ ".6.0**06. '60',6,00.0.0.**4,040-6-444.04****0**4004.00 ,44• FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 For Dffize Use Only Document Ref:YO6T5-HUH8Q-XAWRP-FJ78Q Page 2 of 18 The Commonwealth of Massachusetts ek r!. :I Department of Industrial Accidents ; .z ,.;„1...=7', i 74:3...f. ,,. I Congress Street,Suite 100 Boston,w .inaMAss.02g101w4 d-,1/17 ww . _ Workers'Compensation insurance Affidavit: Builders/Contraetors/Electriciansirlumbers. I ti BF.I 11TO'w 1111 Tilt PEKSIIITING All-1110R111, AD0heantistfonnatim _ Pltiase POO( Letibil Name SDL Home improvement Contractors, Inc (MASirtin/N/09yiniZaii(111A Ildi k jt,t;;;;; Address: 24 Chestnut Street City/State/Zip: Hatfield, MA 01038 Phone #: 413-247-5739 , Are you an employer?Cheat the appropriate hey: Type of project(required): i.0 i am a cmpimcr V.Ith employees i 1011 andior pan-pine i* 7 CI New construction 2 0 I am a:sole proprietor or portnesship and have no employees yyryiking for me in 8. 0 Remodeling ,,,v,„Ap-ixav iNo,,,,,,,iera eotrip insurance required 1 9, 0 Deryielition 0 I ant a 1442140Witer domg all yyork myycir 1No yscyrkers'comp Insurance required 1• 1 0 Q Building addition 4 Di am a homeowner and will be luring cxYntractors to conduct all work on my property I will ensure that all commetOrs either have workers compensation IT441faitt 04 MC WIC 11.0 Electrical repairs or additions Proeitetors with no employees 12.0 Plumbing repairs or additions ,0 1 am 4 general contractor and I have hired the sulssaintrusiors listed on the attached sheet 1 3.0 Root-rera irs Thew yuti-eiontraigars have employ CZA and hay e workers'comp Irt 31 qW710:i'1: frO We are 4 C(1114441441 and as Micas have exercised their right of exemption per Xltil c 14,pothc, ja,i ,..t 1 s2,tilt4),and we have no employees IN°workers'temp IIISUfaMe required NTheant that checks box$1 must also fill not the section helms showing then workers'compenswion policy information ' I larritOMMen who submit this affidavit indicating they art doing ail work and then lure outside contractors must submit a new affidiry it in xui such I:outlay-tors that check alii.Nu t must attached an additional sheet N11044311g the name cat the sub-corttracurry and state u holler or not those entities have employees It the :ub.,,cmuractors hate employ i,es,they riii.6t Tyro hie their voli.ri, ,,,,14, 1:hilh:?, num1-11 I am an employer that is providing warAers'compensation insurance/On'My employees. Below is the polity aadjob site infOrmatioa. Selective Insurance Co Insurance Company Name. ......._ Policy 14 or Self-ins. Lie.4: VVC9024456 Expiration Date: 02/23/2023- Job Site Address: / -12--e_Dr26k,----CH ' ,4- CityfState/Zirr Attach a copy of the tworken'compensation policy declaration page(showing the policy number mad expiration date). Failure to secure coverage as required under MCA,c. 132. §25A is a criminal violation punishable by a fine up to$1,500.00 andior one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a line of up to$25000 a day against the violator. A copy of this statement may he forwarded to the Office of Investigations of the DIA for insurance coverage verification. /do hereby re •: rider runs Will penalties of perjuty that the information provided above A Irste and correct. I',hone 413-24 - 739 Official use only. Do not write in this area,to be completed by city or town offirial 1 I t it or Town: Perm itiLicense# Issuing Authority'(circle one): 1. Board of Health 2. Building Department 3.CityiTniau Clerk 4. Electrical Inspector 5. Plumbing inspector (r.Othei ( on tact Person: Phone 4: