17C-067 (2) BP-2021-1986
151 CHESTNUT ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
17C-067-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2021-1986 PERMISSION IS HEREBY GRANTED TO:
Project# INSULATION Contractor: License:
Est.Cost: 2500 SDL HOME IMPROVEMENT 103635
Const.Class: Exp.Date:05/20/2023
Use Group: Owner: BRENNAN, EMILY K.
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:10/07/2021
TO PERFORM THE FOLLOWING WORK:
INSULATION
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: o
it
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
,•
,,4?4,,,,
„,
,....... .,,,,,, City of Northampton/
-.
Building Department 007.
212 Main Street
Room 100
Northampton, MA 01060- oNt. y
phone 413-587-1240 Fax 413-587-1 ,7'04 /. t- /*A--
APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLiNG ONLY
SECTION 1 -SITE INFORMATION INSULATION PERMIT
1.1 Property AddressThis section to be completed by office
Map 7C....-- Lot iZ7 dr,
Zone Overlay District
Elm Si District CS District
i SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Ern I Iv 6re-1i n a-ki /,_ I C ill_gli-u,t:1- s-f-
Name(Print) Current mailing Vie;... ,,.._-. 74— 3..6
(1 sA__A___ .ca--t-tiv,12_,L..s_k Telephone
Signarture
2.2 AuthorlzedAuent: 0.44,4 chrs,,A, d_.-{-- •
S -k-- 02/ C kW. 4-724.41- M-- -fiti-re-c d
Ns ( Current ailing Address:
-3--
Sig ature Telephone
1 SECTION 3-ESTIMATED CONSTRUCTION COSTS
,
Item ! Estimated Cost(Dollars)to be Official Use Only •
completed by permit applicant
1. Building a...) (a) Building Permit Fee
'SD()
2. Electrical (b)Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total (1 +2+3 4-4+5) 9 --0(..) c'c7
' Check Number
(3</f 7
i
This Section For Official Use Only
1
: Date
Building Permit Number &a 2/, itl Issued:
Signature: e/ 1
/d-7-ZOZI
Building Cominisstoner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) .
SECTION 4-CONSTRUCTION- ICES
8.1 Licensed Construct*
leerNot Applicable 0
Name of Licenselden Ho : fri
Sdh nu d? C... - i c,q.,fit 3 J
License Number
Arc)2V Ccinui` s-�, '0c. ,-[ i f n i cJ oa' ,6-- .d o,?,3
dregs ratio D
4/1,31/9—,6"--2 s_3, Exp1 ate
gnature Telephone
Not Applicable 0
C. . i, . r.. . ,. �,,, egistration Number
Address cj if s4- 1....t..�t" &I'" s 7, , /Q.----
Expo it i
�'` at r>�a#e
`t .. "�' -(...t 8_, h-\'1 i�1(3 TelephonA13"-, /'2 S , 9
SECTION 5-WORKERS'COMPENSATIONINSURANCE AFFIDAVIT(Rel..c.152,§25C(6))
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 bud g permit.
Signed Affidavit Attached Yes No 0
Brief Description of Proposed Work NOTE: INSULATION ONL Y •
A o 6 -'1 - - ( 1 Li r r ( y iie r' Q- q ' kr t-tacit ( -f'0D,e.
t�U . 4- - )e-tO l-k' d , '40 a,t(Is
7417' Se x/(4 t y off, ni..1, �1 .
I. Paik“. 1 ' 'v i ,,, ,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.
jj�� 1 1
,,ti-velft),te.,,,Y1R-nA- (CitfAC4CXS, ri'AC
Print Name
Signatur f own Agent Date
1, i l,t,f !Jrenna/L-)
as Owner of the subject
property
hereby authorize S 6 L—
to act on my behalf, in all matters raln've to work authorized by this building permit application.
-41._124‘.L.d, . 9- 3'6-`D. 1
S ggnature of Owner Date
DocuSign Envelope ID:D353F581-3693-48EB-86FE-9F93DCC98D0A
R I SE
ENGINEERING
OWNER AUTHORIZATION FORM
Emily Brennan
(Owner's Name)
owner of the property located at:
151 Chestnut Street
(Property Address)
Florence, MA 01062
(Property Address)
hereby authorize
Subcontractor(to be filled in by office)
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 subcontractor, 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.
DocuSepned by.
Lii f2v ,
Ow e9`" " i PJIe
6/16/2021 I S:58 PM EDT
Date
RISE Engineering,a Division of Thielsch Engineering, Inc.
60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335
www.RISEengineering.com
City. of Northampton
.�,a 4t+rtA 7`: ;:.:s5 ,,,�;:
Massachusetts A
pt
r
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Straat • Muns.aipal Building Jos �v
Northampton, Mk OlOkr
MANDATORY FOR HOUSES BUIL T BEFORE 1945
Property Address / 67 G -f
Contractor
Name: 'i-....... === - -- r",%0(1.-\: .`i- .J\ --
Address: e,9 4 C_kid `� -'r"vL./,k- V-
City, State: -\-tx-" V-c ‘i• c\v - CD) t--' e
,
Phone: H 13"" ra L 1 - .`' / l
Property Owner
Name: Q n-o t y 'e_r-,rThcci —)
Address: I m 1 -fr. S+
City, State: +" (Su.n.C,A _ , o 1 au
l Pqa J i. �' (contractor) attest and affirm that the building I intend to
insulateoes 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 9- 3,0- -a)
City of Northampton
' Massachusetts *.!/-•
k•,
•
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
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("HIC").
M.G.L.Chapter I42A 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'.LC.`, that entity mast be registered.
• ei0
Type of Work: �� {� r��� ,.,,. 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 building pe t as the agem,of the owner:
_-)%5 '-e%) 4'1 4— ` 5
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
4,-
Massachusetts Ae �,.,
it" ' DEPARTMENT OF BUILDING INSPECTIONS
y 212 Main Street •Munica.pal Building v nay
'.w w '..
Northampton, MA 010604. ,,.
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: •
l .
(Please print house number and street name)
Is to be disposed of at:
as -- e rA ( v,.: ` t- 11 o . ...k. y Y\A
ri(Please print me and loca n of facility)
Or will be disposed of in a dumps r onsite rented or leased frc ( ,.,Lc> TEl �,
81
(Company Name and Address)
-1-' V - .-
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.