43-051 (3) BP-2021-2015
185 PARK HILL RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
43-051-001 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-2021-2015 PERMISSIONISHEREBYGRANTED TO:
Project# INSULATION Contractor: License:
Est. Cost: 800 SDL HOME IMPROVEMENT 103635
Const.Class: Exp.Date:05/20/2023
Use Group: Owner: TREMBLE MARY TRUSTEE
Lot Size (sq.ft.)
Zoning: WSP Applicant: SDL HOME IMPROVEMENT
Applicant Address Phone: Insurance:
24 CHESTNUT ST (413)247-5739 WC9024456
HATFIELD, MA 01038
ISSUED ON:10/12/2021
TO PERFORM THE FOLLO WING WOR K:
INSULATION/WEATH ERIZATI ON
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:
` ' I• O T+,l •
Fees Paid: $6.5.00
212 Main Street,Phone(413) 587-1240,Fax:(413)587-1272
Office of the Building Commissioner
/
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City of Nortltamp n �j'``
,, Building Depart ntOCj
4( ' 212 Main Street
i Room 100 l�` 8 c'049/ TIO1
Northampton. MA 04d
phone 413-587-1240 Fax 4 'i
•���orb o, -
APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY 13WELLING ONLY
SECTION 1 -SITE INFORMATION l NS ULA 1 IO/"1f PERMIT
1,1 Property Atddress' This section to be completed by office
/ �j 3 fll ii !` a Map Lot Unit
01/3,,i1 G r Zone Overlay District
NG11-4/ai---n 'ft-AJ i M 4
Elm 3L District CS District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2,1 Owner of Record:
`�'1'la /r to (-L 1 e S ,I. 401 ie- cl-
-
Name(Pri ) Current Mailing Address:/--SI "711-7
a— c A k- 4--) Telephone
Signature I_
2,2 Authorized Age Pa.vt t s CJ lam- --+
Name(P ) Current Mailing Address:
Signal Telephone
SECTION 3-ESTIMATED CONSTRUCTION COST$
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building '1sco 0' (a)Building Permit Fee
1
2. Electrical (b)Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee 4.(i6
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4 +5) 41 0( 0c ; Check Number A
,/� r This Section For Official Use Only
Building Permit Number ? e A ` r (�Q v`� Date
Issued:
19 1./.Signature /0 1Z-ZU Z i
Building Commissioner/inspector of Buildings Data
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 4- ?„:. y s , z , i,~ a.
Si Licensed Not Applicable 0
II/ au d 1— C- - 'D. 03 S
License NDa ber
Asi2.4 hi cinui- -s-i- 44 -f-ce id/ ni 4 cios" ,6--- .10 1 Q
te
--ZA /3- V 9-.5 73,
gnature Telephone
'� .dam....., y g, ., Not Applicable 0
�- /V >
u,-�ci ,._zr �_. .., i•. - paAttin.S...../tegistration Number
LI /a•5
Address E xprra#+e�ate
k i . `.i'C_18, h'VA 010 a" TelephorI(3-a41''7.579
SECTION 5-WORKERS'COMPENSATION INSURANCE AFFIDAVIT MALL c.152,f 28C($))
Workers Compensation Insurance affide must be completed and submitted with this application.Failure to provide this affidavit will result
in the denial of the Issuance of the but permit.
Signed Affidavit Attached Yes No......
Brief Description of Proposed Work NOTE: INSULATION ONLY
Kh_e� �i I I,�a.0 l s,
1. c)tItt t a' \fix (" ,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.
Prit.d. ' C., cam- �O * t:fit... '—. 1 ` !' '.rr-Y e. 'k-- (il,,)(1.4.(14C;40c-S, is
Print Name
Signatur Agent Date
i, L__x_ , as Owner of the subject
property
hereby authorize
to act n my behalf,in all mratf are relative to wo authorized by this building permit application.
Sc '- --- .. CA-+F c- -4--- / U — S -Q-!
Signature of Owner Date
Permit Authorization •
mass save Form
thx91-,er:c,r¢gp +,^i„',.W,Ki
Site ID: 4319461 Customer: MARY R TREMBLE
Mary R Tremble , owner of the property located at:
(Owner's Name,printed)
185 Park Hill Rd Northampton, MA 01062
(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.
Owner's Signature: /Mary Tietta
Date: 09 / 28 / 2021
9060.000S SS ASS S6,40.** 6**16,0604555551y51S% 1I6 561st%ti�
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 Office Use Only
Document Ref:2B2VE-USXPS-WOJZX-6PPE5 Page 6 of 6
City of Northampton
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-- . Massachusetts 4...
Ai
t. l'r . '' ' ' DEPARTMENT OF BUILDING INSPECTIONS x
, 212 Main Street *Municipal Building ,..E. ,3r
Northampton, MA 01060 '
' ''''•!''.'.”, 4.' . ;*
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:
/ 3—
(Please print house number and street name)
Is to be disposed of at:
UA' 12p CA-4 (LUC rA C LA Cii?„(: -k f' -t-' -k- eXt
''''' ,Cr-t-t, cA IY\0
(Please print n4me and Inca n of facility)' --
Or will be disposed of in a dumps ter onsite rented or leased frnny
C .3_:: C ) .--- e---
,
...
5\- --V\-co-cre 0 \(-\( .14;. Cl
(Company Name and Address)
,
....------
/ 4.) — S--- — I
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 4
, r
Yl;
DEPARTMENT OF BUILDING INSPECTIONS z'
212 Main. Stream • MUnicipal Building �• , �'
Northampton. M71 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 142A 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.
Vote:If the homeowner has contracted with a corporation or LLC,',that entity must be registered
of
'Type of Work: In., Est. Cost: Roo
Address of Work: I a '-41'1\ IQ
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 UNTO 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 pewit as thegent of the o
rAtk), xfir
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
N.
¢, City. of Northampton
KN
Massachusetts {t
i.
DEPARTMENT OF BUILDING INSPECTIONS 4",
mar 212 Main Street • Municipal Building `''b;,. ;`t'v
Northampton, MA 0106r
MANDATORY FOR HOUSES BUIL T BEFORE 1945
Property Address i D 5 Prt
"tl [ I a_
Contractor
Name: ti. CASi., 0 cr\ -1"vz.. -- —.
Address: ,-,9 14 ( 1AL _Sk-r'l LA. ._ \
City, State: -\\ 1 1 - CD\ u
Phone: )``" 1 .5- *a 'i 1 - ,4`� 1
Property Owner Tr- I
Name: t t �'�.w�b(-.-A.--
Address: ar1 r" l 9
City, State: N Ul 1A'N[Yrr,tP c I
I, ati[ ,i-,AN\,,,- r '" (contractor) attest and affirm that the building 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
Date / v _ .0--,0- I