17C-140 City of Northampton
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Massachusetts
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y DEPARTMENT OF BUILDING INSPECTIONS r
� � 212 Main Street • Municipal Building
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Northampton, MA 01060 �t1 3' "0�
Property Address: t t1 i\' cT, fongirNC't A i
Contractor
Name: r ' SLt -h1R 1'
Address: 3 Z`4 GlAtC C-
City, State: (.71 VIATN 6 I M1it A" 6 I, I
Phone: E1 ) /J - i g E 61 5
Property Owner
Name: 114'1144 (r( --
Address: (P id. 1 V S
City, State: il/Ovrkr ui" / PA
I, mtwL ,i441144 0 Y" (contractor) attest and affirm that the building I intend to
insu.ate does not have any a. -n air (knob and tube) wiring in the spaces to be insulated and that I have
provided the property own-r wit a c of th . affidavit.
Al
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Contractor signature 1 ilp
Date
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,
I SECTION 8 • CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: -'' able ❑
Name of License Holder : _ _-_ - Licensed Construction Supervisor:
Paul Schmidt mLa =*
24 Chestnut Si.
— _. ---__. ___-- — llatfield. MA 01038 1�',r,tt. ._
fwr
�'' CS 41103635 U
.' L c.- _ __.._ -Exp. 5/20/2013
sv,i1111c Telephone 413 -772 -8898 (1--
9. Registered Home Improvement Contractor: None Improvement Contractor: • l +cable b
Company Name Co -op Power Inc. / Paul Schmidt
324 Wells St. Lion Number
Greenfield, MA 61301
___ _ _ 31 165217 Ii .m Date
Address Exp. 1 /2112 a tq
413-772-8898
t SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, §25C(6)) l
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
- ! h the denial of the issuance of the bullring permit
Signed Affidavit Attached Yes- . - - -.. Q'' No... _. ❑
11. - Home Owner Exemption
The current exemption for "homeowners" was extended to include Owner- occupied Dwetlines of one (1) or two(2) families
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor. CMR.780, Sixth Edition Section 108.3.5.1.
Definition of Ilomeowner: Person (s) who own a parcel of land on which hesbe resides or intends to reside, on which there
is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm
structures. ; 1, person who constructs more than one home in a two -veer period shall not he considered a homeowner.
Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that helsbe shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, von may be liable for person(s)
you hire to perform work for you under this- permit.
The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, State and Local Zoning Laws and State of General Laws Annotated.
Homeowner Signature
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House 1 j Addition ❑ Replacement Windows Alteration(s) r Roofing n
Or Doors 0
Accessory Bldg. ❑ Demolition I I New Signs jQj Decks ( Siding ED] Other
Brief Description of Proposed � , v`
. Work: At , V
Alteration of existing bedroom Yes " Adding new bedroom Yes ..'"' /
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll r - Sheet
ea. If New house and or addition to existing housing, complete the following: .
a. Use of building : One Family • Two Family - Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
1. Septic Tank City Sewer Private well City water Supply
SECTION Ta - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT '
I 7 C4 - `l. 11-x' , as Owner of the subject
property
hereby authorize :45 ---p f i D ` � e' e'/
to y behalf, in all matters relative to work authorized by this building permit application.
, e .y. ___
Signature of Owner Date
I 14" L KR ? Co - ' l ; 1 nvo , as Owner /Authorized
Agent hereby declare that the stateme is and info ati on the foregoing application are true and accurate, to the best of my knowledge
and belief
Signed un er the . - = nd penalties of perjury
L
4dd � eel
Print Na e if s //6
// 2—
i ure o T /err ent " Date
S gnat �,, Ag ��
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1 Section •4. ZONING II ALL Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing j Yropmed ' Required by Zoning gg
TIM rohimn is to; filind in by 4 _
._.____.___._ -_.
Building Llcp °�7tmisr t r
Lo: Size .. .. - _ .. _.__
Frontage
Setbacks Front
Sloe 1.: 1': L'- i <:_
12rr
Building Reiglu .
bldg. Square Footage %
• Open Space Footage `!c
(l a: •tr.^ minus bldg & jevcd .
p a:iitg)
ii of Parking Spaces
Fill:
(volume - at Location) II _ . . -
A. Has a Special Permit /Variance /Finding er been issued for /on the site?
NO 0 DONT KNOW YES Q .
IF YES, date issued:: {
IF YES: Was the permit recorded at the R stry of Deeds?
NO 0 DONT KNOW YES 0
IF YES: enter Book . Page. and /or Document #
B. Does the site contain a brook,-body of water or wetlands? NO Q DONT KNOW YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO V
IF YES, describe size, type and location: ;
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO
IF YES, describe size, type and location:
E. Mil the construction activity disturb (clearing, grading a ation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
t .
RE�CElVEl� A- 4-t--0 �� l�fMt.,��
Department use only
r Lb ? 3 2012 City of Northampton status of Permit:
:: L at WILDING INSPECTIONli
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer /Septic Availability
NORTHAMPTON. (NAotoeo
Room 100 Water!Well Availability
' Northampton, MA 01060 Two Sets of Structural Plans
phone.413 587 - 11240 Fax 413 587 - 1272 Plot/Site Plans
Other Specify '
r - APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1,1 Property Address: This section to be completed by office
i J N / _ . 1/Y t I( S t •
. Map_____ Lot Unit
• ,/ / � � Zone Overlay District
16 t 2h � v 7 � " �/' r �/� . I 0 WC Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
POI cfriii . k Ra ., - C .4
Name (Print) Current Mailing Address:
Telephone
Siprrature ... A+ / /04.
2.2 Authorized Ascent:
' .tAs Sk /.. • Co- o' ,o.we.L 3Z1 Wells St- n'4 nrIR
Name Prints
Current Mailing Address: �q�Qq 01 3 t o
Signature f Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
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 + + 5) it 2. , CO Check Number 919 C27 21 56
This Section For Official Use Only
Building Permit Number: Date
issued:
Signature:
Building Commissioner /Inspector of Buildings Date
r
j-I ova ��� cone
File # BP-2012-0742 Co °? (1°°
APPLICANT /CONTACT PERSON PAUL SCHMIDT p U
ADDRESS/PHONE 24 CHESTNUT ST HATFIELD (413) 247 -5739 I K �pPj 1
PROPERTY LOCATION 46 NORTH MAPLE ST � `'� 4
MAP 17C PARCEL 140 001 ZONE URB(100)/ p (i e° 2
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid 30 a 9
Typeof Construction: INSULATION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 103635
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
I/ ZATION PRESENTED:
Approved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND /OR Special Permit With Site Plan
Major Project: Site Plan AND /OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received & Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
2 /)‘''' 1
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health, Conservation Commission, Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning & Development for more information.
46 NORTH MAPLE ST BP- 2012 -0742
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C - 140 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit # BP- 2012 -0742
Project # JS- 2012 - 001300
Est. Cost: $2096.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: PAUL SCHMIDT 103635
Lot Size(sq. ft.): 9931.68 Owner: RONDEAU PATRICK D & KRISTA S
Zoning: URB(100)/ Applicant: PAUL SCHMIDT
AT: 46 NORTH MAPLE ST
Applicant Address: Phone: Insurance:
24 CHESTNUT ST (413) 247 -5739 WC
HATFIELDMA01038 ISSUED ON:4/9/2012 0:00:00
TO PERFORM THE FOLLOWING WORK: I NSU LATI 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.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 4/9/2012 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner