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':-17. , r., .7,7.:..i.- 4....7:--...--,..-1.:-.----7.Es.7.4v-v-vix..:r E.Eizaa:11-3/..ag,"ialspecter ill ii ti :7•;.,en..4: ■—.. 3 o a--.: o- 3 . z -s; --Th:- -, - ConNtrucutin cmpeni,mr speci:iir, ,),i,i,„, ,,,,:cia,„ CSSL-103443 i _ s.ss:-s s, CSSL-101880 JAY R BOLAND JAY R BOLAND 12 PISGAH RD 12 PISGAH RD .1 HUNTINGTON MA 01050 HUNTINGTON MA 01050 9:4,..... ...JY..3e4,--- 12127/2014 _ 12/27/2014 s,;-„, it///z-, • •„-,./.)17. if 1,9 ft; '2,0 22 lItg(1 i •i'l, a.6 t' C.,LA JJ z,, ...,-,c,bt., ui. e,„, '. --- -;-- _-:- WI Office of Consumer Affairs and Business Regulation io Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 164603 Type: DBA Expiration: 10/2612015 Tr# 244106 HOME ENERGY SOLUTIONS JAY BOLAND _ --—- 12 PISGAH RD. HUNTINGTON, MA 01050 —— — Update Address and return card.Mark reason for change. SCA 1 0 20M-05111 ::: Address ;7 Renewal Employment ri Lost Card P--3:17;( t"rillar,,ittperild e/17 lailaikedmo-//, Office of Consumer Affairs&Business Regulation License or registration valid for individul use only _.„ 'jr-" -t,ROME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 164603 Type: Office of Consumer Affairs and Business Regulation Expiration: 10/26/2015 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 HOME ENERGY SOLUTIONS JAY BOLAND (----7 HUTINNGTON,MA 01050 Undersecretary Not alt.i 1% ■ t sit:mature __ ON .0„,„....N. ettA mass 51V@ -4•4111.- PERMIT AUTHORIZATION FORM 1, (pv+11;s SI b pis , owner of the property located at: (Owner's Name, printed) ! 1Z0 (Ohs ,qtwoii A I •144 i ayk.. 4 s (Property Street Address) (City/Town) 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 grope 1 go r Owner's Signs ure Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Rev. 12132012 r SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: \ Not Applicable ❑ Name of License Holder: , 'o�� CAL 1 Di J License Number Addrisi Expiration ate n MA oioca Signature j Telephone ,Vr 4 , . 444.111i qt-3-06,---i-51 30 o x� i ate' , "'` Td .g7 `4 x` s roar n ` 1,�r.�..,_: N, �.�,` �.'� �,.�..Z Not Applicable ❑ 0-Drr) ner e, 0 r,. OC)S log tto Com an Name Registrati Numb r L) Pl (5 )O1D4? JI Add ess ' // // Expiration Date (4,c" -Al n 0 in A U I a`r 0 Telephone 111 lI(fl � S — SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the build' permit. Signed Affidavit Attached Yes l No ❑ The current exemption for"homeowners"was extended to include Owner-occupied Dwellings 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 1083.5.1. Definition of Homeowner:Person(s)who own a parcel of land on which he/she 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.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she 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,you 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 Massachusetts General Laws Annotated. Homeowner Signature 4 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors D Accessory Bldg. ❑ Demolition El New Signs [D] Decks [[] Siding ID] Other[0] Brief Description of Proposedi . 7 Work: Pb U I S O :) bael r< Q-4 I1 L2.,( l - �� ■Cl Alteration of existing bedroom Yes ./ No Adding new bedroom Y No Attached Narrative Renovating unfinished basement' es No Plans Attached Roll -Sheet a. Use of building:One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garag- .ttached? d. Proposed Square foo .•e 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 • 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. I. 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 CA./&an S ) j ,as Owner of the subject property _ hereby authorize 72 - - 1�t1 `f'C11 7 !�—' +7 O(1 •45 to act on my behalf,in aattersr lative to work authorized by this building permit application. Signature of Owner Date I, b\ y� ,as Owner/Authorized 9 � Agent here dec re 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. 1'i Print Name • L , 14! e • Signature of Owner/A t Date << -(P Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size 1 , 7 z p Frontage i i Setbacks Front Side Li —, R:? i L: R: i -- Rear =1 Building Height = 7-1 __. t- Bldg. Square Footage --- --i % -- = J i s Open Space Footage (Lot area minus bldg&paved j i i parking) #of Parking Spaces i ; ! .. Fill: I ,- — ..a.— €; , ..-- —,. (volume&Location) _t A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued:! j AtesairliV' '' IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 ,t IF YES: enter Book € a Pagel j and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW 0 YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained © , Date Issued C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: f D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO 0 IF YES, describe size, type and location: : J E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. 0 Rx t City of Northampton ;. ® 1` �� ' Building Department " k` - 12 Main Street it =, \� � `Z '�`'� Room 100 ..E�„ 1 \`„°�,', Q�G Nortti pton MA 01060 $ ” U\i\ -phone 413-587-1240 Fax 413-587-1272 ,_4 t ` K Ens c ( d ,, „. a . < ICATION 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 D�i l Ok Ma Lot - Unit one Overlay District k �N I o ff'�, 1c` r C/k O t aQ 0 Elm St.District GB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owne f Record: (.r l 3 u t S 1 au Gbl.e 3 Me C1i(DLO ` I Name(Print) Cu ®I1 ,1.cjdresas m j _ m - , ` f�^y _� G�� Tele�n (��°O((/��� �- 1 V � � l�r tJ L .C� Signature ...s.-- ` q 2.2 Auth rized Agent: J ib 1 can A t Pl,sas .e .0.L\8_, Name(Pant) C ent Mails g d ir°ss. 4 b I(3 S� Signature Tele hone ) p ?�— [x(07 3i ?S(° SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building &DO �/� (a)Building Permit Fee 2. Electrical of Cam- (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+5) Check Number C 6 066 This Section For Official Use Only Date Building Permit Number. Issued: Signature: Building Commissioner/Inspectorof Buildings Date File#BP-2014-0684 APPLICANT/CONTACT PERSON JAY BOLAND ADDRESS/PHONE 12 PISGAH RD HUNTINGTON (413)214-2414 PROPERTY LOCATION 120 COLES MEADOW RD MAP 13 PARCEL 101 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Q�� Fee Paid n Typeof Construction: INSTALL KNEEWALL INSULATION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 101880 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO TION PRESENTED: pproved 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 e . . .w►delay #411117_ Signature of Building 0 ficial 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. 120 COLES MEADOW RD BP-2014-0684 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 13- 101 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# B P-2014-0684 Project# JS-2014-001163 Est.Cost: $2000.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JAY BOLAND 101880 Lot Size(sq.ft.): 71 177.04 Owner: SUOPIS CYNTHIA A&SALLY BELLEROSE Zoning: Applicant: JAY BOLAND AT: 120 COLES MEADOW RD Applicant Address: Phone: Insurance: 12 PISGAH RD (413) 214-2414 WC HUNTINGTONMAO1050 ISSUED ON:12/5/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL KNEEWALL 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. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 12/5/2013 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner