17C-092 (13) 122 CHESTNUT ST BP-2016-1231
GIs #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C-092 1CITY 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-2016-1231
Project# JS-2016-002116
Est. Cost: $2315.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOHN PERRIER 105319
Lot Size(sq. ft.): 7013.16 Owner: RITT TOBIN C&LAURA A ST PIERRE
Zoning: URB(100)/ Applicant: JOHN PERRIER
AT. 122 CHESTNUT ST
Applicant Address: Phone: Insurance:
18 BROADWAY POND RD (860) 930-7794 WC
STAFFORD SPRINGSCT06076 ISSUED ON:4/21/2016 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL ATTIC 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 4/21/2016 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2016-1231
i
APPLICANT/CONTACT PERSON JOHN PERRIER
ADDRESS/PHONE 18 BROADWAY POND RD STAFFORD SPRINGS06076(860)930-7794
PROPERTY LOCATION 122 CHESTNUT ST
MAP 17C PARCEL 092 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: INSTALL ATTIC INSULATION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 105319
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN 9RNfATION 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 CommissionPermit DPW Storm Water Management
em el
Sig reBui
o lding ffic al 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.
AP
1 Th Co monwealth of Massachusetts
f B ilding Regul tions and Standards FOR
,ti , AN
ams us s State Building Code,780 CMR MUNICIPALITY
USE
Building Permit Application To Constru t,Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property der ss: 1.2 Assessors Map&Parcel Numbers
l
r1.3
Is this an accepted sued?yes no Map NumberParcel Number
oning Information: 1.4 Property Dimensions:
District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(Mi.—G-1 c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: Outside Flood Zone?
Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
caner'a ecoid: I
Name Print l Y Lp
(Print) Clry,�tate,ZIP
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WOR10(check all that apply)
New Construction❑ Existing Building❑ Owner-Occu ied ❑ Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of units Other ❑ Specify:
Brief Description of Proposed Work 2:
To Add R-38 Insulation too en attic
SECTION 4: ESTIMATED ONSTRUCTION COSTS
Item Estimated Costs: Offfcial Use Only
(Labor and Materials)
1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All F s:$
Check An unCash Amount:
Check No,
6.Total Project Cost: $ �3El Paid in Full 0 Outstanding Balance Due:
NEGH
28 Spellman rd
Please Submit Stafford Springs,Ct
Permits to: 06076
The Coino enweatth �trlamccwnrs
Massachusetts Print�
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DeFartment effn s
Affice erf In stfgatlons
1 Crrngren street,suite IOU
Bvston,MA 02114-2017
www:maysgovfdia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricianar lumbers
lest t Information Print Laft
Name(susinzas1prganitatforandividual):New England Green Homes
Address,18 Bfildmy Fond rd
City/State/Zi :Sfi fts�rd Sptintis Ct phone#:06076
Are you an employer?Check the appropriate box:
1.Q 1 am a cmploycr with 4�^ 4• ❑ i am a general contractor and 1 type°f project{required}:
employees(full and/or part-time).' have hired the sub-contractors d, Q New construction
2.❑ f am a solo proprietor or partner. listed on the attached sheet. 7. []Remodeling
shI and have no to ees These subcontractors have
p amp y 8. Demolition
working for me in any capacity, employees and have workers' 9. Builth addition
[No workers'comp,insunrencs comp,in"rance.t
required.) 5. 0 We are a Corporation and its 10.Q Electrical repairs or additions
3.Q I am a homeowner doingall work officers have exercised their
i 1.E)Plumbing repairs or additions
myself.[No workers' comp, right of exemption per MGL
rs
insumaca required.]t C. 1 S2,§1(4),and we have no 12.t3 Roof rsula
tion
employees.[No workers' 13.Z t�thorinrisuia
comp. insurance requirod.
*Anyapplicant that oheeks box#1 must also flit out the aaotion below showing their workers'compeaution policy information,
t RonfsOwnan who submit this afrtdavit indlostlag they arc doing all work end then hitt outside cvntrsciors roast submit a naw aMdavlt indicatiej such.
tContrectors that check this box mut attached att additiontt sheet showing the name or the sub•cowrsetors and state whetbrr or rat those enthici have
employes. if the sub.contramrs have aatploym,they must provide their wotkars'comp,policy number.
1 am an smployer that is providing mwrkers'compensation insurance for my employe:s. Below Is the policy and Job site
Itaformatlun. f
Insurance Company Name:intego
Policy#or Self ins.Lic.#'NEWCW666 _ � Expiration Cate:08/2016
Job Site Address-AH Streets in �0� i�--h- o/o�2_
CitylStatetLip: __._..__.��
Attach a copy of the workers'compensation poticy declaration,page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 23A of MOL o, 152 can lead to the imposition of cri-viral penalties of a
fine up to$1,540.00 and/or one-year imprisonmcm,as well as civil penalties in tate form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this Statement may be forwarded to the Of'f'ice of
Investigations ofthe DIA for insurance coverage verifioation.
I do hereby cera{ ndrr the PaW and gnat es of
peduryttrdr the tar ornratlon provided above is true and earrtat.
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