32C-254 (5) 49 WILLIAMS ST BP-2017-0177
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C-254 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-2017-0177
Project# JS-2017-000288
Est. Cost: $2800.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Cong. Class: Contractor: License:
Use Group: PAUL SCHMIDT 103635
Lot siae(sn.ft.): 4617.36 Owner: YENNER WILLIAM
Zoning: URC(I00)/ Applicant: PAUL SCHMIDT
AT: 49 WILLIAMS ST
Applicant Address: Phone: Insurance:
24 CHESTNUT ST (413)247-5739 WC
HATFIELDMA01038 ISSUED ON:8/11/2016 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 8/11/2016 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0177
APPLICANT/CONTACT PERSON PAUL SCHMIDT
ADDRESS/PHONE 24 CHESTNUT ST HATFIELD01038(413)247-5739
PROPERTY LOCATION 49 WILLIAMS ST
MAP 32C PARCEL 254 001 ZONE URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT `/6` _
Fee Paid 1)` litallc
Buildin• Perini Filled out
Fee Paid
TypeofConstruction: INSTALL ATTIC INSULATION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owned Statement or License 103635
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOIjMATION PRESENTED:
r/Ipproved 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
Dem?,
Sig . tire 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.
City of Northampton
lig co :: Building Department
�, ES w ii 212 Main Street
I
(,rCRoom 100
., 9 i Northampton, MA 01060 `.
p d, - 413-587-1240 Fax 413-587-1272
a
teTa
APPLICATION O .,
SECTION:1 -SITE INFORMATION
1.1 Properly Address: � � s e
�q ` / kui7S(4ms bt
m� O)o(o0
,��rine)m� zons ;oer��rwrc .
Y _ dratGeoid: . . ysElloOko;-,
SECTION 2-PROPERTY OfAUINOR2ED AGENT 1
1 of
I fam / fl4-/ llj r„hK.c�1 A‘ 1t l c� �
Name(Pn Currenntnt cling Addnats' / PrarIC�� rn. l f`rr/'
ca ft— / '�y/
Signature i ` I
2.2 Authorized Apert: Sbl— Pa3'Emile. r\-±-
'A
u eil(- -t- a Cnp4n,.-t-- S+-.--e,fi eIcl Ins
Name(Print) .. Current Mailing Address:
/7 (AY � l/ >�1.- ,- �✓%573�j
Signatures' Telephone
SECTIO/3-ESS1ll'FWD(OBTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Buildieg 300- 6°
(a)Bulking Permit Fee
2. Electrical (b)Estimated Total Cast of
Coraeuction from(6)
3. Plumbing Banana Pemdt Fee
4. Mechanical(FNAC)
5. Fire Protection ,L
6. Total=(1 +2+3+4+5) n(Uy.nU ,a0 Check Number /qqs S(6j
This Section For Official Use Onty
Building Permit Numtec Ike
Issued:
Signature:
Budde®ConsnissionerAnspector of Buildings Date
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 _.
Frontage _
Setbacks Front
Side L:. It L:
Rear -
Building Height
Bldg.Square Footage
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
f (volume&location) — — -
A. Has a Special Permit/Variance/Findin ver been issued for/on the site?
NO Q DONT KNOW 9 YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW YES Q
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW rera YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q , Date Issued:
C. Do any signs exist on the property? YES NO ®�
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO 0"-II
IF YES, describe size, type and Location:
E. Wil the construction activity disturb(clearing, grading,ex atian,or filling)over I acre oris ft part of a common plan
that will disturb over acre? YES Q NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors El
Accessory Bldg. ❑ Demolition 0 New Signs [0] Decks [0 Slding]p] Other[
�n� h ,_i
llm- �
Brief Description of Proposed �' Jen_C-i my ta '
Work: S `S' + I/ �. / t�. te
- !.e e • • iii!,..x. AY spat
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes /No
Plans Attached Roll -Sheet
sa.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 -Hands? Yes No. Is construction within 100 yr. floodplain Yes_No
j. Depth of basement or cell- floor below finished grade
k. Will building conform the Building and Zoning regulations? Yes No.
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRA TOR APPLIES FOR BUILDING PERMIT
I, A It ( a kr) A • i __ _ ,as owner of the subject
property G( �D
hereby authorize lDL - hvi O✓TVe-in-en"4- eerrr ie--- 4-Sl lC°-�.
to act on my behalf, in all matters relative to work abtho'zed by this building permit application.
Sze a -1-at 4vi_ a_ R I (p
Signature of Omer Date
I, �'giU-I Y1ttar& 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.
—lIrl EckniCH
Print Name
�/! - I Le
Signe re ot�Agen( Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor:�j� Not Applicable 0
Name of License Holder: —Eau/ Sdi ti L± I 0 3 Ce 3 5
License Number
(ks-kntti , �a+�rc(d {ti1f4 o oS SAP-6//r
Address Expiration Date
17/3 - aft-57,3 9
ignature Telephone
TOOaWsisl ... wOx `. :a ,/ Not Applicable ❑`
S !-- - MUNi2n1e/If l/.cal-retekgs, -YAC. / 74/17/
Company Name II Registration Number
l
0214 .h.�s+7,.L.Ct �sf-rw oz / -r/ a'7
Address Expiration Date
I YY1,4 0! 036 Telephonel1/239g15739
SECTIIN!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 buildin permit.
Signed Affidavit Attached Yes Na. .. .. 0
I => Velirlatteetbaniffien
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 108.3.5.1.
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
The Commonwealth of Massachusetts
Department ofIndustrial Accidents
r_ . . > I Congress Street,Suite 100
Roston, MA 02114-2017
www.ma.ss.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO RE TILED WITH THE PERMITTING AUTHORITY.
.Applicant Information Please Print Le¢ibty
Name(Business Organization Individual): SOL Home Improvement Contractors, Inc
Address: 24 Chestnut Street
City/State'Zip: Hatfield, MA 01038 Phone r: 413-247-5739
are toy an employer?Check the appropriate boa: Type of project(required):
❑t ars emnl u . 8 pl yees,full ant or part-4 rmI.' ' 7. ❑New constrain-non
-pt am a oI -prop tor or pannexhtp and hase no employees oItfng Mr ln m 8, ❑Remodeling
ant capacity No b insurance required
9. ❑Demolition
❑I m a he domg all work rtssolf [N p tnsarartrat requiredei
amhomeownerwill6 h g t d l ,k p P I id IO ID Building addition
!❑I
ensurethat all convouom either base workers'comp n s,.r'a we m are ale I .❑Electrical repairs or additions
proprietors with no employees
12 Plumbing repairs or additions
5 inn a general contracwr and I haw hired the SLII,' t dined on the aached sheet I,i Roof repairs
These sub-comrmrnrs have employees and have workers comp. .:rano.'
14.❑r Other Insulation
b owe are a corporation and its officer's Nate exercised melt nghtof c empton per MGT c. "'—
._;INt and we haver empkyees.[No workerscompmacrame requiredf { --
'Am applicantot cheeksF . i must also 111 out thesection below h IN theft k 'COISPeosatronmformallon
Ho tow tiers who a lni t this a ft dant 'd' ne_e chin area all wvwed(and el Ire outside too urs must submit a new affidavit indicating snuh.
roc that cheek this box must attached an cheet show mg Mc name of the sub-contractors and state whether or not those entities hate
employees If the subcontractors haveentptoyees.they must protide their worker comp_poppy number
I am an employer that is providing workers'compensation insurance for my employees. Below is the milky and job site
information.
Insurance Company Name: Selective Insurance Co
i -
Policy m or Self-Ins, Lie r.: WC9024455 Enpirauon Date: 23)2017
lob Site Address: .�ins _. City/SraterZip: k tB1 111 a 6a
Attach a copy of the workers'compensation policy declaration page(showing the policy n ber and expire r on da e).
Eailw to secure coverage as required under MMGI.c. ,i_.;25.A is a crimin l violation punishable by a fine up to S7,500.00
and or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
dao against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify yadar the pr s and penalties of perjury that the information provided above is true and correct
�f` , p
Signature: .? % aI re __.... —.. Date: b 7 '/`/g' ._
Phone=: 413-247-5739
Official use only. Do not write in this area,to he completed by thy Or town official
City or Town: Permit/License
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.CiniTown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other ._
Contact Person: Phone#:
City of Northampton
4s .
4_.
Massachusetts f
H ,
DILEaFEICIl .. 220129IClla..
.y
212 lain at ap • laoiat010 andin0 v J'
\_ Northampton, la 01060 ' r—iril
Property Address: 1fq¢ 5-' (,Lkl1IOW).s LS-f"
Contract
Name: « S\h
L. LYYyYci�1�re.M l-en-l• ,I� ani is :rale-
•
1
Address: ra LI ,�YS-t'h(.G�' .moi'(2.2"t'
t-t
city, State: CtiTitici , tY A C1° &'
Phone: '41.3\- a4.1-5739
Nroperty()artier ( (Q1I I l i a rr) 7i n rk1 /"..--
Address:
Address: (i t 9FL-54:2.c i —1 I 1 g-c1
City, State: t '�� I at-in CO P . ` A o o LC
I,'tltt l 5r-vn i d:4' (contractor)attest and affirm that the building I intend to
insulate does not have any open air(knob and tube)wring in the spaces to be insulated and that I have
provided the property owner
wkh a copy of this affidavit.
Corrtractarsigr re y
Date /!// �� /
g- 1.f. Ca
OWNER AUTHORIZATION FORM
wIf tient. 7ert(,t2Y
(Owner's Name)
owner of the property located at \\
(154' rOISC
( 2 /0°' y9wsl4 ) : s 5l 9
(Property Address)
A16,-4-4 A
(Property Address)
614AA_k)
hereby authorize
(Subcontractor)
an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building
permit and to perform work on my property.
•
Owners Signatu
a-23-/6
Date