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17A-007 31 LEENOTER BP-2017-0185 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-007 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-2017-0185 Project# JS-2017-000301 Est. Cost: $2872.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Cons.Class: Contractor: License: Use Group: URBAN & SONS INSULATION CO INC 106062 Lot Size(sq.it): 13503.60 Owner: RYAN-WISE MAUREEN zoninv: R1(1001/URA(100)/WSP(100)/ Applicant: URBAN & SONS INSULATION CO INC AT: 31 LEENOTER Applicant Address: Phone: Insurance: 385 LIBERTY ST (413) 732-3922 WC SPRI NGFI ELDMA01104 ISSUED ON:8/11/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL WALL 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: 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 8/11/20160:00:00 565.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-0185 APPLICANT/CONTACT PERSON URBAN&SONS INSULATION CO INC ADDRESS/PHONE 385 LIBERTY ST SPRINGFIELD01104(413)732-3922 PROPERTY LOCATION 31 LEENO TER MAP 17A PARCEL 007 001 ZONE RI(100)/URA(100)/WSP(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 Tvoeof Construction: INSTALL WALL INSULATION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 106062 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 Dela Sign of Building Official Dale 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 40k Contact Office of Planning&Development for more information. tsuiiatng Department Gs-a ° 212 Main Street Room 100 -"'- R CENED ampton, MA 01060 phon; 41 :7-1240 Fax413-587-1272 r ,y' f 111 APPLICATION TO��,,,,�� '' CT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING rene/OtNF7N This section to be completed by office 1.1 Property Address: 3/ Map Lot Unit $lode - Dfelo4�,' SD L Calxet SECTIO14.2-PROPERTY OWNERSHIPIAUTHORIZH)AGENf -. 2.1 Owner of Record: Name(PAN) Cogent AtaIng Address: Signature Telephone -, \ 22 Authorized AoeuV CDN-/. Y€�; yZ—ry SQ�Li� \\)\k Name(Print) Current Mating Address. Signature Telephone SECTION 3-ESTNMTED;CONSmilarON-COSTS- ' - Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Buiding Parrott Fee - 2. Electrical (b)Es rnabadTotal Cost of Cambodian from(6) : 3. Plumbing BulldingFern*Fee _ - -. 4. Mechanical(HVAC) 5.Are Protection fi. Tofal=(1 +2+3+4+5) y 5<66 ! Check.Maybe 17649 1 ' This Section For Official Use Only Date Budding Permit Number :. Issued: Signature: . Budig Commisarooe gnspector of Buddirgs Date ... Section 4. ZONING AU Information Mot Be Completed.Permit Can Be Denied Due To Incomplete Information •M t, Existing Proposed Required by Zoning Ilia column to be fitted in by Building Department Lot Size Frontage Setbacks Front Side L: I it: L: I �)I Rear Building Height I Bldg.Square Footage Ye Open Space Footage Ye (Luton minus bldg&lave I I--I Paling) #of Parking Spaces Pith I r (v*Fne&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW YES IF YES,date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW 0 YES IF YES: enter Books I Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES 0 NO IF YES,describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES © NO CD IF YES, describe size, type and location: E. Will the construction adivity disturb(dealing,grading,excavation,or filling)over t acre or is it part of a common plan that will disturb over t acre? YES Q NO 117 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTIONOF PROPOSED WORK(cheekaltapoli abte) New House ❑ Addition ❑ Replacement Windows arration(s) D Roofing ❑ �Doors Accessory Bldg. 0 Demolition D New Signs [O] Decks TO Siding OD] Other[151 wodcDesrnption of Proposed y-c\ �-t i 1'S Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No QQPlans Attached Roll -Sheet `Ror at moi'.sv'�,.r _ Tj. Y Y '-v�d. ]% „R i• a. Use of building:One Family N. 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 consWcfon. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woods u es Number of each 9. Energy Conservation Compliance. Masschedc 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 eerier floor below finished grade k. Wiillbuilding conform to the Building and Zoning regulations? Yes No I Septic Tank_ City Sewer Private well City water Supply SECTION 7a-OWNER AIRRORIrMIOIL-TOME,COMPL.Eim WHEN OWNERS AGENT OR CONTRACTOR APPLIES FORRZWLDINGPERYfl r •` 4 b< _. .. as Owner of the subject Property \ / ��{�i ��/9 hereby authors �SrSd-1 �-S—ssn�S ms`s \sot tc Y ` \ / to act on my behalf,in all matters relative to work authorized by this building permit application. \, Signature of Owner Date �' \\7 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 :lies of perjury. 9\oM \y Prim Name \� z Signature of e ' '.'Agent Date SECTION S•CONSTRUCTIONS S.t Llearaed Gpnshuetlon SuaeMsor:- Not Applies:He N hamskanrlfolder: V b� License Nom^— ' S� �t l S� �o-l� 'cS Address -Expiration Date Signature Telephone __- ...,`_ ." ,. :H," -m; -tete;:' 4t' Zu`-1,' Not Applicable ❑ Ca.aar.N oe Registration Number Vitt s ALOUD • Address Expiration Date. TSephpneT .'- '. SECTION11kWORKER$L CWENSATMONINSURANCE AFFIDAVIT(MGL ci"Ma ,S 2CS1n Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit rill result in the denial of the issuance of the big sem*. Signed MidavilAttached Yes lit, No a {i'11er � gfu; The current exemption fin"homeowners"was extended to include Owner-oeeeo'sd OwelSees of one(I) or two(2)families and to allow such homeowner to engage an individual for hive who does not posses a license,provided that the owner acts as a*ervupr.CMH 7S5. Sixth Rain Section 101113.S.7. 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&nn structures.A name who constructs more then one home 1n a two-vs period shall not be considered a homeowner. Such 1isnatorner'shall submit to the Building Official,on a form acceptable to the Building Official,that bdshe shall be fesm>athk for e8 sash work performed*oder the bandine permit. As acting Construction Snpervber 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 portents) 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 Sigartere - The Commonwealth of Massachusetts Depmament of Industrial Accidents Office of Investigations krj 600 Washington Street Boston,MA 02111 - - www.massgov/dia- • - -Workers' Compensation Insurance Affidavit:Btulders/Confractocs/Electricians/Plnmben Applicant InformationPlease Print Legibly Name(Bt tt7tg�ti victual):.' s�j --SS i sr 10A } -Address: `--Sr—t\ j J ,S7 - , - City/State/Zip: d+1\i\UV 1 AL-Phone#: i3t--. •n1 c -c.. Are you an employer?Cheek the appropriate'bos: - Type awoke(requited): / 1 ffl I am a employer with t 4. Q l am a general coni actor and! 6. 0 New coisnuSon employees(full and/or part-time).: have lined the sub-c®tacm�s 2_01 am a bole proprietororperkier- listed onthe'attached sheet 7. ❑.R®ndeling shgramdhare=eaPkYees These snb-c nnlndorz have S. Q�a ou - .. working flame many, city. - a1414--t14Lave workers' 9 0 TraiaiCt arcriaCIn [No wadmrs'comp imam= - tMoisedi 5. Q We are a° °o�n and its - 10.QH •l repaia mad&tiam 3.0 1 am a homeowner doing all work arms have their . 11.0 Plumbing repairs or additions ow camp right Ofexemptioaper MG. .L }Mammas ere ]tc' 152,§1(41 and weravem13:g etheTNzi[b aemployees.(No workers' - 'AM'aPPEataatrt Mb bar#1:n t Sar oRtbeatian bckerstowing airwave a®pmveum poLyidemttm. - - tHmmvmswho mFmtthis a [m&rsdIv-I yvedeugaa nkaea tam lint allsi3ecoatracion vast saute aaew4 davitMelmgsuch Waomcaas*az d kt,box mintamr2ed madEtima tet siwerintb<®e ofthe mhmsaews adip¢vtabenotthi -base eapluyc¢WPoe sd s Ian enip1030,4taey�pt ek tee camµjw&cnumben - . _ 1"am an easployeithat ispreddmg workers'cngiaseroa insansnee.formj'employees Mow unit policy ladjob-sfre Wormalima Insurance Company NamrTC. �\V 11- . - \. Policy/urSelf-roar Ian#: \,s 1• ---S( ���S OW::> b�EiPation D -t\-�— i-.\� _�\,O b,. lob Site Addrea:.° \-: H C) \ a‹. - � P r t--aJt C.f_ a�� Attach a copy of the worker,-ampeasation policy dedanlon Page(showing the ppley n®bat and atint!on date).. Failure tosecure coveageai resmila mals StxLod25A3fMGL'c152 tmm kW—tithe intpohtlon orerinaluapaartasdfa fineup to$1,500.00 andfor one-yeat mtprisonmeq'as well as anlp®abies m the Bonn ofd S1DPvipimaRD€paa4a Ent of up to5250.00 a dayagannadae vtnietn. Be avcd St acEw of fins stateaoe=may be fotwardedtothe Offirsof . ia`vfsnnnonsv the ,A . . . m cove�`e _ . 1du hereLy cutify ands y`-... ' rhafthemforasadan prewaL-d _e-. :*r .... \ w. ..on Phonefi:Th 3L ----.. ck --. _ - Ofjremf we only. nog wale in thbno,to be con by city ertawa ufjaiai City or Town_ - - Permi0itcense/ Issuing Authority(circle one): :1.Board of Health 2 Building Department 3.Citytfown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other F - Contact Person: Phone/:. HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines"Homeowner"as, "Person(s) who owns a parcel on which he/she resides or intends to be, a one or two family dwelling, attachedordetached 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 home owner." The building department for the City of Northampton wants person(s)who seek to use the home owner exemption,-to act as their own construction supervisor,rube aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that thebuilding-department be called to inspect work at various stages,which include foundation/footings(before backfill), sonotube holes (before pour).a rough building inspection(before work is concealed),insulation inspection(if reoured)and a final building inspection.The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a kite of occupancy until the work can be inspected. lithe homeowner hires other trades to perform work(electrical,plumbing&Ems)the homeowner will beresponsibleto make sure that the trades hired secure their proper {termits in conjunction to the building permit issued, and that they get their required inspections.Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued tome. Date Address of work location Property Address: \ —C.---AC) \ R.R. Contractor ` c �' Name: \1�%'V�c� 1�' S LSJ 1 1C AA Address: 3S t ---\ZTCL2 .ST City, State: --S� � � ('�o��p�. N1 (( \\( \-\--'Phone: • —71 �3 —Y d�d� Property Owner � 7 �l� \ Name: U��'l ��� ,7 Address: \ L -Cr-X-riy ----\-- City, State: ` L� (k_ <JC` ' V N Qcc)\cj l \ I, \ , .'s) _\.\\VI (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 signatur , Date ci5, _g _ \\ K RISE60 Shawmut Road,Unit 21 Cation,NA 0202113313-502-6335 ENGINEERING wn'w.RISEengineeregccm OWNER AUTHORIZATION FORM I, 1` 4itv rc,3 Zy'( -k (Owners Name) owner of the property located at: ek, L:-C-r-- 3 a ``e,?---t_ (Property Address) p—cy n^� t C0 l b ( J , (Property Address) hereby authorize �� Y\ —t a2 A�7 1- 4-st (Subcontractor) _\ 2 r `S p vq . an authorized subcontractor for RISE Engineering, to act on my behalf I i BuilIdingu v permit and to perform work on my property.This form is only valid with i d c8idract o Lu'b Owners -rear / O/` Date