Loading...
22D-089 (4) 131 FLORENCE RD BP-2017-0259 GIS g: COMMONWEALTH OF MASSACHUSETTS Map:Block: 22D-089 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Weatherization BUILDING PERVIIT Permit# BP-2017-0259 Project# JS-2017-000447 Est.Cost:$1900.00 Fee: S65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PAUL SCHMIDT Lot Size(sn. ft.): 113256.00 Owner: Cheryl Latuner Zoning: URA(100)/WSP(100)/ Applicant: PAUL SCHMIDT AT: 131 FLORENCE RD Applicant Address: Phone: Insurance: 24 CHESTNUT ST (413)247-5739 HATFIELDMA01038 ISSUED ON:8/30/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:Insulation Weatherization 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: FeeTvpe: Date Paid: Amount: Building 8/30/2016 0:00:00 S65.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner coflemetarereon AUG 2 9 2016 Bating Department 212p Mein Street DEPT OF BUILDING INSPECTIONS Room 100 NONIIgMPrON.M.OIc .• . ••• • MA 01060 phone 413-587-1240 Fax413-687-1272 - 1.1egilildlthala >.... nti. ;�. 7-70 to tD✓ c mfr 6/ 6Cs 1,1 aux ! Lai tentr /31 Ror_ence- Kd "mo \ Current Magna c'��jr— a Q . ad-64-kt ct . 1 misplace Sinatra111 asitengilglak . b +brill_.- inclprzpi terThe r1-- �nLt 0kingI- mc ernlS4elk--�e (d1 n. . c .(-314271217 47-37 39 • Tebphgn Item Estimated Cost camda m 1. Bldlde19 51 (94) 2 Electrical 3. Plumbing tC«1•• . .s!,, - 4 Mechanical(HVAC) 5.Fire Prabelicn 6 Totals(1+2+3+4+5) ' J7o0. oJ _ sf '717 section 4. ZONING Au Information Aiust Be Completed.Permit Can Be Denied Due To incomplete Information Existing Proposed Required by Zoning This column to be Med io by !Wilding Dapertmait Lot Size Fro,ntap Setbacks Ring _ - Side Etw • „. _ Building Height Bldg.Square Footage Open Space Footage panting) a of Parking Spaces _ Fill: Wane&lowsh A. Has a Special Permit/Variance/Find r been issued for/on the site? NO 0 DONT KNOW YES 0 IF YES, date issued:' IF YES: Was the permit recorded at the Regry. of Deeds? e no 0 DONT KNOW yes 0 • IF YES: enter Book ; Page ; and/or Document a B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW (23/ YES 0 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 C) NO Gr"--- W YES,&scribe size,type and location: D. Are there any proposed changes to or additions of signs intended for the pi over Is? YES 0 NO 9' IF YES, describe size,type and location: E. VW the construction activity disturb(clearing,proofing, ation,or firing)over I acre or is it part of a common plan that WV disturb over I aye? YES C.) NO IF YES,then a Northampton Storm Water Management Perna from the DPW is rewired. Nem Nowa ❑ Addition ❑ Or �w aowa Alaraosgs) ❑ RoofingDoom ❑ Awesay Sect ❑ Deaessah 0 NewSigns Decks [0 ef f g j Otlrr(�j — Briitti°t of PropoaM �d14tt2S/ wodcDesc76°1 c'S� n�rhr> �n /?nllzr/OsA?' P2mr12 5dr1oiart- Alteration Attached Narrative Renovating Yee No r YesNopo /No Ptens Aitatled Rog -Stat ✓ a. Use of bunting:One Family Two FanBy Other b. Number Grooms in each Varney teat Number of Bathrooms a Is there a garage Stied? d. Proposed Square fooltce of new construction. e. Number of stories? f. %%Mod afbbemg? --=orWoosstows Number of each_Y g. Energy Oi saystion Compliance. _ Energy Compliance form attached? h. Type of construction i. Is ccMmh%llon red*100 ft of wetlands? Yes No. Is construction stein 100 yr. flu+Qdnhk Yes No j. Depth dbasement oro sea floor below ;... =.grate It Wd bulldeg conform to the Binding and Zoning regulations? Yes No. I. Septic Tank City SewsPrivate seg Cay water Supply SECTIO117i1.ttWNERAUTOISRoo.teato1lptE nut amen MEW Oftfa 'APctittFDRIOUSIOPMMIT ILL L t./_.. as Ossa of the subject property hereby authorize S> 44Cxt)-< o,n/eme.nf eoiedocs,TyiP✓• to act on my behalf,in all mamas release to wortatihafirred by this budding permit sghpPcetion g'a J I Ca �- F are 5zhnict+- as Omer/Authorized Agent hereby declare that the statements aid Idansaak on the foregoing appecagon are true and accurate,to The best of my Knowledge end belief. Sighed under the Paine and penat es of perjury. Pnr Nems (O Y i n Not Applicable 0 NnofLkenm Holder: ALL Sahn i d,—>— 1 y e.3license NumberS Ana a "4 �.(rSn�c�— S� . a+ �rud Yjif4 0103$' S/�/1/ e�W 1/13 - af15�. °/ nature Telephone Not Applicable 0 S t_ moria,e1.eAloz5, / 74)1 / 5— Comoatw Nine Registration Number AdeiR( (he -ruct3.-Free-4— ite17/ 1-1-a Jii ct d i MA 0! 038' Telephones'/.l-dq 15737 Workers Compensation haurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial al the Issuance of the Permit Signed Affidavit Attached Yes No 0 The current exemption for"homeowners"was extended to include Owner-emended DweR19Ye 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 ad es annervber.ChM 7M. Stith Edition Section 118.33.1. pehoidee 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 ceastreeta more than one home in a two-war',tried shall not be cowered a homeowner. Such"homeowner shall submit to the Building Official,on a form acceptable to the Building Official that lee#he shall be femaseffik for all sack work performed seder the baiidioe Permit. As acting Ceestraedee 9setr'vieor 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 maybe Sable 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 40 City of Northampton a or aet_ 1111111MalalB 232 Nista MS .—30403 m....,a smm+ee., r 0304 Ades: /6r-en &J sb 4e,.Im remnn-l• C.nrkarAocs ,die. • Adams c9 ( s1-mL--i- S%-atA City,sense: 42eLA , r A oA% Phone -413-.W#7-67.39 rimy' (' hQ 1 La-kJ/72 Address: A3/ P Ortnee_ 2r1. car,s + J mine nel A at o co TTpawacier)onset adSinn Statile beadingiintend to inatikaithithisgaitsthapsA'*i.S and d ftS$t fri the-y---n to be Mated aid Ink I Sve pmvidedtheprepeetrawnl a copperthhaiadava. C.oriesotor signature,lik., Date S> Coe RISE:: 80 Shawmut Road, Unit 2 I Canton, MA 02021 1339502-0335 ENGINEERING www-RWSEanglneer1ng.cwn OWNER AUTHORIZATION FORM 1, F ... � (Owners ame) owner of the property located at Ia2g-4.k-_ - (Propperty Address) 1/,^ ot& (Property Address) 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.This form is only valid with a signed contract. J Owners Signature Date The Commonwealth of Massachusetts �- ���—n Department oflndustrialAccidents rA _ =— 1St 1 Congress Street, Suite 100 xBoston, MA 02114-2017 "`u„ wwmmass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business:Organization:IndividualL SDL Home Improvement Contractors, Inc Address: 24 Chestnut Street City/State/Zip: Hatfield, MA 01038 phone g: 413-247-5739 Are you an employer?Check the appropriate box: Type of project(required): LID am a employer with ii employees(fulandorpanamet.- 7_ 0 New concoction 2 I am a sole-proprietor or partnership and have no employees working for me'.n 8. El Remodeling an>calydcia.INo workers'Camp-insurance required. s0 am a homeowner doing all work myself[No workerscamp insurance required]. 9. ❑Demolition 10❑ Building addition 4.5 I am a homeowner d will bhiringe contractors to conduct all work on my property. I will ensure that all contractors either have workers compensation insurance or aro sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 55 I am a general contractor and I have hired the sub-coniractors listed on the atrached sheet Roof repairs These sub-contactors have employees and have workers comp.insurance; ° ❑ p 6.5 We are a corporation and its officers hale exercised their right of exemption per MGL¢. 14.QOther Insulation 52. 1141.and we have no employees lNo workers'comp.insurance required.; `Am applicant hat checks box al must also fill ow the section below showing their workers'compensation policy information. ' Homeowners who submit this affidavitindicatingthey are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors thatcheck tis box must attached an additional sheet showing the nameofthe sub-contractors and sate whether or not those entities have employees If the sub-contractors have employees.they must provide their workers comp.poke)'number. l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name. Selective Insurance Co Policy tar Self-ins. Lie.n:/ WC9024456 p Expiration Date:-21223/2017 lob Site Address: o I Coref[Ca C h--Cl City:State/Zip: riQr-Q/4C.QMAttach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date ). Failure to secure coverage as required under MGL c. 152. b252k is a criminal violation punishable by a fine up to 51,500.00 andior one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day 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 certifyinddaarr the p s and penalties of perjury that the information provided above is true and correctr _ Signature:i f: / ' _ DDate: O is-3 - I C/ Phone 413-247-5739 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: AVDONYTO q®DI' CERTIFICATE OF LIABILITY INSURANCE OA„5 /2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT; If the certificate holder Is an ADDITIONAL INSURED,the polcyf es)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(a). PROWLER CONTACT Cynthia Henderson, CUR NAME Webber L Grinnell PHONE (413)586-0111 FAX we,±40.,(4233 S84-6aes B North Rang Street IAP wnderson9Mebberaadgrrmell.COM -. . INSIREIKS)AFPOROING COVERAGE NMC Northampton NA 01060 (INSURERA Selective 19259 __. _.. ILLI INSURED 1,INSURER B:. ILLI SOL Home Improvement Contractors Inc. IH3uRexc. 24 Chestnut Street INSURERo: INSURER E Hatfield MA 01038 INSURERF: COVERAGES CERTIFICATE NUMBERd4Ster 2016 REVISION NUMBER: TIC IS TO CERTIFY THAT THE POLICIES OE INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTMRTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO W,ICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOIAN MAY HAVE BEEN REDUCED BY PAID CLAIMS bbLIWEIA _.__ __ppL-ICY[�� IN9N TYPE OF INSURANCE OINSU WVn _.POLICY NUMBER MOWYWB IMMIVOPWYD LNett R X CCMMFRLSL GENERAL tMBILItt EACH OCCURRENCE 5 1,000,000 A __.. come.MAOE R OCCUR ORM IS S scFTn .100,000 MEDEXPrnyor*pro_)_ 5 _. 9220106$ 2/1/2016 2/1/2019 MED EXP lAny or*person) 5 10,000 _._. PERSONAL.1 ACV INJURY S 1,000,000 GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 A oGlyv PRO-T --OC p3ppUCTS-GJMP(,W A63 5 2,000,000 OTHER AutOMO&LE LIAMUTY (_ XneelenEOta OVAL LIMIT 5 1,000,000 ALBINJURY IPF,Grywn1 AUL TOOSS2,NE x BC17E,GUL-D A910032E yl/2016 2/1/2017 BONNY INJURY' Pmacnam 5 OS -Z_1nRE0 AUTOS I NON-OWNED PROPERTY DAMAGE.. . 5 ILLI - Unaennwrea mauTM(2Elsa 5 100,000 X UMBRELLA Un E OCCUR EACH OCCURRENCE s 1,000,000 EXCESS UPS CLAWS-MADE AGGREGATE _ 5 OED x RETENTION, 10,000 52204065 2/1/2016 2/1/201) WORK RS COMPENSAVON EEMPGYERS'PWTN T?a X .SiAt ._.X R AD ANY PROPTpR REEARTNERrEXFGOTNE c L EACH ACC115CNi S 500,000 OFFICERMEMBER EXCLUDED% y NIA A IIMRanonm NH) - - RG9024456 2/23/2016 2/23/201'1 EL DISEASE EA EMPLOYEE5 500 000 O v 1EeCGCeIanPT10N OF OPERATIONS lOPERAtION91wWw E_EL L DISEASE-POLICY LIMrt 5 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES ACORD I%.AWRINNI Rem.M11 amWW.PxYG scud N Mom Waw M weaken The Workers Compensation policy does not include coverage for Paul Schmidt, Kendrick Dempsey and Douglas Schmidt. Columbia Gas of Massachusetts as hereby named as Additional Insured per written contract with respects to General Liability 6 Auto Liaiblity, for work performed, and per the terms and conditions of the policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABDVE DESCRIBED POLICIES BE CANCELLED BEFORE Columbia Gas of Massachusetts THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 4 Technology Drive Ste 250 I ACCORDANCE WITH THE POLICY PROVISIONS, Westborough, MA 01581 AUTHORISED REPRESRNTATNE Heraersor, GISR/CIG' ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS075,Nilem