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17A-303 (7)
107 HILLCREST DR BP-2017-0598 GIs#: COMMONWEALTH OF MASSACHUSETTS a :Block: 17A-303 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 PERIYIIT Permit# BP-2017-0598 Project# JS-2017-000967 Est.Cost: $1000.00 Fee:$65.00 PERMISSION 1S HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: HOME ENERGY SOLUTIONS 4556 Lot Size(so.ft): 2182156 Owner: DONNELLY TERRENCE P&GAIL K Zoning: URA(I00)/ Applicant: HOME ENERGY SOLUTIONS AT: 107 HILLCREST DR Applicant Address: Phone: Insurance: 27 PERSHING AVE Liability SOUTH HADLEYMA01075 ISSUED ON:1012812016 0:00:00 TO PERFORM THE FOLLOWING WORK DUCTING SEALING, INSULATE ATTIC HATCH, BASEMENT DOOR 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 10/28/2016 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fat:(413)587-1272 Louis Hasbrouck—Building Commissioner File# BP-2017-0598 APPLICANT/CONTACT PERSON HOME ENERGY SOLUTIONS ADDRESS/PHONE 27 PERSHING AVE SOUTH HADLEY PROPERTY LOCATION I07 HILLCREST DR MAP 17A PARCEL 303 001 ZONE URA(100)/ THiS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT �� Fee Paid Building Permit Filled out Tyne aid Fee P, ofConsfructian Construction: ,INSUL.ATE ATTIC HATCH, BASEMENT DOR New Construction Non Structural interior renovations Addition to Existing Accessory Structure Bui ing Plans Included: Qwnert Statement or License 4556 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION 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 Demolition Delay Signa.- if[Milling 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. —.�---' Department use only City of Northampton Status of Permit: i - Building Department Curb Out/Driveway Permit �i L l 212 Main Street SewerfSeptic Availability Room 100 water/Wen Availability \its orthampton, MA 01060 Two Sets of Structural Plans ri,,V_i_ -ghorie 413-587-1240 Fax 413-587-1272 PloUSfte Plans Other Specify APPLICATION 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 .. 109 4'k( 11l�!/ Feces ( Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ocrank c. rvr\ Mil i- ue� i3Driue. . D1 9, fl Name(Pont) Current Mailing Address: alifiChk Signature TeePhcne 1{(3_, Sla — 34ti7O 22 Authori Agent: fes,_,` ,y L" l )D1 fl.!"� \_ �. .ems. •. a.- i . A /Nave(P I) Current Mairmg'ad.r : r fr. 4 *ant 4/7) -2oS-- aqs-isii : re Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit.applicant 1. Building �up (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of _ Construction from(fi) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection , 6. Total=(1 +2+3+4+5) ( t;+„)✓~7plLbb Check Number / 2 ii'M' This Section For Official Use Only Building Permit Number Date Issued: Signature: Building Commissionerflrspector of&Meigs page fiECTION 5-DESCRIPTION OF PROPOSED WORK(check all remittable) New House 0 Addition ❑ Replacement Windows Alteration(s) KT Roofing 0 Or Doors O Accessory Bldg.gD gssdDemolition ❑ New Signs [OIC Deckse [q Siding[p] Other'[CB Brief Work o �Nf - rib%, tt 0,3l khc>ct x Ant \-\44. L , , � 'ytny'Lt 1..tbDr Alteration of existing bedroom �J Yes `/,,J(—/No Adding new bedroom Yes o Attached Narrative ( Renovating unfinished basement Ye No Plans Attached Roll -Sheet /// se.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 G, Is there a garage attached? d. Proposed Square footage of new constru $•• Dimensions e. Number of stories? f. Method of heating? i -•aces or Woodatoves Number of each g. Energy Conservation Compliance. Massoheck •.. Compliance form attached? h. Type of consWction I Is construction within 100 ft.of wetlands? Yes No, 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 teaL (, - Q - • t"1f\2_ ,as Owner of the subject property _ \\ hereby authorize �Ic5t.� to act on my behalf, in all matters lje �\' + lative to work authorized by this building permit application. (/tL Kt .. t ' ......... SignaWre of Cr 7ODale ri*4 SIS _ C ,as Owner/Authorized Age�-•y ns na that the statements and information on the foregoing application are true and accurate,to the best of my knowledge • • •elief. Signed under the pains and penaMessoof perjury. . 11 Poot Na% ` Signal /Agent Date RI S E f- 60 Shawmut Road, Unit 2 I Canton,MA 02021 1339-502.6335 ENGINEERING' www.RlSEengineering.com OWNER AUTHORIZATION FORM lr� I, P A/A1e LLy , . l gtna i�.rD/ Nom( IEk� QP1\GP ( metas Name) (� owner of the property located at: /07 ,Q, LLCReST 2Q FLn4eP }"-/A rjnr� (Property Address) (Property Address) ' 1I hereby authorize @ii&LL (Subcontractor) an authorized subcontractor for RISE Engineering, to act deny behalf to obtain a building permit and to perform work on my property.This form is only valid with a signed contract. Ther Permit will be secured by the insulation contractor, at no additional cost. It is the homeowner's responsibility to close out this permit by contacting their municipality at the completion of this work. '.A Dano etto, / /SLnq Owner's Signature /0//7/d 0/6 Date 9.2018 SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed ConstructionioSupervisor 1 \ Not Applicable 0 Name of License Holder: �1c1-t \c)4 - 1 Dl [. !s V License Num r 1a `PI s J* IR f J-- v.A nq�m CIA- (DID 1 �� k I co Address ) Expiration Date Si• ure - Telephone 9. cloistered Home improvement Contractor Not Applicable 0 ccs `gal¢ �\��iaNS I (sq las Com�m.. Name t Registration Num er kiss 'sit' — 1 "A o(�� Expra�o�Date 11 CJ13. 2D3-91-}S e epnone 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 building/ilpermit. Signed Affidavit Attached Yes `6W No ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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 tinder 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 Cowan ofMassochnem Department of hadestriel Accidents ����••=�:t Office ofInvestlgmions G; S ; l CoCongress51Store;Sadie l00 taiar.,_ aO BAan bfAt72ll4IgU ;tiz a l eese¢gowidie Workers'Compensations iasmmeeAffidavit D Wn.Ie..aacto Applicant Watena tin. new brie Lcetbly Namur \�o fl ro� •v• a Ai_ . 4t Addsw. I .1. �1 sqi �AR ©a^ _ city Hi n;t4exi n{F mg) phone L q13-(i(01- 313b Am pma employe.!tAak bar TiPt of talon(eal•i`l): 1.❑ 1um•anpbya with 4. ❑ lam agmad mvamraml 6. ❑New contusion (MI nota patMeeyv have eHthe wb-coeaamn 7-Cooke pupiaaa Paine` listed on Pot..chmd sheet 7. ❑R®ode&g rhp and hone no employees aobataaai beam R. 0 Drmofaim saki c form in nay traceemployees tad bare wortrJs' 9. 0 Bmld'otg addittim No workers'comp Mace comp.$tante. 5. 0 We ma corporation end as 10.0 Electrical repairs or addmom 3.❑ I am a hmeowoa degaflwin office Ire a¢saited 8ci 1L0 Numbing repairs or ddtton tight of exemption per M©. 12.0 MIEEMCC �imyself re ekeco� C.152,11(4),and we ane no 13.0 Other employee(No wore/ camp.insurance rewired.) •wq appear ant ober Well ride a col Ss=dim ban Swig Inmale Dzsialiolipdel_____im t B®umatamale*aft mart Skagen a timed Wirt.dace Meet roe emdwit Mattagami' 43tenectantSeek0i la emelt mtendoes ee ntriq Oe me natSte-mmNn ad C@ Mier seam cttt here earbpee E!a►asees Vremgbym.they met papa&'1e flare ma p&y et IOR a apbpa me Is pse.lir''.Asa''n.peamlen ifs my aFloyea any Is a4paaey ad lob sae berets emgymemery Nem S Utica ■th _ r c 'der Policy a Self-ins.Lim r .)F1W‘ le 154"11 FX1711romle:.�ll - 4 - 22) (12 Agate Site AltY }t,IU Ur-4J1 10C Cit)'S�/Lip7Otaf10Q MA Attach a copy of the w.ahm'osapeatioa peraey declaration pee(flowing the policy caber wad eetptia de). Fano at seam tonnage a raped under Seim 25A of MCL c. 152 em lead to the hapoddm ofcrininal penalties ofa ate op to$1,500.80 Nota eye apri®rae,n—a can pees he the form of a STOP WORK CRD and a free plop to 525080dry against the siolaa. Be'dyied the a copy of this sense may be forwarded es the Office of htewatp6m arty DIA for inmate cora'vuA aria Ide hereby me wads Septa+aodfo q,.4...,meaaew.foraaaiwp.aedddwine b awe and%ISM •S -: oma IaSI-;10I (o Pham It: x{13-4111 -313 ODk?ae wee t. Oe law flee Ms area., beaww ltwdy dry w coat aJkrIal. (Sty or Tome Fe mil icemeK d+4 Aaaaay(aide one) I.Semi wt Ueda 2 Bang Depaet•at 3.City/Pwn Oct L 61emleai Leta 5.rra}ig kipbriOT goat Ca Para: Phonedt 1 c- . Woovnicfrnateeta 4/0At . � . Office of Consumer Affairs and Business Regulation . 10 Pack Plaza- Suite 5170 Boston,Massacluisetts 02116 Home Improvement Ceatatctor Registration �. v7- = R a it 164803 r, �1p ,yDec DEM ea .'-- J, Fon: 702812/117 TA 270869 HOME ENERGY SOLUTIONS - : JAY t10[AND t e t i-' 12 PISGAH RD. HUNTINGTON.MA 01050 Jr:. _ _ --. 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