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32A-196 (3) 22 PHILLIPS PL BP-2017-0893 GIs a: COMMONWEALTH OF MASSACHUSETTS Map:Block:32A- 196 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category INSULATION BUILDING PERMIT Permit 4 BP-2017-0893 Project JS-2017-001516 Est.Cost: $2000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Grow PAUL SCHMIDT 103635 Lot Size(sp. ft.): 7666.56 Owner: STODDARD MIKE zoning:URC(loo). Applicant. PAUL SCHMIDT AT. 22 PHILLIPS PL Applicant Address: Phone: Insurance: 24 CHESTNUT ST (413) 247-5739 WC HATFI ELDMA01038 ISSUED OM 1/26/2017 0.00:00 TO PERFORM THE FOLLOWING WORK.688 SO FT 12" LAYER R45 ADDED TO ATTIC FLOOR OPEN BLOW CELLULOSE, AIR SEALING AS NEEDED 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 H 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 1/26/20170:00:00 $65.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-0893 APPLICANT/CONTACT PERSON PAUL SCHMIDT ADDRESS/PHONE 24 CHESTNUT ST HATFIELD (413)247-5739 PROPERTY LOCATION 22 PHILLIPS PL MAP 32A PARCEL 196 001 ZONE URC(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 TypeofConstructiom 688 SO FT 12"LAYER R45 ADDED TO ATT C FLOOR OPEN BLOW CELLULOSE AIR SEALING AS NEEDED New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 103635 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOQMATION 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 Dei ition Delay �7a Signa ue of Building O [tial 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. \ ta, � o _ �� r� � i:r 2 . �� ,. _� r � • t� � _ -�. _ �� u aI . T� �� ._. - � : � . . �� ` � .r...'-'ss-z .*�a�ra�--- - Section a. ZONING al kdo waOw AWr[Be Completed.Petmn Can Be Denied Due To Incomplete Wf tlon Emstiag Pro?xrsed Requied by Zoning flus cdwm m 6efBbd m by &nDepmcomr Lot Si. Frontage Sedawks groat ------ L,— _ ___L .._ R:.___._ L luar Building AaigLt .—...- ..._.__. —_.._. Bldg.Square Footage -__ ___. % Open Space Footage .. % ,.._- --.... m kmo #ofParking Spa— Fill:Fill: A. Has a Special PeamittVariance/M been issued for/an the site? NO © DONT KNOW YES 0 IF YES, date issued:. IF YES: Was the permit recorded at theof Deeds? NO 0 DONT KNOW � YES p.._ IF YES: enter Sook - page: and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW a YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained © , Date Issued: C. Do any signs exist on the property? YES © No G-' IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO Q' IF YES, describe size,type and location: E. VO the construction acOvity disturb(dearing,wadit or filling)over i acre or is it pan of a conmon gran that will diaaab over i acre? YES O Np IF YES,than a Nodimunpton Siorm Wates Managernent Permit from the DPW is MiUred. sECTIDN s O (DP PRDR1kY0�cIMe�E.�i�abwt Nm Nave ❑ Addltaft ❑ RRsplwsmnkNh�aws mm"') ❑ RooMtg ❑ Ammory O9. ❑ DOW,~ ❑ *WSW" [f7]O Deck [O Od ) Otlar[ Woric bLftm�ftdr n AlYnstorn dea ing bedroom_Yes ZNO Adding new bsdntom_Yes _No Anachad arfove Plane Ata -Shea Renawatlrg unflnhhW bmeaMm Vea ✓NO a. Uw d buidng:One Famy Two Fa*y Ogner b. Number of rooms in each fainly urn't: Number of Satl1Non13 c. Is these a garage attechedt d. Proposed Spare footage of new mrwauctim Dimensions e. Numbs of stories? f. Method dNOW Fireplaces or waotlrtrnres Number of each_ g. Energy Cain Compf�e. M=Bcheck Energy OofnpAance form attached? h. Type of Construction L Is wradwtion wghin 1OD dwetlaas7__Yes _No. Is oonatructon within 1110 yr. tootDlsin_Yes_No j. Dean d basemaH reser floor below finished grade k. Wall bdid'eg tb the S�9 and Zonbg mgWetora? Yes_No. I. Sew Tads_ Cly Seger_ Private well— Cay wale Supply_ SECTMNTa-OMI ER4Aa}iOFMk ADN-TOl3E•lOMPLEFM YNEN ORN@yP�BAJNiCB(��UOROOMRi�C'hLi_R'X1PPLM FMSURDMDMMfT 1, / �I.Oc+tom- � 1 -)- , es ONnerdthe subject Property hereby autortre _>��.... I.w10✓hJ2./y}C✓1'{' to ad on my betat,in�matters Ma0ve to by 1W baldug paint apptotan. �JI.L J / -,-ZI.n [ -7 d Dde I. �2u� vL:�7/1'L[/�"r as OwnedAutorized Agent hereby dedae tat the sumanneras and information on the foregoing appfiaton ere uue and socura[e,to the best of my knowledge and belief. Signed user the plans as peralEea d perlury. �{ err , 6�1'Jwn f a�ii- Pnm Name d Dere 0040 M NaApplicable ❑ NtM of Lionaa Hilmar: ' d--j- 10 s (.e 35"' i.Jcense Number j7zs� is - �s� , �a��rudfMfel ofo�4 ,moi ���� AdOreas Expiration Deb /3 - a ( y57'3g . . Not Applicable ❑ s� >r �)4reLe f)zs, i741AI/ Cmnomsv Name RegftaGon Numbs Address Expiration Data reed- {-{'a.--si tl d rY-),4 Cil D 3c� relep.r.Y13 dN'/-5'/3 Workers Compernetion hrsurarce 9#dffvit must be wmpleted and submitted with this application. Failure to promde this affidavit will result in the decrial of ft issuance ofthe bttMdi R Signed Afidsvit Mantled Yes....... No..__ ❑ The current exemption for"lwmeowcers"sues extended W include Owser.¢ccupied DweUbm of one(1) or two(2)families and W allow such homeowner to eagage an individual for hire who does not possess a license.provided*9 We owaer ace as mpervieer.CHER 7M. Sam Edon Section MIS 1. pagioNtisisotHemeowxr:Person(s)who own a parcel of land on which heJshe resides or intends W reside,on which there is,or is intended W be,a one or two family dwelling,attached or detached structures accessory W such use and/or farm stmcdaes.A Baca wise e6aptrRrm more*U enc WHO in a twaWdkr amiod ahaN Rat be CQMdMd a homepwaer. Such"homeowner'shell submit to the Building Official,on a form aoceptable W the Building Officials that bathe sbaB be responsible for 98 such work trerfermed ander the bgUdhM nernrit. As acting Coustrudin S®eryvor your presence on the job site will be required from time W time,during and upon completion of the work for which this permit is issued. Also be advised that with reference W Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)ofthe Massachusetts General laws Annotated,von may be 6"for person(s) you hire to perform work for you render this permit. The undernigned"homeowner'certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,Stam and Local Zoning Laws and State ofMassachteear General Laws Annotated. Homeowner Signature cit? of lortbai gtm keaepeCo.vCEe ar mmaeramm 2Z2 rm Sb. ♦�*W umobr�, m /calwadw Tau( 4 mih kr NOW �`h� c�rv�e. T'rn, yrorinr (�na� e ,�n� AddFeW Stake: MA Qi� phww NOM, Addmw CRY,smw I, AdL�.,....._�I,S_ J Lit C�Cmwkir 9.a 1tCM.ik 9reYkiak�pikMendm k deserikR.hkbsryapeetaP(babaed ie6yaadrg'new apteee to be baahad mWtmt I hm peo��pepr®petry aetwirrdls a capYe►8is ate. °`m 1-aD- r 1 Permit Authorization 9 mass save Form ate swGoru.u�'.•nw.r.WaddlcY. EORIMCfOR Site ID: 2316970 Customer: Michael Stoddard I, Michael Stoddard ,owner of the property located at: (Owners cam•,w�m..a) 22 Phillips PI Northampton IYrd n,SV Address) (c" hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherizatlon work on my property. g Owner's Signature: :•tf v Date: •••.••••••••••••••••••..e.......•••.•...••.••.•••.••••••••••........ FOR CLEAResutt OFFICE USE ONLY CLEAResult has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date cLEAhesuh • 50 Waihingtan Sheet,Suite 30W • WeslpomuBh,MA p1581 . 180P4�-7473 PorofRU Use Only Rev.102015 The (i unmmn ealth o/ tfassac husetts _ Department of Industrial 9ecidents '- i Congress Street Suite 190 Boston. JAN 92114-10i i - \l tri kers' Compensation Insurance Affid,1,r Builders.Cumractor,Electricians Numbers. TO BE EILLD ee JH THE PERlll ITIV. et THORITY. applicant Information Please Print Le 'bk .. , _ , e ".crxe _Co^,ra-7ws, Inc l:dre,e 24 Chestnut S±Fee! ( n,.Slate Zip 11aVieiu MA -01038 = 3-2E7-5739 s ,,,,uxmPm er°cnea ro..Pe n .a n.. — Te pe of project(required), 8 - - - - -. ❑ csnuaon L�J R 'l F7 ,rFer,or addlll0p> Insulation t mn mt emplp)'er that is pro,idmn norke,' ,upeesmimt LruvaneeJnr ntc ,nptocees. Below is the palm i ndpb site Dt6mmatian. InJCt3n CC ;. ., -- WC902l4 a D._:c 223)2017 Attach a cops of the,corkerscompensation pobc� dcdaratimr p _c tehmsing the police number and expiration date). 11:".1 pucish,hi-' a fire up to 57500.00 1 u=year it pr rn,:rt .i _ .,;o I ORH ORDLR al, fm:of ap to s'R1 00 u all Ne ehr(ertif,_"rthep r andpenaltiec offiernin rhaTthe rllormationp idea above true andcorrect. i C) 7 _ `3-247-5739__ �i Ojji 1 t 1p O t t n m th area.n h mi � ( It or Tma ver,ahl tnae= Issmng antholin(circle ones 1. Board of Health 2.Building Department 3.Cin Tr ('lurk 1. Eleadcal Inspector 5. Plumbing Inspector o-Omer i� ( onmct Person! phone=: --, ACCI CERTIFICATE OF LIABILITY INSURANCE ,TEIMM,°"YYYY, RAI °1/15/2016 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 Policylles)must be endorsed. It SUBROGATION IS WAIVED, Subject to the terms and Conditions Of the Policy,certain Policies may require an endorsement A statement On this certificate does net confer rights to the Certificate holder in lieu Of such endorsamentls). PRODUCER CONTACT Cynthia Henderson, CISR RANE Webber 6 Grinnell WG.1m EM). (413)586-0311 CRN,. aI,EFF-Rea: 8 North Ring Street A ANDIE chenderson@Me randgrinnell.COP INWRERIS)Aff ON01NG COVENAGE NAICY Northampton NA 01060 INSURER A:Selective 19259 INSULAE° INSURER B SOL Hoole Improvement Contractors Inc. INSURER C. 24 Chestnut Street INSURER. INSURER E Hatfield RA 01038 weURERF' COVERAGES CERTIFICATE NUMBERSHastef 2016 REVISION NUMBER: THI515 CO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BFIOW HAVE BEEN ISSUEO TO THE INSURED NAMED ABOVE FOR THE-O''OV PEP.100 NDICATED NOTWTHSTANDING ANY REOLIIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NTH RESPECT TO WEICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS ARE CONDITIONS OF SUCH POLICIES LIMITS SFI MAY HAVE BEEN REDUCED BY PAID CLAIMS AOULFUNA Ijq "RE OF INSURANCE POLICY NUMBEN ii ICIYYYY POIICYn LIMITS X COMMERCIAL GENERAL FIREFLY -_ - - - 1,000'000 _ E .000 A f_...�c % C.-- P A E E...—I. 100 - 93[oaLs zci2CC1 11F/201: VICE + oe:IN' s 10,000 1,000,000 X 2,000,000 ALT....IIE UAWUry 'Na-S«K "`F 'M" - 1,000,000 A X - . -L ARmoi1a - e X X - ... 31M_GE 100,000 X WBREW DAN X _ 111E I 1.000,000 A EXCESS HAS I-N.L- �z X o 10 A. 020<C65 LIF 2/1/201- WXNRERSCOMPENSATON X - X AND EMPLOYERW LIABILITY I F ' E .. - - 500,000 I C.. Y A A IMaMlwymNI e rSCkaaSe 2:2J'2<15 2123'+111 _ . — r 500,000 -- - - 's V Z 50010 DESCRIPTION OF OPERATIONS LOCATIONS;VEHICLES ACCAD lot A amAm xnort Aux.Aux.n.aa .T.,A. Pr.R HArtPmrtYl The Workers Compensation policy does not inolutle Cover.ge for Paul Schmidt, Kendrick Dempsey and Douglas Schmidt, CLEAAesult, Eversource and National Grid, NSTAR. Boston Gas Co. , Colonial Gas Co. , Essex Gas Co. , and Western ED, Eslectric are named as Additional Insured per written contract with respect. to General Liability for work performed antl per the textus and condition. of the policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CLEAReSOlt THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Contractor Services ACCORDANCE WITH THE POLICY PROVISIONS. 50 Washington Street, Ste 300 Was thorough, MA 01581 AUTHORRED REPRESENTATIVE Rr__ l __ 0 1988-2014 ACORD CORPORATION, All rights reserved. ACORD 25(2014101) The ACORD name and Logo are registered marks of ACORD INS025 '