The URL can be used to link to this page

17A-185 (6) 173 NORTH MAPLE ST BP-2019-0355 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A- 185 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit# BP-2019-0355 Project# JS-2019-000581 Est.Cost: $2600.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: PAUL SCHMIDT 103635 Lot Size(sq.ft.): 7187.40 Owner: ERDMAN HARLEY M&SARITA E HUDSON Zoninsz:URB(100)/ Applicant. PAUL SCHMIDT AT. 173 NORTH MAPLE ST Applicant Address: Phone: Insurance: 24 CHESTNUT ST (413) 247-5739 WC HATFIELDMA01038 ISSUED ON.9/21/2018 0:00:00 TO PERFORM THE FOLLOWING WORK:422 SQ FT, 14 LAYER R-49 FLOORED ATTIC SPACE 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# 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: FeeTyne: Date Paid: Amount: Building 9/21/2018 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner peRartment use oniY RECEIVED Status o{Pei` GutlOnvewaY Permt{— Gurb _ ' 018 of Northampton ttc AvailabiCltY City geweriSep guaclrng oePartn`er't NlateriWe\1 A�a�\a'oiCtt� �� ``-• -'2'12 Main Street t c ,�r Room 100 -Two Sets - Northampton, MA 01060 P1otlSite Plans 413-587-1240 Fax 413-587-1272 hone p .ether Spe6tY--- 0 FAMILY DWELLING CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR% y APPLICATION TO �----_ ' b SECTION'1 -SITE INFORMATION This section to be completed by office 1.1 Pro er Addr ss: �� Unit_______ Map l?� Lot /1 C) -a Zone Overlay District Elm St.District CB DistriCt SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: 1 �y-� JJ AA S4 bt r ,ted ice-��. 2-z-'� / �PI�Q L Name(Print) Current ling Address, n�� " Telepho e ignature 2.2 6Wthorized Agent: `-' P��ruY�nt Name P ' Current Mailing Address: � d)t%3�r Z agture Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building r�U (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee / 4. Mechanical(HVAC) V 5. Fire Protection 6. Total =0 +2+3+4+5) i �} Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: 9/ZOh Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) �"s colIncome tete to Informat'on it Can Be Denied Due To zOntn� Completed•Perm ;,red by in by All Intormation Must Be proPOSQd be filled Section 4. ZONING umn ent Existing guilding�P Lot Size Frontage Setbacks Front _ — - Side L: - �' R:� _�_ L'_....._ R. Rear EBIdg. eight are Footagehen pace FoutaV (Lot area minus bldg&pavetl --- arkin #of Parking Spaces Fill: volume&Location ___ A. Has a Special Permit/Variance/Finding ver been issued for/on the site? NO DONT KNOW YES 0 IF YES, date issued:: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW GK YES IF YES: enter Book Page s and/or Document#? B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained 0 , 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 0 NO IF YES, describe size, type and location: : ��-�� - •�•��-��-�.^•__ _~ E. Will the construction activity disturb(clearing,grading, ex ation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES ® NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. WOR II a livable) Q K check a Roofing pSED oESCRIPT%a OF PROP Alteratiionls� eczIota 5- Replacement W indows (g Q © Si Q Addition or Doors din9 New Hou se Q New Signs l �00 L �J Accessory Bldg- Demolition e �t Brief De ri tion of No works 'L- ,Yes — `/ Yes No Adding new bedroom Yes _=Ne Alteration of existing bedroom Renovating unfinished basement Attached Narrative Sheet Plans Attached Roll 6a. If New house and or addition to existinq housin complete the followin 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 wetl ds? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar flo below finished grade k. Will building conform to th uilding and Zoning regulations? Yes No . I. Septic Tank ity Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1 as Owner of the subject property hereby authorize �� 1.r t�yrY1.L �D tyV-ea r�I i C_�'n4y-z`(G"tbr-s to act on my behalf, in all matters relative to work aut orized by this building permit application. Signature of Owner Date 1, ,U 3 M 1 �'f� 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. Sigra'a under the pains and penalties of perjury. 1C;h m i`�-�- Print Name Sig ure of Owne(/AKnt Date Not Applicable 1 ' �ci�oN SERV►CES L SECT\ON a-CONSTR umber </ isor: �`cer\seN c:;;2� I ..j Licensed Constructlon Su C m Q� v� �, `"i Name of license H97_der ✓Vl4�� CJ Expiration C to Addres SI at re ! Telephone Not Applicable ❑ 9.Re istered Home tm rovement Contractor: T(�fh.�� C—.`tRegistration Number Com an Name < Expiration ate Address� �n / 'e ! I ' l �3� Tele SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)) Workers Compensation Insurance affil vit must be completed and submitted with this application. Failure to provide this atl'It18Vlt WIII ASU t in the denial of the issuance of the buil ing permit. Signed Affidavit Attached Yes....... No...... ❑ Cit of Northampton =.'S Y S G ` Massachusetts w 3a 1ECTIONS NT OF BUILDING INSP ' DEPARTME ipal Bu ilding Main street ■Munic01060 Northampton, Af Affidavit t Debris DispO5a a that as a condition of the building osed governed by this Building Permit shall be p In accordance of the provisions he co structtion ac,tivtykg acknowledge MGL c 111, S 150A. permit all debris resulting from the disposal facility, as defined by of in a properly licensed solid waste The debris from construction work being performed at: '�1)44) LC-- C:�' (Please print house number and street name) Is to be disposed of at: (Please print name and location of facll y or will be disposed of in a dumpster onsite rented or leased from: (company Name and Address) eigdnature ZofPer*Mitpp�!&icanor Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. City of Northampton Massachusetts DEPARTELNT OF BUILDING INSPECTIONS y 212 Main Street • Municipal Building Vb� CD Northampton, MA 01060 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation,repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity mustb registered J- - ll c� Type of Work: L oto Est. Cost: Address of Work: be, Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): _Job under$1,000.00 _Owner obtaining own permit(explain): Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby app y for a building pe t as the agent of the.oNvn r: R 17 5 Date Contractor N me ('�UA4y?4_C{of_5� HIC Registration No. OR: Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature RISE ENGINEERING' OWNER AUTHORIZATION FORM I, Harley Erdman (Owner's Name) owner of the property located at: 173 North Maple Street (Property Address) Florence, MA 01062 (Property Address) hereby authorize r> L_ (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. Owner's - n urs Date RISE Engineering, a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 j Canton, MA 02021 1 339-502-5335 www.RISEengineering.com i 7'he Commonwealth cif Massac•htrsetts r Department of IndustrialAccidents Qjftre of*lit vestigatioas ' 600 Washington Street Boston. MA 82111 www,mass.govldia NVorkers' C.'ompensation Insurance Affidavit: Builders/('ontractors/Electricians/Plumber. Applicant Information Please Print LetiblN Dante SDL Home Improvement Contractors Inc Address: 24 Chestnut Street City/State/Zi Hatfield, MA 01038 phtalle 413-247-5739 Are you an employer?Check the appropriate box: Type of project(required): 4. I am a general contractor and I 1.[� i am a employer with_ , m� ❑ 6. Q Iver construction employees t full anchor part-time).• have hired the sub-contractors ❑ I am a sole proprietor or partner- listed on the attached sheet. i. Q Remodeling ship and have no employees These sub-contractors have R. Q Demolition working for me in any capacity. employees and have workers' ct Q Building addition [No workers'camp. insurance romp, insurance.» required.] 5. Q We are a corporation and its 10.❑ Electrical repairs or additions 3.Q i am a homeowner doing all work officers have exercised their I l.Q Plumbing repairs or additions myself.(No workers'comp, right of exemption per MGL 12.Q Roof repairs insurance requite-d.]t c. 152,§1(4).and we have no employees.(No workers' 13.[a Other-Insulation m comp. insurance required.} 1m a +itcatn that cheeks txty al mast a1u>rill out the section heti w shooing their workers'coniNnswion rk�ftc% ml'xnwttun, i ktincovvnets oho suhtntt this affidavit indicating they are doing,all+kirk and then hire outside a»tar tar;mutt submit anew affidavit indicating such Contractors that check this box must attached an additional shed shoring the name ofthe sub-,00ntractcus and state whither or tux thaw entities have ernplo%ces 11'11-te cuh-c+rnurztrtrzr4 have employees.the! mast provide their wtrken, omp pohcN numher 1 am an eamplUrer that A providing workers'compensation insurance,for int-er rkree-s. Below is the polit y anti job site information. Insurance Company dame:_ Selective Insurance Co Policy#or Self-ins.Lic WC9024456 Expiration late: 02/23/2019 Job Site Address:__'f� lr� �CQ, �� rithstate zip. e-,(— , ' ► 1 4 Attach a copy of the workers'compensation policy declaration page(showing the pokey number and expiration date). Failure to secure coverage as required under Section 25A of MCL,c. 152 can lead to the imposition of criminal penalties of a fine up to$1.500.00 andror one-year imprisonment.as well as civil penalties in the form of a STOP WORK GIRDER and a fine of up to$250.00 a day against the violator. He advised that a copy of this statement may be forwarded to the Office of Investigations ofthe DIA fir insurance coxerage verification /do hereby cer"nder 1l paras anti penaluev of perjury that IheF information provided above is true and correct. Si rrr t re ._� Date. Offtrial use only. Do nor write in this area,to he completedl h.y citt•or town official. City or Town: _. Permit/License# Issuing.authority(circle one): 1. Board of Health 2. Building Department 3.(.`ityffos+tt ( Jerk J. Llectrical inspector 5. Plumbing Inspector 6.Other Contact Pemon: Phone#: DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 1/15/2018 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 policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to I 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 endorsoment(s). ---j! vRooucER ,.AME° Cynthia Henderson, CISR ' Webber S Grinnell acN o.Esti (413}586-Dill (AJCNol. ;413)586-6481 8 North King Street ;iADDRESS chenderson?webberandgrinnell.com I 3 NSURERIS)AFFORDING COVERAGE NAIC 0 Northampton MA 01060 INSURER A.S8IeCt1Ve Ins Co of S Carolina I INSURED INSURER S:SeleCtlVe ins CO Of Southeast 39926 SDL Home Improvement Contractors Inc. INSURER I24 Chestnut Street INSURER INSURER E Hatfield MA 01038 11 1 INSURER F COVERAGES CERTIFICATE NUMBER-.Master Exp 2019 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOl WITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH 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 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR iADQLjSUBRi, POi,ICY EFF Y E%P LTR TYPE OF INSURANCE POLICY N R M D!Y YY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 3 1,000,000 i DAMAGE TO RENTED A G AilA5-YA:J1, X PREMISES(Ea 000stIl e; a 100,000 i 52204065 1/1/2018 1/1/2019 {MED EXP(Any one person) S 10,000 PERSONAL.8 ADV INJURY $ 1,000,000 GEN L AGGREGATE LIMIT APPLIES PER GENFRAt.AGGRFGA'TF S 3:000,000 X POLICY JCC') _!JC ' PRODUCTSPR •COMPtOp AGG f S 3,000,000 OTHER I t i r AUTOMOBILE LIABILITY , ( U $ 1,000,000 (Ea acceded) A ANY AUTO ROD4.Y INJURY(Per pe,son. $ ALL OWNED X -. SCHEDULED A9100328 i! -,'.C`.H i il2019 RODLY INJLRY(Per acaeent) $ AUTOS X N REDAUTOS X AUTOS NON-OWNED PR+�OPEPERTY DAMAGE Z Underim"Wed motorist RI apis $ 100,000 X UMBRELLA LIAR X OCCUR EACH OCCURRENCE a 1,000,000 A EXCESS LIAO CLAIM, AGGREGATE $ 1,000,000 E?ED X 19,000 32204065 1/.:2C'.e 1/:/2019 S I WORKERS COMPENSATION X ' X i 1 AND EMPLOYERS'UA LITY Y t N ATUTE ER ANY PROPRIETORIPARTNERtEXECUTiVF E L EACH ACCIDENT `S 500,000 OFFICEWMEMBER EXCLUDED') y N 1 A B (Mandalay in NH) WC9024456 2/23/2016 2/23/2019 F L DISEASE-EA EMPLOYEE i 500,000 if as desenbe under LIESCRIPTION OF OPERATIONS be. E L DISEASE-POLICY LIMP S 500,000 r _ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Scneduie,may oe attached if more space,s required) The Workers Compensation policy does not include coverage for Paul Schmidt, Kendrick Dempsey and Douglas Schmidt, Columbia Gas of Massachusetts is hereby named as Additional Insured per written contract with respects to .General L1ab_lity & Auto Liaiblity, for work performed, and per the terms and conditions of the policy, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Columbia Gas of Massachusetts THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN 4 Technology Drive Ste 250 ACCORDANCE WITH THE POLICY PROVISIONS. Westborough, MA 01581 AUTHORIZED REPRESENTATIVE ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025�2014W i x , V',