31A-211 (5) 35 HARRISON AVE BP-2017-0892
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:elock: 3IA -211 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-2017-0892
Project# JS-2017-001515
Est.Cost:$3560.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: POTENTIAL ENERGY LLC 106184
Lot Size(sq. ft.): 8537.76 Owner: LELIEVRE ROBERT
Zoning: URB(100)/ Applicant: POTENTIAL ENERGY LLC
AT: 35 HARRISON AVE
Applicant Address: Phone: Insurance:
61 EAST MAIN ST (860) 620-4433 WC
BRISTOLCT06489 ISSUED ON:1/31/2017 0:00:00
TO PERFORM THE FOLLOWING WORK INSULATION FIBERGLASS & CELLULOSE, AIR
SEALING, 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:
FeeType: Date Paid: Amount:
Building 1/31/20170:00:00 $65.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0892
APPLICANT/CONTACT PERSON POTENTIAL ENERGY LLC
ADDRESS/PHONE 61 EAST MAIN ST BRISTOL (860)620-4433
PROPERTY LOCATION 35 HARRISON AVE
MAP 3IA PARCEL 211 001 ZONE URB(I00)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid 4! , 4
Building Pennit Filled out
Fee Paid
Tvpeof Construction: INSULATION FIBERGLASS&CELLULOSE,AIR SEALING, INSULATION
WEATHERIZATION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 106184
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
r 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
4lhiraY
Signa taDate
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.
y MARNEY
-
ELECTRIC, INC.
175 Main St, Leeds, MA 01053
(P): 413-584-073 (F):413-587-0737
customerservice@marnevelectric.com
MA License A-17123
January 30, 2017
RE: 35 Harrison Ave - Knob &Tube Wiring Remediation
To Whom It May Concern,
Marney Electric, Inc. has removed the knob and tube wiring at the residence of
35 Harrison Ave, Northampton, MA 01062. All rewiring has been inspected and
approved by the Northampton Wire Inspector.
Sincerely,
5e4 *tax.
Bob Jensen
Operations Manager
Marney Electric, Inc.
cc:
Jeff Marney
__ DepaMtent use only
City of Northampton Stabs of Point:
j.- (1,0 \ \Building Department Curb CWDriveway Permit
2Sj 7212 Main Street Sewer/Septic Availability
„ Room 100 WatOImOIAvailability
\ii �` Northampton, MA 01060 Two Sets of Structural Plans
\ ,�`/ hone 413-587-1240 Fax 413-587-1272 PIoUSpe Plans
w . Other Specify
'PLICATION 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
35 HOHrccoYI Avery f_... Map Lot Unit
NOV VQThrfOY MA Oak Sone Overlay District_
N Elm St.timet „ CB District
SECTION 2.PROPERTY OWNERSHIP/AUTHORIZED AGENT 1
2.1 Owner�,�i P)010 Le
Record:
Name(Print) Lelievve, ........ 35CurTent 1t1 i=,=nl \v� 1NUrtln`ath �� n(.1/1
- �e� ltv&i11. -1 U�w— TelephoVli l.. 41`Y .../1I "$ I MA U' OS V
ne
Signature
2.2
2.2 Authorized Agent:
_Nicht1 S Mecster er\ria\ C-he i3 lo Mailingw o SI-413riste\ , CT ()U N D
Name(Print)
t n1,e, . t100-SO 1-124(-0
Signature Telephone
SECTION 3•ESTIMATED CONSTRUCTION COSTS
Bern Estimated Cost(Dollars}to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction Surf (6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection
6, Total=(1 +2+3+4+5) to , .100 ---_ Check Number3 f/ 106
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commt ionmmnspector of Buildings Data
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicgble)
New House 0 Addition ❑ Replacement Windows Alteration(s) ❑ Roofing in
Dr Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs IC] Decks ICJ Siding IC] Other(
C ra ''
•
Brief Deawip(loe)of .. -. - �, : ,SS i
Work: (Pim" Qir li
SECTION 8-CONSTRUCTION SERVICES
81 Licensed Construction
Superviis�("or: Vitt ' p y/ Not Applicable ❑ (y
)lame of License Holder:IT G101\1t IYLCiI 1001%)-'
License Number
�D C�ueev 12,YY , SCufihvinc ova , GT NAP / 2c''IC)
Address y Expiration Date'
•
SW— Dtq
Signature Telephone
L Registered Home Improvement Not Applicable 0
Rte& -/ gal ererC) Niche I( 5 \A 5reY 1al
Company Name Registration Number
nTetY. S(Gk_ htiri#Dn (A94 cis I f 2R/L01
Address ! [[��II,,,,rr�� ''ryry ' y Expiration Date
'.'. Telephone'JW0'(07V, U�433
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 buil
log permit
Signed Affidavit Attached Yes No 0
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings 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 acts
as supervisor.CMR 780, Sixth Edition Section 10834.1,
Definition of Homeowner:Person(s)who own a parcel of and 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 fawn
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 au such work performed ander 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,von 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 he State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State ofMassachusens General Laws Annotated.
Homeowner Signature
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: 35HQyticD011 AVrnUt,
The debris will be transported by: Y61-ey bb cA\ E Y f..t1
The debris will be received by: Via-1-\eysoy) Volt/rot-yes -619WQCT
Building permit number: 1
Name of Permit Applicant N\C U as w'IQAS}f'd Rti-fAitl a I vc 9
Date Signature of Permit Applicant
The Commonwealth of trlassnchtrsetts
[ / Department of Industrial Accidents
0
s�l—. Office of Investigations
1_ - 1 Congress Street,Suite 100
. Boston,Mil 02114-2017
www.mass.gov/ilia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leejbly
•
Name(nnsincss/Organiratiionandividtia : ctk-i,vf I 11 ri( a7...L L.L 1-- _ NL 1.. i�'H ) Y�i..k+�' t
Address: E y f WO�r1 1 t VL1.e - -
CityiState/Zip ? :401: j rThi' Phone#: 'ThC7()_\(:) 2'
Are -on an employer?Check the appropriate box:
Type of project(required):
Ll am a employer with 4, [] I am a general contractor and I
employ=(full andfor pad-time).* have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet, 7, 0 Remodeling
ship and have no employees These sub-contractors have 8. E Demolition
working for me in any capacity. employees and have workers'
s insurance!:insurance!: 9. Q Building addition
cote
[No workers'comp. insurance comp.
required.] 5. 0 We are a corporation and its I0.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their I I_(,Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MOL l2.(—Roof repairs
insurance required,] a c. 152,§I(4),and we have no _. y.
employees. [No nrorkers' ;3.p4 Other I Vl's(,R 4(i t (Ur:
comp.insurance required.]
'Any applicant that checks box al must also fill out the section below showing thek workers'compensation policy infomration.
t Homeowner who submit his affidavit indicating they ore doing all work and Then hire outside aadmnors must submit a new aaidavil indicating such.
:Contractors that check this box must attached an additional sheet shoving the name of the sub-cuntracton and state whether w not those entities have
employees. If the sub-conauetais have employees,they must pmvide their wnrkccx comp,policy number,
t am an employer that is providing workers'compensation insurance for my employees. Below Is the policy and job site
information. I ( (' ` T�/�c 1 v (ii�rI\
Insurance Company Name: \-alit fold i i ' >Ltr c,gI(..e. ( ,l Le-rtt
,,7 p ( 7 ppp
Policy N or Self ms i u. P. ) L VV ��—}�" t f"" �� Expiration Date Riv/ .-/I 1
Job Site Address: .Perri DnAve.nUe Cry/$ate/zIp: NGrt�cim tor., N14J\OcO
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGi c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
Ido hereby certify nutlet the pairs and penalties((perjury that the information provided above is true and correct.
Phone#: ?ilL'U' ?ii lU I'"'2�ILt
Official use only. Do not write in this area,in be ramble/ell hi,city or town official.
City or Town: Permit/License Il. .
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 it:
Owner Authorization Form
I, Bob LelFevre
(Owner's Name)
Owner of the property located at:
35 Harrison Avenue
(Property Address)
Northampton, MA 01060
(Property Address)
hereby authorize Potential Energy, LLC , a certified Mass Save Home
Performance Contractor, to act on my behalf to obtain a building permit and to
perform work on my property. e t //.
va
(Owner's Signature)
7/78//7
(Date)
Client#: 82429 MEISTNIC
ACORD.. CERTIFICATE OF LIABILITY INSURANCE DATE(MMADTWY)
7/272016
THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AF FIRMATIVELY 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:It the certificate holder is an ADDITIONAL INSURED,the policy(ies)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(s).
PRODUCER CONTACT Audrey Lamontagne
Fradette Carlson Agency .860 tFAcX No- 860-585-0038
PO Box 2456 EPAMRILo,EMI. 583-0943
Bristol,CT 06011-2456 ADDRESS'. alamontagneestarshep.com
860583-0943
INSURER(S)AFFORDING COVERAGE NAICY
INSURER A:Ha rtford Ins Group 19682
INSURED INSURERS:
Nicholas Meister DBA -- - -----_-_---
Potential Energy LLC INSURER
INSURER
4 D Queen Terrace
Southington,CT 06489 INSURER E'.
INSURER F:
COVERAGES CERTIFICATE NUMBER: 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. NOTWITHSTANDNG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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.
ADSL SUER POLICY EFF POLICY EXP
LTR
TYPE OF INSURANCE INSR WVDN/
POLICY NUMBER IMCOf/YYYI MNItOM1YYYI LIMITS
A X COMMERCIAL GENERAL LualuTv X 02SBMRB0509 08/052016 08/05I2017 I LIAL a2,000,000
„ L- x� P `Lg1ELEE PEM :
di DooDDo ---
_____
HID Ler I __ $10,000
( )Fusw.N a ml.wage_12,000,000
_erre LIM APPL $PDR C Er -mow<TE t4,000,000
PHIL
=oucY .Lcr (V DGCDucs-sI^Y"-INS 14,000,000
Omw
A AUTOMOBILE LIABILITY 025BMRB0509 08905201608105121117`s7/-P.H ,Ir.Ia
I_a„ace T2,000,000
LUTE. yc�ru.elUT� y7/ $
LELP,WED � SCHEILLv J.R Ps,ea�eT
¢ v O m1 L E
__
X HRED OX UTD
A X UMBRELLA LIAB X occup X 02513MR00509 08/052016 08/052017 rme x 11,000,000
EXCESS LIAO CLIMS-MADE .r<;R CAT 11,000,000
DED X ?CTENTION$10,000
A AND EMPLOYERS'
YERS'LSAnoN 02WECCRO745 '081052016 08/052017 X 17-::„
PNODROLLEFOT'LIABLLY YIN C fF
YC .mor S<CLUDED:.LaTIVE a EC ,clw.ur 1500,000
Fnd t fNH) EXCLUDED' y NIA
II .+ .
(Mandatory in NHi EL DISEASE-a E�nao a500,O1W
I.e ,o o rider uP_reo„ =I ar -. ..r.IMT r500,000
DESCRIPTOR OF OPERAnoNS r LOCATIONS(VEHICLES ACORD 101.Additional RemeM3 Schedule,may be.mored n more space is requlrtel
Columbia Gas of Ma Is an additional insured on the General Liability and Umbrella Liability Coverage per
written contract or agreement.
CERTIFICATE HOLDER CANCELLATION
COIUmbla Gas of Ma SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN
4 Technology Drive Suite 250 ACCORDANCE WITH THE POLICY PROVISIONS.
Westborough,MA 01581
AU
T�HORIZED REPRESENTATIVE
/�.t..Q- c3 C—C
@1988-2014 ACORD CORPORATION.All rights reserved.
ACORD 25(20141011 1 Oft The ACORD name and logo are registered marks of ACORD
MS843449/M843422 FCAJL
%do
C {) ((O al !remit/ (7fl//((IJJ(lC (fJeUJi
;" Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 179401
Type: Individual
Expiration: 7/28/2018 TO 419291
NICHOLAS MEISTER
NICHOLAS MEISTER
4 D QUEEN TERRACE ---
SOUTHINGTON, CT 06489 —
Update Address and return card.Mark reason for change.
Address [1 Renewal [I Employment f_ Lost Card
//. f.iu... /4.
Office of Consumer Affairs&Business Regclafioo License or registration valid for individual use only
A. HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
x. Office of ConsumerAffairs and Business Regulation
Registration: 179401 Typo: >ti
Expiration: 728/2018 Individual 10 Park Plan-Suite 5170 _
Boston 614021/6
NICHOLAS MEISTER ._ .
NICHOLAS MEISTER
4D QUEEN TERRACE .___
SOUTHINGTON.CT 06489 Undersecretary Not valid without signature
iassac'' _arf _..
pard o. .. rj OAS I _ S... �. :
r. 1 - .n1'. 1
.< CSFA- 06184
NICHOLAS MEISTER
413 QUEEN TERRACE
Southington CT 06489
IDSL¢..
r.....,s..�r... 04/27/2019