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13-011 (5) 24 COLES MEADOW RD BP-2017-1039 GIS a: COMMONWEALTH OF MASSACHUSETTS Map:Block: 13 -011 CITY OF NORTHAMPTON • Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGLLcc.1144/2�A) Category: INSULATION BUILDING PERMIT Permit 4 BP-2017-1039 Project 4 JS-2017-001786 Est.Cost:$130000 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: use Group: ENERGIA LLC 92540 Lot Size(sq.ft.): 29620.80 Owner: BRADLEY MARILYN J&RHONDA MARIANI Zoning: Applicant: ENERGIA LLC AT: 24 COLES MEADOW RD Applicant Address: Phone: Insurance: 242 SUFFOLK ST (413) 322-3111 WC H O LY O K E MA0104 0 ISSUED ON:3/1 7201 7 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL THERMAL BARRIER POLYISO ON OPEN CRAWL SPACE 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 ft 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 3/17/2017 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File# BP-2017-1039 APPLICANT/CONTACT PERSON ENERGIA LLC ADDRESS/PHONE 242 SUFFOLK ST HOLYOKE (413)322-3111 PROPERTY LOCATION 24 COLES MEADOW RD MAP 13 PARCEL 011 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid I ' Building Permit Filled out IVI" Fee Paid TypeofConstruction: INSTALL THERMAL BA ER POLYISO ON OPEN CRAWL SPACE New Construction Non Structural interior renovations Addition to Existing_ Accessory Structure Building Plans Included: Owner/Statement or License 92540 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: 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 • /i. 3-/7 /y Si: . re of I di g G"Ictal 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. „ '1%1\t1/4 paparnr t bse a dy \ City of Northampton Statue of Permit Building Department Cw6Gtt OreweyPamet 212 Main Street Room 100 Ve4efr^- ' ' ` ` , .r. -..._ .....� - ' Northampton, MA 01060 Two Sets of Structural Plans. phone 413-587-1240 Fax 413-587-1272 PbtrSite Wena ONbr Speldfy APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 11 Property Address: This section to be completed by office Map Lot Unit 2y Cotes VyAt&c‘CU Q-c1 Zone Overlay District 01-kr)CLA-Y%ciTort , opt ClOLv0 Elm St.District CS District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT Z/Owner of Record: 'k1Y1nY1r'vG 4AO,T10.$1l 7L\ CO‘ CCACLCLL. F,l%. Name(Print) Current Ma ng cess N 7'1 T c'OST\ r{py ✓e: ”. Petit ti Aurae Telephone Signature 23 Authorized Agent: GYI CN Od& Lt-C acc. . 1. ' •: .>, « Name(Print) / Gwe41'3 Mailing Address: 413- 3da -3Ltf Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only Completed by permit applicant 1. Building 11500 fl0 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of _ Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection 8. Total=(1 +2+3+4+5) f, \ t -50D . Pa Check Number / jaFir This Section For Official Use Only Date Building Permit Number Issued: Signature: Building Commissioner/Inspector of Buildings Date Section 4. ZONING Alt Information Must Be Completed, Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning Thise umn to be Pilaf intry Building Dcpartmem Lot Size Frontage _. Setbacks Front Side L: - R: .. L: R: Rear Building Height Bldg.Square Footage — ,a Open Space Footage . ..... % (Lot area minus bldg&paved Parking) #of Parking Spaces Fill: (volume&Location} - _ - A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW O YES 0 IF YES: enter Book Page and/or Document it B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES O 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 O NO O 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 O IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO O F YES,men a Northampton Storm Water Management Permit from the DPW is required. SECTION ti-DESCRIPTION OF PROPOSED WORD((check ail apolicabiet New House El Addition El Replacement WIndows Alteration(s) n Roofing C Or Doors ❑ / Accessory Bldg, U Demolition © New Signs [Oj Decks [C7 Siding[CII Other[ 1 'lfin Brief Desc&ription of ProposedL Work:RiA 'VsA..l thVtOO-A rrktytes Pblu�1`^,O 6rs oocj-1 ,�c�••--c�rk I� Lsscia CE, Alteration of existingbedroom year No Addingnew bedroom Yes y2.1110.- Attached Narrative L Renovatig unfinished basement Yes 4'��Ho Plans Attached Roll -Sheet es.if New house end 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 c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions a. 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 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 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, • •M • U • \ ,as Owner of the subject property hereby authorize T nrnO-S. Orf"r S Syr,ass.-e c" to act on my behalf,in all matters relative to wont authorized by this budding permit application. Signature of Owner Date I, TrnrnC ClOSSMC.&s1 C ' ,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. Signed under the pains and penalties of perjury. Print Name Ai 4 /!(1/7 Signature of• ertAgent Date SECTION 8-CONSTRUCTION SERVICES 8,1 Licensed Constructleen Supervisor: !� • Not Applicable Nameen ❑ Ne oftdese Hoid.r_1earkO'Ct.i T")O {, }„ yC\t' �' q-Z,se-,f.(} License Number \ t\oNO\LC Vv06 cap°LAO 91x11? Address ' Expiration Dale 413- 3'2_1- 3o Sig cure Telephone 9.ReWstertd Nome Improvement Contractor Not Applicable 0 Company Name Registration Number ZLV) sof\tm\r ;i. -rtr)1'\ot lift In oIOLIk t1tt1 ( $. Address Expiration Date Telephone 13-3.12-31 l SECTION 18-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(8)) 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 builddiipq permit. Signed Affidavit Attached Yes H 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.C91R 780. Sixth Edition Section 1883,5.1. 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 under the building Permit. As acting Construction Supervisor your presence cm 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 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: 2q (Oej ven( \O1 o) ishd The debris will be transported by: \\t? a WGSr( The debris will be received by: \\CO, WO.S1-2 Building permit number: Name of Permit Applicant %,hoy-a,Q rnar to,x\ 'b/t1/7 Date Sign ture of Permit Applicant Staa Department of Industrial Accidents nr. �l =zYi_ Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Energia, LLC. _ Address: 242 Suffolk Street City/State/Zia: Holyoke, MA 01040 Phone #: 413-322-3111 Are you an employer?Check the appropriate box: Type of project(required): I.® I am a employer with 24 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp:insurance comp. insurance.] 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]f c. 152, §1(4),and we have no employees. [No workers' I3.® Other insulation comp. insurance required.] *Any applicant that checks box al must also all out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I ain an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: HDI - Gerling America Insurance Company Policy#or Self-ins.Lic.#: EWGCR000186816 Expiration Date: 7/1/2017 Job Site Address:2,1-1 ( 0,CS 'Mj'(acXW) ? ( City/State/Zip:NOY112Corn pepn \V\ O\O(DC 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 MGL 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 nder the pains and penalties of perjury that the information provided abr ye is t e and correct. �. iu :s e: 4 Date: /S Ph. a#: ' - - 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): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: • Office of Consumer Affairs&Bnsineas Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: •legation: 165169 Type: Office of Consumer Affairs and Business Regulation Expiration: 1/11/2018 LLC 10 Park Plaza-Suite 5170 Boston,MA 02116 ENERGIA LLC THOMAS ROSSMASSLER 242 SUFFOLK STREET __ HOLYOKE,MA 01040 Undersecretary Not valid without signature / . aMassachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-092540 Construction Supervisor . THOMAS BROSSMA55(ER „,z 100 MAIN STREET HATFIELD MA 0)031 • *' r� -M n • Expiration: Commissioner 09/04/2017 A d CERTIFICATE OF LIABILITY INSURANCE DATE IM 6GInWl 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(les) 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 CUNIALI NAME: Mary Conroy James 1. Dowd and Sone Insurance Agency Inc. PHONEmit Esti 413-STB-9449 la<.NoC 14 Bobala Road Holyoke MA 01040 ADDRESS: CO TO edowd,Com CUSTOMER ID a:ENERLLC-01 INBURERISI AFFORDING COVERAGE MAIC. INSURED INSURERA:HTI-Gerling America Insurance CamPa Energia, LLC INSURERB:Torue National Insurance Company 25496 242 Suffolk Street Holyoke MA 01040 INSURER c: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:2034052479 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER 00CUM ENT 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 FBEEFNpR�pE��DyUCED BY PAID CLAIMS. ILTSRR TYPE OF INSURANCE (MSR Wv0 POUCT NUMBER LMN&NTEc1 (MMIOD I UNITS A GENERAL LIABILITY Y Y EGGCR000186516 7/1/2016 7/1/2017 EACH OCCURRENCE $1,000,000 UAMP.GE IV NEN IED X COMMERCIAL GENERAL LIABNTY PREMISES(Ea occurrence] $100.000 CLAIMS-MADE n OCCUR MED EXP(My me person} $ _ PERSONAL SADV INJURY _ 51.000,000 GENERAL AGGREGATE $2,000,000 GENE AGGREGATE LIMIT APPLIES PER: PRODUCTS.COMPOP AGG 52,000,000 7 POLICY IA Tr9i ri LOC A AUTOMOBILE LIABILITY Y Y BAGCR000186816 7/1/2016 7/1/2017 COMBINED SINGLE LIMIT $1,000.000 IEa aalgent) ANY AUTO BODUY INJURY(Per person/ E ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTYDAMAGE X HIRED AUTOS (Per accident) X NON.OWNED AUTOS S 5 S UMBRELLA LIAB OCCUR Y Y 85393N2SOALI 7/1/2015 7/1/2017 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAMS-MADE AGGREGATE $1.000.000 _ DEDUCTIBLE _ $ X RETENTION $10,000 A WORKERS COMPENSATOR Y EPGCR00018SS16 7/1/2016 7/1/2017 X WCSTAT S 0M. MD EMPLOYERS'LWBIUTY TORYLIMIS ER OFFIICEE EMBER EXCLUDED? Y� NIA ELEACH ACCIDEM $1,000,000 IV .Abry WWI EL DISEASE.EA EMPLOYEE 51.000.000 V .m9mge gnoer ICESCRIPTION OF OPERATIONS below EL DISEASE.POUCY LIMIT 61,000.000 DESCRIPTOR OF OPERATIONS I LOOATIONSI VEHICLES (Attach ACORD 101,Additional Remarks SCIedule,If MOM apace Is required) CERTIFICATE HOLDER CANCELLATION 30 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL HE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE •®1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name end logo are registered marks of ACORD City of Northampton 'or-Massachusettsor- ' - fe 40.14,7 DEPARTMENT OF BUILDING INSPECTIONS a 212 Main Street • Municipal Building 2s _�, .4. n i /NNoo-rthaapt//on,, MA]�0106�0 /• 01 Property Address: 27 Cah6J , 211 JQ YV ph • Name Contractor aa/ 10/A- SLG Address: 212 Sl'FFp2k ST• City, State: /./O At A- Phone: y/?, • 322 - Z // f Property Owner e. //���f lnC IA N/ Name: Address: 27 C&I S /4g4 d7T I • City, State: fl d ttr MA/itnTO ry /ern ,ea 55 I-M Sc e* (contractor) attest and affirm that the building I intend to insulate does not have any open air(knob and tube)wiring in the spaces to be insulated and that I have provided the property owner with a copy of this affidavit. Contractor signature Date �/' 11-7 Permit A: ttioi hoiza '' `'% mass Save . - m �� Swops PARTIMMIRG.amr8r44e044ey annum • Site ID: 50288715 Customer: Rhonda Mariani Rhonda Mariani ,owner of the property located at: (Owner's Name,printed) 24 Coles Meadow Rd Northampton (Property Street Address) latyl hefeby 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 weatherlzation work on my property. ' Owner's Signature: ( I turn-, Date: a/4aon • FOR CLEAResult OFFICE USE ONLY • CLEAResult has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: . • Participating Contractor Date CLEAResult • 50 Washington Street,Suite 3000 • Westborough,MA 01581 • 1800.480-7473 Qi FarOffce use Only Rev.102015