38B-050 (3) 9-11 LYMAN RD BP-2017-1472
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mao:Block: 38B-050 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 PERNIIT
Permit# BP-2017-1472
Project# JS-2017-002454
Est.Cost: $6000.00
Fee:$400.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Grouo: JAY BOLAND 101880
Lot Size(sg. ft.): 0.00 Owner: NAVARRO SANDRA
Zoning; URB Applicant: JAY BOLAND
AT: 9-11 LYMAN RD
Applicant Address: Phone: Insurance:
12 PISGAH RD (413) 203-2454 0 WC
HU NTINGTON MA01050 ISSUED ON:6/16/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:UPGRADE INSULATION - AIRSEALING
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 Occu.anc Si•nature:
FeeTvpe: Date Paid: Amount:
Building 6/16/2017 0:00:00 $400.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck-Building Commissioner
File 4 BP-2017-1472
APPLICANT/CONTACT PERSON JAY BOLAND
ADDRESS/PHONE 12 PISGAH RD HUNTINGTON (413)203-24540
PROPERTY LOCATION 9-11 I-NMAN RI?
MAP 38B PARCEL 050 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT(1/4:e*
Fee Paid11�iliine Permit FiElad outFee Paid
T1p' eofConstruction: UPGRADON-AIRSEALING
New Construction
Non Structural interior renovations
Addition to Existing
_ Accessory Structure
Building Plans Included:
Owner/Statement or License 101880
3 sets of Plans i Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
V Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: SSie 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 '�1Lb�j L��fr_
Signature Building Official Date 6� ! t
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.
Versionl.7 Commercial Building Permit May 15,2000
• Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
c 212 Main Street Sewer/Septic Availability
Room 100 Watermell Availability
Northampton, MA 01060 Two Sets of Structural Plans
\ phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property A1IddreI ss: This section to be completed by office
q, I\ I l�n' I rOa1a ,,11 �""11�� Map ,Zj�/ Q60 60 Unit
Nur4llamovn , MA ViDUV Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
S&ndrt 1\fa l mxneoa-I Norl-t np+bn
Name(Print) Current M ling Address:
11D- 6-uo- 2)S1
Signature Telephone
2.2 Authorized Agent:
Shawn a hIJI a33 CoSocth n to
Name(Print) � Current Mailing Address: 010 3
Signature Telephone
SECTION 3-ESTI ATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building /- /1 rb'1 oD (a)Building Permit Fee
2. Electrical l.0 V W (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection
6. Total=(1 +2+3+4+5) (.0 DDD . 00 Check Number / g, cloo
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
Version1.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition Repairs Additions ❑ Accessory Building 0
Exterior Alteration ❑ Existing Ground Sign❑ New Signs 0 Roofing 0 Change of Use❑ Other❑
Brief Description Enter a brief description here. •
Of Proposed Work: ( f p c rad c :VILA-tied-ton - A r S tA1 v I(
SECTION 5-USE GROUP AND CONSTRUCTION TYPE J
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly A-1 El A-2 ❑ A-3 0 1A 0
A-4 0 A-5 0 1B ❑
B Business 0 2A 0
E Educational 0 2B ❑
F Factory 0 F-1 0 F-2 0 2C 0
H High Hazard ❑ 3A 0
I Institutional 0 I-1 ❑ 1-2 0 1-3 0 3B 0
M Mercantile ❑ 4 0
R Residential ❑ R-1 ❑ R-2 0 R-3 ❑ 5A 0
S Storage ❑ S4 0 S-2 ❑ 5B 0
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(SO
161
1•'
2e 2m
3p 3m
4th 4m
Total Area(sf) Total Proposed New Construction (st)
Total Height(ft)
Total Height ft
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal 0 On site disposal system❑
Versionl.7 Commercial Building Permit May 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable R
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address • Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
Not Applicable la
Company Name:
Responsible In Charge of Construction
Address
Signature Telephone
Version!.7 Commercial Building Permit May IS,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes O No if
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
C'(-O , as Owner of the subject property
hereby authorize - to
act on my behalf, in all matters relative to work authorized by this building permit application.
CVS (2- I - 2 17
Signature of Owner Date
k as Owner/Authorized
gent reby 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
20 1-7
Signature of Os M1'V' Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Superrvvisor: \ \ Not Applicable ❑
Name of License Holder: J� JI�I�C. b1 2 2 L 0
License Number
Address Expiration Date
015 L X13 �o3-ays`I
Signature Telephone
SECTION 13-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 permit.
Signed Affidavit Attached Yes 010 No 0
160%
Jay Boland
ID#2011-554
t
1401,10,,i dr,i Nn; ii.r:.,n Inr,�4i ,
11)11).„!..0WUr,.rIh 11 ',jiff�u h•nnui r
Oa I tit h WYY.nrl. li Se•,tflmi/
save
If
may Massachusetts Department of Public Safety
171 Board of Building Regulations and Standards
License: CBSL-101850
Construction Supervisor Specialty
JA1Y NR AH.RD
H INGT RUN71ND7gN MA 01060
' 4:& o Expiration;
'Commissioner 42/27?W018
II
f r'//. f r'tlr;WC irrr t. lid r/f/ttuiirrc/uar//J
I j
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 021 ie
Home Improvement Contractor Registration
Type: Corporation
Home EnergySolutions Inc
Registration: 186724
Expiration: 01/03/2019
•
68 Russellville rd
Southampton, MA 01073
Update Address and return card. Mark reason for change.
. ❑ Athena rt plenewal n Fmniovment ❑ Lost Card
Ot&.of Consumer Affairs&&einess Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only
TYPE:Corporation before the expiration date. It round return to:
pgglauatlon Fvolration Office of Consumer Affairs and Business Regulation
186724 01/03/2019 10 Park Plaza•Suite Silo
Boston.MA 02116
Home Energy Solutions Inc
Shawn Milcheil
68 RusseiMlle rd -r�CL.• -"�
Southampton,MA 01073
Undersecretary Not valid without 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: C– I , Urn f-r\ ZO A a � �or*ham o ff\
The debris will be transported by: -E. A • , , So _ on —'
The debris will be received by: WA-j-\-Q YY\f/-a1Q CV MIA I
Building permit number:
Name of Permit Applicant s h 4`ILk-Ve-k42_,I
lD- ly 7011 4. ;%
Date Signature of Permit Applicant
the Comte nrreeldt ofMassech teas
Department of71sassier
C.i!--741r-r-t
:i Officeof Investigations
==i z
I Contras Sherr,Sade I00
==t'3 Bostoa,MA 02114-2017
A ' aJ
onrotasess-gea✓daa
Workers'COraprasation Laurance Affidavit BuBdel&tCOrutl7Ct0Ci/E1. letrIO.M/Pmmblff
Applicant Information Please PrUtt Leaibly
Name : Srbu - t i A i i-. - at - -
Address:__Loci, , 9j32_1\Vt\1L inaa
i /Sight/En: 1i _ let tlstijk inti 0 iiPhone#: qIS— s_i r . 45t"
------ - ----- - --- ------
Are Title of Paled(fid):
1.❑ 1 am a® }oyer with 4. ❑ I am a gmval contractor and 1 6. ❑New construction
(full audlor Pat-time).•
have!aired
employees
2❑ I am a sokpntprietmcv partner-
These
on the ranched 7- E]Remodeling
ship and have no employees
nab-a tors have S. 0 Demolitim
mocking fax me in any capacity. employersand have warlme' 9. ❑Building addition
[No odes•' comp.itnuraece romp u ni.a-t
required.) 5. El.We are a corporation and its I0.❑Electrical repairs or additions
3.❑ I am a homeowner doing all wort officers have eaacised the I L❑Thumbing repairs or additions
myself[No vaarkeas' _ right of exemption Per MGL ❑
repairs
I comp.
� c.152,§1(4),and ore have i 12 Roof
employees. [No wadolse 13.❑Olin ..�
comm-imarance reviled]
'M
i4- -amhnar1 mean n fill oat the seem Slow abowbttheirnwi%'mopaanapolicy iefo®tion
t l7tmeaaom who aubmittmm affidavit mdcatoadey me dotes all work ad that l*c oda:---s -®e neat mew atr>b.tmsmtg tech_
tat deck this btu—aaachnl=additional Awl Mowing Aeon=ado Samoan ad NM wbeher a at those DNi.p lime
employed If thr sob-coo nem lone anpbyea,they®t po ire rhes madams'amp pity member
Iamest v/foym that bposidigwortoa'asper atiom oma meeforary employes Bdom b shapo$ey tad sae
irjarnatdm- (� (� 1 1 7....-41
,
Inseamecampmy Namcy\bU ` Sal ) -" pc ( �'(1i�(tll _
Pokey r orSelfuts-Lir M. , 1 , )C tit'f`~,9 ai - . Etpis--lian Dam_ .-1't - a' Wi)52
(( � m
lob Site Adh.ae. j�l- la all . , CCity/State/Zip. V� '1 I Un. p
Attach a copy.f the workers' .,,:::. .. ti
policy*technetium page(.L.. e pan nor and ecplratfom date}1D�Dworkers'
Failure to secure coverage m required ander Section 25A of MGL c. 152 can lead to the®Position of criminal penalties of a
foe up to SI,500.00 ad/er a t-yw imprisonment,as well m oral penalties in the form of a STOP WORK ORDER and a fax
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to toe Office of
hivachgtirm of the DIA for 115Marce coverage ve.ii.wtion
1 do hereby - . / n' afperjuryMattheinformauomprorit&above b sae and cow.
��i
Date: (0' 15 , 2C 1 "1
Phone it. HI ;1)- x.03 - at{j�
1 Official ase only. Do twrite mcorm Si be onop4ta
tntty dry or me ofdat
City or Tann: P...drrt Y--..it
1 Loving Aetiaclty(circle ore): 1
1:Beard of Health 2.Badiag Dept tdt 3.CltyfToran Cork 4.Electrical inpeehr 5.Pinkie:Inspector
6.other
C.atiet Persia: Phone a: __ -
City of Northampton
4:.
Massachusetts
a y
s
C.,f DEPARTMENT OF BUILDING INSPECTIONS i
212 Main Street • Municipal Building us Y `,
//'�� T''
Northampton, NA 01060 silt
Property Address: "t' [ t Lyme 17,L6(
Contractor �,l (J; \ I,,,,
Name: $ E/�A � SD\uklons -A-f\� �ratbr Th�Q�.\
Address: (a�33 Ca ‘�P 11�P qtr A v�
City, State: Cf1�,t4�M OJOCI fV 0\b13
Phone: Lill- 2403- at}cL\
Property Owner
Name: /SOA vjI& )$ VAf U 110 - 10C, - 1ac'1
Address: 1q "q -1. ( L �t'�1"m \ SWAZI-
City, State: , V``or4' Vytlnpv) �.k D (D�U
I, %Ikon �l-kk i I (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 /-_ I , Zoite
ACcutof
CERTIFICATE OF LIABILITY INSURANCE 1
TINE CERfFICATE IS ISSUE)AS A/MTTSt OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON 711E CER11nCATE MOLDER.THIS
CSRTFHCATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AWED, MEND OR ALPER THE COVERAGE AFFORDED BY THE WAXIER
BELOW. TINS CERTIFICATE OP INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING RNSURER4S), AUTHORIZED
REPRESENTATIVE0R PRODUCE((,AND TRE CERTFICATE HOLDER
BRbRTANT: N Ss certificate holder bit ADODXNtML*WEED,the pdgflss)must be endorsed. F SUBROGATION RI ri,flied to _
the bete and wrdSlWM of the poesy,cabin pales mem TmWm an ender st. A statement an this taetIllele doss not cones Agit to the
nMkab holder In Seo of Mee end a0.609gs}
PR0683m MCllailtabilt11 CartmT to
Mack i Pari:an Inturanaa Agemoy im. Wpm (413)527-5520 IMym p1s1627-s410
6 Campus lane bonrpalloffinekandpacri team
MIRMIRRMMOIM COMM ME MICR
Saatha.pton IN 01027 e664aRA3ztNtlla ,Tupurpop Or00- 17000
SOMMNelq(a elaOLm*, Insatmnoa Coop a 42390
Ikea Energy Solution Ina 44111411114; 111111111111
68 Hassellville Rd IMMURE.o:
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MI
Southampton W 01013 mMaP1 IIIIIIIIIII
COVERAGES CERTIFICATE NUMEMCh16323002617 REVISION NUAIBI R
THIS m TO CERIFY THAT THE POLICIES OF INSURANCE USE)D13,OW HAVE SEEN ISSUED TO THE INSWED NAMED MOVE FUR THE POLICY PERIOD
INDICATED. NO WTHSTAtOMO ANY REQLW&ENT, TERM OR CONDOMS OF ANY CONTRACT OR OTHER DOCUMENT MVM RESPECT TO YHMAI THIS
CERTIFICATE MAY SE ISSUED OR WY MATAS,711E ISSUANCE AFFORDED SY THE MIMES DESCRIBED HEREIN M SUBJECT TO Al THE TERMS,
EXCLUSI NSMD CON IIiOMs CF SUCH POLICIES LANES SHORN WY HAVE Da31 REDIOFDSSY PAID 111 A4
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Proof of Cavaraga
CERTIFICATE HOLDER CANr�1 ATiL.fli
SHOULD ANY OP THE ABOVE tt*SCREEED POLICIES BE CANCELLED BEFORE
THE EMIRATION DATE nearecw,City of Northampton ACCORDANCE MINIM POLICY PR01MONSE WILL BE OEUYEO.T N
212 Main Street
Northampton, ha 01060 AanwF®1mgEawN1NE
0188.2914 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and boo ere registered marks of AWED
mS026poe n