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23A-270 45 MIDDLE ST BP-2019-0755 GIs#: COMMONWEALTH OF MASSACHUSETTS MV.-Block:23A-270 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-2019-0755 Project# JS-2019-001238 Est.Cost: $1875.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: RICHARD ABTS 74666 Lot Size(sa.ft.): 13634.28 Owner: WALLACE JENNIFER&CAROL WALLACE Zoning: URB(100)/ Applicant. RICHARD ABTS AT. 45 MIDDLE ST Applicant Address: Phone: Insurance: 132 PROSPECT ST (860) 306-7275 WC EAST LONGMEADOWMA01028 ISSUED ON.12/27/2018 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSULATE ATTIC FLOOR WITH 12" BLOWN CELLULOSE & INSULATE ATTIC HATCH 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 Sisnature: FeeType: Date Paid: Amount: Building 12/27/2018 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner �b0�19 7 lj City of Northampton .. 3' � Building Department 212 Main Street , r Room 100 +. r _7-_7 Northampton, MA 01060 T phone 413-587-1240 Fax 413-587-1272 r APPLICATION TO CONSTRUCT,ALTER,REPAIR, RE VATE DEMOLISH rNE R TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION DEC 2 7 2018 '2 3'4 -a70 1.1 Property Address: I This sec ion tc be completed by office DEPT.OF BUILDING INSPECTIONS 49 ' M; _/ _ le 6+L-ee+ NoNI*pMPTON.MA2jMQ Lot Unit A/otP+k aVVP+°K MA 010&2_ Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: t e_y1 w% &0 1A)&11-c-e- 'ws Mid d i e- &t. .A)o v+lhal 40+otA MA oo l c Name(Print) Current Mailing Address: 917- 817- 79�� See nwi%" oLL&+k6Vi2a*col,& Telephone Signature 2.2 Authorized Agent: "` 12 cl,�ad►� �'1(o-I-S 132 ?rosAett 5f. , E«-si- LowSw►eadow MA,-0 110 Zy Name(Print) Current Mailing Address: 10"j Q,(» Y&8 - 3o& - 7275' Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item 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 0 Construction from 6 3. Plumbing 6 Building Permit Fee � C 4. Mechanical(HVAC) O J 5. Fire Protection 6. Total=(1 +2+3+4+5) `) Check Number P This Section For Official Use Only BuildingPermit Number: Date Issued: 42 Signature: 12-2-7-I Pj Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: _ R L L:. _ R:. Rear Building Height Bldg. Square Footage % - 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 Q DON'T KNOW � YES 0 IF YES, date issued:; IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book . Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW IVYES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained Q , Date Issued: C. Do any signs exist on the property? YES Q NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO 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 © NO Q) IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all ap)licable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks [p Siding[❑] Other[no WC0.tkewiZa.'tt0b Brief Descrytion of Proposed f+ Work: 1N.suda� 4-4;r- -F 1cno tai-Aa. a"61oWK GeffiJaSC. 1,4su(,-fie. &*is Itod"G Alteration of existing bedroom Yes C No Adding new bedroom Yes x No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa.If New house and 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 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 -1. 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 I, See aWttey 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. Signature of Owner Date G f j� ycl A(6t5 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. A ia+s Print Nam .._. Signature of Owner/Agent I Date SECTION 8-CONSTRUCTION SERVICES 9.1 Licensed Construction Supervisor: A Not Applicable ❑ a Name of License Holder: �1 c— aa6d A b is C S - 07 q-tL to License Number l 13-;k ?I y-ay&c-t 54. cask L0j4u e&-6(dcc) NA >io?-T? I./K / 2d Address Expirati n Dater -.C." 160 30 75- Signature - Telephone 9.Reuistered Home Improvement Contractor: Not Applicable ❑ 1%&%A.+tyK Ei&e%&gv - LILC 177389 Company Name Registration Number .sue. . NDVnwicl CT O(a3(o6 I�.�1 1(9 Address �y Expirat on D to (o � Telephone 95-300 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 building permit. Signed Affidavit Attached Yes....... No...... ❑ City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS �$ 212 Main Street • Municipal Building 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 must be registered Type of Work:��o .�.e� t mat iobt�:h s�.�of io 1A Est. Cost: l Address of Work: 1f,5 /4 i cW to 5't /11oV4- a�,w nth r" A 0/O La'Z 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: -4*,� a- I hereby apply for a building permit as the agent of the owner: 1973 8 9 Date Contractor Name 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 City of Northampton `r Massachusetts N :• DEPARTMENT OF BDZLDING INSPECTIONS q 212 Main Street •Municipal Building Northampton, MA 01060 Debris 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. The debris from construction work being performed at: Its M;Aa re s-t. . Alovy." lot ow M A (Please print house number an street name) Is to be disposed of at: 024 (Please print name and loca' n of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) 'j 6j��— Signature of Permit Applicant or 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. ry= = Permit Authorization mass save Form Site ID: 3571992 Customer: JENNIFER WALLICE l�4GL owner of the property located at: (owner's Name,printed) 45 Middle St Northampton, MA 01062 (Property Street Address) (Cfty) 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 weatherization work on my property. Owner's Signature: Date: t— FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: 69w.4±eu`k L v�e�►fa U L—t..C. 12/10 Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Pape 1 of 1 far C"C•Ua•Only Rev.10201S The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations y 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): L,.&I& VVk Eyaenv_ Ll_L Address:_ 3 3 UZ;seeu s:N, AueKute. City/State/Zi : Phone#: 877-9700-300& Are you an employer?Check the appropriate box: Type of project(required): 1.2 I am a employer with 3 D 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 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. E] Building addition [No workers' comp. insurance comp. insurance. required.] 5. E] We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.® Other AMk &TAA+ io comp.insurance required.] .iy applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name loS M u+y41 Ca S t4cd'ry Go n1.o. Policy#or Self-ins.Lic.#: 15 HS 10 Z$ Expiration Date: ),2431 /2019 Job Site Address: M i alci le 5ttree-t City/State/Zip: Alay*ltaw►l4-0t1� AM olo6Ll 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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: (� Date: Phone#. %Q -3 0(e- 7275 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#: Al400 CERTIFICATE OF LIABILITY INSURANCE °ATE(M�D°IY 18 `� 12/17/2018 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 3ELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED `rew REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or 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 ondomement(s). PRODUCER CONTACT NAME: Sheri King, CIC Byrnes Agency, Inc. - Norwich 6 Consumers Avenue (860) 886-5498 AC PHONE No):(860) 859-5075 Norwich CT 06360-7521 E-MAILDDR : sking@byrnonagency.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Lloyds of London INSURED (877) 878-3006 INSURER B:Employers mutual Casualty Comp 21415 Lantern Energy, LLC & Lantern Electrical, LLC INSURER C:ENCA3C0 Iaeurance Company 21407 33 Wisconsin Ave INSURER D- Norwich CT 06360-1550 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:cert ID 20387 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. NOTWITHSTANDING 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. I TR TYPE OF INSURANCE AD L S POLICY NUMBER MMIVDD CY EFF MMID I EXP LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTE15— CLAIMS-MADE Fx_1 OCCUR SD81028 12/31/2018 12/31/2019 PREMISES Ea occurrence $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT LOC PRODUCTS-COMP/OPAGG E 2,000,000 X OTHER:Location $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident .• X ANY AUTO 5881028 12/31/201812/31/2019 BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident S B X UMBRELLA LAB X OCCUR SJ81028 12/31/201812/31/2019 EACH OCCURRENCE $ 5,000,000 71 EXCESSLUIB CLAIMS-MADE AGGREGATE $ 5,000,000 DED X RETENTIONS 10,000 1 $ W B ORKERS COMPENSATION PER OTH- ANDEMPLOYERS'LWBILITY YIN 5881028 12/31/2018 12/31/2019 X STATUTE ER OFFICEOPR TORPBER R ER/E ECUTIVE NIA E.L.EACH ACCIDENT $ 1,000,000 (MandstorylnNH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S A Professional/E&O PGiARK0841600 02/23/2018 02/23/2019 $ 2,000,000 $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached K more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ®1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 1 i i f i l 2018 WEATHERIZATION mass save BARRIER INCENTIVES 1 Based on your Energy Specialist's recommendations,your home can benefit from program-eligible insulation and/or air sealing improvements.Before moving forward,please follow all the instructions below to remediate your weatherization barriars. CUSTOMER INSTRUCTIONS >. Hire a qualified,licensed contractor to evaluate and/or remediate the weatherization barrier(s). z. Submit signed and completed copies of this form and a copy of the paid contractor invoice(s)within 60 days of your Home Energy i Assessment to:Pre-Wx Barrier Incentive,c/o CLEARest t,SO Washington Street,Suite 3000,Westborough MA 01581 or email to prewxoffei*- fearestdt.com. 3. The weatherization incentive will be deducted from the customer co-payment amount of the weatherization work,A rebate check will be issued in the event the amount exceeds the customer's co-payment amount. 4. Complete the recommended weatherization improvements. Customer Name. Jennifer WalliCe __,ClienttforSiteID: 3449()02 Site Address: 45 Middle St City:State:MA _ jam• 01062 _ Phone Number: Email: —j-w�653g�nVn�edn1� 8i7 �- ti -- -^ Customer/Homeowner Signature: Date: To determine if there is any active knob and tube wiring,the contractor will evaluate the following areas where eligible Mass Save'weatherization recommendations have been made: fR Attic Floor 0 Attic Wall jQ Attic Slope O Exterior Wall 0 Basement 0 Other:_0 Other:— M i have performed my inspection apnoll6etermined there is no active k /and tube wiring in the areas selected below. [ftALticHoor 0 Attic Wall IgAtticSiope O Exterior Wall JABasement 0 Other: 0 Other:_ ,ova p*f�L r/�r. 0 i have read and agree to the Terms and Conditions on the back of this form. Robert M Cote Jr. Contractor Name: J Address:34 Rural Rd City.Belch down State:Mass QIP: 01007 Company Name:Blancf)Pnf)0, Pall Electric Inc License Number: 50145 Contractor Signatu Date: 10/15/18 High Carbon Monoxide:Contrfor is to service and re-evaluate the selected mechanical systems)and reduce the carbon monoxide level, as measured in the undilutedAlue gas,to below 100 parts per million(ppm). Draft Failure:Contractor is to correct the draft in the selected flue(s).Refer to table on reverse for acceptable draft ranges. High Carbon Mcnoxicie Draft Failure I Exls jig GO gjoin: Revised Co ppsn. Exi#ing Draft Pa; Ryvised Draft Pa; Heating System f Hot Water Heater 4 Other: I Spillage:Contractor is to correct the spillage of flue gases in the selected mechanical system(s).Must not spill after 60 seconds of operation. 0 Heating System 0 Hot Water Heater 0 Other: 0 1 have performed my inspection and have corrected the items noted in the areas selected above. 0 1 have read and agree to the Terms and Conditions on the back of this form. Contractor Name: Address: City: State: ZIP: Company Name: _ License Number: Contractor Signdture: Date.. Continued on back (page 1 of 2) Office of Consumer Affairs and Business Regulation One Ashburton Place- Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: Supplement Card LANTERN ENERGY I.L.C. Registration: 177389 33 WISCONSIN AVE Expiration: 12/01/2019 NORWICH,CT 06380 Updab Address and Return Card. SCA 7 b 20M-W17 OHbe of Consumer AWalrs!Business Repletion HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Supplement Card before the expiration date. M found ratum to: 9 Offlee of Consumer Affairs BusinessRegulation 177389 12/01=19 10 Park Plaza-SuRe 5170 LANTERN ENERGY LLC. Boston,MA 02116 RICHARD ABTS 33 WISCONSIN AVE NORWICH,CT 06.380 Undersecretary wi�0ut sig�m A., L Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Con str ri'topervisor CS-074666 empires.02105!2020 RICHARD L AST& "i 132 PROSPECTS EAST LONGMEA _ 910 _ Commissioner �✓""