16A-014 451 SPRING ST 13P-2019-0821
GIs#: COMMONWEALTH OF MASSACHUSETTS
Mg-Block: 16A-014 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-2019-0821
Project# JS-2019-001355
Est.Cost: $3500.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JOHN PERRIER 105319
Lot Size(sq.ft.): 16378.56 Owner: CROCKA LYNN E
Zoning:URA(100)/WSP(44)/ Applicant. JOHN PERRIER
AT. 451 SPRING ST
Applicant Address: Phone: Insurance:
18 BROADWAY POND RD (860) 930-7794 WC
STAFFORD SPRINGSCT06076 ISSUED ON:1/23/2019 0:00:00
TO PERFORM THE FOLLOWING WORK.-ADD R-49 CELLULOSE INSULATION IN ATTTIC
FOR WEATHERIZATION PURPOSES
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 1/23/2019 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
0
m
01 The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CMR MUNICIPALITY
o USE
o z Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
>z
One-or Two-Family Dwelling
DN
o
This Section For Of iiaa. se only
0 o
;Burmit Number,
(ficial(Print.Namc) Signature Of
SECTION l:SITE INVOR1MATION:,.
1.1 Pro a Addr s: 1.2 Assessors 1 ap&Parcel Numrs
� JZ;V2J-?4 , Ll— la
L l a Is this an acc .ted stree yes no Map Number ParcelDQNtun er
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes13
SECTION 2: PROPERTY'" NERSHIPI
2.1 Owner' f Record:
- -r-�U G� a __ _ ,J /� /D
Name(Print) ' City, �tate,ZIP
IYA
33-7 6
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORKS(check all that apply) .
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
Thief Description of Proposed Work'':
To Add/Achieve R-49 Cellulose Insulation in Attic for weatherization puiposes
SECTION 4:ESTIMATED-CONSTRUCTION COSTS
Estimated Costs: z.
Item . ._.Otlichd Uge'Odl
Labor and Materials Y =
1.Building $ 1. Building Permit:Fee:$ , Indicate how-fee is determined
2.Electrical $
E3 Standard City/Town Application Fee a.
❑Total Project.Cose(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) S List:
5.Mechanical (Fire $
Suppression) Total All Fees: /,
Check No: q�u Check Amount; O Cash'Amounii..
6.Total Project Cast: $ / p Paid in Full ❑Outstanding 13alance Due;:
NEGH
28 Spellman rd
Please Submit Stafford Springs,Ct
Permits to: 06076
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
John Perrier 103319 12-12-2019
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) I
18 Brsdway Pond rd y� 777777
No.and Street U Unrestricted f(Build!M up to 35,000 cu.ft.
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC R ofing Covering
Stafford Springs Ct 06076 WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
413-244-2003_ jperrier06076@yahoo.com
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) t73021 &26-2020
HIC Company Name or HIC Registrant Name
John Perrier HIC Registration Number Expiration Date
No.and Street iperrier06O76@yahoo.com
18 Bradway Pond rd Email address
Stafford Springs,Ct.06076
Ci /Town,State,ZIP Telephone 413-244-2003
SECTION 6:WORKERS'COMPENSATION INSURANCE-AFFIDAVIT.((K Cr;L. 2,5 (!3}:
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...........M
SECTION 7a:OWNER AUTHORIZATIONIO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BM.DING,PERMIT
I,as Owner of the subject property,hereby authorize New England Green Homes to act on my behalf,in all matters
relative to work authorized by this building permit application.
i-- l / / /201
Print Owner's Name(8rectlonic Signature) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the Information
contained in this application is true and accurate to the best of my knowledge and understanding.
John Perrier
j //"//20101
Print Owner's or Authorized Agent's Name Electronic Si ature Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass. ovIota Information on the Construction Supervisor License can be found at www.mass.gov/dns
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
City of Northampton
Building Department
212 Main Street
Room 100
Northampton, MA 01060
phone 413-587-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION''i'�StTE11VFOfMi :T1.QN.:.
1.1 Property Address: "`T,hlst3"fit oh'a' 'qe= om�ileted by office
1Ula : ;:;. Loti.:
::: •:
>; ,: •. Y.
':�1'ii�iS�{•1�t8tr(ct�� _ 'CB�Ol�trlct'..
:'SC Ii7Nz= ?fZOPI OIINl '44lAU CkORifrdit3N7::-
2.1 Owner of Record:
aC "
Name(Print) . Current Mailing Address:
Telephone
Signature
2,2 Authorized_Agt t
Name(Print) Current Mailing Address:
Signature Telephone
sECTIPrJ
Item Estimated Cost(Dollars)to be OffiCi'ahaJs.81'Orily :.
completed by permit applicant
1. Building ,(8"stiflC(i)iP�PiS1it'>�tl.
2. Electrical ";6' l ti[ridwt.`btal' c$f'ofr
•( ),IEd�`stivaClongr}�o'-`t3._ ;�:- •
3. Plumbing '<t3ulldjngP_err f ase;.:':.
4. Mechanical(HVAC) _
5.Fire Protection
:Nt , -
6, Total= 1 +2+3+4+5) .Kt,.fL.
't• ib�t Far •-1� lis h -
- "3ect
Y
- . :,_� ..-!: . ,......,..,::..;•:,..,.... ...E %���Q;�:".•�',••:"•f:� - _
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n P� iim -
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Sulldtn�rCoritmisslonerlCiispe"clot of 8`Uiliilrigs.. p8te
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
< Boston,MA 02114-2017
www.massgov/dia
Workers'Compensation Insurance Affidavit:General Businesses.
TO BE FILED WITH THE PERMTrMC AUTHORITY.
Applicant Information Please Print Ledbly
Business/Organization Name: NEW ENGLAND GREEN HOMES
Address: 1813RADWAY POND RD
City/State/Zip: STAFFORD SPRINGS CT 06076 Phone#: 413-244-2003
Are you an employer?Check the appropriate box: Business Type(required):
1.[D I am a employer with 4 employees(full and/ 5. ❑Retail
or part-time).* 6. E]Restaurant/Bar/Eating Establishment
2.0 I am a sole proprietor or partnership and have no
7• E]Office and/or Sales(incl.real estate,auto,etc.)
employees working for me in any capacity.
[No workers' comp,insurance required] 8. Non-profit
3.0 We are a corporation and its officers have exercised 9. ❑Entertainment
their right of exemption per c. 152,§1(4),and we have 10.0 Manufacturing
no employees. [No workers'comp, insurance required]'
4.❑ We are a non-profit organization,staffed by volunteers, 11.0 Health Care
with no employees. [No workers'comp.insurance req.] 12.d Other INSULATION
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
**If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an
organization should check box 41.
I am an employer that is providing workers'compensation insurance for my employees Below is the policy information.
Insurance Company Name: AP Intego Ins Group
Insurer's Address: 18 Bradway pond rd
City/State/Zip: Stafford Springs CT. 06076
Policy#or Self-ins.Lic.# NEWC920850 Expiration Date, 8/01/2019
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 1he pains and penalties of perjury that the information provided above is true and correct.
i
Phone#• 413-244-2003
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.Licensing Board 5.Selectmen's Office
6.Other
Contact Person: Phone#:
www.num.gov/dia
NEWENGL-20
A404:>RJX DE`„r..- CERTIFICATE OF LIABILITY INSURANCE 0812912MMro0w B,
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 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 endorsement(*).
PROOUCER C
AP Intego Insurance Group,LLCFAX
1601 Trapelo Rd Suite 280 N
PSN@o
Waltham,MA 02451 su o a inte o.corn
INSURERIS)AFFORDM QOVERAGN
INSURER A:Guard Insurance Group*' 25844
INSURBD INWRER S,
NEW ENGLAND GREEN HOMES LLC INSURER ;
18 Bradway Pond Rd IN
Stafford Springs,CT 06076 RER
INeURER F
COVERAGES CERTIFICATE NUMBER: 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.
.1l TYPE OF INSURANCE ADDL SUEPOLICY NUMBER POLICY EFF POLICY EXP LIMITS
COMMERCIAL GENERAL LIABILITY EACH Q=RPrzNCE
CLAIMS-MADE E]OCCUR G T RENTED
MED EXP ono
PERSONAL&ADV INJURY
GEN L AGGRETE LIMIT APPLI 8 PER: GENERAL GRE
POLICY�JEL'T LOC PR -COMPIOP
OTHER:
AUTOMOBILE LIABILITY COMeI ED SINGLE LIMIT
ANY AUTO 80 I Y INJURY Perperson)
OWNED $CHEDULEO
AUTOS
ONLY AUUTNOpSy� p DIL RY a t
AUTOS ONLY AUTOS ONY OPER.11 AMAGE
UMBRELLA LIAS OCCUR EACH OCCURRENCE
—A EXCESS UAB CLAIMS-MADE AGGREGATE
pED I I RETENTION i
A WORKERS COEMP ;&N x P TH
AND EMPLOY NEWC920850 08/0112018 08101/2019 508,000
ANY PROPRIETORIPARTNER/FXECUTIVE N I AE.L.EACH ACCIDENT
g,FICEE nNH) LUDED? DISEASE- PLO 500,000
It yes,describe under 500,000
DE RIPTI N PE TION below .L.DIS E- O LICY IMIT
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101.Addhimal Remarks Soheduls,may be aflaetred Ninon$Peen Is required)
CERTIFICATE LER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD 25(2016103) ®1988.2015 ACORD CORPORATION. AN rights reserved.
The ACORD name and logo are registered marks of ACORD
_--waSa"i NEVIIE-GC OP ID:RO
'`#416 RLY 1 CERTIFICATE OF LIABILITY INSURANCE °�06/2012TE "�
08129!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(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 endorsemen s.
PRODUCER NAME: Lori J Meagher
Wilcox&Reynolds L.L.C.
922 Stafford Road PO Box 521 :860.429.9387 ; 860.429-2394
Story.Mansfield,bT 06268-0521
Joseph A.Barrett ADD :mea her ilcox-re olde.00m
(NSU AFFORDING COVERAGE NANO B
INSURER A:Ohio Mutual Insurance Group 10202
INSURED Now England Green Homes LLC INSURER B_:
John Perrier
16 Bradway Pond Rd INSURER C:
Stafford Springs, CT 06076 INSURERD:
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, 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.
INSR ADOL5UBR POLICY EFF POLICY MIP
LTR TYPE OF INSURANCE PO CY NUMBER MIND UNITS
A X COMMERCIAL GENERAL LU1aILrrY EACH OCCURRENCE $ 1,000,00
_91 CLAIMS-MADE ❑OCCUR BP 0026743 07/14/2018 07114!2019 i 100,
X Business Owners MED EXP afe p 5,00
PERSONAL A ADV INJURY f 1,000,00
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00
X POLICY❑JE
LOC PRODUCTS-COMP/OPAGO f 2,000.00
OTHER: f
AUTOMOBILE LIABILITY nw— s 1,000,
A ANY AUTO CPP0022611 07/1412018 07/1412019 BODILY INJURY(Par parson) S
AALL
UTOS NED X SCPHEDULED BODILY INJURY(Per awldent) s
r AUTOS eM s
HIRED ALIT NOON-OW P
(PeraoW
s
X UMBRELLA LIABX OCCUR EACH OCCURRENCE S 2,000,00
A EXCESS LIAR CLAIMS-MADE CX 0002971 07/1412018 07/14/2019 AGGREGATE = 2,000,00
DED I XRETENTION
WORKERS COMPENSATION PER
AND EMPLOYERS'LIABILITY !N BTA E
ANY PROPRIETORIPARTNERIEXECUTIVE I❑NIA E.L.EACH ACCIDENT $
OFFICERIMEMBER EXOLUDED7
(Mandatory In NH) E.L.DISEASE-EAEMPLOYEEi
It yos.describe under
OE IPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT I f
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Addidenal Remarks Sche",maybe attacMd k mon spaos is reWrod)
INSULATION CONTRACTOR
CERTIFICATE HOLDER CANCELLATION
COLUGAS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Joseph A.Barrett
01988.2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
Office of Consumer Affairs and Business Regulation'
1000 Washington Street-Suite 710
Boston, Massachusetts 02118
Home lmprovemehtContractor Registration
Type:`.. lr4viduW
E IE :G, :'r :r::r>h Repisvefivo .:.17302.1
JOHN P
AA R �,s'r, EIratfon: rr, ..+•,
16 BRAOWAY POND ROAD `,•n�di i i-'T i�•: '� 7+
STAFFORD SPRINGS,CT 06078
7' ,
_ .. •UPdei Ad6rw iY�d,A�111¢R.
$CAI O 70u4L17 :;;�+y:.�p•.tlij# ;l'{,t✓p� •'t..i;,.b..�.. r
JhR�f(/I/N�IIOn:a f4�Ll �ii41(ica�We/Q :.... '.... .•a...'J. .'f, .:..:
x ti'• yi. v i:..tiei.'vifa. #��
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HOMEIMPROVEMENTCONTRACTOR. "'f iyleUeffierMidh!{11�YIdYiiuit",
TYPE:IrKMAahrsY dMt fa(wuid'i�tiri►lof' -'`: _ -r
fl!9l�SIDCs?G Of60e ,COMuntN'AfNM'MW
173021 ON262020 �1000Wfahbwpfon91 WTSUUTl
JOHN PERRIER
."scow,MA�02110
'!i'i
JOHN PERRIER •;,.�,..'..L ( w ". 1u�ri ,.r'f .,�:�{ '«'i`. ',:.+:'•_s:^.
18BRADWAYPOND ROAD!
'.
STAFFORD SPRJNGS.CT 00070 LJrldB "">: a yplild YI►{}NQUt 6141�91xIDB�' ++ ',' �'
..... .. _,...... .'w.'. :.yr; M:^'v.W I►R; S .
Commonaith of :'.iass aclltlSet tS
Division :-.f Professional L;censure
Board of Building Regulatio(is arta Standards +
11'_'C3rlrStrii: .t:G+,i. '.0pervisor Snwcmlty.
CSSL-105319 Expires. 12/ 12,'2019
JOHN A PERRIER
16 BROADWAY POND ROAD *
STAFFORD SPRINGS CT 06076
Commissioner
City of Northampton
Massachusetts
�X
DEPARTANT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building g
Northampton, HK 01060
Property Address: �� fJ/7j
Contractor
Name:
Address:
City, State: CALk44,1,
Phone: �!�y ` �� 7;1 J�Z'
Property Owner
Name: G
(_.,.
Address: S`�/ `7 _
City, State:
1,. ) ' �� .
� (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 co is affidav'
Contractor signature
r
Date