24C-069 (4) 66 MASSASOIT ST BP-2019-1131
GIs#: COMMONWEALTH OF MASSACHUSETTS
MU.Block:24C-069 CITY OF NORTHAMPTON
LOC-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-2019-1131
Project JS-2019-001840
Est_Cost 5900.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: ENERGIA LLC 92540
Lot Size(sp.R), 13068M Owner: ILLINGWORTH MARK
zoning URB(1001/ Applicant: ENERGIA LLC
AT: 66 MASSASOIT ST
Applicant Address: Phone: Insurance:
242 SUFFOLK ST (413) 322-3111 WC
HOLYOKEMA01040 ISSUED ON.4/16/2019 0:00:00
TO PERFORM THE FOLLOWING WORK:INSULATE ATTIC FLAT, PULL DOWN STAIR
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 Deoartment 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:
FeeTvpe: Date Paid: Amount:
Building 4/16/20190:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
City ofNortamp0iE-C-E
ED 'IVOR
Building D. art.¢nt
212 Main tree,, APA 1 2 2019 / SULA TION
(0Room 11I00 i
Northampton, MA 0 060 ws ONLY
phone 413-587-1240 ax Q9$58i•t2�781 T,
NOPTHPMPNN.MAn1
APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY
SECTIONI -SITE INFORMATION INSULATION PERMIT
1.1 Property Address: This section to be completed by office
Map "� VC— Lot CXZF nit
66 l IV SJ avv\` 5{Y� Zone Overlay District
Elm SL District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZEDAGEffT
2.1 Owner of Record: y-
ylY V� \ V\%�Q\.�Y `c�c9 Mn.��n.`��\\ �'t Tec
Name(Print) i Current Mailing Address. ^-,\���-\,��0\
VU, (.fir \\ 1 Telephone —)--CY1
Signature'
2.2 Authorized Agent:
r 7u7 Svf���� 5{ {k �uov�N\ ov Uo
Name(Print Cunenl Mailing Address:
Signal Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
2. Electrical —1�1J (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6, Total=(1 +2+3+4+5) C)an. Check Number ^'
This Section For Official Use Only
Date
Building Permit Number: issued: qq�
Signature: 14-12- U 8
adding Commissioner/Inspector of Buildings Date
=tIEL( CG @O�rLa/4%�4$' CDS,
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 4-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 1❑
Name of L'oense Holder: \n\T RQ`�Yl�C7.SS�FY \J`AL)l1" C)
Liceme Number
2- C Oji 2�102102120\0\
Addres Expiration Date
\
Si.i TElephon
94 Reaistered Home Impho"ment Contractor: Not Applicable ❑
tYIE YG�Q \G�5 fG
Com oanv Na Registration Number
2U-) 5u \V-, I Iy(,) IZQX,)
Address Expiration Dale
TelephoneU k-1 ?)22-M\\
SECTION S.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.,..... Qjx No...... ❑
Brief Description of Proposed Work NOTE: INSULATION ONLY
nsv\a� e fit�G k Icz -\`\ F\o®Ted 4q Dente kioijo,:I�-,
nSv\GLtE. ��\ ��n stag . TheYrna��
I, Tom F�(�S�YY\�5 j\�'✓ , 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 parishes of perjury.
Cx \ p-
Pr nt Name
1
S,gni of OwnebAgent Date
I, \-l_AYyi \\\�YK�VyJY'ih 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.
,Y Irma yJ--; IMn
Signature of Owner Data
City of Northampton
Massachusetts
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'I DEPARTMENT OF BUILDING INSPECTIONS 2
212 xain St�eet • Municipal Building
xarthe,i¢ton, ts. 03060
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 am adjacent to such residence or building"be
done by registered contractors.
Note.Ifthe homeowner has contracted with a corporation or LLC,that entity mist he registered.
Type of Work:TyY\ d
11 ODA nEst. Cost: �C\m
Address of Work:c-k 1�'k).S�.�LIrF- SAYen
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.C.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:
I hereby apply for a building permit as the agent of the owner:
1A151zo\a -Cam t�55rno���r 1�� 1�q
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
Q—
•"t Massachusetts
/ , c
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1 I DEPARTMENT OF BUILDING INSPECTIONS
212 .tlain Stteet •Municipal Building
�` NOttlampton, !p 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:
FSo 1"1(a��Sott StYCo-
(Please print house number and street name)
Is to be disposed of at:
fllue�lyr�(O�tE. t 14 PAF S�. S�rtfl�field!mf�\ CAvQJ-\ .
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
6
Signature Permit Applicant or Owner to
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.
City of Northampton
/ Massachusetts
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DQEPARTMENT OF BDILDINS INSPECTIONS 9
212 Main Street • Municipal Building
\
0
Northampton, 1.A 01060
MANDATORY FOR HOUSES BUILT BEFORE 1945
Property Address: 100 1 t���.50�� 1':WYC-V
Contractor _ n �y�
Name: IOYY\ V.cL! -)n T��` llCy(
Address: T-12T \V-, --A-Ycf
City, State: I lt�C)\Yx�V N\� OIOyO
Phone: \q �J-lw
Property Owner
Name: PrbNV-� 11\111
Address: (�G MO,SSO..501 A AYf C V
City, State: W)V t "MWnn . My \ n��
I,TC)m Rty"SP cG--aEr (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 y '5 � oC cA
TS
m CERTIFICATE OF LIABILITY INSURANCE DA 8102018 1
ACORO
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,ANO THE CERTIFICATE HOLDER.
IMPORTANT. If the certificate hold.,is an ADDITIONAL INSURED, the pollCy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the Lam1s and conditions of the policy,certain policies may require an endorsement. A statement on this cedfMcate does not confer rights to the
cartlRcate holder In lieu of such endorsoment(s).
PRODUCER OO PC MaryCOnm
The Dowd Agencies, LLC PHoxs 413-538-7444 PA No
14 Sobsla Road
Holyoke MA 01040 EMAIL
PR CERa.10 1,ENELL
INSURER S AFFORDING COVERAGE NAI..
INSURED
Energia, LLC IxA
su ER :Evanston Insurance Com an 5378
242 Suffolk Street WSURERB:Commerce Insurance Company 34754
Holyoke MA 01040 Nsua nt c:Staten le National Insurance Company 25496
W WRERD:GUartl nSUIanee Group 6261
NSONES E:
INSORER F:
COVERAGES CERTIFICATE NUMBER:1131630225 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.
IpaqTYPE OF INSURANCE L POIJCY NUMBER PO DD E P IOY P LIMITS
A GENEPgLUP&LLry 2GI maois ]11,2012 EACH OMUME14CE SLpW,WO
X
COMMERCIAL GENERAL LIABILITY A I b e urs M. SSO.WO
CUH-EMACS .00CUR MEDE%PlMGAROMMml SLOW
PERSONAL a AOV INJURY S1AOpW0
GENERAL AGGREGATE S2. am
GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPNP ADD 52,031000
FOILICY X FRO. LOC 5
0 AUTOMOBILE L1ABRlry SHOP" ]',1018 "ICOta COMBINED SINGLE LIMIT
ANY AInO (Ee emtlm9 SIAOOAM
PLL ONMEOAUTOS BODILY INJURY(Per pxeon) 5
x SCHEOVLEOAUTOS BODILY INJURY iPN. earn S
x HIREDAUTOS PROPERTY DAMAGE S
(Pr'Froe.n6
x NOµOVrNEDAllT05 5
C $ UMBRELLA LIAB $ DOME i5T50H1aCALI ]111201. 7"C019 EACHOCOURRENCE 51 AMAD0
excess LIPS
CLAIMEMAOE
AGGREGATE a1AM.Wp
DEDUCTIBLE
RETENTION 5
O
ON ......Pu1BATION EM1YA52172 71112018 i1L2019 x WCSTATO' OTH-
ANDEMPLOVERS'LIABILIry YIN
ARYPROPRIE,OR,PARTNERYINCOUTIVE
Mentleo.C.NH'. ..LODE. � NIP EL.EACH ACCIOENi 51.Ooo Utl
II eP.tlerulbe watt EL.WSEASEEAEMPIAYEE SyWO.OM
IPTIONOF PERATONSHA— EL,DIS E.PoLICYUMIT S
DESCRIPTION OF OPEMl10Nb ILOCATONS I VEN(CLES(Atloca ACORD I.I,A0tl111mn1 F—Ino aeao4ub.Ir—,e N,rm N mriII.)
CERTIFICATE HOLDER CANCELLATION 30
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED
IN ACCORDANCE WITH THE POLICY PROVISIONS,
To Whom It May Concern AUTHON,2ED REPRESENTATIVE
®1986-2009 ACORD CORPORATION. All rights reserved.
ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD
Commonwealth of Massachusetts
19 NlVislon Of PYOfeSSjOnal Lleen9lre
Board of BURding Regulations and Standards
construction Supervisor
CS-092540 Expires:09/02/2019
THOMAS BSSLER
YOOMAIN STREET y
HATFIELD MA OYO(S'B,/�/ ,r1
Commissioner
un."k,
.Or4ea of Consumer Affairs&Buxiucu acgulatian Lieense or rogistrntion 1.116 for individul use only
'
HOME IMPROVEMENT CONTRACTOR before the expiration date, Yffound return to:
Itegistratiom. 165169 Type: Office of Consumer Affairs and Business Regulation
'. Expiration: 9e/�1112018 LLC 10 Rark No=-Suite 5170
Boston,MA 01116
ENERGIA LLC f Q
TtiOMAS ROSSMASSIER
242 SUFFOLK STREET
HOLYOKE,MA 01040 Llu4crsecrctary Notvalid wkitout signsRlre
The Commonwealth of Massnelutsetts
Department of Industrial Accidents
��
W. Ice o Investigations
1 'i i6 l Off 1 8
� 600 Washington Street
Boston, MA 02111
wwtumass.govIdin
Workers' Compensation Insurance Affidavit:Builders/Conti-actors/Electricians/Plumbers
Applicant Information Please Print Leeibly
Name(Bnsincss)Organintionlindividnal): �110fQ1a LLCi
Address: 242 Suffolk St.
City/State/Zip: Holyoke, MA 01040 Phone#: 413-322-3111
Are you an employer?Check the appropriate box: Type of project(required):
Q1 me a em to er with 4. Q 1 am a g7ed
tov and I ❑p y 1"9_{ have hitractor's 6. New constructionemployees(full and/m part-time).I ala a sole proprietor or pnitnor- listed oheet. 7. ❑ 2emodehng
ship and have no employees These sub-contractors have 8. Demolition
working forme in any capacity, employees and have workers' 9. Q Building addition
(No workers' comp. insurance comp. insurance.t
5. ❑ We are a corporation and its 10.1]Electrical repairs or additions
required.) officers have exercised then 11. Plmnbin repairs
or additions
3.0 1 am a homeowner doing all work ❑ g V
myself. [No workers' comp. right of exemption per MGL 12 0 Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees. [Na workers' 13.0 Other
cor
p. insurance requited.)
*Any appticmt that ohe.ks bon 01 oast also fill out dve swims below showing their'wttew coarpeimntoa peli.y infomwtlon
t Ilomeownms who submit this.mdwlt indi.imd May are doing all work and uwa him AceiJe commotses evio submit a new afHd.vir indicming u¢h.
iC.doacters that cbcck 0iis box mnsl..ached an eddifmml sb.m shmvin6 the name of the sab-contractors and stole wimthe,or not dmse entities bane
enployces. Ir the sub-conlmevas have cmpkyces,they must provide their anrkers'cored.pollcy numwen
t oar a++employer tlml is piovirlH+g workers'con+pensalion insurance for my employees. Below is the policy and job site
information.
Insurance Cmnpany Name: Guard Insurance Group _
Policy#or Self-ins.Lic.S: ENVVC952172 Expiration Date: 7/0112019
Job Site Address: ( Cj t-V Si ICP* C4ty/State/Z1p:N'11I'CCli KnG *%O\CW
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. M can lead to the imposition of criminal penalties of
fine up to$1,500.00 amuor 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 maybe forwarded to the Office of
Investigations of the DIA fay insurance coverage verification.
loo hereby certify unite hepndas andpe+mlfes ofperjrsry feat the infornmtionprovided above free ticorrect.
S'enature' Date' 4'/Phan.M' 413-322-3111 �T
Oficial ase only. Do nuf write in this area, to be completed by city or town official.
City or Town: Permit/License tf
Issuing Authority(circle one):
].Board of Health 2. Building Department 3.Cityffown Cleric 4. Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
t
2018 WEATHERIZATION
mass save BARRIER INCENTIVES
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 barriers,
CUSTOMER INSTRUCTIONS
1. Hire a qualified,licensed contractor to evaluate and/or remediate the weatherization carriers).
2.Submit signed and completed copies of this form and a copy of the paid contractor Invoices)within 60 days of your Home Energy
Assessment to [ my t mmn 11
0,"al Solo II l; p,,. R i.r r ,..,
3.The weatherization Incentive will be deducted from the customer repayment 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 INFORMATION I
Customer Name: Mark llfingworth Ceent 9 or sae iD: 481746
site Adaes.. 66 Massasoit Street City, Northampton State' MA ZIP: 01060
Phone Numben 603769-9301 Email: amysteln@gmall.COm
/.
cretactrufAtfain.0,Sgrultund. Dow 3/IM LI
To determine If there is any active knob and tube wiring,the contractor will evaluate the following areas where eigible Mass Save'
weatherization recommendations have been made.
®Attic Floor DAttic Wall DAttIc Skme ❑Exterior Wall ❑Basement ❑Other. ❑Other:
❑ 1 have performed my inspection and determined there is no ive knob and tube wiring In the areas selected below.
®Attic Floor pAttic Wall dAtticslope Exterior Wall Basement ❑Other, ❑Other:
Lt(I have read and agree to the Terms and Conditions on the back of this form.
Contractor Name: C- ItLSTCr L C-01- ,::
Address. fd(J�9 ST City. r �O r'C.x'1[m Stater ZIP.
/ �26 �Q�
Company Name. �j enr G G-e(ac -(efrT(C�ri�men.e Number:
contntt«signam ' / (`" G �+"l`� Date: 31/9
High Carbon Monoxide:Contractor is to service and re-evaluate the selected mechanical systems)and reduce the carbon monoxide level,
as measured In the undiluted flue gas,to below 100 parts per million(ppm).
Draft Fall..:Contractors to correct the draft in the selected flue(s).Refer to table on reverse for acceptable draft ranges.
Existing CO ppm'. Revised CO ppm: Existing Draft Pa: Revised Draft Pa:
Heating syatetn
Hot 111famr Heater
Ode.
SRltlage:Contractor Is to correct the spillage of flue gases In the selected mechanical system(.).Must not spill after 60 seconds of operation.
❑ Heating System ❑ Hot Water Heater ❑ Other,
D I have performed my Inspection and have corrected the items noted in the areas selected above.
❑ 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 Signature: Dem:
(page Iof 2)
RISE
ENG7NEERING-
OWNER AUTHORIZATION FORM
I, Mark Illingworth ,
(Owner's Name)
owner of the property located at:
66 Massasoit Street
(Property Address)
Northampton MA 01060
(Proper/ty1A1dd```rosss))
hereby authorize (� Nf- �j
(Subcontractor)
an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building
permit and to perform work on my property. This form is only valid with a signed co ract.
x
Owner's Signature
Date
RISE Engineering, a Division of Thielsch Engineering, Inc.
60 Shawmut Road Unit 2 1 Canton, MA 02021 1 339-502-6335
www.RISEengineering.com