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35-275 (6) 74 WOODLAND DR BP-2020-0088 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:35-275 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-2020-0088 Proiect# JS-2020-000141 Est.Cost: $3900.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: THE ENERGY STORE 106082 Lot Size(sg.ft.): 67953.60 Owner: KENNEDY MARY JO Zoning. Applicant: THE ENERGY STORE AT. 74 WOODLAND DR Applicant Address: Phone: Insurance: 3 SIMM LANE WC NEWTONCT06470 ISSUED ON:7/23/2019 0:00:00 TO PERFORM THE FOLLOWING WORK:INSULATIONNVEATHERIZATION 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: FeeTyae: Date Paid: Amount: Building 7/23/2019 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Y2S Dep off City of North a pier .. .�j Building Depa�melf'L C I 212 Main S eet E' v D � l SULATION ;;� Room 1 Northampton, A 01b60�� 2 2 2019 phone 413-587-1240 F x t-587-1272 ONLY T pFf: A%4r7o P APPLICATION FOR INSULATION FOR A ONE OR G NLY SECTION 1 -SITE INFORMATION INSULATION PERMIT 1.1 PropertyYAddress: ^'\ This section to be completedbyoffice �q ��} ��C��l�J►��\ Map Lot 7J Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Ma Address: Telephone Signature 2.2 Authorized Agent: LLC '31 Name(Print) Current Mailing Address: py\-�ciAc ;c,\ t9C(1 uu3�i Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Buildinga ( )Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 1/ 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5) Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: 7- 2,Z Building Commissionedlnspector of Buildings Date YY>v-•Q_C-_T'"i EMAIL ADDRESS (REQUIRED: EITHER HOMFnWNFR no rnluraef`rnD% SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: 3�, � License Number Address Expiration a e ignatur Telephone 9. Registered Home Improvement Contractor. Not Applicable ❑ c Company Name Registrati n Number ��, A r�dess �,� / �, �( ►©_/ I Expira ion DaTe l/�_(�) -Io) Telephone �1 C(JIQ SECTION 5-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...... ❑ Brief Description of Proposed Work NOTE: INSULATION ONL Y 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 .� I� ignatur f Owner/Agent Date f � 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. Rinnati irc.of Ownor _._ TT.7V.LUY U.l 1VUL L.ildiLL.PL.UI1 r;. . . t Massachusetts �`'' ' DEPARTMENT OF BUILDING INSPECTIONS 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: ��6 \ok i�Q i \�)—Q— (Please print house number and streef name) Is to be disposed of at: 11-1.1 (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) ignaturJpf 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. Permit Authorization mass save Form Site ID: 3844506 Customer: MARK KENNEDY I, r v`q-cv� N • K , I'trJ,� , owner of the property located at: Is (Owner's Name,printed) 74 Woodland Dr Northampton, MA 01062 (Property Street Address) (City) hereby authorize the Mass Save Nome 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: FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: RCS PLAINVIEW DIAGRAM Customer- �C ---- _ ti L�►_IrK X�ht?d It�nne()h.>nn ( �. ��)-�� -_0.6 Address: � _ —I. ICl Town: h70L P ----'- -- r.r.11 Phr,r,.- Any Lmitntrpni fpr ccrit by I.vpr lnrr i? it yro rin•,r rd.n Any sprCd.c duectioni or Lvk MvLS7 IJp Y Site ID: U e�r. —_—_b ly +vL Energy specialist: Reviewed by; - M�1'la" ��.b l one,; io14\r S f3 OQGt :�e -( % viou , t "nC (S,4 Ob Ck.U,(t 1-LO Q�!,j veM`b F 4-D rap F�zl f L 2°IT pv�' •1'IGJI'C(.t LI � 4 t 2 Ls D, 2% I RIME, c� For Office Use Only Bushes Ladder Neighbor Proximity Pocket Doors Insert Radiators Fence(s) Existing Conditions X=Access ❑=Vents Note Inside Square R=Roof RV=Ridge Vent CS=Continuous Soffit S=Soffit G=Gable COE=Continuous Drip Edge T=Triangle Install O=New Access Note in Circle C=Ceiling W=Wall S=Sheathing Temp Unless Noted Otherwise Q=Vents Note in Triangle R=8"Roof S=Soffit G=Gable M=12"Mushroom For Access 2200-10-1/15 --s and Business Regulation Office Of CWISLImeT Aff mh One Ash DLII-t011 PI@Ce ... Suite '13 01 Boston, Massachusetts 02108 Horne Improvenient Contractor Registration Type: LLC THE-EkIERGY STORE, LLC Registration: '178392 Expl 3 SIMM LAME s'rr—ic i-a-Hon: 04/09/2020 I\IEWTOWN, CT 06470 Update Address and Rettorn Card. Office of Consumer Affairs&Business Regulation HOME OMPROVEMENT CONTRACTOR Registration valid for individual Use only TYPE-. LLC befom the expivation date. 11 found return to: Registration Exp—Irailon Office of C01ISM-ner Affairs and Sminess Regulation 178392 64/09/2020 One Ashbuo-ton Place-SLIKe 1301 THE-ENERGY STORE, LLC Boston, MA '02'108 ROBERT NEAL 3 SIMM LANE STE IC NEWTOWN, CT 06470M/Kh0LA Glynaftire Undersecretary TIze Cormillonweakh 01Aplassachriseffs Z De n ts pal-twelze.oflizdustrialAccide, -ess Sh-eae t,Sr~Le 100 pi I Coggi Bostoin,JYM 027114-2017 i i 10,i 2 2 C,S S,-0 3 Ik_71r, waricerss,Compensation 7nsurnnceAffida-vit_Suilde--sfContz,-nctorslr.lccr-ici--rs/Pluynbers- To BE MILED VATH THE PERi-VIIII—I 11PIG AUTHORITY. Please P:int Legibl! Th Marne(BusinmOrgani�!�ort(Indiijidtial)- e Energy More,LLC . -- A ddreSS: 3 Sinn Lone ,::jty!.StatefZip- NeMolfisn,GT 06470 Ph0nC#-___ 888-840-6541 kre v u an employer?Cheel,the appropriate box, Type of project(required): am a employcr wifli.__�_cmplqyaes(full and;or part-linic). 7. L]New construction wo zi 2.f I Ltio,a sole pniprictorcirpartnership and have no cmploYcc:, rLng F0rmain Remodeling any capacity. camp.insurance reaulreU 9- C3 Demolition n a lioincoxvncr doi,-4 ail:cork myself[No ixarj=-�camp-koarwite iquircd� I 10 C]Building addition 4.Q i art a wmeawnerandiviB bchiring connectors to conduct 211 work onlity p-- y. F trill ei is w c il ia t a I I cont ractor,eizherh__�e woth—,xs*comp:nsation insu;once a r a re sole 17- Electrical repairs or additIons PrOmPrictors,with no empinyees. 12-CIPlumbing repairs oraddifions a S.f—j i am.3 general conTractarimd I liave hired the sub-conunctotsitsicil an the attached shed. IS_[]Roofrepairs -c These sub-conti-actors have employees and havewor, rs'camp.insurance.-' 14-EaOther Weatherization GQ wL are a corporation and its officers have exercised iltcir right a 151,§1(4),and 1.vahave noempitivcam.[Noworkers'camp.innirancereauired-j Any npplicani:that cbccL-sb0xt.l must also Fill out the section War.-sbatifirgbeir waycers'compensation policY in runnoiinn. �f-lomeowntas i..,be submit this affidavit indicating they aradoin-all work and then]tire outside contractors mus[Submit 2 new affidavitindicatia-Z such. 'Con tactors that check-this box inusiVuadied an additional shout sborring-tbennnicorthe sob-contractors and state whetherarnot those entities have employees. Tribusub-contractors haveernp!qyces,they must Of0vide their .,,orkers coing poliCY number- he MAZY an 0 BN C fisurcanceA gan c3r, Inc finsurance Company Name:___ .. !-.- PolicV-_U or Self-ins.Lie.4: 6NUWC0I 13 137,9' &piradon Date: 04195P_020.___- _ Job Site Address- e I ow-ing the policynarsiber and e%pir2tion- dOl' e). AtIMCII a copy of the workers'cone-pensatiOT-1 policy declazation pave Failure to secLire coverage as required under MOL c. 152,§25A is a criminal violation-punishable by a fine up to SL500.00 and/or one-year imprisonment,as}yell as civil penalties inthe forn, of a STOP'WORY,ORDER and a fine of up to$250.00 a day against the violator.A copy of this Statement may be:f6rivarded to the Office of Investigations of the DIA for insurance coverage Verification. )z pro vided abare is trize raid coj?-eet 1 do 1rereby cer-,ify wider-dizeDasirs a tesolp erinry alert the hifolwatio V --Date: Sir nature: AJ34154-49,I Cell 888-8A0-6641 0 MiCe Cff icilti rase gal a'- Completed by ch�,or touts officIaL -Do),otwrite in this c-rea,to he fj City or'7'0ivn-. Essuinr-Authority(circle one): ziC_I InSpeetox-5.PIUMbing IIISDeCtDr ilding-06partin-ent I Cifyl'fown Cler e 1.Board offfenlrh 2- ILI ii 6-Other 1 Contact Person: MYYYI ACO CERTIFICATE CERTIFICATE OF LIABILITY INSURANCE ��04 l2019 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,EXTENID OR ALTER THE COVERAGE AFFORDED SY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED.. REPRESENTATNE 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 WANED,subject to the terns 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 endorsemant(s). CONTACT PRODUCER NA-" ONE 914 337-1833 Fax PH Brown&Brown of New York,Inc. A1C No ) Arc.No 7133 Westchester Avenue q DRESS: ��ca�IQbbinsny�om Suite N-136 INSURER(S)AFFORDING COVERAGE NAICD White Plains NY 10604 INSURERA: Homeland Insurance Company of New York 34452 INSURED INSURER s: Atlantic Specialty Insurance Company ZT154 Energy PRZ LLC Dba The Energy StoreINSURER C StarNet Insurance Company 40045 3 Simm Lane Suite 1 C INSURER D: Twin City Fre Insurance Company 29459 INSURER E: Newtown CT 06470 INSURER F: COVERAGES CERTIFICATE NUMBER- 19 20 Renewed WC REVISION NUMBER: THIS IS TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED. NOTWITHSTANDINGANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALLTHE TERMS- EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDLSUBR POLICY EFF POLICY EXP �S LTR TYPE OF INSURANCE INSD V" POUCYNUMB132 ?=0V D COMMERCIAL GENERAL LIABILITY OC CE S 11,000,000 COMMERCIAL CURREN100,000 CLAIMS-MAGE OCCUR PREMISES Ea occurrence S MED EXP(Any one Person) S 10.000 A Y 793009081000D 03/27/2019 0312712020 PERSONALggpv'NJURY s 1,000,000 GEITLAGGREGATE UMrrAPPUES PER GENERALAGOREGATE S 2.000,000 PRO- PRODUCTS-COMP/OPAGG S 2.000,000 POLICY©JECT F LOC S OTHER: COMBINED SINGLE UMTT $ 1,000,000 AUTOMOBILE LIABILITY Ea accident ANYAUTO BODILY INJURY(Par Person) S B OWNED SCHEDULED 7930090820000 03/27/2019 03/27/2020 BODILY INJURY(Pers0dident) S AUTOS ONLY I—IAUTOS PROPERTY DAMAGE HIRED NON-OWNED oNLD Peraccident S AUTOS ONLY � S <✓ EACH OCCURRENCE S 5.000,000 UMBRELLA UAB v� OCCUR A EXCESS LIAB CLAIMSMADE 7930090830000 03/27/2019 03/27/2020 AGGREGATE S 5,000,000 S DED RETENTION S WORKERS COMPENSATION I STATUTE ER AND EMPLOYERS'LIABILITY YIN 1,000,000 C ANY PROPRIETORIPARTNERfEXECUTIVE Q NIA BNUWCD131379 04/1512019 04/15/2020 ELE.ACHACCIDEN7 5 OFFICERWEMSER EXCLUDED? 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S _ If yes,describe under E.L.DISEASE-POLICY LIMIT s 1.000,000 DESCRIPTION OF OPERATIONS below Polution Liability 16SBAAB2188 03/27/2019 03/27/2020 Each Condition 1,000,000 D DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remad6 Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WALL BE DELMNU D IN Proof of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. 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