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31A-040 (3) 187 ELM ST BP-2020-0332 GIs#: COMMONWEALTH OF MASSACHUSETTS MV.Block: 3 1 A-040 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-2020-0332 Project# JS-2020-000561 Est.Cost: $2500.00 Fee: $78.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ENERGIA LLC 92540 Lot Size(sq. ft.): 13155.12 Owner: WOHL MARTIN&G MARISA LABOZZETTA Zoning: URB(100)/ Applicant. ENERGIA LLC AT. 187 ELM ST Applicant Address: Phone: Insurance: 242 SUFFOLK ST (413) 322-3111 WC HOLYOKEMA01040 ISSUED ON.9/13/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.INSULATE KNEEWALL SLOPE 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 9/13/2019 0:00:00 $78.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner T � - � f . Ss -. - F.� `� f `. � , J � .,.{ � - ._ .' � _. .� - � � �. y � � .5 .. r. r _� � , l _ � . . � _ _: , . . ° . �� � ,.l .� , . . � ,. .. - � � r - .. - - .. ,. � a- a r _ '; .. � _ \ •. � � _i ' �. � _ ,` {.. _�' — Dep City f No ampton .,y k Buil#g Dopa � 1 ? 019 nt j ; 21� Mair Sti ? I fl ` koon, 100 INSULATION Northampto phone 413-58741240 INW144 e - ONLY APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INSULATION PERMIT This section to be completed by office ; 1.1 Property Address. Map 3 Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current rv� Current Mailing Addre�1 1 " 1� �a(m Telephone Signature 2.2 Authorized Agent: TomY 2-'1Z �yeQN "GWO-AL"A tic Name(Print) Current Mailing Address: Signature elephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building Z,SOJ.Uo (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) ItTY 5. Fire Protection �� 6. Total= (1 +2 + 3+4+5) Z,.S� ,C)C� Check Number This Section For Official Use Only Building Permit Num er: Date Issued: Signature: q-/Z- �61�1 Building Commissioner/Inspector of Buildings (' Date ce @ EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) t"#h .eye• '';<�.:`Fi,.. �_. ..�"'�?`}a=; .,Y'' '��,,�t}�t, �:;,';'�r ;�'#:Si t"� �r4� >� �.!�'�'��.�,}t'i� ' ,..-...$,.»..-w:.w.. ... ,> r r....>.L�• ....(, - .w-•,.�wrv. ;,,., s.... ,-r,.....,,..�.,,...rt`.:_:.�, ..;,;,.•..,..r.+,.A.+w• ..,..wt.^^.��w, .n,Mur. .. .a..M.'•,.,... • �,„„>...,,,•. .,,,,....-.�w...n..ir+}�-} _,,..,,. ,�• ,:.+�. a..wr.r.,,.. y:., ..o. ... .a .,. . .,,..Y>.,,°ra»,..->a .,ta r,.,.�'wM. ++M-.:nsu.>.rr�.�*mm:.ys.cit..,.:..ae�ar.,w_..w+y , r � r' • r r, a•.•4- :5.,t .,.. ,fry°' � .. I L'a`.,. ' FS'�.)G�. ...h.di:'+v,{'..I„•.t.r�.'.Jr' •t-`4 1 t '.t. ( to ,, �. . _._.-_• Cw.,... .�! .+a; � *r' �:.._. L�,� .~.t 1,v, +�.+ ",ra'rr"t��3.t .. ;.�� • - +.•,ty,: ,� � -! ' .« •��`! ...r; ;t= �, _ f .. ��f''�}Ylel't'}'e'TM''rYvi�rn.r.4,`.� 1 1) �v. RS.' «� �$� ,. °} t':�, i• at> i - e.. P 1...- .x.r .i'�tt^t�.� �. •__._1.4.. i:.6 f�'�3._.:L _.. _ �.s .r�ya�F�, ` .rjy't'�t„_�_, ,,...__..y t,. SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder � f'i_��J(�1��,�5\�� gn-Ao License Number Z Q1c;-Ao C9 101 12O\q Address Expiration Date SigrAture Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ ��a�oi. �� ►c,�yea Company N Registration Numb r 2-�AZ. <,)Q4Q\, S�- oto\uC — MSA CA PA 0 111()1-2-0 Address —J Expiration Date TelephoneL \`, -6117;�1,l 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 I, To �SSt(`(\GSS1 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 Signa e caner/Agent Date I, N\wyY \)2�1 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 i - _ 1 R !. 6 Ar?-4 R t a•,�* _„_.� Ep«^. k,,.?» .A4 ki JA v; _ � `�� { r, ti. -:1r. + r f�t f\ � rt�� � ) 1 4 '+-. ,•+4 • � - �'¢ <ffs• ”if -1 %'. ''k-P ...E tit's_ )i }. City of Northampton Massachusetts iK DEPARTMENT OF BUILDING INSPECTIONS yJ 212 Main Street •Municipal Building ti C Northampton, MA 01060 ssNfp ����� 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: Ise E-\rte -�k ng cxo(:�O (Please print house number and street name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Signature f 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. City of Northampton j� �`� �s««'�':•sic Massachusetts A f ;c wf :3 DEPARTMENT OF BUILDING INSPECTIONS S ' �"'• 212 Main Street • Municipal Building Northampton, MA 01060 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: lC6� i�ArT\ S't- Oncic Contractor Name: TC-)m P )5'a (f a-z Y Address: _)_',A2 bO-F QW, City, State: "O\yO1he mpt Phone: fit?;32Z 3\1\ Property Owner Name: t/\OXAAcr NLN10h\ Address: City, State: Nc�Y'tmp�, M�\ 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 � 6 Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction Supervisor Q CS.092540 Expires: 09/` THOMAS B ROSSMASS 100 MAIN STREET LER HATi:19L.0 MA 01038 J commissioner 0 _ OCG cc of Coasumcr rj /(•,••./r;,,;i �:I''•fOME IMPROVEMAffa &i3usiacss Rcgulntion ' kemstration: ENT CONTRACTOR License or registration valid Expiration. 165169 T before the expiration date for individul use only 1/71/2018 Type: Office of Consumer If use return ENERGIA LLC ��,//'' LLC 10 Bark Plaza_ Affairs and to: Suite $usiness Regulutidn /I Boston,IW 02116 5170 THOMAS ROSSMASSLER 242 SUFFOLK STREET HOLYOKE MA 01040 _ ••�•� _ Undersecretary Not valid without signature Licensing Home Page The list below displays all licenses associated the information you provided in your license search and are currently available for online services. The Licenses Eligible for Processing list shows licenses that can be renewed.Click on Renew License in the menu to start. You will be redirected to the Mass.gov Bill Pay site for Office of Public Safety and Inspections payments.Acceptable methods are Visa or MasterCard credit or debit cards which have a 2.3%processing fee or an Electronic Funds Transfer from your bank account with a processing fee capped at$1.95. Upon completion,you will be transferred back to this site. License fees are non-refundable. Name Name: THOMAS B ROSSMASSLER Address: 100 MAIN STREET HATFIELD,MA 01038 Licenses Eligible for Processing No license Full Online License List Building Licenses License Type Construction Supervisor License Status: Active License Number: CS-092540 Expiration Date 9/2/2021 ENERLLC-01 CHRISTINE A�o,Rto CERTIFICATE OF LIABILITY INSURANCE DATE(M6(26/20101112YYY( 9 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 BYTHE 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 poiicy(ies)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(s). PRooucER coNTMe.ACT Christine Sullivan NA IPhillips Insurance Agency,Inc. PHONE 97 Center Street (A/C,No.Extq:(413)594-5984 FAX ,Nol :(413)592-8499 Chicopee,MA 01013 E-MAIL .Christine phillipsinsurance.com INSURERS AFFORDING COVERAGE NAIC# — INSURER A:State Automobile Mutual Ins CO INSURED INSURER B:Guard Insurance Group I — INSURER C: Energia LLC INSURER D: 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. ILTR NSR TYPE OF INSURANCE ADDL1 S11 i POLICY NUMBER R: POLICYEFF POLICY EXP LIMITS r A �( COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1+000+000 CLAWS-MADE j X !OCCJR ( , PBP2870943 7/112019 711/2020 CAa AGE TO RENTED $ 100,000 ISESMEu EXP(Any oneperson) 5+000 PERSONAL SADV INJURY 1,000,000 N'L AGGREGATE LIMIT APPLIES PER: E NERAL AGGREGATE $ 2,000,000 POLICY a PET 17 LOC I PRODUCTS-COMPiPAGE $ 2,000,000 OTHER: 5 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 X ANY AUTO iBAP2477206 7/1/2019 711/2020 ; v OWNED SCHE3t!LED Bt,D L.f fJJURY!Pel erson $ AUTOS ONLY AI8p11SS�S I BODILY INJURY(Per accident $ _ ATOS ONLYAl1T0S ONL� p>eOa.-`s.,RdTent AMAGE $ A X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1+000+000 EXCESS L(AB CLAIMS-MADE PBP2870943 711/2019 j 7/112020 Ar REGATE $ 1,000,000 DED I X I RETENTION$ 0 $ B ':.WORKERS COMPENSATION 'AND EMPLOYERS'LIABILITY PERT c OTH- AIJYPROPRt=TCRiPARTNERJEXECUTIVE YIN � ENWC989226 711/2019 7/1/2020 -L=ACHACCIDENT' $ 1,000.000 OFF.GERIMEM6 ;EXCLUDED? NIA1,000,000 (Mandatory in NH E�L.D,SEASE-EA EtdPLOYE Ifes describe under DESCRIPTION OF OPERATIONS below ` E.L.DISEASE-POLICY LIMIT S 1,000,000 17l DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required} CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Energia LLC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 242 Suffolk St. ACCORDANCE WITH THE POLICY PROVISIONS. Holyoke,MA 1040 AUTHORIZED REPRESENTATIVE i` ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of Massach usetts ' Department of Industrial Accidents Office of Investigations r- A&I600 Washington Street �. AZIBoston,MA 02111 www.mass.govfdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le�nbly Name (Business/Organization/Individual): Energia, LLC Address: 242 Suffolk St. City/State/Zip: Holyoke, MA 01040 _ phone : 413-322-3111 Are you an employer?Check the appropriate box: 1.VI am a employer with 1_ 4. ❑ I am a general contractor and I Type of project(required): 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 g_ ElDemolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp. insurance.{ 9. ❑ Building addition required.] 5. ❑ 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- insurance required.] ' c. 152, 51(4),and we have no 12 ❑ Roof repairs employees. [No workers' 13.❑Other comn. insurance required.] RAny applicant that checks box 41 must also fill out the section below showing their workers'wmpensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and stats whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that isproviding workers'compensation insurance for my employees. Below is tJtepolicy ndjobViteinformation. Insurance Company Name: Guard Insurance Group Policy#or Self-ins.Lic.#: ENWC989225 7/01/2020 ,r ,�'/ t+ Expiration Date,{:fj����-/�//f��� � Job Site Address: { S _A v u t�LC,4oAt, /911� City/StatelZip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). (utltt� 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 under1pains andpenalties of perjurl,that the information provided abo a i, true and correct. Si nature: Date: 2 Phone#: 413-322-3111 Official use only. Do not write in this area,to be completed by city or town official. [6. ity or Town: Permit/License# ssuing Authority(circle one): .Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector Otherontact Person: Phone#• DocuSign Envelope ID:C52769ED-2C99-4A6D-A934-54E95AFF9603 2019 WEATHERIZATION mass save BARRIER INCENTIVES Savings through energy efficiency 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 barrier(s). 2.Submit signed and completed copies of this form and a copy of the paid contractor invoice(s)within 60 days of your Home Energy Assessment to:RISE Engineering,60 Shawmut Rd,Unit 2,Canton,MA 02021 Or email to ColumbiaGasMAlnfo aRISEengineering.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: Martin WOhl Client#or Site ID: 485003 Site Address: 187 Elm Street City: Northampton State: MA zip: 01060 Phone Number: 413-695-6780 Email: mlabo@comcast.net DT To determine 'ring,the contractor will evaluate the following areas where eligible Mass Save' High Carbon Monoxide:Contractor is to service and re-evaluate the selected mechanical system(s)and reduce the carbon monoxide level, as measured in the undiluted flue 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. CarbonHigh Existing CO ppm: Revised CO ppm: Existing Draft Pa: Revised Draft Pa: Heating System Not Water Heater Other: Spillage:Contractor is to correct the spillage of flue gases in the selected mechanical system(s).Must not spill after 60 seconds of operation. ❑ Heating System ❑ Hot Water Heater ❑ Other: ❑ 1 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: Date: Continued on back (page 1 of 2) . � ,6 V L �• � ..sYr r: � •. Kj •` y � t .�� 2 Ir��` ,t.xv. +,m• .w3 �'t �.a , ���.� `*,� , ♦. • o�} x, +. ..e b{'Z T, t / 4'"�5. ,� ,. -1 ., .. :1F �. r! r... ./+, r:a t.;r! ` . aa, ,¢♦ �..�.. Sl. 'Six a „ S+s .{ v.S 111- .Y+1,i .Y. ,. •ii.1`.l�t�'�'. !t1� i' 'r' fr;+` .T' {f. Lrt ' 'X .i!- .. r•`": tt .. :x .y .. 1 'll r`.t -, .. � f, ' , ±?i;, q ''7t z.�: a ?_' _ ..''1 ItM`,'ifi^ .. •a,!- �t r Mp jlw 4041 Jr-Itswifm N��d..--... ,_,_.._. .__.._. �t+�,�.•_x y{,•f• .,. a.� ,..aft,�v�;lg,; Y. ,z. a9F� ,.. Ili x; �.e• Y. 'A++Fr �Tt.�"., '+ fiik• ;w ", ;} .,. , .+ ,{i tc •t.- : -r.A, M r .. ;} _ ,re:'r?: . rrAl- IVA Mc t,e�,sy''s-letir +7fii °i �*+' �c���c?'l•+�L t'�;� 's`y=�v�'Ji r 1ii'� �f* L'�l�i�l .•><f + ' - �•` � * ��1h+�.Tr: '.'i �'"Ndx y �i'� ::* "• fP�;+�'R�.- .,J f 1 w•' l :K• :-.� x+' �}aiM 1 r'� ? �ipilx'3-'kf°tL -?�c"Y•J �-4iTF.> , .{:�. ..1,.F .!" . ..`,1-:P;?�':•r' .is '); ,.:r•.• 9u ,,:;:>• i '( . 'r `,'_ •�i -,r t3) •N',+a, p;, e., f1l: Yi:Lpi... a } s�L� 3 • •i :IE ^r ° I.,t :h, p�;. F, .,ri ."..M. ,. . :,t`` ,+{-� L:�- /�+: tip� ,9. _ �.. + 'o ;1�=-•.'e'.. .,a r ar/:•,`:LY J . i i n .... �. _ i.: .. .__ �} ... ., .._ t..EYE _l•t r _'' W ..... . ._ - ... _ .�� .-... •.• ... •1.; - a RISE ENGINEERING' OWNER AUTHORIZATION FORM I, Martin Wohl (Owner's Name) owner of the property located at: 187 Elm Street (Property Address) Northampton, MA 01060 (Property Address) hereby authorize r- 1I 62GIA (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my pro e . This form is only valid with a signed contract. wner's Signature D RISE Engineering, a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 1 Canton, MA 02021 1339-502-6335 www.RISEengineering.com