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18C-141 680 BRIDGE RD-6 ASPEN LANE BP-2020-0752 GIS#: COMMONWEALTH OF MASSACHUSETTS MW:Block: 18C- 141 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-2020-0752 Proiect# JS-2020-001296 Est.Cost: $2500.00 Fee: $60.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SEAN BRADSHAW 108517 Lot Size(sa.ft.): 1497897.72 Owner: DENNEY EDITH Zoning: Applicant. SEAN BRADSHAW AT. 680 BRIDGE RD - 6 ASPEN LANE Applicant Address: Phone: Insurance: PO BOX 944 (413) 301-8010 WC CHICOPEEMA01021 ISSUED ON.112412020 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: FeeType: Date Paid: Amount: Building 1/24/2020 0:00:00 $60.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Dep OR City of Northampton Building Department 212 Main Street Room 100 INSULATION :�,I►1.. �'� � r <! Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 ONLY NI 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 Lot Unit 6 Aspen Lane, Northampton Ma 01060 Zone_ _Overlay District Elm St. District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Edith Denney 6 Aspen Lane, Northampton Ma 01060 Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: 413-301-8010 413-301-8010 Name(Print) Current Mailing Address: 413-301-8010 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 2700.00 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = 0 +2+ 3 +4 + 5) 2700.00 Check Number This Section For Official Use Only p 0�� Date Building Permit Number: 1313" C7�✓ '�� Issued: Signature: / Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Sean Bradshaw License Number P.O Box 944 CS-108517 Address Expiration Date Chicopee, Ma 01021 12/10/2020 Signature Telephone 413-301-8010 9.Realstered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number Bradshaw Enterprises LLC 194456 Address Expiration Date P.O Box 944 Chicopee Ma 01021 4133018010 Telephone 02/07/2021 SECTION 5-WOE"QRS' 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 as Owner/Authorized Agent hereby decl'i,f� that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the and penalties of perjury. S 4_:: � � Print Name l� Signature of Owner/P nt Date I, -!� Q� �Z as Owner of the subject property hereby authorize to act on my behin all matters relative to work authorized by this building permit application. Signature of Owner Date BRADENT-01 NICOLE CERTIFICATE OF LIABILITY INSURANCE DATE 516/2019 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(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). CONTACT Nicole Waslick PRODUCER NAME: Phillips Insurance Agency,Inc. PHONE FAX 97 Center Street (A/C,No,Ext):(413)594-5984 A/r.No):(413)592-8499 Chicopee,MA 01013 aoo MAIL nicole@phillipsinsurance.com INSURERS AFFORDING COVERAGE NAIC# INSURERA:State Auto Insurance Cos 11017 INSURED INSURER B:Liberty Mutual Insurance Co Bradshaw Enterprises,LLC INSURER C: PO Box 944 INSURER D Chicopee,MA 01021 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 TYPE OF INSURANCE IVSD SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR NSD WVD MM/D M / A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000 CLAIMS-MADEX OCCUR PBP2856439 4/2512019 4/25/2020 DAMAGE TO RENTED 100,000 X I occurrence $ MED EXP(Any oneperson) $ 10'000 PERSONAL&ADV INJURY $ 1'000'000 GENT AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE 2'000'000 POLICYFX PES 7LOC PRODUCTS-COMP/OPAGG 2'000'000 OTHER: $ A COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABLnY Ea accident $ X ANYAUTO BAP2476397 4/30/2019 4/30/2020 BODILY INJURY Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOSyyyyryry BODILY INJURY Per accident $ AURTOSONLY AUTOONL� Parra..denDAMAGE $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2'000'000 EXCESS UAB CLAMS-MADE PBP2856439 4/2512019 4/2512020 AGGREGATE $ 2'000'000 DED I X I RETENTION$ 0 $ B WORKERS COMPENSATIONX STATUTE ER AND EMPLOYERS'LIABILITY WC5-31S-621612-019 4/25/2019 4/25/2020 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y/❑ E.L.EACH ACCIDENT $ 9FICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LMR $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CLEAResuk,Eversource and National Grid are included as Additional Insureds in regards to General Liability on a primary and noncontibutory basis when required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CLEAResuR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ATTN:Contractor Services Dept. 50 Washington St.,Suite 3000 Westborough,MA 01581 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD dotloop signature verification: �.,us/acrl I I i;1N ?,.,,VT The Conimonivealth ofMassachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Bostor:, MA 02114-2017 www.mass.gov/dia 11rorlcers'Compensation Insurance Affidavit:Builders/Conti-actors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING ALTHORITY. Applicant Inforation Please Print Le ibl Name(Business/Organization/lndividual): m P r ll f Address: ! b �6 X �' City/State/Zip: /,Q Lo Phone rc: Areyou an employer?Check the npproprinte box: Type of project(required): 1. I am a employer with _employees(full and/or part-time).• 7. ❑New construction 2. I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.(No workers'comp.insurance required.) 9. Demolition 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.)t ❑ 10 ❑Building addition 4.17 I am a homeowner and will be hiring contractors to conduct all work on my property r will ensure that all contractors either have workers'compensation insurance or are sole 1 1.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑1 am it general contractor and 1 have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 14.*Other Tn5-ut?a.ho>7 6.❑we are a corporation and its officers have exercised their right of exemption per M01,G. 152,§1(4),and we have no employees.[No workers'comp.insurance required.) *Any applicant that checks box ill must also fill out the section below showing their workers'compensation 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 state whether or not those entities have employers. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing woi*erscompensation insurance for my employees. Below is the policy and job site information. L Insurance Company Name:Policy#or Self-ins.Lie.M �' �(LJ Expiration Date: /2 D 11i: Job Site Address: /38 Cx�Th u p 5 AedT City!State!Lip: !e( Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,S25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify a pains and penalties of perjury that the information provided above is trueandcorrec4 Signature: Phone#i: --- -- Official use only. Do not write in this area,to be completed by city or Iowa official. City or Town: ----Perm it./License# _ Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CityMown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other �` tO Phone#: Contact Person: _— — dotloop signature verification:ddp.us/a:rl i i iiiN-d:avi Commonwealth of Massachusetts ® Division of Professional Licensure Board of Building Regulations and Standards Constr-gc&ti'Supermor CS-108517 + Expires '•2i10i2020 SEAN MATTHEW BAILEY BRADSHAW 246 CONNECTICUT AVENUE nt' SPRINGFIELD WA,01104 Commissioner �/""� Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: LLC Registration: 166074 J/�SPrI ENTERPRISES LLC Expiration: 04112012020 P.O.BOX 1276 CHICOPEE,MA 01201 Update Address and Return Card. SCA 1 a 20`.1.05;17 .%i. %.,,.,:..�„•.,,•iii,�. !/<..;.;..�/,:..;.,,�• Office of Cor•sumerAffairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: Reiaistration Expiration Office of Consumer Affairs and Business Regulation 166074 04!20(2020 One Ashburton Place-Suite 1301 JASM ENTERPRISES LCC Boston,MA 02108 } JEFFEREY BRADSHAW 805 NEWBURY ST SPRINGFIELD,MA 01104 Undersecretary Ni5t valid without signature 0 w v m c 00 0 0 0 o v Federal ID#05-0405626 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 CT Contractor Registration No620120 RISE 60 Shawmut Road,Canton,MA 02021 ENGINEERING' 339-502-6335 X-7109 FAX 339-502-6345 CONTRACT ' 1nIZ Page 1 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CMA-HES ENGINEERING AND THE CUSTOMER 17OR WORK AS DESCRIBED BELDW CVSIOMER PHONE UAC CLIENt 1 WORK O DLR Edith Denney (774)573-9547 11/08/2019 492257 23802 SERVICE STREET BILLING STRELI 6 Aspen Lane 6 Aspen Lane SERVICL CITY,STATE,ZIP BILLING CITY.STATE,ZIP Northampton, MA 01060 Northampton, MA 01060 DESCRIPTION QTY COST INCENTIVE TOTAL ATTIC DAMMING-R-38 FIBERGLASS 45 $92.25 $69.19 $23.06 Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass batts for damming purposes. ATTIC FLAT- 10"OPEN R-37 CELLULOSE 1,021 $1,592.76 $1,194.57 $398.19 Provide labor and materials to install a 10"layer of R-37 Class I Cellulose to open attic space. VENTILATION CHUTES 40 $100.00 $75.00 $25.00 Provide labor and materials to install ventilation chutes in the rafter bays to maintain air flow. VENT BATH FAN THRU ROOF 4 INCH 1 $118.75 $89.06 $29.69 Provide labor and materials to install an insulated exhaust hose with roof mounted flapper vent to exhaust existing bathroom fan(s). HOME AIR SEALING 8 $680.00 $680.00 Provide labor and materials to seal areas of your home against wasteful,excess air leakage. Materials to be used to seal your home can include caulks, foams and other products. Primary areas for sealing include air leakage to attics,basements, attached garages and other unheated areas(windows are not generally addressed.) A reduction in cubic feet per minute(cfm)of air infiltration will occur,but the actual number of cfm is not guaranteed. At the completion of the weatherization work,and at no additional cost to the homeowner, a final blower door and/or combustion safety analysis will be conducted by the sub-contractor. Federal ID#05-0405626 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 CT Contractor Registration No620120 RISE60 Shawmut Road,Canton,MA 02021 ENGINEERINGCONTRACT - WZ 339-502-6335 X-7109 FAX 339-502-6345 Page 2 PROGRAM THIS CONTRACT 15 ENTERED INTO BETWEEN RISE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PIIONt DATE CLIENT YORK ORDER Edith Denney (774)573-9547 11/08/2019 492257 23802 SERVICE STREET BILLING STREET 6 Aspen Lane 6 Aspen Lane SLRVICL CITY,STATL,ZIP BILLING CIIY,SIATL,ZIP Northampton, MA 01060 Northampton, MA 01060 DESCRIPTION QTY COST INCENTIVE TOTAL I-INCENTIVE:75% For eligible measures,Columbia Gas of Massachusetts is offering an incentive of 75%for insulation measures and 100%for the air sealing measures,both with no limit. Total: $2,583.76 Program Incentive: . $2,107.82 Customer Total: $475.94 WE AGREE HEREBY TO FURNISH SERVICES•COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Four Hundred Seventy-Five 8T 94/100 Dollars $475.94 UPON RECEIPT OF YOUR RISE ENGI.'' NG INVOICE.CUSTOMER AGREES TO REMIT AMOUNT DUE IN PULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 70 GAYS. EER RSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,S f HEDULINn.AND CONTRACTOR RFGISTRATION. NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE T'tt l I Imo\jl I 3O DAYS. ACCEPTANCE OF CONTRACT-THE ABOVE PRICES.SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY TO US AND ARF.HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE RISE ENGINEERING" OWNER AUTHORIZATION FORM I, Edith Denney (Owner's Name) owner of the property located at: 6 Aspen Lane (Property Address) Northampton, MA 01060 (Property Address) hereby authorize (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 contract. Owner's Signature Date RISE Engineering,a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 1 Canton, MA 020211339-502-6335 www.RISEengineering.com