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32A-183 (19)
73 BRIDGE ST#9 BP-2021-1278 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:32A- 183 CITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit# BP-2021-1278 Project# JS-2021-002113 Est.Cost: $1700.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SEAN BRADSHAW 108517 Lot Size(sq.ft.): Owner: OLSZEWSKI TEDDI Zoning: URC(100)/ Applicant: SEAN BRADSHAW AT: 73 BRIDGE ST#9 Applicant Address: Phone: Insurance: 264 CONNECTICUT AVE (413) 250-4746 O WC SPRINGFIELDMA01104 ISSUED ON:5/3/2021 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 NOR HAM 'TON ON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. . 9)• ` Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 5/3/2021 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner dotloop signature verification:dtlp.us/T4rg-GKOO-06aF ! ` V The Commonwealth of Massachusetts 2X,q(gr �J Board of Building Regulations and Standards '�/'To'o/ FOR Massachusetts State Building Code, 780 CMR \�SoFor /.IvIUNIUSE ITS Building Permit Application To Construct,Repair,Renovate Or Demolish'a/KS' Revised Mar 2011 One-or Two-Family Dwelling Thisk,,•: A'on For Official Use Only ButlllxngPermit Number: #,P— At" /) " '•i Date Applied: (;J r A-) J.0,,,, 5 3-26Z4 _pptingOfiicial(Print Name) Signature Date SECTION 1•SITE tFORMAT[ON 1.1 Property Address: 1.2 Assessors Map&Parcel Numbe 73 BridgeStreet, Apt 9 Northampton _ 3;A,. i 3 l.1a 1slYli s 3t11l(Vepteci street!yes x no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided N/A N/A N/A N/A N/A N/A 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ - SECTION 2:; PROPERTY OW$EN ...'OIP' 2.1 Owner'of Record: Northampton Ma 01060 Teddi Olszewski p _ Name(Print) City,State,ZIP 73 Bridge St Apt9 413-230-6665 No.and Street Telephone Email Address SEei1ON 3:DESCRIPTION OF PROPOSED WORKielieck all that apply) New Construction 0 Existing Building la Owner-Occupied ❑ Repairs(s) 0 Alteration(s) ❑ Addition ❑ i Demolition 0 Accessory Bldg. 0 Number of Units Other ® Specify:_Insulation MassSave Brief Description of Proposed Work2:Adding blown cellulose to attic flat to achieve an aggregate R-49.Please see attached work work order. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials) Official Use Only 1.Building $ 1700 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ' I i0 Standard City/Town Application Fee -❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: S.Mechanical (Fire $ Suppression) Tutal All Fees:$ 6.Total Pro Cost: $ 1700 Check No. eck Amaun Lt4 Cash Amount: J '`❑Paid in Full , 0 Outstanding Balance Due: dotloop signature verification:dtlp.us/T4rg-GKOO-O6aF SECTIONS. 'CONSTRUGTION`SERVICES 5.1 Construction Supervisor License(CSL) CS-108517 12/1.0/2022 Sean Matthew Bailey Bradhsaw License Number Expiration Date Name of CSL Holder U List CSL Type(see below) 246 Connecticut Ave No.and Street Type Description Springfield,MA,01 iO4 U Unrestricted(Buildings up to 35,000 Cu.ft.) -------- R Restricted 1&2 Family Dwelling City/Town,State,ZIP FYI Masonry RC Roofing Covering - WS Window and Siding SF Solid Fuel Burning Appliances 413-250-4746 Sean@BradshawEnterpisesLLC.com 1 Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 194456 02/07/2021 Bradshaw Enterprises,LLC HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name Sean Matthew Bailey Bradhsew Sean@BradshawEnterpisosLLC.com No.and Street Email address 246 Connecticut Ave,Springfield,MA 01104 413-250-4746 City/Town,State ZIP Telephone iECTION 6c WOR RS'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 0 No ❑ SECTION 7a:OWNER AUTHORIZATJDNTO BE COM , , `ED WHEN OWNER-$.AGENNT..ORCONTRACTGIk PIES FOR.B.,T !0110'-PERMIT, I,as Owner of the subject property,hereby authorize Bradshaw Enterprises,LLC to act on my behalf,in all matters relative to work authorized by this building permit application. Please see attached customer signature authorization form provided MassSave. Print Owner's Name(Electronic Signature) Date SECTION 74i:OWNER',OR AUTOS 6.AGENT-DECLA1RATION1L 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 /� , dotloop verified Searcy/5a,� 44w 04/26/2111:53 AM EDT I/issiv✓ ABTZ-TDEZ-M5R5-506G Sean Bradshaw authorized Agent _ Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES:. l. 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.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 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" dotloop signature verification:dtlp.us/T4rg-GKO0-06aF < The Commonwealth of Massachusetts ,' " p+ Department of industrial Accidents " " 'r 1 Congress Street,Suite 100 it t tom .. i Boston,MA 02114-2017 •,,' „- ' www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Name(Business/Organizational/Individual):Bradshaw Enterprises, LLC Address: 34 Front St Indian Orchard Mills Suite G60 City: Springfield State: MA Zip: 01051 Phone#: 413-250-4746 Are you an employer?Check the appropriate box: Type of project(required): ✓ 1. I am an employer with 11 employees(full and/or part time)` n 7. New construction 2. I am a sole proprietor or partnership and have no employees working for me in any I 8. Remodeling capacity.(No workers'comp.insurance required.] 1-1 9. 19. Demolition 3. I am a homeowner doing all work myself.[No workers'comp.insurance requiredit 10. Building addition 04. I am a homeowner and will be hiring contractors to conduct all work on my property. 11. Electrical repairs or additions I will ensure that all contractors either have workers'compensation insurance or are — sole proprietors with no employees. 12. Plumbing repairs or additions u5. I am a general contractor and I have hired the sub-contractors listed on the attached 13. Roof Repairs sheet. These sub-contractors have employees and have workers'comp.insurance.t - I6. We are a corporation and its officers have exercised their right of exemption per MGL. 1 14. Other Li c.152,§1(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box tn.must also fill out the section below showing their workers'compensation policy information. tHomeowners 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 attach an additional sheet showing the name of the sub-contractors and state whether or not those entitles have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation Insurance for my employees. Below is the policy and job site information. Insurance Company Name: Sentry Insurance (Agent - Phillips Insurance 413-594-5984) Policy#or Self-ins.Lic.#: A0158300004 Expiration Date: 8/21/2021 Job Site Address: 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,§25A 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 under the pains and penalties of perjury that the information provided above is true and correct,and that clicking this checkbox and typing my name in the field below will act as my signature. Name: Sean Bradshaw Date: 9/29/20 Phone#: 413-250-4746 Email: sean@bradshawenterprisesllc.com Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC Registration: 194456 BRADSHAW ENTERPRISES, LLC Expiration: 02/07/2023 246 CONNECTICUT AVE SPRINGFIELD, MA 01104 Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE: LLC before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 194456 02/07/2023 1000 Washington Street -Suite 710 BRADSHAW ENTERPRISES, LLC Boston, MA 02118 SEAN M. BRADSHAW 34 FRONT STREET ,((.441.40(a.(Z '4. SPRINGFIELD, MA 01151 Undersecretary o 'acid Wi i out - gnature dotloop signature verification:dtlp.us/T4rg-GKO0-O6aF _�..-+llo BRADENT-01 BROOKE ACORv' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) `.--- 9/28/2020 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 ri his to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Brooke Barre Phillips Insurance Agency,Inc. PHONri,Est):(413)594-5984 I FAX No 413 592-8499 97 Center Street No E-MAIL brooke hilli sinsurance.com Chicopee,MA 01013 pflRlcss; @P P INSURERS AFFORDING OVERAGE NAIC# INSURER A_Middlesex Insurance Company INSURED INSURER B:Sent Insurance __. 124988 Bradshaw Enterprises,LLC INSURER C: - PO Box 944 INSURER D: Chicopee,MA 01021 INSURER E: i 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 SUCI I POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE IADDL SUeRi pOUCY NUMBER D(POLICY EFF POLICY EXP LIMITS LTR IN$D, wvo I IMM/DYYYY) (MMIDD(YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR A0158300 811212020 8/12/2021 DAMAGE TO RENTED 500,000 X 1�R€MISES_iEd ocrunvnca� $ --------__ MED EXP(Any ono person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: - GENERAL AGGREGATE _i 3'000'000 POLICY ri i JEC7 r 1 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 I(Ea sccid_ent1 _$ X ANY AUTO X A0158300003 8/12/2020 8/12/2021 j BODILY INJURY(Per_person) $OWNED SCHEDULED _ AUTOS ONLY _ AUTOS i BODILY INJURY(Per accident) $ _ __ _ __ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident) i$ $ A X UMBRELLA X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LAB CLAIMS-MADE A0158300 8112/2020 8/12/2021 AGGREGATE 2,000,000 BED X RETENTION$ 0 $ B WORKERS COMPENSATION X PERTUTF1 _ 0R AND EMPLOYERS'LIABILITY TYIN A0158300004 8/12/2020 8/1212021 1,000,000 ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? Y NIA 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S It yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ t DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 1e1,Additional Remarks Schedule,may be attached if more space Is required) Thielsch Engineering,Inc.is listed as Additional Insured on a primary,non contributory basis with respect to General Liability and Auto Liability per written contract. CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Thielsch Engineering,Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 g ACCORDANCE WITH THE POLICY PROVISIONS. 195 Frances Ave Cranston,RI 02910 AUTHORIZED yREPRESENTATIVE ,EPRES ENTATIV E ✓r ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD dotloop signature verification:dtlp.us/T4rg-GKOO-06aF . , ,,,,-77// ,,/,/,,,..),.-4.),..)(7,(..h.((/(,)e . Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts Home ImprovementtGontractor Registration - -- ->i Type: LLC -t... ` • i�' Registration: 194456 BRADSHAW ENTERPRISES,LLC -- - •'• - .-t Expiration: 02/07/2021 246 CONNECTICUT AVE `•117.1'''' &.-` SPRINGFIELD,MA 01104 "'' Update Address and Return Card. SCA 1 8 2010-0S&t7 • T Yr•..,n rnu s 40,1.#/islysn vfu.N•//v Office of Consumer Maim&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If d Registration! Expiration Office of Consumer Affairs andfoun Businessreturn Regto:ulation 19445E 02/07/2021 t000 Washington Street.Suite 710 BRADSHAW ENTERPRISES,LLC Boston,MA 02118 SEAN M.BRADSHAW `,P1 �_�-�` 34 FRONT STREET L, SPRINGFIELD,MA 01151 Undersecretary Not v.,•• without si• •ature n, .44r. ''` :„: 'F'++ a>.,k k7.4 "+„d t a h ,,r_ .1 j r,1 � 'AT! r'r"y € �'',,- °3 ..,,. y �F,,44,JJ:! �7 ., 44 '�+r�". Ar ^'t" + t f:: �✓,f, rtfau `a�,.,vt t.1"'� ,�i j �`>'" ‘:,_ ,,T,...::,, ...,'.,,,.,, ,. ,:, 07.... , .",,,_• •^ ,-,. , f .,44„,_,.,:<-,,,,,-,.,31'..I. -''':l'A):-I''''1;4 --ff.:.°r'47%4;:i,',1';54:: S jy ° ' 4rF'�nS K "S�. .,r .p,. rr rani, w ! a Tt vt 4'. ,44 ?,� �.,t' i' ', a7f' ys �',,4 5 i may' ,. ,: i t ��a a +r ' , 4 x.,��.ii j^ .�r - 3`ay �' �`. tx z .� tom;; i. ..k ,iq , : 4+ : .1 '-''.t. S s.'' i cf ei ,sT --. '. 1 1 1 dotloop signature verification:dtlp.us/T4rg-GKO0-O6aF • DEBRIS DISPOSAL AFFIDAVIT In accordance with the provisions of MGL c.40, s.54, is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c.111, s.150A. ANY AND ALL DEBRIS PROUCED AS A RESULT OF WORK PERMITTED UNDER THE ATTACHED APPLICATION WILL BE DISPOSED OF IN: USA Waste Recycling Name of Licensed Solid Waste Disposal Business/Facility 15 Mullen Rd, Enfield CT 06082 Address of Licensed Solid Waste Disposal Business/Facility USA Waste Recycling Name of Hauler Sean Bradshaw 9/20/2020 Print Applicant Name Date ❑ I,Sean Bradshaw do hereby certify under the pains and penalties of perjury that the information provided above is true and correct, and that clicking this checkbox and typing my name in the field above will act as my signature. CLEAResult CONTRACTOR WORK ORDER Mass Save® Home Energy Services 50 Washington St.Suite 3000 Westborough.MA 01581 Customer Name:TEDDI OLSZEWSKI Bradshaw Enterprises LLC Email:jeffbankman@gmail.com PO Box 1276, Phone:413-230-6665 Chicopee,MA.01021 Premise Address:73 Bridge St,APT 9,Northampton,MA 01060 413-301-8010 Project ID:3780348 Applicable Customer Required Actions: Notes: • Storage Removal Customer must Remove Storage and Old Insulation From Basement Before Contractor Arrival. Location Measure Description Quantity Unit Unit Cost Total Cost Air Sealing at Estimated 62.5 CFM50 Per Hour 1 hr $92.58 $92.58 Exterior Door Weather Stripping(with AS hrs) 2 each $30.07 $60.14 Basement Ceiling-9" Fiberglass Batting 500 SF $2.82 $1,410.00 Door-2"Thermal Barrier Polyiso 1 each $90.44 $90.44 Wx PPE Costs 1 each $90.00 $90.00 Installed Measures Total $1,743.16 WorkOrder Notes Utility Incentive and Customer Share Information Utility Incentive Weatherization incentive $1,125.33 Air sealing incentive $242.72 Total Utility Incentive $1,368.05 Customer Share Total Customer Share $375.11 Less Deposit Of $75.22 Customer Share Balance $299.89 Page 1 of 1 DocuSign Envelope ID:7DA50229-7C62-45F0-8487-538536A1 D221 • Permit Authorization mass save Form Site ID: 3780348 Customer: TEDDI OLSZEWSKI Jeff Bankman , owner of the property located at: (Owner's Name,printed) 73 Bridge St APT 9 Northampton, MA 01060 (Property Street Address) (City) hereby authorize the Mass Save Home 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. ^• cu � �� DocuSigned by: Owner's Signature:( �`�r b ^k ' " 72DC/DCOCC13'C3.. Date:10/8/2019 111:17 AM EDT 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: Page 1 of 1 For Office U-e Only Rev. 102015 dotloop signature verification:dtlp.us/T4rg-GKO0-O6aF Bradshaw Enterprises, LLC P0. Box 944 Chicopee, MA 01021 Hello Building Department We are Bradshaw Enterprises, LLC located in Indian Orchard, MA. We are an Insulation / weatherization contractor for MASS SAVE. Enclosed in this packet is our Permit application and supporting documentation as follows: -Application -HIC Registration -Insurance Certificate -Signed customer Authorization form or copy of signed contract -Construction Supervisor License -Worker's Compensation Insurance Affidavit -Pre stamped return envelope We hope you find this packet intact and convenient. If you have any questions or concerns please call or email at 413-250-4746 Sean Bradshaw 413-301-8010 Office phone Email: Sean@BradshawEnterprisesLLC.com