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32A-124 (12)
B '-2022-1287 57 KING ST UNIT A COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 32A-124-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2022-1287 PERMISSION'S HEREBY GRANT A D TO: Project# INSULATION Contractor: License: Est. Cost: 79000 ENERGIA LLC 92540 Const.Class: Exp.Date:09/02/2023 Use Group: Owner: FINN JACK V&PRISCILLA R TRUS EES Lot Size (sq.ft.) Zoning: CB Applicant: ENERGIA LLC Applicant Address Phone: Insurance: 242 SUFFOLK ST (413)322-3111 WMZ-800-8008072-20 2A HOLYOKE, MA 01040 ISSUED ON:10/11/2022 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHERIZATION 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOL TION OF ANY OF ITS RULES AND REGULATIONS. Signature: ` 3-1.� l Fees Paid: $553.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner i Versionl.7 (mi. r is , din&Permit May 15,2000 '13 ZOOZ [— • ( J Department use only C r 1� City of NortharnptorO7 \.\ status of Permit: �uilding'DeRa�tment `2 Curb Cut/Driveway Permit 1 ocj _ / 212 Main S (9Q(� S wer/Septic Availability i 7 20�2 Room 106"'''r ;(//, aterA/ell Availability Northampton, MA 010641 %, / Two Sets of Structural Plans 'T of ho a 41.3-587-1240 Fax 413-58 '727- Ply./Site Plans MAornra`"'a --,. they Specify APPLICATION TO CONSTRUCT, REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office 57 KING ST NORTHAMPTON MA Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ANDRE BOULEY 57 KING ST NORTHAMPTON MA Name(Print) Current Mailing Address: (413)585--I411- Signature Telephone 2.2 Authorized Agent: TOM ROSSMASSLET 242 SUFFOLK ST HOLYOKE MA 01040 Name(Print) Current Mailing Address: (413) 322-3111 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $79,000.00 (a)Building Permit Fee 2. Electrical (b) Estimated Total Cost of $0.00 Construction from (6) 3. Plumbing 1-------- $0.00 Building Permit Fee 4. Mechanical(HVAC) # 56,3 5. Fire Protection $0.00 /� 6. Total=(1 +2+3+4+5) Check Number 7 77 This Selction For Official Use Only Building Permit Number 6/9 ;- '' jJ/� D 7 Date Issued Signature: 7 j id-II-20Z2 Building Commissioner/Inspector of Buildings Date Versionl.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations El Existing Wall Signs ❑ Demolition❑ Repairs El Additions El Accessory Building❑ Exterior Alteration El Existing Ground Sign El New Signs❑ Roofing El Change of Use❑ Other 1 Brief Description INSULATION NO CONSTRUCTION= SPRAY FOAM CLOSED CELL TO RQOF, Of Proposed Work: SKYLIGHT, RIM JOIST - INTUMESCENT PAINT SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A 0 A-4 ❑ A-5 El 1 B ❑ B Business 2A ❑ E Educational 0 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard 0 3A 0 I Institutional 0 1-1 ❑ 1-2 ❑ 1-3 El 3B 0 M Mercantile ❑ 4 0 R Residential 0 R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 El 5B ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1st 1st __l nd 2nd _._._..._ _.._.__........ —._. I 2 3rd 3ra 4 4th th Total Area(sf) Total Proposed New Construction(sf) Total Height(ft) Total Height ft 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal Sys RITE Public ❑ Private ❑ Zone Outside Flood Zone Municipal ❑ On site disposal system Versionl.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: { Rear Building Height Bldg. Square Footage 0/0 Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW 0 YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained © , Date Issued: C. Do any signs exist on the property? YES O NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES ©i NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Version 1.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable Cl Name(Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Il Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor ENERGIA LLC Not Applicable ❑ Company Name: TOM ROSSMASSLER Responsible In Charge of Construction 242 SUFFOL ST HOLYOKE MA 01040 Address (413) 322-3111 Signat Telephone Version1.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes © No 4 SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ANDRE BOULAY , as Owner of the subject property hereby authorize ENERGIA LLC to act on my behalf, in all matters relative to work authorized by this building permit application. s ,*4' -(4"-r::'.6, 09/30/2022 Signature of Owner Date TOM ROSSMASSLER as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best 1:)f my knowledge and belief. Signed under the pains and penalties of perjury. TOM ROSSMASSLER Print Name 09/30/2022 Signatur f Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: TOM ROSSMASSLER 92540 License Number 242 SUFFOLK ST HOLYOKE MA 01040 09/02/2022 Address Expiration Date (413) 322-3111 Signature Telephone SECTION 13-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 4 No 0 DocuSign Envelope ID:B521952A-D328-45CD-9419-5427F9D98B39 EvERs .... uRcE i Contract for Energy Efficiency Work Under the Eversource Commercial/industrial Energy Efficiency Program The purpose of Eversource's Commercial and Industrial Energy Efficiency Program is to conserve natural gas through commercial and industrial energy efficiency improvements.The Center for EcoTechnology,Inc. (CET)is providing program services which include recommending and arranging for the installation of certain energy efficiency measures in the businesses of Eversource(customers.The Customer and the Contractor listed have signed and entered into this legally binding Agreement below for the installation of certain energy conservation measures under Eversource'program at the Customer's place of business: A2Z Science&Learning CUSTOMER'S BUSINESS NAME(Referred to as"Customer") 57 King Street, Northampton MA 01060 CUSTOMER'S BUSINESS ADDRESS fpdmfb ', b I44 7/7/2022 AUTHORIZED SIGNATURE,TITLE AND DATE AGREEING TO BE BOUND BY ALL PROVISIONS HEREOF. BUILDING OWNER APPROVAL SIGNATURE PLEASE PRINT Energia,LLC cAAriGd'QR'S BUSINESS NAME(Referred to as"Contractor") (udia, (titinivt, / fbt,t,r'lia (AL 7/14/2022 CONTRACTOR'S AUTHORIZED SIGNATURE, 1'I ILE AND DATE AGREEING TO BE BOUND BY ALL PROVISIONS HEREOF. Ivelice Lefebvre Energia LLC CONTRACTOR'S BUSINESS ADDRESS • A.CONTRACTOR'S RESPONSIBILITIES 1. Contractor will carry out the work described in the contractor estimate,which is attached by reference and made a part of this Agreement. 2. Contractor will follow manufacturer's instructions where applicable.All work performed shall be of good quality and shall be carried out in a professional manner.Contractor will not knowingly use any damaged materials: 3. Contractor will not perform work if it discovers any wiring,structural,moisture,or other problems,which may adversely affect or may be adversely affected by this work. • 4. Contractor will comply with all applicable laws,ordinances,codes,regulations,permitting requirements and standards that apply to the work. 5. Contractor will keep Customer's place of business as free as possible from waste materials while working.After completion,Contractor will clean the work area,removing all waste materials,tools,and supplies. 6. Contractor will complete the work on a timely basis,but not later than thirty(30)days after begin ►ing the work. This may be extended by CET and Customer if materials ordered by Contractor in a timely manner have not been supplied or for other good cause. The Commonwealth of Massachusetts -- Department of Industrial Accidents _ ► : Office of Investigations =lele- Lafayette City Center gmaaa��- 2 Avenue de Lafayette, Boston,MA 02111-1750 www.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/Organization Name: ENERGIA LLC Address: 242 SUFFOLK ST. City/State/Zip: HOLYOKE, MA 01040 Phone#: 413-322-3111 Are you an employer?Check the appropriate box: Business Type(required): 1.© I am a employer with 16 employees(full and/ 5. ❑Retail or part-time).* 6. ❑Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7. ❑Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers' comp. insurance required] 8. El Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per c. 152, §1(4),and we have 10.0 Manufacturing no employees. [No workers' comp.insurance required]** 11.0Health Care 4.❑ We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp. insurance req.] 12.1M1 Other Insulation *My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#I. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name: A.I.M. Mutual Insurance Insurer's Address: 57 K/k(& S T. City/State/Zip: tV 0 l2 T ef6t-eU4A"-7vtf"!.. ./A4- Policy#or Self-ins. Lic. #WMZ-800-8008072-2022A Expiration Date:7/01/2023 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under§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,under t ains and penalties of perjury that the information provided above is true and correct. Signature: Date: /t2/'5/ Zz Phone#: 413-322- 11 Ext 122 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(check one): 10Board of Health 2.0 Building Department 30 City/Town Clerk 4. Licensing Board 50 Selectmen's Office 6.❑Other Contact Person: Phone#: www.mass.gov/dia Commonweeftn of NIasiwchusettc bfvriion of Profess,onas Lstensure Board r..0 6u4ldsng Regulations and Standards CoMtmattOf rstiper v t f or CS-092540 ,4V . Flpues.09)0212023 •;:- in .,„ .,,, , T►toMAS a ROSSM4 s 100 MAIN STREET a,.'7!., I, c}_ I MA,.oio3 ` ,,,,J.„ . • ,i1A4Csioner dttfit r1. U »pit;.._ THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:LLC Registration valid for individual use only Registration Expiration before the expiration date. If found return to: 165169 02/Expiration Office of Consumer Affairs and Business Regulation ENERGIA LLC 1000 Washington Street -Suite 710 Boston,MA 0211E f. 4 , it THOMAS ROSSMASSLER :,.`..: • L......--- ' I 242 SUFFOLK STREET , . � -,� 4ii a � z Not valid without signature HOLYOKE,MA 01040 �ia.,.7- ems 9 Undersecretary a I it I -----"'""" ENERLLC-01 JOCELYN A�- ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM(DD/YYYY) 7/5/2022 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). PRODUCER I CONTACT Jocelyn M Douglas ME: Phillips Insurance Agency,Inc. PHONE I FAX 97 Center Street (A/c,No,Ext): (A/C,No) Chicopee,MA 01013 ADDRESS:Jocelyn@phillipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:State Automobile Mutual Ins Co INSURED INSURER B:A.I.M. Mutual Insurance Company Energia LLC INSURER C:Markel Insurance Company 242 Suffolk Street INSURER D Holyoke,MA 01040 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 ADDL SUBR POLICY NUMBER POUCY EFF POLICY EXP LTR INSR WVD (MMIDD/YYYY)_(MMIDD(YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE , $ CLAIMS-MADE X OCCUR PBP2870943 7/1/2022 711/2023 DAMAG PREMIS EES REaocNcurreTEDnce) $ 500,000 TO(E MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 I POL,— I x 1 PRO- I V 1 , 2,000,000 1 J O f PRODUCTS-LUMP/OP AGO $ IOTHER: j $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,0001 Ea accident) i $ X ANY AUTO BAP2477206 71112022 711/2023 BODILY INJURY(Per persons $ OWNED — SCHEDULED AUTOSO ONLY AUTOS Vy BODILY INJURY(Per accideit) $ AUTOS ONLY AUUTOS ONLDY (Perr accident)DAMAGE $ S - A j X UMBRELLA LIAB X OCCUR yEACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE PBP2870943 7/1/2022 7/1/2023 AGGREGATE $ 2,000,000 DED X RETENTION$ 0 _ $ PERB WORKERS COMPENSATION X STATUTE ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WMZ-800-8008072-2022A 711/2022 7/1/2023 E.L.EACH ACCIDENT 1 $ 1,000,000 FFICER/MEMBEREXCLUDED? N N/A 1,000,000 Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Equipment Floater PBP2870943 7/1/2022 7/1/2023 Leased/Rented 35,000 C Pollution Liability CPLMOL106305 4/19/2021 4/19/2023 Pollution 1,000,000 I I I DESCRIPTION OF OPERATIONS I LOCATIONS/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 Evidence of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of AGORD