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13-021
BP 2023-0030 480 NORTH KING ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 13-021-001 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-2023-0030 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est.Cost: 5500 HOME ENERGY SOLUTIONS INC 106188 Const.Class: Exp.Date: 12/28/2023 Use Group: Owner: L COURAGE, KENNETH F&DEBRA Lot Size (sq.ft.) Zoning: RI/SR Applicant: HOME ENERGY SOLUTIONS INC Applicant Address Phone: Insurance: 68 RUSSELLVILLE RD (413)203-2454 HOWC1361807 SOUTHAMPTON, MA 01073 ISSUED ON: 01/12/2023 TO PERFORM THE FOLLOWING WORK: INSULATI ON/WEATHERIZATI ON 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: Fin a►: 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 VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: jt 44;14_. 4 . , _ • _ _y... Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner VLr /Cf7 Dep City of Northampton FOR Building Department :'A‘tt 212 Main Street `J4N 0 INSULATION Room 100 a),,?3 '; Northampton, MA 0106 .-„ phone 413-587-1240 Fax 413-587.212ZZ- ONLY APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION 1 INSULATION PERMIT This section to be completed by office 1.1 Property Address: Map Lot Ur-HI Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Jeffrey Caron Name(Print) c4!,1441t-tfitrial7S4—NiatthamPt°nTen MA 01060 413-85'88-79655 Jeffery_CtoniAttached Telephone Signature r- 2.2 Authorized Agent: Shawn Mitchell ..233 College Hwy Southampton MA, :11073 Name(Print) Current Mailing Address. SACLZILde 77/44f:Gide 413-203-2454 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 5,500 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+ 3+4+5) _5,500 Check Number This Section For Official Use Only Date Building Permit Number4gs Issued: Signature: tir "" ZOZ5 Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable D Name of License Holder: Shawn Mitchell 106188 License Number .8 Russellville Rd 12/28/23 Address Expiration Date 7//7/4&-1-41e 413-203-2454 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable O Home Energy Solutions Inc. 193885 Company Name Registration Number 233 College Hwy Southampton MA, 01073 12/4/24 Address Expiration Date Telephone 413-203-2454 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 the;affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes t No 0 (Brief Description of Proposed Work NOTE: INSULATION ONL Y Blown in insulation and air sealing i I j{ 1 I Shawn Mitchell as C3wnerlAuthorizad 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. Shawn Mitchell Print Name 12/29/22 Signature of Owner/'Agent Date I, .__ Jeffrey_Caron__.._. ,as Owner of the subject property hereby authorize Shawn Mitchell to act on my behalf, in all matters relative to work authorized by this building permit application. Attached 12/29/22 Signature of Owner Date RISE ENGINEERING OWNER AUTHORIZATION FORM Jeffrey Caron 12.,P,'t C ovm (Owner's Name) owner of the property located at: 480 N King Street (Property Address) Northampton, MA 01060 (Property Address) hereby authorize Subcontractor(to be filled in by office) 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. The permit will be secured by the subcontractor, at no additional cost. It is the homeowner's responsibility to close out this permit by contacting their municipality at the completion of this work. -16/11, "ji.k)\-1 Owner's gnature 913SitI Date RISE Engineering, a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 Canton, MA 02021 339-502-6335 www.RlSEengineering.com City of Northampton 5te Massachusetts / 4 DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal SurldIng Northampton, MA 01060 .4r)'tis CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, 554, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: Springfield, MA The debris will be transported by: Name of Hauler: Waste Management Signature of Applicant: c 'ke.„(..,fm, 7Aja.11 Date: 12/29/22 RISE Client: Jeffrey Caron Address: 480 N King Street ENGINEERING" Northampton, MA01060 Energy Specialist: Daniel Diaz Phone: (413)588-7965 Program: CMA-HES Client# 328904 Work Order# 38503 Work Scope DESCRIPTION Qty Notes 1 COMBUSTION GAS SPILLAGE 1 2 HOME AIR SEALING 7 6 FOR BOTH ATTIC SPACES AND 1 FOIR SILLS 3 WEATHERSTRIP AND ADD DOOR SWEEP 2 DOOR LEADING TO GARAGE AND FRONT DOOR 4 ATTIC DAMMING - R-38 FIBERGLASS 64 5 ATTIC FLAT- 11" OPEN R-40 CELLULOSE 761 6 KNEEWALL SLOPE: 6" FIBERGLASS R-19 & RIGID 160 7 REMOVE EXISTING INSULATION 160 8 WALLS THIN BATT 680 ALL EXT IN MAIN BUILDING. BUMP OUT WALLS ARE OK 9 COMMON WALL R13 FIBERGLASS AND RIGID BOARD 121 10 REMOVE EXISTING INSULATION 121 11 BASEMENT SILLS R19 FIBERGLASS BATT 29 12 REMOVE EXISTING INSULATION 6 13 VENTILATION CHUTES 90 160/C 14 VENTILATION OK 1 15 FAN VENTING OK 1 16 VENTILATION OK 1 17 CUSTOM DISCLOSURE 1 Diagram 16' 14' 12' 32' 2,4,5,13 TEST HOLE 2,4,5,13 21' ACCESS 25' INACCESSIBLE 6,7,9,10,13 CRAWL. EITHER THROUGH 31 10' CUSTOMER WI_L GARAGE DEED TO MAKE AN ACCESS AND 4' 16' HEAD ROOM OR VAULTED SIGN MOISTURE 1 DISCLOSURE The Commonwealth of Massachusetts Department of Industrial Accidents 7 ,:,,r,,,,,, ,, ,,, Office of in ;;Liii, ,,:::=1 ,:;' Lafayette City Center 2 Avenue de Lafayette, Boston, MA 02111-1750 wirwmass.govidia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant information Pleasg Print Legibly Name (13usinesOrganizatiortfInclividual):Home Energy Solutions Inc Address:233 Odle e Hw . _ City/State/Zit: Southamitton, MA 01073 Phone#: 413-203-2454 .... Are you an employer? Check the appropriate box: Type of project (required): I.V 1 ani a employer with 5 4. 7 I am a general contractor and I 6. 0 New construction employees (full and or part-time).* have hired the sub-contractors i listed on the attached sheet, 7, Ej Remodeling 2.Li I am a sole proprietor or partner- These sub-contractors have ship and have no employees 8, Ej Demolition working for me in any capacity. employees and have workers' , 9, 0 Building addition [No workers' comp, insurance cornp. insurance.- 5 0 We are a corporation and its 10,0 Electrical repairs or additioi I required.] 1 3 0 1 am a homeowner doing all work officers have exercised their 11,0 Plumbing repairs or additiot i myself, INo workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] ' c. 152, §1(4),and we have no employees. [No workers' I 3.1VOtherinSUI t. comp. insurance required.] 'Any applicant that checks box;i must also fill out the sciction below showing their workers'compensation policy information. ' !forneowners 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 Nibs-diet or not those entities have employees. (the sub-contractors have employees,they must provide their workers'comp,policy number, si /am an employer that is providing workers'compensation insurance for my employees. Below is the polity and job Sit'.' information. Insurance Company Name:AmGaurd Insurance Company Policy#or Self-ins. Lic. 0:HOW423317 Expiration Date: .1/4/24 Job Site Address:480 North King St City/State/Zip: Northmpton, MA 01060 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). 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 S1,500.00 andior one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a IT 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. l do hereby certiff un e pains and penaltie , .,,jury that the information provided above is Mae and correct. SiWAttirS.L___ •/';.e 1. . ..,- Date; 12/29/22 .._._ -- — . .. Qfficial use only. Do not write in this area, to be completed by city or town official. 1 City or Town: Permit/License # . Issuing Authority(check one : 10Board of Health 20 Building Department 30City/Town Clerk 4.0 Electrical Inspector 5D'iii tubing Inspector 61:Other Contact Person: Phone#: AC O® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 4/11....../ 01/04/2023 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 CONTACT Elizabeth Carballo,CISR,CPIA NAME: Finck&Perras Insurance Agency Inc. (A//CON,Ext): (413)527-5520 FAX No): (413)527-5970 6 Campus Lane A-DRESS: bcarballo@finckandperras.com INSURER(S)AFFORDING COVERAGE NAIC# Easthampton MA 01027 INSURER A: Arbella Insurance Group 17000 INSURED INSURER B: NorGUARD Insurance Company , 31470 Home Energy Solutions Inc INSURER C: Russell Bond 68 Russellville Rd INSURER D: INSURER E: Southampton MA 01073 INSURER F: COVERAGES CERTIFICATE NUMBER: CL231406962 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 TERMSI,/ EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 50,000 MED EXP(Any one person) $ 10,000 A 8500066829 01/02/2023 01/02/2024 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT PRO LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: Employee Benefits $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ 1,000,000 A OWNED SCHEDULED 1020061519 01/02/2023 01/02/2024 BODILYINJURY(Peraccident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) Underinsured motorist BI $ 50,000 UMBRELLA LIAB V"'y" OCCUR EACHCC OCCURRENCE $ - A EXCESS LIAB CLAIMS-MADE 4620089819 01/02/2023 01/02/2024 AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER v/N 1,000,000 B ANYCER/MEMBR/PARTNER/EXECUTIVE Y N/A HOWC423317 01/04/2023 01/04/2024 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? )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 LIMIT $ , , Pollution peroccurence $1,000,000 C ' G283145890003 11/23/2022 f. 11/23/2023 aggregate $2,000,000 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Proof of Coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main Street AUTHORIZED REPRESENTATIVE Northampton MA 01060 2:fol,Clk- ,,L$9hal. 0 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD