22B-037 (11) BP-2023-1291
24 CORTICELLI ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
22B-037-001 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-2023-1291 PERMISSION IS HEREBY GRANTED TO:
Project# INSULATION 2023 Contractor: License:
Est. Cost: 2000 HOME ENERGY SOLUTIONS INC 106188
Const.Class: Exp.Date: 12/28/2023
Use Group: Owner: HARVEY FELIX
Lot Size (sq.ft.)
Zoning: URB/WP Applicant: HOME ENERGY SOLUTIONS IC
Applicant Address Phone: Insurance:
233 COLLEGE HWY (413)203-2454 0 HOWC140654
SOUTHAMPTON, MA 01073
ISSUED ON: 09/18/2023
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 VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
,2 _ 59.147
.v
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
4 _ 10- z
City of Northampton
/,`' �., Building Department
s INSULATION
{ 212 Main Street
��- Room 100
Northampton, MA 01060
phone 413 587 12d0 Fax 413 587 1272 �
APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY
rSECTION 1 -SITE INFORMATION INSULATION PERMIT
1.1 Property Address: This section to be completed by office
Map Lot Unit
24 Corticelli St
Northampton, MA 01062 Zone _Overlay District
CB District
Elm St.District__
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
_Felix Harvey 24 Corticelli St
Name(Print) Current Mailing Address:
Attached Telephone
Signature
2.2 Authorized Agent:
Shawn Mitchell 233 College Hwy Southampton_MA. 01073
Name(Print) Current Mailing Address'
li 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 $2 000 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) `/ 6 .-
5 Fire Protection
6, Total= (1 +2 + 3 +4 + 5) Check Number 1 4,j V
This Section For Official Use Only
Building Permit Number: Go- .`3 /L'!J Date
Issued:
Signature; /__/ _ !"/D zoZ3
Building Commissionerlinspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
I SECTION 4-CONSTRUCTION SERVICES
8.1 riconsedConstructiQn Supervisor: Not Applicable ❑ 1
Name of License Holder: Shawn Mitchell 106188
License Number
.68 Russellville Rd 12/28/23
Address Expiration Date
413-203-2454
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
Home Energy Solutions Inc. 193885
Company Name Registration Number
233 College Hwy Southampton MA, 01073 12r4'24
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 this affidavit will result
in the denial of the issuance of the building permit,
Signed Affidavit Attached Yes 2/ No O C �+ /� j
'Brief Description of Proposed Work NOTE. INSULA 1rI�.�li^� 1;,�����'�I. �'
Blown in insulation and air sealing
1. Shawn Mitchell , 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.
Shawn Mitchell _
Print Name
9/11/23
Signature of Owner/Agent Date
1,Felix Harvey/Attached ,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.
Felix Harvey/Attached 9/11/23
Signature of Owner Date
City of Northampton
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DEPARTMENT OF BUILDING INSPECTIONS
v 212 Main Street • Muruclpal Building
Northampton, MA 01060
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
in accordance of the provisions of MGL c 40, S54, 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 'je,„.//tivi.„ 7/fizi_47,j0,12 Date: 9/11/23
Y1
mass save
PERMIT AUTHORIZATION FORM
i, Felix Harvey owner of the property located at:
(Owner's Name)
24 Corticelli Street Northampton
(Property Street Address) (City)
hereby authorize the Mass Save° Home Energy Services Program assigned Participating
Contractor to act on my behalf and obtain a building permit to perform insulation and/or
weatherization 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.
Owner's Signat
*41iO 7;3
Date
FOR OFFICE USE ONLY
We have assigned the following Mass Save Home Energy Services Participating Contractor
to the above referenced project:
Participating Contractor Date
Client: Felix Harvey
Address: 24 Corticelli Street
AN EMPLOYEE OWNED COMPANY Northampton, MA 01062
Energy Specialist: Jeff Ledoux Phone: (610)721-5253
Program: EGMA-HES Client# 523185 Work Order# 61606
Work Scope
DESCRIPTION Qty Notes
1 ATTIC DAMMING 96
2 ATTIC FLAT-7"OPEN R-26 CELLULOSE 912
3 RECESSED LIGHT COVER NO INCENTIVE 1
4 RECESSED LIGHT COVERS 6
5 VENTILATION CHUTES-HALF 57
6 PREPARE YOUR HOME 1
Diagram air sealing complete
24
\ The Commonwealth of Massachusetts
Department of industrial Accidents
Office of Investigations
Lafayette City Center
2 Avenue de Lafayette, Boston, ,M4 02111-1750
www.m ass.g ovldia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please. Print Legibly
Name (ausmess/organizatiotondividuat):Home Enersgy Solutions Inc
Address:2_33 College Hwy
City/State/Zi•; Southam'ton MA 01073 Phone #: 413-203-2454
' Are you an employer? Check the appropriate box: Type of project (required):
I am a employer with 4. El I am a general contractor and 1
f: New 6.
employees (full and'or part-time).* have hired the sub-contractors eonstniction
I am a sole proprietor or partner-
hated on he attached sheet. 7. Remodeling
These sub-contractors have
ship and have no employees 8. Demolition
working for me in any capacity. employees and have workers'
9. 0 Building addition
[No workers' comp. insurance comp. insurance..
required.] 5, 0We are a corporation and its 10.0 Electrical repairs or additic
3,0 I am a homeowner doing all work officers have exercised their I 1.0 Plumbing repairs or additic
myself. [No workers' comp. right of exemption per MGL
12.0 Roof repairs
insurance required.] * c. 152, §I(4),and we have no
employees. [No workers' 13 gother jnst
comp. insurance required.]
'Any applicant that cheeks box PI must also fill out the section below showing their workers'comp nation policy information,
t tomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such,
Contilictors that check this box must attached an additional sheet showing the name of the sub-contractors and sone whether or not those entities have
:!.rriployees, 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
infrrmution.
Insurance Company Name:AmGaurd Insurance Company
Policy#or Self-ins. Lie. #:HOW423317 Expiration Date: 1/4/24 _„_
Job Site Address:24 COrticelli St City/State/ZipNOrthaMptOn,MA 01062
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
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 f
of up to S250.01)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.
=amommuswamma, .4.L. f.. --L. -
I do hereby certify und e pains and penaltie' airy that the information provided above is true and correct.
Sitpature: ,Date: 9a1/73
4.40s.".•
Phone#: 3-24&4.
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):
tO Board of Health 20 Building Department 30CitytTown Clerk 4.0 Electrical loopoesor Saiumbing
inspector 6.DOther
Contact Person:_ Phone#: