11A-089 BP-2024-0497
72 UPLAND RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
11A-089-001 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-2024-0497 PERMISSION IS HEREBY GRANTED TO:
Project# INSULATION 2024 Contractor: License:
Est.Cost: 6623 SCOTT MCCRAY 117322
Const.Class: Exp.Date: 04/14/2026
LEARY JANE M &RICHARD T LEARY JR&
Use Group: Owner: RAYMOND J LEARY &RUSSELL J LEARY &
Lot Size (sq.ft.)
Zoning: URA Applicant: PROSPECTIVE ENERGY SOLUTIONS INC
Applicant Address Phone: Insurance:
14 PINEBROOK CIRCLE (413)424-3600 WC533SB23J7Q013
GRANBY, MA 01033
ISSUED ON: 04/24/2024
TO PERFORM THE FOLLOWING WORK:
INSULATION/W EATH ERI Z ATI 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:
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: ff://0
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
DocuSign Envelope ID:7B5221C5-9BC1-4ACD-B5CE-F66752F3B318
1 ui, r 206Z d E�'�" L.
The Commonwealth of Massachus tts FOR
Board of Building Regulations and St4idar APR 2
J Massachusetts State Building Code,7 0 C 2 2Oa 4UI lICIPALITY
USE
Building Permit Application To Construct,Repair, ovlaae,+ lish.A__Reviled Mar 2011
One-or Two-Family Dwellin ^foa7� 1-w,,�P I;� ,iNspecTorus
J,, "p 01000
This Section For Official Use Only
Building Permit Number: bI yq 7 D to Applied:
4V0J 7g �L j� L-21-Zaz.
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
72 Upland Rd. Leeds MA 01053 11A-089-001
1.1a Is this an accepted street?yes 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
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public El Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Jane Leary Leeds, MA 01053
Name(Print) City,State,ZIP
72 Upland Rd. 413-584-4560
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building 0 Owner-Occupied El Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other E Specify:Insulation
Brief Description of Proposed Work2: Bl own cel 1 ul ose insulation (R-60) i n atti c
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 6,623.96 1. Building Permit Fee:$ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $ 0 Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ Total All Fees:$ Q
04
Suppression)
6,62 3.96 Check No. 109 5 Check Amount: • Cash Amount:
6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due:
• DocuSign Envelope ID:7B5221 C5-9BC1-4ACD-B5CE-F66752F38318
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CS-117322 02/17/2025
Scott McCray License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) Unrestricted
14 Pinebrook Circle
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
Granby, MA 01033 R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
413-219-1304 scott.mccray@prospectivenrg.com I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 207208 12/15/2024
Prospective Energy Solutions, Inc. HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
14 Pinebrook Circle rachel.hall@prospectivenrg.com
No.and Street Email address
Granby, MA 01033 413-424-3600
City/Town,State,ZIP Telephone
SECTION 6: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 ® No ❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize Prospective Energy Solutions
to act on my behalf,in all matters relative to work authorized by this building permit application.
see attached permit authorization form. 4/10/2024
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
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 best of my knowledge and understanding.
taut AA 4/15/2024
't di i sor Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. 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"
' Massachusetts
DocuSign Envelope ID:7B5221C5-9BC1-4ACD-B5CE-F66752F3B318
Department of Industrial Accidents
ZrE= Office of Investigations
EV_ Lafayette City Center
IL-j./ 2 Avenue de Lafayette, Boston,MA 02111-1750
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Prospective Energy Solutions, Inc
Address: 14 Pinebrook Circle
City/State/Zip: Granby, MA 01033 Phone#:413-434-3600
Are you an employer? Check the appropriate box: Type of project(required):
1.❑■ I am a employer with 5 4. ❑ I am a general contractor and I 6. New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance.# 9. ❑Building addition
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. 152,§1(4),and we have no 13.❑Other
employees. [No workers'
comp. insurance required.]
*Any applicant that checks box#1 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.
$Contractor;that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities 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: LM INS Corp
Policy#or Self-ins. Lic. #:WC533SB23J7Q014 Expiration Date:02/17/2025
72 Upland Rd. Leeds, MA 01053
Job Site Address: City/State/Zip:
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$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 the pains and penalties of pedury that the information provided above is true and correct.
Signature 1'Ar1.r l Date:
l'H 4/15/2024
Phone#: 413-434-3600
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 20 Building Department 31:City/Town Clerk 4.0 Electrical Inspector 51:1Plumbing
Inspector 6.0Other
Contact Person: Phone#:
DocuSign
Certificate Of Completion
Envelope Id:7B5221C59BC14ACDB5CEF66752F3B318 Status:Completed
Subject:Complete with DocuSign:Permit Application Packet.pdf
Source Envelope:
Document Pages:5 Signatures:2 Envelope Originator:
Certificate Pages:2 Initials:0 Maeghen Malone
AutoNav:Enabled maeghen.malone@prospectivenrg.com
Envelopeld Stamping:Enabled IP Address:73.16.45.21
Time Zone:(UTC-08:00)Pacific Time(US&Canada)
Record Tracking
Status:Original Holder:Maeghen Malone Location:DocuSign
4/10/2024 5:11:08 AM maeghen.malone@prospectivenrg.com
Signer Events Signature Timestamp
Maeghen Malone Completed Sent:4/10/2024 5:15:14 AM
maeghen.malone@prospectivenrg.com Viewed:4/10/2024 5:23:15 AM
Administrative Assistant Signed:4/10/2024 5:23:47 AM
Prospective Energy Solutions Using IP Address:73.16.45.21
Security Level:Email,Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Rachel Hall ' �°o�c!uSigf n ' Sent:4/10/2024 5:23:48 AM
rachel.hall@prospectivenrg.com Nita RAU, Viewed:4/15/2024 9:18:36 AM
7EDFE 06f.AD4C5
President Signed:4/15/2024 9:19:06 AM
Security Level:Email,Account Authentication
(None) Signature Adoption:Pre-selected Style
Using IP Address:73.142.6.162
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
In Person Signer Events Signature Timestamp
Editor Delivery Events Status Timestamp
Agent Delivery Events Status Timestamp
Intermediary Delivery Events Status Timestamp
Certified Delivery Events Status Timestamp
Carbon Copy Events Status Timestamp
Witness Events Signature Timestamp
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 4/10/2024 5:15:14 AM
Certified Delivered Security Checked 4/15/2024 9:18:36 AM
Signing Complete Security Checked 4/15/2024 9:19:06 AM
Completed Security Checked 4/15/2024 9:19:06 AM
DocuSign Envelope ID:7B5221C5-9BC1-4ACD-B5CE-F66752F3B318
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
z
Pm 7
I ( f ,pe: Corporation
R
PROSPECTIVE ENERGY SOLUTIONS, INC. egistration: 207208Expiration: 12/15/2024
14 PINEBROOK CIRCLE ' = •
GRANBY, MA 01033 lilt __
P "
lop � r
%1M IMO i`��,
Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the
HOME IMPROVEMENT CONTRACTOR expiration date. If found return to:
TYPE:Corporation Office of Consumer Affairs and Business Regulation
Registration Expiration 1000 Washington Street -Suite 710
207208 12/15/2024 Boston,MA 02118
PROSPECTIVE ENERGY SOLUTIONS,INC.
oSCOTT MCCRAY Nri
":-Si y
14 PINEBROOK CIRCLE
GRANBY,MA 01033 .4 ok`
Undersecretary of valid without signature
DocuSign Envelope ID:7B5221C5-9BC1-4ACD-B5CE-F66752F3B318
Commonwealth of Massachusetts
�t Division of Occupational Licensure
• Board of Building Regulations and Standards
Constk+ ��nT 1Srvisor
" Jy
CS-117322 _ pires: 04/14/2026
SCOTT ANDf. EW MCCRAY
14 PINE BROAK CIRCLE
GRANBY MA'- 1033
?b-.
y-�1 L r'3:133
Commissioner da,d2a
Construction Supervisor
Unrestricted-Buildings of any use group which contain
less than 35,000 cubic feet(991 cubic meters)of enclosed
space_
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
For information about this license
Call(617)727-3200 or visit www.mass.gov/dp1
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House I I Addition Replacement Windows Alteration(s) n Roofing
Or Doors El
Accessory Bldg. ❑ Demolition ❑ New Signs [DI Decks [[] Siding[O] Other[DI
Brief Description of Proposed
Work:
Alteration of existing bedroom _Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing, complete the following
a. Use of building :One Family_ Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank City Sewer_ Private well City water Supply
SECTION 7a -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, _ ,as Owner of the subject
property
hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
• .......;, .y ia,3,, d___„ «-yc'y- .,,Z./ , /,2 4/
I, , 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.
City of Northampton
r �:, 5�5. ..
Massachusetts ��{� <
DEPARTMENT OF BUILDING INSPECTIONS �l it
rr-
j E
��, - 212 Main Street • Municipal BuildingJ�' �1�� Northampton, MA 01060o�
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: \Wig aLjet(Jl / 2.3c-f ect-rhciokfittv F4
The debris will be transported by:
Name of Hauler: 0163Qe G vQ Salt.) 30 kr,.,vu
Signature of Applicant: Date: