37-105 (2) BP-2024-0925
68 ICE POND DR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
37-105-001 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-2024-0925 PERMISSION IS HEREBY GRANTED TO:
2024
Project# INSULATION/WEATHERIZATION Contractor: License:
Est. Cost: 5451.72 SCOTT MCCRAY 117322
Const.Class: Exp.Date: 04/14/2026
Use Group: Owner: R. PATEL, RHYTHM S. & ROSHNIBEN,
Lot Size (sq.ft.)
Zoning: SR Applicant: PROSPECTIVE ENERGY SOLUTIONS INC
Applicant Address Phone: Insurance:
14 PINEBROOK CIRCLE (413)424-3600 WC533SB23J7Q014
GRANBY, MA 01033
ISSUED ON: 07/23/2024
TO PERFORM THE FOLLOWING WORK:
INSULATE/WEATHERIZE ATTIC & BASEMENT
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: 172,
Fees Paid: $75.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
D velolie ID:D7200BA9-1C05-4752-8CF2-52D3 82959E
ii 1-- f ' ''' a
p lo-/s-
The Commonwealth of Massachusetts
l :-j Board of Building Regulations and Standards FOR
'.' lMUNICIPALITY
��;� , Massachusetts State Building Code,780 CMR_ i USE
l uilding Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
; One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number:D1 Zo2+.(- Oq Date Applied:
g-tx,..) / ; /‘ 7-23-zozy
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
68 Ice Pond Dr. Northampton Ma 01062 37-105-001
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
S R. . 38 L-ae,rr._
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 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Rhythm Patel Northampton, Ma 01062
Name(Print) City,State,ZIP
68 Ice Pond Dr. 413-695-8128 irhythm88@yahoo.com
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied El Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other O Specify:Insulation
Brief Description of Proposed Work$1 own cellulose insulation (R-60) in attic; i nsul ate to
R-19 in basement.
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 5,451.72 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire
Suppression) $ Total All Fees:$ i„
Check No]d q.s Check Amount:7.. Cash Amount:
6.Total Project Cost: $ 5,451.72 0 Paid in Full 0 Outstanding Balance Due:
Docusign Envelope ID:D7200BA9-1C05-4752-8CF2-52D3AF82959E
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 O No 0
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. 4/25/2024
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.
r—DocWgnw by:
(, 7/18/2024
rr nt owner s or 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.govdps
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"
Docusign Envelope ID: D7200BA9-1C05-4752-8CF2-52D3AF82959E1 f Massachusetts
Department of Industrial Accidents
Office of Investigations
Lafayette City Center
"��- 2Avenue 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.❑1 I am a employer with 5 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. New construction
listed on the attached sheet. 7. ❑ Remodeling
2.❑ I am a sole proprietor or partner-
ship and have no employees These sub-contractors have 8. ❑ Demolition
workingfor me in anycapacity. employees and have workers'
p tY 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.:
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 11.0 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
employees. [No workers' 13.0 Other
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.
:Contractors 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
Job Site Address: 68 Ice Pond Dr City/State/Zip: Northampton, 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 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 perjury that the information provided above is true and correct.
.S«b
Signature) 7/18/2024
� Date:
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 2❑Building Department 3.❑City/Town Clerk 4.0 Electrical Inspector 51=1Plumbing
Inspector 6.1:1Other
Contact Person: Phone#:
Docusign Envelope ID:D7200BA9-1C05-4752-8CF2-52D3AF82959E
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Im rovement Contractor Registration
1..4 —........... • — ,x(f/
rw __ `' Type: Corporation
I•c 1w;
1 - Registration: 207208
PROSPECTIVE ENERGY SOLUTIONS INC. Expiration_ 12/15/2024
14 PINEBROOK CIRCLE `:GRANBY, MA 01033
-
t
1Ci I M _,
o, see
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
Rggistratipn Expiration 1000 Washington Street -Suite 710
207208 12/15/2024 Boston. MA 02118
PROSPECTIVE ENERGY SOLUTIONS, INC.
SCOTT MCCRAY
14 PINEBROOK CIRCLE..., " V�,.,.N. z!G.<-
GRANBY. MA 01033 •
Undersecretary of valid without signature
Docusign Envelope ID D7200BA9-1C05-4752-8CF2-52D3AF82959E
Commonwealth of Massachusetts
®: Division of Occupational Licensure
Board of Building Regulations and Standards
Constuon ISpervisor
CS-117322 � a#pires: 04/14/2026
SCOTT ANDEW MCCRAY
14 PINE BROAK CIRCLE =_
GRANBY MA^01033
Commissioner diaA R.
Construction Supervisor
Unrestricted-Buildings of any use group which contain
'ess 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
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111 , S 150A.
Address of the work: 68 ice Pond Drive
The debris will be transported by: Prospective Energy Solutions
The debris will be received by: Valley Recycling
Building permit number: TBD
Name of Permit Applicant Rachel Hall, Prospective Energy Solutions
Q4__ez(.1etaf
7/22/2024
Date Signature of Permit Applicant