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BP-2024-1014 13 GREGORY LN COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 29-524-001 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-2024-1014 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2024 Contractor: License: Est. Cost: 1800 BRADSHAW ENTERPRISES LLC 108517 Const.Class: Exp.Date: 12/10/2024 Use Group: Owner: GRIMM,DEREK C.& MARIKA P FAYTELL GRIMM Lot Size(sq.ft.) Zoning: WSP Applicant: BRADSHAW ENTERPRISES LLC Applicant Address Phone: Insurance: 246 CONNECTICUT AVE 413-310-8010 A0158300004 SPRINGFIELD, MA 01104 ISSUED ON: 08/14/2024 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATH ERIZATI 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 Urivenay 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: 16.70 Fees Paid: $75.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner /07 The Commonwealth of Massachus- s Board of Building Regulations and S ndar '41U0 �J O Massachusetts State Building Code, 80 CIP ITY T 3<90(9 US Building Permit Application To Construct,Repair, Reno, lish a Re,ised ar 2011 One-or Two-Family Dwelling gMnT�/�G,n,� szsection For Official Use Only �°,o60 s Building Permit Number: "We,* ' Date Applied: oe/ /cop S it '•%3.2-y Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers _13 Gregory Lane,Florence Ma 01062 _ 1.la 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 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: Derek Grimm Florence,Ma 01062 Name(Print) City,State,ZIP 13 Gregory Lane 303-525-8846 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other El Specify: Insulation Brief Description of Proposed Work2: AdNitlg'1 tStllatt8tiQ6 Meatiitl'apac r .41111Entokiwpittt,vs. Copy of contract attached. SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1800 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: Check No.10J)U Check Amount: / — Cash Amount: 6.Total Project Cost: $ 1800 ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-108517 12-10-2024 Sean Matthew Bradshaw License Number Expiration Date Name of CSL Holder 1981 Memorial Drive #167 List CSL Type(see below) Unrestricted No.and Street Type Description Chicopee, MA 01020 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-250-4746 Sean @BradshawEnterprisesllc.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) Bradshaw Enterprises, LLC 194456 02-07-2025 HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 1981 Memorial Drive #167 Sean@BradshawEnterprisesllc.com No.and Street Email address Chicopee, MA 01020 413-250-4746 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 .O 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 Please see attached authorization form (Mass Save). to act on my behalf,in all matters relative to work authorized by this building permit application. 06/06/2024 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 containe . this application is true and accurate to the best of my knowledge and understanding. rin r s r 's N e(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" WEATHERIZATION CONTRACT EVERSeURCE CUSTOMER PHONE DATE CLIENTS WORK ORDER Marika Faytellgrimm (303) 525-8846 06/24/2024 567647 11803 SERVICE STREET BILLING STREET PROPOSED BY: 13 Gregory Lane 23 Lane 23 13 Gregory Lane 23 Cole Payne SERVICE CITY.STATE,ZIP BILUNG CITY,STATE,ZIP Program Florence, MA 01062 Florence, MA 01062 EGMA-HES Page 1 DESCRIPTION QTY COST INCENTIVE TOTAL INCENTIVE 75% For eligible weatherization measures, Eversource is offering an incentive of 75%for insulation measures and 100%for the air sealing measures, both with no limit.You are eligible to apply for the 0%Heat Loan to finance your co-pay, applications must be submitted before the weatherization work begins. HOME AIR SEALING 4 $426.36 $426.36 Seal areas of your home against wasteful,excessive air leakage. Materials to be used to seal your home can include caulks,foams and other products. Primary areas for sealing include air leakage to attics, basements, attached garages and other unheated areas (windows are not generally addressed.) ATTIC DAMMING 24 $66.72 $50.04 $16.68 Provide labor and materials to install an approved damming material in the attic ATTIC FLAT- 10"OPEN R-37 CELLULOSE 486 $1,146.96 $860.22 $286.74 Provide labor and materials to install a 10"layer of R-37 Class I Cellulose to open attic space. HATCH-INSULATE RIGID BOARD 1 $53.96 $40.47 $13.49 Provide labor and materials to insulate the back of an attic hatch with 2"rigid insulation board at R-10. WEATHERIZATION CONTRACT EVERS URGE CUSTOMER PHONE DATE CLIENT s WORK ORDER Marika Faytellgrimm (303) 525-8846 06/24/2024 567647 11803 SERVICE STREET BILLING STREET PROPOSED BY: 13 Gregory Lane 23 Lane 23 13 Gregory Lane 23 Cole Payne SERVICE CITY.STATE,ZIP BILUNG CITY.STATE,ZIP Program Florence, MA 01062 Florence, MA 01062 EGMA-HES Page 2 DESCRIPTION QTY COST INCENTIVE TOTAL VENTILATION CHUTES 27 $126.36 $94.77 $31.59 Provide labor and materials to install ventilation chutes in the rafter bays to maintain air flow from the soffit ventilation. Total: $1,820.36 Program Incentive: $1,471.86 Client Total: $348.50 I.DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the above work at the Client's Address in a professional manner and in accordance with the terms of this Contract: Client agrees to pay the Contractor for the Work,the Client Share of the Contract Cost is payable to the Independent Installation Contractor(I IC)upon satisfactory completion of the Work.Client understands that they will not be required to pay the Program Incentive Share of the Contract cost.Changes to the individual line items and/or previous incentives may increase or decrease the size of the Program Incentive Share. a&-PalfAeDPIek Grace& RISE Representative Client Signature Cole Payne 06-24-2024 Printed Name Date of Acceptance 4\014i mass save Savings through energy efficiency PERMIT AUTHORIZATION FORM Marika Faytellgrimm owner of the property located at: (Owner's Name) 13 Gregory Lane # 23 Florence (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. Derek Cruutu Owner's Signature 06-24-2024 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 _____......14, BRADENT-01 BROOKE '4 C-1C4ORif, CERTIFICATE OF LIABILITY INSURANCE DATEIMM/DDIYYYY) 3/612024 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 ACT Brooke Barre Phillips Insurance Agency,Inc. (NC,No, (413)594-5984 FAX 97 Center Street l h lac,No):(413)592-8499 Chicopee,MA 01013 Man brooke@phillipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIL Si INSURER A:Middlesex Insurance Company 23434 INSURED INSURER B:Sentry Insurance 24988 Bradshaw Enterprises, LLC INSURER c:EVANSTON INSURANCE CO. 35378 1981 Memorial Drive Suite 167 ;_INSURERD: Chicopee,MA 01020 I INSURERE: _ 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 POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMMIDDIYYYYI IMM/DDIYYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE X CCCUR X A0158300 8/12/2023 8/12/2024 pREMISESO(EaEocuErrence) ,$ _ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL BADVINJURY $ 1,000,000 • GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY X JI T LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: S A AUTOMOBILE LIABILITY I fOMaB EeD'INGLE LIMIT S 1,000,000 X ANY AUTO X A0158300003 8/12/2023 8/12/2024 BODILY INJURY(Per person' S OWNED SCHEDULED AUTOSRE� ONLY AUTOS BODILY BOODILY INJURY(Per acc denim,S AUTOS ONLY .AUTO ONLY (Pper accident�AMAGE S S A I X UMBRELLA LIAR X OCCUR EACH OCCURRENCE S 2,000,000 EXCESS LAB CLAIMS-MADE A0158300 8/12/2023 8/12/2024 AGGREGATE S 2,000,000 DED X RETENTION$ 0 S B WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y I N X .STATUTE " ER _ A0158300004 8/12/2023 8/12/2024 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y NIA E.L.EACH ACCIDENT S FFICER/MEMg��EXCLUDED? - - andatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Pollution Liability CPLMOL122400 3/2/2024 3/2/2025 Aggregate 250,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Eversource Gas of Massachusetts is listed as Additional Insured on a primary,non contributory basis with respect to General Liability and Auto Liability per written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I ///" L L I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 5 �1= � Lafayette City Center 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): Bradshaw Enterprises, LLC Address: 1981 Memorial Drive #167 City/State/Zip: Chicopee, MA 01021 Phone#: 413-250-4746 Are you an employer?Check the appropriate box: 1. I am a employer with 8 4. El am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. New construction 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' 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.] ° c. 152,§1(4),and we have no employees. [No workers' 13.Dij Other Insualtion comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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. lithe 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: Phillips Insurance Agency, INC Policy#or Self-ins. Lic. #: A0158300004 Expiration Date: 8/12/2024 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 er the pain !ties of per' that the information provided above is true and correct. Signature: Date: 4/2/2024 Phone#: 413.250.4746 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): 11:1Board of Health 2❑Building Department 3.DCity/Town Clerk 4.0 Electrical Inspector 51=1Plumbing Inspector 6.0Other Contact Person: Phone#: _. Commonwealth of Massachusetts 11 Division of Occupational Licensure Mailing Address: Board of Building Regulations and Standards Bradshaw Enterprises, LLC constcd 'tan svisor 1981 Memorial Drive #167 CS-108517 E pires: 12/10/2024 Chicopee, MA 01020 SEAN MATTHEW BAILEY µ. BRADSHAW ;, - : 1981 MEMORIAL DRIVE STE 167 '. CHICOPEE.MA 01020 - - ` l Commissioner d;v K. tfe..e»r_l.ca_ THE COMMONWEALTH OF MASSACHUSETTS i I Office of Consumer Aff.,MLio!Business Regulation 1000 Washing .,._ - Suite 710 Bostor} &assachuse 118 Home Im.ro _ !_ -•---e•istration r 11M1111111/..11111Mmiiii WO`� �liallif Type: LLC . BRADSHAW ENTERPRISES, LLC _in e. - ation: 194456 E ation: 02/07/2025 1981 MEMORIAL DRIVE '" SUITE 167 _« _ ! di CHICOPEE, MA 01020-4322 MIA = M CN ------;, Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS r Office of Consumer Affairs&Business Regulation I Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:LLC Office of Consumer Affairs and Business Regulation • Registration Expiration 1000 Washington Street -Suite 710 194456 _. 02/07/2025 Boston, MA 02118 BRADSHAW ENTERPRISE<:,_C •— ` ' .4' -:-.'_—LITIIII===-:-------7-- 0 SEAN M.BRADSHAW f _t_f—_ 1981 MEMORIAL DRIVL.• �4; ,�u,,,,„.1,a.1,,e,6.4' SUITE 167 CHICOPEE,MA 01020-432 UP Undersecretary Not valid without signature DEBRI DISPOSAL 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: Off Site waste container (USA WASTE RECYCLING) Location of Facility: 555 Taylor Rd, Enfield, CT 06082 The debris will be transported by: Name of Hauler: USA Hauling & Recyclnig Signature of Applicant: Date: April 2024