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18C-063 (2) BP-2024-1039 165 PROSPECT AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 18C-063-001 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-2024-1039 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2024 Contractor: License: Est.Cost: 900 BRADSHAW ENTERPRISES LLC 108517 Const.Class: Exp.Date: 12/10/2024 Use Group: Owner: LE MILIANN KANG &CUONG N Lot Size(sq.ft.) Zoning: URB Applicant: BRADSHAW ENTERPRISES LLC Applicant Address Phone: Insurance: 246 CONNECTICUT AVE 413-310-8010 A0158300004 SPRINGFIELD, MA 01 104 ISSUED ON: 08/15/2024 TO PERFORM THE FOLLOWING WORK: INSULATION/W E ATH ER I ZATI ON POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector 1'nderground: Service: Meter: Footings: Rough: Rough: House # Foundation: Final: Final: Final: Rough Frame: Gas: Fire Department I)rnveway 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: Lf/.4.2- Fees Paid: $75.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner 406 1 The Commonwealth of Massachu ettso Board of Building lations and S Massachusetts State Building FA Code, 780 CM oO Nq'N� F ON Mgp8 1� I PALITY o, s SE Building Permit Application To Construct, Repair, Renovate Or Demolish a ise Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: /G31 Date Applied: wilding Official(Print Name) S Date SECTION 1: SITE INFORMATION 1.1 Property Ass: 1.2 Assessors Map&Parcel Numbers 165 Prospect Wig,Northampton Ma 01060 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: C N Le Northampton Ma 01060 Name(Print) City,State,ZIP 165 Prospect Street 413-210-8150 No.and Street Telephone Ismail Address SECTION 3: DESCRIPTION OF PROPOSED WORK2 (check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Insulation Brief Description of Proposed Work2: At igill taitiatftc § a1Piti l top plates. Copy of contract attached. SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 900 1. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical $ ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees:$ Check No.t0f ZTheck Amount: )6 Cash Amount: 6.Total Project Cost: $900 0 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.) City/Town,State,ZIP R Restricted 1&2 Family Dwelling tyM 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 Memmorial Drive #167 Sean@ Bradshaw Enterprisesllc.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 j8[ 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 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 containec ' this application is true and accurate to the best of my knowledge and understanding. j'rint is o is 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" WEATHER IZATION CONTRACT EVERS=URCE CUSTOMER PHONE DATE CLIENT b WORK ORDER NUMBER C N Le 413-210-8150 05/24/2024 406017 11805 SERVICE STREET BILLNG STREET PROPOSED BY: 165 Prospect Avenue 165 Prospect Avenue Cole Payne SERVICE CITY,STATEE,ZIP BILLING CITY,STATE,ZIP PROGRAM Northampton, null 01060 Northampton, Massachusetts 01060 EGMA-HES DESCRIPTION QTY COST INCENTIVE TOTAL BASEMENT CEILING - 6" FIBERGLASS C.M Initial Here Provide labor and materials to install R-19 faced fiberglass batt insulation to the basement ceiling. This will be installed with the paper backing up against the floor above.The un-papered fiberglass side will be facing the basement,and these exposed fiberglass fibers will be the visible side when standing in the basement.Your initials are your agreement and understanding of this measure HOME AIR SEALING 2 $213.18 $213.18 $0 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(wndows are not generaly addressed.) Total Price $939.36 Total Incentive 757.82 Amount Updated $181.54 Customer Copay I,DESCRIPTIur OF 4V0kK 10 BE PEW cm%ILi 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 terns of this Contract: II. PAYMENT Cent agrees to pay the Contractor for the Work,the Client Share of the Contract Cost is payable to the Independent Installation Contractor(IIC)upon satisfactory completion of the Work.Client understands that they we 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. Eileen Barrett C N Le RISE Representative Client Signature Eileen Barrett 05-25-2024 Printed Name Date of Acceptance Document Ref:MLVM2-JHNCV-KHPNB-PKEXR p ye•1e 4 mass save PERMIT AUTHORIZATION FORM l C Le owner of the property located at: (Owner's Name) 165 Prospect Avenue 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 Signature 05-30-2024 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 Document Ref:OVPGK-68ZGF-B7TGA-U7Z7Y Page 1 of 1 �...% BRADENT-01 BROOKE ACORO" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDFYYYY) kift—i 8/13/2024 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 Brooke Barra ' AME: Phillips Insurance Agency,Inc. PHONE rnx 97 Center Street (NC,No.E n: (413)594-5984 (A,C.Nol:(413) 592-8499 Chicopee,MA 01013 _,,•RESS.brooke@phillipsinsurance.com INSURERS)AFFORDING COVERAGE NAIC a INSURER A:Middlesex Insurance Company 23434 INSURED INSURER B: Bradshaw Enterprises,LLC INSURER C: PO Box 944 INSURER D: Chicopee,MA 01021 INSURER E: 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 LTRINSD WVD IMM/DD/YYYY1 IMM/DO/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR A0158300 8/12/2024 8/12/202$ DAMAGE TO RENTED 500,000 • PREMISES{Ea ocwrrence) $ .MED EXP(Any one person) . $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 3'000'000 X POLICY j eT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: S A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) • $ X ANY AUTO A0158300003 8/12/2024 8/12/2025 BODILY INJURY(Per person) S OWNED SCHEDULED AUTOSRE� ONLY AUUTNOSy��p BODILY INJURY(Per accident) S AUTOS ONLY AUTO'ONLY wee aEcR�tDAMAGE $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE A0158300 8/12/2024 8/12/2025 AGGREGATE $ 2,000,000 DED DED X RETENTION$ 0 $ A WORKERS COMPENSATION I X PERTUTE ERH AND EMPLOYERS'LIABILITY A0158300004 8/12/2024 8/12/2025 1,000,000 ANYQF PROPRIETOR/PARTNER/EXECUTIVEE YY N/A E.L EACH ACCIDENT $ (Mandat�orMjr In EXCLUDED? 1,000,000 E L.DISEASE-EA EMPLOYEE $ II yes.des«t�e ruder 1,000,000 DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 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 '' 9 � Lafayette City Center .'l 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: Type of project(required): IN I am a employer with 8 4. ❑ I am a general contractor and 1 employees(full and/or part-time).* have hired the sub-contractors 6. El 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 g, ❑ Demolition workingfor me in anycapacity. 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.❑ 1 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.N Other I n s u a l t i o n comp. insurance required.] *Any applicant that checks box#l must also fill out the section below showing their workers'compensation policy information. t I lomeowners who submit this affidavit indicating they arc 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: Phillips Insurance Agency, INC Policy#or Self-ins. Lic.#: AO158300004 Expiration Date:_ 8/12/2025 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 certif' er the pain Ides 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 20 Building Department 3DCity/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone#: L. Commonwealth of Massachusetts IPDivision of Occupational Licensure Mailing Address: Board of Building Regulations and Standards Co tomfS ervisor Bradshaw Enterprises, LLC ,�,, r 1981 Memorial Drive #167 CS-108517 E,%pires: 12/10/2024 Chicopee, MA 01020 SEAN MATTHIEW BAILEY - BRADSHAW 1981 MEMORIAL DRIVE STE 167 r CHICOPEE,MA01020 • • ` - Commissioner o I K i:leTenC THE COMMONWEALTH OF MASSACHUSETTS I I Office of Consumer Aff. Business Regulation I 1000 Washing_..; Suite 710 I Boston ; .--- -- -• 118 - '"-m'_"_ I Home Im•ro : - _- - - -•istration i _Irr�MINI f 1 mimemime=� # Type: LLC I imis if�l�� -• ,ation: 194456 BRADSHAW ENTERPRISES, LLCI 1981 MEMORIAL DRIVE E ; ation: 02/07/2025 SUITE 167 lik Viaii s ©, CHICOPEE, MA 01020-4322 —Willi 711111:14, d.O 14 UN Update Address and Return Card. ' THE COMMONWEALTH OF MASSACHUSETTS 1 Office of Consumer Affair&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:aC Office of Consumer Affairs and Business Regulation Refit tratio,= Expiration 1000 Washington Street -Suite 710 194456' .02/07/2025 Boston.MA 02118 BRADSHAW ENTERPRISE-jt C •— - SEAN M.BRADSHAW '_(-{_ 1981 MEMORIAL DRIVE�:,� : ` 4"-"If4.i1 .4- SUITE 167 \ - CHICOPEE,MA 01020-4322- Undersecretary I 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