49-050 (3) BP-2024-1435
691 PARK HILL RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
49-050-001 CITY OF NORTHAMPTON
Permit: Solid Fuel
Appliance
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2024-1435 PERMISSION IS HEREBY GRANTED TO:
Project# WOOD STOVE 2024 Contractor: License:
Est.Cost: 0 NORA WINE CSSL-106199
Const.Class: Exp.Date:08/24/2026
Use Group: Owner: ERIC BERZINS
Lot Size (sq.ft.)
MCKENNEY HEARTH&HOME/MCKENNEY
Zoning: WSP Applicant: ELECTRICAL CO INC
Applicant Address Phone: Insurance:
100 NORTHAMPTON ST (413)586-5351 A106-642-917
HOLYOKE, MA 01040
ISSUED ON: 10/29/2024
TO PERFORM THE FOLLOWING WORK:
WOOD STOVE
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:
Final: 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: S60.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
ft �c City of Northampton _•
7 -_; y- `. ){ ! S.s.. .fib.
(4,40, a 1 V ,�1 ssachusetts ?� 4.
°� t, ' DEPJU iC
OF BUILDING INSPECTIONS y, /,
r OCT 2 8 2024212 klain treat • Municipal Building .C..„„ ��
N thampton, MA 01060 +y4 •ar,
4c-TG, -
APPLICATION ID FUEL APPLIANCE INSTALLATION
Property Information
Owners Name: (eta .Et1.1S
Address: q 1 - Lk__ pb
(No.) (Street Address)
Phone:103.90( .a- Cell: Email:
Owners Signature: 0WZA 1,-lJ-e Date: 14l, ( -
Contractor's Information (If Applicable)
Name: 0 6 IAA ut Phone:
Construction Supervisor's License #: (;SSL- 1 0(0 l Cli Expiration: S 12(o
Home Impr. Contractor License #: a e v (3c Expiration: <( .2
Stove Information
Type of Fuel (check all that apply): Wood ✓ Pellet Coal
Location: L<✓i 13 4 t✓w Freestanding ✓ Insert
Manufacturer: VE - C AS-T1,J Model: 61- c-v
--------------TOR BUILDING DEPARTMENT USE ONLY------ ___ --
Permit# ON('dt1 5 Date Applied: Total all Fees: $ �� C g/
Building Official: 9a7,6--' f/F/t I7 Date Issued: /a-Z9-ZY
.. "_...t2,.. ..,
Signature of Building Official:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
a _� ►_
% _,. . Lafayette City Center
C -f= / 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): McKenney Electrical Co. Inc.
Address: 100 Northampton Street
City/State/Zip: Holyoke, MA 01040 Phone #: (413) 536.5551
Are you an employer? Check the appropriate box:
Type of project(required):
1.❑I 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. 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 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.] t c. 152, §1(4),and we have no Solid fuel appliance install
employees. [No workers' 13.0 Other pp
comp. insurance required.]
*Any applicant that checks box ill 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: Green Mountain Insurance Company Inc.
Policy#or Self-ins. Lic. #: A1106-642-917 Expiration Date: 07/2025
ic
Job Site Address: �Q l [ PAe 411-A— .� City/State/Zip: t• c f M jt N4.
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 cer`tiifyunder the pains and penalties of perjury that the information provided above is true and correct
Signature U v,N Date: 10( t( ))"y
Phone#: (413) 536.5551
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 21:Building Department 31:City/Town Clerk 4.0 Electrical Inspector 511'lumbing
Inspector 6.0Other
Contact Person: Phone#:
Commonwealth of Massachusetts Construction Supervisor Specialty
Division of Occupational Licensure
Board of Building Re ulations and Standards Restricted to:
ConstructrgisOAPfr Specialty CSSL•SF-Solid Fuel Burning Device
CSSL-106199 s tt t,pires:08/02/2026
NORA E Wll -
28 CENTER REI:
AGAWAM M 010:
ter- 1 1
1
yN0GGVdQ1'�? Failure to possess a current edition of the Massachusetts State
Building Code is cause for revocation of this license. •
Commissioner t / Contact OPSI:(617)727-3200 or visit www.mass.gov dphopsi
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
m)z fsf-
^' �-�- , :- r,Type: po
waist , :e istfation: 200Cor135 ration
MCKENNEY ELECTRICAL CO,INC
D/B/A MCKENNEY HEARTH&HOME Et iiration: 02/05/2025
100 NORTHAMPTON STREET + 4;i
..f_.
HOLYOKE. MA 01040 = raw
r �r 1 p
4
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
Reaisttation Ex_gisitigfl 1000 Washington Street -Suite 710
200135 02/05/2025 Boston,MA 02118
MCKENNEY ELECTRICAL CO,INC
D/B/A MCKENNEY HEARTH&HOME
NORA WINE " t
100 NORTHAMPTON STREET ,,,,.e!
kIOLYOKE,MA Q1040 l
- _ - = secretary -- - N.. without signature - -
McKenney Electrical Co. Inc. Sales Receipt
DBA McKenney Hearth&Home
100 Northampton Street
Holyoke,MA 01040 H h ey Date Sale No.
P:(413)536.5551
www.mckenneyhearthandhome.com 8/10/2024 S081024-5
Sold To Customer Phone
Eric Berzins 203.561.2029
691 Park Hill Road
Florence,MA 01060 Customer Alt. Phone P.O. Number Payment Method
Description Qty Rate Class Amount
Vermont Castings#2044-CAT-C,Encore 1 2,449.00 Stoves 2.449.00
Bordeaux Enamel,top load.List:$4.699.00,03/2024
SN#HF2524554
(*)Enamel door&trim kit required to complete stove
Vermont Castings#2044-CAT-C-DR I 1.749.00 Stoves 1,749.00
Bordeaux Enamel,traditional door&trim kit
AJM#H054-SC-PCCS-I,54",Copley Sq. 1 679.00 Stoves 679.00
Single Cut(Corner),type I,Ceramic Tile
List:$679.00,06/2023(Oversize)
Dbl.wall black pipe,6DCCSA,6DCCTSSBK,(2)6DCC45BK,6DCC I8BK 1 549.00 Venting 549.00
Class A Chimney,6TLCCCSA,(2)6TLC48,6TLCC,TLCHDRBK,VAF0606SS,VASCO6 1 1,139.00 Venting 1,139.00
Install- labor,Class A chimney as required.Deliver and install wood stove as required.Building 1 1,295.00 Labor 1.295.00
permit additional.Labor only cost,parts additional.INSTALL 10.09.2024
Building Permit,2024 I 95.00 Stoves 95.00
McKenney Hearth&Home will obtain permit for solid fuel appliance installation.Customer is
however,responsible for arranging final inspection/signoff with town.
Cash/check payment discount -I 155.00 Stoves -155.00
Payment,check#2027,08.10.2024 -7,800.00 Payment -7,800.00
Building permits are required for installation on wood/gas/pellet stoves. Subtotal $0.00
Customer is responsible for permit application if one is not provided for you.
Sales Tax (0.0%) $0.00
On parts only.refund within 10 days. Store credit up to 30 days. Must provide original receipt. Total $0.00
Returns not accepted on electrical parts or 25%restocking fee(assessed on part returned).