31B-036 (2) Mar 30 12 03:03p Jay Boland 14136673130 p2
tinel 1,c3
Customer ID ,300 Customer Name .Address tO 114414
K
irorie,‘
NOB & TUBE WIRING f `
During the Energy Survey of your home, indications of "knob and tube" wiring were found. This old style of wiring
involves individual wires that are rum through walls and ceilings in a house, with ceramic "knobs" and "tubes" to
prevent contact with wood framing. The knob and tube wiring that has been noted may or may not appear to be active.
Even if the observed wiring appears to be inactive, there may still be active knob and tube circuits hidden inside walls
or other inaccessible areas of the house.
The Mass Save Programirequirements require that you have the home checked by a licensed electrician and certified as
being fr ee of all active knob & tube wiring where needed, before insulation and/or air sealing work can be done. Your
electrician should fill out and submit a copy of this document to the Cevter for EcoTechnology (CET) in order to verify
the absence or inactivityof the knob and tube wiring in the areas of your home where we are proposing insulation to be
installed. Due to the liability involved in signing such a form, we suggest you show or describe this form to your
electrician before hiring hits to inspect your home to be sure he/she is willing to sign it. The Center for
EcoTechnology (CET) and the. Mass Save prograrn will rely on. the electrician determination and certification below and
will not be liable if inaccurate.
Your home could benefit from insulation and/or air sealing in the:
Attic Slope 00, ,TIVI Exterior ❑ Basement Attic Floor ❑ Kneewall Floor
Walls
** Only after this certification is received by CET can a Contract be issued for vlt,pl" t4
energy saving insulation and/or air sealing work. ** Dk4csd k
Electrician's Certification
(This form is invalid when any qualifications or alterations are added-)
Company Name & Address .- c er.*0 , e 'L
7 k ,07 . �.�C t i'# ' ol
� t�
Electrician's Name /�*�C.� - gwtlf License # rst,✓�c!.3 ji J
I have performed an inspection of the wiring at the home of:
A, -e,14/ -'Z at /c' o - in . a4 'ettowlewt ,,?_ 4
(Owner's Name) (Street Address) (City)
Upon completion of my inspection 1 have found that there is no active knob and tube wiring in the areas) noted
below.
VA-- Attic Slope `*Exterior 15 Basement Ili Attic Floor .. Kneewall Floor
Walls
Electrician's Signature � Date / "3 --901A
Please mail this certification letter to: Center for EcoTechnology
112 Elm Street
Pittsfield, MA 01201
Or fax to: 413 -443 -8123
Rcv. 9n /1 I
Please call 800 -238- 1221 with any questions or concerns.
Customer (mail -in when completed) - White Customer Copy — Yellow Auditor = Pink
Mar 30 12 03:03p Jay Boland 14136673130 p.3
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Property Address: _ -�-� t •t�'i, r_ux
rop�erty -
Contractor
Name: HOME ENERGY SOU3nCNS
12 PlSGPH ROAD
Address: HUNTINGTON, MA 01050
City, State: 1 115 (pCo7 - 31 3
Phone:
•
Property Owner �^
• Name: �+ yt.�; JSAt 411,.-
City, State: pvq)4 ''1 fl-
R las In (contractor) attest and affirm that the building 1 intend
• to insul not have any open air (knob and tube) wiring in the spaces to be insulated and
that 1 have provided the property owner with a copy of this affidavit.
HOME ENERGY SOLUTIONS
1.0R. HUNl1NGTO N, NIA 01050
Contractor signature
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SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder,: 90 iSU l / Col a / j / �� � / c f a7)
License Number
A j i /26ar' /(4P--7
Address Expiration Date
- 0 , X/9 /65
Signature Telephone // h
>.,
e a :W jat2P r Not Applicable ❑
Company Name Registration Number
/-join r� SO I cr41 61: s Id! l /3
Address // ,� f / - Expiration Date
19-di ad l r Telephone % V 4
U f'1C /
SECTION 10- 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 ❑
The current exemption for "homeowners" was extended to include Owner occupied Dwellings of one (1) or two(2) families
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor. CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner: Person (s) who own a parcel of land on which he /she resides or intends to reside, on which there
is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm
structures. A person who constructs more than one home in a two - year period shall not be considered a homeowner.
Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he /she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [❑ Siding [0] Other [0]
Brief Description of Proposed
Work: C9n, ' ,+. a � f
`� 41, 0 e l a �-k 1� C, /1-id itiet up e
/
Alteration of existing bedroom Yes No Adding new bedroom Yes No F tict.106
Attached Narrative Renovating unfinished basement Yes No te.4
Plans Attached Roll - Sheet
Ga' f e ii afilSe ddi a citinc ffs>�np ait anpF to # totta i q:
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, 4 / ki/ L 'LL�I Sr �t , as Owner of the subject
property 1 HOME ENERGY SOLUTIONS
hereby authorize 12 PISAAH ROAD
to act on my behalf, in all matte authorized by this building permit applic feNTINGTON, MA 01050
Signature of Owner Date
e titierv4HOME ENERGY SOLUTIONS as Owner/Authorized
Agent hereby t statements and information on the for PIE , �� 11 t % Je and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
,J4- y 4O/ dild
Print Name Signature of Owner /Ag Date
k
Section 4. ZONING Alt Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by 1 * l� ‘ �w com
Building Department i`li1 3
Lot Size . r --- - :. } i
s .
Frontage E _. .
Setbacks Front i '
Side L:L____i _ R:= i L:I I R:1 i 1 I I 6
Rear
Building Height 1--- -- = L J
Bldg. Square Footage — % 1 ( i
Open Space Footage % 1
(Lot area minus bldg & paved , _ L--'
parking)
# of Parking Spaces
Fill:
(volume & Location) _ ' -
: b
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued:!
•
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
l
IF YES: enter Book I i
1 Page i and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained ® Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO . _
IF YES, describe size, type and location: 1
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 0
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
RECEIVED City of Northampton 34,A
Building Department
212 Main Street
SIMI 2 7 Room 100
Y. [St i'Mr* 17r177
Northampton, MA 01060
DEPT.
c of stmnxua ne 13- 587 -1240 Fax 413- 587 -1272
NORTHAMPTON, MA at
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
This section to be completed by office
® R Y- Map Lot Unit
Zone ` Overlay District
EIm St Dis trict " CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
n rfW Sidi /7h 1 /11 K! ILe .. -S -7 - r
Name (Print) Current Mailing
4 7)./7/4..p et—) Telephone
Signature
2.2 Authorized Anent:
F ENERGY SOLUTIONS
12 PISGAH ROAD
Name (Print) HUNTING ON, ►A 0105 Current Mailing Address:
Signature a Telephone
SECTION 3 STIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) Check Number 5
This Section For Official Use Only
Date
Building Permit Number. Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2012 -0834 N ► ' EC o 4 J0 6'' -t° I �, e
APPLICANT /CONTACT PERSON JAY BOLAND ,� { W ° fro '
ADDRESS /PHONE 12 PISGAH RD HUNTINGTON (413) 214 -2414 � Cc U(
PROPERTY LOCATION 10 MYRTLE ST o rj) v
MAP 31B PARCEL 036 001 ZONE URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 2 y
Fee Paid 573 Orr
Typeof Construction: INSTALL ATTIC INSULATION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 101880
3 sets of Plans / Plot Plan
THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN ATION PRESENTED:
Approved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND /OR Special Permit With Site Plan
Major Project: Site Plan AND /OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received & Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission - Permit DPW Storm Water Management
Demolition Delay
it e of Buil • ng io' V Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health, Conservation Commission, Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning & Development for more information.
10 MYRTLE ST BP- 2012 -0834
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31B - 036 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit # BP- 2012 -0834
Project # JS- 2012- 001475
Est. Cost:
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JAY BOLAND 101880
Lot Size(sq. ft.): 4530.24 Owner: SMITH ANDREW & EMMA GILBERT
Zoning: URC(100)/ Applicant: JAY BOLAND
AT: 10 MYRTLE ST
Applicant Address: Phone: Insurance:
12 PISGAH RD (413) 214 -2414 WC
H U NT I N GTO N MAO 1050 ISSUED ON: 4/2/2012 0:00:00
TO PERFORM THE FOLLOWING WORK: INSTALL ATTIC INSULATION
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:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department 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.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 4/2/2012 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner