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29-291 (2) CS-074666 RICHARD L ABTS 132 PROSPECT STREET EAST LONGMEADOW MA 01028 02/05/2014 I, L 4 eC Olik = V et % V y L U. _ O R C c L E U ! 1 L o 6.Mt rs CV - CO CO ! O O D i+ OD �_ J _ C C: p w`1 Q Q ~ N a h 6. • v I C O O 01 a 1 �� X w 4 ,,)N � w y o w, .q p .a ... O c v 73 40) w O s = Q v '3 � ct aS U 1_ = N < .. \fir, 0 +��,y1 1. = w °� Z oPik CO^� (� iwl y d O _ i..� '� ...1 � 0 ° mp tiE a.4 o O � / , 0 "•L 10 w N. _ si.t.c) 0 0 : ° Cn i� tu`rz. o Q V O co } ' m z O v � Zajw V `o G w m ; o ZDJV) d 2 co w � W : E W co QMQ c = O = = • o = 0W ° a >ZU00 V 7 v )- H w �Q — N > J j o H a w Z I- V y W U.' k 2 CO Z`�,,,. cI� /, i w a cl I F- ;,�i iIIIIIIRriuIr. M,�� i v CL Erb a :Ill M z U r� en ►- °p„ / . \ t toy-- - %/IfzooacAeoet? ,i Office of Consumer Affairs and usiness Regulation ,= I `ttl e , 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 169979 Type: DBA Expiration: 8/25/2013 Tr# 216225 LANTERN ENERGY PETER CALLAN 33 WISCONSIN AVE. NORWICH, CT 06360 Update Address and return card.Mark reason for change. 0 Address fl Renewal ❑ Employment ❑ Lost Card DPS•CA1 0 50M-04/04.0101216 g2e e°ommonweald ii,a4ouc"Q License or registration valid for individul use only Office of Consumer Affairs&Bufsiness Regulation g y * (�HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: iI "_Registration: 169979 Type: Office of Consumer Affairs and Business Regulation I f-- Expiration: 8/25/2013 DBA 10 Park Plaza-Suite 5170 • Boston,MA 02116 LA` RN ENERGY PETER CALLAN 1200 MILLBURY ST 9D _ '!/�%' .� � * WORCESTER,MA 01607 Undersecretary f N alid without signature ACORD TPA CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYYYY) 12/27/2012 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. ,NPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must 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 NAME: Shoff Darby Companies, Inc. PHONE No,Eat; 203.288.7305 l( 203.354.6480 250 State Street A-1 EMAIL fA ,"O) — - ADDRESS: _ _ North Haven, CT 06473 PRODUCE CUSTOMER R ID M: 00046616 INSURER(S)AFFORDING COVERAGE NAIC N INSURED INSURERA: Union Insurance Company Lantern Energy, - — gy LLC INSURERS: Acadia Insurance Company 31325 33 Wisconsin Avenue INSURER C: Evanston Insurance Company Norwich, CT 06360 INSURER D: — INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 12-13 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. FAA ADDL SUBRI POLICY LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER I /YYYY) (MMI POLICY LIMITS GENERAL LIABILITY CPA5077122 12/31/2012 12/31/2013 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE 70 RENTED — (� PREMISES(Ea occurrence) $ 100,000 J LA CLAIMS-MADE I " I OCCUR MED EXP(Any one person) S 5,000 A X PERSONAL a ADV INJURY $ 1,000,000 1--- - GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:POLICY n PRODUCTS_COMP/OP AGG $ 2,000,000 PRO- JECT X LOG $ _ AUTOMOBILE LIABILITY CAA 8077124 12/31/2012 12/31/2013 COMBINED SINGLE LIMIT Xi AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY(Per person) $ B SCHEDULED AUTOS BODILY INJURY(Per accident) $ PROPERTY DAMAGE X HIRED AUTOS (Per accident) S r_. X NON-OWNED AUTOS $ $ X UMBRELLA LIAR X OCCUR CUA507712 412/3112012 12/31/2013 EACH OCCURRENCE $ 4,000,000 EXCESS LIAB CLAIMS-MADE B AGGREGATE $_ 4,000,000 DEDUCTIBLE X RETENTION $ Oi $ -- --- ---- WORKERS COMPENSATION WCA507872812/31/2012 12/31/2013 X I WC STATU- IOTH- AND EMPLOYERS'LIABILITY Y/N TQgY LIMITS 1 ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 B (OFFICERIMEMBEREXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 Professional Liability 12CPL01180f 07/15/2012 12/31/2013 Each Claim $1,000,000 C Contractor's Pollution I Each Condition $1,000,000 DESC}}liAN OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Western Mass Electric Company, and Bay State Gas, Berkshire Gas, Cape Light Compact, National Grid, New England Gas, NSTAR Electric & Gas and Unitil as program sponsors are included as additional insureds per written contract or agreement. 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 A. Megan McCloskey/MEGANM ©1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD irtik 4.„ osik mass save CONIRACTOR PARUCIPATMG I ..1'a;r!y5:Mdtrci^,t•!K!+,IY C(}Cit`r.(.Y PERMIT AUTHORIZATION FORM 6' A- 1 � s ly; I, �� a , owner of the property located at: (Owner'same, printed) (Property Street Address) (City/Town) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. Pcelk wy-si Owner's Signature LI(()I I Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: L0.vt-t.e.V.11 EtkesAsy , Li_.G 5/7A0/3 Participating Contractor Date Rev. 12132011 Property Address: 24 7 Acvt bwon k Iov'e14 ce Contractor Name: L a.u.♦EAPVt k.ktP.o-g•y 2 Lt--C- Address: 33 IA) .s c.o a s; City, State: Nov,u) ) LT O(a3(Qp Phone: g??- $78 -30O(i Property Owner Name: &v`e /1/l«.(y rnosk i Address: '197 Acne brook Dt. City, State: F � Wt A . A krt-S (contractor)attest and affirm that the building I intend to insulate does not have any open air(knob and tube)wiring in the spaces to be insulated and that I have provided the property owner with a copy of this affidavit. Contractor signature e4:4 Cat_ Date 5/ 9/94 t3 1 ne ..urrununWCUtun of .0114Jaua,isssocuu Department of Industrial Accidents s1. Office of Investigations .. �=. 1-7-:� k' 600 Washington Street :-Vri--.7 Boston, MA 02111 s www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): A„-f o�.V'yl {;, rt e yF 5y L L G Address: 3 3 Wt's co vts;n a ve. City/State/Zip: AiorwicK CT O(o3(r0 Phone#: $ 77- 978- 300(o Are you an employer?Check the appropriate box: Type of project(required): 1. © I am a employer with 3b 4. 0 I am a general contractor and I 6. New construction employees(full and/or part-time).* have hired the sub-contractors 2.1=1 I am a sole proprietor or partner- listed on the attached sheet. 7. El 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 employees. [No workers' 13.1g Other i K St t w a-t-k,Y► 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. 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: A c.0,c,( i a Lot LAO c.&v►c e. C o w%p o.i y Policy#or Self-ins.Lic.#: LOG SO7 S 7 2.$ Expiration Date: [2./3I / 2.0 13 Job Site Address: 2. ? Ac brooK D rl.+e. City/State/Zip: F t ovtet tc,e /l14 O1 067._ 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 (der the pains and penalties of perjury that the information provided above is true and correct Signature: !� .c.�i ab:C Date: 5/7/26 i 3 Phone#: 8'Cs - 301, - 71.75` Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: G a vrel A in+S f174 44 L License Number 132. - v'osloec.t s+.) Est Lorn.Sw'..e t-cloud) MA 61 62-51( 2.1 ""/ y� Address Expir lion bate T645- 304, - 72.75 Signature Telephone 9.Resiistered Home Improvement Contractor: Not Applicable ❑ 1 v►.-feat �Kersy� L_LC /(0q71 Company Name Registration Number 33 GcI.,4c.ox.s;h. aver Vod'ul rc�. ) c-T Ola34O gia.s a o 13 Address ���� ���� Expi ation Date C�LI� Telephone$77-8?8-300LG 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 1e No ❑ O"' 11. - Home Owner Exemption 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 buildine 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 #11 14 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aoolicabie) OW New House ❑ Addition ❑ Replacement Windows Alteration(s) ® Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [p Siding[D] Other[RI] Brief Description of Proposed p Work: LvtSula+e. Ai+�c -Ir1oo cu.+l, sr ocu (dos e—. Ivtsulate. 0.44 . Alteration of existing bedroom Yes X No Adding new bedroom Yes )< No Attached Narrative Renovating unfinished basement Yes X No Plans Attached Roll -Sheet sa.if New house and or addition to existino housino,colmniete the foiiowinst 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 RE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, See Ocutaet, tai.44.0iz0.f;OK -POOH& as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date Akr$ , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. 'Z ;c.ke.,frei 14bts Print Name // -' p- - 1-�t S 7/.o t 3 Signature of Owner/Agent 'Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg.Square Footage Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: , (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW e YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW © YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES (� NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO 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 O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only . Ci of Northampton Status of Permit: B 'Wing Department Curb Cut/Driveway Permit MAY - 8 2013 12 Main Street Sewer/Septic Availability Room 100 Water/Well Availability ort ampton, MA 01060 Two Sets of Structural Plans ppPT.OF 6UILCiNG� rEGi�O NGRTHAMPTGt}! c4413-5 7-1240 Fax 413-587-1272 Plot/Site Plans Other Specify 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 9,9 7 Acrre broo k �v4ve. Map Lot Unit P.I oV`P�ILG /�A Zone Overlay District 010l2- Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Cares Mal yvl<osk; 9. I . L - u _ • • Name(Print) Current Mailing Address: 4'/3- 7R.7 - S"is- Telephone Signature 2.2 Authorized Aaent: 11 i2;r_I,,dv. A bts i 32. IPro d- sj-re s r t L.e KS w�eo`J� cJ1 M4 Uwe plaits) Cbisentt Iltf�lla ACdl�s� 0/07-/e C, 87to0-3o(2.-7295 Signature Telephone SECTION 3-ESTIMATED 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) 2pa 2.41' Check Number 96/7 _ �S This Section For Official Use Only Building Permit Number Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2013-1072 APPLICANT/CONTACT PERSON RICHARD ABTS ADDRESS/PHONE 132 PROSPECT ST EAST LONGMEADOW (860)306-7275 PROPERTY LOCATION 297 ACREBROOK DR MAP 29 PARCEL 291 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: INSTALL ATTIC INSULATION New Construction Non Structural interior renovations Addition to Existing_ Accessory Structure Building Plans Included: Owner/Statement or License 74666 3 sets of Plans/Plot Plan TH OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN ORMATION 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 3e . itio D- •y _..ii&ir,, - s"/ —/� Signature of Building Official 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. 297 ACREBROOK DR BP-2013-1072 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29-291 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-2013-1072 Project# JS-2013-001767 Est. Cost: $2028.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RICHARD ABTS 74666 Lot Size(sq. ft.): 10759.32 Owner: MALYNOSKI GREGORY A&KATHLEEN Zoning: Applicant: RICHARD ABTS AT: 297 ACREBROOK DR Applicant Address: Phone: Insurance: 132 PROSPECT ST (860) 306-7275 WC EAST LONGMEADOWMA01028 ISSUED ON:5/14/2013 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 5/14/2013 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner