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35-279 P��� L mass save commies ..fv _ :�✓avre�4nG'y of}C:mc.1. PERMIT AUTHORIZATION FORM 1 0 ms) , owner of the property located at: (Owner's Name, printed) % WOOOLA-n1' D/2 F/-oRt,t)Cc )1,64- a/o�y (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. Q-149kY3 Owner's Signature 7Z -V, tZ, 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: Participa ing ntractor Date Rev. 12132011 ‘la.wrhu.rtt• - peparuncnt of Public satrt% ., . Board of Buildiarg Ret:ulation. and 'tandard• ■ Construction Supervisor License License CS 92540 THOMAS B ROSSMASSLER 100 MAIN STREET 4;; HATFIELD, MA 01038 °..��-- --a'-- �.G` Expiration 9/2/2013 ( .. r.,..wrr Tr* 794 4. Office�t co 6 m°e r ao�n°ioca41Yea u`*oefb License or registration valid for individul use only � HOME IMPROVEMENT CONTRACTOR M` before the expiration date. If found return to . Registration: 165169 Type: Office of Consumer Affairs and Business Regulation ,Expiration: 1/11/2014 LLC 10 Park Plaza-Suite 5170 .4 Boston,MA 02116 E IA LLC THOMAS ROSSMASSLER 242 SUFFOLK STREET „K�X; ■ HOLYOKE,MA 01040 Undersecretary Not valid without signature '4.,_,,°RO CERTIFICATE OF LIABILITY INSURANCE °"�„ " TIES CERTIFICATE IS ISSUED AS A MATTER OF MiFORMATIOII ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY MEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY TIE POLICES BELOW. THUS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN TIE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT: IT the certificate!older Is an ADDITIONAL.I/SUM,the pallgT(iss)must be endorsed. If SUBROGATION IS WANED,subject to + the teas 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 endarsew»nt(s).. PRocucen JAMES J DOWD&SONS INSURANCE AGENCY INC cojnACT m: 14 BOBALA RD HOLYOKE, MA 01040 uic.Ns tali(413)538-7444 1 FAX IArc.FRI: (413)536-6020 E4MUL ADORING; MNeleRt*I AFFORDING COYeRAGE BAIL• POURER: LJRERTY MUTUAL INSURANCE PEURIED ENERGIA LLC rwlletlOIS 242 SUFFOLK STREET e.suRIAC: HOLYOKE MA 01040 NNW D Naultaa a: eSiMeR F COVERAGES CERTIFICATE,NyMINIR:)5612830 REVISION NUMBED THIS IS TO CERTIFY THAT THE POLE OF INSURANCE LISTED NUM NAVE BORN=SLED TO THE PalkiRED NAMED A-OVIE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER OCCUPANT%MTh RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PEiRTAW,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MAR OR TYPE OF PASURANCE A,� rtin, Fpe$cY N UNN r1iYYl ga y WETS GENERAL ENMITY ' , EACH OCeOE S COMMERCIAL GENERAL LIANA Tv pOelanNnooJ S 1 GAFASUADE n OCCUR /EDEXP(My one moon) S PERSONAL a ADV INJURY S GENSRAL AGGREGATE S GENL AGGREGATE I=ANT APPLES PER ! PRODUCTS-COMP/OP P/OP AGO S nPa.ICY PI PA nice $ AUTOr&OMIA UAM.ITY - ea e}$_ 1IGLET e!T $ ANY AUTO BODILY INJURY 9''r Oeaaal S ALL OWNED SCHEDULED AUTOS _ AUTOS BODILY INJURY(Par xeitlefal S MESS UAB r HIRED AUTOS AUTOS tae rt S S t S UMBRELLA UM OCCUR EACH OCCt1iRENCE $ CLAriASSi/At AGGREGATE S DED Li RETENTIONS S S A WORKERS CaarFeletATION -A447%1 S MID WI LOWIR UNTO JTY Y/N I WC5 31 S 3139490-013 2/17/2013 2/17/2014 I` ANY FROPIRETORPARVNEREXECUTNE Off EXCLUDED? © N!A■ Si..EACH ACCIDENT S 1000000 yia NO 14p��t daaae*sWo, E.L.DISEASE•EA EMPLOYEE S 1 .-, ,tPTION OF OPERATORS babes 1 E L DISEASE-POUCY LIAR S 1000000 DESORPTION OF OPERATIONS I LOCATIONS/YrdeCUMI (Alban ACORD BM Addlhoar Rr11111M4s eaAAAAA a sot*pre*Y rrquiroM1 Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. SHOW)ANY OF THE ABOVE DES POUCIES BE CANCELLED BEFORE THE EIIPIRATIDN DATE THEREOF, NOTICE SILL BE DEL VERED IN ACCORDANCE WITH TIE POLICY PROVISIONS. motorman WIPRESENTATela A )i- L. 11 V. 7� Jeff Eldridge 0186&2010 ACORD CORPORATION. AU rights Deserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD iisNOCer[i i ate°cane® s `ano supe'rrs'edsas, "prev}.ous1y issued certificates. The Commonwealth of Massachusetts Department of Industrial Accidents =: !_��l Office of Investigations 7:0 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): Energia, LLC. Address: 242 Suffolk Street City/State/Zip: Holyoke, MA 01040 Phone #: 413-322-3"I 11 Are you an employer?Check the appropriate box: Type of project(required): I.Ed I am a employer with 10 4. ❑ I am a general contractor and I • [::]New construction employees(full and/or part-time). * have hired the sub-contractors 2.❑ 1 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 10.1] 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.E Roof repairs insurance required.]+ c. 152,§I(4),and we have no 13.® Other Insulation employees. [No workers' 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: Liberty Mutual Insurance Policy#or Self-ins. Lic.#: WC5-31 S-389490-013 Expiration Date: 2/17/14 Job Site Address: f e Wü1icL,/ö..,1d" 7)/.. City/State/'Lip: 1�- CFil � 0IO1aZ 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 ce/i1 under the pains and pe allies of perjuty that the information provided above is, ue and correct. Si_nature: Date: i 11 Phone#: 413-322-3111 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: 7/ LñM5 7e y25 (J License ber 2 , 14 Sk• ■ dA1, , - IA k o 2 1 13 Address / Expirati8n Date / 13-322- 3i,, Signatur- Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ /I - r,' ict} / 1,5-1 (aq Com an Name Registration Number 2 2 k • • o e r /� 01046 1 11 1 y Addres- / Expiration Date I Telephone y/3"322-// 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 ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied wellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess 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 w th the State Building Code,City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts eneral Laws Annotated. Homeowner Signature I 9 ' SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House E3 Addition ❑ Replacement Windows Alteration(s) 0 Roofing Ei Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [[] Siding[0] Other i�� Brief Dessription of2.4posed/7 �� Workyf iC i /Di0r (/,$o? Nap �-x/ fist- 7d (23 Alteration of existing bedroom Yes Adding new bedroom Yes No Attached Narrative / Renovating unfinished basement Yes No Plans Attached Roll -Sheet ga.If New house and or addition to*mishap housing.complete the foiiowino: 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, ?�-v 7� , as Owner of the subject property hereby authorize r Ae(/ to act on my behalf, in all matters relative to work authorized by this building permit application. See-///�i 7� 7Zia t) ' h r nt — ,f744 c� to / ` 3 Signature of Owner Date miiiimaim I, reb1OJ''C.-a-S �,OS Y katfccr -e-r , as Owner/Authorized Agent y declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed and r the pains and pities of perjury. 2s I O sS , sss I`er Print ame a Signature f er/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 DON'T KNOW 0 YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW O YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O 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 O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES © NO O 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. RECEIVED Ci of Northampton Bui ing Department JUN 2 2013 21 2 Main Street Room 100 DEPT.OF BUILDING INSPECTI• rth•mpton, MA 01060 NORTHAMPTt,,;.,;,;,�. :7-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: ,I This section to be completed by office 9� waahz-N b D t . Map Lot Unit ;FLd 2&a(Ce , /(4 Zone Oveday Midst FAN St.District + CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: �e--r /2 -so 1.1 99 I,0OOb L4JJ I3 1) Name(Printt r Current Maili Address: See- I"eemi`- k CA M4etL y/3- 37- 7S:C,C"� Telephone Signature 2.2 Authorized Anent• as rk ° S7S S-1 2 I(2 Sce-P-Po i ( � S� d ( e N m/ o�nt) I Current Mailing Address: l3 .322-3i// Signature Telephone SECTION 3-ESTIMATED CONSTRUCTIQN 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) n',Z U()i. 0 6 Check Number ,�/Q �j /`� This Section For Official Use Only Building Permit Number. Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2013-1193 APPLICANT/CONTACT PERSON ENERGIA LLC ADDRESS/PHONE 242 SUFFOLK ST HOLYOKE (413)322-3111 PROPERTY LOCATION 98 WOODLAND DR MAP 35 PARCEL 279 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out (�J•a/9>g Otr;- Fee Paid `r Typeof Construction: INSTALL ATTIC FLOOR INSULATION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 92540 3 sets of Planot Plan THE F OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON 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 D if• , lay 64/..?13 Signa . of Building's fici 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. 98 WOODLAND DR BP-2013-1193 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 35-279 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-2013-1193 Project# JS-2013-001963 Est. Cost: $2000.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ENERGIA LLC 92540 Lot Size(sq. ft.): 35283.60 Owner: BOND PETER A&JEAN B Zoning: Applicant: ENERGIA LLC AT: 98 WOODLAND DR Applicant Address: Phone: Insurance: 242 SUFFOLK ST (413) 322-3111 WC HOLYOKEMA01040 ISSUED ON:6/14/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL ATTIC FLOOR 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 6/14/2013 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner