17D-021 (7) 105 STRAW AVE BP-2014-0712
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17D-021 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-2014-0712
Project# JS-2014-001206
Est. Cost: $5126.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: CO-OP POWER INC 095430
Lot Size(sq. ft.): 9583.20 Owner: BLACK LANCE
Zoning:URB(100)/ Applicant: CO-OP POWER INC
AT: 105 STRAW AVE
Applicant Address: Phone: Insurance:
15A WEST ST (413) 772-8898 () WC
WEST HATFIELDMA01088 ISSUED ON:12/10/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL WALL, ATTIC & GARAGE 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 12/10/2013 0:00:00 $55.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2014-0712
APPLICANT/CONTACT PERSON CO-OP POWER INC
ADDRESS/PHONE 15A WEST ST WEST HATFIELD (413)772-8898 Q
PROPERTY LOCATION 105 STRAW AVE
MAP 17D PARCEL 021 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out f��� ��
Fee Paid J
Typeof Construction: INSTALL WALL,ATTIC&GARAGE INSULATION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 095430
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOIRMATION 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 De ay
•
Sig re of Buil,ing 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.
7
City of Northampton Yli g ., ;
�; „ I Building Department Y _ = r
1I DEC — 9 �b;� .
' 212 Main Street ;P, , . ��
J Room 100 Y ,4 ', .i
Electric, Plurrbina&(.:.,a:-., in,ueetion�Ortham tOn, MA 01060 ;�� '
Ncrthr rp1on ICA 01360 p ,* 0t
phone 4 3-587-1240 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: This section to'be cc�lete office
o�u/ ve12 tot,
's 4 5 I t �l� /v 1T J/✓ J d �, Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Late c,_ 6/ d lO 5 Saw Avei1 ,f/f4c9/ác '&
Name(Print) Current Mailing Address: Caa-7'1 �/� _ ��
5 2— /V(_l OL E✓ Telephone <
Signature
2.2 Authorized Agent: (
l -a# ,in _. /.l Y1 6c _4_ he --- 1 4 I _ A '1- ■G1 k' 4 Al i / 0 •
Name(r rint . Current Maili Address.
qr i"----------4..- /!,3 3g --- 2/9C'7
Sig Telephone
SECTION 3- - (MATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 45//02/
(� (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) ir Sa<o Check Number 37417
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings 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 _.._.._ i ( .,_.__.....___
Frontage __i
M
Setbacks Front
Side L.=__ R:? L. R .._.
Rear I
Building Height
I
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 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
IF YES: enter Book Page) , and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW ® YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued
C. Do any signs exist on the property? YES Q NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 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 0 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors El
Accessory Bldg. ❑ Demolition ❑ New Signs [D] Qec[ e Siding[0] Other[ f
�UISiclq,'d-7 7 i
Brief Descripf n pf Propoed /_ /�/j
Work: Wall) A,fit O[l� 7I�Gi l�_ lrlSPlof� if) l (Oc ►✓I Gf 1C ���7 1,'? Wotik
Alteration of existing bedroom Yes 2 No Adding new bedroom Yes K No
Attached Narrative Renovating unfinished basement Yes X No
Plans Attached Roll -Sheet
6a. If New house and or houie end oraddition=;fit.=ex tra ho ihsf'co#ete:' foi s :
a. Use of building: One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathroo •:
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 Complian - Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction wi n 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of b ement or cellar floor below finished grade
k. Will b ding conform to the Building and Zoning regulations? Yes No.
I. ptic Tank City Sewer Private well City water Supply
SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, Lafle 6/ el as Owner of the subject
property a hereby authorize (A,e� s hi" ��l �
to act on my behalf, in all matter relative to work auth ized by this building permit appli tion.
5" E1/6LD5 F C54t-RA-Ut-
Signature of Owner Date
I, 5 awn j / f
as Ownerr:A 'zed
ent h eby declare that t e statem is and information on the foregoing application are true and accurate,to the best of my knowledge
dint ief.
Signed nder the pains an• •enalfjes of perjury.
• . %,_ ;• .� A ec--
Print ,� jr"er- • y gent Date
/03
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: c 5720Aif Ala A er- ( 5 -095-1/3&
(c4 ''r ( I/ V V eS� ke//14 f../G v ro- License Number
�`7 /
Addre / / Expira on Dat
Oture Tel one
. ..j. .. x" j.0 4 3wia i ,t i4:i.® ' ,. ,. ; W,; ,mss, 4 ,
. � � ,... �;.`, Not Applicable ❑
CO - e i('S2/7
Company l ame Registration N ber
/ q- lA✓ef ai4 Ali i , Iii l02/ /47
Address /�—'�/�/, (/-,7I j�,/(/ 2/ /` Expir tion to
/7/�i ✓ Telephone J'6 ! ` l�(li
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 k No ❑
X 1
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
The Commonwealth of Massachusetts
Department of Industrial Accidents
J `=
tM==1,341r,=,
z � 1, Office of Investigations
" 1 Congress Street, Suite 100
Boston,MA 02114-2017
` tl www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Co-op Power
Address:15A West Street
City/State/Zip:West Hatfield, MA 01088 Phone #:(413) 772-8898
Are you an employer? Check the appropriate box: Type of project(required):
1. ❑ I am a employer with 10 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.Ill 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'
[No workers' comp. insurance comp. insurance.$ 9. Building addition
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.❑ Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.]
*Any applicant that checks box#I 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:Liberty Mutual Insurance Company
Policy#or Self-ins. Lic. #:WC5-315-388/245-013 Expiration Date:11/02/14 ! /�
Job Site Address: / O5 n a1N 've zu.e- City/State/Zip: /(JQY)% y!'1 Dc/f1 N O/V(Ot/
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 certi 1' ' the pa'•s and penalties of perjury that the information provided above is true and correct.
I
Signature:- .�f/� Date: �a (5
40,Phone#: (4 r 24q -I/16V
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#:
_._-) -■••____
� RETAIL SALES CONTRACT Phone:(413)772-8898;Toll-Free: (877)266-7543
CO QJpaf` _ �. _ 15A West Street,West Hatfield,MA 01088 Home Improvement Contractor Registration#165217
� PO W ER Web:http:!lwww.cooppower.coop Shawn Gallagher, Director of Energy Efficiency Programs
� Email:info @cooppower.coop Cell:(508)317-0041 Shawn @cooppower.coop
r�UfIDING CDNMSfNifY(SNII}$1fSi AkNAl3Lf CHLf3GY Construction Supervisor License#CS-095430
Federal Tax ID 20-2201642
P 4 � TELEPHONE DATE
e '' N _ —
e„
EMAIL ADDRESS TENANT NAME(IF APPLICABLE)
L0,-'ce . C . Z ( oc�zCG 0..
13€105AD, uJ JOB AT
C€ Y STATE, P ....<„..4 ". ....-y-
-
14 v��I LA• MT 01060 CITY,STATE,ZIP e
STATEMENT OF WORK/SCOPE OF WORK TO BE COMPLETED _
RECOMMENDED MEASURE QUANTITY UNIT PRICE TOTAL COST ACCEPTED
Please Initial}
CAP � : D 11�+e ..ft- '� I CO . I i'`1 4 ,� 1
(1/342 *( f� A i�Y `` c6L . o (G+0t 1.64'.. 17.2..., 10
,Nk_WA/Paw knic. (1-00 N cat T1 12,24 1,44/. ' '2.,9 co.
P--1Z
AA 501-0t1/4/6 WOKS' It I (30,01 360 xrn'
(per VeNit5 iz) ctiO kTrtc 02 1 (.) 1 1 a I (7L''
p 4-W c-" air frpij ri 5 PI-a6.5 i I ; .
•Vi/V1 t 5)12 EP : ' IPt : � t,K c-'tt.g`t 16 32/ 1-02,2 qc1. 11
<`/ 1 `S (9 Vv U P C .2-12 2,27- 603 ,3%7
NOTICE TO THE BUYER-PLEASE READ CAREFULLY TERMS BASED ON ACCEPTED WORK SCOPE 1 +
1. You are entitled to a copy of this agreement at the time you 1/3 Deposit upon acceptance of contract $....-.t
sign it. 1/3 upon start of work L\..c'( V31G �''� -7,.-It"
2. YOU MAY CANCEL THIS AGREEMENT by mail,telephone, Balance Due Immediately Upon Completion $
email,or in person not later than midnight of the third I. In the event legal action is necessary to collect monies due the
business day following the signing of this agreement.YOU contractor,the customer will pay all costs incurred including
MAY CANCEL THIS TRANSACTION WITHOUT PENALTY attomey`s fees and court costs.
OR OBLIGATION WITHIN THREE BUSINESS DAYS FROM 2. Any unpaid balance after 15 calendar days of work completion will
THE ABOVE DATE. be subject to 1.5%interest charge per month.(ANNUAL
3. This contract price is valid when signed and returned with PERCENTAGE RATE 18°!°}.
your deposit wit 30 days. 3. I have read this entire agreement and received a copy.I agree to the
i terms and conditions,INCLUDING THE ATTACHED SCOPE OF
WORK AND THE TERMS AND CONDITIONS ON THE REVERSE
Contractor:::m- ® + '� ), *ate id t 13 SIDE of this agreement.
�J .;,,,f� DO NOT SIGN THIS CO '4-' -3 - ARE ANY BLANK\-,
Contractor it � '+<i SPACES. % C{{\\-
Contractor Staff Title t i: w Ei LA C Yom. , stomer Sign Date
Contractor Staff Phone 'i D T2- 39 " Customer Signature Date
Arbitration: The contr or and the Customer hereby mutually agree in advance that in the event that the contractor has a dispute concerning
this contract, the co traitor may s yb��mit such dispute to a pri ate arbitration service which has been -:• • - - r Office of Consumer
Affairs and Busine s !.r ulatio -I% the consumer ha! • -. ired to submit to such arbitra "_ . c 142A. `�
Contractor Signet e : !o Date 1 i Customer Signet -- 'ate `2-
Customer Signe . Date
NOTICE: The signatures of the .arties above apply only to the agreement of the parties to alternate dispute resolution initiated by the
contractor. The Customer may initiate alternative dispute resolution even where this section is not signed separately by the parties."
IR', t. f 1v7 'Z/04suo-ef J . t'J/c./g14 660342 { P -
c""F, , Office of Consumer Affairs and Business Regulation
{ 10 Park Plaza- Suite 5170
Boston,Massachusetts 02116
Home Improvement Contractor Registration
Registration: 165217
Type: Corporation
Expiration: 1/21/2014 7rtt 220702
CO-OP POWER, INC.
SHAWN GALLAGHER : , _,-.1--.,
324 WELLS ST -_-- _
GREENFIELD, MA 01301 _,,,_____
'Update Address and return card.Mark reason for change.
LjSCA 1 ii 20M-05/11
Address D Renewal ❑ Employment U Lost Card
C 2e.War/1/0101744Maith a)/Fe.2:addidefll
- : Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
' will-`'r ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
- ,fi 'egistration: 155217 Type: Office of Consumer Affairs and Business Regulation
.: xpiration 10;12014" Corporation 10 Park Plaza-Suite 5170
, - Boston,MA 02116
CO-OP POWER INC
SHAWN GALLAGHER , A/r
324 WELLS ST � �® *F
GREENFIELD,MA 01301 Undersecretary slid without signature`._
. .•
litMassachusetts -Department of Public Safety
Board of Building Regulations and Standards
Cunstruitiun Super isur f.°: T
License: CS-095430 I ` H°
SHAWN GALLACHE11,,
. 14 BELTRAN ST. PTA„ -` Iij t
Malden MA 02145 �' .
t7.2._ .y , ' Expiration
Cormnissionel 04/29/2014