Loading...
31B-243 Massachusetts " Department of Puouc Safery Board of Builaing Reguianons ana Stanaaras (on%tructiun Supery i%or _.tense CS-092540 THOMAS B ROS r"A 100 MAUI STREL7 HATFIELD MA 01038 +s 09/02/2015 �e , ffalr" �` if "`�`� License or registration valid for individul use only Office o onsumer airs u mess egu anon � y 1 t� HOME IMPROVEMENT CONTRACTOR 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 Boston,MA 02116 E GIA LLC T>--MAS ROSSMASSLER 24_ SUFFOLK STREET HC-YOKE, MA 01040 t:ndersecretar} Not valid without signature Aco f CERTIFICATE OF LIABILITY INSURANCE F DATE(MMIDDIYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CODERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEN, 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. IMPORTANT: B the certificate holder is an ADDITIONAL INSURED,the polic y(iss)must be endorsed. If SUBROGATION IS WANED,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 fieu of such endorsemen s . PRIER JAMES J DOWD& SONS INSURANCE AGENCY INC CONTACT NAIft 14 LYOKE, A PHONE(,�No.LIL 4413)538-7444 c HOLYOKE, MA 01040 --- E NJRER(S)AFFORDWG COVERAGE NMC I INSURER A INSURED ENERGIA LL" idSURERe 242 SUFFOLK: STREET wsuRERc HOLYOKE Mrs 01040 INsuftRD eNS URER t INS R F COVERAGES CERTIFICATE NUMBER: 1 1 REVISION NUMBER: THIS IS TO CERT€-Y THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NCT.VTTH:STANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE ktAV 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 11 TYPE Of YiSURANCE �Y NUMBER E Y EXY L1r11TS GENERAL L&AAMUTY . EACH OCCURRENCE S COMMERC A: GENERAL LIABIL Tv { P l Sa s x �1 $ I CIA htS aADF OCCUR MED E P iAay one person) S I PERSONAL 3 ADV INJURY 5 I GENEIRAL AGGREGATE S i GEN L AGGREGATE L 647 APPLIES PER PRCCUCTS-COL4P,'OP AGG S POLICY PRO. IOC S AUTOMDBR-t I.IASIXY ( e acx t S I ANY AUTO BODILY IPLURY(Per person) $ ALL CWNEC SCHEDULFC AUTOS � AUTOS BCCILI N„URY(Per a=.dent) S I NCN-OWNEC HIRED AUYCS AUTOS I $ S UMBRELLA L)AB OCCUR FACH OCCURRFNCF $ EXCESS LIAR C.AkMS-MADE AGGREGATE S DEC RETENTIONS S 5 S A WOVJMRS CORV*NSATION WC S 31S-389490-013 2/17/2013 2!17/2014 we STATU ply AND EAN-LOYERS'LIA61L(TY YIN ./ T RY rS ER ANY PROPRIETORIPARTN£R,EXECUTNE E L EACH ACCIDENT 5 100000 OFFICERIMEMSER EJCCLUDEDP ❑N N/A (MandatY in NHI, E L DISEASE-EA EMPLOYEE $ 1 If yea,deco'+De unucr DESCRIPTION OF OPERATIONS bebn,. E L DISEASE-POLICY LIMIT $ 100000 I DESCRPTION Of-OW.;>-,'"ttNO.S f LOCATIONS I VGi11CLES(A"=h ACORD 101,Addk1g~Rer rka Schsd t.,If r -apace w r.Qt ,ed) Workers comper, uuon insurance coverage applies only to the workers compensabon laws of the state of MA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE VATH THE POLICY PROVISIONS. AUTNtXU=REPRESENTATIVE Jeff Eldridge ®1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD R. h'G 1`•b, b�5 �:.oi Gan as 2!_d�sU.� lS AM F e O>' . �s ceruf«atz ,_ar.ce�ls and sLper'sedes AL?. previousir issued cer�if cates. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 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/'Lip: Holyoke, MA 01040 Phone #: 413-322-3111 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 1 6. [--] 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 !hese sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have worker 9. ❑ Building addition [No workers' comp. insurance comp. insurance.- required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.7 Roof repairs insurance required.] c. 152. §1(4),and we have no employees. [No workers' 13.21 Other �11SUlatlOn comp. insurance required.J *Any applicant that checks box d 1 must also fill out the section below showing their workers compensation policy uttonnation I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new attida),it indicating such. Contractors that check this box must attached an additional sheet showing the nanw of the sub-contractors and state whether or not those entities ha%e 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 police and job site information. Insurance Company Name: Llbert�rlVltatural �rlsUrance __.._ Policy a or Self-ins. Lic. #:___ _ WC5-31_S-389490-013 _ Expiration Date: 2/17/-14­--- ­-­-- Job Site Address: (,:�T City/State Zip:/1x;W/,(�W_ #--old, 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 tine 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 under the pains and penalties of perjury that the information provided above is true and correct. Si nature: Date: Phone P• 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#: Version].7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes No SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize GC� to act on Jb in all matters relative to work authorized by this building permit application. Signature fp Owner Date S ?—ossiq A-ssLf—f,R— 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. To s V OSS u ASS L4E7P- Print Name --l�' ,� - _ r2 Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applica�ble/ ❑ Name of License Holder: License Number Address Expiration D to 4(3-32,2--3111 nature Telephone SECTION 13-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 bu4 ing permit. Signed Affidavit Attached Yes No 0 Version 1.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name(Registrant): _ Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General��Contractor Not Applicable ❑ Company Name: �/ / 2USS��I SSL� Responsible In Charge of Construction ?,uZ Su 'd I..�, _S T _ t--f D L-y OBE ,,A(& _Q <o ko Address Signature Telephone Version 1.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING 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 Q DON'T KNOW Q YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW © YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW 0 YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: C. Do any signs exist on the property? YES Q NO Q 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 Q 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 © NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other W�1vSvZ..*r1d Brief Description Enter a brief description here. 4P Pyr.444d C u,t dS C-- To A T-TI C_ Of Proposed Work: OV 7 p 2 3Y SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: _ _ Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1 St 15t 2nd 2nd 3rd _ 3rd 4ch 4th Total Area(sf) Total Proposed New Construction(sf) Total Height(ft) _ Total Height ft 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system❑ Versionl.7 Commercial Building Permit May 15,2000 Department use only City of Northampton Status:ofPermit: �.- Building Department Curb CuUDdveway Permit la f r _. ', 212 Main Street SewerfSeptic Avallabillty Room 100 Waterell Auailabitlty I _ Elec ,,;or Northampton, MA 01060 Two Sets of Structural Plans _.phony-443-587-1240 Fax 413-587-1272 PlIoUS#ePlans Other Specify APPLICATION TO CONSTRUCT,REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office 46�i"` ST- Map Lot Unit Zone Overlay District Elm St.District C13 District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 5/q 172Y C61 Name(Print) Current Mailing Address: G�v i' ILIT)( 11��+�'1 t�7vT Z�° leis J f ��e,�'dvs��t,k.-.• � � � M17741-7 Signature Telephone 2.2 Authorize9 Agen : .......... RUSSA sSLGrc'. 2-V2- SUPPOLk, ST ffol YOKE kl�---- Name(Print) Current Mailing Address: Le(3 -3L2 - 3 /( Signature 4 Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building p _elo (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) - O Check Number This Section For Official Use Only Building Permit Number Date Issued Signatur Bu Commissioner/Inspector of Buildings Date 138 ELM ST BP-2014-0745 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:3 1 B-243 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category: INSULATION BUILDING PERMIT Permit# BP-2014-0745 Project# JS-2014-001268 Est. Cost: $8000.00 Fee: $48.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ENERGIA LLC 92540 Lot Size(sq.ft.): 11194.92 Owner: Smith College Zoning.URC(100)/EU(57)/ Applicant: ENERGIA LLC AT. 138 ELM ST Applicant Address: Phone: Insurance: 242 SUFFOLK ST (413) 322-3111 WC HOLYOKEMA01040 ISSUED ON.1212012013 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 12/20/2013 0:00:00 $48.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner