24A-037 HONEYWELL CUSTOMER CONTRACT
, IM One Hartford Square Suite 16-206
New Britain, CT 06052
877.306.4483 Office
860.357.5691 Fax
HIC # 167827
info @victoryenergysolutions.com
Representative:
Jody Fogg
44 Blackberry Lane
Northampton, MA 01060
Customer ID: 218376
Contract ID• WORK
5, � .fix :a.n '-4;.'�,.�s,��,. �.,, �r�'�� � t �i- •-� � ,r � �
Above Gm&wall la"llion Clapboard 1704.00 sgff.. $29$2.00
Sub Total: $2982.00
Energy Efficiency Incentive $2000.00
Net Sales Tax After Incentive $0.00
Total $982.00
TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE
The Contractor agrees to perform the above described work,furnishing the material and labor specified above for the total price listed above.
Payment of the full amount of Total is expected by cash or check upon completion of contracted work.If paying by credit card a 3%service
charge will be added.Deposit may not exceed one-third of total balance. ,(
Deposit Amount EGG Deposit Date
Final Balance Balance Due Upon Completion of Work Scope.
TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE
The Contractor agrees to perform the above described work,furnishing the material and labor specified above for the total price listed above
Payment of the full amount of Total is d.expected by cash or check upon completion of contracted work.If paying by credit card a 3%service
charge will be added.
The customer agrees to pay the balance of the cost above upon completion of the job.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
Customer Signature: Date:
na
Contractor signature: nndtea atJ1toae oN%-pPlapt Date: December 4, 2013
LIMITED TIME OFFER:The prices and incentives offered in this Contract are subject to change in accordance with the Mass
Save Home Energy Services Program o
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Office of Consumer Affairs and gusiness Regulation
10 Park Flaw.- Suite 5170
Boston,MassacIggetts 02116
Home Improvement C rotor Registration
Registradon: 167827
Type: LLC
E*ratan: 1115/2014 Tr# 231538
VICTORY ENERGY SOLUTIONS
RAQUEL KENNEDY
1 HARTFORD SQUARE SUITE 206
NEW BRITAIN, CT 06052
Update Address and return card.Clark reason fbr change.
Addrus F� Renewal M Employment Lost Card
�Sfinz G i0�4OfiISa.Gi412t6 ��
c Offl.�o dm � License or regia4vtion v%IW for indivWul am only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
RegWxatlon: .167827 Type: Office of Consumer Affairs and Business Regulation
Explrafm: .1`1=14 LLC 14 Park Plata-Suite 5170
Boston,MA 42116
Y ENERGY SOUMONS a1G•
RAQUEL KENNEM
1 HARTFORD QUAf�$' 1UM206
NEW BRITAIN,CT 06Q52 Uadersteretuy Not d without signature
Tke Commonweuttk ofMassuckusettr
13gwln eat of lndustriat AccMents
Office of Invesdgadons
600 Washington Street
Boston,MA 02111
www Mass 0V1dk
Workers' Compensation Insurance Affidavit-.Buiiders/Contmetors/Eiectricbmstflumbers
Applicant InfDrInSAM Please t 'b
Name(Busmen orvnizatioaandividusiy ��;� E'0Rg%;,I -SzSy �►3
Address:, (One 13. x• Sq Lw-r--
Citv/Staxe/Zip,
Phone#: I
Are you an empiayer?Check the appropriate box: Type of project(required):
1.91 am a employer with IQ 'I• Q I am a general contractor and T
employees(full and/or part-time).* have hired the sub-caatraotars 6. New aoastxuctioa
2.❑ I am a soh proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees 'These sub-contractors have S. Q Demolition
working for me in an employees and have workers'
Y amity. 9. Q Building addition
[No workers'comp.im lance comp.insurance.
required.] 5. ® We area corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.[]Plumbing repairs or additions
myself;[No workers'comp, right of exemption per MGL 12.n Roof repairs
insuratree required.]t c.152,§1(4),and we have no
employees.[No workers' 13.❑Other
insurance required.]
'Any appiwant dear chucks box d1 must also fill out ft section below showing was'=apcwAd n policy id'muotim
Homcownea who submit this of idawk mdicadng dw ate drying all work and tt w bee:x�oannamn cant sn aw a new affidnit i such.
:C=vacuors that ctxek this box mast attaeiaed an addrtionar sheet shaavatgdu name of tht sub•cu s and stags whether cr not dune a ativs have
catployen if ft v b-=Vad=lom cmployom dry mmst pmt&theat wod='gip•policy n=ber•
I am an enq*yer t&aa'kproWdbig workers'compensation insurance for my empfoyeet. Bdow&tthepo&7 and,ob aka
lnformallon, /
Insurance Company iatne; Cfl. :cm,( .,o,i t„�rr�i+r+•+ C--�.,y_„Ll .
Policy#or Self-its.Lic.# r 2L,1 "319 I!q Expiration Date: q
Job Site Address: 9�i .MG.a'1'it. City/State2ip: gyp( c,1 6
Attach a copy of the workers'compensation policy declaration page(showing the policy numberr 441ration date}
I'aih=to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of
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 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Off1ce of
Investigations of the DIA for insurance coverage verification.
I do hereby der Ike pains and penafths of perjatry that the ixfomwfim pr+ovi"abowa is true Qad con ux
Si
Mont#;
tf`icral use only. Do not tyke in this ova,to be compleW by do or town opkiai
City or Town: Permit/Licetase#
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 M.
NNW
t y
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
C
Name of License Holder: L_) �( J 1 V(/�
License Number
LO CM e ilk
Address ^� �- Expiratio Date
�`ti c
Signature ✓ Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
Company ame Ji Registration umber
ILI
Address Expiration bate
t-
C ca Telephone ffi-306_. L'"93
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 buildo permit.
Signed Affidavit Attached Yes....... V No...... ❑
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
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding [O] Other V1
Brief Description of Proposed
Work: UC,\\ 4nr cam-177bu I-h l oeu—j ! S4t
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing,complete the following:
a. Use of building: One Family V" 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. n\C- Dimensions
e. Number of stories?
f. Method of heating? �. 1C Fc rcl 'J Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. k.S Masscheck Energy Compliance form attached?
h. Type of construction '\�SLJ-
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 n" C"
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
1, GEC' as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relat' a to work auth ri 48 by this building permit application.
t-(
Signature of Owner Date
I, [ 1 'i 0 rVI, as Owner/Authorized
Agent hereby de fare that th-yLtatements-ino information on the f regoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
n �� ,- (4 v
Print Name a
Signatur f Owner/Agent Date
A '
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 Speci l Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW 0 YES
IF YES, date issued:'
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW 0 YES
IF YES: enter Book Page, and/or Document#'
B. Does the site contain a brook, body of water or wetlands? NO Ile DONT KNOW 0 YES
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 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,excav +on,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.
t
Department use only
City of Northampton Status of Permit:
Building Department Curb CuttDriveway Permit
Sr '' 212 Main Street Sewer/Septic Availability
FEB r! 2U14 Room 100 Water/Well Availability',_
orthampton, MA 01060 Two Sets of Structurat Plans
-- pi c �1 -587-1240 Fax 413-587-1272 Plot(Sde Plans
ric
Elect F 060
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
i_1 1>�C���Cr Ile Map Lot Unit
V ir ('L�^Ce ItiID O l I G"� l Zone Overlay District
t Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
.1ii�fltV f�fact rrnt Ln. ,N10Ah o6, R
,P1 , C?I0
Name rint) T Current l d ress-
MI 5914555_7
Teleph��
Signature
2.2 Authorized Agent:
i H A�-'
Name(Print Current Mailing Address:
Si ure Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building A (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) L`� Check Number
This Section For Official Use Only
Building ermit Number: Date
9 Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2014-0890
APPLICANT/CONTACT PERSON VICTORY ENERGY SOLUTIONS LLC
ADDRESS/PHONE 1 HARTFORD SQ SUITE 206 NEW BRITAIN (877)206-4483
PROPERTY LOCATION 44 BLACKBERRY LN
MAP 24A PARCEL 037 001 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 �7 Q
Fee Paid
Typeof Construction: INSTALL WALL INSULATION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License 93101
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF 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 y
Signature of uildin fficia 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.
44 BLACKBERRY LN BP-2014-0890
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24A-037 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-2014-0890
Protect# JS-2014-001543
Est.Cost: $2982.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VICTORY ENERGY SOLUTIONS LLC 93101
Lot Size(sq. ft.): 5357.88 Owner: FRANK RICHARD E&JUDY FOGG
Zoning: URB(100) Applicant: VICTORY ENERGY SOLUTIONS LLC
AT. 44 BLACKBERRY LN
Applicant Address: Phone: Insurance:
1 HARTFORD SQ SUITE 206 (877) 206-4483 WC
NEW BRITAINCT06052 ISSUED ON:212012014 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL WALL 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 2/20/2014 0:00:00 $55.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner