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30A-025 (3) !X j�' / «•/ + -t ;hllf., Office of Consumer Affairs and Business Regulation 10 Parr Plaza - Suite 5170 Boston, Massachusetts 021. 16 Home Improvement Contractor Registration Registration: 165217 Type: Corporation Expiration: 1/2112016 Tr# 247991 CO-OP POWER, INC. SHAWN GALLAGHER 12A WEST ST WEST HATFIELD, MA 01088 Update Address and return card.Mark reason for change. Address Renewal Employment Lost C;acd License or registration valid for individul use only office of Consumer Affairs& business Regulation SOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 165217 Type: Office of Consumer Affairs and Business Regulation Expiration: 1/21/2016 Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CO-OP POWER,INC. SHAWN GALLAGHER 12A WEST STG4- WEST HATFIELD, MA 01088 Undersecretary o valid without signature y !Massachusetts Department of Public Safety Board of Building Regulations and Standards Cimsrriailhui +ilierrsi+,ra License: CS-095430 x ,ia ,4 r StiAWN GALLAC�OER, 14 BELTRAN S'T.APT2 Malden MA 0213 TM Expiration Commissioner 0412912016 ® DATE(MM/DDIYYYY) A�o CERTIFICATE OF LIABILITY INSURANCE 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. IMPORTANT: 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 JAMES J DOWD &SONS INS AGCY INC CONTACT NAME: 14 BOBALA RD PHONE aC No HOLYOKE, MAO 1040 E-MAIL ADDRESS: INSUREII AFFORDING COVERAGE NAIC# INS URER A INSURED INSURERS: CO OP POWER INC 15 A WEST STREET INSURERC: WEST HATFIELD MA 01088 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 18307643 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. INS POLICY EFF POLICY EXP LTR R TYPE OF INSURANCE ADDL SUER POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS GENERALLIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE 0 OCCUR MED EXP(Any one person) $ PERSONAL&ACV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ JFC POLICY PRO LOC $IT AUTOMOBILE LIABILITY a acci enl)INGLE $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED B SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Peracadent) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION WC5-31 S-388245-013 11/2/2013 11/212014 'A sTATU- OET�1- AND EMPLOYERS'LIABILITY YIN ✓ IT ORY LIMBS ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1000000 OFFICERIMEMBEREXCLUDED' ❑ NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1 000000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1000000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it more space is required) Workers com f MA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CONSERVATION SERVICES GROUP THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 40 WASHINGTON STREET ACCORDANCE WITH THE POLICY PROVISIONS. WESTBOROUGH MA 01581 AUTHORIZED REPRESENTATIVE Jeff Eldridge v Q ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD ;,FIRE NO.: 18002 F>43 y Oidi Oangas 11/7/2013 11:52�00_AN�,`'�ge 1 of,l A" ° CERTIFICATE OF LIABILITY INSURANCE DATE /DD/YYYY) 3/14/2014 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. IMPORTANT: 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). CONTACT PRODUCER NAME: Debbie MacNeal James J. Dowd & Sons Iris PHONE FAX 14 Bcbala Road A/c No EXt: - - A/c No:413-53 E-_L_02Q____ E-MAIL Holyoke MA 01040 ADDRESS: dmacneal @dowd.com PRODUCER CUSTOMER ID#: COOP INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA:MOunt Vernon Fire Insurance Company Co-op Power, Inc. 15A West Street INSURERB:Safety Indemnity Company _-_ 33.6_18 West Hatfield MA 01088 INSURERC: INSURER D: INSURER E: INSURER F, COVERAGES CERTIFICATE NUMBER:400481920 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. ADDLSUBRI INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LTR I WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY CL1566148A 11/8/2013 11/8/2014 EACH OCCURRENCE $1,000,000 XDAMAGE TO RENTED 10 0,0 0 0 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE 1-1 OCCUR MED EXP(Any one person) $5,000 PERSONAL SADVINJURY $1,000,000 GENERAL AGGREGATE $2,00.0,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,0 0 0,0 0 0 POLICY PRO g LOC $ B AUTOMOBILE LIABILITY 6212701 3/23/2014 3/23/2015 COMBINED SINGLE LIMIT $1,C00,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ~ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULEDAUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS deductible $500 Comprehensiv $ A !,X UMBRELLA LIAB OCCUR CUPl SS0265A 11/8/2013 11/8/2014 EACH OCCURRENCE $1,000,000 EXCESS LIAB HCLAIMS-MADE AGGREGATE $1,000,000 DEDUCTIBLE $ X RETENTION $0 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY T RY LIMIT ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N E.L.EACH ACCIDENT $ OFFICERWEMBER EXCLUDED? N/A E.L.DISEASE-EA EMPLOYE $ (Mandatory in NH) If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION F OPERATIONS/LOCATIONS/VEHICLES Attach ACORD 101,Additional Remarks Schedule,if more space is required) O Workers' Compensation Certificate of Insurance to follow separately from the carrier. RCS Network,Conservation Services Group, National Grid, NSTAR, Boston Gas Co. , Colonial Gas Company and Essex Gas Co. are named as additional insureds per written contract in regard to general liability only. Waiver of Subrogation Applies. 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. Conservation Services Group 40 Washington Street Westborough MA 01581 AUTHORIZED REPRESENTATIVE 4. ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents a Office of Investigations a I Congress Street, Suite 100 Boston,MA 02114-2017 yV ° 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 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ 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.❑ 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.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no ,,, f 13.❑■ Other V V�qe.� Z 4�Z 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. 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. #:WC5-31S-38824�5-013 Expiration Date:11/02/14 Job Site Address: 5� L x� Pave City/State/Zip: R(c fe-91cf lf ro-A d 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 under the pains and penalties'1 of perjury that the information provided above is true and correct. 0 Signature� ip;� 24 �'[,��, Date: Phone#' �-{ I — 7 7;? 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#: CO-OP POWER PRRNIT ARTNORUATION FORK owner of the property located at; (Owner's Name) (Property Str Address) (City/Town) hereby authorize Co-oo pp u r Inc. (Contractor) to act on my behalf to obtain a>buildng permit and to perform Insulation and/or weatherizatlon wor'h on my pr rty. t es S mature) ; t r kkE k t Co-op Power 15A West Street,West Hatfield,AAA 01088 phone:413.772.8898 or 877.266.7543,fax;413St7.0300 Ern ltc infofcoo ower.coop Website:!A X00 oarer.coop F; � x Audit Date: 5/28/2014 ABOVE GRADE WALL INSULATION Improve 872 sq ft of above grade wall insulation from 0 inches to 3.5 inches. Improvement Measures Wood Shingles 872 Detailed Improvement Properties Existing Wall Insulation Depth (inches) 0 Thickness of propsed wall insulation 3.5 powered by "Compass Audit Date: 5/28/2014 ATTIC INSULATION Improve 875 sq ft of attic floor insulation from 3 inches to 12 inches. Improvement Measures Open Blow R-30 875 Propavent 2'or 4' 30 WeatherStrip Hatch 1 Detailed Improvement Properties Existing Attic Insulation Depth 3 Proposed depth of Attic Insulation in inches 12 AIR SEALING Reduce the house air leakage from 1548 CFM50 to 989 CFM50. Improvement Measures Air Sealing -maximum 8 man-hours at no cost to customer. 8 Detailed Improvement Properties Proposed Infiltration (CFM50) 989 CFL BULB CFL Bulb (7.0 each) Improvement Measures 14 Watt A-Lamp 1 15 Watt CFL Mini-Spiral 2 15 Watt Globe 4 p«waby '� Compass Audit Date: 5128/2014 Summary of Recommendations This list is a summary of the improvements we recommend you undertake, based on the current and potential energy performance of your home. These improvements are expected to provide you with the greatest benefits. You will find detailed information on all these recommended measures on the following pages. Most of the work we recommend pays for itself over time through electric and fuel savings. We are happy to work out a plan to make your home efficient, comfortable, and affordable. Proposed Status Estimated Available Customer Annual Payback Improvement Cost Incentives Contribution Savings (years) CFL Bulb Installed $70 $70 No Cost $50 Immediate Air Sealing Recommended $760 $760 No Cost $179 Immediate Attic Insulation Recommended $1,285 $914 $371 $77 4.84 Above Grade Wall Recommended $1,526 $1,086 $440 $196 2.24 Insulation Summary $2,811 $2,000 $811 $502 * Improvements with a Customer Contribution of"No Cost' are not included in the Summary Total incentive for recommended insulation measures cannot exceed $2,000 To Help You Get Started Your Energy Specialist has installed some low cost energy savings upgrades to help you get started on the path toward greater home energy performance. We urge you to take action on the list of recommendations as soon as you can and learn more about the incentives available, including 75%, up to$2000, for the installation of approved insulation upgrades. The HEAT Loan Program provides customers the opportunity to apply for a 0% loan from participating lenders to assist with the installation of qualified energy efficient improvements in their homes. The loans are available from $500 up to $25,000, with terms up to 7 years.To apply for the loan, the property owner should review the information provided in the loan package. pmereSf by �; tttnpsS$ 2 Audit Date: 5/28/2014 Prepared for: s£ �A r Debra Boutin 38 Lexington Ave Florence, MA 01062 COIL111161a as, Prepared by: jV't�I'S'S;IChtv-'CttS Joe Pagano A NlSource Company '15A West Street West Hatfield, MA /. mass save `+`t�?^�7z Thank you for inviting us into your home. Your Mass Save Home Energy Improvement Plan provides valuable information on how you use energy and offers you a plan to improve your home's energy performance, comfort, durability, health, and affordability. Your Energy Specialist evaluated your home and is providing the following Summary of Recommendations.Each recommended improvement includes a description, available incentives, your costs, and an engineering estimate of annual savings and the corresponding payback time. The estimates are based on the bills you had available or on average energy costs in your area. Mass Save, an initiative sponsored by Massachusetts'gas and electric utilities and the Cape Light Compact, urges you to take charge of your energy costs and become a Mass Saver. To learn more, visit www.niasssave.com. Compass d j SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: S�nQ ��'1 C��(((CL,k 0 t 1 L� :�b License Number 1J St vY �d q/off R /1<2 Addres Ex iration Date -3)1y�22 - 3°9F n ure Telephone/ 9. Registered Home Improvement Contractor; Not Applicable ❑ Company Name Registration Number C:T IA/, t�P, F '� Co ��' '12 1 (42 i Addre s° , Ekoirati6rf Date / Telephone`1(WZ� SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(; 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....... bi No...... ❑ 11. - me Owner Exemption The current ex ption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such meowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 0 Sixth Edition Section 108.3.5.1. Definition of Homeowu 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 two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constr s more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to th uilding Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performe nder the buildine permit. As acting Construction Supervisor your pre nce on the job site will be required from time to time,during and upon completion of the work for which this permit is is ed. Also be advised that with reference to Chapter 152( rkers'Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)of the Ma chusetts 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 responsibi ' for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State o* assachusetts General Laws Annotated. Homeowner Signature SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) I New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding[0] Other[ ] Brief De§rription of Propo d _ I Work f 11Q ` � I. jC)!�Z?✓\ _ ) V t�4 �i C r L�V� 1 i 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 housina, complete the following: 44 a. Use of building : One Family Two Family Other i b. Number of rooms in each family unit: Number of Bathrooms j c. Is there a garage attached? j d. Proposed Square footage of new construction. Dimensions j 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 j i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No r j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. i I. Septic Tank City Sewer Private well City water Supply i SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 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. siP N f��1 V 1G� \ �� i C"c\ Signature of Owner Date }} I, �V_\0,tAJ r1 101 C k C' as Owner/Authorized j Agent hereby declare that the statenients 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. 12 01 `? r'rint Na Sig ture;d caner/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 i Setbacks Front j Side L: R: L: R: 0 Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg&paved parking) #ot'llarking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Findin ever been issued for/on the site? NO () DONT KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Re ' try of Deeds? NO 0 DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 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 ex vation, 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. pypl0vv'i'hiO:dSa Department use only -� City of Northampton Status of Permit: I jut_ 1 ZW 1 Building Department Curb Cufi/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability ! Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans+ Other Specify — i APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING ± i —_i SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Property Address: i 1 P �'r C1 L' Map Lot Unit—_.__—_._.. t� Zone Overlay District__- t Elm St.District CS `SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 11.1 Owner of Record: In f� ��y x V P U( (�CU _ Name(Print) Current Mailing Address: r f ux- t z Ci�T t -�-) C��°v��-- Telephone ignature .2 Authorized Agent: E Name(Pri Current Mailing Address: ture Telephone - i SE ON 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by,permit applicant i. Building (a) Building Permit Fee Electrical (b) Estimated Total Cost of Construction from(6) Plumbing - � Buildi:g 'Permit Fee 'Mechanical(HVAC) j 5. Fire Protection n Total=(1 +2+3+4+5) - Check Number This Section For Official Use Only { Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2015-0051 APPLICANT/CONTACT PERSON CO-OP POWER INC ADDRESS/PHONE 15A WEST ST WEST HATFIELD (413)772-8898 O PROPERTY LOCATION 38 LEXINGTON AVE MAP 30A PARCEL 025 001 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 Fee Paid Typeof Construction:_AIR SEALING&ATTIC 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 FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF MATION 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 Delay Signa of ui ding ffic' 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. 38 LEXINGTON AVE BP-2015-0051 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 30A-025 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-2015-0051 Project# JS-2015-000093 Est. Cost: Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: CO-OP POWER INC 095430 Lot Size(sq. ft.): 13068.00 Owner: BOUTIN DEBRA Zoning: URB(100)/ Applicant. CO-OP POWER INC AT: 38 LEXINGTON AVE Applicant Address: Phone: Insurance: 15A WEST ST (413) 772-8898 () WEST HATFIELDMA01088 ISSUED ON:711512014 0:00:00 TO PERFORM THE FOLLOWING WORK.-AIR SEALING & 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 $55.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner