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38D-022 (3) - City of Northampton x Massachusetts DEPARTMENT OF BUILDING INSPECTIONS yJ. 212 Main Street • Municipal Building Northampton, NX 01060 �►T � Property Address: r12- %A&0, eh a_ Contractor Name: i 1A ONS Address: 4C r-4r W-4 .Wt..0AL City, State: A3e.tJ '.sc.k4C.r,i tT �linS Phone: Property Owner Name: Address: 3.1.. 'rkO.t�joctea, -V'� . City, State: .► fw+ -r-�jmZd I,— I rA �_(contractor) attest and affirm that the building I intend to insulate do&9 not h e any open air(knob and tube)wiring in the spaces to be insulated and that I have provided the property owner with a copy of this affidavit. Contractor signature Date 711 r/ter Y Massachusetts -Department of Public Safety Board of BuNding Regulations and Standards Construction Sapere-isor License: CS-093101 `�1 'I 1 `` dr. S'T'ANLEY P KARW OSXL- 80 CASTLEGATSD Springfield MA 01 12'7`;:,V ; f 5J,.� — ty Expiration Commissioner 05107/2015 ' J I Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston,Massaclsetts 02116 Home Improvement C: trtor Registration .�._ Registration: 167827 Type. LLC Expiration: 11152014 Trd 231538 VICTORY ENERGY SOLUTIONS Lw. RAQUEL KENNEDY 1 HARTFORD SQUARE SUITE 20 NEW BRITAIN, CT 06062 Update Address and return card.Mark reason far thug. Address :] Renewal [] Employment t� Last Card PS-CA! 0 5 M440,GIO 6 Otm-.�o "er '&'�> — License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date If found return to: Rogi : .187827 Type: Office of Consumer Affairs and Business Regulation Expiration: ,11{512414 LLC 10 Park Plaza-Suite 5140 Boston,MA 02116 VIENERGY SOUAK i15 LLC. RAQUEL KENNEDY I KkRTFORD SQUARE,SL M206 Nt„W BRtTAiN,Cf 052 Uaderaecretary Not 'd rih Signature Tke Comnso iwealth of Massackasetls Vartment of industtW Accidents Office of Investigations 600 Washington S&eet Braun,MBA 42111 ta+w�ma�sgrn+ldia Workers' Compensation Insurance Affidavit Builders/Contmetors/ElectriciandPi tubers A>nolicantt jA jM j §U 911me Print lAgi_bly Name musines or izati�t * �'-c� `r tiJ 1 .S Address' n i A<:x* rix� S , City/SttatelZip. Phone#. Are you an empleyer?Che&the appropriate box: 'Type of project(required): 1.91 am a employer with 4. fl 1 am a general contractor and l 6. D New Construction employees(frill and/or )." have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attacked sheet. 7. ❑Remodeling ship and have no employees These sub-oontractors have 8. (7 Demolition working for me in any deity, employees and have workers' 9 M Building addition (No workers'comp.ins mmoe 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 11.[]Plumbing repairs or additions myself.[No workers'comp right of exemption per MGL 12.M Roof repairs insurance required.]1 c. 152,$1(4),and we have no employees.[No workers' l3, Other insurance .) *may apps drat checks beat#1 must also AU out tbo seetmn below shovring their worikers' m Polky idbm as Ae� t Iiomaywaess who submit this affidavit iddintift they are dwAg all work and then ho outside oamtraoM must submit a new affidavit indicating such. tContramts that dm&this box must atutchad an adduntl shed stutaving the now of rte sub-000011=n add oft whether or not those entities have employees Sf rte sdb-omhacmes lea eagrloyees,ffiey anent Dxovide their worimw'cosaP.tY . I am an employer liar'k provaAarg workers' huumnce f©r my employrix Below h tke po&7 0d job nice brforn gdon. lnsurance company Nazme: l+,C.Q.. acs, =Conm._ zc,-. Policy#or Self-ins.Lie.0: ate . ' t Fxgiration Date: 4 1'-CIA: s Job site Address: 22 VkCk m pelac-.Si, City/st t&Zip: 616nMPn,MQ 011)C0 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$1,5M.04 andlor one-year imprisonment,as well as civil penalties in the tbrm of a STOP WORK ORDER and a fine of up to$250.00 a day again the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the D1A for insurance coverage verification. I do hereby c der the psbrs axdpmaftks of pedury that the WormidwrproWded above is lure and correct Offrrzal use o* jw wrbe in this arras to be compiled by city or town offWaL City or Town; PermWLiceose## Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector S.Plumbing Inspector S.Other Contact Person: Phone M E ............. SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: S' L a,r k-)cza License Number Address p Expiration D to Signature t - Telephone 9 ReqiskQ Home Improvement Contractor: Not Applicable ❑ -4 Iunpo Coumany Name Registration Number -� , Address Expiration Date C)L) lkCx SG k2.z.1 F-.-V1, 1 C4 01561elephone 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 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)ofthe 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[0] Other IV Brief De ription of Proposed ` Work: Sbe C:Cl j'1Ct l�i°�`� 41J��+`C1'tN Alteration of existing bedroom Yes ./ No Adding new bedroom Yes °--'�'No Attached Narrative Renovating unfinished basement Yes _[GNo Plans Attached Roll -Sheet 6a, If New house and or addition to existing housing, complete the following: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: tv Number of Bathrooms c. Is there a garage attached? S d. Proposed Square footage of new construction. Dimensions e. Number of stories? Tom'—^ f. Method of heating? &%- ^vc li Fireplaces or Woodstoves fA 0 Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction "41 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 v-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,_('�\" . C'— CNN,P- -C as Owner of the subject property hereby authorize to n behalf n II matters tive to woW Juthorized by this building permit application. 7 � t Aiguature-3f Owner Date I, M"k- C'1` \J (4u iV E,gyp_ k'-J '' as Owner/Authorized Agent hereby declare that the statements and informatiouf on the foreg&Ag application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. M�)Lo C1,t9r1 ;(Qd Print Name `7/2 f U11'4 Signature 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 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 Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW 0 YES IF YES, date issued:`' IF YES: Was the permit recorded at the Regi try of Deeds? NO 0 DON'T KNOW YES 0 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 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 NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading,f;'xcavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NQ IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability. Northampton, MA 01060 Two Sets of Structural Plans hone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify -„ AgEICATION 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 Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ra (P Curre tMailing Address: tWA Telephone re 2.2 Authorized A ent: c i v COcOL Name(Print) Current Mailing Address: Li $))-3cLt�A �P��Z Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building ),co 06 (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-i e,.60 Check Number 0 G 5S—" This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioned]nspector of Buildings Date File#BP-2015-0055 3 APPLICANT/CONTACT PERSON VICTORY ENERGY SOLUTIONS LLC ADDRESS/PHONE 1 HARTFORD SQ SUITE 206 NEW BRITAIN (877) 06-4483 PROPERTY LOCATION 32 HAMPDEN ST MAP 38D PARCEL 022 001 ZONE URB(100) THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid I3 4 S5 Building Permit Filled out Fee Paid Typeof Construction: WALL INSUALTION 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 FOLLO G ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN FOR ION PRESENTED: pproved 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 e Sign o Building 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. 32 HAMPDEN ST BP-2015-0055 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38D-022 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-2015-0055 Protect# JS-2015-000097 Est.Cost: $4200.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: VICTORY ENERGY SOLUTIONS LLC 93101 Lot Size(sa.ft.): 7797.24 Owner: CHIERICHINI CLAUDIA Zoning-: URB(100)/ Applicant: VICTORY ENERGY SOLUTIONS LLC AT: 32 HAMPDEN ST Applicant Address: Phone: Insurance: 1 HARTFORD SQ SUITE 206 (877) 306-4483 O WC NEW BRITAINCT06052 ISSUED ON.711712014 0:00:00 TO PERFORM THE FOLLOWING WORK.-WALL INSUALTION 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 Sisnature: FeeType• Date Paid: Amount: Building 7/17/2014 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner