Loading...
17C-136 (3) pt1 fiC/ G'//G!/1(!C/'/rflr[.i*a�'{/f(,/ . l 11 (j ewl Office of Consumer Affairs and Business Regulation _V--ky, 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Con tractor Registration Registration: 165217 Type: Corporation Expiration; 1/21/2016 Tr# 256968 CO-OP POWER, INC. MICHAEL SUTER 12A WEST ST WEST HATFIELD, MA 01088 Update Address and return card.Mark reason for change. SCmi 0 2OM-05111 (—] Address [_] Renewal Ej Employment Lost Card Office of Consumer Affairs&Business Regulation License or registration valid for individul use only r Aai.A#aHOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 1;Registration: 16,5217 Type: Office of Consumer Affairs and Business Regulation Expiration: 112112016 Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CO-OP POWER, INC. 1 r MICHAEL SUTER 12A WEST ST WEST HATFIELD,MA 01088 Undersecretary, of Val signature Massachusetts - Department of Pubdio Safety Board of Building Regulations and Standards �tsrlvtrtltdltaf"t �'itli3t"iiS�tef License: CS-107884 MICHAEL SUTER-' 94 PRATT COMER R N fi Shutesbuty MA 01077 Expiration Commissi net 0411212018 5/28/2014 11:40:06 AM PST (GMT-8) FROM: 100005-TO: 14135170300 Page: 2 of 2 AC�0 DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 5/28!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). PROD NAME: PRODUCER JAMES J DOWD& SONS INS AGCY INC ME: 14 BOBALA RD PHONE FAX HOLYOKE, MAO 1040 AIC ac No: E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: LM Insurance Corporation 33600 INSURED INSURER B: CO OP POWER INC 15 A WEST STREET INSURER C: WEST HATFIELD MA 01088 INSURER D: INSURER E: WSURERI-: COVERAGES CERTIFICATE NUMBER: 20313592 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DDIYYYY MMIDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE r_1 OCCUR PREMISES DENTE I occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLES PER GENERAL AGGREGATE $ POLICY D PER' 171 LOC PRODUCTS-COMPIOP AGO $ OTHER, $ AUTOMOBILE LIABILITY COMBINED SIN $ Ea accident ANY AUTO BODILY INJURY(Par person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTYDAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS MADE AGGREGATE $ DEC I I RETENTION $ A WORKERS COMPENSATION WC5-31 S-388245-013 111/2/2013 11/2/2014 1 STATUTE ERH AND EMPLOYERS'LIABILITY �. ANY PROPRIETOR/PARTNERIEXECUTIVE — N/A E.L.EACH ACCIDENT $ '1000000 OFF I CER/MEMBER EXCLUDED? FN I (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/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space Is required) This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. Workers compensation insurance coverage applies Only to the workers compensation laws of the state of MA. CERTIFICATE HOLDER CANCELLATION THIELSCH ENGINEERING, INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 195 FRANCIS AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. CRANSTON RI 02910 AUTHORIZED REPRESENTATIVE r' LM Insurance Corporation ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD CERT NO.: 20313592 Lucy Ga fieLd 5/28/2014 2:37:04 PM (EDT) Page 1 of 1 PERMIT AUTHORIZATION FORM I, JoAnne P Howlett ,owner of the property located at: (Owner's Name) 66 N. Maple St., Florence MA 01062 (Property Street Address) (City/Town) hereby authorize Martin Ciernia (Contractor) to act on my behalf to obtain a building permit and to perform insulation and/or weatherization work on my property. (Owner's Signature) 9/30/14 (Date) Co-op Power 15A West Street,West Hatfield,MA 01088 phone:413.7728898 or 877.266.7543,fax:413.517.0300 Email:info @cooppower.coop Website:www.cooppower.coop The Commonwealth of Massachusetts Department of Industrial Accidents u Office of Investigations W 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lep-ibly 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): 1.0 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. E]New construction 2.❑ 1 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 or me in an capacity. employees and have workers' g y $ 9. F-1 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 " employees. [No workers' IAM Other V.v '� �"� �_C� 2 c�t7 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. TContractors 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. #:WC5-31 S-388245-013 Expiration Date:11/02/14 Job Site Address: (�? (o �G� l si�)E City/State/Zip: ��C YlC(', yyV_A f cla 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 of perjury that the information provided above is true and correct. Signature: Date: �GCJ l Phone#: 7 _Z K Y 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#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Constructions Supervisor: L Not Applicable ❑ Name of License Holder: i ' t(Lv-�G f License Number A dress . Expiration Date Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone '-!I 772 LPL 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. - Rome 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)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 D Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding[0] Other[1!q] r C r� Brief Description of Proposed Work: �0 1 G 4�1-1 C AT�-' [� - 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'followino: a. Use of building : One Family -� 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. Dimensions 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 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 k. Will building conform to the Building and Zoning regulations? X 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 I, c"l P �)C C.J I e-� �- 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. Signature of Owner Date 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 'e igne under the ains and enalties of perjury. ALL int Na e Signature of Owner/A 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 Side U R:e_ 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 0 DONT KNOW YES IF YES, date issued:'' IF YES: Was the permit recorded at the Registry 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 Q DONT KNOW 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 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 I NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading,excpvation,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. Department use only ity of Northampton Status caf Permit: Building Department Curb Cut/Driveway Permit OC� 222d�f.� `212 Main Street Sewer/Septic Availability Room 100 Water/INeil Avari0bitsy` &Gas Ir, N�5t1! ampton, MA 01060 Two Sets of Structura)Plans thampgn - 7-1240 Fax 413-587-1272 P1ot/S1te Plans lot h rSpecify' 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 (Pco Map Lot Unit Zone Overlay District ©� c) Elm St.District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: ] c - 19 2--�f,-- V 7 ;Z Telephone Signature 2.2 Authorized Acient: E''`i'\� �h :;r-- _�`'� � In./C'S�" S�. VII,'N �l��►t'�,� , ��� C� '�S`� a e(Print) Current Mailing Address: Sign ture Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building 7 7 (a)Building Permit Fee r _l 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =0 +2+3+4+5) ( , 7 7 ` Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2015-0464 APPLICANT/CONTACT PERSON CO-OP POWER INC ADDRESS/PHONE 15A WEST ST WEST HATFIELD (413)772-8898 Q PROPERTY LOCATION 66 NORTH MAPLE ST MAP 17C PARCEL 136 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid BuildinV Permit Filled out Fee Paid Typeof Construction: INSTALL ATTIC INSULATION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 107864 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOI A4ATION PRESENTED: t/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 oDemol- el y i ure of uilding O icial 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. 66 NORTH MAPLE ST BP-2015-0464 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C- 136 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-2015-0464 Proiect# JS-2015-000883 Est. Cost: $1779.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group CO-OP POWER INC 107864 Lot Size(sq ft.): 9626.76 Owner: HOWLETT JO-ANNE P zoning: URB(100)/ Applicant: CO-OP POWER INC AT. 66 NORTH MAPLE ST Applicant Address: Phone: Insurance: 15A WEST ST (413) 772-8898 O WEST HATFIELDMA01088 ISSUED ON:1012412014 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 10/24/2014 0:00:00 $55.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner