29-607 55 STONE RIDGE DR BP-2016-1005
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map-Block:29-607 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
i
Category: INSULATION BUILDING PERMIT,
Permit# BP-2016-1005
Project# JS-2016-001698
Est. Cost: $3360.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: AMERICAN INSTALLATIONS LLC 106178
Lot Size(sq. 1): 83635.20 Owner: KROSOCZKA JARRETT
zoning: Applicant: AMERIC.AN INSTALLATIONS LLC
AT. 55 STONE RIDGE DR
Applicant Address: Phone: Insurance:
130 COLLEGE ST X413) 552-0200 WC
SOUTH HADLEYMA01075 ISSUED QN:2111120�6 0:00:00
TO PERFORM THE FOLLOWING WORK.IINSTALL ATTIC/BASEMENT INSULATION
POST THIS CARD SO IT IS VISIBLE FROM THF. 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 2/11/2016 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2016-1005
APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC
ADDRESS/PHONE 130 COLLEGE ST SOUTH HADLEY01075(413)552-0200
PROPERTY LOCATION 55 STONE RIDGE DR
MAP 29 PARCEL 607 001 ZONE
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: INSTALL ATTIC/BASEMENT INSULATION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 106178
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
roved 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 o ' y
� J
Signa ure of uild' ficial 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 au(horities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning& Development for more information.
Departrriertt use only '
City of Northampton Status of Permit
Building Department Cu"rb CutlDriveway Permit...;.
212 Main Street Seuper/Septid Availablitar
Room 104 WatarMfeN�Availabifity
f EBjy�pT.Oorthampton, MA 01060 Two sett of Stn lcxural Pians
nihni64 4 3-587-1240 Fax 413-587-1272 A668,ita 11A
F F$LitiD;`dG 4NSPEGTtIYNS
IjWTHAMPTON MA 01060 Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1 property Add ress•
This section to be completed by office
Map Lot Unft.
55 Stone Ridge Drive Florence,MA 01062
f Zone Overlay District
Elm St DWq_ CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Gina&Jarrett Krosoczka 55 Stone Ridge Drive Florence,MA 01062
Name(Print) Current Magro Address:
1 (860) 610-5246
See attached Telephone
Signature
,2.2&uthorked Agent.
American Installations 130 College St., Ste 100 South Hadley,MA 01075
Name(Print) Current Mailing Address:
American Installations — U� � 413-552-0200
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimates!Cost(Dollars)to be Official Use Only
completed by permit appPM
1. Building 3360.00 (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=11+2+3+4+5) 1 3360.00 Check Number ,
This Section F Official Use Only
Building Permit Number Issued,
Signature:
Building Commissloner/inspector of Bulidings 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 Sued in by
Building Dcpartmcnt
Lot Size
Fr-otop
Setbacks Front C�
Side L:= R:= L:= R.=
Rear
Building Height
Bldg.Square Footage C� a/o -
Open Space Footage %
(Lot area minus bidg do paved
#of Parking Spaces
Fill: ---
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DONT KNOW O YES O
IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book I I Page[ and/or Document#�—�
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW O YES O
IF YES,has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO 0
IF YES,describe size,type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO 0
IF YES, describe size, type and location: j
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 O NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTIO 5-DESCRIPTION OF PROPOSED WO K(check all a llcable
New House 0 Addition Replacer nt Windows Alteration(s) ❑ Roofing ❑
Or Doors O
Accessory Bldg. ❑ Demolition ❑ New Sign ' [O] Decks [C] Siding 0] Other[&
Brief Description cif Proposed
Work: Attic and basement insulation and air sealing thrdughout
Alteration of eAsting bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a N Newhouse and'or addition to a cisttn housing;comatete the-following:
a. Use of building:One Family_ Two Family Other
b. Number of rooms In each fan-My unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of now construction. Dimensions
e. Number of stories?
f. Method of heating? Filreplac:es or Woodstoves Number of each
g. Energy Conservation Compliance. Masschec k 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? _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 OERMiT
1. as Owner of the subject
properly
hereby authorize American Installations
to act on my behalf,In all matters relative to work authorized by this building permit application.
See attached 2/9/2016
Signature of Owner Date
I. American Installations ,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.
American Installations
Print Name
American Installations WJ-A 2/9/2016
W
Signature of OwnedAgent Date
9CAe�gi�
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: Wesley K. Couture 106178
Ucense Number
130 College St., Ste 100 South Hadley, MA 01075 9/29/17
Address Expiration Date
�_k)U— Z-- 413-552-0200
Signature Telephone
9.Re1istered Home Improvement Cotitrac£or. _ ... Not Applicable D
Wesley Couture 175982
Company Name Registration Number
American Installations 6/27/17
Address Expiration Date
130 College St., Ste 100 South Hadley, MA 01075 Telephone 413-552-0200
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)j
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....... if No...... ❑
11. Home Owner Egemution
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 persons)
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
i
The Commonwealth of Massachusetts
.Departme of Industrial Accidents
' Offac q oflnvestigations
600 Washington Street
Boston,Mass 02111
www mass govtdia '
Workers' Compensation Insurance Affidavit.Builders/Contractors/FIectricianslPiumbers
Applicant Information Please Print Le0bly
Name(Business/Orrg-anization4iidividuan:hfPo cn n T=—n S U J iiogrz Llf
Address:
City/StatelZip: ,R-g— �T t1 0)61 Phone#i:— oao o
Are ou an employer?Check tke appropriate boa: Type of project(required):
1 A am an employer with a 4.01 am a general contractor and I 6.0 New construction
employees(full and/or part time).* have hied the sub-contractors 7.0 Remodeling
2.01 am a sole proprietor or partner- listed ark the attached sheet.
ship and have no employees These s6b-contractors have 8.0 Demolition
working for me in any capacity. employees and have workers' 9.13 Building addition
(No workers'comp.insurance comp.insurance.$
required] 5.OWe are a corporation and its 10.0 Electrical repairs or additions
3.01 am a homeowner doing all work officers have exercised their 11.[3 Plumbing repairs or additions
myself [No workers'comp. right of exemption perm MGL
insurance required]t c.152,11(4),and we have no 12.0 Roof repairs
employees.[noworkers' 13.XOther�yc1A6!J,1b0
comp-insurance required.]
*Any applicant that cheeks box 91 must also tin out the section below shWag their workers'compensation policy information.
thomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new aifidsvitindicating such.
$Contactors That cheek this box must attach an additional sheet showing;the name of the sub-contractors and state whether or not those entities have employees.if
the subcontractors have"n to the must pravklc Their workers'Sft Eeliznumber.
I ant an employer that is providing workers'compensation i#suranc e for my employees Betow is the policy and fob site
information. t F y
Insurance Company Name:_ ,�mayy(�y -�•�
Policy#or Self-ins.Lic. 1-._ to RW C Ub1*1 I t Expiration Date:
Job Site Address:_5 S W(j-v-,-tcir,& 2klL ChAtate/Zip: 412-\2,y A H A' '- 10(,..2—
Attach
2—
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 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
$250.00 a day against violator.Be advised that a copy o(`this statement maybe forwarded to the Office of Investigations of the
DIA for goverage verification.
I do herby cert under the pains and penalties ofper)lu y that the information provided above is true and correct.
Si nature.
Date.
Print Name: Ua-- - ill
L,4,,re, Phone 4.
Official use only Do not write in this area to be completed by city or town official
City or Town: Permitilicense#:
Issuing Authority(circle one):
1.Board of Heath 2. Building Department 3.Cityttown Clerk 4..Electrical Inspector S.Plumbing Inspector
6.Other
Contact person: Phone#-
1
i
1 � www.AmericaninstaIlations.com
BBB., FASTICIPlam
coffrascm
• Licensed&Insured
MA C5L#:106178
`- MA Registration#175982
American Installations
130 College Street Suite 100,South Hadley,MA 01075•Office:114}3)552-0200 Fax:(413)552-0202•Email:SuPport@Americaninstallations.com
Krosoczka,Gina&Jarrett 11/25/2015
(last) IN.) (Date)
55 Stone Ridge Drive Florene MA 01062
(� I (city) � (scate) (Zip)
860.670.5246 gkroso@gmail.com
IH I Ica)
IEma�q
425031 15-2134
DI
(lob M)
Quantity Unit Unit Cost Total
Air Sealing
AIR SEALING14 man hour $ 85.00 $ 1,190.00
Total Air Sealing $ 1,190.00
Total Air Sealing Incentive $ 1,020.00
Additional Air Sealing= $ 170.00
Weatherization
FLAT-5"OPEN R-18 1,400 lsqft $ 1.21 $ 1,694.00
HATCH SEAL&INSULATE 1 leach $ 60.00 $ 60.00
DAMMING R-38 130 linearft $ 2.05 $ 266.50
VENTILATION CHUTES 75 each $ 2.00 $ 150.00
Additional Air Sealing 2 Iman hour $ 85.00 $ 170.00
Total Incentivized Weatherization $ 2,340.50
Total Project $ 3,360.50
Total Utility Contribution $ 2,775.38
Total Customer Contribution $ 585.13
WARRANTY:American Installations,LLC will provide the above stated homeowner with a 2,year workmanship warranty.
American Installations,LLC hereby proposes to furnish all material and labor to complete the above scope of work in accordance with the above specifications and all local and state building
regulations for the Total Contract Value as stated herein.
ACCEPTANCE OF PROPOSAL:The above prices,specifications and TOTAL CONTRACT VALUE= $ 585.13
conditions are satisfactory and are hereby accepted.You are
authorized to do work as specified.Payment will be 1/3 down prior to Down Payment= $ 195.00 IN 11-25-2015
start of work,and balance due upon Completion. PAID
Balance Due Upon Completion= $ 390.13
gnature
Date
44,er—
Krosoczka,Gina&Jarrett 11/25/2015
Property-r(Priml Pra ner(Sg DA.
Craig t) Dragovich 11/25/2015
Represemative(print( epresemative(Sign
Date
THIS AGREEMENT IS COMPOSED OF THIS PAGE AND THE REVERSE SIDE OF THIS PAGE AND SHALL BE CONSIDERED THE ENTIRE AGREEMENT BY THE PARTIES INVOLVED.THIS AGREEMENT IS BETWEEN AMERICAN INSTALLATIONS,LLC HEREINAFTER
REFERRED TO AS"COMPANY",AND THE CUSTOMER(S)NAMED ABOVE,HEREINAFTER REFERRED TO AS"CLIE NT"AND WILL BE SUBJECT TO ALL APPROPRIATE LAWS,REGULATIONS AND ORDINANCES OF THE STATE OF MASSACHUSETTS OR
CONNECTICUT RESPECTIVELY,AS WELL AS ALL LOCAL JURISDICTIONS.