32A-083 (5) 46 GRAVES AVE BP-2016-1462
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32A-083 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-2016-1462
Project# JS-2016-002507
Est.Cost: $2375.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: POTENTIAL ENERGY LLC 106184
Lot Size(sq. ft.): 4356.00 Owner: JESWALD PETER&PHYLLIS K AND BOB ABRAMMS
Zoning: URC(100)/ Applicant: POTENTIAL ENERGY LLC
AT: 46 GRAVES AVE
Applicant Address: Phone: Insurance:
4D QUEEN TERR (860) 620-4433 WC
SOUTHINGTONCT06489 ISSUED ON:8/4/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:INSULATION IN CEILING
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 Sienature:
FeeTvpe: Date Paid: Amount:
Building 8/4/2016 0:00:00 $65.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2016-1462
APPLICANT/CONTACT PERSON POTENTIAL ENERGY LLC
ADDRESS/PHONE 4D QUEEN TERR SOUTHINGTON (860)620-4433
PROPERTY LOCATION 46 GRAVES AVE
MAP 32A PARCEL 083 001 ZONE URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid Cl-a /a13'/ 0s—
Building Permit Filled out
Fee Paid
Typeof Construction: INSULATION IN CEILING
New Construction
Non Structural interior renovations
Addition to Existine
Accessory Structure
Building Plans Included:
Owner/Statement or License 106184
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION 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
0.1>rill. o1i •. . . g
"....,
2 ar—
Sig . re o urldin_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.
sire, 4rg
City of Northampton ' c �� �
/ ''�2 «as,1 :r, ��`
�_ Building Department '� ''� ' G: . -
41 212 Main Street `"'( `•^
' - Room 100
t /. : Northampton, MA 01060 - � '� ' � g
phone 413-587-1240 Fax413-587-1272 -a , , ^° � ;,.. _ , ,
Mgr • . t •. _ : : _ .. . I. • IJ
SECTION 1 -SITE INFORMATION
1.1 Properly�Address:
This section to he completed by office'TAY G r c&ves Averlut Map Lot Unit
Zona Overlay District
NCrthathr00NA &IWO Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
iOh AOvra✓��riS 40 6Ya&e SAue,Noilhar`npton,In4
Name(Print) Cu t Mail less.-
' IG Z On) ()(0(%(i
T One
" 5 5
Signature
2.2 Authorized Agent: _
POteliii FfFtq y1 LLC A .01 [ .vr (` � . hiitsi fCITAli
Name(Print) Current Mailing Address:
• */l 4G'+o- 1413
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Offidal Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Pemlit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) , `n
I 3-5, 00 Check Number sa34/
This Section For Official Use Only
Building Permit Number: Date
at
ed:
Signature:
Building Commissioner/Inspector of Buildings Date
SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) I I Roofing ❑
Or Doors C
Accessory Bldg. ❑ Demolition ❑ New Signs DJ) Decks [[] Siding[0] Other[En
Brief Description of Proposed cef frog 1i r SLI iGtl6 �
Work: l (/✓ l/U
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
ea. If New house and or addition to existing housing.complete thefolowlna:
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 stones?
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? 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, / 3(117 bitomm( ,as Owner of the subject
property
hereby authorize fro[t 17 1 i a/ LL-C-
to act on my behalf, in all matters relative to work authonzed'py(his building permit application_
Signature of Owner Date
1, J Spt .e ( o ' ✓ r ey ✓ I—1- C-
as Owner/Authorized
Agent hereby declare that the statements anu 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.
NIOW/61 Me ,SiCi'
Print Name
Signature of Owner/Agent Date
SECTION 8.CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor:
/? ( I /, ) Not Appplicable 0
Name of License Holder: tAi( (.11C/(L.S Il1EIJI l,l Csri� 1Of(/i54
License Number
Address 4 (1�Wen T(�.-5/�i; hi�?gfG�,�)( /� (J� 41231.201g 1 Expiration
Signature 'J�i 'I�� �� 13 �L✓TU
Telephone
$.Reolstered Nome Improvement Contractor, Not Applicable 0
`CV l Vci l!,/ 1 LL 'N. 1 y; , I., i �r ISf"iY I7g1401
Com n Name �/ - /:` �� G Registration Numbermg
AddressQ ue4/ i -en/ ,/)ou/ki ilcil OX rbli Rq 7'22L20' 8
,L 'L Expi ation UUUaaattteee
Telephone IV 42t I�
— I
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 X No__.. ❑
11. — Home Owner Ent-motion
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
jf
The Commonwealth of Massachusetts
4.
�_rn Department of Industrial Accidents
r 1 Congress Street, Suite 100
1r1. S cr Boston,MA 0211 4-2 01 7
��' www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information ,y�}.p ire s� /� Please Print Legibly
Name Business/OOrrganiizzatiowlnppdividuaalL rt/ -e In tIaI Er er y, LLeIN I c hoins Mast er
Address: 4 i) IY�Ae.em Terrace Jf,,J ��/l��
^Oi. EI Atria LTtf4njPhone#: (WO (.V20 4 '
City/State/Zip:
Are you an employer?Check the appropriate boa:
Type of project(required):
II am a employer with 5 employees(full Sor part-lime).•
I. 0 New construction21 amok proprietor or partnership and have no employees wetting for mc in
any capacity.[No workers' im
comp. umnce required) 8. ❑Remodeling
10 I am a homeowner doing all work myself.[No workers coop.insurance required.]t 9. ❑Demolition
<.❑Iamahomeowner adwill behiring contactorstocoductall work onmypropetly. I will 100Bnlldngaddi on
ensure that all contactors either have workers compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees. 12.0 Plumbing repairs or additions
50 I am a general contractor and I have hied the subcontractors listed on the attached sheet.
These subcmmnetors have employees and have workers'comp.insurance.: 13. Roof repairs1nn
6.0 We arc a corporation and officers their right ofexemption per MGL c 4. Ohe 4k15 l I4,CIGV
152.§I(4),and we have no employee.INo workers'comp.insurance required.)
*Any applicant that chocks box MI must also fill out the section below showing their workers compensation policy information.
'Homeowners who submit this affidavit i dicating they are doing all work and then hire outside wohacmn most submit a new affidavit indicating such.
;Contactors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employees If the cob-contractors have employees,they not provide their workers'comp-policy number.
/am an employer that is providing workers'compensation(�/ k/iinsuu�rance for my employees. Below is the polity and job site
information. "
Insurance Company Name:/ `,f[[,7, �)(et E leulotnef GYVNp p i/�
Policy#or Self-ins.Lie./#::7)Aii- 2Lip
11 jREO V� /09 Expiration Date: pO O/057/4u1iv /}�/J/"� �'�/ ��
lob Site Address:4cc l V0 VexS %lV nlil1. City/State/ZipA/OklhC/nriO/(i(//T/C/(i(P(,'
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to 51,500.00
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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
1 do hereby certify under thepains and penalties of perjury that the information provided above is true and correct
�
Signature: /'-"J÷ 2 Date: (Olt; i i I'
Phone St: CMOO ) 1a20- 4433
Official use only. Do not write in this area,to be completed by city or town ojjicialu
City or Town: Permit/License#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Client*: 82429 MEISTNIC
ACORD. CERTIFICATE OF LIABILITY INSURANCE °"'E1"x"°NTYYY)
07/31/2015
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 POLITIES
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 N an ADDITIONAL INSURED,the holicy(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 =rAFT Audrey Lamontagne
Fradette Carlson Agency
alamontaAc EA.!860 583-0943fc 1 ,xq: 860-585-0038
PO Box 2456 Eaw. -ins.com
Bristol,CT 06011-2456 AwREssl g
s
860583-0993 INSURER
s)AFFORBNG COVERAGE PINCE
URER A:Hartford Ins Group 19682
INSURED INSURER 8.
Nicholas Meister DBA —-
INSURER C
Potential Energy LLC
4 D Queen Terrace D
Southington,Ct.06489 INSURER E
aaus F:
COVERAGES CERTIFICATE NUMBER: 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
NDICATED. NOTWrHSTANDNG ANY REQUIREMENT. TERM OR CONDITION OF NW CONTRACTOR OTHER DOCUMENT WFH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCEDD BY PAD CLAIMS.
LTxR TYPE OF INSURANCE xlS�p a POLICY NUMBER (=gym
IIwYDNYEYYYYY)_' LIMITS
A GENERAL LIABILIY x 02SBMRB0509 08/05201508/05/2014 EACH OCCURRENCE s2,000,000
COMMERCIAL GENERAL LIABILITY1R ppElEgn
SIP/N000
I CLAIMS-MADE X OCCUR MED EXP(Any one Parson) s10,000
PERSONAL S AIN NARY _s2 000,000
!GENERAL!GENERALAGGREGATE s4,000,000
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COWIOP AGO $4,000,000
POLICY JJEESOT n LGG s
AUTOMOBILE LY,BLrTY
COWERED SINGLE LIMIT
(Ea accident) $
ANY AUTO BODILY INJURY(Par IvcnE.
_ ) E
ALL OWNED I-7 SCHEDULED BODILY INJURY per amide/0 $
AUTOS
F--4..N N O
NPO PROPERTY DAMAGE E
HREDAUTOS AUTOS AUTOS Apar arnMnlZ______
$
A _X UMSREDA Lva OCCUR 02WECCR0745 08/05201508/05/2010 EACH OCCURRENCE sl,000,000
EXCESS MAB CLAIMS-MADE AGGREGATE SE,000,000
DED I XI RETENTION 610000 _ -T $
A WORKERS COMPENSATION 02WECCR0745 8/05201508/052018 XIwiiariAiurs FaN
AND EMPLOYERS'LIABLITY T�----_.--
ANY RiOPAIMBEREXRTNER/EXECLRIVE YIR EL EACH ACCIDENT $500,000
OfEIGER/EMBER EXCLUDED? V NIA
IMeMYVYInNN) EL DISEASE-EA EWLOYEE $566,000
[AsaoIPTION unlit
RlPrIDNDEwERArlOns mm. EL.DISEASE-POucvuMr 1500,000
DESCRIPTION OE OFERATENS I LOCATIONS I VEHICLES(Attach ACORD 101,AVORbnalRemate Schedule,E Imre yam 1st-equine)
Columbia Gas of Massachusetts is additional insured on general liability and umbrella liability per written
contract or agreement
CERTIFICATE HOLDER CANCELLATION
Columbia Gas of Massachusetts SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE E1IPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
4 Technology Drive Suite 250 ACCORDANCE WITH THE POLICY PROVISIONS.
Westborough, MA 01581
AUTHORLTED REPRESENTATIVE
i..lot' a 4-2
I
ei 1958-2010 ACORD CORPORATION.All rights reserved.
ACORD 25(2010/05) I of I The ACORD name and logo are registered marks of ACORD
#57166666/M716663 FCAJL
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st2?1, Apo
Dan Whiteley, Inc.
52 Conace St.
Easthampton MA 01027
(413)527-1440 FAX (413)529-9788
LIC ? A7975
August 2. 2016
Bob Abramms
Peter 7eswald
P.O. Ras 367
Conway_MA 01341
RE: 46 48 Graves Ave.. Northampton
Jo Whom It Mac concern:
Please note that all knob and tube wiring to the best of our knowledge has been removed or made
dcsfunctional at 46148 Graves Ace.. Northampton. MA . All yisihle wires connecting the knob
and tubes have been removed.
Sincerely. '
Dan Whitelec
Dan Whiteley. Inc.