38D-023 (2) 30 HAMPDEN ST BP-2017-0682
nils#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:38D-023 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Petma: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:INSULATION BUILDING PERMIT
Permit# BP-2017-0682
Project it JS-2017-001115
Est. Cost: $130.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
eGroup_ THE ENERGY SPECIALISTS99381
Lot Size(sq.ft): 14897.52 Owner: NOLAN PATRICIA&DENNIS NOLAN& ROBERTANIEZGODA&CC
NOLAN
'num Applicant: THE ENERGY SPECIALISTS
AT: 30 HAMPDEN ST
Applicant Address: Phone: Insurance:
212 AhES RD (413) 566-1058 WC
HAM PDEN MA01036 ISSUED ON:11/17/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:ADD 2" THERMAX TO K-WALLS, ADD R-49 TO
K-WALL FLOORS
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 ft 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 11/17/2016 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0682
APPLICANT/CONTACT PERSON THE ENERGY SPECIALISTS
ADDRESS/PHONE 212 AMES RD HAMPDEN (413}566.1058
PROPERTY LOCATION 30 HAMPDEN ST
MAP 38D PARCEL Q23 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPL CATION CHECKLIST
' CLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid {
Buildine Permit Filled out
{iiI"
Fee Paid
Typeof Construction: ADD 2" THE, • TO - ALLS,ADD R-49 TO K-WALL FLOORS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 99381
3 sets of Plans I Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ION 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
I-• olition relay
1
Si rirrire of :uild g OfFiicial 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 grunted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
Department use only
_ , City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
_ - 212 Main Street Sewer/Septic Availability
i 6 - Room 100 Waler/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans _
dho 413-557-1240 Fax 413-587-1272 Plot/Site Plans
JEPt Oc eJ ) 6 V$
N6itYAtttC A.. -
.. .. ( Other Specify
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
30 /40,e/eat, „Il Map Lot Unit
,4Jor//.c m/e/c_�. At Zone Overlay District
/ Elm St.District_,,,,, _,.„ _ CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 nOwner of Record: '/
Name'Pynt) Current Mailing Address:
j /' h V �Y- )9v5
I IL &4j-vr ✓ i ;!` i l'It -`� Telephone
Signature
2.2 Authorized Agent:
Z //
,
Sdour ..
. c /3/3 e(/I 4 jryy.
/ , ,.�_ /r//
NameG • / GanemAddress:
4d
Signature telephone _ J
SECTION 3-ESTIMATED CONSTRUCTION COSTS 1
Item Estimated Cost{Dollars)to be Official Use Only
completed byn`er_mi(a Meant
1. Building (a)Building Permit Fee I
1)66 "-
2. Electrical (b)Estimated Total Cost of
14 _ Construction from(6) _ I
3. Plumbing Building Permit Fee
4- Mechanical(HVAC)
5.Fire Protection /4 p _
6. Total=(i +2+3+4+5) /moo. Check Number J ins (16
This Section For Official Use Only
Building Permit Number: Date
— - - aed
Signature.
Building Cornmissionernnspector or Bultdings Date
Section 4. ZONING Alt Information Must Be Completed, Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be tilled 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 moms bide.&paved
parking)
k of Parking Spaces
HI:
shwaz 1poarogt
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO _faDONT KNOW 0 YES Q
IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Page andfor Document It
B, Does the site contain a brook, body of water or wetlands? NO e DONT KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES Q NO 0
IF YES, describe size, type and location:
0. 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,excavation,or filling)over 1 acre or is it part of a common plan
tom'
that will disturb over 1 acre? YES Q NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 6-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House In Addition ❑ Replacement Windows Alteration(s) ❑ Roofing n
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs (D) Decks ED Siding(Cl Other pal
Brief Description of Proposed
Work: ,?// g" Yin we- r /0 A-Uo//5/ Jul4 /95 fe, f- wq// ,444..-s
Alteration of existing bedroom YesYNo Adding new bedroom Yes X No
Attached Narrative Renovating unfinished basement Yes Z No
Plans Attached Roll -Sheet
se. If New house and pr addition to existing housing, complete the following:
a. Use of building: One Family Two Family Other
h. 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 H-of wetlands? Yes No, Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
A Will building conform to the Building and Zoning regulations? Yes Na .
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
L t /irr 1 /' .N6 > ,as Owner of the subject
property
hereby authorize 7/ir b,.v// }} f'///un 4. /)
to act on my behalf, in all matters mien/etc)worlf authorized by this building permit application.
5i turd at Owner 3 Date
I, Jr J jA'.4 / J/ ) ,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.
9
/LMM't 4-f •roc t4c"J _. _.— _
Print Na
114—
Ig ure of Owner/Agen Dale
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: �nr Not Applicable C�
Name of License Holder: ,4/t t.„r„/ 4Yr r,✓c,,iou +t 9',SW
License Number
614 "PI'S .1 4470.✓ in/7 j - 9/b
Address Expiration hate
SGC` //x. Y _........
Signal e Telephone
9.Registered Homa Improvement Contractor: Not Applicable 0
/oft &l`s .f /J/5 /f ,aJ S 1
Company Name 1 Registration Number
Address ' Expiration Date
Telephone fl C- .1.14..
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,925C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
hp the
the butldm arms[
ned Affidavit Attached Yes
Si
- Home Owner Exemption
The current exemption for`homeowners'was extended to include Owner-occupied Dwellings of one I I) or two(2)Homilies
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 788, Sixth Edition Section 1083.E
Definition of Homeowner:Person 1s)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 rho one home is a two-year period shall not be considered a homeowner.
Such"homeowner"shalt submit to the Building Official,on a farm acceptable to the Building Officialthathe/she shall he
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the tab site wilt 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 1liable 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
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: 'c /4 �, I ✓i
The debris will be transported by: /.(. ,., .52//c
The
/, s
The debris will be received by:
Building permit number:
Name of Permit Applicant __
//IG /1 .^
!lJ
Date Signature of Permit Applicant
City of Northampton •
Massachusetts
A
a
ll �i. DEPARTMENT OF BUILDING INSPECTIONS i, �/(t
212 Main Street • Municipal Building �-4, 0b
/'^! Northampton, MA 91660 tp a7‘
Property Address: 30 (y4ntdo/r_. S/
Contractor _
Name: /f L-.or3J ,firv .4l3
c.
Address: 2ft//2 �y�!Asr„t_[, el
13
City, State: - , /14
Phone: 764-410 Si
Property Owner // /
Name: (94, j/, /r✓o%..
Address: Jo /r'r,-.,0Je-. .1/
City, State: ruongsn.p.54-7 /t74
I, 4 E v a/af) (contractor) attest and affirm that the building I intend to
insulate does n4,f have 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 sign. ,. -
Date
//-/6/4l
The Commonwealth of Massachusetts
Department of Industrial Accidents
( Office of Investigations
I Congress Street, Suite 100
Boston, MA 0.2114-2017www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name diusincss/Organization Individual): The Energy Specialists
Address:212 Ames Road
City/State/Zip: Hampden, MA 01036 Phone#:413-5664058
Are you an employer? Check the appropriate box: Type of project(required):
1.0 I am a employer with 2 4. ❑ I am a general contractor and I 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 8. ❑ Demolition
working for me in any capacity. employees and have workers'
9Building addition
[No workers' comp.insurance comp- inmranccl
required.] 5. 9 We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their II.❑ Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] c, 152,$1(4),and we have no
13. Other insulation
employees. [No workers' _.—
comp. insurance required.)
*Any applicunl that checks hux al must also IiII out the section below showing their porkers compensation policy information.
Homeowners who submit the affidavit indicating they um doing ell work and thenhireoutside contractors must submit a new affidavit indicating such.
Contractors that check this horn est attached al dditional sheet showing the name of the sub-contractorsandState a bet h hose entities have
employees- le the sohmonnwcum have employees,nxy nom provide IOU wnrken comp_policy mtmb.x
l am an employer that is providing workers'compensation insurance fir my employees. Below is the polity and job site
information.
insurance Company Name:Associated Employers Group
Policy#or Self-ins. Lie, #:WCC5009547012014 Expiration Dale: 10-16-2017
Job Site Address: i'k,..dJf.,) SI City/State/Zip: Abrgc,.- fp r9-
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. i52 can lead to the imposition of criminal penalties ofa
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form ofa 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 he forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
l rho hereby e-+-- er the pain pewit' ien p
fry that the information provided above is true and correct.
Signature: ..i" Date: //-/G/G
mew : 4135661058
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):
I.Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other -
Contact Person: Phone a:
uc NCluvou a ici.y
V r Board of Budding Regulations and Standards
License: CSSL-099381 ,.,.,�
Construction Supervisor Speclaity N -,1
MICHAEL EOADENWOOD
212 } -
212 AMES ROAD
HAMPDEN MA 01036
N-1.--, ......C_N-1.--, =xpiration-
Commissioner 03/09/2018
-J:1 •0,,,/,,(,,,,,,,(t///or:r(„jac/fnjr< - -
Office of Consumer Affairs 8,Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
Type: IntliNtlual before the expiration date. 0 found return to:
}V_ Registration Expiration Office of Consumer Affairs and Business Regulation
153287 11/13/2018 10 Park Maza-Bode 6170
Boston,MA 02116
The Energy Speciafsts
Mike Grenwood
212 Ames Rd. `D cr5 --
Hampden,MA 01036
Undersecretary Not valid without signature
"1 ACOROR CERTIFICATE OF LIABILITY INSURANCE pArel.eaopn..n10ngrm15
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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 poticyOes)must have ADDITIONAL INSURED provisions or 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).
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'lL• cd In policy terms and conditions Sole Proprietor excluded from coverage on the Workers Compensation policy Additional Insured status is a ulcer ads with
'e{0<i.e.to Inc General Lability and Auto Llabihly policies when requested by written contract.
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CERTIFICATE HOLDER CANCELLATION
•
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
i [no Energy Specralisls THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
I 212 Ames Rd ACCORDANCE WITH THE POLICY PROVISIONS.
han'mden.MA 01035
AUTHORIZED RE PRF SE N TAnVE
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