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24A-250 (3) 201 NORTH ELM ST BP-2017-0778 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24A-250 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-2017-0778 Project# JS-2017-001290 Est. Cost: $3000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JAY BOLAND 101880 Lot Size(so.ft.): 7971.48 Owner: HEBERT MARGUERITE F&JOSEPH 0 HEBERT III Zoning:URA000)/ Applicant JAY BOLAND AT: 201 NORTH ELM ST Applicant Address: Phone: Insurance: 12 PISGAH RD (413) 203-2454 0 WC HUNTINGTONMA01050 ISSUED ON:12/13/2016 0:00:00 TO PERFORM THE FOLLOWING WORK INSTALL POLYISO IN & 12" CELLULOSE IN KNEEWALLS 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 12/13/2016 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck-- Building Commissioner File#BP-2017-0778 APPLICANT/CONTACT PERSON JAY BOLAND ADDRESS/PHONE 12 PISGAH RD HUNTINGTON (413)203-2454 0 PROPERTY LOCATION 201 NORTH ELM ST MAP 24A PARCEL 250 001 ZONE URA(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled outFee Paid TypeofConstruction: INSTALL P64,0 12"CELLULOSE IN KNEEWALLS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 101880 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO TION 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 fffi '�'r 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. {-C � Department use only ce....„----- tIc•• �V \ City of Northampton Status of Permit ` 9� . \ :uilding Department Curb Cut/Driveway Permit ` J 212 Main Street Sewer/Septic Availability \ I IRoom 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 PIotfSite Plans 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 �U ' l ccIM 5 Map Lot Unit IIINIk c-H , r D-\-cr) m A Z) I U co U Zone Overlay District Elm St.Disbict CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: lit/Z-- 1 \�h,zr't 9c) N i m stry ' Name(Print) Current i gA d ss: 7C� uphPrl ) vr - n o-I-7,0 on e; oIo6,0 Telephone / Slgnatu R I t3 - CD ei S c/-'Q Sb 2.2 Autho ized Agent;., as3 Cz, IIaL,e Qk hu- Name(Pont) � s Current Mailing Address: ��G am-1) unrel OI O �� �1 i Signature Telephone y 13- ,;D .3 - 044 ry SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of I Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection l/ 6. Total=(1 +2+3+4+5) Check Number /6 39" /,S This Section For Official Use Only Building Permit Number: Date tIssued: Signature: Building Commissioner/Inspector of Buildings 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: It: L: R: Rear Building Height Bldg. Square Footage % • Open Space Footage (Lot area minus bldg&paved parking) N of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW CY YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW G YES O IF YES: enter Book Page and/or Document// B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained ® , Date Issued: C. Do any signs exist on the property? YES O NO ..13 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES NO cr 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 that will disturb over 1 acre? YES NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ri Addition ❑ Replacement Windows Alteration(s) Roofing 0 Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [0 Siding[pJ Other[CO Brief Description of Proposed-- tl Work: 1-1-\S 1k �a �Iw In 13 0_LILO o .� t-, Krks-4.,�e'.a\\ S Alteration of existing bedroom Yes '�No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes -No Plans Attached Roll -Sheet sa.If New house and or addition to existing housing, complete the following: a. Use • •uilding :One Family Two Family Other b. Number of roo 'n each family unit: Number of Bathrooms c. Is there a garage attaches' d. Proposed Square footage of new co cion. Dimensions a Number of stories? f. Method of heating? -'laces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck -- sy Compliance form attached? h. Type of construction i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. -••dplain 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 AG)FNT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, --\ Ci,e___ —40E0- ,as Owner of the subject property �J, hereby authorize vA'�' A 0LI.-� to act on my b half,in all matte re alive to work authorized by this building permit a plication. ak ' _he �L r ( �� ( I h Signature of Owner II -- Date 11111111111111 -f.,---\ ,as Owner/Authorized Agent reby declare th t th statements and information on the foregoing application are true and accurate,to the best of my knowledge lief. Signed undef the pains an penalties of p rjury. � 1. 01 Print Name N ME ENERGY SOLUTO S „uHTwc N M 050 Wad 131 C2I Gc Signature of Owner/Agent /"} - Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder_ S' 1 ' A�1�� \ 0 ( 2 C License mbar 33 <,oI\ .$ u ' . _ a--i \ ) Address Expiration Date . Ox41 , v•-3 (TIA _A Signature Telephone 9.R ` .. - ome Improvement Contractor. Not Applicable 0 *AIL 4fl2rqu Sulu hoc\ S lL./ Lk,o `.3 Company Name l ,3�IRegist tion Nui^ber :33CVi (0 - 41�i1U''rnl� SutLihlm (I ) l] 4 6 f �(P1i7 Address .JJ LII 3 '0)D )' /,C rEzpiration Date Telephone 'I I SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 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 buildi permit. Signed Affidavit Attached Yes No '0 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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 Permit Authorization 4,„ `"t 55 Form "� Site ID: 2206210 Customer: Joe Hebert I, Joe Hebert ,owner of the property located at: :owners Name,printed) 201 N.Elm St Northampton (Property Street Address) Ian) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. Owner's Signature: D 1'-.i—eut•r'�tA0. Date: ISI 4/) b FOR CLEAResult OFFICE USE ONLY CLEAResult has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor - Date R-❑ • CLEARewa • 50 Washington Street,Suite 3000, 0 Westborough,MA 01581 • 1800420-1472 - W] 12 rotOMce Use they Rev.10201s 4t' .. The Commonwealth ofD4oesaehHAWN j-x Department,f Industrial:Accidents t" c 1 Congress Street,Suite l fltl 44 Boston, MA 02114-2017 F` _-7 'Zi ' ; ,i%gj--' "' mmm.nmsvgolthlia Workers' Insurance Affidavit:inuikleisfCuutrectarstElectriciansfPWadurs. ILO BE FILED WITH-rm.:FERMI-11W st'rlIORI I. \Dplirxnt lnfnrntadmt Please Print Iceni_ebly ---on,�, l S.Lr enS cll.):StO '/ip _ . l ._ (l\AY01J0u0Plu'nc '!: 'i`�1,3- �j�// ii Ira,.. chart mr app o-u": 1 project eq 1 1 'type ur ni eco(r uirnl : 10 a:r..: ‘"rt emilli,cc niai and o:rv,l-true' 7. ❑New construction iil i atu rink propretar 44 put' a,.:h!I,'c a0 C3100 %.\Olkillgfor nm in s. ❑Remodeling. :ar:e . IN0.ve,c.. comp o,:wn.e re,paral i9. ❑Demolition It)[0 Building addition I❑h i n.irc.-aaaac?, b,,aa$,h n ra _. i_a\ obara ao - I -r.n.ahc-haL , cuopu, ,.0 ,,.,+ x,Air I I.❑Electrical spc ricat un or additions rngv:ax...rl,:,.,cryo,.„e= I,.❑Plumbing repairs or additions a 0 I am a pn¢r:a Ccan,no lar nal I hate hared IM ad.-Canna ctor%INN]on xn nilachd Aa.-. I3.1-1Rtxrl repairs If ratraNagractor:Kne emit,tra.md true kcompinmiCallee N 0 t ate-c.+rr. x ... ka .sixt tRM m6eieaaiwr MGI... IJ.[�()tlter - _ .. .Ort.al ti hl,,a,cmptt..re, No.eorkars comp nmuawe ryu,mdI 'Any Ill want ilia: I t I must also Ill gatd MI Mi l :'corairatration r.lii.winlinriallt,11. 'II s who s.W Illi taina nJ of nc.., dela all k and then slde C ale must maim , ..d :mdi.al;n...cah raxar,.a,xs that duck Jib boxNur,:m ch... :n w:T.nu:ul six 7 SJhmai flit mtox afth(sab.oatmehnx mid ale"cher or,w.I;M,a maim-.Ii;, rtart”tras 9zhamuS aareo4^hat emrloyrrN Mn-mut prey Seting suetai n.:nr polw'x ntndxr 4.,.....--- .......-- I I am an employer that is providing oaken'compensation ins:waneeJim nn'employees. Rehm,ix the policy oadjob cite itttl motto tri. /1 InsuranceCompany Name: G QI�.: - .tor ncQ. earn c? Policy c or Sell-ins.Lie _ 3..tutJL l alta. _— F,pmrtion lkm: MY ..il 2O I Joh Site Address: Cl K. 0111 cifez City:State:Zip_N'S' \ionpith 1M0 ^ Attach a ropy of the Workers'compensation policy declaration page(showing the policy number and expiration date). (% I 0(470 Failure to secure coverage as reyuir v!under MGI.c. I S §25A is a criminal violation)xoi,dnable by a tine up to S 1500.00 and.'or one-year imprisonment.as well as civil pcn:dties in the form of a STOP'YORK ORDER and a 0nC of op to 5250.00n day against the violator.A copy of this statement may be Ibnraded to the 011ice of Investigations of the Dl-\ fur insurance coverage verification. I do hereby certiji under the pal r al unties ofper ocr and Me infOrmotion prmided ohms,is true and correct 'l ' 17C1 (C Phone _. . _—.... .." x-}13 00_32-04514 0.3 51{�_ Official nose only. Do not write in this area,to he completed by cite or town official City or Town:�.._ Permit/License Q . Issuing Authority(circle one): I.Board of health 2. Building Deportment 3.City/Town Clerk 4.Electrical I nspecto r 5. Plumbing Inspector 6.Other Contact Person: Phone tt; m. Office of Consumer Affairs and Business Regulation N1/4 i 10 Park Plaza-Suite 5190 Boston,Massachnsetis 02116 Home Improvement C dor Registration DEA 1-44121-":;:Eft i-'— '- E 161Ma17 Trt 270928 HOME ENERGY SOLUTIONS :Y -ki r JAY BOtANOI'd >; 12 PISGAH RD. ';;>�1, -a HUNTINGTON,MA 01050 (F*T rt `t9' = "'Dgbiat /eA+ uadn oa. cd r , Mss ..for ac., o aaa.n ❑Adam ❑gra 0> Q t.a,cc.rd Gowerlir Vafantemeoreti Wafaadaoseat Mot idM au a:na:co a.aa a.. .soca or.rw.mao mid to iaaind.°.e,.y .9ROM9EJrtt7DxtB TOR aa2aetbeenfiad..4.*. IX*adman lox +: Regf.__ 162803 Typo OmteeRawlrwrerA .and.e•apta. � _ II batlike*-Satan* HOME EMER6r a -11Z:;_:;-: B«O..MAUIIs -. JAY BOXAtm -S:-.:,, _ 12 FaSfiaHRD. _ Vis} ak-ra----- MMDNGTON.aa01tt50::' Ia rowie an Net.aaiiib..a._eat 9 ma.acttt -Department of plaint safety Dowd of HudkEng Roguiatians and Standards CoUcenow ratnadkaa$SpSpedaLly Abb ahr- sse MIraa.aa= X 1 t. aintionum Y'r, . 1.(.C. arena' EXpio T`` taHn NTEM A CERTIFICATE OF LIABILITY INSURANCE DATE MUUMI11/2/2016 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). PRODUCER “nnna Barbara Van Mourik Finck 5 Perras Insurance Agency Inc. ?HONE (413)527-5520 FAX NoL(4151527-6970 6 Campus Lane Itittransourik@finokandperras.com -...- INWRER(S)AFFORDING COVERAGE /WC II Easthampton MA 01027 INSURERaI4ain Street America Asar Co29939 INSURED INSURER BEEP( Insurance Comgany 14788 Home Energy Solutions INSURER C NOrCTJARD Insurance Company 31470 Jay Boland dba amuses e: 233 College Highway INSURER E: Southampton NA 01073-9324 INSURER?: COVERAGES CERTIFICATE NUMBER:CL16101702534 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, R TYPE OF INSURANCE men SWenISR ?ONLY NURSER 100101)Y EVE imUCYEXP LIIWYYI IIIMMORYYY1 GYMS X COMMERCIAL SMARM. II ran nY EACH OC4LWRENCE 5 1,000,000 TWIXORIPPTATED A CLAIMS-MSE L.1 OCCUR1 5 500,000 _ 1011922T 11/1/201.6 11/1/2011 ME0 Exp(Any pleµ/9p) g 10,000 -I LWT7922T 11/1/2015 1111/2016 PERSONAL&ADV INJURY 5 1,000,000 GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 5 2,000,000 X Mt" 1MCI LOG PRODUCTS-COMP/OPAGG f 2,000,000 OAR. EPU S 10,000 AUTOMOBILE UABILitt GOWNED SINGLE LIMIT $ 1,000,000 lEr040nR1 AM,AUTO BODILY INJURY(Per person) 5 B ALL OWNEDSGEODULED AUTOS X AUTOS T4150457n 1/02016 1/02017 ecOtt tOuRyiPa'a(NaY) S © HIREtl AUTOS X gm EO PR ONMGE S .J- uednnewetracist Bark $ X UYeRELLA LAB X 00011 EN* OCCURRENCE 5 1 000,000 MESS GAB CU ]925T 11/1/2016 11/1/2017 AGGREGATE SBi 1 000,000 PEO RETENTIONS C011925T 11/1/2015 11/1/2016 L MOSCOW COSPINSAIION X FN OTM- ANDOIPLDY?.RS'MAmgnY I`T.tE_ER_,1.� AW PROgBETOWPARTIIDJ XECUUVE YIN MIA E.L EACHACOIOENT S 500,000 aFlCFRMF.ABER EXCLUI)ED1 C (� ARUymuU,Mpy in NH) 21101 8269 11/1/2016 11/1/2017 EL DREAPA•EA EMPLOYEE ,,, S 500000 _ under ILL Tk ATION:IRA . TiF12B269 lij1/2015 11/1/2016 EI iMSEASE-NUCY two 5 500.000 t DESCRIPTION OF OPERATIONS/Lo:NIgIS I?ENCLES(MOORS a%,AbRUmal Rmmals Schedule,may M Mather/Nnwn apace W remirk) Proof Of coverage CERTIFICATE HOLDER CANCELLATION (413)587-1272 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Northampton THE EXPIRATMN DATE THEREOF, NOTICE WILL BE DEWERED IN 212 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Northampton, MA 01060 A REPRFSExrpm.>_ / yyyy// / /'/,1i/n///dWZ. ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INSO25(2014011