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24A-039 48 BLACKBERRY LN BP-2017-0881 GIS#: COMMONWEALTH OF MASSACHUSETTS Mao:Block:24A-039 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-2017-0881 Project# JS-2017-001496 Est. Cost:$2057.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group THE ENERGY STORE Lot Size(sp.ft.): 10410.84 Owner: CALDWELL OKEEFE JENNIFER Zoning: URB(IOU) Applicant: THE ENERGY STORE AT: 48 BLACKBERRY LW Applicant Address: Phone: Insurance: 97B E TAYLOR HILL WC MONTAGUEMA01351 ISSUED ON:1/23/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:AIR SEAL ATTIC & BASEMENT, INSTALL 12" OF BLOWN-IN CELLULOSE TO ATTIC FLOOR. INSTALL R19 FIBERGLASS TO KNEEWALL SLOPE & R13 FIBERGLASS TO GABLE WALL 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: Feerype: Date Paid: Amount: Building 1/23/2017 0:00:00 $65.00 212 Main Street,Phone(413).587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-0881 APPLICANT/CONTACT PERSON THE ENERGY STORE ADDRESS/PHONE 97B E TAYLOR HILL RD MONTAGUE PROPERTY LOCATION 48 BLACKBERRY LN MAP 24A PARCEL 039 001 ZONE URB(100)/ 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: AIR SEAL ATTIC&BASEMENT,INSTALL 12"OF BLOWN-IN CELLULOSE TO ATTIC FLOOR. INSTALL R19 FIBERGLASS TO KNEE WALL SLOPE&R13 FIBERGLASS TO GABLE WALL New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ION 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 Pennit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management D-moli['tn D ���/� /—f3/7 .me of Bur din ffrcial Date * Variances are granted only to those applicants who meet the strict standards of MOL 40A.Contact Office of Planning&Development for more information. r 2 -� 'City of Northampton Status of IM� 1 /Building Department Curbs of Permitveway Permit use only 2 3 LN, 212 Main Street Sewer/Septic Availability i _ Room 100 WateNWell Availability _ • - --1 Northampton, NIA 01060 Two Sets of Structural Plans _ phone-443-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION ;-4it 1.1 Property Address: This section to be completed by office HF atokocscRWj sm. Map Lot Unit NoRflAw?Tbal AA oloNDO zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: JEtJAi)FER CALDWELL- OK£Er6 `/g BLAOXOCRRY L. I. MoRTt1A,4 , MA oil Name(Print) Current Mailing Address: SFE A'TYAcMeel Telephone signature BOT-223 - 03-10 2.2 Authorized Agent: Cts 0 E. 1719Loa tit LL RP, CHRt5ruP11Ee ALLed f-towrAGJE, rMM4 01351 Name(Print) Current Mailing Address: (zuct 475-zoo- 1/5-1.5" Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee i 2051 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection e i% �" 6. Total=(1 +2+3+4+5) 42pr7 Check Number !Oa?0 y �p This Section For Official Use Only Date Building Permit Number: Issued: Signature'. Building Commissioner/Inspector of Buildings Date Section 4. ZONING AU Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to he filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage in (Lot area minus bldg N paved parkins) #of Parking Spaces Fill: (vulume&Libation) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW Ai YES (Ti IF YES, date issued: 1111'"""'"`` IF YES: Was the permit recorded at the Regi try of Deeds? NO 0 DONT KNOW YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW 0 YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® 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 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,ex anon.or filling)over 1 acre or is it pan of a common plan that will disturb over 1 acre? YES O 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 n Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors 0 Accessory Bldg. El Demolition 0 New Signs [p] Decks ID Siding l0] Other0 WEAThERIZATa4I Brief Description of Proposed Work: Ate 5EAL I nc. 3 &,nnfl . IOTALLx r OF 134,61N-b4 CELLULOSE re *me FLOOR. ,.35TALL Rt9 FlSER*LAs5 TE fNEEvJtrLL, S�o9E 3 RI5 FIBEe$LA65 Te GABLE WALL. Alterationof existing bedroom Yes X No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes X No Plans Attached Roll -Sheet 6a.If New house and or addition to existing housing, complete the following: 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? 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. JEAnii FEM. CAL DWELL--OKEEFE , as Owner of the subject property hereby authorize CH1215 Tb Nat ALLEJ to act on my behalf, in all matters relative to work authorized by this building permit application. SEE A}rrk4-1ED Signature or of Owner Date I. ChRLSToPPIE¢ A LLE4 ,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. CItRlyr-PUEK ALA-Ea Print m• • o at 1�19�1� Signature of 0 er/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holler_ CNRLSTDQHER AL LEJ IOU/O$2 License Number i-bFThA..V sr. Toge JC<rorJ cT 436440 3/ Isizo Addr ss + Expiration Date (ex. q --asr�S og1 4 Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ 17g 39 2- Company Name Registration Number E4tsY Pott LLL. / ko5cet /key- "Tho/Ig Address Expiration Date 3i OLD Rant I H¢ookFi6LDiLt" O elephone -tie-ULU 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. - 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 1083.5.1. 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 foracceptable to the Building Official that be/she shall be m responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will he 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 I 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 NSA SEE A-rrAcHED 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: 'fl BhsctBE.ae.Y L-pJ, The debris will be transported by: tic DEBR1s The debris will be received by: No DEBats Building permit number: Name of Permit Applicant/nlint� CsRtsToVi{Et2 A1 .4 .-E 1119117 Date Signature of Permit Applicant City of Northampton Q i X Massachusetts . i d ' t '' 4 DEPARTMENT OF BUILDING INSPECTIONS V ® ^. 212 Main Street a Municipal Building FI ^ Northampton, MA 01060 rf'W go‘� Property Address: i'% BLAUcaEQ 'l Int Contractor f' Name: CHRASToc4kEt. ALtEr4 Address: 97-B 6. rolLoe HILC P.D. City, State: ni0r3TACsuE , MA 01351 Phone: 144-S—244 —4SlC Property Owner Name: itNnhc,E2 Cr4LDVJELI_— ©kEEFE Address: Lit $LAcie EQRY L-rj City, State: Abet kAwPTanl, M,i ©IO(a0 I, CI#eisroPKie 4 LLE.( (contractor) attest and affirm that the building I intend to insulate does not 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 signature (( ckfh Date ( ' (/19117 =a„ The Commonwealth of Massachusetts ,,L"_ Department ofIndustriatAccidents "_ ! !fit Office of Investigations _ _x ) I Congress Street,Suite 100 ./.✓ �' �u Boston,MA 02114-2017 °%`' www.mass.govi la Workers'Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers Applicant Information �( Please Print Legibly Name(sosinesiorgaaniizationttndiivvid1uai): he E{p j S± 'f�� __ ( Address: t) )i --\-- 7 l City/State/Zi•: j'I4ss. i ' #4itC _ Phone#: g71 Sio- lob41 Are ou an employer?Check the ape ropriate box: of ec[ 1. I am a employer with 3 4. 0 I am a general contractor and 1 Typeeproject j (�uwed) employees(full and/or part-time).* have hired the subcontractors 6. New construction listed on the attached sheet. 7. 0 Remodeling 2.0 I sur a sole proprietor or partner- ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp. insurance.; 9. ©Building addition required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 P ing repairs or additions myself [No workers' comp. right of exemption per MOL l2. oof re , insurance required.] t c. 152, §1(4),and we have no employees.[No workers' 13. Other lit,.11E1 D■ comp.insurance required:I _ 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all wore and then hire outside ct naactors must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the name of the sub-contactors and state whether or not those entities have employes. 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. 1n�`�//�` -�`. Insurance Company Name:_ N(j },..(Y.tllra(] f t[}j',(iarlf 1 ,---ric - Policy#or Self-ins.Lic.#:,. I, A . 9 •x..11 j Expiration Date: y 161 2.017 Job Site Address: ''Pi Bt AUC BERRY L J, City/State/Zip: A)ORYt♦AMPniffit MA ()IOW 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 cerci under the pains and penalties of perjury that the inform talon provided above is nue aid correct Sia attire; .„'r^^Ij it.. Date: ij 08117- ........ Phone#: 47C—204 4“5- 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#: ACORO CERTIFICATE OF LIABILITY INSURANCE D&12J2(ISSW 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 CONS1TI13TE 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 policyjias) must be endorsed. If SUBROGP.TION 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 cerd;icate holder in lieu of suchendorsement(s). PRODUCTO Cabinet.Brian Gallagher BITE Insurance ILCjenCY, Inc. PNONE (914)931-1230 FAX 000I3t-1a LAIC NP E#i_. LA!6 NoJ_ G _.. 111 South Ridge Street n De R65s:boa1lagherebncagencY-coin INSUHER(5)AFFoROW6 COVERAGE NAIL a. ._.._ _—_9 :itie Break VL ''±0573 !retinaeASaler .re Ins Co of South Carolina 23254 UlSUREu INSURER B.S`e*Net Insurance enflINIE 400$5_, MICRO'S PRZ LW Iusuaeac:Landmark American Snenranre Co. 33138 db2 TEE ENERGY STORE INSURFR n: ..__ ..— . .• — ..__. 31 OLD ROME 7 INSURERE:_ I BROMFIELD CT 06004_0711 INSURER a: COVERAGES CERTIFICATE NUMBER:CLl64117051E REVISION NUMBER: I THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE HELY ISSUED'TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD RIRIE:TRE. NowaTHSTANDasle ANY REQUIREMENT, TERM OR Conyi?UN OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO 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 OE SUCH POLICIES LIMNS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MR .t00G5U8R _.-.._ .-...QducY EFF POLICY EXP . LTR T+PE Of INSURANCE INS. l n POLICY NUMBER MMIC. y!,WEt LIMITS ' X COMMERCIAL GCCNERAL BAG/LITT EACH OCCURRENCE 51,000,000 ~. ._, CAGIS-MADE X �PAMISES(difrE0415D 100,000 5 { OCCUR PREMISES(Eyl�e7n4^) = _.__ X Contractual Liability 52153542 3/2i/2e16 312'1/2014 LS Ea PiP(wry and person) '_ 5,000 _— PaRS1344412.4 &INJURY 3 1,000,000 OEN'LGREGA LmppIT� a LES PER: GEWERAL AGGREGATE 5 2,000,000 PCLLR X JJ'-_CT , LOC PRODUCTS-COMPIOP AGG 5 2 000,000 OTHER: . AUTOMOBILE UAEIUN i COWSINEO SMG`E MCT 5 1,000,000 y, __ ANY AUTO - BODILY INJURY Barnard+) 5 ALL OWNED SCHEDULED AUTOS 52/54542 3/2T/201d 3/41/ICU WPLY INJURY araceitl_ 9 a HIAUTOS -, 04014:^.ED PROW P R aCE ( a `-: UMBRELLA UAB X OCCUR EACH OCCURRENCES 5- 000,_00_0_ MAIMS-GABE: -- PSESs GAB AGGREGATE 5 5 0 0 00.000 As DEC yETu BOve 52535:2 3/^_7/2014 3/27/2017 5 '.WORKERS CCMPENtATION • S A d - :A1:DEFAPLOVERSLIABILIryX STATUTE EER _ 11,14.cERnta.JRanit0EEE%ECU.u<', rim'TI t ACH ACCIDENT 5 1,000,000 lav E. .QBERty,CW°ED' y.,yi.CmvY3vP 4/33/2014 1{7/3017 qls-ns.v:Ef Lo 1. la N UNl c� 1 000,000 DSCE desu:SNOF0 __. RIPTION OF OPERAn0N5 Mow ELON.EAW-XRSY Haar S 1,000,000 C Prateszdiaca1 Liability LER036563 3/27/2016 . 3/27/2017 LIMIT 2,000,000 095CRIPTION OF OPERATIONSI LOCATIONS t tease IACORD fit,Additional Remudcs Scbe6ute,may be attacted it more spare is required) __oat of insurance- :.ERT1F{CATS HOLDER _- CANCELLATION SHOULD ANY OF TRE AOOVE DESCRIBED POLICIES BE CANCELLED BEFORE PROOF Or INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATNE /// 0 Colacell_e/SCALL ©19B8-2014 ACORD CORPORATION Ail rights reserved. CORD 2S(2o141oi) Tee ACORO name and logo are registered marlts of ACORD JSO2 umefl', `7 d Permit Authorization 111855 save Farm mamma Site ID: S00050250030 Customer: JENNIFER CALDWELL-OKEEFE JENNIFER CALDWELL-OKEEFE ,owner of the property located at: (Owner's Name,printed) 48 Blackberry Ln NORTHAMPTON (Property Street Address) (City) 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 andjor weatherization work on my property. Owner's Signature: '1: 6 r Date: 1/18/2017 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 aro CLEAResut • 50 Washington Street,Suite 3006 • Westborough,MA 01585 • 1800-48G-1472 For Office Use Only Rev.102015 ®, Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-106082 Construction Supervisor Specialty CHRISTOPHER ALLEN 143 HOFFMAN STREET ` 3/t TORRINGTON CT 06790 r,../_AA (.1. "L" Expiration: Commissioner 03/1512020 Construction Supervisor Specialty Restricted to: CSSL-IC-Insulation Contractor Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DPS Licensing information visit:W W W.MASS.GOV/DPS When the permit is ready to issue please mail to: Christopher Allen 97B E.Taylor Hill Rd. Montague, MA 01351 OR call or email me: -- =-cl?" v.1r-zoo- 4riS ch visa l len @the-energystore.corn IM'4 CJRREaT MA\ut1CT IS +rCEREnt'� r1200-1 APPe�'� ON GSL , j JJST Mo O AND 144: E SI3V11" HAILED IMy AOPCEsy CfiA.U6E.