32A-216 (8) 79 POMEROY TER BP-2017-1211
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:32A-215 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-2017-1211
Project# JS-2017-002039
Est.Cost: $3000.00
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: ENERGIA LLC 92540
Lot Size(sq. ft.): Owner: CONZ LINDA
Zoning: URC Applicant: ENERGIA LLC
AT: 79 POMEROY TER
Applicant Address: Phone: Insurance:
242 SUFFOLK ST (413) 322-3111 WC
HOLYOKEMA01040 ISSUED ON:4/25/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:INSULATION -ATTIC FLOOR OPEN BLOW
CELLULOSE 4" TO R49 WALLS DENSE PACK CELLULOSE
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 4/25/2017 0:00:00 $100.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-1211
APPLICANT/CONTACT PERSON ENERGIA LLC
ADDRESS/PHONE 242 SUFFOLK ST HOLYOKE (413)322-3111
PROPERTY LOCATION 79 POMEROY TER
MAP 32A PARCEL 216 001 ZONE URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
E\CLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid v(
Building Permit Filled out \
Fee Paid
Typeof Construction: INSULATION -ATTI FLO OPEN BLOW CELLULOSE 4"TO R49 WALLS DENSE
PACK CELLULOSE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 92540
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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
400r
i �.�/%
. e : di g ffi 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.
Version1.7 Commercial Building Permit May 15,2000
Department use only
City of Northampton Status of.Permit
Building Department Curb Cut/DdiewayPemlb
212 Main Street Sewer/Septic Availabifdy
Q Room 100 WaterMlell Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 PlouSila Plans
Other Specify
APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
79 Pomeroy TernMap AA 4 Lot 30 Unit
Northampton, MA 01060
Zone Overlay District
Elm St District CB Dlstdct
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Linda Conz 79 Pomeroy Ten. Northampton, MA 01060
Name(Print) Current Mailing Address:
..II—�t� �1
(413) 586-7139
Signature SGC' atK IT`t/ Telephone
2.2 Authorized Agent:
Tom Rossmassler/Energia LLC 242 Suffolk St. Holyoke, MA 01040
Name(Print) Current Mailing Address:
(413)322-3111
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building $3,000.00 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
$0.00 Construction from(6)
3 Plumbing $000 Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection $0.00
6. Total=(1 +2+3+4+5) Check Number 44M7 8(w
This Section For Official Use Only
Budding Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
Version 1.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions 0 Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing El Change of Use 0 Other❑+
Brief Description Insulation-Attic Floor Open Blow Cellulose 4" to R49 Walls Dense Pack Cellulose
Of Proposed Work:
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 0 A-3 0 1A ❑
A-4 ❑ A-5 0 18 ❑
B Business ❑ 2A ❑
E Educational 0 2B I ❑
F Factory ❑ F-1 ❑ F-2 0 2C ❑
H High Hazard 0 3A 0
I Institutional 0 I-1 ❑ 1-2 ❑ 1-3 ❑ 3B 0
M Mercantile ❑ 4 ❑
R Residential 0 R-1 0 R-2 ❑ R-3 0 5A 0
S Storage ❑ S-1 ❑ S-2 ❑ 5B J 0
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group- Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
a 1:t
2d 2m
3rd 3rd
4m 4t"
Total Area(sf) Total Proposed New Construction(sf)
Total Height(ft)
Total Height ft
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private 0 Zone Outside Flood Zone❑ Municipal 0 On site disposal system❑
Version].7 Commercial Building Pemlit May 15,2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled 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 minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Speciat Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW 0 YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW 0 YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O
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 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 ®
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 O NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Version1.7 Commercial Building Permit May 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
N/A Not Applicable 0
Name(Registrant):
N/A Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
N/A
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
Tom Rossmassler
Not Applicable 0
Company Name:
Energia LLC
Responsible In Charge of Construction
Tom Rossmassler
Address
(413)322-3111
Signatu Telephone
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes O No O
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Linda Conz ,as Owner of the subject property
hereby authorize Tom Rossmassler/Energia LLC
to
act on my behalf, in all matters relative to work authorized by this building permit application.
SEt 7 2/ ( ( T .jt.o 04/21/.017
Signature of Owner Date
Tom Rossmassler
, 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 penury.
Tom Ross .ssler
Print Name '
04/21/2017
Signature Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Noma of License Homer Tom Rossmassler 92540
License Number
242 Suffolk St. Holyoke, MA 01040 09/02/2017
Address Expiration Date
A Asa. (413) 322-3111
Signature Telephone
SECTION 13-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 O No 0
ner is
)1 BUTLDLNG PERMIT AUTHORIZATION FORM
I. l I A K C C ey Z__ .owner of the p orwty located al
(Owner's Name, printed)
r
(Property Street ••. s) (City Town)
hereby authorize Thomas Rossmassler of Energia, LLC to act on my behalf and obtain a budding permit to perform
insulationn'weathenvnon wadi on the above named property.
C
x- 17 [
a nds Signature Telephone Number
Date
The Commonwealth of Massachusetts
Department of Industrial Accidents
h =fig
= 141,=; Office of Investigations
9r.= c
_: 600 Washington Street
'�i'1= Boston,M4 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): Energia, LLC.
Address: 242 Suffolk Street
City/State/Zip: Holyoke, MA 01040 Phone #: 413-322-3111
Are you an employer?Check the appropriate box: Type of project(required):
1.® I am a employer with 24 4. ❑ I am a general contractor and I
employees(full and/or part-time).` have hired the sub-contractors 6. New construction
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'
[No workers' comp. insurance comp. insurance.: 9. ❑ Building addition
required.] 5. ❑ We are a corporation and its l0.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself No workers' right of exemption per MGL
Y [ comp. 12.❑ Roof repairs
insurance required.]r c. 152,§1(4),and we have no
employees. [No workers' 13.® Other Insulation
comp.insurance required.]
'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 work and then hire outside contractors must submit a new affidavit indicating such.
Contractors 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 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.
Insurance Company Name: HDI - Gerling America Insurance Company
Policy#or Self-ins.Lic.#: EWGCR000186816 Expiration Date: 7/1/2017
Job Site Address: lel Pcm-ec-ato -c-e rr. City/State/Zip: NUY-rtnn.m pStri g *mot
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). 01O(s 0
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.
Ido hereby certify under he pains and penalties of perjury that the information providedabo e is t e and correct.
Signature: Date: ti 2/
Phone#: 413-3 -3111
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):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
AccwLI CERTIFICATE OF LIABILITY INSURANCETDATzo'ossAre'
THIS CERTIFICATE IS ISSUED AS A MATTER OF#/FORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED SY 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. Irthe certificate holder Is an ADDITIONAL INSURED,the pollo2Nes)must be endorsed If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require en endorsement. A statement on this certificate does not confer tights to the
certificate holder In lieu of such endorsements).
PROW CER COMAE!
Jame0 J. DOWd and Sons Insurance Agency Inc. /HONE MMary Conray Y X
14 Sobala Road Lp Ne,EXn:413^538-7499 IARC,No):
Holyoke MA 01090 Att BsizJncorirRY&doWd,Com
CUSTOMER tot GT7£RLLC-01
INSURERIBIAFFORDING COVERAGE NAICft
INMURED INSURERS:RDI-Gerl for America Insurance CompM
Enorgia, LLC eisuesR a:Torus National Insurance Company 25496
1242 Suffolk Street
:Holyoke MA 01040 INSURER c:
Int/REED:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:2039052479 REVISION NUMBER:
THie AS TO CERTIFY THAT THE POLICES 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 HE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED SY THE POLICIES DESCRIBED HEREIN IS SUBJECT
TO ALL THE TERMS.EXCLUSIONS AND CONDITIONSg1OF SUCH POLICIES.LIMITS SHOWN MAY
I1JJHAVE
FFBEEN
��REDUCED BY PAID CLAIMS.
ILTR TYPE OP INSURANCE _NASA SUER
PERCY NUMBER IMmO1YYYYI IMM(W 1 LIMITS
A ofNERAL LABILITY Y Y afGCR0001dfi816 1/1/2016 ?/1 2017 EACH OCCURRENCE 11,000,000
X COMMERCIAL GENERAL DREDGE PORpENM�ItE.S1 RENTER i f
CLAIMS,MADE I^ OCCUR MED EXP(My one person) 5
_ -
PERSONAL&MTV INJURY 51,000,000
GENERAL AGGREGATE 52,000,000
GENE AGGREGATE pLIMIT)PPUEES PER PRODUCTS,COMPLP AGG 52,000,D00
—1 POLICY ix JH? I we S
A AUTEMO&LE UMW"( Y Y PleoR000x56815 7/1/2016 7/1/2017 COMBINED SINGLE LIMIT 51,000,000
(E9 eMdentl
ANY AUTO
BODILY INJURY(Pet Rosen) B
ALL OWNEDAUTOS BODILY INJURY(Per cement) 5
X SCHEDULED/MOOS PROPERTY DAMAGE
X HIRED AUTOS (Per accident) S
X NONOWNEO AUTOS
5
B X UMBRELLA LIAR OCCUR Y Y e5293e150ALX 7/1/2515 711/2017 EACH OCCURRENCE 51,000,000
EXCESSLIAB CtNMS,MADE AGGREGATE $1,000,000
_ DEDUCTIBLE
X RETENTION 510.000 U.
A WORKERS COMAENSATON Y EI aCR00910691& 7/1/2016 7/2/2017 X J Wt.
[NITSi IDER
AIL EMINLYERS UABNJTY ViH
ANYPROPRIETOWPARN:ENEXECiTIVE(^ NIA EL.E0. tA000EM S3,909,000
�MmdebryInNNMIM fi%ULUOEW L�
EL.DISEASE EA EMPLOYEE 51,000,000
lAinettrrder
1'A:BplIPT19N OF pPEMTIONS bNOWI ,- E1. DISEASE.POLICY LIMIT S1.0001000
DESCRIPTION OFCPERAnONS LCCATONSI VEHICLES(AMMO ACM Wt,AMIttionMRemetke Sensdvie,N mon specs le reWIN91
CERTIFICATE HOLDER CANCELLATION 30
SHOULD ANY OP THE ABOVE DESCRIBED,NOTICE
ES BECANCELLED
IN CCO THE WITH
DATE THEREOF,NOTICE WILL BE DELIVERED
- IN ACCORDANCE WITH TXE POLICY PROV1610N8,
AUTHORISED REPRESENTATIVE
•®1888.20118 ACORD CORPORATION. All rights reserved.
ACORD 25(200910$) The ACORD name and logo are registered marks of ACORD
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your l .l Energy Efficiency ExpertFiler glUS.co no
April 18, 2017
Commissioner Hasbrouck
RE: Request for Waiver
I request that you grant a modification to waive the requirement for control construction
for 69-79 Pomeroy Terrace in Northampton because the work is of a minor nature, will
not affect health, accessibility, life and fire safety, or structural requirements and is
impractical in that the cost of control construction is considerable when compared to the
cost of the proposed work. All work will be completed within the prescriptive
requirements of 780 CMR. Thank you for your consideration.
"Mass Amendments, sections 107.1 allows for an exclusion from control construction for
this project"
Please feel free to contact me by telephone at (413) 326-1860 or by email at
tomr@EnergiaUS.com.
Respectfully,
Tom Rossmassler
President & CEO
rcas - 111 • u o ree , 'o oke ' ' on , . ner•,a/ .com
•
,,,,,. id gr.i7e, :.,,,
Office of Consumer Affairs&Baness Regulation License or registration valid for ndividul use only
9 . . IOME IMPROVEMENT CONTRACTOR before the expiration date. If found return tot
agistrabon 165169 Type: Office of Consumer Affairs and Business Regulation
Ezpimbon 1/112018 LLC 10 Park Plaza Suite 5170
s" Boston,MA 02116
ENERGIA LLC
THOMAS ROSSMASSLER
242 SUFFOLK STREET
HOLYOKE.MA 01040 Undersecretary Not valid without signature
Ea Massachusetts Department of Public Safety
®I Board of Building Regulations and Standards
License: CS-092540
Construction Supervisor -
THOMAS B ROSSMASSLER
IN MAIN STREET q
HATFIELD MA 01039
Ni-,sn n Expiration:
Commissioner 09/02/2017