10D-005 81 WATER ST BP-2017-1362
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 10D-005 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Wood Stove BUILDING PERMIT
Permit# BP-2017-1362
Project# JS-2017-002268
Est. Cost:$2916.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: SANDRI ENERGY LLC 086668
Lot Size(sq. ft.): 13024.44 Owner: WILLIAMS DEANE A&JEANETTE S TRUSTEES
Zoning: URB(100)/ Applicant: SANDRI ENERGY LLC
AT: 81 WATER ST
Applicant Address: Phone: Insurance:
P O BOX 1578 (413)772-2121 () Workers Compensation
GREEN FI ELDMA01302-1578 ISSUED ON:5/25/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:ENGLANDER TIMBER RIDGE STOVE
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 Occu.anc Signature:
FeeType: Date Paid: Amount:
Building 5/25/2017 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
City of Northampton
eM Massachusetts
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SINGLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
\,t _ FOR WOOD,COAL,PELLET,CORN,STRAW OR MILSIMILAR STOVES,ORAFIREPLACES Check# a,`�yl q l yjyo
Please fill in all appropriate information
1. Name of Applicant : £v' t t Le r^�
Address: OQ C.-hcxp YVan�1 , G-1d.� 0130Telephone: Q �Oa.�., DC)
2. Owner of Property Z2a1 U9' 1+{2 r✓TS I
Address: 8I 0.itr" St. -tdS Telephone: 13 565 -- 01-79
3. Status of Applicant : Owner Contractoorr
A- Type or Brand ofStove
SIt�Coyyve: En..� _ _rte f icAbt(
5. UL Listing : i `1 d�
5
6. Estimated Cost: d' (g
7. Email : a_ao�.q-� 0.1 `J oord.r , C30(1
If applicant Is not the homeowner::
II
Contractor name )Q�a• (It E. ] . U. mail : 6 airldv�1 ( Q 1"Ymi
Construction Supggrvisor's License NumberX$ 0Wptap 3 Expiration Date 1 / 1 u
C.M0.r� 7v lLA-K �/tJ �1 111
Home Improvement Contractor Registration Number � p ( 1 0, Expiration Date J'�"C.1 fa-0 I 2
All Applicants must complete a Workers Compensation Insurance Affidavit before we can issue a permit
B. Certification: I hearby certify that the information contained herein is true ac)e ,. the best of my
knowledge.
DATE: 5 ( I d { 1.1 APPLICANTS SIGNATURE A_ I
DATE: 111 HOMEOWNERS SIGNATURE Fitt 0.5-f Se-t... (SICK. kwL CtrJta
APPROVED
�J
DATE: `-' 2517 BUILDINGOFFI4./,f+'�
The Commonwealth of Massachusetts
Id=ale Department ofLndustrialAccidents
el_ I Congress Street,Suite 100
a Boston,MA 02114-2017
@, ,� www.mass.gov/dia
11 orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name(Business/Organization/individual):Sandri Energy LLC
Address:400 Chapman St
City/State/Zip:Greenfield, MA 01301 Phone#:(413)772-2121
Are you an employer?Check the appropriate bo'' Type of project(required):
1:1]am a employer with 700 employees(full and/or part-time)'
7. ID New construction
2.19lam a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling
any capacity No workers'comp insurance required]
3.❑lar a homeowner doing all work myself [No workers'comp insurance required J' 9. ❑Demohhon
4❑l am a homeowner and will be hiringcontractors to conduct all work on m 10❑ Building addition
y propemy+ I will
me that all contractors either have workers'compensation insurance or are sole II.❑Electrical repairs or additions
proprietors with no employees
12.9 Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. �{r� p
These sub-contractors have employees and have workers'comp.insurance: 13.0 Roof rep7{rs6LU�Sibv6"
6.❑We are aw tion and its officers have exercised their nght of14.[�D[hu Y
corporation p per MOLc
152,6I(4),and ise have no employees.[No workers'comp insurance required]
"Any applicant that checks box FI must also fill out the section below showing their workers'compensation policy information.
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 sub-contractors 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
Policy#or Self-ins.Lie.#:EWGCD000182216 Expiration Date:7/31/2017
Job Site Address:81 Water St City/State/Zip:Leeds, MA 01053
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$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.A copy a this atement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification. / /
I do hereby cert'y - 't pai and penalties of perjury that the information provided above is true and correct.
Signature: ,I I� . ^y
I � Date: N'yit /? �l7--
Phone#: 'T�3 - 3(ory - 32, -
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#:
Quote#: Williams 001
" —tor PO Box 1578 Date: May 9, 2017
Greenfield, MA 01302 proposal Valid For: 30 days
Sandri 800-628-1900
Prepared For: Presented By:
Jeanette Williams
81 Water Street Thom Burden
Leeds, Ma. 01053 413-364-3217 Mobile
413-625-0196 413-223-1117 Office
rpease@mohawkschools.org tburden@sandr,cogs Email
Quote:
QTY Description Ea.price _ Total
1 England Stove Company 55-TRP22 Pellet stove 1.4 gr/hr 76% efficiency $1699.00 $1399.00
1 4" x 35' Chimney liner Stainless Steel $780.00 $440.00
1 Metal Fab stove adapter to 4"pipe 4BT 3AB Black Tee adapter $56.44
2 Metal Fab 46 366 36" double insulated pipe Black $47.46 _ $94.92
F _ . ._
1 Metal Fab 4B12AB adjustable 12" black double insulated pipe $29.31 $29.31
1 I Metal Fab 4B90LB 90 elbow black $59.71 $59.71
1 Metal Fab 4B4FAB female flex adapter black $25.89 $25.89
1 Installation labor 2 x 4 hours $680.00 $680.00
Stove change out rebate 80% with efficiency adder $3000.00 $2785.27
Sales Tax $131.58
$2916.85
Scope of Work: Remove old wood stove dismantle for recycling.
Install new Stainless Steel chimney liner in existing chimney, inspect for repair.
Install new Pellet stove, and double wall pipe to Chimney adapter
Test operation and confirm draft.
Instruct owners on operation and maintenance, leave owners' manual on site.
Remove all debris from site and drop old stove at recycler, get signature on disposal form.
TERMS:
50% of the contracted amount to be paid upon signing of contract(net 10 days); 50% due upon completion of final billing.
(Subject to: A.R. Sandri, Inc. and/or Sandri Energy LLC Credit Department Approval).
All material is guaranteed to be specified.
Equipment, parts and labor warrantied for one year.
All work to be completed in workman like manner according to standard practice.
All alterations or deviations from above specifications involving extra costs will requires an addendum to the original
contract with customers signature.
All agreements are contingent upon strikes, accidents or delays beyond our control.
Owners to carry fire, tornado or other necessary insurance.
Our workers are fully covered by Workman's Compensation Insurance.
Other terms and conditions may apply and will be noted on the contract to cover specific circumstance.
Sandri Energy, Greenfield. MA
Quote#: Williams 001
- PO Box 1578 Date: May 9, 2017
• Greenfield, MA 01302 Proposal Valid For: 30 days
Sandri 800-628-1900
"The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the
work as specified. Payment will be made as outlined above. Furthermore, I shall accept the terms and conditions as
follows:Any amount not paid within thirty(30)days will be charged a FINANCE CHARGE of 1 1/2 % per month (periodic
rate)which is annual percentage rate of 18%. Minimum FINANCE CHARGE each month is fifty cents (.50). Buyer further
agrees to: reimburse Sandri Energy or affiliates for all collection expenses including reasonable attorney fees incurred in
connection with the collection of any delinquent amount."
Authorized by: _T)'1Ovm(31.A4'dali Date:_May 10, 2017
Accepted by' a '—,24'o Ye2,r,,,.> Date: Y.—/?'-/7
Sandri Energy, Greenfield, MA