31A-033 15 FRANKLIN ST BP-2019-0084
cls#: COMMONWEALTH OF MASSACHUSETTS
MamBlock: 31A-033 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateuorv, INSULATION BUILDING PERMIT
Permit# BP-2019-0084
Project# JS-2019-000127
Est Cost$4000.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ENERGIA LLC 92540
Lot Size(sg ft.), 9931.68 Owner: MUSPRATT MATT&ASHLEY
Zoning_ URB(100)/ Applicant: ENERGIA LLC
AT: 15 FRANKLIN ST
Applicant Address: Phone: Insurance:
242 SUFFOLK ST (413) 322-3111 Liability
HOLYOKEMA01040 ISSUED ON:7/2 7/2018 0.00:00
TO PERFORM THE FOLLOWING WORK INSULATION -WOOD SIDED WALLS
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 7/27/2018 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
RDepartment use only
City of Northampton Status of Permit:
Building Department Curb CuVi)dveway Permit
JUL 19 2016 212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
BEPt a suaowc lNsneonous N rthampton, MA 01060 Two Sets of Structural Plans
Noa1�.,atmclow.++a 587-1240 Fax413-587-1272 Plot(Sita Pians
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY Dy/}W[EpLLING
SECTION 1 -SITE INFORMATION -f " 7
1.1 Property Address —, /TIhis Section to be completed by office
15 rRAN / 11V � Map i? LL3_—. Lot 63 Unit
AAM7-hIA R'A?7Y4 A ) ^4 Zone Overlay District
+"{ !r' Elm St.Ohadct Ca Dlstricl_„
SECTION 2-PROPERTY OWNERSHIPIAUTHORISED AGENT
21 Owner of Regard:
MAT-Z- Al (ASPRA_77- / 5 �RANLiAl S— uoa.Ttl, PP
Nene(Priv!) Cwmm Ma ng Address:
`y6G rPBQ/tl7 AtA- M6 Telephone
Signature
22 Authorized Ament:
T s s 2112 5u��nt psi. tIoL dtl u4
Name(Pdm) Current Mating Address:
_earl-
Signature Telephone
CTI -E MAT C TRUCTION COSIE
Rem Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building O (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from fi
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection
6. Total=(1 +2.+3+4+5) GG Check Number
This Seaton For Official Use Only
Building Permit Number: Date
Issued:
sgnaturs: 7/7-7 (f 412a-�...�
Building Commisi lenemnspector of Buildings Dale
Section 4. TONING Ali Information Mont Be Completed.Permit Can Be Dented oee To kxmnptete infom,atiroa
Existing Proposed Required by Zoning
Tla..Wm w be dAd in M'
Huiidiag Department
Lot Size
Frontage
Setbacks Eont
Side L: R: L: R:
Rear
Building Height
Bldg, Square Footage
Open Space Footage
(lot arae mima bid,&paled
#ofParking Spaces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW 0 YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW Q YES Q
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO e�ONT KNOW a 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 O
IF YES, describe sine, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO Q
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 sere? YES 0 NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION S DESCRIPTION OF PROPOSED WORK(check all applicable)
Naw House ❑ 1 Addition ❑ Replacement Wlndowa Alterations) ❑ Roofing ❑
Or Dbon ❑
Accessory Bldg. ❑ Domoutim ❑ New Signa [O] Deeke [[] Siding M Other
Brief Description of Pfoposad�,,-
Work: 1 bJSU L.�'(/a/JY
Alteration of existing bedroom—_--Yes t: No Adding new betlroom_Yes Nr
Attached Narrative Renovating unfinished basement _Yes
Pians Attached ROP -Shoet
Ga.If New ho se and or addition to4ki—stfing hourri complete the following:
a. Use of building: One Family Two Family Mar
b. Number of rooms in each family unit Number of Bathrooms
c Is there a garage affachedl
d. Proposed Square footage of new oanstuction. Dimensions
e. Number of stories?--
f. Method of hosting? Fireplaces or Woodstoves Number of each_
g, Energy Conservation Compliance. Massch ick Energy Compliance form attached?
h. Type of construction
i. is construction within 1008.ofwetiands?—Yes —No. is construction within 100 yr. floodplain-----Yes_No
j. Depth of basement or cellar floor below fmisired grade
k. Will building conform to the Building and Zoning regulators? Ves_No,
1, Septic Tank_ City Sewer. Private well City water Supply_
SECTION Ta-OWNER AUTHORIZATION-TO BE GOMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUI�L7DIN.G-P.E�R—MIT
I, �// Ay S as Owner of the subject
Property
hereby authorize c/''sr//612l.'!�I`/
to�.act
toonn�my cooled,lin all matters relative to work authorized by this building perp application.
I'"
Si nacre of Owner i Oat.
I, �� �4OSSA�R- �.E' ,as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to ft best of my knowledge
and belief.
Signed under the pains and densities of perjury.
i54nt -^—
� Y
S atunsmOwredAgent Date
SECTION 8-CONSTRUCTION SERVICES
81 Licensed Construction S�uoervlsor. A ,{ Not Applicable ❑
e5,&z
Namof Llosn,s Hoirler:� rt{, )S5,/%'�,p
License Number /
f
Address Expratio ate
--�_ yrs - 322- 3/ii
Signature Telephone
9 Registered Homs Improvement Contractor. Not Applicable ❑
Comes"Nanta Regis I
ation Number
r7/OHIO
Address-�' Expiration a�
TelephorH"�[
SECTION 10•WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(8))
Workers Compensation Insurance affidavit must he completed and submitted with this application.Failure to provide this affidavit witt result
in the denial of the Issuance of the building per
Signed Afftdav0 Attached Yes....... No...... ❑
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to historic Owner-accunied Dwellinea of oose(1) 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 agony' or CMR 780 Sixth Edition Section 108.3 5 i
Definifion of Homeowner Person(s)who own a parcel offend 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
struchares.A person be constracts more than one bomse in a ra year ner'od shall not be considered a hooneownen.
Such"hamcowner'shall submit to the Building Official,on a form acceptable to the Building Official that he/she shall be
responsible for a8 such wok 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 maybe Bab le for person(s)
you lure to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the Slate 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 01460
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: /SS7'
The debris will be transported by: /4L.1-/G41 (4//4 `7�-
The debris will be received by: 4 , �l 4 A WA S/—
Building permit number:
Name of Permit Applicants
� 2 �
Date Signature of Permit Applicant
RISE
ENGINEERING
OWNER AUTHORIZATION FORM
1, Matthew Muspratt
(Owner's Name)
owner of the property located at:
15 Franklin Street
(Property Address)
Northampton MA 01060
(PropertyAddress)
hereby authorize G&W-G1A
(Subcontractor)
an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building
permit and to perform work on my property.This form is only valid with a signed contract.
Os Signature r
�I �Slix
Dat
RISE Engineering,a Division of Thielsch Engineering, Inc.
605hawmut Road Unit 2 1 Canton, MA 020211339-502-6335
www.RISEengineering.com
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office offnvestigations
1 600 Washington Street
Boston, MA 02111
www.massgovldia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Pie se Print Legibly
Name(Business/Organization/individual): Energia, i_i_e. Y _
Address: 242 Suffolk Street
Ci /StatelZi : Holyoke, MA 01040 phone#: 413-322-3111
Are you an employer?Check the appropriate box:
I.ba1 am a employer with 24 4. [] I am a general contractor and 3 Type of project(required):
employees(full and/orpert-time).
have hired the sub-contractors 6. ❑New construction
2. 1 am a sole proprietor or partner- listed an the attached sheet 7- Remodeling
ship and have no employees These subcontractors have g. Demolition
working for me in any capacity. employees and have workers'
insurance.# 4. [� Building addition
cora
[Na workers' comp. insurance P•
required.] 5. ❑ We are a corporation and its 10.(_] Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers'comp. right of exemption per MGL 12❑Roof repairs
insurance required.]t c. 152,§I(4),and we have no
employees. [No workers' 13.91 Other Insulation
comp.insurance required.]
*
Any applicant that checks box 01 must also fill out the section below,showing their workers'compensation policy information.
t liomeowrcrs who submit this affidavit indicating they are doing all work and then hireoutside arnhapmrs must submit anew affidavit indicating such.
iComroctors that check this box must attached an additional sheet showing the name of the sub�contmcmc,and state whether ar not those entities have
employees. It the sub-contractors have employees,they most provide their workers'comp.policy number.
loan 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.. �-
Lia 4:: rE�WGCR000186$16 Expiration Date:f 7/1/2018
Job Site Address: 15 t' tW"�..�. M 1 i _City/State/Zip:,dAp T CPT"/�Tdtt/ ,.(4
Attach a copy of the workers' compensation policy declaration page{showing the policy number and expiration datc)O/ow
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 mid/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.
too hereby certify un r the pains�undpenalfles�ofperjuryatthe lnjorma�ffrovidedabove is Yrue and correct.
ure:
Pho a#: �—
Ofj9clal rise only. Do not write in this area,to be completed by city of town official.
City or Town: Permit/License# _
Issuing Authority(circle one):
1.Board of Health Z Building Department 3.City)Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other_
Contact Person: Phone 4:
''✓I CERTIFICATE OF LIABILITY INSURANCE D" a"'H8 )
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 eertigeete holder Is an ADDITIONAL INSURED,the policy([") must be endorsed. H SUBROGATION IS WAIVED,subject to
the tome and conditions of the policy,certain policies may require an endorsement A statement on this cedfflm%does not confer rights to the
certificate holder In lieu of such endomement a.
nNODUPS CONZC1 MoryConn
James J. Dowd&SODS Ins
14 BDbals Road As s .413-538-7444 EAX
Holyoke MA 01040E.RL
P�DucEXa IDI. ENELL
INSURENSI AFFORDING COVERAGE NAIL#
INEns ia LLC SURED INSURER A:Evanston Insurance Com an 35378
rg
242 Suffolk Street NwjUN B:Commerce Insurance Company 34754
Holyoke MA 01040 INNUMERc:StarSlone National Insurance Company 25488
INSURER o:Guard Insurance Group 8281
NBURERE:
INSURER F:
COVERAGES CERTIFICATE NUMBER: IM1818189 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.
U. TYPE OF INSURANCE A00 aR POLICY NUMBER feOUCYERF POJCYINP IJMIT9
A GENERALUAMILITY fOaG40fi 711915 ]/14019 EACH OCCURRENCE $2 '0w
X COMMERCIAL GENERAL LIABILITY
pR EtOU.OW
CLAIMS�MAUE 1K OCCUR MEDEXP( E0
PERSONAL a MVI NJURY ES Cdl,No
GENERAL AGGREGATE $2".
GE N'LAGGREGATELIMITAPPLIE$PER: PRODUCTS-COMPIOP ADD E20 co
PalCyr
v X PRQ LOC E
8 AUTOMOBILE WUNUI MAECAU ]114018 7/1/3019 COMBINED SINGLE LIMIT LYE1 CW D]c
ANY AUTO (Ea avidnl)
ALL OWNEDAUT08 EOLYINJURY(Px Pana.) $
BJDILYINJURY(Para OWA) $
X SCHEDULED AUTO
MCPERTY DAMAGE
X HIREDAUTOS (PeranoSRD $
X NON-0O.EDAUTOS E
E
LUMBRELLA WB X OCCUR 757WHlWALI 7/1=18 111..10 EACH OCCURRENCE E1,rA0,DTO
X EXCESSMS CLAIMS MADE
AGGREGATE $
OEWCTIBLE
RETENTION EIs
0 AND MMES COMPENSATION TBUGUARD ]fl2018 II1Rm0 X NC BTATU-UARRUITY ylA,
NYPROPEMSER EARTNER,EXECVLIVE E.L.EACXACCIOENT E1 dyJ,W]
(M....,In BER EYCLUOED] ❑ NIA
(MaMebryln NN) E1.018FA8E-EA EMPLOYE E1.0N.OGJ
ryeg0e60PIM Nnax
OE SCRIPTIONOFOPEBATIONSWIl EL 015EA8E-PoLICY LIMIT E
OEW0.1pTW OF OpERATPYs ILOCAIN)N81 VEHMLEB fAbdl ACMD101,At101Nemlgmu SSChWula,xnwnepwbngWMI
CERTIFICATE HOLDER CANCELLATION 30
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED
IN ACCORDANCE WITH THE POLICY PROVISIONS.
To VMom It May Concern
AUTMORaED pEpgEEENTATNE
®1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Construction Supervisor
CS-092540 Expires:09102@019
THOMAS 8R085MASSLER
180 MAIN STREET
HATFIELD MA 828/318
tit
Commissioner
Offs«oCCaroumcrAttairs&Burfront Reguladau License or registration valid for individul use only
i10ME IMPROVEMENT CONTRACTOR before the expiration data. If found return to:
ult Registration: 168169 Type: Office of Coriander Affairs and Rushand Regulation
'.. Expiration: 1111f2018LLC 10 Park Phos-Suite 5170
Roster,AIA 02116
ENERGU+LLC 1`\OD
THOMAS ROSSMASSLER
242 SUFFOLK STREET
HOLYOKE,MA 91040 —'- _. .—._
Urdmsecretery Not valid without aEgnaturt