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24A-139 44 ROE AVE BP-2019-0339 GIs#: COMMONWEALTH OF MASSACHUSET'T'S Map:Block:24A- 139 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-2019-0339 Proiect# JS-2019-000549 Est. Cost: $4000.00 Fee: $89.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ENERGIA LLC 92540 Lot Size(sq.ft.): 7710.12 Owner: HOAG CORINNE Zoning:URA(100)/ Applicant. ENERGIA LLC AT. 44 ROE AVE Applicant Address: Phone: Insurance: 242 SUFFOLK ST (413) 322-3111 �WC HOLYOKEMA01040 ISSUED ON:9/24/2018 0:00:00 TO PERFORM THE FOLLOWING WORK:INSU LATION WALLS ALUMINUM SIDED BLOWN 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: FeeTyim Date Paid: Amount: Building 9/24/2018 0:00:00 $89.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of Northampton Status of Permit: s Building Department Curb Cut/Driveway Permit 1 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans - '. phone 413-587-1240 Fax 413-587-1272 Piot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION Ag/-7l'?,— 3 3 1.1 Property Address: This section to be completed by office a. tnU� �1Gv�-Ylprn� Map M Lot / Unit �� 0�6( Zone Overlay District w Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: (-cv er1t\L E1130Q qLA R',/ .)C'nk �c mb tammn 810 Name(Print) ( C�re IP ai in A r—15 91� ���, y Y`{ �k A Qelepho 1 Signature 2.2 Authorized Agent: Name(Print) urrent Mailing Address: Signature elephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building O�JV O('\ (a) Building Permit Fee 2. Electrical v (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =0 +2+3+4+5) Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: `� 9(4t8 t8 Building Commissioner/Inspector of Buildings Date ce EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) S'e &AAA-t L KAja6 � 7a6l�) t ! , i 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: 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 Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O 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 DON'T KNOW Q YES 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 © NO 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 © 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 ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors 0 Accessory Bidg. ❑ Demolition ❑ New SignsJO] Decks Siding[O] Other[ n�l�lCk�aC�Y1 Brief Description of Proposed Work: 1 'E Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes 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, L36�n� "Cnn , as Owner of the subject property c �' hereby authorize �v" ' �a✓c W J'S� 1,4 to act on my behalf, in all matters relative to work authorized by th building permit application. i gnature of Owner Date 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. SS Print Nam Signatur of er/ gent Date 4t �� ., �r`;. SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor:�C C Not Applicable [I //'+� Name of License Holder:--T �Z5 yl) License Number WAG Q NQY Q M 102-12.019. Address Expira ion Date At 3 - 3ZZ - 3i�� signal e e ephone 9.Registered Home Improvement Contractor: Not Applicable ❑ Ecm-ia U C , 1l&5 IPQ Company Namej Registration Number 2_u`Zsugo l o,5+ i±)1 c ey' '(o, on(4c) IT 12-0 Xddress `J Expiration Date Telephone Yl3 -32L"31 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 p it. Signed Affidavit Attached Yes....... No...... ❑ i City of Northampton Massachusetts W � DEPARTMENT OF BUILDING INSPECTIONS �+ 212 Main Street • Municipal Building Northampton, MA 01060 ssbh 3,7<�O AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes, a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L. Chapter 142A requires that the "reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must berr registered. Type of Work: ��,S�G�T�l�A/_ " Est. Cost: 1 Co Address of Work: "1� &Mue; Date of Permit Application: (::\ -1 211 S I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): Job under$1,000.00 _Owner obtaining own permit(explain): Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: o d�ss�,�s �e D 7Contractor Name HIC Registration No. R: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton Massachusetts kiJ' N' c � WK DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building � n, Northampton, MA 01060 \rt - Debris 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. The debris from construction work being performed at: 914 Vae, -Rk e2D& )E� (Please print house number and street name) Is to be disposed of at: AIxle.d wmAe-- Qq RrEe' ST Y� %e\6� wo�' 0\104 (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) 4SignatureP%4r'mitApplicant or Owner to If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. i .. L `; Y The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations UV 600 Washington Street Boston, MA 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 St. City/State/Zip: Holyoke, MA 01040 Phone #: 413-322-3111 Are you an employer?Check the appropriate box: Type of project(required): 1. 1 am a employer with_ 19 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 g, ❑ Demolition workingfor me in an capacity. employees and have workers' Y + 9. F-1 Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §](4),and we have no employees. [No workers' 13.❑ Other 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 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: Guard Insurance Group Policy#or Self-ins.[[Lic.#: E!!N''WC952172 Expiration Date: 7/01/2019 7n� Job Site Address: � 2yc #qyE' City/State/Zip:A 4/Z rM—A—f1004W 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 f insurance coverage verification. I do hereby certify and the pains and penalties of perjury that the information provided above is tr e a correct. Simature: Date: Phone#: 413-322-3111 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#: ij::' �� �� � �1. r* .. .. i S M1 ... ,. r '..: ... .:. ,.. '.., .. _ ,. -.P X54 , y ' .. ,. � ' .�+,,. 1 � K .. ' .. 1�: '.3...• y ® Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction Supervisor CS-092540 Expires: 09/02/2019 THOMAS B ROSSMASSLER • 100 MAIN STREET HATFIELD MA 01038 Commissioner A!b!!N/!9 lllW Office of Consumer Affairs&Business Regulation License or registration valid for individul use only '-AOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: Registration: 165169 Type: Office of Consumer Affairs and Business Regulation Expiration 1/11/2018 LLC 10 Park Plaza-Suite 5170 Boston,MA 02116 ENERGIA LLC �/ 'Zo THOMAS ROSSMASSLER i 242 SUFFOLK STREET HOLYOKE,MA 01040 "" "�` - - • - "—�- � Undersecretary Not valid without signature I �`� CERTIFICATE OF LIABILITY INSURANCE DA a;2,0�8' 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 CONTACT The Dowd Agencies, LLC PHONE Ma ConroyFAX 14 Bo Road 413-538-7444 A/c No): Holyoke MA 01040 A DRIES : PRODUCERCUSTOMER 1p#; ENELL INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURER A:Evanston Insurance Company 35378 Energia, LLC 242 Suffolk Street INSURER B:Commerce Insurance Company 34754 Holyoke MA 01040 INSURER C:StarStone National Insurance Company 25496 INSURER D:Guard Insurance Group 8281 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1131630225 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. INSR TYPE OF INSURANCE ADDL SUER POLICY EXP POLICY NUMBER MI D/YYYY POLICY LIMITS MDD/YYYY LTR A GENERAL LIABILITY 2DB4466 7/1/2018 7/1/2019 EACH OCCURRENCE $1,000,000 DAMAGE TO RENT X COMMERCIAL GENERAL LIABILITY PREMISES Ea occl!zze $50,000 CLAIMS-MADE rT]OCCUR MED EXP(Any one person) $1,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY rX PRO- LOC $ B AUTOMOBILE LIABILITY BHQPBJ 7/1/2018 7/1/2019 COMBINED SINGLE LIMIT $1 000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS X PROPERTY DAMAGE $ HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ C X UMBRELLA LIAR X OCCUR 7575OH180ALI 7/1/2018 7/1/2019 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DEDUCTIBLE $ RETENTION $ $ D WORKERS COMPENSATION ENWC952172 7/1/2018 7/1/2019 X I WC STATU- OTH- JORY LIMITAND EMPLOYERS'LIABILITY Y/N S ER ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEd$1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below I I I E.L.DISEASE-POLICY LIMIT 1$,000.000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) 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 Whom It May Concern AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD .. t _ . ; ' .,r RISE ENGINEERING- OWNER AUTHORIZATION FORM I, Corinne Hoag (Owner's Name) owner of the property located at: 44 Roe Avenue (Property Address) Northampton, MA 01060 (Property Address) / hereby authorize V (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. x Owner's Signature Date RISE Engineering, a Division ofThielsch Engineering, Inc. 60 Shawmut Road Unit 2 1 Canton, MA 02021 1 339-502-6335 www.RISEengineering.com t 1MY of Louis Hasbrouck<Iasbrouck@northamptonma.gov> Nord IV�it 44 Roe Ave 1 message Louis Hasbrouck<Iasbrouck@northamptonma.gov> Thu, Sep 20,2018 at 5:31 PM To: Ivelice Lefebvre<ivelice@energiaus.com> Ivelice, The house at 44 Roe Avenue was built in 1922 and could have knob and tube wiring.We need an affidavit stating that it does not. Please send us one. I've attached an example. Thank you. Louis Hasbrouck Building Commissioner City of Northampton Town of Williamsburg (413)587-1240 office (413)587-1272 fax ., Affidavit Regarding Knob and Tube Wiring.pdf 94K