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25C-040 (4) 212 NORTH ST BP-2019-0502 G1S#: COMMONWEALTH OF MASSACHUSETTS Mao-Block:25C-040 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-2019-0502 Project# JS-2019-000813 Est.Cost: $2000.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JAY BOLAND 101880 Lot Size(sg.ft.): 6577.56 Owner: GOLD HOWARP J&JENNIFER INNES Zoning:URB(100)/ Applicant: JAY BOLAND AT. 212 NORTH ST Applicant Address: Phone: Insurance: 12 PISGAH RD (413) 203-2454 WC HUNTINGTONMA01050 ISSUED ON:11/9/.2018 0:00:00 TO PERFORM THE FOLLOWING WORK:BLOWN IN INSULATION AND AIR SEALING 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 Sienature: FeeType: Date Paid: Amount: 4 !. Building 11/9/2018 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Dnt.use only !` City of Northampton Status of Permit -- Building Deparb7tent Curb.CuUDriveway Permit 212 Main Street -q&Aw sepgc Arra labilifjr ' , #► Room 100 alVater/tiNeM Ayait$t�lity Northampton, MA 01060 Two.SetsofSt uatPlans: phone 413-587-1240 Fax 413-587-1272 Piousite , (#hee5pea(y, APPLICATION TO CONSTR ,ALTf R A ONE OR TWO FAMILY DWELLING SECTION, -SrTE 91FORMATWN .6l" - q• ts'Ua 1.1 Prrooecty Addy-ss: This sectrkm to be completed by ot}ice u. y� � h DEPT.OF BUILDING;INSPECTIONS g/l NORTHAMPTON,PAA 010 WAddd Nov-�an�1( oh �` a l o(o o Ern St.e-rsttic CB Dwtrir- SECTION 2-PROPERTY OWNBOWIAUTHORIZED AGENT 1 Owner of Narne(Print) Current tag Addams: a-44 ac Telephone 2.2 Audborized A1121s W� 3 I!e Narne(Print) adder:r, Z Y13 R gsq sigr>ehrre Telephone SECTION 3=ESTNAAT®CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be ofr>dd use Only =mWed by Permit aWhcaM 1. Building rl G (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Big Perm*Fee �[ v�!n 4. Medw*M(HVAC) l� 5.Fire Protection 6. Total=(1 +2+3+4+5) Ctredc Number This Section For Olhciai.Use Only Date Building Permit Number: Issued: Signature: Bukft corra*ssionwnnspector of Buiidsxjs Date EMAIL.ADDRESS(REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aonlicabis) New Mouse ❑ Addition ❑ OReplacernent r firs ❑indows Alberation(s) ❑ Rooting ❑ Armory fig• ❑ Deno tion ❑ New Signs [pj Docks [q Siding M Other t� Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a.if Neill►house and w adeWI1;to exLsdm bousim .d'IB#o1Wudna: a. Use of building:One FamBy 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. IWasschedc 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 buuiding conform to the Building and Zoning regulations? Yes No. i. Septic Tank City Sewer Private well City water Supply SECTION 7a-ovei R AUTttoRI2ATM-TO BE COMPLETED WHEN OWNERS AGM VOR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, dawvo as Owner of the subject party hereby authorize to acton my�m all mafters relative to work authorized by this buWM permit apron. 0-T-�ae. . 1/ l as /a k Signatm of Owner Date as OwnedAult,orized Agent hereby dedare that the statennents and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penaltieg of ury. S1Aa ui i Print Name Signam of Ownw#&Wt SECTION 8-CONSTRUCTION SERVICES 8.1 LicftnW Can Sc or: Not Applicable ❑ Name of l.;cerse a 161&B Ucerm Number a l la u 197-hk Addrm Expirefion Date o � Sig Tetepwm 9.RAMIG101ed Ham-lenoMnt;Contactor: Not Applicable ❑ S'h Mt c�al1 MIL ConmamfName Registrafion Number Ho me 1btwfqkion I /3i/g Address('� / // Expiration Date �U 4U(" &�01I Telep— • `i SECTION 10-YYORI E COMPENSATION INSURANCE AFFIDAVIT(11.G.L c.15X§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 issuarme of the budding permit Signed Affidavit Attacdied Yes...... No...... ❑ Wifihmodia .Siae . 117 'ill Nato . . E N.4 rtel inc VI) '�'�" �aac Tyke� £�'�' ' wmw9Iwpw4m** 7. & 0 fasag ' mea 9_ Nom'aa=P..-%Nmmm S. 0 Wawa a mdift as aaeeueeaee �aa �e�eia� - '�aio�a tea& 11.0 aca&"eus uFflampftwodm . emplagemu%wadmie COUP- .) � n � sRs �RastessW kY- ius�ntiwe. ie�raAr: a�asics�t�s _ eswraanMiiaea�irawree..� �e � p. :f,,., sc ?Olky _ Oo 9 LOA O/ff-, . e,aea .�rc3rsirwreg �a.i .. }- �� e.�sSs 2�,1. .c eeel�#a��ir�swdoR�e�ai�, es�'a _ - eoaea ,saw sg aat� oAna 'VOK . aI a Sme ace"stOkmoommamay be fwwomkdla*c of w imp' . � ,�rso�ks�ailli� sss�. yVIA, , r .� cm X0 m :q r Jay Boland Z D t , ID �201'I-.�.�4 G� Z Q RI ' 1�T1 i!t{ I 1 { ll, I Lr Jil, rl •''� ��t rpo-i ! '3 0X©x :j'�/,•.!{ih-II ',it it •ll 11,;117111. 1 ( 'I,,. ,t,,t,� C ^�. D 0 ', g omA 0 n 0 z19 . 5 Q-1 a Massachusetts Department of Public Safet, Q j Board of Building Regulations and Standarc ECS License: CSSL-101880 a � � Carl�trtl>:ilUrt :3uper��i��r;;�arlc)rtlhl JAY R BOLAND 12 PISOAH RD HUNTINGTON MA 01060 411 10, y o �11 ,rtfi�v ,1��ta�-. Expiration ON 'Commissioner 12/27/2018 I iD O� a 4 M t A/ Office of Consun'Afisim and Business Regulation 10 PS* sults 51 TO Wets - 02116 Hornet Ii r Registration lietraWn: 1i�f'l Home Energy Solutions Inc �. �xPirstion: OVOW9019 68 Russellville rd Southampton, MA 01073 f� Update Adtdreq and retwa:iard, Mark rsason for 01100pi. q 11 A,ddroms r mentwo n emptoymint 0 Lost Card 0"1"of Goneutrw Am"R i safregu Ib" HOMN IMPf OVOMr i'fffZ100 R vdW for individual use**y TAIL . ?YPt i ra#icar bofto bi:imptmIkfn doW If found+ew n to: 0"4W4&M asrr►�'AAtfeiri and busirwas itsoatlon �� $00tons VIA 021 Is i J6170 Now EtwaY as soutit" ton,Md':.. Undemeoretary MW vslI d without WSnoture t City of Northampton Massachusetts i ZI WAR1MM OF SUZLDXW narz cffs t 212 Maio Street •Mbaiapal BaUdiag Mosthowton, MA 01060 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 property licensed solid waste disposal facility, as defined by MGL c 111,S 150,. The debris from construction work being performed at: 0 1� oo Y-4k aiaL�- (Please print house number and street name) Is to be disposed of at -� r (Please pW nqphe and location of Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) 4 4. i-A Signature of Permit Applicant or Owner Date 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. DocuSign Envelope ID:FFOCA4CB-DF8E-421F-BOB2-494CCF173581 'aMr r .N�i°1 RISE ENGINEERING_ OWNER AUTHORIZATION FORM I, Howard Gold , (Owner's Name) owner of the property located at: 212 North Street (Property Address) Northampton, MA 01060 , (Property Address) hereby authorize Uvvul E SG I (Subcontracto 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. Docuftned by: ��{{.. L\i WA4 rU'0 fore 7/25/2018 ► 11:00 AM EDT Date RISE Engineering,a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 1 Canton, MA 020211339-502-6335 www.RISEengineering.com 2018 WEATHERIZATION BARRIER INCENTIVES Sased on 1o._rjergy Specialist's recommend at!ons,your home can benefit from program-eligible insulation and/or air seating _pnave,nen>s.Before moving forward,please follow al?t,.e instructions below to remediate your weatherization barriers. CUSTOMER INSTRUCTIONS 1. �re a o°aiif ed,licensed contractor to evaluate and/or remediate the weatherization barrier(s). 2.Sub?-i"signed and completed copies of this form and a copy of the paid contractor invoices)within:60 days of your Home Energy Assessment to:RISE Engineering.60 Shawmut Rd,Unit 2,Canton,MA 02021 Or email to Columbia€iasMAinfo@RISEengineerinl 3.The weatherization incentive will be deducted from the customer co-payment amount of the weatherization work.A rebate check will be issued in the event the amount exceeds the customer's cc-payment amount. 4.Complete the recommended weatherization improvements. Customer Name: Howard Gold -_15ent n or Site ID: 469931 Site Address: 212 North Street Northampton Northampton State: MA ZIP: 01060 Phone Number: 413 320-3037 Email: hojogo58@gmail.com Customer/Homeowner Signature: Date: I ec r To determine if teaere is any active knob and tube wir rag.the contractor will evaluate the following areas where eligible Mass Save' weatherization reaamr<-endations have been made: VAttic Ploor ~7`attic Wall At is Slope-vtExterior�A'ail 43,asement ❑Other: ❑Other: " I have performs ^rys inspection and derermined there is no active knob and tube wiring in the areas selected below. I `1�4'AtticFlocr >6.ttic"» _'aV YAtticSicoe ❑Exterior'vdall ❑Basement ❑Other: ❑Other: I have read ano agree tc the Terms and Conditions on the back of this form. Contractor Name. �' �'� '✓7 � .' _ '4 � Address: 2_110 �L ^� , ,&d_-.r City: ,sp State:/744 ZIP: 0/06:_L 6:_L Company Name: License Number: Contractor Signature: ' Date: 7 High Carbon Monoxide:Contractor is to service and re-evaluate the selected mechanical system(s)and reduce the carbon monoxide level, as measured in the undiluted flue gas,to beicvt 10x3 parts per million(ppm). Draft Failure:Contractor is to correct the dra in the selected flue(s).Refer to table on reverse for acceptable draft ranges. o - Existing Co pprn: w ®Revised COlppm: Existing Draft Pa: i Revised Draft Pa: Heating System { Hot Water Beater LOther: { Spillage:Contractor is to correct the spillage of flue gases in the selected mechanical system(s).Must not spill after 60 seconds of operation. ❑ Heating System ❑ Hot Water Heater ❑ Other: ❑ 1 have performed my inspection and have corrected the items noted in the areas selected above. G 1 have read and agree to the Terms and Conditions on the back of this form. Contractor Name: Address: City: State: ZIP: Company Name: License Number: Contractor Signature: Date: Continued on back (page 1 of 2)