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05-066 (10)
372 AUDUBON RD BP-2019-0872 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:05-066 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-2019-0872 Proiect# JS-2019-001456 Est.Cost: $4000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor., License: Use Group: POTENTIAL ENERGY LLC 106184 Lot Size(sq.ft.): 142876.80 Owner: JUDD EDGAR R JR&CAROL A Zoning: RR(100)/WSP(100)/WPP(4)/ Applicant. POTENTIAL ENERGY LLC AT. 372 AUDUBON RD Applicant Address: Phone: Insurance: 4 D QUEEN TER (860) 506-4266 O WC SOUTHINGTONCT06489 ISSUED ON:2/8/2019 0.00.00 TO PERFORM THE FOLLOWING WORK.-INSULATE ATTIC WITH BLOWN IN 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 2/8/2019 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner BFOEIVED r� rtrrte�t ose on City of No ham ton ~ P . F E 8 ..qui D part ent C #a utll�twaji F?em�lt 212 Mai Str t Steer/ J�yet 00 WaterNVeN,Aver EPT_OF BUl IN NS NONTHAno 1060 Twro its crf � e phone 13-587-1240 Fax 413-587-1272 Ie Mans Other APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING 107 SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office 3?z uj(600 RcAo Map Lot— 0&_r.' Unit LC DS1 M4 O T-5 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: � e 6tRot Low 3-7 2-ALocJAW khO I1211-Dlos 3 Name(Print) Current Mailing Address: —S[rLr A U�1z ?*17W M— Tel�l3 bphone 03-32 Signature 2.2 Authorized Agent: Name(Print) urrent Mailing Address: /I - 860 620 X131 Signatu Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building &0 (a)Building Permit Fee .r 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee t7 d 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5) Check Number c7 L/ This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/inspector of Buildings Date l r�Ao @�r��r��-� �R6��s� coA4 EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) 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 Heigbt Bldg. Sq Footage % Open Spa otage % (Lot area min b dg&paved ark ing) #of Parking pa es Fill: volume&Locat o A. Has a Sp cial ermit/Va 'ance/Finding e r been issue r/on the si ? NO DONT NOW O YES IF YES, date iss e& IF YES: W t permit ecorded t the Registry o\Pag , ? NO NT KN W © ES IF YES: en er Book and/or Document# B. Does the site c tan a brook, bo of ater or we . NO O DONT KNOW © YES Q IF YES, has a p r it been or need to be obtained from the Conservation Commission? Needs to be obta ed O Obtained © , Date Issued: C. Do any signs exist on the property? YES o NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES © 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 acre? YES O 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 I] Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding[l7] Other Brief Description of Proposed Work: itl2N. k L_)&aVA)lA1 d�l�t>C,DS� Alteration of existing bedroom Yes— et—No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No 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 1, /_ �4� ,ko as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to wo authorized by this building permit application. — ur(fod.12 tay M — -Z _ / Signature of Owner Date I, it-oLk-& Alrtm? 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. SiZned under the pains and penalties of perjury. CNoLAs lqnfek Print Name Signatur f r/ Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor Not Applicable ❑ Name of License older: & AS 4030 /,*4/8 License Number '-1I� y50/ T�R,�i9ur� A)GOA), � o(,y,5 ZI 9 Address Expiration Date /3 MO Sig Telephone 9.Realstered Home Improvement Contractor: Not Applicable ❑ -T0T A)7-J .�ti�'RG�t /9228 Company Name Registration Number i / trf-Dio -,�Oftgc fox 2�, ,)eU) 6R1JaW, Cro4oSZ 6 2/12a Address / Expirat�Date Telephone 4l1 NO2?3 OF 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 permit. Signed Affidavit Attached Yes....... No...... ❑ City of Northampton Massachusetts ,�w} ►- '<< DEPARTMOIT OF BUILDING INSPECTIONS �= 212 Main Street • Municipal Building b Northampton, MA 01060 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 be registered Type of Work: &SULl7-f�,o� Est. Cost: Address of Work: 322, X004)&0 KD,'l) Date of Permit Application: 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 buildingp ermitas the agent of the owner: 2-�•/9 /YZ2 y Date Contractor Name HIC Registration No. OR: 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 I f Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main street a Municipal Building �uj•.,, Cs Northampton, MA 01060AW 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: 392 4&A) & (Please print house number and street name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: Qaww-XT' Jai' Nt� � � ✓ccs ��- (Company Name and Address) Signature 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. i i I CLEAResulti CONTRACT CtEARasult WaafNrlQton S ! Customer Name:EDGAR R JUDD �f4 f1U1,OfSD1 Emall:padrerj99@gmail.eom Phone:413.575.0332 Prendse Address:372 Audubon Rd.Northampton,MA 01053 Project ID:3592741 Date:Nov,8,2018 Applicable Customer Reaulred Actions: Notes: • Storage Removal Please clear all storage items away from the rear basement foundation wall prior to the contractor arriving. Job Description Contractor will perform or cause to be performed the following work on these"Premises"in a professional manner and in accordance with the terms of this Contract,including the attached recommendationslwork order describing the work in detail(the"Work')which are incorporated herein by reference. Mme Locaf m Qua* '"Unit Total Cost Cuslontsr Cost ' Air Sealing at Estimated 62.5 CFM50 Per Hour 10 hr $925.80 $0.00 Whole House Fan Box-2"Thermal Barrier Polyiso(with AS hrs) 1 each $187.70 $0.00 Attic Floor-4"Open Blow Cellulose 1080 SF $1,598.40 $399.60 Damming 86 each $205.54 $51.38 Hatch-2"Thermal Barrier Polyiso 1 each $46.28 $11.57 Basement Wall-2"Thermal Barrier Polyiso 224 SF $1,070.72 $267.68 Total: $4,034.44 Program Incentive: -$3,304.21 Weatherizatlon Barrier Incentive: -$0.01 Customer Total: $730.22 Payment Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows:Payment tri:$24140 as a Deposit payable to CLEAResult upon signing the Contract(not to exceed 1/3 of the total retail costs).Mail check&contract to CLEAResuk 50 Washington Street,,Westborough,MA,01581.Final Payment:$486.82 as the final payment for the Work shall be payable to the Home Performance Contractor(HPC)or Independent Installation Contractor(IIC)upon satisfactory completion of the Work.Customer understands that he/she will not be required to pay the Utility Incentive Share of the Contract price in the amount of $3.304.22.Changes to individual line items and/or previous iricenlives may increase or decrease the size of the Utility Incentive Share. Page 1 of 4 i t I Dispute Resolution The IIC and Customer hereby m u*agree in advance that in the event that the IIC has a dispute con erranp this Corsrad,tha IIC may submit such dispute Io a p*a%arbdraftn service~has been approved by the OHice of Consumer Affairs and t3us'ness Re"tion and Customer"be required to submit to such arbitration as provided in M.G.L.c 142A. i You may cancel this agreement H it has been signed by a party at a place other than an address of the seller,provided you notify the seller in writing by ordinary mail post9d.by telegram sent or by delivery,not later than midnight of the third business day folly vi ng the sign t this agreement.DO IGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. �- ///Y//,? L- Cusiomaa re toe* Indicate your selected IIC here,if applicable InWal k you Program to attti 0 a Parkiptg CorMractor CLEAResutt Signature Date Name of CLEAResult Representative Page 1 of 4 i A 4 The Commonwealth otf.M`assachusetts Department of Industrial Accidents Office of In wstigations 600 ffravhirx ton Street " Boston,-4.4 02111 §: www.mass.gorrlflla 'corkers' Compensation InsuranceAffidavit: Builders/Contractors/Electricians/Plumbers ApBlicant Information Please Print Legibly Name (BusiDess/Organizatiotv'l divide il): � r 1AL1CJJQJ.AZ s e Adch-ess: QE� TE — clt:y/ tate;;'Zip:� _ " " 455 Phone#: -50(o VZGG Are you an employer'. Check the appropriate box: Type of project(required): 1. I am a employer with 4• CI I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors6. [� Netiv construction 2- 1 am a scale proprietor or partner- listed can the attached sheet. 7. Remodeling These sub-contractors have ship and Nave no ernplcayees 8. Demolition working for me in an capacity. eanployces and have workers' y ca P 9, Building addition [No workers* comp.insurance comp.insurance., required.} 5_ F-1 We are a co loration and its I€3•❑Electrical repairs or additions f oficers have exercised their i 1. Plumbin repairs car additions I am a homeowner doing all work � g •'"P�irs myself. [No workers' comp. right of exemption per MGL 12.7 Roof repairs insurance required.] ` c. 152, §1(4),and Svc have no employees. [No workers' 11 comp. insurance required.] J "Any-appitcant that checks boa 41 must also fill out tb•section below shoti;nng their word ers'con€prnsation policy inrormationi Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors than check this box must attached an additional sheet showing the name(if the sub-contractors and state whether or not those entitles have employees. Ifthe sub-contractor,have employees;,they must preside their tiro kers'comp-policy number, I arts art employer that is providing workers'eampen sation i surance for my etrx kyees. Below is the polhi r card job site in,f cwmation. Insurance Company Name: -go — r Police#or ;elf-ins.l..ic.I: Expiratacn Date:_ {� :lob Site Address: 372 Audubon Road cityJStateZip:Northampton,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 Section 25A of MGI.c. 152 can lead to the imposition of criminal penalties of a fine tido to$1,500.00 mid/or Lane-yeah imprisonment, as well as civil penalties in tine form of a STOP WORK ORDER and a Zine of up to 5250.00 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. I do hereby veru;f-u r fire esus and;pewaides of per ury,that the information provided ed above is tare and correct. 2/8/19 ;i Tnattlrr ; `• `' D, Phone9: �, 3 �..�' `_� .._..:.. .....................___...._._._. ._._.__._._._...... Official use only. Do that write in this area,to be completed by chy or town of iciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Berard of Health 2.Building Department 3.Cityffow-n Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.tither Contact Person: Phone#;