30B-058 (5) 147 RIVERSIDE DR BP-2019-1130
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map.Block: 30B-058 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Pennit. Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2019-1130
Project JS-2019-001837
Est Cost' 5800 00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: ENERGIA LLC 92540
Lot Size(sa. ft.A 24742.08 Owner. DEMARIA SUSAN
zopin% URB(100) Applicant. ENERGIA LLC
AT. 147 RIVERSIDE DR
ApplicantAddress: Phone: Insurance:
242 SUFFOLK ST (413)322-3111 WC
HOLYOKEMA01040 ISSUED ON.411612019 0:00:00
TO PERFORM THE FOLLOWING WORKINSULATE COMMON WALL RIGID BOARD
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 ft 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 Sinnature:
FeeTvpe• Date Paid: Amount:
Building 4/16/20190:00:00 $65.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
6pt9- // 30
City of North mptcH E Q C� �y D
IFOR
Building De rtment
212 Main Street
Room 100 APR 12 201 1 SOLA TION
.'.�(
Northampton, MA 01060
phone 413-587-1240 Fax 4431`y4;IJ,LUZ ONLY
_.
Y, 1---„ .—. . I.. IDNS i —
APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY
SECTION? -SITE INFORMATION INSULATION PERMIT
1.1 Property Addresa: This section to be completeedd eby office
T� Map�9 Lot d J u Unit
Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
5l `�dl OPcoo-YvQ 1�1� Rv r5ide l7rvye,
Name(Print) 1 �yy� rV\ Current Mailing Address:�11\�\�
, C �t VY1\ \ & Air\ VCi i 1 Telephone
Signature
22 Authorized Anent:
1ev 7�12 �v �,Fftti\Y-� Str�-t1c�A�v-eM �
Name(Print) 11Cuu1rrent Mailing Address:
Signature �Elephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by Permit applicant
1. Building C�-.� (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee 3
4. Mechanical(HVAC)
�//G�—
5. Fire Protection
6, Total=(1 +2+3+4+5) Check Number
This Section For ficial Use Only
Date
Building Permit Numbe Issued' (J
Signature'. /
Building Cammissiorwlllnspedor of Buildings Dale
l�EL1LE @ ofe/71,5E q S-
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 4-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable El
Name of License Holder�Cll'Y-1 aP)iS� A�S1� Cq2—'SyV
License Number
Y BYO\ 0 \04CG OSYOi 1201q
Atlol i Expiration Date
� 3-3vv 1
Sign re T leph e
9.Reaistered Nome Improvement Contractor: Not Applicable ❑
Y �YQ1(a i I' . IGS I��\
ComoanvN Registration Number
247 '-i AGv6' �Syru Y kKAA Qy-e MA O\(XIC 1llICj 170
Address Expiration Date
Telephon��
SECTION 5-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._.._ A No...... ❑
Brief Description of Proposed Work NOTE: INSULATION ONLY
RSvKRtc comm \rJo-k V'kC)vd mrd
I, Tnor, 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.
Pont Name
� �j s�jr,IG
Signature o r/Agent Date
I, cy )u�'N2I, 1 L�\a as Owner of the Subject
property
hereby authorize TC')CY\ Rr� «IYYJ,S` 1E r
to act on my behalf, in all matters relative to work authorized by this building permit application.
�<z; IZc- lc\
Signature of Owner Date
City of Northampton
•3 Massachusetts Aye ?
m-
c
s
A DEPARTMENT OF BUILDING INSPECTIONS y z
212 Mein 5[rnet a lLnicvpel 8.rtIding p,
RoctTeuq�ton, 14h 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 an 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"mconstruct on, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition, or construction of an addition to any preexisting owner-occupied building containing
at least one but not more than lour dwelling units....or to structures which are adjacent to such residence or building"be
done by re istered contractors.
Note:If the homeowner has contracted with a corporation or LLC,that entity mast be registered.
Type of Work:Tn 2!1 la(\ Est. Cost:
Address of WorkAq-A DY\Ue
Date of Permit Application: /S J�)
I hereby certify that:
Registration is not required for the following resson(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:
'I IS17nla Tr)m C,G\
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
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS Z �"
212 Main Straec •Manlcipal Building
\ Northampton, MR 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 properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
W1 'RtreYslcle 'N-\> )�!!
(Please print house number and street name)
Is to be disposed of at:
t\wo:AVyRcinc �h. ,S�rlr ,(ZNd
(Please print name and location of facility) _�
Or will be disposed of in a dumpsler onsite rented or leased from:
(Company Name and Address)
Y//0
Signatur o ermit Applicant or y ner ate
/
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.
city of Northampton
Q®
'' Massachusetts
D r= i rrL
f ;
i ARTBENT OF BUILDING INSFECTIONS
\ 212 N in Stteat • Mnicipal Building
Notthq tOn, N 01060
MANDATORY FOR HOUSES BUILT BEFORE 1945
Property Address:
Contractor
Name: Tom Rc�55rsX��51�Y
Address: 2W �)u�f n\lk SA y ec k
City, State: )\gny' P ,_MF9 0\01-10
Phone: ��IL31'�7-31i1
Property Ownef c�
Name:
Address:
city, state: NQA (��-�On ' tw" O\CX�
I,TC�Y`(1 QOaSYY'C��l� (contractor) attest and affirm that the building I intend to
insulate does not have any open air(knob and tube)wiring in the spaces to be insulated and that 1 have
provided the property owner with a copy of this affidavit.
Contractor signature
Date
Ilsi
2018 WEATHERIZATION
mass save
5avin9[[FmugF energy sefficiency BARRIER INCENTIVES
Based on your Energy Specialists recommendations,your home can benefit from program-eligible Insulation and/or air sealing
Improvements.Before moving forward,please follow all the instructions below to remediate your weatherization barriers.
CUSTOMER INSTRUCTIONS
1. Hbe a qualified,licensed contractor to evaluate and/or remediate the weatherization barrier(s).
2 Submit signed and completed copies of this form and a copy of the paid contractor Invoice(s)within 60 days of your Home Energy
Assessment to:RISE Engineering,60 Shawmut Rd,Unit 2,Canton,MA 02021
Or email to COlumbleGaSMAlnfok RISEengineering.cum.
*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 co-payment amount.
4 Complete the recommended weatherization Improvements,
Customer Name. Susan Demarla Client R or Site ID: 481522
,amc,ne: 147 Riverside Drive c!h„ Northampton State: MA ZIP: 01060
Phone Number:L413548-5969 Email:
` Y b
Cbtprnler/lrarrraorenw 49natur�y� � f�l� Cele:
To determine N Mere is any actio knob and tube wiring,the contractor will evaluate the following areas where eligible Mass Save
weatherization recommendations have been made:
®Attic Floor OAUic Wall 0A1tc5lope ❑Exterior Wall ❑Basement ❑Other ❑Other:
„�e yaw o,•rn nr re�.sscs.�ar
JL 1 have performed my inspection and determined there is no active knob and tube wing In the areas selected below.
?Attic Floor "Attic Wall Pl Aftic Skpe ri
Exteor Wall W9asement DOMer: ❑Other:
m Arte.. w
I have read and agree/�1Re T ms and Condit, on the back of this for .
Contractor Name: M0
Address: j )S iY1 !!,�� City. State:�rC%/_ZIP: 0149,5-3m
CopaM Nm
ae I/7 _License Number'
Contractor,SIRrleNrre:X Cera:
NISh Carbon Monml4e: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 hebw 100 parts per million(ppm).
Craft Reernac Contractor is to correct the draft in the selected flue(s).Refer to table on reverse lot acceptable draft ranges.
Existlrg CO PPm: Revlzed CO ppm: Existing[)raft Pa: Revised Oran Pa:
Neeprlp SYatelrt
! Not WeW Werar '
.Other:
SpRtepe:Contractor is to comttt Me spillage of flue gases in the selected mechanical system(s).Must rat spill after 60 seconds of operation.
D Heating System O Hot Water Heater. ❑ Other:
O 1 have performed my inmection and have corrected the items noted in the areas selected above.
D 1 have read and agree to the Terms and Conditions an the back of Mis form.
Contractor Name:
Address: City: State:_ZIP.
Company Name: License Number:
Contractor Ministers, alae:
Continued on back
(page l of 2)
ACORO
CERTIFICATE OF LIABILITY INSURANCE .AM
018 riI
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON TXE CERTIFIR. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDEOLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUORIZEDREPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les) must bB endorsed If SUBROGATION Iubject tothe terms end conditions of the policy,certain policies may require en endorsement. A statement on this certificate does nhts to the
Pardo sle hddaT In lieu of such endomemanl(s.
Pa"UCER COxi Ma Gonro
The Do vid Agencies, LLC "exon Ax
14 BODa1a Road .413-538-]444
HDlyoke MA 01040 EmAI
P o ENELL
INSURE S AFFOROINO COVERAGE FINCY
INSURED
Energia, LLC NsuRERq: venslon Insurance Company 35378
242 Suffolk Street INSURERS:Commerce Insurance Cam an 34754
Holyoke MA 01040 INSURER C:StarSmos Nat'--Insurance Com an 1 25496
WSURERD:Guardinsura ceGroup 6281
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
PERIOO INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITHRE 'CECTCT
TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJE
TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
M R TYP E OF INSUMAND E AUDI u POLICY NUMBER I POLICY P CTB P LIMITS
A CENERALUABIIJtt 2DIM,se VION5 ]/12010 EACH OCCURRENCE SI'Mue.
X CQNMERCNLGENEMLIWBILITY FA my Sa,
CIAIMSIMADE OOCCUR MEOE%PIA nmopFsanl 81.Mo
PERSONAL SAOV INJURY SL DOs
GENERAL AGGREGATE Seo 000
GI AGGREGATE LIMIT APPLIES PER. PRODUCTS COMPgPAGG 52.DW.000
POLICY X Pq LOC S
B gUTOM091LE LNBILIN BxOPBJ A1201a 7M2019 COMBINED SMOKE LIMIT S1 W0.000
ANY AVTO
IF.wiNnp
BODILY INJURY IPB,11111 6
MDILYr1LL ONMEDAVT05
X sCHEOULEn pUT06 INJURTIFerectlneM) s
PROPS
X PROPERN DAMAGE
HIflE0AUT0.3 IPOreultlanp S
X NO&OVrNF0 gUT05
S
C $ UMBRELLA LIAR X OCCUR IIIIIHI-11 11laO1B ]112019 EACH OCCURRENCE 51001
EXCESS LIAS CUMMeMgOE AOGREWTE 31 DO ow
DEWCTIME
RZTENJUNON
NORRERs CO.lMBAT10N ENµC0S3P2 7/12018 11=11 X RCSTATU. DTX'
AND IMM OYERS44BILITY YIN
ANYPROPRISTOS AIR EPRY,EOUTNE
OFFICERMEM ST Sn' 'Em ❑IN E.L.FALNACCIOENT S11MO.gq
(MmtletoryM led E.J.DISEASE-FA EMPLOYEE S I,MI
MI
IIn W in NMel
SEs RIpi19NDFOPEggI Ns ttlgv E1.OISEASE-POLICY LIMIT b
lopgo
oESCgIPT10N OFOPIRpnONb(LOCATIONS/VEXICLEs IAnaep gCORO101,gtltllllenol RUma,Xp Scpotluler Ilmerc epaco le rcpUlntll
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 REPRESENTAME
. .
01988-2009 ACORD CORPORATION. All fights reserved,
ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD
anmm�wealth of Massachusetts
Division of PrOreSS}Ona!Licensure
10 Board of sodding Regulations and Standards
Construction Su w¢ iso,
CS-092540 Expires: 09102/\2019
100 MAI BTREET SSLCR
1
foo MAIN STREET
HATFIELD MA 01039 A—
Commissioner
. Office of ConsumerAffvrs&Busvers tiegulnrim Lieense or cegistrntion valid far tudividul use anty
A DME IMPROVEMENT CONTRACTOR before the expiration dote. if found return to:
Rdglstrauow 165169 Type: Of9ee of Consumer Affairs and Business Aegulation
Cxpiretion: 11.1112018 LLC 10 Park Plaza-Suite 5170
.fr Boston,MA 01116
ENERGIA LLC •�✓�{yO' �
THOMAS ROSSMASSLCR
242 SUFFOLK STREET
HOLYOKE,MA 01040 ilndencsretnry ryot valid without signature
f
' The Commonwealth of Massachusetts
x 2,.
Department of Irzdush'ialAccidents
Office of Investigations
600 Washington Street
,;,{(-".'•` Briton, MA 02121
w pmourss.gov/dirt
Workers' Compensation Insurance Affidavit:BuildersiContractors/Electricians/Plumbers
Applicant Information Please print Le¢ibly
Naive(busincsslOrganisationlInd'++vidual):_,-EllBf IH„ 1_C
Address: 242 Suffolk St.
Fe
e/Zi : Holyoke, MA 01040 Phone#: 413-322-3111
employer?Check the appropriate box: Type of project{rerynircall
employee with A,9^ 4, ❑ 1 am a general contractor and 7
r have hired the sub-contractors 6. ❑New consI've n
yees(full and/or port-time), 7, Remodelin
a sole proprietor or partner- listed on the attached sheet ❑ S
nd have no employees These sub-contractors have g. ❑ Demolitioning for me in any capacity. eniployeas and have workers' q ❑Building addition
orkers' com inswanee camp. Isurance?V• 5. ❑ We are a corporation and its 10,[]Electrical repairs or additions ed.]
3.0 t am a homeowner doing all work officers have exer..isad(heir }i.(�Plumbing repairs or additions
myself. o workers' com right of exemption per MGI. 12. Roof re an s
insurance recollect) p ^. 152,§t(4),and we have no 13.0 Other
p
employees.[No workers'
comp. insurance required.]
^Any nppikant eat checks box lit Zonal also fill uul the s¢clion below shoreu+gdaL,wrWas'co'.owvllm wlicy manalltion~
—
tHomeownerswhosubslilIhi¢ Ind.—it indicatlng Lucy ON doing oil wort:and Ilion hire ourslde conlraemrs must subnrir anew orfidevit indicmingsuch,
1Co0tractoss mm e}uck tries box ord+e suGcwneeuars and state wham,ar net sre"entities have
cmpinyccs, Itthasubcanuuxntt ftavc cny�teym0.Rwy nWstpsavidntheh aoskeis'comp.policy nnmbtt.
f axe au employer hear isQrovirling workars'rnnrperrsatinn irarrraneefar rrry emptapeex. Below is the polies and job site
information.
Insurance Company Name: Guard Insurance Group
Policy#or Self-ins.Lie.d: 7/01/2019
, Expiration Date: 710112019
Job Site Address:1y�' R.\ \'"7�d�' 1 \ _City/Soca/Zip: fa\ \ l`A'lf�� l
Attach a aroY of the workers'compensation pntky dcclaratior page(showing the policy mother and expiration date).
Failure to secure coverage as regoired.under Section 25A of MGL,e. IS2 Gan 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 WORX 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.
I do dereby earfio under 16 Was mrd penalties ofperjuqthin the inforonloon provided above is rue at t correct.
$' tura _,., _ ate'.
phot e it. 413-322-3111_
Official use only. Do nor rwite in this area,as be completed by city or toren official
City or Tmvn; Permit/Lieeasa#
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.City/Town Clark A. Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Persan: Phone#: