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29-267 (6) 52 LONGVIEW DR BP-2019-1494 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Bim :29-267 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category,INSULATION BUILDING PERMIT Permit# BP-2019-1494 Proiect# JS-2019-002418 Est.Cost:$5757.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: POTENTIAL ENERGY LLC 192284 Lot Sizetso. R.): 19079.28 Owner: KELLY VIRGINIA Zoning, Applicant. POTENTIAL ENERGY LLC AT. 52 LONGVIEW DR ApplicantAddress: - Phone: . Insurance: 4 D QUEEN TER (860) 5064266 0 WC SOUTHINGTONCT06489 ISSUED ON.•6✓2712019 0:00:00 TO PERFORM THE FOLLOWING WORK.6 IN OPEN BLOW CELLULOSE IN ATTIC, KNEEWALL 3 IN BATTING, 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 Signature: FeeType: Date Paid: Amount: Building 62720190:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck-Building Commissioner 7-IvS&L/, �o � Department use only City of Northa pro ECEI V snit. Building Depa me ut/D iveway Permit 212 Main S at Se Sep c Availability Room t0 JUN 2 6 ppi at lWel Availability Northampton, 01 0 m is Structural Plans phone 413-567-1240 F 41 -1272 PIoV ite P ns DEPT OF BUILDING INSP ba6Spe 'I NOPTwA p APPLICATION TO CONSTRUCT,ALTER REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION I -SITE INFORMATION t5/a / DR, � 1.^1 PmDertrAddress: �r� /This section to be completeedd by ofnea 59 koAJGV(6r� A— I Map d l Lot—4)C1'7 Unit Zone Overlay District Elm SL District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: JIMU11A Wd 6A lah"i" oa(ier elDa-nla rw . aaya Name(Prim) TCurreRI 9le m Meiling Add_rp>js:a- Telephone Signature 2.2 Authorized Agent. ,Uw—STE � MRVASI54rARr of i c Name(Prim Cu mt Mailing Address: �.nt� i 9�1- ne Ua73 S nature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building JV.l dL Gr75 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 8 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) !�"� 5.Fire Protection 6. Total=(1 +2+3+q+5) $ rj, Check Number This Section For Official Use Only [BuildinPermh Num er: Date Issued: Signature: 4-2L-2019 Building Commissionedinspectc r of Buildings Date 1 � @Po [int fltr��.uti.RC,� (J' '. COW EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incanplete Information Existing Proposed Required by Zoning Thi.mlumn m be filled in by Buildin,Dcp.mnent Lot Size Frontage - — Setbacks Front Side L:= R: -71 L:C. . R: Rear �J Building Height Bldg.Square Footage O Open Space Footage (Ut era nu.bid,&pvd parking) It of Parking Spaces '..-� Fill: volume&Location A. Has a 5 (Flat Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW O YES O IF YES, date issued:, IF YES: Wa/s�th($permit recorded at the Registry of Deeds? NO V DONT KNOW O YES O IF YES: enter Book Page and/or Document k B. Does the site contain a brook, body of water or wetlands? NO & DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , 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 O NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,exca 'on,or filling)over 1 am or is it partof a opinion 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 0 Accessory Bldg. ❑ Demolltlon ❑ New Signs [01 Decks [0 Siding�) Other[ 7AISULAT/dAJ Brim Description of Proposed Work- &A 1pFr19.1A.1 /'ato_ YCF_ Im "1C. VA)ffWAU-'T%APr,A1j2gr 49 5rAJ1rJ Alteration of existing bedroom_Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ea.N 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 o. 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 1. Is construction within 100 0.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 Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ,as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Data I, 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. PON Name Signature of Owner/Agam Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(5)) 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 5 - . Massachusetts Azs oft DEPARTNENT OF BUILDING INSPECTIONS trea 212 win at a r nicipal Bulldung Northampton, M 01060 ry e AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontracmrs performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor most be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconshuction,alteration,renovation, repair,modernization, conversion, impmvement, removal,demolition, or construction of an addition to any pn-axiadng ownerbccupied building containing at least one but not more than fourdwelling units....or to stmctures which areadjacent 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 registeerd e Type of Work: 11J5tItA'1lQk Est.Coat: $6.767 Addressofwork: 5a GoIJGVI" )lftlf . ALUTAµPTCM A 01o(m2� 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 owneroccupied 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 RESPONSIBHdTES 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: 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 •rt '\ Massachusetts m c 1212 i in S OF BOIL ici IBSPSClI Ws 212 Main Stzeet Nm 010 Building MonUempton, MA 01060 Massachusetts Residential Building Code Section 110.R5.1.2 Homeowner: Person(s)who own a parcel of land 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 structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Section 110.85.1.3.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR 110.R5,provided that if a homeowner engages a person(s) for hire to do such work, then such homeowner shall act as supervisor. Such homeowner shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall be responsible for all such work 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 may be liable for person(s) you hire to perform work for you under this permit. City of Northampton Massachusetts Yfs 4 a DBPARTDRM! OF BUILDING INSPZ=QUS 212 win Stt et •Municipal NuilLing NO�ton, 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 properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from construction work being performed at: 6 L(wG�jt;'r W 'mVx'-' (Please print house number and street name) Is to be disposed of at: 0 W kR.'! f4S , MOW, CT (Please print name and location of fatlli[y) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) //Co4 na u of ftrmit 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. The Commonwealth of Massachusetts Department of Industrial Accidents Orwe of Investigations 0 600 Washington Street Boston,dIA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name(Brien/ass/Orgm+tstioanndiwdaal)!?o yaiAt ClIep&a e, LLil IticmoLAS Mn—srn Address: D QUM4 T ERRPCE City/State/Zip: Phone#: 860-GD6-tf Are you an employer?Check the appropriate box: Type of project(required): 1.� I am a employer with� 4. ❑ I am a general contractor and I employees(full and/or part-tune).' have hired the sub-contractors 6. E]Nm 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, ❑ Denmlitioo workingfor me in an capacity- employees and have workers' Y aP tY- 9. ❑Building addition [No workers'comp, insurance comp.insurance.I ❑ We are a corporation and its 10.[]Electrical repairs or additions required.] 5. 3.❑ 1 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 / f c. 152,§1(4),and we have no insurance required.] employees. [No workers' 13.0 Other 1A,f01„ATION comp.insurance required.] 'Any applicant Net check box#I moat also fill can the search below showing tharworkcrs'compensation polity information. }Homewncm who submit this affidavit indicating the,are,doing all work and theo hive outside contracmts most submit a acro affidavit battening such. tcontmcmrs that check this bon mast mtached an additional shat stowing We name of Ne subconoacmrs aml state whether or rat arose entities have employes. [fthe sub-conuactors have employes,they mustpmvide the"v workers'ramp.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:§ARrFORU I149ORMIC6 GJWQR Policy#or Self-ins.Lic.#: Expiration Date: �q .lob site Address:52 Longview Drive city/statc/zip:Notthampton, MA 01062 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Faihae to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up on$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 for insurance coverage verification. I do hereby cerafy u4*r the poup and penaMes ofperjury that the information provided above is true and correct Sianemre' f '� Date' re Pho 4� g6o•50G .gZ&( 1/ Official ase only. Do not write in this area,to be completed by city or town ojj ciak City or Town: PermittLicense,# 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#: CLEAResult CONTRACT CLEAReself 50 Weahkuwn St.,, Customer Name:VIRGINIA M KELLY Wesraemugh,MA.01591 Email:gmarafn 7@yalvacr m Phone:7819644422 Promise Addmaa:52 LONGVIEW DR,NOfiTHAMPTON,MA 01062 Mailing Admen:52 Lor cr iew or,Normorpron.MA 01062 Project lo:3825324 Dale:May 22.2019 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 Contractincluding the attached recommendations/work order describing the work in detail(the'WoRc-)which are incorporated hereinb reference. Air Sealing at Estimated 62.5 CFM50 Per Hour 10 hr $925.80 $0.00 Exterior Door Weather Stripping(with AS hrs) 2 each $60.14 $0.00 Door Sweep(with AS hrs) 2 each $60.62 $0.00 Whole House Fan Box-2'Thermal Barrier Polylso(with AS hrs) 1 each $187.70 $0.00 Attic Floor-6'Open Blow Cellulose 1008 SF $1,632.96 $163.30 Damming 20 each $47.80 $4.78 Hatch-2"Thermal Banner Poli 1 each $46.28 $4.63 Basement Ceiling-9'Fiberglass Batting 796 SF $2,244.72 $224.47 Kneewall Wall-3'Fiberglass Baning 294 SF $561.54 $56.15 Total: $5,757.56 Program Incentive: -$5,304.23 Customer Total: $453.33 Payment Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows:Payment al:$151.11 as a Deposit payable to CLEAResuN upon signing the Contract(not to exceed 1/3 of the total retail costs).Mail check&contract to CLEAResuh,50 Washington Street,,Westborough,MA,01581.Final Payment:$302.22 as the final payment for the Work shall be payable to the Home Performance Contractor(HPC)or Independent Installation Contractor(1IC)upon satisfactory completion of the Page I of 4 Work.Customer understands that he/she will not be required to pay the Utility Incentive Share of the Contract pace in the amount of $5,300.23.Changes to individual line items and/or previous incentives may increase or decrease the size of the Utility Incentive Share. Dispute Resolution The IIC and Cuslomer hereby m itually agree in advance that in the event that Iba IIC has a dispute concemirg this Contract,the IIC may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and Customer shall be required to submit to such arbitration as provided in M.G.L.c 102A. You may cancel this agreement it it has been signed by a parry at a place other than an address of the seller,provided you notify the seller in writing by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement.DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Virginia Kelly 05/22/19 VR Customer Signature Date Indicate your selected IIC here,if applicable Initial here if you want the Program to assign a Participating Contractor MeaghanJablonski 05IM19 Meaidm fabloruki CLEAResult Signature Date Name of CLEAResug Representative Pap 2 oro 'qwe Ko?"7 Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement.Contractor Registration Type: LLC POTENTIAL ENERGY LLC Re xpireoon284 1 HARTFORD SQUARE Expiration:Expiration:: 00661(21/2020 BOX 2-E NEW BRITAIN,CT 06052 Update Address and Return Card. scA1 o sax., omAneln a ITRegulallnn NOME IMPROVEMENT CONTRACTOR Registration fl ,e valid for individual use only TYPE:LLC before f expiration date. a found return to: B!flB� 06, 1Expired, 1000Offica,Wrf ConsumerAffairsand Business Regulation 192284 11N212020 1000 Washington Sheat-Suite 710 POTENTIAL ENERGY LLC Boston,MA 02110 NICHOLAS MEISTER ` �--- 1 HARTFORD SQUARE U DOOR65SUITE216 Undersecretary Not valid without signature NEW BRITAIN,CT 66052 Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards ConstmOiort-SUd>:rW9allr 1 8 2 Family CSFA-106184 Ej,pires:04/27/2021 L NICHOLAS A1:E1r111®[MEISTFA, ANDREWS Y 9T SO SOUTHINGTOW CT 0siltl Commissioner IDTpaT91YM,ymYVYY) CERTIFICATE OF LIABILITY INSURANCE 8009 8/zo/2o18 THIS CERTIFICATTBS ISSUED ASA MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATWELY 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,See policy(1es)must have ADDITIONAL INSURED provisions or be endorsed. M SUBROGATION IS WAIVED,subject to the toms and cwMNlws af the Policy,certain Policies may renuim an endorsament A sbtamard on this cerSRcab does not corder rights to the cerfificate holder In Neu of such endo ssmen s. STARKWEATHER s SHEPLEY INS BK/PHS ac.w ea: (866) 467-8730 lMw (888) 443-6112 090570 P: (866) 467-8730 F: (888) 443-6112 wogae: 301 WOODS PARK DRIVE IxmEsxgwrawxom+FnwE gas CLINTON NY 13323 usmA: sentinel Ins Co LTD 11000 MUYe savage a: Hartford Fire and Its PAC Affiliates 00914 POTENTIAL ENERGY LLC. 4 D QUEEN TER sal,alE: SOUTHINGTON CT 06489 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NTH 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. eve maovauva.Ure Ins agttYn'oAvrA /o[rt'Fsrr alLl(IFxr �R PIG 6L1aALWBRgY URK.E 2r000,000 CLAMs4Mce .� DwADE TO RENTED1,000,000 MEYSEs IE.xumwA Qera1 Ltdb 02 SBM RB0509 08/05/2018 08/05/2019 Mm Fxv Ppa.wwnl 10,000 PERsaNA1..I.1 2,000,000 R: 0EHLAOOR TE UNM1 MffxENLA46REwlE 4,000, 000 Poucr�JI��% LocEEwooucls.cawrorAoo 4,000,000 OTHER: AIJrdMDNLF LIABILITY COMgsgxDLEUYR 2,000, 000 ..-TO YJALr INJUFr IYvgrwnl A ONNED SCHEDULED 02 SBM 880509 08/05/2018 08/05/2019 9onLYTwam IP' nvve AIIIOBCMLY AUTOS x HIRED x NCN4MaED PROPERry pAWOE AUTOS WILY AUTOS ONLY (W PmYe X ueTAELU. x OCCUR EACH OCCURRENCE 1,000,000 A DmESS IMa CL.VMSHLD 02 SBM 800509 08/05/2016 08/05/2019 AOGREO.ATE 1,000,000 X ,a „,la,000 xm ANY PROPRIETOMP TNEMEX IJrNE YM E1.EAGI ACCIDENT 500,000 OFFICEPMEMYR E%CLUDEw ❑ B drewen'm MO 02 VIC CR0745 08/05/2018 08/05/2019 LL.MsFASE-EANP. $00,000 if yes inner MEASE-Pea UaT `500,000 OESCRIPTDIN OF OPERATIONS. aFEWIpIlOPM9111010/ILfJiAVg/YHIJ'Ed IACOIDtM,10/eMIRY�beweYY.�EAeiRY4e,eaeeu Yn4Yw4) Those usual to the Insured's Operations.Columbia Gas of Ma is an additional insured per the Business Liability Coverage Form SS0008 attached to this policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Columbia Gas of Ma 4 TECHNOLOGY DR STE 250 WESTBOROUGH, MA 01581 O 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD