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42-145 923 WESTHAMPTON RD BP-2020-0027 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:42- 145 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-2020-0027 Project# JS-2020-000043 Est.Cost: $6338.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor. License: Use Group: RICHARD ABTS 74666 Lot Size(sg. ft.): 34368.84 Owner: SOSA TIMOTHY zoning: Applicant. RICHARD ABTS AT. 923 WESTHAMPTON RD Applicant Address: Phone: Insurance: 132 PROSPECT ST (860) 306-7275 WC EAST LONGMEADOWMA01028 ISSUED ON.7/12/2019 0:00.00 TO PERFORM THE FOLLOWING WORK.-INSULATE ATTIC FLOOR, KNEEWALLS, BASEMENT AND CRAWL SPACE 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 Si<(nature: FeeTy pe: Date Paid: Amount: 11111 i d i m, 7/12/2019 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck-Building Commissioner VAV -d 7 CitY of Northampt . Building Department 212 Main Street JUL - R ?019 Room 100 iINSULATION Northampton, MA 0 phone 413-587-1240 Fax 41_1,.T, ll���{]]�y INSPE Tl:) 1s APPLICATION FORIIAA 01 OL Y INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INSULA TION PERMIT 1.1 Property Adder: G This section to be completed by office �3 �l%S+{' 0* t'O K R�. Map �v1 Lot Unit ,� '�-I�t ♦o KA DID b?' Zone Overlay District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Elm St District CB District_ 2.1 Owner of Record: I v►10+(may 5 os� za Name(Print) tn[) e O i0�-e K tw 5 Current Mailing Ad�jrgss. NPS x 4141- yC - 33 coo 2 Signature Telephone - 2.2 Authorized Aaent• 'me(Punt) 132_yQSJ1Nl.� Sri Cy,,S.l,.Lo1�.1��21��.�/ttr4 Current Mailing Haoresr Signature jSI6 —30(o—?�?s Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be com feted b ermit a licant Official Use Only 1. Building 3 3 (a) Building Permit Fee 2. Electrical O (b) Estimated Total Cost of 3. Plumbing Construction from 6 � Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection O �! 6. Total=(1 +2+3+4+5) Check Number � This Section For Official Use Onl Building Permit Number. Date Issued: Signature: a Building Commissioner/Inspector of Buildings Date @ 1 �.+ewN ekeUcv cow. EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR,CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES —7 8.1 Licensed Construction Supervisor: //�� Not Applicable 11lame of License Holder: 9K i c.kG� A 6+!s 074(,p&L( License Number 132 t�iros.eQ� �- 6+ �� Lok o..,�lo«� NAA 2./S /x6 Address 0 Expiration D e 102.� Y�&Q-3o(o - 7Z.?S Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ 1. &KftvwN 1773f i Company Name Registration Number 33 t, 4-"WSZIA gJL.)e- AIOyWiGL GT 063 (60 12./ �L /t� Address ``�— Expiratifin Dafe JI.IR^ Telephone 4171-37$-3 4 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....... )( No...... ❑ 3rief Description of Proposed Work NOTE: INS ULA TION 6NL Y 1,wt,4,4-�e attic �b v w1+1--, 4bcow" cellulose 4 *,IA5ta1l pvtooa-ve.rt.ts . k Kee wa.l(6 w i+Iti 14' 1°01 y i s o cy 0A(-woa i-e- "OLi►�sA�t -*e a*i C k J.KS ms -v-LA,+e lo ae t4tewt- c e `�"tS c-U D Lt)l space w i i tk �t " !-i beu`g l4Lss w a it. I, A6+5 , as Owner/Authorized Agenthereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knno edge andel elief. Signed under the pains and penalties of perjury. c,LcIa&J A 6tS Print Name JLd�--� _ ZZq 1 Signature of Owner/Agent ate I, S eR. O WLI:Lk ot,u+Lo U 'AA 0,+10 til 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 Date City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 7E yJ. :D1e 212 Main Street • Municipal Building `.,. 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: W3eCL{Jey►;-Lp,};&K �iKsMJC,, ,6K Est. Cost 33 S3 Address of Work: 4)eus+ +0 L4 �,� r /I�DIF1�.0.1�a,1,otOK MA 2- Date 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: � Lt I hereby apply for a building permit as the agent of the owner: ��g f 19 L.au.+ear I,te�cy L77 3 V`r 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 �;,=.•\'� Sys .�- sic 1t Massachusetts w�`' .. �e A, DEPARTMENT OF BUILDING INSPECTIONS /y \ F, 212 Main Street •Municipal Building tiJb� OCa� Northampton, 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: "12.3 Wes+kA-y% .,ot o ti 'Rd- I JO tI",w..PtO k 4 (Please print house number and 9treet name) Is to be disposed of at: -Pv%+* Tirt-IK. (Please print name andlocation of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) C""t r-1 JJS- 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. City of Northampton 255 _,. sic Massachusetts ' -A S+/ N f1 DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building 100 Northampton, MA 01060 Property Address: 9123 Oestl1&wy"K �U . 1fA4A Contractor Name: �d.�w ♦ gw K. E IS2.1&4 v �-L�- Address: 33 W iscnks& K Aue City, State: /,�,,,.r 1 < <�. C-T to (a� Phone: '922-211, - 300(,o Property Owner Name: TGyt a+6 Soso 11 Address: Cl2.3 U)es+�.o.w-j4fibK 12.k City, State: 1V6V+ka.H.A.a+nom 1K Ar 01660-1 I, T\ AI t- . (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 I have provided the property owner with a copy of this affidavit. Contractor signature Date � / g / 1 CLEAResult CONTRACT CLEAResult 50 Washington street, Customer Name:TIMOTHY SOSA Westborough,MA,01581 Email:sossa.tlmothy®gmail.com Phone:914-774-6331 Premise Address:923 Westhampton Rd,Northampton,MA 01062 Melling Address:923 Westhampton Rd,Northampton,MA 01062 Project ID:3826619 Date:May 24,2019 Aaolicable Customer Required Actions: Notes: • Other Customer agrees to dismantle and remove all ductwork In basement prior to weatherization upgrades being completed 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 recommendatlons/work order describing the work in detail(the"Work")which are incorporated herein by reference. Meas s Iptlon Location Quantity Unit Total Cost Ctaelorrik Cost Air Sealing at Estimated 62.5 CFM50 Per Hour 8 hr $740.64 $0.00 Exterior Door Weather Stripping(with AS his) 3 each $90.21 $0.00 Door Sweep(with AS hrs) 3 each $76.93 $0.00 Attic Floor-4"Open Blow Cellulose 688 SF $1,018.24 $254.56 Kneewall Wall-2"Thermal Barrier Polyiso 184 SF $879.52 $219.88 Door-2"Thermal Barrier Polyiso 2 each $180.88 $45.22 Hatch-2"Thermal Barrier Polyiso 1 each $46.28 $11.57 Basement Ceiling-9"Fiberglass Batting 576 SF $1,624.32 $406.09 Crawlspace Ceiling-9"Fiberglass Batting 168 SF $495.60 $123.90 Crawlspace Celling-2"Thermal Barrier Polyiso 168 SF $803.04 $200.76 Bath Fan-Vent to Roof 1 each $141.30 $35.32 Damming 18 each $43.02 $10.75 Propavent 48 each $199.68 $49.92 Total: $6,338.66 Program Incentive: -$4,980.69 Customer Total: $1,357.97 Page 1 of 4 Payment Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows:Payment#11;$400.00 as a Deposit payable to CLEAResult upon signing the Contract(not to exceed 1/3 of the total retail costs).Mail check&contract to CLEAResult,50 Washington Street,,Westborough,MA,01581.Final Payment:$957.97 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 $4,980.89.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 Customer hereby mutually agree In advance that In the event that the IIC has a dispute concerning 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.a 142A. You may cancel this agreement if 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 posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement.DONOTSIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. CzustoerSign ture Date Indicate your selected IIC here,if applicable Initial here If you + want the Program to assign a Participating 5e4j-,Mai*,, Sem N&j*v Contractor CLEAResult Signature Date Name of CLEAResult Representative Page 2 of 4 Permit Authorization � 1 ' . mass save Form Site ID: 3824301 Customer: TIMOTHY SOSA I, /I 11L105o SS 14 t Ji owner of the property located at: (Owner's Name,printed) 923 Westhampton Rd Northampton, MA 01062 (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. Owner's Signature: 172 Date: FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: LCxtti+eoLk C.tAeJ&cv Participating Contractor' Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 For Office Use Only Rev.102015 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 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): Lwoevm Em►pa,4ev. Address: 3 3 /Vist-ams;N AueKae. City/State/Zi Phone #: $ - - oo G Are you an employer? Check the appropriate box: Type of project(required): 1.2 I am a employer with .36 . 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 working for me in any capacity. employees and have workers' 9. ❑ 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 o myself. workers' right of exemption per MGL y � comp. 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.® Other ulea►+kenr;2a�fo comp. insurance required.] y applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. -)meowners 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: E wl deo VeV',s M u♦VQ1 Ca S tAsI ty Go m is Policy#or Self-ins. Lic.#: HS 10 2$ Expiration Date: 12131 /2019 Job Site Address: 92.3 W P_St hawwo to lam. City/State/Zip: AJ6V -&_6A"1O bt 41A 01,04Z 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 for insurance coverage verification. I do hereby certify yypunder the pains and penalties of perjury that the information provided above is true and correct. Sip-nature: /� �� �.u�'b Date 71/ A5- Phone#: V 4r o — l o& — Z?.ir 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#: ,4lco/ O® CERTIFICATE OF LIABILITY INSURANCE °A12/1,°°"Y, V 12/17/20188 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 3ELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED 2EPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or 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 NAME: Sheri King, CIC Byrnes Agency, Inc. - Norwich 6 Consumers Avenue PHONE (860) 886-5498 A1C No:(860) 859-5075 E-MAIL Norwich CT 06360-7521 ADDRESS: skin *b mesa enc .com INSURERS AFFORDING COVERAGE NAIC# INSURERA:Lloyds of London INSURED (877) 878-3006 INSURER 8:Employers Mutual Casualty Comp 21415 Lantern Energy, LLC & Lantern Electrical, LLC OVSURERC:EMCASCO Insurance Company 21407 33 Wisconsin Ave INSURER D: Norwich CT 06360-1550 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:Cert ID 20387 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM1DD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FXIOCCUR 5D81028 12/31/2018 12/31/2019 DAMAGE TO RENTEff__PREMISES Ea occurrence $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY aRCT 7 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 X OTHER:Location $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 g ANY AUTO SE81028 12/31/2018 12/31/20191 BODILY INJURY(Per person) $ OWNED SCHEDULED P INJURY(Y BODILY INJUer accident AUTOS ONLY AUTOS B ) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ B X UMBRELLA LIAB X OCCUR SJ81028 12/31/201812/31/2019 EACH OCCURRENCE $ 5,000,000 EXCESS UAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- B AND EMPLOYERS'LIABILITY Y/N J;881028 12/31/2018 12/31/2019 X STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? F`N] N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A Professional/E&O IPGIARK0841800 02/23/2018 02/23/2019 $ 2,000,000 $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more apace is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 1 67.4-e f6mmoww� oICAwadm4ev* Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: Supplement Card Registration: 177389 LANTERN ENERGY L.L.C. 33 WISCONSIN AVE Expiration: 12/01/2019 NORWICH, CT 06360 SCA 1 0 20M-05/17 Update Address and Return Card. � Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs d Business Regulation 177389 12/01/2019 10 Park Plaza-Suite 5170 LANTERN ENERGY LLC. Boston,MA 02116 RICHARD ABTS 33 WISCONSIN AVE �\ NORWICH,CT 06360Undersecretary 'N Vali without signature a Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction Supervisor CS-074666 Expires: 02/05/2020 RICHARD L ABTS 132 PROSPECT STREET EAST LONGMEADOW MA 01028 - Commissioner