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24B-008 (3) 69 BARRETT ST BP-2020-0437 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24B-008 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit# BP-2020-0437 Proiect# JS-2020-000743 Est.Cost: $2400.00 Fee: $77.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ENERGIA LLC 92540 Lot Size(sq. ft.): 87991.20 Owner. MERESCHUK CHRISTOPHER Zoniniz: URB(100)/WP(57)/ Applicant: ENERGIA LLC AT. 69 BARRETT ST Applicant Address: Phone: Insurance: 242 SUFFOLK ST (413) 322-3111 Liability HOLYOKEMA01040 ISSUED ON.101912019 0:00:00 TO PERFORM THE FOLLOWING WORK INSULATION - ATTIC FLOOR 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 Sh.,nature: FeeType: Date Paid: Amount: Building 10/9/2019 0:00:00 $77.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of North pto Permit: Building Dep, rtmEot t arl riieway Permit 212 Main ,tree OC/ ySewr/Sep c Availability Room�100 , 201g /We Availability Northam tort MA�6 et of Structural Plans p ' A! phone 413-587-1240 Fax15 f; Sp it Plans v eN.Mq nF�T� cher pecify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE ORD ISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 6p_ a®y 7 This section to be completed by office 1.1 Property Address: Map � Lot o6 Y Unit C1� �QY Y EA-V �,k Zone Overlay District Elm St. District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Not n2 bre .1111 0 Name(Print) t[ cu[Lent Maili ddresjRIM )� C— �l E2Nl c 7 t ` t U Telephone Signature 2.2 Authorized Agent: 2Lkl r�k 4OW-\� 1u0V-f MIS MAC) Name(Prin Current Mailing Address: 11:�j�ZZ X11 Signature Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building z- ` 00 lJw (a) Building Permit Fee 2. Electrical ` (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =0 +2+3+4 +5) Z • (c�) Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: h4k— f I 110 Building Commissioner/Inspector of Buildings Date �- 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: �� 0 Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW © YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DON'T KNOW © YES O IF YES: enter Book Paget_ and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained 0 , Date Issued: C. Do any signs exist on the property? YES © NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES © NO 0 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 © NO I© 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 171 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[E-3] Othe Brief Description of Propose Work: r - '' its F r - '� I CCAIU►c�j.- Alteration of existing bedroom Yes 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 I. ('YIY 157� CT � 1 Y ►`` yt""T VA as Owner of the subject property I hereby authorize -yam to act on my behalf, in all matters relative to work authorized by this building permit application. �E r mit R�`ItY� Y m q 1201 ZO►q Signature of Owner Date 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. Print Name �\ Signature of wner/Agent Date w4 5.. LW" rj� '1 tt ! rS' t t( t• ra! "C h I1 c.i) s.':/ .a` ra • tit• +�/ r r r , T4, k -. :� � '-'(r14�ri'ip.)Lpl$rd3.' rl, ' �� .�� •...Y,„ _. _ .. . .. .,,,,,._ _. ,_ ,. `! :� , S _ 4f 1.!'I si C 1 • i".•y.'!.,{� Cit.i,� y ._ � h�''r'slT �a__._ ,,_... - s. :L•' .. ._ f . • .1` .- �„:. .tSt'`S r'y'<yi!'�. 2d p t�`�, UY .�'- f _j b ' i t'. ; ` ;'Tt!,5�. jj}'/} '1,.. f � �.bj, t'• ` 1 r., r .... .,p....,/`rl.n.,�ir ea _ •.... ♦ a.•.u• w •IN• t•' .,.Te FIY V es�►A,,n.a/r a 41 ylt t,j 1£of iZ�1',i�' - C. ..'-f i:wlr:.�. .1.....J•�ir _�. _._. � 1.,. i' t � - _ <.. .�.._ .-. - l,.�. ,R - - t e , C. t��/�.•tt• ,� ,-r? _ .,tl,'�y;.�~` ~s '�ti�l`1� r- _ ,i .... ,r, � .. S { ��. .•'. i' , '� .[�:r'v'�"E�hir''1.;'. �cti'�'Y3',:��i7 -i.'�+tfx�sG��:.jc'•''�"";:+x.,i,�: , SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not AApp�pllicable (❑ Name of License Holder:� � �� " `L��`J License Number "Ohlr�,Vlc MIA akoyc) M 10 2J 2f)9-1 Addret j Expiration Date 3 - Si ature Telephone a Registered Home Improvement Contractor: Not Applicable ❑ FX`-yaia UL. 165168 Company Nage Registration Number Zy7- 1 ACj 120 Address Expiration Date Telephone 2- -A 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 1' '• DEPARTMENT OF BUILDING INSPECTIONS P 212 Main Street *Municipal Building .,�w�^` 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: �Iv (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: (Company Name and Address) Signatuk of Permit Applicant o O er 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. Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Consp"?W6 �rvisor CS-092540 THOMAS B IHSS cPires:09/02/2021 100 MAIN STREET HATFIELD MA�0103 Commissiorwr -•— ,../l, r �iiva�inr,.��/ice--+—..��. ::• -•rte.. .- - . Ofr1cc of Consumer y r. Affairs&Business Regulation License or registration valid for individul use only 'kIOME IMPROVEMENT CONTRACTOR before the expiration date. If found re turn to: �tegistration: 165169 Expiration: 1/11/2()18 Type: Office of Consumer Affairs and Business Reguiatidn LLC 10 Parlt Plaza-Suite 5170 ENERGIA LLC 12 0 Boston,MA 02116 THOMAS ROSSMASSLER 242 SUFFOLK STREET HOLYOKE, MA 01040 ``�'� >--•_ I Undersecretary Not valid without signature The Commonwealth ofMassachusetts 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): Energia, LLC Address: 242 Suffolk St. City/State/Zip: Holyoke, MA 01040 Phone #: 413-322-3111 Are you an employer? Check the appropriate box: 1.VI am a employer with 19 4. ❑ I am a general contractor and I Type of project(required): 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' [No workers' comp. insurance comp. insurance.# 9• E] Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp, right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners 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: Guard Insurance Group Policy#or Self-ins. Lic. #: ENWC989225 Expiration Date: 7/01/2020 Job Site Address: �11YYf- pA- City/State/Zip:No\bmav1,MIA 010W 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 certi under the pains and penalties of perjury that the information provided ab ve is true and correct. Si nature: Date: Phone#: 413-322-3111 Official use only. Do not write in this area, to be completed bV 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#: ENERLLC-01 CHRISTINE CERTIFICATE OF LIABILITY INSURANCE DATO/YYYY) 6!/26122612019 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 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,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 Christine Sullivan NA Phillips Insurance Agency,Inc. PHONE FAx 97 Center Street AIC,No,Ext:(413)594-5984 (FACN.):(413);(413)592-8499 Chicopee,MA 01013 E-MAIL .christine@phillipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC k INSURERA:State Automobile Mutual Ins Co INSURED INSURER 8:Guard Insurance Group Energia LLC INSURER C: 242 Suffolk Street INSURER D: Holyoke,MA 01040 INSURER E INSURER F: 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 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. ILTIR NSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE a OCCUR X PBP2870943 7/1/2019 7/1/2020 DAMAGE TEMISESO RfEaENTED S 100,000 MED EXP(Any oneperson) 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 POLICY❑X JE [:]LOC PRODUCTS-COMP/CP AGG S 2,000,000 OTHER: AS AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT(Ea acc dent) S 11000,000 X ANY AUTO BAP2477206 7/1/2019 7/1/2020 BODILY INJURY Perperson) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ E SV N Pd20PERTY DAMAGE AUTO ONLY ATOS ONLDY LAO accitl Y S 5 A X UMBRELLA LIAR I X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAR CLAIMS-MADE PBP2870943 7/112019 7/112020 AGGREGATE S 1,000,000 DED I X I RETENTIONS 0 S B WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITYSTA ITE EIR ANY PRCPRIETORIPARTNERIEXECUTIVE Ya IN ENWC989225 7/112019 7/1/2020 E.L.EACH ACCIDENT 1,000x000 QFFICER/MEMgE�EXCLUDED? N/A (Mandatory In NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) 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. AUTHORIZED REPRESENTATIVE I ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Permit Authorization mass Save Form Site ID: 3772660 Customer: CHRIS MERESCHUK I, l �,,�yvt��.i M�.�Sr( k , owner of the property located at: (Owner's Name,printed) 69 BARRETT ST NORTHAMPTON, MA 01060 (Property Street Add,ry d (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 weathenzation work on my property. Owner's Signature: ( -e Date: • FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Pago I of l Fcr :e use:",.!, Rev 102015