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44-099 (2)
390 ROCKY HILL RD BP-2020-0860 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:44-099 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERFD CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING P E RM I T Permit# BP-2020-0860 Proiect# JS-2020-001470 Est.Cost: $3300.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: BAYSTATE ENERGY REDUCTION LLC 102811 Lot Size(sq.ft.): 31232.52 Owner: FITZGERALD HAROLD R JR Zoning: Applicant: BAYSTATE ENERGY REDUCTION LLC AT. 390 ROCKY HILL RD Applicant Address: Phone: Insurance: 83 MORSE ST UNIT 4E (401) 523-6805 WC NORWOODMA02062 ISSUED ON:1/28/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-WALL AND ATTIC INSULATION 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 1/28/2020 0:00:00 $65.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only. City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 �if l��anil APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR EMOLISH A ONE ORT FAMILY DWELLING SECTION 1 -SITE INFORMATION LDEPT._ 1.1 Property Address: N. gr,1r rdjjAFi060 ple d by office �// — (b� Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of R cord: k4�- ',� Name(Print) V Current Mailing Addr�ss;� � / M n U Telephone !1 (�a �-`� Signature 2.2 Authorized A ent: Name(Print) Current Mailing Addressnor wc� t Q�D/_ Signature Telephone ( 1 �P SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only com feted by permit applicant 1. Building '3 30 1) ' V T (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) v o 5. Fire Protection 6. Total = (1 + 2 + 3+4 + 5) 3 D D. D D Check Number 2 Q ThisSectionFor Official Use Only Building Permit Number: /�` �— CJ Date Issued: Signature: IV Building Commissioner/Inspector of Buildings Date >Io @ luM EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s)� 1 LFA Roofing Or Doors 0 `�� Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks Siding[0] Other[OJ Brief Description of Proposed Work: �C/�--W� /) 0 %^'Su / A T (�(�Tl ' (. ' ! V Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Ba. 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, , 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 I, C. dv 'C C C-Y f 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. Signunder the pains and penalties of perjury. lb (-0q dy��(,� Print Name Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: ✓i'+ e ,S5L - License Number Address Expiration Date J, Signature Telephone 9.Registered Home Im orovement Contractor: Not Applicable ❑ s W,�j Company Nam Registration N ber g�3 Address Expiration Da Telephonea 21 la �3 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 I " Massachusetts ' f?1{ y DEPARTMENT OF BUILDING INSPECTIONS r� 212 Main Street •Municipal Building yew �4 ' 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: 310 r'J a4akA V (Please print house number and street na ) Is to be disposed of at: 0AY' J,-V 94 fD t-� r (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: ompany Name and Address) Signature of Perrrlk Applicant wner 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 Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Baystate Energy Reduction Address: 83 Morse St City/State/Zip: Norwood, MA 02062 Phone #: 401-523-6805 Are you an employer?Check the appropriate boa: Type of project(required): 1.0 I am a employer with 8 4. ❑ I am a general contractor and 1 employees(full and/or part-time).* have hired the sub-contractors �' ❑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 workingfor me in an capacity. employees and have workers' y p �'• 9. ❑ Building addition [No workers' comp. insurance comp. insurance.T 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 1 1.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.E Other Attic insulation 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 andjob site information. Insurance Company Name: Berkshire Hathaway Guard Policy#or Self-ins. Lic. #: BAWC054403 Expiration Date: 3/2020 Job Site Address: City/State/Zip: 4_10&284�Q�6 Attach a copy of the workers' compensation VAcy declaration page(showing the policy number and expiration date)./)�p 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 u der the pains andpenalties ofperjury that the information provided above is true and correct. Signature: Date: Phone#: 401-523-6805 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#: � l CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YVYY) 01/06/2020 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 Keiko Gianfriddo NAME: Southeast Agency,LLC ATONE Ext): (860)376-2535 (A/c,No: (860)376-8505 108 Main Street t-MAIL s: keikog@seagencies.com ADDRE INSURER(S)AFFORDING COVERAGE NAIC# Jewett City CT 06351 INSURER A: Arch Specialty Insurance Company 21199 INSURED INSURER B: Utica National Ins.Company of Texas 43478 J Baystate Energy Reduction LLC INSURER C: Nautilus Ins Co 17370 83 Morse Street,Unit 4E INSURER D: Berkshire Hathaway Homestate 20044 INSURER E: Norwood MA 02062 INSURER F: COVERAGES CERTIFICATE NUMBER: CL196708023 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. N R POLICY EFFP LI Y EXP LTR TYPE OF INSURANCE INSD WVD POLICYNUMBER (MM/DD/YYYY) MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 10,000 A AGLOO52287-01 03/01/2019 03/01/2020 PERSONAL BADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER. GENERAL AGGREGATE $ 2,000,000 X JECTaLOPRODUCTS-COMPOPAGG $POLICY ❑PRO 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANYAUTO BODILY INJURY(Per person) $ B OWNEDX SCHEDULED 4941834 03/14/2019 03/14/2020 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY $ X AUTOS ONLY Per accident X UMBRELLA LIABX OCCUR EACH OCCURRENCE $ 2,000,000 C EXCESS LIAB CLAIMS-MADE AN063957 03/01/2019 03/01/2020 AGGREGATE $ 2,000,000 DED I X RETENTION $ 10,000 $ WORKERS COMPENSATIONX SPERTATUTE EORH AND EMPLOYERS'LIABILITY YIN 500,000 D ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA BAWC054403 03/01/2019 03101/2020 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Homeworks Energy is named as Additional Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Homeworks Energy ACCORDANCE WITH THE POLICY PROVISIONS. 101 Station Landing AUTHORIZED REPRESENTATIVE Medford MA 02155 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD f Office of Consumer Affairs and Business Regulation One Ashburton Place-Supe 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: Supplement Card SAYSTATE ENERGY REDUCTION LLC Registration: 184841 83 MORSE STREET UNIT 4E Expiration: 02/0112020 NORWOOD,MA 02002 Update Address and Return Card. SCAt Q 2CAI- IT �i�i'�%-mrnr�rrctl�r�'`""�ifaasa.�uuo(1'.t offloe of Consumer Atfaha E Susiness Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use ordy TYPE:Suoaarierd Card before the expiration date. It found return to: Office of Consumer Affairs and Business Regulation 184541 02tOtt2020 10 Pa a-Suite 5170 BAYSTATE ENERGY REDUCTION LLC Host MIS ROGER OUELLETTE 1� 83 MORSE STREET UNIT 4E �} NORWOOD,RAA 02062 Undersecretary Not Valid without Signature Conxrwnwea#fi of Massachusetts Dry ion of Professianal Licensure Board of BWlding Reguiations and Standards Conitructicot 44ivuor specialty GSSL-102811 E ires:09113!2020 ROOM A 0 W- 83 MORSE ST��i�tt+pT � NORWOOD MA 42062 Commissioner C k Insulation/Air Sealing Permit Authorization Specialist: Anna Kochaniec Company: HomeWorks Energy 6f, i Email: anna.kochaniec@homeworksenergy.com Address: 102 Station Landing Cell: 413-355-9775 Medford,Ma 02155 Phone: 781-305-3319 .......___ . _..............-__- . ._._..._...._.....,�.-d ._.._...._._ ......... Customer: Harold Fitzgerald Address. 390 Rocky Hill Rd Email: 0 Northampton, MA 01060 Site 117: 3942457 Phone: {413)297-0840 1,the owner of the property identified above hereby authorize HomeWorks Energy Inc.,or their Partner to act on my behalf in obtaining any building permit that maybe required to perform insulation and/or Weatherization work on my property and all matters related to the work authorized by said permit if one is obtained. Any related permit application cost will come at no additional charge provided that the agreed Weatherization work is completed. Customer ' Signature: ,.' . Date: 1211112019 .- .. _.._......._................. Ha Id Fitzgerald Project Summary Name: Harold Fitzgerald HomeWorks Energy,Inc, 0 Phone: (413) 297-0840 101 Station Landing Vrn Email: 0 Medford,Ma 02155 Site ID- 3942457 781-305-3319 HaMWO& MASS SAVE Cost Incentive Air Sealing 1,036,56 $ 1,036.56 Weatherization 2,305.56 $ 1,729.17 Duct Sealing $ - $ - Duct Insulation $ ----1Mass Save Rebates Cost Incentive Preweatherization Incentive $ - $ - tAdditional listed work may be a requirement of the Insulation proposal.HomeWarks will only remove those 11he Items If completed prior to install date,All work performed beyond Moss Save carries no incentive c7ent1y7 e SUMMARY Cost In7 Mass Save $ 3,342.12 + Beyond Mass Save ................. TOTAL PROJECT 3,342.12 $ 2,765.73 Total Copay 576.39 Customer Deposit Applied 50.00 FINAL COPAY (due on completion of work) 526.391 HomeWorks Energy,Inc.agrees to perform the above summarized work(Mass Save&Beyond Mass Save),furnishing the material and labor specified for the contract price(Total Project).All work is subject to change,and homeowner's approval is required for completion of any and all work. Preferred Day of Week for Insulation install: Customer: -14�1 Date: 12111/2019 . ........................................ Haro d Fftzge Specialist: Date: 12/11/2019 Anna Koch anna.kochaniec@homeworksenergy,com 413-355-9775 v,13