35-302 (10) 80 WOODLAND DR BP-2020-0858
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:35 -302 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categorv: INSULATION BUILDING PERMIT
Permit# BP-2020-0858
Proiect# JS-2020-001468
Est.Cost: $4498.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BAYSTATE ENERGY REDUCTION LLC 102811
Lot Size(sq.ft.): 197762.40 Owner: PAMELA ERICKSON
Zoning: Applicant: BAYSTATE ENERGY REDUCTION LLC
AT: 80 WOODLAND DR
Applicant Address: Phone: Insurance:
83 MORSE ST UNIT 4E (401) 523-6805 WC
NORWOODMA02062 ISSUED ON.112812020 0:00:00
TO PERFORM THE FOLLOWING WORK.-BLOWN INSULATION AND AIR SEAING IN ATTIC
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
i
F Depiriwse,only
City of Northampton Status of Permit: "
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
I � Room 100 WaterNVell Availability
Northampton, MA 01060 Two Sets of Structural Plans
q phone 413-587-1240 Fax 413-587-1272001
Pfo#{ Re P!larxs
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE P R DEMOLISH A ONE OR TWO AMIIi Y DWELLING
JAN 2 8 Popp
SECTION 1 -SITE INFORMATION
' -section to lets by office
1.1 Property Address, Q //�� nn DRPT� ri;��� ;TiONS
So ( OO& lcty c . K.. Map �" Lot - Z Unit
Zone Overlay District
Elm St.District CB District
SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 9
2.1 Owner of Record:
Name(Print) Current ailing Address:
413 -!(a1-
Telephone
Signature
2.2 Authorized Agent:
Name(Pri t) Current Mailing Address:
Signature Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building � (a)Building Permit Fee
2. Electrical ( (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee r
4. Mechanical (HVAC) "
5. Fire Protection
6. Total = (1 + 2 + 3 +4 + 5) Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature: lar
Building Commissioner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alterations) Roofing ❑
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [p Siding [I]] Other[O]
Brief Descriptiof Proposed ' • ,
Work: ISh2"A& iNSV(Q.�KI"% 'r *w^` Stave•�..o iN / C,_
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
Isa, ,m
'ioti �i�, � „ tin � Uri '�th�f+� irt'
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
OWNERSAGENT 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, &div[ UwAcQ� as Owner/Authorized
Agent herebt declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed undef the pains and penalties of perjury.
'CK UcfG��-Qi
Print Name
-Z Q I✓�
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor:: /� ( Not Applicable ❑
Name of License Holder h CSSL— lOp2kift
1 e License Number
AddreExpiratio Date
d
Signa e Telephone
9,Registered Home Improvement Contractor: Not Applicable ❑
lir ys K I
CompanyName ^� Registration Number
Address Expiration ate
Telephone 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
Massachusetts
" DEPARTMENT OF BUILDING INSPECTIONS pi
212 Main Street •Municipal Building
Northampton, MA 01060 r j18
�W
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:
c..vua 10"'VL a 0'.
(Please print house number and street name)
Is to be disposed of at:
G r�l�r� cticc s �r� Kfv�1YVV+
(Please print name and location o facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Signature it 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
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 Leaibly
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 box: Type of project(required):
1.0 I am a employer with 8 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
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' g ❑ 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
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.EEOther Attic Insulation
comp. insurance required.]
*Any applicant that checks box#I 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: Berkshire Hathaway Guard _
Policy#or Self-ins.Lic.#: BAWC054403 Expiration Date: 3/2020
Job Site Address: �LG1 lLC/lDl_Lir, City/State/Zip•., r �kA, i /n/9
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 u der the pains andpenalties ofperjury that the information provided above is true and correct
Signature Date: 10/28/19
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#:
C-���ie' �om�;n.a�nu.��cz�� o����zrs.�ac�►•cu��
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Type: Supplement Card
84541
BAYSTATE ENERGY REDUCTION LLC Registration: 2/01/2020
B3 MORSE STREET UNIT 4E Expiration: 02/01/2020 02/01/
NORWOOD,MA 02062
Update Address and Return Card.
scAt a
Office of Consumer Affaire&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:Suoofement Card before the expiration date. If found return to:
Rgalslration Ex IrtZ ation Office of Consumer Affairs and Business Regulation
184541 0201/2020 10 Park-Plaza-Suite 5170
BAYSTATE ENERGY REDUCTION LLC Bostn,MA 02116
ROGER OUELLETTE
83 MORSE STREET UNIT 4E
NORWOOD,MA 02062 Undersecretary Not valid without signature E� Conrnonwealth of Massachusetts
Division of Professional Licensure
Board of Budding Regulations and Standards
ConAructiorySUpervisor Specialty
CSSL-102811 Expires: 09/13/2020
u
ROGER A OVELLETTE '
83 MORSE ST,-UNIT 4E,
NORWOOD MA.0.2062 Commissioner
Specialist: Matthew Mondell Insulation/Air Sealing Permit Authorization
Email: matthew.mondell@homeworksenergy.com Company: HomeWorks Energy
Address: 101 Station Landing
Cell: 413-519-0429 Medford,Ma 02155 HWVWorkS
Customer: Pamela Maurer --- - Phone: 781-305-3319--
Address: 80 Woodland Drive
Email: scmau@comcast.net Northampton, MA 01062
Site ID: 3891776 Phone: 413-427-9797
I,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: d ' / Date: 9/26/2019
Pamela Maurer
Page 1 of 2
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HomeWorks mass save
Energy, Inc PARTNER
101 Station Landing Ste 110,Medford,MA 02155
(781)305-3319 ext.120
Customer Name:Pamela Maurer
Email:scmau@comcast.net
Phone:413-427-9797
Premise Address:80 Woodland Dr,Northampton,MA 01062
Mailing Address:80 Woodland Dr,Northampton,MA 01062
Project ID:3898456
Date:Oct.31,2019
Job Description
Measure Description Location Quaritity UnitTotal Cost Customer Cost
Air Sealing at Estimated 62.5 CFM50 Per Hour Other 14 hr $1,296.12 $0.00
Rim Joist-2"Thermal Barrier Polyiso Other 28 SF $133.84 $33.46
Attic Floor-3"Open Blow Cellulose Other 1120 SF $1,568.00 $392.00
Hatch -2"Thermal Barrier Polyiso Other 1 each $46.28 $11.57
Bath Fan Hose Other 2 each $52.40 $13.10
Propavent Other 100 each $416.00 $104.00
Damming Other 75 each $179.25 $44.81
Attic Floor-5"Open Blow Cellulose Other 210 SF $323.40 $80.85
Walls-Buffered Interior-4" Dense Pack Cellulose Other 48 SF $121.92 $30.48
Exterior Door Weather Stripping (with AS hrs) Other 1 each $30.07 $0.00
Total Contractor Price and Payment Schedule
HomeWorks Energy, Inc. agrees to perform the above described work,furnishing the material and labor specified for the listed total
price. Payment of the balance ofthe customer contribution is expected upon completion of the work.
Customer Signature: Date:
Customer Phone:
Specialist Signature: Date:
UMFTED 11ME OFFER:
The prices and Incentives In this contract are subject to change in accordance with the sponsoring utility MassSave Home Services Program offers.
Proposals con be sent to:lnboxLWHomeWorks£nergy.com
• Page 2 of 2
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m - HomeWorks mass save
rn �
Energy, Inc PARTNER
101 Station landing Ste 110,Medford,MA 02155
(781)305-3319 ext.120
Customer Name:Pamela Maurer
Email:scmau@comcast.net
Phone:413-427-9797
Premise Address:80 Woodland Dr,Northampton,MA 01062
Mailing Address:80 Woodland Dr,Northampton,MA 01062
Project ID:3898456
Date:Oct.31,2019
Project Total $4,167.28
Weatherization incentive ($2,130.82)
Air sealing incentive ($1,326.19)
Total Program Incentive -$3,457.01
Customer Total $710.27
Total Contractor Price and Payment Schedule
HomeWorks Energy, Inc.agrees to perform the above described work,furnishing the material and labor specified for the listed total
price. Payment of the balance of the customer contribution is expected upon completion of the work.
Customer Signature: Date:
Customer Phone:
Specialist Signature: Date:
uMffM 7MK OFFER:
The prices and incentives in this contract are subject to change in accordance vAth the sponsoring utility MassSave Home Services Program offers.
Proposals can be sent to:inbox@NomeWorks£nergy.com