24C-015 260 PROSPECT ST BP-2020-1046
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24C-015 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-2020-1046
Project# JS-2020-001774
Est.Cost: $3000.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: HOME ENERGY SOLUTIONS INC 106188
Lot Size(sq.ft.): 27442.80 Owner: PFLUEGER NATHAN
Zoning: URB(100)/ Applicant: HOME ENERGY SOLUTIONS INC
AT. 260 PROSPECT ST
Applicant Address: Phone: Insurance:
68 RUSELLVILLE RD (413) 203-2454 WC
SOUTHAMPTON MA01 073 ISSUED ON:4/1/2020 0:00:00
TO PERFORM THE FOLLOWING WORK:insulation and weatherization
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 4/1/201-0 0:00:00 $65.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
_ I Y
T—
_ I MAR 3 0 202&y f Northampton
5p g Department
BUILDING INSPE ,
'?�9Mait1 Street
t, AA10 10N.MA o-,---Room 100
Northampton, MA 01060
phone 413-587-1240 Fax 413-587-1272ONLY
APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY
SECTION 1 -SITE INFORMATION INSULATION PERMIT
This section to be completed by office
1.1 Property Address: �-
f�
,q'0 s c#' ' LIC Map Lot / Unit
Zone_ Overlay District
Elm St.District C8 District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Aan
Name(Print) L urrent Mallin Address o'f o6Q
el�ephone
Signature
2.2 Authorized Agent:
a33 C Aq4 Q Sou gn
Name(Print) Current Mailing Ad ess:
Signature Telephorie
SECTION 3 -ESTIMATED CONSTRUCI-fON COSTS
;e- Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated 7otai Cost of
Construction from 6
i 3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total= (1 + 2+3+4+5) Check Number 451& 7
n This Section For Official Use Only
Building Permit Number: 64P. 2_0 Issued:
ed:
Signature:
Building Commissioner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
City of Northampton
s �
Massachusetts
DEPART14WT OF BUILDING INSPECTIONS
212 Hain Street • Municipal Building
Northampton, HA 01060
Property Address: l9y a� �e�� S4
Contractor d rn 1. �'I,C�V �I
Name: (f/Y\
Address: IWI 14Wq
City, State: �24ama /4 CJ�
Phone:
Property Owner ��
Name: NAG,ff nL
Address: �lpQ �rdS 1'� J7
City, State:
1, (�3dtWyA 1��I ���iY� (contractor)attest and affirm that the building ! intend to
insulate does not have any open air(knob and tube)wiring in the spaces to be insulated and that 1 have
provided the property owner with a p of this affidavit.
Contractor signature
Date
y Permit Authorization
mass save Form
Site ID: 3714033 Customer: NATHAN PFLUEGER
I, �rzai� �-lu eq e r , owner of the property located at:
(Owner's Name,printed)
260 PROSPECT ST NORTHAMPTON, MA 01060
(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: t/ A
J,44-,
Date: 1212bf 2Ut�
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:
Page 1 of 1 For Office Use Only
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The Commonwealth of Ma eAusetts
Department of Industrial Accidents
Office of Investigations
Lafayette Crit, Center
2 Avenue de Lafayette, Boston, AM 02I11-1750
www.rnass.govldia
V4or ers' :'r mpe nsation Insurance Afrida Gen" Businesses
Applicantinformation Please Print Legibi
Businm/Organization *game:Home Energy Solutions Inc.
Address:233 Collep Hwy
City/State/li p:S€�uthamptOn MA 01073 Phone ;493-203-2454
kre you an employer? Check the appropriate box; Business Type(reyttlred):
i, 1 am a enTioyer with _ empiuyees (ruh an&
or pars-time).* 6. Q Kest rant/Bar/Eating Establishment
2. 1 am a sole proprietor or partnership and have no i. Office anrllor Sales(incl, real estate,auto,etc.)
employees working for me in any capacity.
No workers' comp. insurance required" $. �]Non-profit
. e are a corporation and its officers have exercised q. [� xrt tarint nt
their right of exemption per c. 152, §1(4),and we have 10. Manufacturing
no employees. Igo workers" romp. insurance r uired]" I l.F1 Health Care
4.r-1 we are a non-profit organization, staffed by volunteers,
with no employees. No workers' cormp, insurance req.j U Other
$Any aiMiczit that cheeks,box fq I muse also,hti out t#e s tion:below showing their wu&m s'convensation policy information.
"If"tfsc COITK)r=Officers have exempted thmseivca,but the csrrporartim.has cAher emooyem a wmkcn*eompatsatirm policy is required and such an
orgarnn im sahouw Check hox#I.
I ram an employer that is proldding workers'rompensation insurrance,for my empfayee_�. Below is the policy fn jOrmration.
Insurance Company Name:AmGUARD Insurance Company
Insurer's Address:16 South River")r
citylStatr"Zip: Wilkes-Barre PA 18703
Policy#or Self-ins. Cic.#HOWC14W54 Expiration Date°1/4121
Attach a copy of the workers' comprnsaflon policy declaration page(showing the policy number and expiration tate).
Failure tv szwaTe .ovge as
gfi2 rrvrl xvG z, 1154 tw1 iCxd t3 i ituposiiicm GfCrimi
nal
Wt3iliis of a fine Lip
to$1,NX).00 mid/or care-yew imprisonment, as well as civil penalties in the form of STOP WORK ORDER and a fine of up to
250,00 a day a ainst the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of
the DIA for insure coverage verification.
J do here t>certify, ander th andpemP5lest the information provider?ahow is true it catered
Date:
l'13c>,te . 413-203-2454
f, !Official use only. Do not write in this area,to he carnpleted by eh�r arYawn official.
l C"itv or Towyn: P rraiVUeense
Issuing Authority(cheek tone):
I rd of Head 2.0Bnilding Department 300ty/TownClerk 4.01,1 end Board
l
9,0 Selectmen's Office 6.[)Other ._.....
_.,__._
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Contact Person- Phone##: