06-010 (5) 595 HAYDENVILLE RD-Route 9 BP-2021-1037
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 06-010 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-2021-1037
Project# JS-2021-001766
Est.Cost:$4308.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: POTENTIAL ENERGY LLC 106184
Lot Size(sq. ft.): 548856.00 Owner: GREGORY ANGELA
Zoning: SR(103)/ Applicant: POTENTIAL ENERGY LLC
AT: 595 HAYDENVILLE RD - Route 9
Applicant Address: Phone: Insurance:
I HARTFORD SQ BOX 2E (413) 798-0273 O WC
NEW BRITAINCT06052 ISSUED ON:3/23/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:INSULATION/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. 3.-11I j- '
Certificate of Occupancy Signature: '
FeeType: Date Paid: Amount:
Building 3/23/20210:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
�,'The Commonwealth of Massachusetts q9 j"} R
!I } Board of Building Regulations and Standards c)�O `�' ICIPALITY
� � Massachusetts State Building Code, 780 CMk �/ USE
Building Permit Application To Construct, Repair,Renovate Qr cilish a Revi$d Mar 2011
One-or Two-Family Dwelling NI.,47.,;`cr /
This Section For Official Use Only \O 04/6, /
g ermit Number:Nu�� of ?/'i� Date Applied: \'Buildinf'
Evi,3° 05) ___/Z 3 23.2621
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
5`95 Vic v,1 'itc ci Cx,/oio(pot ('Xo r0►0 -adl
1.1a Is this an accepted street?yes , no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Q k S%,,y-Le_ %.s 1 z �s 2�L.
Zoning District Propose?Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
/ Zone: _ Outside Flood Zo ?
Public 6Y Private❑ Check if yes Municipal(fin site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
j..r,4. —,C:` C 1 f�b .rnrikoh ,r(f- 01 o S 3
Name(P t) City,State,ZIP
s`9 S \ d, .Ake, kt-Icsc0 Li 1.3 -522 -to2y or13,e oc/p rc::l ew'n
No.and Street Telephone cl afn Address
SECTION 3:DESCRIPTIION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 6Y Owner-Occupied fa'] Repairs(s) 0 Alteration(s) Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units t Other ecify:`r 11St tlo.4-lq<\
Brief Description of Proposed Work': Lic4k1,S Ai:r,t A" AD.4e. ,QCc.ic 4-4 cse._(121t.so-) i
Q:. J D i (A- (D " - -. V.ectil 4 YS 'beA-%lAck I SZ .S P,) 0-c.' 7" 'T 2.1 II ordee
PvkrSQ L (Z1 i S .t- AYE" SC.4."C{ 'J
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ j 1 30$.tl,'4 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Cost3(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ Total All Fee l
Suppression) !�
y I•
Check No. ✓ heck Amount: Cash Amount:
6.Total Project Cost: $ Li ❑Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
A):chn\.gs me_.S-ter License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
%4 4 lr.dre.rJS 54: 3e `.(r LI OL4
No.and Street t) Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
SIL-.61,,mtikaii, CE a L ti Irct (1} Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
91 -'igg-WAS "KAI)e_y tireNlic4 emir us.ca,r� I Insulation
Telephone Email addre D Demolition
5.2 Registered Home Improvement Contractor(HIC)
clam la-z1•a
Q eZ. E!1ecgy,L.Cl IBC Registration Number Expiration Date
HIC CCC,orn any Name or Hit Registrant Name
No.and Street Email id8ress
City/Town,State,ZIP Telephone
SECTION 6: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 Sr No 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize Iplt•ecNki C.l r'ec�n is LI-C_
o act on my behalf,in all matters relative to work authorized by this building permit application.
S•ef C 'q 2fs en.Sear". 3-r--Z.6
;'rint Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
„y entering my name belpw,I hereby attest under the pains and penalties of perjury that all of the information
6•ntained in this application is true and accurate to the best of my knowledge and understanding.
��� ca Lik ac,2g-"Vior\ .Drrr --2 -2,4
-
' int Owner's or Authorized Agent's Name(Electro c Signature) Date
NOTES:
An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or granty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.aov/aca Information on the Construction Supervisor License can be found at www.mass.govvdps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) 1 ;Z' o S is (including garage,finished basement/attics,decks or porch)
Grtoss living area(sq.ft-) I 1- 1(4, s . Habitable room count t-
.l tuber of fireplaces ► Number of bedrooms
IV tuber of bathrooms Number of half/baths
T e of heating system C..1 W anr4 Ar( Number of decks/porches (
Type of cooling system Enclosed Open s
3i. i "Total Project Square Footage"may be substituted for"Total Projecr-Cost"
.
tt.,,.,i City of Northampton
v �, V. Massachusetts ,...
1
• * DEPARTMENT OF BUILDING INSPECTIONS
''• .: 7; � 212 Main Street • Municipal Building fss ,CS
+;- Northampton, MA 01060 11Y 'TO
Property Address: Cq Lj 1-rq.0e_s\v.\\e toc,4
Contractor
Name: t0-\rci,- ctl ErwscJ..y , L LC-
Address: l u►as-Ir SgLtr.,e .\:,:.12e 2A4) A.ie� 13c,N-e.;.1.4 CC Cl-,DSO
City, State: /\I e_v `gc,;-11-c„,-,, zr o u,c
Phone: %-tv' - V•-c)�,1_
Property Owner
Name: J ,g-ei.c- Ceireg,x`�
Address: rs cif \tG,t d P1v,\te_ Q.d
City, State: Nam 0..E mac,, nnA-
I, A)' cA \cs rnk,.s}Z ,"Ak:14-,e,(Ld- , (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 Lt....:4 "
Date
sI,,1�� )-i
City of Northampton
f,='' '�, Massachusetts R. ''
LI
U �I + tp4' DEPARTMENT OF BUILDING INSPECTIONS y�
4,'r"A. � /4 212 Main Street • Municipal Building � ., Ca
Y ' 4 Northampton, MA 01060 "J.1')i— P0
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
Location of Facility: 1_\-- -a.iN; ,-� 3 (is c • C, ,.,,� et— v(o ill
J ,
The debris will be transported by:
Name of Hauler: Q,�enrc,,,( EAL,5,.,,,,,,,, —7 .3c.,t J e;,-a ? ��dic�
Signature of Applicant: Date: .1/0'2432..1
DocuSign Envelope ID:831435D0-A63E-40B8-89E0-CE8F609CF753
CLEAResult CONTRACT
CLEAResult
50 Washington Street, Customer Name:ANGELA GREGORY
Westborough,MA,01581 Email:angiejgregory@gmail.com
Phone:413-522-1029
Premise Address:595 Haydenville Rd,Northampton,MA 01053
Mailing Address:595 HAYDENVILLE RD,Leeds,MA 01053
Project ID:4086274
Date:Oct.14.2020
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 recommendations/work order describing the work in detail(the"Work")which are
incorporated herein by reference.
Measure Description Location Quantity Unit Total Cost Customer Cost
Air Sealing at Estimated 62.5 CFM50 Per Hour 2 hr $185.16 $0.00
Attic Stair Cover w/Carpentry(with AS hrs) 1 each $289.31 $0.00
Door Sweep(with AS hrs) 2 each $50.62 $0.00
Exterior Door Weather Stripping(with AS hrs) 2 each $60.14 $0.00
Walls-Vinyl-4"Dense Pack Cellulose 1216 SF $3,222.40 $0.00
Rim Joist-6"Fiberglass Batting 152 SF $410.40 $0.00
Door-2"Thermal Barrier Polyiso 1 each $90.44 $0.00
Total: $4,308.47
Program Incentive: -$4,308.47
Customer Total: $0.00
Payment
Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows:Payment#1:EN 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:I=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-.
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.c 142A.
Page 1 of 4
DocuSign Envelope ID:831435D0-A63E-40B8-B9E0-CE8F609CF753
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. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
ebSged by:n D8
Ceoop 10/16/2020 11:07 AM EDT FG
enteitrieraignature Date Indicate your selected IIC here, if applicable Initial here if you
want the Program
to assign a
Kevi n Cote Contractor g
oh," 10/19/2020
CLEAResult Signature Date Name of CLEAResult Representative
Page 2 of 4
DocuSign Envelope ID:831435D0-A63E-40B8-B9E0-CE8F609CF753
Arft Permit Authorization
mass save Form
Site ID: 4086274 Customer: ANGELA GREGORY
Angela Gregory , owner of the property located at:
(Owner's Name,printed)
595 Haydenville Rd Northampton, MA 01053
(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.
—DocuSigned by:
Owner's Signature: Qklc,(,a, i vt, oVt1
�—BA2FF8C4FA0C403..
Date: 10/16/2020 I 11:07 AM EDT
#.... .....ea+•lissi*ssAMl•••ll11*8••••S •S•.....f*AM00a Musa+!••fl•li
FOR OFFICE USE ONLY
We have assigned the following Mass Save Home Energy Services Participating Contractor to the
above referenced project:
P 0 Gs ,� 40 - i
Participating Contl'dtor Date
Name: CLEAResult
Phone: 800-480-7472
Email:
Page 1 of 1 --rOtrr_e Ue Orly
Rev. 102015
'RCS PLANVItiW"Dfi!
c'"7.: '.\\,AL t f z
Home Phone ( _ ) I)
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C' rr4 •-.._.... _. ... .._.,.__._ Work Phones (� )- -
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Coll Phony (�3_,_)- 5,A - wag►
kMI t"i 4.9.t>utik* No.. !,_. vsr.._,__...._...... a rr. iMsr.d�w _._._......... . .,, w_,._,.... ._.
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cd61.
For Office Use Only
Bushes I Ladder Neighbor Proximity I Pocket Doors ! Insert Radiators I Fence(s)
Existing Conditions X=Access 0=Vents Note Inside Square R=Roof S=Soffit G=Gable
RV=Ridge Vent CS=Continuous Soffit CDE=Continuous Drip Edge T =Triangle
nstali 0=New Access Note in Circle C=Ceiling W=Wall S=Sheathing Temp Unless Noted Otherwise
A=Vents Note in Triangle R=8"Roof S=Soffit G=Gable M=12"Mushroom For Access
2200-10-1,
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Recommended1
Ventilation Calculation j A
,... __
Recommended i
Ventilation Calculation
AIR SEALING WORK HOURS
Air Sealing Work Hour
Calculation is KT 04-.Li z •*- .
....,...._ ... ,
_,
Work Hours 4 i 6 1 8 10 12 In 16 (.2)
1 + i
Attic Sq.Footage <500 1 501-800 ! 801 - 1100 1101- 1400 ' 1401 - 1700 1701 - 2000 2001 - 2300 Every 300'
_ I
Exception&AFL Hours Primarily Floored Attics Chimney or BF = 1 Hour Multiple Chimney/BF = 2 Hours
.
Prefab/Modular Hours No Chimney=4 Hours
1 Chimney=6 Hours
Exceptional KW Hours X<20 feet=1 Hour
I 20 ft<X<40 ft=2 HOUrs X>40 ft=4 Hours
Rim Joist Only Hours RJ<150 ft =1 Hour
ICJ>150 ft = 2 Hours ,..D
BMT Ceiling Only Hours Ceiling Area<2,000 sq ft --- 1 Hour Ceiling Area>2.000 sq ft=2 Hours
_
"'NOTE:You MUST be INSULATING RJ or Basement Ceiling to specify RJ or BMT Ceiling ONLY Air Sealing Hours"'
glij ?6"Loose Insulation Cross Batt Insulation
_ .
Multipliers —-- -- - — ----
>6"Mix Batt&Loose Insulation Truss Construction
0 .
For Office Use Only
Q/7L Q/PATQdadtuoe l
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: LLC
Registration: 192284
POTENTIAL ENERGY LLC Expiration: 06/21/2022
1 HARTFORD SQUARE
BOX 2-E
NEW BRITAIN,CT 06052
Update Address and Return Card.
SCA I CT 20M-05!1?
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:LLC before the expiration date. If found return to:
Registration Expiration Office of Consumer Affairs and Business Regulation
192284, . 06/21/2022 1000 Washington Street -Suite 710
POTENTIAL ENERGY LLC Boston,MA 02118
NICHOLAS MEISTER
1 HARTFORD SQUARE 4. ZGrti
DOOR 65 SUITE 216 UndersecretaryNot valid without signature
NEW BRITAIN,CT 06052
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Construction-SmW
Astor1 &2 Family
CSFA-106184 Wires:04127/2021
NICHOLAS ALEXIIIVOEI MEISTER;
344 ANDREIAJS ST
SOUTHINGTtI CT 06489
Commissioner p.1w4-4- '+
The Commonwealth of Massachusetts
Department of Industrial Accidents
=M►r Office of Investigations
fZ=;:pia
t: «- 600 Washington Street
Boston,MA 02111
"'.�• www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le2ib1v
Name(Business/Organization/Individual): - ,}e-r G.l E nI.'iti,
Address: \ ��C� e� � - St-, CrocztiZa
City/State/Zip: xie.,4TS�;�c ,'. ,C i �C c 2 Phone t: y 13 7'Are you an employer?Check the appropriate box: Type of project(required):
1.E1 I am a employer with \4 4. [] I am a general contractor and I 6. El New construction
employees(full andlor part-time).* have hired the sub-contractors
listed on the attached sheet. 7. ❑Remodeling
2.❑ I am a sole proprietor or partner-
ship and have no employees These sub contractors have 8. 0 Demolition
working for me in any capacity. employees and have workers' 9. []Building addition
[No worker,'comp.insurance comp.insurance.
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 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' 1 P21 Other_it c...nrNYN
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.
tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employees. ff 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. A �t
Insurance Company Name: J
_ Sue; („Ae_j ‘n 1 Ct co
Policy#or Self-ins. Lic.#: (1LL f{ Expiration Date: $3' )-y 1'.C4.
Job Site Address: ,' {t{'iilG�,,,jam j _ City/State/Zip:AL '- ►C 4 U l GS3
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
It}vestigations of the DIA for insurance coverage verification.
I do hereby certify on, • the.p •. ' p• ' 'es of perjury that the information provided above is true"and correct
Signature_, _ Date: 7
Phone#: ` t I 7Ci 4s
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
b.Other
Contact Person: Phone#: