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17C-323 (7) 40 OAK ST BP-2021-1072 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C-323 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-2021-1072 Project# JS-2021-001816 Est.Cost:$3200.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ENERGY PROTECTORS - JOSHUA DADA 101143 Lot Size(sq.ft.): 12501.72 Owner: OMAR HAYTHAM M Zoning: URB(100)/ Applicant: ENERGY PROTECTORS - JOSHUA DADA AT: 40 OAK ST Applicant Address: Phone: Insurance: 64 PAXTON RD (774) 253'-0277 WC SpencerMA01562 ISSUED ON:3/29/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:INSULATIONNVEATHERIZATION 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 NO'THAMPTON PO VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 3/29/2021 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner r / C / / ` "60 �// / *C , ( � n YJ, The Commonwealth of Mac l? �J Board of Building Regulations and FOR 'Llt Massachusetts State Building Code,780 n Rtv!� ^� UNICIPALITY i Mq°F�r� USE Building Permit Application To Construct,Repair,Renovate Or ' lklh a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: �j��a�l���'7�' Date A lied: Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Paerty Adb-e K c� 1.2 Assessors Map&Parcel Numbers mb�3 1.1a is this an accepted street?yes no Map Number Parcel Number„ 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed 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: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Re o d: 00A.ctr ki COI it COON Fto('ev\Ce, ‘fivii 0 t oG 3.__ Name(Print) City,Stale,ZIP Lk() Oo l SA- cq-� '350--)1I q No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction Cl Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify: t Brief Description of P oposed Wo 2 Cl‘1.-- Se GLLh l.VL g U � c vicv 4 c. SECTION 4: ESTIMATED CONSTRUCTION COSTS item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 3 d(96 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ 1 0 Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:Sri Check No.3\\ Check AmountA Cash Amount: 6.Total Project Cost: $ 3‘). 60 ❑Paid in Full 0 Outstanding Balance Due: i 51 C Lieemse(CSL) tOt 14.3 bI Zz l o Sh ` 1)c,a ck License Number Expiation Date Name of CSL Holder List CSL Type(see below) v No.and Street Tee Descripticm ?€ C Q t � 6 ct R Restricted Ida Family Dwelling to cu.R) City/Town,State,ZIP M Mom, -riLt - as 3 - O 1 RC Roofing Covering WS Window and Siding SF Solid Fuel Baffling Appliances 4 iru3 *•w t -c Insulation Telephone Email address D Demolition 5.2 Home Improvement Coetraetor(RIC) 7 a C ,v co � Cl 12 2_ ?icy rS WC Registration Number Expiration Date HIC br H Registrant N l ( �`-t GtX dl� j CQ4-�C1 l gyp V\01w"5i .Cc,en Street _ a- _ F adder N ,p��c t^e1 L/ ©use 7)kt 3 —c :17 City/Town,State,ZIP Telephone SECTION 6:W©A7atS'COMPS!ATION 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 Issu2e ofthe building permit_ SignedAffidavit Attached? Yes No —O SECTION OWNER AUTHORIZATION TONE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize . - Q. to act on my behalf,in all matters relative to work anatborrzed by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and ceding. 111.A441' 2-/ Print a or Authorized Agent's Name(Electronic Signat ue) NOTES: 1. 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,Ed have access to the arbitration program or guaranty fund under M.G.L c.142A.Other important information on the HIC Program can be found at www.mass'Rov/oca Information on the Construction Supervisor License can be found at www_mass_gov/dps 2_ When substantial work is planned,provide the information below: Total floor area(sq.fd_) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half7baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3_ `Total Project Square Footage'may be substituted for`Total Project Cost" D cuSgn Envelope ID B77B2AF9-E559-4042-9681-3EA055668CF6 RISE ENGINEERING OWNER AUTHORIZATION FORM Omar Haytham (Owner's Name) owner of the property located at: 40 Oak Street (Property Address) Florence, MA 01062 (Property Address) hereby authorize - py►Pr<<-i pr.)i« -b'' Subcontractor(to be filled in by office) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. This form is only valid with a signed contract. The permit will be secured by the subcontractor, at no additional cost. It is the homeowner's responsibility to close out this permit by contacting their municipality at the completion of this work. On tar RatifLua 3/16/2021 110:19 AM PDT Date RISE Engineering, a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 Canton, MA 02021 1339-502-6335 www.RISEengineering.com a ‘ ;�L t - • �e �i € ='-t�_= • 1 Owns Stree4Seik lee -'' AY -?8l7 unpounanginakt r, TO UM=TATHTHEp fir_ blaiiialdifinfia Plena Priat boil* Nano Paisiniessidmiiimialiihst4 Irsirl ec9*f Veco c t,. - Addage foil .Pg1404 Ttd atosigiatcs , + 4 © , Phones: "In 4 -115-3 -o ti,7 soilltreCimit ?Ma TrPrgieet(MOM* =as umel•prvak 117""Imigt/speandlirpolgisr 7. 0 Pim coosivadias 3[] pli � It a ❑Da.oTitioe 4011./adommersolaillishiagivaitemsiscrketallmokosieypetiow Twill 1 a[ s einai e.ti ...oticalier,aaa:a� aaa s s -.sinbuswe raeaele 1 i�tI ELOPhshignipas croaking L3Q 40111kidealsendamil ilk �'�afap+mpeiaaladifiL e. ftestramemoket re taLsaH 1 ekaiidtiir trymiigaR�taiiaeiie aralnaiarpi�rktsaiaa aeisk Stkormilthasheltilklimmtasi- - - ioubbmiugiba - -Lae aatirlim Vas• - • mid perrimiic I an eseescayeremaspreekleg owes compeoallar immemeJlirera sae Nets,a depiewaRtjeksle isOrsailim bsmaceQmsaPliaaae A. 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" ►hit fiebliwaritsapirsiiisteigrebteseend alined 041 ilagc el l 2-4 I 2--i Offici idea* to mentwie is likesen,laiea MsrIgoalp.r•imWald cry WIWI= Pandit/kneel Min Andhsragekrtie mak ----,---.- -...] L Haaad offlemeNh L Daps st 3.(>i/1Luai eh* 4.131ee3esd -i insialinginspactor i`Oar Ossaet Passaic Thane#; TE AW a CERTIFICATE OF LIABILITY INSURANCE � ` `` ' kw....----- 08/31/20 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 pollcy(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- • Cindy Davis Coonan Insurance Agency,Inc. Plie#HEt 508-987 T122 IPkx i►ic No) 87-1090 26T Mein Street rialtjWADDRres& cindy6Coonaninsurance.com Oxford,MA 01540 INSURER(S)AFFORDING COVERAGE NAIC S INSURER A: Capital Specialty INSURED INSURER B: Safety Energy Protector,inc. INSURER c: Starstone 64 Paxton Road INSURER D: Spencer,MA 01562 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES 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 YYHICIH 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.UNITS SHOWN LAY HAVE BEEN REDUCED BY PAID CLAIMS. R TYPE OF INSURANCE POLICY NUMBER (MMfDO'YYY POUCY OUP L YY) Y) UMITIS X CONNE RCIAL GENERAL UAaIUIY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE1:21 OCCUR PREMISES( eccwn'nee) S 100,000 MED EXP(Any one peen) S 5,000 A y CS 16001320-05 08/31/20 08/31/21 PERSONAL s ADV INJURY S 1,000,000 GEM AGGREGATE UNIT APPLES PER GENERAL AGGREGATE S 2,000,000 1 POLICY n JECT 0 LOC PRODUCTS-COMP/OP AGO S 2,000,000 OTHER S AUTOMOBILE LIABILITY (Es azsrzsoeennt))SINGLE Lain S 1,000,000 ANY AUTO BODILY INJURY(Per person) S B „___AUTOS ONLY X AUTOS LM y , 6238518 12/23/1g iv-mg BODILY INJURY(Per accident) S XHi RED X NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY {Peron:408 ) S , X UCLA LIAB x (pry IN EACH OCCURRENCE S 3,000,000 C - EXCESS LIAR CLAIMS-MADE y 1 89362T193AU 08/31/20 08/31/21 AGGREGATE S 3,000,00C DED I 1 RETENTION S . S vwRICERB COMPENSATION PER OTH- ATUTE ER AND EMPLOYERS'LIABILITY Y!N ANY PROPRIETORRARTNER/ECECU IVE❑ CI N!A EL EACH ACDENT S OFFICERMU]EBE�R EXCLUDED? (Mwl dory In NH) EL DISEASE-EA EMPLOY S If y DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LINK S DESCRIPTON OF OPERATIONS!LOCATIONS!VE:HICL ES(ACORD Tet,Additlonsl Remarks Screduie,may be attached If more space Is required) Workers Compensation insurance certificate to follow under seperate cover. entailed josh 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. Evidence of Coverage AUTHORIZED REPRESENTATIVE Jvck — &ii_alLt,D 15 ACORD CORPORATION. All rights reserved. ®1888-20 ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AC0RDD® CERTIFICATE OF LIABILITY INSURANCE DATE 1 "r)/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 pollcy(ies)must 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 CONTANAME: Nidia DeCastro COONAN INSURANCE AGENCY PHONE °Exu: (508)987-7122 ;FAX ADDRESS: NidiaO00onaninsurance.ODm 267 MAIN ST INSURERS)AFFORDING COVERAGE NAICS OXFORD MA 01540 IWSURE%A: ACE AMERICAN INSURANCE CO 22667 INSURED INSURER B ENERGY PROTECTOR INC INSURER C: INSURER D: 64 PAXTON RD INSURER E: SPENCER MA 01562 INSURER F: COVERAGES CERTIFICATE NUMBER: 569858 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. ►OTWITHSTANDING 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 AU.THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NISR PO TYPE OF INSURANCE ADD,SUER ( AVDDDITTYTI; • POLICY EXP LTR UNITS NOD,yryp POLICY NUMBER COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occ re ce) S MED EXP(Any one pesos) S N/A PERSONAL&ADV INJURY S GEM.AGGREGATE LIMIT APPLES PER GENERAL AGGREGATE S PRO- POLICY JEcy LOC PRODUCTS-OOMP/OP AGG S OTHER AUTOMOBLELIABLRY COMBINEDj UNITE T ANY AUTO t1OOEY INJURY(Per person) S ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per eraderrt) S AUTOS NON-OWNED PROPERTY DAMAGE S HIRED AUTOS (Per accident) _ S UMOREI I AUAS OCCUR EACH OCCURRENCE S EXCESS We — CLAIMS-MADE N/A AGGREGATE S DED RETENTION WORKERSCOMPENSATION S i X I STATUTE I s AND EMPLOYERSLIAIILITY ANYP'RD!'RIITOPoPARTNERIEXECUT1VE Y/N EL EACH ACCIDENT S 500,000 A OFFICEwMEMDERExcLUDEm N . NM 6S62L)BOG29826020 09J01/t020 09/01/2021 (Mendsiery M Mt) EL DISEASE-EA EMPLOYEE S 500,000 tl yyeass,.dasPTIO iroe under DESCPoN OF OPERATIONS below EL DISEASE-POLICY LBMM S 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be Mashed if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B.no authorization is given to pay claims for benefits to employees in states other than Massachusetts If the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.m ass.gov/Iwd/workers-compensation/invesllgations/. Sole proprietor has riot elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Enemy Protectpr Inc ACCORDANCE WITH THE POLICY PROVISIONS. 64 Paxton Rd AUTHORIZED REPRESENTATIVE Spencer MA 01562 1 Daniel M. ,CPCU,Vice President—Residual Market—WCRIBMA ©1988.2014 ACORD CORPORATION. Ali rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusstts it" Division of Professional Lkinsun Board of Building Regulations and Standards ConstruetllAuppr lsor CS 101143 Qiipirs:Od/1;. 022 JOSHUA S DADA 14 PAXTON RD SPENCER MA,O1162. • ,�'c,l4ti'l ' . • t Commissioner l bits+,a#.+a, Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation Registration; 172960 ENERGY PROTECTORS INC. Expiration: 08/19/2022 64 PAXTON RD. SPENCER, MA 01662 Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation • before the expiration tote. If found return to: RSglainitlaa Exairdeo Office of Consumer Affairs and Business Regulation 172960 08/10t2022 1000 Washington Street •Sults 710 ENERGY PROTECTORS INC.• Boston, MA 02118 JOSHUA DADA 14 PAXTON RD. 10464i/.4.44" Not valid without signature aPENCER,MA O116d2 Undersecretary City of Northampton Massachusetts 4o/ ,{ r 'c DEPAR2WENT OF BUILDING INSPECTIONSps 212 Main Street • Municipal Building Northampton, NA 01060 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: Llo The debris will be transported by: Name of Hauler: ET-'�er ��` Pct.k',.c•-- S � � ID 11 Z Signature of Applicant: �� Date: 3 I 4 21