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24A-010 (10) 130 PROSPECT AVE BP-2021-1168 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24A - 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-2021-1168 Project# JS-2021-001960 Est.Cost: $10000.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ENERGY PROTECTORS - JOSHUA DADA 101143 Lot Size(sq. ft.): 61419.60 Owner: BASS GWENDOLYN Zoning: URB(100)/ Applicant: ENERGY PROTECTORS - JOSHUA DADA AT: 130 PROSPECT AVE Applicant Address: Phone: Insurance: 64 PAXTON RD (774) 253-0277 WC SpencerMA01562 ISSUED ON:4/13/2021 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: (.as: 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. I ill )2 Tie 67 Certificate of Occupancy Signatur.! I 1 FeeType: Date Paid: Amount: Building 4/13/2021 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner ���� �.) 1 n i APR 2 1 2021 l,_,,.r n` t lll!(1 INSPECTIONS The Commonwealth of Mataat aiu 'LV/ Board of Building Regulations and-St t 01pso__ MUNICIPALITY Massachusetts State Building Code, 780 CMR 1 FOR USE Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This ection For Official Use Only Building Permit Number: b'r o ' at CI'D Date Applied: kEvW rKo,s /42._. 144316Z1 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 o e 'ddrSs: 1.2 Asse o ap&Parcel Numbers/ oi` 0 COpeCt RUC.- 1.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public CIPrivate 0 Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Ow er'of Record: Ci-PW e.vi 6 cA cs ivc1C hctirn n - ©t ObC) Name(Print) City, State,ZIP L30 ecoS pe.ci' kut.. Li 11-is°tb-3$t No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction CI Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Access Bldg. 0 Number of Units Other GAS r y� Y gP�fY',4-r1 S v v_ ' Brief D� gycrlptio�of Proposed Work2: � Y1$L, t(�`� ,� aA't ck vile, icAA SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ t(, t0 0 1. Building Permit Fee:$ Indicate how fee is determined: 2 Electrical $ t 0 Standard City/Town Application Fee 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:$ /' Check No.,�j�j�Check Amotm : L ' Cash Amount: 6.Total Project Cost: $1,0 t) d 0 0 Paid in Full ❑Outstanding Balance Due: I sitieniaoktot S 1 C . Supervisor Li o n(COL) I of i4 � (1{ b( 2-1- 3-0 Sh UO\ CtGk Ucense'Number Eamon Dale Name off.Hobbs. /` 4 Kkix, �} List cSL Type(see below) v No.and Street (!c U( Type Dcscnoun- Cifown,State.BP? M My - 0.1:71 RC Roan Covering WS Window and ruling SF Solid Fuel Bowing Apprtmees T address D DemoItion Si Home Improve a tat Conttraeter( C) t ?a ck(00 ci 1 ... on e l C.c fi)S HIC Registration Number Expiation Date stEcet 1—cQ� City/Town,State,ZIP Telephone SRG I o1Yi� RO ATIO1� F ' ISL 4 ist )) Workers Compensation Insurance affidavit most be completed and submitted with this application. Falhws to provide this affidavit will result in the denial of the Issaanje of the building permit. Signed Affidavit Attached? Yes H. No _0 _ cormtacroR Al 1,as Owner of the subject property,hereby authorize _ate, em to act on my behalf,in all matters relative to work by this building permit application. Pend Owner's Name(Electronic Signature) Date _S A .. . .MT1 DECLARATION By entering my name below,I hereby ate realer the pains and penalties of perjauy that all of the information csmained in this . is tnae and accurate to the best of my knowledge and imcicrstanding. TC'S V P j?C't 4/61 21 a r tO 's'brAndminsi Agent's Noma(Eieet aeicSignature) Date 1. An Owner vrbo obtains a building permit to do hisdrer own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will sat have access to the arbitration program orguaranty fend under MAL.c.142A.Ocher important information on the H1C Program can be found at www.mass..govloca Information on the Construction Supervisor License can be fond at www.mass.gov/dps 2. When col work is planned,provide the information below: Total floor area(sq.IL) (mcluding garage,finished basementlattics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bedrooms Number of halftbatbs Type of heating system Number of dacha/porches Type of cooling sYslein Enclosed Open 3. Project Square Footage"may be substitabed for"Total Project Cost" ram; The Comtgoniveelttt ofMassrrcltrrsetts Department of_►`ft(lrestriolAcculenfs "!' 1 Congress Street,Suite 100 ► �� Boston,MA t02114 2017 "', wivit.rrrtcss.gop/diet Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plttrabers. TO BE TILED WITH THE PERAfITTtNG AUTHORITY. /ljruttcantlnfornatton Please Print Legibly Name(eusinesstorganizationn dividduua!): fly� C4.r CoT -VOCS C- Address: (o t P a.XTOi t `t d City/State/Zip: S pence( oil OI sba. Phone#: 4 --1-S3 " ° 2l 7 Arc you all employer?Cheek the ppropr:ete ham. Type of project(required): 1. Jaen a employer with l I employees(full and/or part-timc).r 7. ❑New construction 2 Q lama sole proprietor or partnership and have no employees working forme in S. ❑Remodeling any capacity.[No workers'comp.insurance required] 3.0 I am a houieowner doing all work myself.(No workers'comp.insurance required.]t 9. Demolition 4.0 I am n homeowner and.•.ill be hiring connectors to conduct all work on my property. I yell 10[]Building addition ensure that all contractors either have%Nu erg'compensation insurance or aresole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions lam a general contractorard I have hired the sub-coniredors listed on the attached sheet These sub-contractors have employees and have vnukcrs'camp.insurarn-c t 13.❑Roof repairs &D Weave a corporation and its officers have exercised their right of exemption per MGL c. 14.[?iOtherTiNS 'l.J-Y�� 152,§1(4),and we have no employees.[Na workers'comp.inauance required.] ')Any applicant that cheats box C I must also fill oat the section below showing their'corkers'compensation policy information. t Homeowners who submit this affidavit indicating they Ere 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 sub-contractors and state whether or not those entities have employees.If the sub-coatraciors have employees,they must provide their workers'romp.policy number. lam ma employer that Is providing workers'compensation Insurance for ng,employees. Below Is the policy and job site Infolinotlon. Insurance Company Name: A C.C. 1'1'a Rai v t *L4 •Zir\cuC CA n Ce..... Ga Policy#or Self-ins.Lie.1: o S ).k..)g d G"r-ct 0'o a I3iq iration Date: C ( 112- Q _. y P i A-ht..,w4 q J"1A 3 t O Ji) Job Site Addross: , 1. u City/State/Zip:/Stalt�L[ : 4 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date] Failure to secure coverage as required under Mt3L o.152,§25A is a criminal violation punishable by 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 S250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage verification. I do hereby mil nadirthe and penalties ofperjnry that the Informallon provided above Is dye and correct. Signature: cbA l G( 4 61 Date: ( t —2- 1 Phone#. e)7 l - 7 Official use only. Do not Sprite in this area,to be completed by city or town official. City or Town; Permit/License# Issuing Authority(circle one): 1.Bonrd of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing inspector 6,Other Contact Person: Phone 11: City of Northampton �t,AMF 'Z s s •.. Massachusetts &.Q,; 4 c O-A I .# DEPARTMENT OF BUILDING INSPECTIONS a, x ,' 212 Main Street • Municipal Building v`•. Ca 't',_' Northampton, MA 01060 'r.'pyr - ;10 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: Colt Pkk..E ) . Vt _0 Location of Facility: 5 V)t4 C e l~` M A.- m t S6 The debris will be transported by: Name of Hauler: Etner`)1 9fvttc tor rJA_ 40 .---:\ c vdC / � Z1 Signature of Applicant: �� � Date: DocuSgn Envelope D CE71BOCF-86D4-4F79-BF80-89E4AEE2E906 RISE ENGINEERING OWNER AUTHORIZATION FORM Gwen Bass , (Owner's Name) owner of the property located at: 130 Prospect Avenue (Properly Address) Northampton, MA 01060 , (Property Address) hereby authorize C'1^‘'rr7��. f/'/i/1, 41 (Subcontractor) 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. Ooc sSgned Ly rl44,g{gture 10/3/2020 14:S5 AM PDT Date RISE Engineering,a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335 www.RlSEengineering.com DATE AWR El CERTIFICATE OF LIABILITY INSURANCE [ R 1 ) /20 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY MD CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY MEND,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 holder In lieu of such endorsement(s). PRODUCER ozw/T cr Cindy Davis Goanan Insurance Agency,Inc No pa ant 508-987-7122 mx 1 gm:,Nor 508-667-1090 287 Main Street =item cindy§Coonanirsurance.can Oxford,MA 0154CI BISURE:HS)AFFORDS/a COVERAGE HNC* , INSURER A: Capital Specialty INSURED DISURSR a: Safety Energy Protector.Inc. afaURE t C: Stalsbone 64 Paxton Road INSURER D: Spencer,MA 01562 INSURER E: M$URBR F: COVERAGE CERTIFICATE NUMiR REVISION NUMBER THIS IS TO CERTIFY THAT THE PAS OF INSURANCE LISTED BELOW HAVE BEEi+I ISSUED TOTHE ENSURE)NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR an-ICR DOCUMENT WITH RESPECT TO Y*UCH THIS CERTIFICATE MAY BE ISSUE)OR MAY PERTAIN.THE INSURANCE AFFORDED WINE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALLTI TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAO CLAIMS. TYPE of elsuRAkcERIBR vOLJCY wuem R Ike ioa rYYT). Lwrrs X cO c AL GE4BtAL UMW./ EACH OCCURRENCE S 1,000,008 CLAIMS-MADE LI OCCUR v PREMISESr „eel S 100,000 — MED ExP(Any tine Cason) s 5,000 A y CS16001320-05 08f3120 0813121 PERSOriM.&ADMINJURY s 1,000,000 GOD.AGGREGATE UMfr APPLES PER: GENERAL AGGREGATE s 2,000,000 X rim ri LOC PRODUCTS S 2,000,000 i _ AUTOMOBILE LIABIU1Yecc COMBINED szIGLE Ltuti $ 1,000,000 ANY AUTO BODILY INAIRY(Pet paean) S B —Tammy X Amuse LED y 6238619 1223119 122320 BODILY INJURY(Per awdett) S X fit® X NO -OWNED PROPERTY DAMAGE S AUTOSOHLY 3,-AUTOSt1VLY /Peraaaaem S x UMBitH.LAWe X,necHR EACH OCCURREICE s 3,000,000 C ~E zDE s Uas CAMS-MADE y 83362T133AL1 08/31/20 08/3121 AGGREGATE 5 3,000,000 DEC 1 RETENTIONS S WORKERS COMPENSATION I S [STATUTE I ER AN0 EMPLOYERS'LIABILITY ANY PROPRETORIP EARTN RIE XECtlTAFE V_!N It 1 A EL EACH ACCIDENT S OFFICERAiEMBER EXCLUDED? (M fnd, DI abetysINH) EL DISEASE EAEUPLOYEkS If s useat DESCRY OF OPERATIONS berm EL r ePAcc-POLICY LOUR 5 I 1 I DEERIPT1Ort OF OPERATIONS/LOCATCM5l VENICL ES(ACORD 101.Addisowi Remarks So s Ie,a sy be aim IT mote spate Is!centRd) Workers Compensation insurance certificate to follow under separate cover. entailed josh CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE 0EJVBtED Di Evidence of Coverage ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESS/TAME I lidk:a.-- &---0—aebe- LID 01888-2015 ACORD CORPORATION. Ail rights reserved. ACORD 25(2018103) The ACORD name and logo are registered marks of ACORD ARIJ CERTIFICATE OF LIABILITY INSURANCE DATE 1m /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 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 Nidia DeCastro COONAN INSURANCE AGENCY PHONE ao. (508)987-7122 FAX (A/C,Not ADDREss: Nidia@coonaninsurance.com 267 MAIN ST INSURERS)AFFORDING COVERAGE NMCI OXFORD MA 01540 INSURER A: ACE AMERICAN INSURANCE CO 22667 INSURED INSURER B: ENERGY PROTECTOR INC INSURERC: 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. 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 AM)CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ATE TYPE OFMSURANCE al D SYAM POLICY NUMBER (MMD (,N1,11D0tVYYY) LIMITS COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE S DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occwryneln S MED EXP(Any one person) S N/A PERSONAL 8 ADv INJURY S GENT AGGREGATE LIMIT APPLESS PER GENERAL AGGREGATE 5 _ POLICY JCCT I 'LOC PRODUCTS-COMPNOP AGG S OTHER _ S AUTOMOBILELIABI RY COMBINED SINGLE LIMIT s fEa aandenD ANY AUTO BODILY INJURY(Per person) S_ ALL OWNED SCHEDULED AUTOS —_ AUTOS N/A BODILY INJURY(Per accident) S HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per oxidant) S UMBRELLALIAO OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE N/A AGGREGATE S DFD RETENTION S S WORKERS COMPENSATION X S AT TUTS OTH- ER AND EMPLOYERS'LWBIUTY Y I N AN A OFF ICEWMEEMBEREXCLU�ECUTiVE I I N/A NIA 6S62UB0G29826020 09/01/2020 09/01/2021 E'L EACH A�IDENT S 500,000 (Mandatory in NH) EL nlspssn.EA EMPLOYEE S 500,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT S 500,000 N/A DESCRIPTION OF OPERATIONS i LOCATIONS/VEHICLES(ACORD 101,Addleonal Remarks 8dadda,maybe attached Emote 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 cairns 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.mass.govAwd/workers-compensat nvestigaUons/. Solo proprietor has not 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 POUCY PROVISIONS. 64 Paxton Rd AUTHORIZED REPRESENTATIVE • Spencer MA 01562 • Daniel M.Crowley,CPCU,Vice President—Residual Market—WCRIBMA 1 U 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD • Commonwealth of Massachusetts Division of Professional Licensune Board of Building Regulations and Standards ConstructthiniUpervisor CS 101143 • • , ESpires:06/1 2022 JOSHUA fl DADA 04 PAXTON RD SPENCER MA(01662. •• •,.„, ()/Sc.1-Ik°'. • Commissioner ,14. f; 1141-1A..' r-Ye4 Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type; Corporation Registration; 172980 ENERGY PROTECTORS INC, Expiration; 0811912022 84 PAXTON RD, SPENCER, MA 01682 Update Address and Return Card. Ohba of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR . Registration valid for individual use only TYPM Corporation before the expiration date. If found return to; S4 111011EMW Office of Consumer Affairs and Business Regulation 172900 08/19/2022 1000 Washington Street •Suite 710 ENERGY PROTECTORS INC. Boston, MA 02118 JOSHUA DADA /� 84 PAXTON RD. of9, lot valid without a netur+e SPENCER, MA 01862 Undersecretary