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24D-222
BP-2022-0131 31 PERKINS AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24D-222-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2022-0131 PERMISSIONIS HEREBY GRANTED TO: Project# insulation Contractor: License: Est. Cost: 2000 HOME ENERGY SOLUTIONS INC 106188 Const.Class: Exp.Date: 12/28/2023 Use Group: Owner: KAUFMAN CHARLES N Lot Size (sq.ft.) Zoning: URC Applicant: HOME ENERGY SOLUTIONS INC Applicant Address Phone: Insurance: 233 COLLEGE HWY (413)203-2454 0 HOWC 140654 SOUTHAMPTON, MA 01073 ISSUED ON:02/10/2022 TO PERFORM THE FOLLO WING 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: Gas: Final: Final: Rough Frame: Rough: Fire Department Driveway Final: Fireplace/Chimney: Final: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: t ' I • f - Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner 1. 1ty4d(.t City of Northa-m-p;oiR F L,L p i3 Building Department A 212 Main Street `.; INS UA TI FEB - ..1,,,,,.(0,,.,,,,,'' Room 100 9 ?G^ Northampton, MA 01060 phone 413-587-1240 Fax 4 (Jj ' I NORTHAMPTON.MAC) APPLICATION FOR INSULATION FOR A ONEOR TWO FAMILY DWELLING ONLY PERMIT 1 -SITE INFORMATION INSULATION PE 1D 1 rll T This section to be completed by office 1.1 Property Address: PQX' n P ) Map p Lot Unit v ( Zone Overlay District_ Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Lousia Wimberger 31 Perkins Ave Name(Print) Current Mailing Address: 413-242-9989 Telephone Signature 2.2 Authorized Agent: _SLOW 233 College Hwy Southampton MA, 01073. Name(Print) Current Mailing Address. ,,(> 413-203-2454 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 2000 2. Electrical (b)Estimated Total Cost of Construction from(6) 3 P1t,mhing Building Permit Fee . / 6 4. Mechanical(HVAC) / (J 5. Fire Protection tie/6. Total=(1 +2+ 3+4+5) 2000 Check Number 17 This Section For Official Use Only �� Building Permit Number: / 5/ DateIssued: .�d Signature: Ci1 � c) .c d P' • Building Commissionerilnspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) • • • • • • ' _ 7 i .' .... . ' '., ., -.".. -,.-.'........:, - .%\\ • • . :_`. . 4 • • 1 • • . 1 SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder. Shawn Mitchell 106188 License Number 68 Russellville Rd 12/28/23 Address Expiration Date 413-203-2454 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable Home Energy Solutions Inc. 193885 Company Name Registration Number 233 College Hwy Southampton MA, 01073 12/4/22 Address Expiration Date Telephone 413-203-2454 J SECTION 5-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 172/ No...... 0 Brief Description of Proposed Work NOTE: INSULATION ONLY Blown in insulation and air sealing I, Shawn Mitchell ,as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Shawn Mitchell Print Name 2/3/22 Signature of Owner) gent Date Lousia Wimberger , as Owner of the subject property hereby authorize Shawn Mitchell to act on my behalf, in all matters relative to work authorized by this building permit application. _ Attached 2/3/22 Signature of Owner Date DoneSign Envelope ID:3CA7BE3C-F8F5-4965-883F-05A6D86C900D RISES ENGINEERING` OWNER AUTHORIZATION FORM I, Louisa Wimberger (Owner's Name) owner of the property located at: 31 Perkins Avenue (Property Address) Northampton, MA 01060 (Property Address) hereby authorize 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. /---^Doe uSpned by: (*Sit 0Jig,k cr Ow`�i 4 Matare 12/16/2021 1 3:43 PM EST Date RISE Engineering, a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335 www.RlSEengineering.com F r;`.ire. .•.�:V. •.-�;1:1'V-.3; `•.'!o',.�';*�� - t ,� �•'tt "! SS, i!'. .. ,;-it. , .... .i�,.._., fl. _�._..�«.._�._... • • • • • • .;f , ,- . _. _<. . _ t.,. • • • mass save Weatherization barrier incentives Based on your Energy Specialists recommendations,your home can benefit from program-eligible insulation and/or air sealing improvements. Before moving forward,please follow all the instructions below to remediate your weatherization barriers. CUSTOMER INSTRUCTIONS 1. Hire a qualified,licensed contractor to evaluate and/or remediate the weatherization barrier(s). 2.Submit signed and completed copies of this form and a copy of the paid contractor invoice(s)within 60 days of your Home Energy Assessment to: RISE Engineering,60 Shawmut Rd,Unit2,Canton,MA 02021 or email to Eversoumeinfo@RlSEengineering.com, 3.The weatherization incentive will be deducted from the customer co-payment amount of the weatherization work,A rebate check will be issued in the event the amount exceeds the customer's co-payment amount. 4.Complete the recommended weatherization improvements. 5.The Mass Save' HEAT Loan offers interest-free financing opportunities that may be used to remediate eligible weatherization barriers. Learn more at masssave.com/en/saving/residential-rebates/heat-loan-program CUSTOMER INFORMATION nnnn � Customer Name: Louisa 1r°vlmDerger Client or Site+D: JJGet A C Site Address: 31 Perkins Avenue City: Northampton _._..---...__st.:-it "'A__._. ZIP: 01060 co be pef h.r e; Phone Number: ..434-242-99$9 - Email: weehahl@aol.com Customer/Homeowner Signature: h/1_{Alf-' - '�C ' _ _. Date: KNOB AND TUBE WIRING _ To determine if there is any active knob and tube wiring,the contractor will evaluate the following areas where eligible Mass Save' weatherization recommendations have been made: Attic Floor Q Attic Wall to Attic Slope 0 Exterior Wall k7 Basement O Other: . 0 Other: .;rd;;:.i:Y.,r i?v the d nky'.ay.Sb1 ii5! have performed my inspection and determined there is no active knob and tube wiring in the areas selected below. c3KAzttic Floor Q Attic Wall Attic Slope O Exterior Wall !casement 0 Other: 0 Other: '!:, ctiiod ca,t by the I_r�:�na.7d f' c'rrr_Fa Contractor �Name: 4%'�tr'�_,--� ._ _ ,11 .__ .. Address: r2 ///,lam S _._a City: ,.714/ Lie' State: ZIP: C/<'%'47 x-; Company Name J/�h7P1 « `�i ' ��+�1 � / �rtse Number: _ r / S / ��, � • Contractor Signature: L 2——_. Date: ../ � .2:Z My signature confir t I have performed my inspection of the electrical systems listed above and have corrected any barriers as indicated.My signs e also confirms that I have read and agree to the Terms and Conditions outlined on the back of this form. MECHANICAL.SYSTEM BARRIERS - High Carbon Monoxide:Contractor is to service and re-evaluate the selected mechanical system(s)and reduce the carbon monoxide level, as measured in the undiluted flue gas,to below 100 parts per million(ppr5). Draft Failure:Contractor is to correct the draft in the selected flue(s).Refer to table on reverse for acceptable draft ranges. High Carbon Monoxide Draft Failure Existing CO ppm: Revsed CO ppm. Existing Draft Pa: . Revised Draft Pa: Heating System ..._. _.. Hot Water Heater Other: Spillage:Contractor is to correct the spillage of flue gases In the selected mechanical system(s).Must not spill after 60 seconds of operation. 0 Heating System Q Hot Water Heater 0 Other: Contractor Name: __..._ Address: . _ -�_— City: . . ._ ., ..- State:__._, ,_._ ZIP: . Company Name: — License Number: Contractor Signature: v Data: , . My signature confirms that I have performed my inspection of the mechanical systems listed above and have corrected any barriers as indicated My lure also confirms that I have read and agree to the Terms and Conditions outlined on the back of this form. . i j .- . . _ . .. . .. f • r.. . 1 i 1 1 . t fl . - 1 DATE IMMIDDlYYVY) ACORN CERTIFICATE OF LIABILITY INSURANCE 01/05/2022 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 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 I CONTACT Elizabeth Carballo.CISR,CPIA NAME: Frock&Perras Insurance Agency Inc PH NNEo,Ect1: (413)527-5520 AX( Nol: (413)527-5970 LAX,6 Campus Lane ADDRESS. bcarballo/finckandperras corn INSURERS)AFFORDING COVERAGE NAIC E Easthampton MA 01027 INSURER A Amelia Insurance Group 17000 INSURED INSURER a; NorGUARD insurance Company 31470 Home Energy Solutions Inc INSURER c: Russell Bond 68 Russellville Rd INSURER D INSURER E Southampton MA 01073 INSURER F: COVERAGES CERTIFICATE NUMBER: CL221508175 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 CR 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 AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INIR TYPE OF INSURANCE JNSO -WVBR- POLICY NUMBER fMMM/DDOIYPOLIC�I IMPMKDDIY I. LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE cDAMAGE r0 1 000,000 CLAIMS-MACE XI OCCUR PREMISES(EaENTED ctu on@nce) $ 50.000, MED EXP(Any ona person; i 10,000 A 8500066829 01/02/2022 01/02/2023 PERSONAL S ADM INJURY $ 1,000,000 LOC GEEN'L AGGREGATE LIMIT APPLIES PER. GENERALAGGREGATE 3 2.000,000 POLICY PRO PRODUCTS-COMP/OP AGG $ 2,000 000 XjECTPRO. OTHER. $ • AUTOMOBILE LIABILITY COMBINED$INGLE LIMIT 3 1.000.000 SEe accident) ANY AUTO BODILY INJURY(Per person) $ A OWNED x. AUTOS 1020061519 01/02/2022 01/02/2023 BODILY INJURY)Per accaaent S AUTOS ONLY HIRED x NON-OWNE) PROPERTY DAMAGE 3 AIJTOS ONLY AUTOS ONLY (Per actident) S X'UMBRELLA LIAS X',,.00CUR EACH OCCURRENCE $ 4.000.000 1 A EXCESS UAB 4 ,000.000 620089819 01/02/2022 01/02/2023 4 I ' CLAIMS-MADE AGGREGATE $ , j DEG 1 X1 RETENTION 5 10,.000 3 WORKERS COMPENSATION PER OTH, AND EMPLOYERS'LIABILITY STATUTE ER , Y I N 1000.000 B R;ANYPROPRIETOPARTNER/EXECUTIVE Y NIA HOVtfC361807 01/04/2022 01/04/2023 E.L EACHACCIDENT S , • OFFICER/MEMBER EXCLUDED' 1.000,000 (Mandatory in NH) E L.DISEASE-EA EMPLOYEE $ II yes describe girder 1000,000 DESCRIPTION OF OPERATIONS oe+ow E.L.DISEASE-POLICY LUMiT S , per occurrence 51.000.000 Pollution C j G28314589002 11/23/2021 11123/2022 aggregate $2.000,000 j DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 101,Additional Remains Schedule,may be attached it more spacer required) Proof of Coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main Street AUTHORIZED REPRESENTATIVE Northampton MA u106C; eiskje C 1'440.640 ©1988-2015 ACORD CORPORATION. All rights reserved, ACORD25(2016/03) The ACORD name and logo are registered marks of ACORD r • F. .. ::a te 'i .i 44'?:, ctt :..,.,„y.,.,...1.„.e.... w.7 i,;1' .::.7",w l'..r., +,'A•14,'' —'*':. *2. -s r „14,,* *' _rr".:A.' ' 4_ 'A s r,:' • • 'y•. i f t•, •• ••• t .'t 'c ...k. ry •-`x .ra..• ! 17'77fi 17.tl.1 Pam' 3�i:: • rf ... tb • y g i' • • 4,,i, •.f71f°Z:4i `west •,, L 5 .y -. fF 4 ,.. _. .. k ° 4y fe i is, tE+f. ' ,.: t.r. at"•' .i. 37t 1 + 7,h Z.' t 6 "i t di k-^.a r • I t. • a j..a 1 t 4, £,L ,1E,, it'' 4/„' ' , .t . ' • t. '1 • r The Commonwealth of Massachusetts Department of industrial Accidents Office of Investigations Lafayette City Center 2 Avenue de Lafayette, Boston, MA 02111-1750 / WWW.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (autiinesvOrganization/Individual):Home Energy Solutions Inc Address:233 College Hwy Cit /StaterZii: Southern eton 17 Phone #: 413-203-2454 Are you an employer? Check the appropriate box: Type of project (required): am a employer with 5 4, Ei I am a general contractor and I 6 D New construction employees (full axid/or part-time).* have hired the sub-contractors ' 2.D I am a sole proprietor or partner- listed on the attache,' sheet. '7 Ej Rmodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. employees and have workers' 9, 0 Building addition No workers' comp. insurance comp. insurance. required] 5 0 We are a corporation and its 10,0 Electrical repairs or additiot 0 I am a homeowner doing all work officers have exercised their 11,0 Plumbing repairs or additiot myself [No workers' comp. right of exemption per MGL 12.E Roof repairs insurance required] ' c, 152, §I(4),and we have no employees, [No workers' I 3.0 Other comp. insurance required] An applicant that checks box I must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new afftdavit indicating such :Contractors that check this box must attached an additional sheet showing the name of the sith-contractors and state whether or not those entities have employees, If the sub-connactors have employees,they must provide their workers' enp.policy number, I an:an employer that is providing workers'compensation insurance for my employees. Below A the policy and job site information. Insurance Company Name:AmGaurd Insurance Company Policy#or Self-ins. Lie. # H0W0361807 Expiration Date: 01/04/2023 job Site Address: 31 Perkins Ave City/StateiZip: N )106: 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 MCIL c, 152 can lead to the imposition of criminal penalties of a fine up to$1,5C6.00 antifor one-year imprisonment, as well as civil peaale.es in',.he folm of a STOP WORK ORDER and a fi (.,1 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. 1 do hereby certify un t e pa/u.s and penaltie- 'iiry that the information provided above is true and correct Silo) -..mr-40100r, Date: 2/3/22 • 44.14,1-, P ) #• - - Official use only. Do not write in this area, to be completed by city or town official. City or Town: PerniWikense # Issuing Authority(check one : I OBoard of Health 21:Building Department 3LJCity/Town Clerk 4.0 Electrical Inspector 5EiPlumbing Inspector 6.00ther Contact Person: Phone#: