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24D-181 PERMIT NOT ISSUED Li dotloop signature verification -le �) k4-T l91pfipivi. The Commonwealth of Massachusetts Board of Building Regulations and Stands• S<20((2, ifuN IF 11 IIPALITY Massachusetts State Building Code,780 C/Vik,. USE /+ 4Yl Building Permit Application To Construct,Repair,Renovate Or 1), ' h a Revised Mar 2011 One-or Two-Family Dwelling .7=' p/ --- T 's Section For Official Use Only 414. / . .ing Permit Number:Old- Date Applied: ri Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 22 Aldrich Street,Northampton Ma 01060 , v / / •)\\\ °If4)))\ 1.1 a Is this an accepted street?yes x 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 N/A N/A N/A N/A N/A N/A 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 Record: Sarah Fowler Northampton Ma 01060 Name(Print) City,State,ZIP 22 Aldrich Street 413-588-1566 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. ❑ Number of Units Other 0 Specify:Insulation MassSave Brief Description of Proposed Work2:Adding blown cellulose to attic flat to achieve an aggregate R-49.Please see attached work work order. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 5600 1. Building Permit Fee: $ Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ 0 Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees 5600 Check No.6,O n 11 Check Amoun . O6 Cash Amount: 6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due: dotloop signature verification: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-108517 12/10/2020 Sean Matthew Bailey Bradhsaw License Number Expiration Date Name of CSL Holder List CSL Type(see below) ll 246 Connecticut Ave No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) Springfield,MA,01104 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-250-4746 Sean@BradshawEnterpisesLLC.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 194456 02/07/2021 Bradshaw Enterprises,LLC HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name Sean Matthew Bailey Bradhsaw Sean©BradshawEnterpisesLLC.com No.and Street Email address 246 Connecticut Ave,Springfield,MA 01104 413-250-4746 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 0 No ❑ 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 Bradshaw Enterprises,LLC to act on my behalf,in all matters relative to work authorized by this building permit application. Please see attached customer signature authorization form provided MassSave. 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 ,egt of my knowledne and understanding .�8���z lei/ dotboppverified dotico21 -04Z-E EST Sean Bradshaw authorized Agent SRH8 IIXX-04ZA EZBM Print Owner's or Authorized Agent's Name(Electronic Signature) Date 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 not 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.gov/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.ft.) (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 half/baths 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" dotloop signature verification: --- The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Name(Business/organizational/individual):Bradshaw Enterprises, LLC Address: 34 Front St Indian Orchard Mills Suite G60 city: Springfield MA 01051 413-250-4746 State: Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): ✓ 1. I am an employer with 11 employees(full and/or part time)* 7. New construction 2. I am a sole proprietor or partnership and have no employees working for me in any 8. Remodeling capacity. [No workers'comp.insurance required.] 9. Demolition 3. I am a homeowner doing all work myself.[No workers'comp.insurance required]± 10. Building addition 4. I am a homeowner and will be hiring contractors to conduct all work on my property. 11. Electrical repairs or additions I will ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 12. Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached 13. Roof Repairs sheet. These sub-contractors have employees and have workers'comp.insurance.± 6. We are a corporation and its officers have exercised their right of exemption per MGL. ✓ 14. Other c.152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box d1 must also fill out the section below showing their workers'compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ±Contractors that check this box must attach an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If 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. Insurance Company Name: Sentry Insurance (Agent - Phillips Insurance 413-594-5984) Policy II or Self-ins.Lic.if: A0158300004 Expiration Date: 8/21/2021 Job Site Address: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL.c. 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$250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct,and that clicking this checkbox and typing my name in the field below will act as my signature. Name: Sean Bradshaw Date: 9/29/20 Phoned: 413-250-4746 Email: sean@bradshawenterprisesllc.com dotloop signature verification: BRADENT-01 BROOKE ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �--�� 9n8/2020 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 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 Brooke Barre NAME: Phillips Insurance Agency,Inc. PHONE FAX 97 Center Street (NC,No,Ext):(413)594-5984 rm.No):(413)592-8499 Chicopee,MA 01013 E-MAIL DRlEss:brooke@phillipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Middlesex Insurance Company INSURED INSURER B:Sentry Insurance 24988 Bradshaw Enterprises,LLC INSURER C: PO Box 944 INSURER D: Chicopee,MA 01021 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD -(MM/DD/YYYY) DAM/OD/MT A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR A0158300 8/12/2020 8/12/2021 DAMAGE TO RENTED 500,000 X PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) X ANY AUTO X A0158300003 8/12/2020 8/12/2021 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY _ AUTOS BODILY INJURY(Per accident) $ HIRED NON-AWNED PROPERTY DAMAGE _ AUTOS ONLY _ AUTOS ONLY (Per accident) $ A X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE A0158300 8/12/2020 8/12/2021 AGGREGATE $ 2,000,000 DED X RETENTION$ 0 $ B WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY X STATUTE ER A0158300004 8/12/2020 8/12/2021 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ MFFICER/MEMBER EXCLUDED? Y N/A andatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached N more space Is required) Thielsch Engineering,Inc.is listed as Additional Insured on a primary,non contributory basis with respect to General Liability and Auto Liability per written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Thielsch Engineering,Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 g, ACCORDANCE WITH THE POLICY PROVISIONS. 195 Frances Ave Cranston,RI 02910 AUTHORIZED REPRESENTATIVE /Y 1?"' ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD dotloop signature verification:dtp.:a2n.&-3<0. :::. • /if>( '17(V1M1/(V,f(tr(77/9/10/./K:we).)(1//(4.,;(//) Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration .i'-f) Type: LLC t _. Wt. Registration: 194456 'BRADSHAW'BRADSHAWENTERPRISES,LLC t - "� Expiration: 2021 246 CONNECTICUT AVE x, ' SPRINGFIELD,MA 01104 " :, y 04 Update Address and Return Card. SCA I 8 20A1-05i 17 .1/. Yr,....ey,,,,r.,///r f . /4 ;.:nn$;nir//.: Office of Consumer Affairs 8 Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LI..0 before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 194456 02107/2021 1000 Washington Street-Suite 710 BRADSHAW ENTERPRISES,LLC Boston,MA 02118 SEAN M.BRADSHAW N2.,CC.ael---- __"'��a_ 34 FRONT STREET G SPRINGFIELD,MA 01151 Undersecretary Not v Without Si• •ature Commonwealth of Massachusetts I); Division of Professional Licensure Board of Building Regulations and Standarsis--- Constr.i$tliwri upervisor / ,/ CS-106517 4 • �' es: 12/10/2020 7SEAN MATTHEW BAILF BRADSHAW .) r 1 246 CONNECTICUT AVENUE ��'' SPRINGFIELD MA,01104 N' Commissioner { 1 dotloop signature verification:., DEBRIS DISPOSAL AFFIDAVIT In accordance with the provisions of MGL c. 40, s.54, is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c.111, s.150A. ANY AND ALL DEBRIS PROUCED AS A RESULT OF WORK PERMITTED UNDER THE ATTACHED APPLICATION WILL BE DISPOSED OF IN: USA Waste Recycling Name of Licensed Solid Waste Disposal Business/Facility 15 Mullen Rd, Enfield CT 06082 Address of Licensed Solid Waste Disposal Business/Facility USA Waste Recycling Name of Hauler Sean Bradshaw 9/20/2020 Print Applicant Name Date ❑ I, Sean Bradshaw do hereby certify under the pains and penalties of perjury that the information provided above is true and correct, and that clicking this checkbox and typing my name in the field above will act as my signature. DocuSign Envelope ID:856A1 F27-A437-4416-8D65-79E970455889 Federal ID#05-0405629 RISE Engineering RI Contractor Registration#8186 MA Contractor Registration#120979 RISE 60 Shawmut Unit#2,Canton,MA 02021 ENGINEERING CONTRACT - WZ (401)784-3700 FAX(401)784-3710 Page 1 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE C MA-H ES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CLIENT A WORK ORDER Sarah Fowler (413)588-1566 03/02/2020 479491 62903 SERVICE STREET BILLING STREET PROPOSED BY: 22 Aldrich Street 22 Aldrich Street Jeff Ledoux SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Northampton, MA 01060 Northampton,MA 01060 DESCRIPTION QTY COST INCENTIVE TOTAL ASBESTOS PRECAUTION A blower door diagnostic test will not oe conducted at your home,as a precaution for the presense of steam heating (past or present)that was most likely insulated with asbestos. KNOB&TUBE WIRING (Northhampton) We have identified that your home might have Knob&Tube wiring S IiIIitiHhl present. The following contract is not valid unless accompanied by the Pre-Weatherizat€on Barrier Incentive form, signed by your licensed electrician. Work will not proceed with this work until we receive a copy of the form. ATTIC DOOR- INSULATE&WS 1 $110.00 $82,5C S27.50 Provide labor and materials to insulate the back of the attic door with 2"rigid insulation board and seal the door's edge with weatherstripping to restrict air leakage. HOME AIR SEALING 2 S170.00 $170.00 Provide labor and materials to seal areas of your home against wasteful,excess air leakage. Materials to be used to seal your home can include caulks,foams and other products. Primary areas for sealing include air leakage to attics, basements, attached garages and other unheated areas (windows are not generally addressed.) A reduction in cubic feet per minute (cfm)of air infiltration will occur, but the actual number of cfm is not guaranteed. At the completion of the weatherization work, and at no additional cost to the homeowner, a final blower door and/or ccmbustion safety analysis will be conducted by the sub-contractor. WEATHERSTRIP AND ADD DOOR SWEEP 2 $160.00 $160.00 Provide labor and materials to install 0-Ion weatherstripping and a doorsweep to door(s)to restrict air leakage. WALLS WOOD SIDED 2,380 $4,783.80 $3,587.85 $1,195.95 Furnish and install blown in Class I Cellulose to shingle and/or clapboard exterior walls. The butt of the upper course of your wood siding is cut to drill holes into the wall sheathing behind.The holes are then plugged and the wood siding is reinstalled using stainless steel finish nails. Touch-up painting, if needed, will be the customer's responsibility. Invoicing will occur upon completion of installation. Homeowner has received a copy of the EPA's Renovate Right Lead- Safe information guide expraining the potential risk of the lead hazard exposure from the weatherization work to be performed. Your DocuSign Envelope ID:B56A1F27-A437-4416-8D65-79E970455889 Federal ID#05-0405629 RISE Engineering RI Contractor Registration#8186 MA Contractor Registration#120979 RISE 60 5hawmut Unit#2,Canton,MA 02021 ENGINEERING" CONTRACT - WZ (401)784-3700 FAX(401)784-3710 Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE Ci MA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CLIENT I WORK ORDER Sarah Fowler (413)588-1566 03/02/2020 479491 62903 SERVICE STREET BILLING STREET PROPOSED BY: 22 Aldrich Street 22 Aldrich Street Jeff Ledoux SERVICE CITY,STATE,ZP BILLING CITY,STATE,ZIP Northampton, MA 01060 Northampton,MA 01060 DESCRIPTION QTY COST INCENTIVE TOTAL signature is your acknowledgement of receipt and agreement to proceed. BASEMENT SILLS RIGID BOARD INSULATION 100 $396.00 $297.00 $99.00 Provide labor and materials to install rigid board insulation to the perimeter of the basement ceiling at the house sill. Total: $5,619.80 Program Incentive: $4,297.35 Customer Total: $1,322.45 WE AGREE HEREBY TO FURNISH SERVICES.COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF "**One Thousand Three Hundred Twenty-Two&45/100 Dollars $1,322.45 UPON RECEIPT OF YOUR RISE ENGINEERING INVOICE.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 30 DAYS,SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES.RIGHTS OF RECISION,SCHEDUUNG.AND CONTRACTOR REGISTRATION. —JJ��,,'DD'/ocuSgned by: �.-r—DocuSIgncd byy;y/ WSCFGPHESEN7 AINE LE�Si4ENKE(t ir ---81051-WAHL:924F I s•--A<:356A45a6CI)431- 3/5/2020 1 5:23 AM EST NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE SIGN UATL 30 DAYS, ACCEPTANCE OF CONTRACT•THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTUNED ABOVE DocuSign Envelope ID:856A1 F27-A437-4416-8D65-79E970455889 RISE ENGINEERING- OWNER AUTHORIZATION FORM I, Sarah Fowler , (Owner's Name) owner of the property located at: 22 Aldrich Street , (Property Address) Northampton, MA 01060 , (Property Address) hereby authorize , (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. DocaSvned by Sank Favtur 1Q41,44 144 3/5/2020 I 5:23 AM EST Date RISE Engineering, a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 ( Canton, MA 02021 i 339-502-6335 www.RlSEengineering.com dotloop signature verification:.;.. Bradshaw Enterprises, LLC P0. Box 944 Chicopee, MA 01021 Hello Building Department We are Bradshaw Enterprises, LLC located in Indian Orchard, MA. We are an Insulation / weatherization contractor for MASS SAVE. Enclosed in this packet is our Permit application and supporting documentation as follows: -Application -HIC Registration -Insurance Certificate -Signed customer Authorization form or copy of signed contract -Construction Supervisor License -Worker's Compensation Insurance Affidavit -Pre stamped return envelope We hope you find this packet intact and convenient. If you have any questions or concerns please call or email at 413-250-4746 Sean Bradshaw 413-301-8010 Office phone Email: Sean@BradshawEnterprisesLLC.com