Loading...
38B-058 PERMIT NOT ISSUED I ;`1 :..,, Pa:---0 )1--T OFF)IDA-ter dotioopsignatureverlfi on:dtlp.,s + gEati,...;- ,L-�T Emil IL 2-ZZ_21 / 9 20 e Co o.nwealth of Massachusetts �JJ,,0�, �Bo.,d of uilding Regulations and Standards FOR Il p' o y uiio n, M.,sack efts State Building Code,780 CMR MUNICIPALITY(TfY q USE 6 • .��� Appli ation To Construct,Repair,Renovate Or Demolish a Revised Mar 201 ,1-K , �06p NS One-or Two-Family Dwelling \I\ lTSection ForOfficialUseOnly,[} a'_ct) t Buildin P a/Pr ' Date Applied: UI'" C` I Building Official(Print Name) Signature Date SE •N 1:SITE INFORMATION �ronerty Address: 1.2 Assessorsss Map&Parcel Numbers ^ 289 South Street,Northampton Ma 01060 3 � 6 a b en 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: Stephanie Nurenberg Northampton,Ma 01060 Name(Print) City,State,ZIP 289 South Street 413-586-3350 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 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: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 $ 7,000 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ 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 $ x Suppression) Total All Fees j §.I 4-7 7,000 Check No.IZ1a`'� Check Amount: Cash Amount: 6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due: dotloop signature verification:dtl p.us/ZieA-FfWS-gEaE 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) lJ 246 Connecticut Ave No.and Street Type Description Springfield,MA,01104 U Unrestricted(Buildings up to 35,000 Cu.ft.) 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 lest of my knowledge and understanding � /�� �� MAIM' ,'ea/vO'14GA hwe fi2/11/21 11:18 AM EST Sean Bradshaw authorized Agent F� BVKL-Awsw-ORM%-NAZC 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" dodoop signature verification:dtlp.us/ZieA-MS-gEaE The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 t - 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 State: MA Zip: 01051 Phone#: 413-250-4746 Are you an employer?Check the appropriate box: Type of project(required): n1. I am an employer with 1 1 employees(full and/or part time)' n 7. New construction n2. 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 n3. I am a homeowner doing all work myself.[No workers'comp.insurance required]t In10. Building addition ❑ III___JJJ 4. I am a homeowner and will be hiring contractors to conduct all work on my property. I 111. Electrical repairs or additions I will ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 012. Plumbing repairs or additions n5. I am a general contractor and I have hired the sub-contractors listed on the attached n13. 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. 1-114. Other c.152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 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#or Self-ins.Lic.#: AO 158300004 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. nI 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 Phone#: 413-250-4746 Email: sean@bradshawenterprisesllc.com dotloop signature verification:dtlp.us/ZieA-FfWS-gEaE ,�--.1,1 BRADENT-01 BROOKE ACORO DATE(MM/DD/YYYY) `,�� CERTIFICATE OF LIABILITY INSURANCE 9/28/2020 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 ACT Brooke Barre Phillips Insurance Agency,Inc. 97 Center Street (a"c°O,,"N,Ext):(413)594-5984 1(Arc,N0:(413)592-8499 Chicopee,MA 01013 ADDRESS:brooke@phillipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC ft 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 ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER IMMIDD/YYYYI (MMIDD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X A0158300 8/12/2020 8/12/2021 pRAEM SES(EaEoccurrencel $ 500,000 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: $ COMBINED SINGLE LIMIT 1,000,000 A AUTOMOBILE LIABILITY (Ea accident) $ X ANY AUTO _ X A0158300003 8/12/2020 8/12/2021 BODILY INJURY(Per person) $ OWNED SCHEDULED _ AUTOS ONLY — AUTOSyy BODILY INJURY(Per accident) $ AHIRD UTOS ONLY _ AUTOSp ONLYry�p (Perr accident)p AGE $ $ A X UMBRELLA LIAB 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 IA X STATUTE ER AND EMPLOYERS'LBILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N A0158300004 8/12/2020 8/12/2021 E.L.EACH ACCIDENT $ 1,000,000 MFFICER/MEMBEEREXCLUDED? Y N/A 1,000,000 andatory In NH) E.L.DISEASE-EA EMPLOYEE $ 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 if 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 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD dotloop signature verification:dtlp.us/ZieA-FfWS-gEaE ./AK) 6ri1//1/(Y/((1("1r/r)1 Kr // 14),)/ri 4iii/4 Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration = � Type: LLC T,,------- T.'iRegistration: 194456 BRADSHAW ENTERPRISES,LLC i Expiration: 02/07/2021 246 CONNECTICUT AVE "'— SPRINGFIELD,MA 01104 . ) `> Update Address and Return Card. SCA 1 O 20M-05/17 .%/,• Kiviuii,,iicivii///i e'./�ii 4.7.74lr// 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: Reaistration Expiration Office of Consumer Affairs and Business Regulation 194456 02/07/2021 1000 Washington Street-Suite 710 BRADSHAW ENTERPRISES,LLC Boston,MA 02118 SEAN M.BRADSHAW 34 FRONT STREET C' _` SPRINGFIELD,MA 01151 Not v.y Without si• •ature Undersecretary Commonwealth of Massachusetts ` 5 Division of Professional Licensure Board of Building Regulations and Standards Constr t6rt i$upervisor CS-108517 �• �i 0- Wires: 12/10/2020 i. SEAN MATTHEW BA BRADSHAW_ 1 f. 'r 246 CONNECTICUT AVENUE \' - SPRINGFIELD MIA,4011,041 tl�AN - Commissioner v"''" r i li dotloop signature verification:dtlp.us/ZieA-FtWS-gEaE 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 0 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. CLEAResult CONTRACTOR WORK ORDER Mass Save® Home Energy Services 50 Washington St.Suite 3000 Westborough,MA 01581 Customer Name:STEPHANIE NURENBERG Email:sjgn289@aol.com Phone:413-586-3350 Premise Address:289 South St,Northampton,MA 01060 Project ID:4091022 Applicable Customer Required Actions: Notes: • Storage Removal Customer agrees to the following prior to weatherization • Flooring Removal upgrades being completed: 1)have flooring removed from attic(customer elects to have IIC do this for her) 2)move storage away from perimeter in basement and remove first acoustic tile closest to wall around interior perimeter of basement Location Measure Description Quantity Unit Unit Cost Total Cost Air Sealing at Estimated 62.5 CFM50 Per Hour 8 hr $92.58 $740.64 Exterior Door Weather Stripping(with AS hrs) 3 each $30.07 $90.21 Door Sweep(with AS hrs) 3 each $25.31 $75.93 Hatch-2"Thermal Barrier Polyiso 1 each $46.28 $46.28 Door-2"Thermal Barrier Polyiso 1 each $90.44 $90.44 Rim Joist-6"Fiberglass Batting 112 SF $2.70 $302.40 Damming 26 each $2.39 $62.14 Attic Floor- 11"Open Blow Cellulose 784 SF $1.98 $1,552.32 Walls-Wood Sided-4"Dense Pack Cellulose 1730 SF $2.43 $4,203.90 Installed Measures Total $7,164.26 WorkOrder Notes Utility Incentive and Customer Share Information Utility Incentive Weatherization incentive $6,257.48 Air sealing incentive $906.78 Total Utility Incentive $7,164.26 Customer Share Page 1 of 2 DocuSign Envelope ID: 119BE883-3C01-470C-AEC5-ED78DA4F8A78 Permit Authorization mass save Form Site ID: 4090138 Customer: STEPHANIE NURENBERG Stephanie Nuremberg I, , owner of the property located at: (Owner's Name,printed) 289 South St Northampton, MA 01060 (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: SitrLUA.it, tqAMAJog Owner's Signature: EAD1CBDAEC69411 10/22/2020 I 8:54 AM CDT Date: FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 Far Office Use Only Rev. 102015 � sw ri. r - �-.. .tea'- �. - "-_ ririlegilissi__ __ Ce>wnrnonw[aNft of MassachuhSls Division at Professional Licensure y Berard at&nkting Relirlatrnns and Standards - =_ ". ; CansyuLt jr�* +yp yvtsar .. CS-10E517 3' 1 gIPdPt: 12r10l2022 '� SEAN MA '"1 BRAD'SIHAW r 0 L 246 R ONNEC1)CUR ,i SPRINGFIELQ14A'' 7O " , Commission detp4 K. Ve&c.b.. 11111 EVANSTON INSURANCE COMPANY MARKEL' ENVIRONMENTAL COMMON POLICY DECLARATIONS THE COVERAGE PROVIDED BY ONE OR MORE COVERAGE FORMS OR INSURING AGREEMENTS INCLUDED IN THIS POLICY MAY BE WRITTEN AS CLAIMS-MADE AND REPORTED COVERAGE. CLAIMS-MADE AND REPORTED COVERAGE REQUIRES THAT A CLAIM BE FIRST MADE AGAINST YOU AND REPORTED TO US DURING THE POLICY PERIOD OR ANY APPLICABLE EXTENDED REPORTING PERIOD WE PROVIDE. POLICY NUMBER: CPLMOL105072 RENEWAL OF POLICY: NEW Named Insured and Mailing Address(No.,Street,Town or City,County,State,Zip Code) Bradshaw Enterprises LLC PO Box 944 Chicopee, MA 01021 Policy Period: From 01/01/2021 to 01/01/2022, at 12:01 A.M. Standard Time at your mailing address shown above. Form of Business: ❑ Individual ❑ Partnership ❑Joint Venture ® Limited Liability Company 0 Organization, including Corporation (but not incl. Partnership,Joint Venture or LLC) IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. Coverage is provided for the following only if indicated with an"X"in the checkbox(es)below: Claims-Made Occurrence Premium ❑ Commercial General Liability ❑ ❑ EXCLUDED ❑ Contractor's Pollution Liability ❑ ® INCLUDED ❑ Owners And Contractors Protective Liability Not applicable ❑ EXCLUDED (Monoline Coverage) ❑ Products-Completed Operations Liability ❑ El EXCLUDED (Monoline Coverage) ❑ Professional Liability ❑ Not applicable EXCLUDED ❑ Site Pollution And Environmental ❑ Not applicable EXCLUDED ❑ Terrorism Risk Insurance Act(TRIA): EXCLUDED Advance And Deposit Premium: $1,358.00 Other Charge(see MDIL 1002): $154.32 Other Charge(Specify): $ Inspection Fee(100% Fully Earned): $ GRAND TOTAL(Including all charges and fees): $1,512.32 Producer Number, Name and Mailing Address 216041 Alternative Risk Company 605 SW US Highway 40#359 Blue Springs, MO 64014 MDEI 2014 11 17 Page 1 of 2 Combined General Aggregate Limit Of Insurance $250,000 The amount shown above is the most we will pay under all coverage parts attached to this policy Audit Period (Indicated by an"X"in the checkbox(es)below): ® Flat 0 Annual 0 Semi-Annual ❑ Quarterly 0 Monthly Endorsements Forms and Endorsements applying to this Coverage Form and made part of this policy at time of issue: SEE FORMS SCHEDULE MDIL 1001 ATTACHED These Declarations, together with the Common Policy Conditions, Supplemental Declaration(s), Coverage Form(s), and any Endorsements(s) complete the above numbered policy. 01/12/2021 Countersigned By Countersignature Date MDEI 2014 11 17 Page 2 of 2 dotloop signature verification: itlp.us/ZieA-FfWS-gEaE Bradshaw Enterprises, LLC PO. 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