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23D-128 (10) BP-2022-0503 16 WINSLOW AVE COMMONWEALTH OF MASS CHUSETTS Map:Block:Lot: 23D-128-001 CITY OF NORTHAMPT N Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERE CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY F ND (MGL c.142A) BUILDING PERMIT Permit # BP-2022-0503 PERMISSIONISH REBY GRANTED TO: Project# INSULATION Contractor: License: Est. Cost: 2000 HOME ENERGY SOLUTIO S INC 106188 Const.Class: Exp.Date: 12/28/2023 Use Group: Owner: L KRASSNER DANIEL B& NICOLE Lot Size (sq.ft.) Zoning: URB Applicant: HOME ENERGY SOLUTIONS IC Applicant Address Phone: Insurance: 233 COLLEGE HWY (413)203-2454 0 HOWC 140654 SOUTHAMPTON, MA 01073 ISSUED ON:05/12/2022 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHA PTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: 52 cs- • • a, . Fees Paid: $65.00 212 Main Street,Phone(413) 587-1240,Fax:(413; 587-1272 Office of the Building Commissioner r De* aria., tt rf , City of Northampton r, � y Building Department AMY - 9 212 Main Street 202, Its/S tILi TIC)t'l�y '1 Room 100 _ $ ` 4 Northampton, MA 01060,�' i(,""; , phone 413-587-1240 Fax 413-587-1272 - °- ONLY ,_„,_ APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION 1 INSULATION PERMIT I 1.1 Property Address: This section to be completed by office Map aZ' 0 Lot P" o Unit Zone __. Overlay District Elm St.District CS District S 2-PROPERTY OWNERSHPIAUTH{ RIZED AGENT FECTION 2.1 Owner of Record: I Daniel Krassner 16 Winslow Ave Northampton 01062 Name(Print) Current Mailing Address: Attached e ePhone Signature 2.2 Authorized Agent: _Shawn_ ) r all__ 733 i nllerge Hwy .n.lithamptnn MA, 01073 __ I Name(Print) Current Mailing Address. // 413-203-2454 Signature����� j _ _._. _.---.. Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 2,000 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4! 4. Mechanical(HVAC) i ./ o. Fire Protection (�(y { 6. Total=(1 +2+3+4+5) 2,000 Check Number 1 8 03 This Section For Official Use Only Building Permit Number:. A " 5 6 J gate Issued' l Signature: I 55-1C O ZZ Building Commissionerilnspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8,1 Licensed Construction Supervisor: Not Applicable Name of License Holder: Shawn Mitchell 106188 License Number 68 Russellville Rd -_V 12/28/23 Address Expiration Date — 41 -203-2454 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable 0 Home Energy Solutions Inc. 1885 Company Name Registration Number 233 College Hwy Southampton MA, 01073 12/4/22 Address Expiration Date Telephone 413-203-2454 SECTION 5-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,125C(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 t' No !Brief Description of Proposed Work NOTE: INSULATION ONL Y Blown in insulation and air sealing 1,_ Shawn Mitch��, as OwneriAuthorized 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 5/2/22__ Signature f en Date Daniel Krassner ,as Owner of the subject property hereby authorize Home Energy Solutions Inc. Shawn Mitchell to act on my behalf, in all matters relative to work authorized by this building permit application, Attached _ 5/2/22 Signature of Owner Date DocuSign Envelope ID.87B0A44A-62A6-4FCA-877F-FF6A512C85A1 RISES ENGINEERING" OWNER AUTHORIZATION FORM Daniel Krassner (Owner's Name) owner of the property located at: 16 Winslow Avenue (Property Address) Florence, MA 01062 (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. --DaouSigned by; Ow ff °'r rra re 2/24/2022 I 5:47 PM EST Date RISE Engineering,a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335 www.RISEengineering.com H mass save Weatherizatian barrier incentives Based on your Energy Specialist's 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 Eversourceanfo*RISEengineering.com. 3.The weatherizatran incentive win 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. S.The Mass Save'HEAT Loan offers interest-free financing opportunities that may be used to remediate eligible weatherization barriers. I..earn more at masssave.tam/en/saving/residential-rehate5/heat-ioari-program CUSTOMER INFORMATION Customer Name: Daniel Krassner _........, Client#or Site ID: 480047.._ ___. -- Site Address 16Winslow Avenue _. _...._ _City: Florence .._... ___State MA ZIP:,01062 Phone Number: 850 321 0432 Email: dankrassner@,gmaii.com — _ q Customer/Homeowner Signature: Date: 3/7-- ! /7-,Z.. KNOB AND TUBE WIRING Cup to$250 incentive; To determine if there is any active knob and tube wiring,the contractor will evaluate the following areas where eligible Mass Save weatherization recommendations have been made' lei Attic Floor ')Attic Wall (2;Attic Slope (.'_'Exterior Wall Basement i- Other:__ 0 Other: ' :I have performed my inspection and determined there is no active knob and tube wiring in the areas selected below. / tic Floor ' / is Wall IS..6ttic Slope ,-c;,Exteno rnWall,-Baseeme}rntt 0 Other:fn ' Other: Contractor Name: ('_In>re2_._G�_. �! ��/1�" •�` "� ""' r, Address_�j_ ( ( /_L�c.✓' __._ state: � / ZIP: DI?'fl.J _���J-J��-_ City: � _.lyL.t�' 7,""` +� License Number.__. 439, ....__ Company Name: _. �_� -�--- Contractor Signature: _.__. Oa Ye' � .7°�"' ",...... __._. My signature confirms that I have perfor ed rn inspection of the electrical systems listed above and have corrected arty barriers as indicated.My signature also confirms th I h e read and agree to the Terms and Conditions outlined on the back of this form. MECHANICAL SYSTEM BARRIERS eased contractor) figh Carbon Monoxide: ontractor is to service and re-evaluat7 th.)sel=cte'mechanic., ;stem(s)ar,- dr'na th_cr,bcn as measured in the undiluted flue gas.to below 100 parts per million(ppm). Draft Failure:Contractor is to cor r' the draft i n the,selected flue(s).Refer to table on reverse for acceptable draft ranges. ,.S High Carbon Monoxide Draft Failure f rase=ng CO ppm it i a;ect O ppm E/'st.nr.Draft Pia, Rr+ .c. .,d Draft Pa Heating System f `� Hot Water Heater ,< Other: _ Spillage:Contractor is i "roc t, s..pillage or flue gases in the Sr.c cted mechanical cy-.tano(s) Must nat spill attei eO t,e.ids 3'1 operation. 0 Heating System rice Weti'r#Hater 'j Oth ': _ ._ _.. /r iontractor Name: "'...` ."" {`iti i i , Stati Zi4a Company Nanae: �. Licence Number. i ,._ ..___ Contractor Signature: -,—,,i;-,--,— , -.w ,/ —w.„��..�,�,,,, .«� ' 11$t + < , S o yh h s tem 'ab 'anr nave e refted an b ' r .. r nr,<5 r f:r that 1 nave P i9? fI3 nf ter r/ .,+rjPt�t,,m',.,w."r rf"nfif ,ftY I have rO£E04 G+,frarxt£�fh per t and(t+ft f(, g°/''brHei'l OHIn of the:,f irrtt,, i iii „'/hz//aiY''—- ya---,-.,' ' / ;rr 7''''rn % City of Northampton , 40',04.* <• Massachusetts r'1' ta DEPARTMENT OF BUILDING INSPECTIONS 1.. -., Main Street • Municipal Building r th any.tgn I4A. C I 0 CONSTRUCTION DEBRIS AFFUJAT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of !Via 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 ill. S 1SOA. The debris will be disposed of in: Location of Facility: Springfield, MA The debris will be transported by: Name of Hauler: Waste Management _ Signature of Applicant: 3,1a,,,,,i-if, 7th,iL-4,, ,, ,, Date: 5/5/22 The Commonwealth of Massachusetts Department of Industrial.4ceidents t`� .{ Office of Investigations ;• jai= - Lafayette City Center ., , 2.4%'enue de Lafayette, Boston,MA 02111-1750 7,,i<' www.mass`gw/dia Workers'Compensation Insurance lffidavit: Builtiers/ContractorsiElectricians/Plumbers apt ant Information Please Print Legibly Name (Ru mcsvor •aation'Th t,vtdual):Home Energy Solutions Inc Address.233 Colie_ge Hwy City/State/Zip: Southampton, MA 01073 Phone 4: 413-203-2454 - Art you an empioyer? Check the appropriate hos: 1 'Type of project(required): i.V 1 am a lover with 5 4, 7 I am a general contractor and 1 , �... 6. Li Ne construction employees (full anti or pert-time i,* have hired the sub-contractors # 2.Lit am a title proprietor or partner- ship listed on the attached sheet. 7 © Remodeling ship and have no employees '1"hese sub-contractors have 8 0 Demoittie,n woritin for me III anyerriployees and have workers' & capacity. 9 ❑Building addition [No workers' comp. insurance comp. insurance , required 1 5 Q We are a corporation and its 10,0 Electrical repairs or additic>t i 3 0 i am a homeowner doing all work officers bare exercised their 11,0 Plumbing repairs or aciditiot mvc.elf. No workers' right of exemption Fier kit;+t_. I l I2.0 Roof repairs insurance required.' ' i 52. *1(4). and we have no mplovees [Nil workers' 13 0()user comp, insurance required.] *Arty, applicant the ticks by.d;MUM t aihfl 1-0,rill the '1ow ihciwis'tg thetr waters'competsMIts.rn Thahe'y InfOrt ition. 'J4ci Heroines who submit SnIS affidavit indicating they arc doing all work ani then hire outside contractors must submit a new affidavit indicating such :Contractor:that check this hos tnuct attached its additional sheet showing the name of the soh-contractors and vine whethrt.w•not those entities have et€iplo sees if the wb-cantr`.:torx have employees,they roul.i pm vide their workers'comp policy number. I tins«n employer that is providin'workers'compensation insurance for my employees. Below is the policy and job site information_ Insurance Company Name:AmGaurd Insurance Company Ply #or Self-ins. I. ~ H©WC361807 Expiration Date:, 01/04/2023 ;tit)Site Address. 16 Winslow Ave City'Statrdzip:Northampton, MA 0106: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Sec:ion 25A of MGL c, 152 can lead to the imposition of criminal penalties of a fine up to$1,500 00 and ar one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and aft .,f up to S25.0,00 a day against the violator, Be advised that a copy of this statement may be forwarded to the Office 4. Investigations .of the DIA for insurance coverage verification. 1 do here=ht'vrrtifj`on a pains and penaltie "ulya that the information provided ahr,ve is true and co,veil. Si ttattitc: ate 5/5/22 I't ne . 413- -24.54 _ a . I Official use only. Do not wrist in this areaa, so be completed by city ar town official. 11 i City or Town: i'erini#I[.keast Issuing Authority(check one): IDD$ostrd of Health 20 Building Department 31:1CitylTewn Clerk 4.0 Electrical Inspector {Dillittubini 1 l t:.pecror 6.d()thcr La ( intact Person: �___� Phone#:,