43-140 (2) BP-2022-0623
38 LONGFELLOW DR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
43-140-001 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-2022-0623 PERMISSIONIS HEREBY GRANTED TO:
Project# INSULATION Contractor: License:
Est.Cost: 5086 NORTHEAST HOME& ENERGY 110804
Const.Class: Exp.Date:06/28/2022
BRINKMANN. JARRED&VERONICA MARTIN
Use Group: Owner: RUIZ
Lot Size (sq.ft.)
Zoning: WSP Applicant: NORTHEAST HOME& ENERGY
Applicant Address Phone: Insurance:
21 NORTH MAIN ST (508)839-7001 6HUB9F43401320
NORTH GRAFTON, MA 01536
ISSUED ON:06/01/2022
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 NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: g TI
( (�
• iv • yQ f
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Buildinc Commissioner
i\*....''.&-,-„,,,
ti,
1,4
The Commonwealth of Massachuse s qr 3
Board of Building Regulations and Stitt is 1 FOR
�� UNICIPALITY
Massachusetts State Building Code, �� ,USE
Building Permit Application To Construct, Repair, Renovate.041 ish a Revised Mar 2011
One-or Two-Family Dwelling "�q ocTi ,
This Section For Official Use Only
Building Permit Number: 6"2 A 4-' &.2 .3 Date Applied:
iC`v„—> I/14, //' 1.-/-2022
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
.38 LollgfetfocV J . 43 iyo
1.1 a 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 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
21. Owner'of ecord:
J�rrrA h. r i n i,smct-lent Nor-I-Nu/4)1 i I 1 A. 01 D67 2.
Name(Print) City,State,ZIP
39 LINA FthI uj bR. HOST. 1p655(t
No.and Stre Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s)Af Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work':,' 9'(J. _1 ri a- LCL �,_ 1.1 Z >4
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 5 (Tip 1. Building Permit Fee: $ Indicate how fee is determined:
i 0 Standard City/Town Application Fee
2.Electrical $ 0 Total Project Cost3 (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Feesn$
Check No. rj 1 Check Amount. (/,14 Cash Amount:
6. Total Project Cost: $ 5 O 8[p 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
• roc
Massachusetts
•
l.Ni 4 DEPARTMENT OF BUILDING INSPECTIONS
�N ti
'
212 Main Street • Municipal Building Jb a
\ k'r Northampton, MA 01060 'PSfr
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW
1 & 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES,
FENCES, GROUND MOUNTED SOLAR, ETC.
I. Building Permit Application signed by legal owner and filled out by owner or authorized agent.
2. One set of plans and specifications of proposed work. (Digital and hard copy)
3. Site plan with location of proposed structure(s) and set backs.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (new / replacement windows).
8. Home Owner's License Exemption Form filled out and signed by Homeowner (if applicable).
9. Note any Conservation and/or special permit requirements (if applicable). 10.
Driveway Permit (if applicable).
11. Proof of Water and Sewer entry fees paid (if applicable).
12. Trench Permit - public land by DPW / private land by Building Dept.
13. Stretch Energy Code - all new construction will require a HERS Rater Affidavit to be submitted with permit
application before issuance of permit.
14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) I I V
f y p 28122
�
ohm PruAh u,v- License Number Expiration Date
Name of CSL Holder
2-I N 1,)c;N'nt St. List CSL Type(see below)
No.and Street Type Description
((�� /' ` - U Unrestricted(Buildings up to 35,000 Cu.ft.)
N. it lA . Q R Restricted 1&2 Family Dwelling
City/T wn,State,ZIP M Masonry
508 a,;(1 r1oD I RC Roofing Covering
WS Window and Siding
c )Y,�N� ,VIA- SF Solid Fuel Burning Appliances
Perm�_�nDr-itast- D . arm r l I Insulation
Telephone Email address D Demolition
5.2 Registeredgi �e Home Improvement Contractor(HIC) lb to 2 5 3 f"112 1 )22.
Rdr1 1' t.4S I"1 V - Fine r1 Li HIC Registrationat- Number Expiration Date
C Corp anga crin strant Name n i-{sa))V r eps- %Ii bme.eu
m
NN. vc U+t n, r 1\a. o 1531p OeB c�, 'i lob I Email address
City own,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 A No .O
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
to act on my behalf,in all matters relative to work authorized by this building permit application.
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 best of my knowledge and understanding.
PA&M.M .
'tit Owner's o 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"
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
�•.-r� Massachusetts
?h tt
' DEPARTMENT OF BUILDING INSPECTIONS T
212 Main Street • Municipal Building f .a
Northampton, MA 01060 ss t h .�,�‘'N'
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:
Location of Facility: ND bt1,96s/ NO L5tuvLO5trt(
The debris will be transported by:
Name of Hauler:
Signature of Applicant: 4)kh pI,� Date: 5/als IAX
- - - . The Commonwealth of Massachusetts
Department of Industrial Accidents
- 1 Congress Street.Suite 100
',:
414 Boston, ,NA 021/4-2017
www.ntass.gov/dia
1S orkers•('onipensation Insurance Aliidavit: Boilderx/Contractort/EEkctricians/Plumbers.
I-0 His 111.l:D%S 1 t H 11W PI*( 1l it AtITHORIT .
Applicant Information Please Print Let;ihly
Name I Hustncss Organization Indtsidual►: NO r!w I- HOW, `t' e I/1 D.L� 1.9 y
Address: 2 1 N • ! r►Cl- • I
City/State/Zip:AI. @faces 1 �Q .Q 1 S3(4 Phone#: g 3 9 '7Q 6
Are'ea is etwpio ir`('heck the apprupriatt touts:
Type of project(required).
am a etnplaryef xtt6 employees i lull and;.n p:at•tiurte t• 7. New construction
20 I am a aide pcupnctur or pannenhip and have no employees%or►tng for me in t. Q Remodeling
any.apacuy [Nu wurkers'camp.us%urancr n4tund I
10 I au t a hum.aowner doing all%uk myaell.INo,orl.1%.cutup insurance required
)'
9. ❑Demolition
4.0 I am a Inunseoaner and kill by hiring evntr:w:tur' to conduct all atwk on my pteaperty 1 will
10 0 Building addition
cnsurr that all a tors other has workcn'compenaauon tmurane or are solo 1 1.I Electrical repairs or additions
ptupneturs with no tmpluyces
12.0 Plumbing repairs or addition.
50 I am a gt1a rat conuactot and I fuse hired the soh-cunttacton listed on the attached art
13 Roof repairs
Thcsc wb-cuntra.lun haw rmpluycr+and have wcakcrs'comp.insurance.'
6.0 We arc a corporation and u,ot7'iccn has c etaLised thenngla of churl(ton pet Mtrl_
14.0 Other
152,Q 1(i),and we has.:no employees.[No acmiters'comp insurance reywted.I
•.Any applicant the duals boa a I mutt also till out the scctuon below%bowing that%oilers'eumpensatlon policy udanMitiOts,
r Homeowner',who submit ttus silwktt a tn4axafng they arc doing all work and then hire outside e miractor.must submit a new a1 da'ii indicating such.
:Contractors that check thu KA must atta:b d an adaltuonal aheet%bens mg the name of ate sutstunira:tor,and'tate w/tether or not dame entitles haws:
employers if tic%tsh-curstrsctois 11.1.c curio!,cos.dirt must prof udc their stwirers'tromp ptrh.t nuunhrr
I am an employer that is providing wurAers'compensation insurance for my employees. Below is the policy and job sire
information.
lnsur-ante Company Name: / / C(,V€l
Polies>i or Sett-ins.Lie.#: (�' j ty.6 R r Li D 1 320 Expiration Date: q/jJl' /22
Job Site Address: D L Dn - Fe//o�W tom. City.�`StateZip: AIO 'g p1/ 0''tq
Attach a copy of the workers'compensation policy declaration page(showing the policy number sad ezpiratfon date).
Failure to secure coverage as required under`iGL r. 152. §25A is a criminal violation punishable by a line up to S 1.500.00
and'or one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.(K)a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for tti"suruncc
:o%eraCe scriticatton.
1 do hereby • Mir under the ns and penalties of perjury that the information provided above is true and correct.
Stgnaturc: � Date: 61 I L. 2
Phone>:: 1)3 ?S /9 ''!do
Official use only. Do not write in this urea. to be completed by city or town official
( its or toss n: Permit I.iccttse st
Issuing authority (circle 'met:
I. Board of health 2. Building Department 3.( its'1 ossn( lerk 4. Fleetrical Inspector 5. Plumbing Inspector
6. Other
( ontact Person: Phone 4:
CLEAResult CONTRACT
CLEAResult
50 Washington Street, Customer Name:JARRED BRINKMANN
Westborough,MA,01581 Email:jarredbrinkmann@gmail.com
Phone:408-646-6559
Premise Address:38 Longfellow Dr,Northampton,MA 01062
Mailing Address:38 LONGFELLOW DR,Florence,MA 01062
Project ID:4497158
Date:May 12,2022
Job Description
Contractor will perform or cause to be performed the following work on these"Premises"in a professional manner and in accordance
with the terms of this Contract,including the attached recommendations/work order describing the work in detail(the"Work")which are
incorporated herein by reference.
Measure DascriPtian Location Quantity Unit Total Cost Customer.Cost
Air Sealing at Estimated 62.5 CFM50 Per Hour 14 hr $1,296.12 $0.00
Bath Fan-Vent to Roof 2 each $282.60 $70.65
Propavent 143 each $594.88 $148.72
Damming 45 each $107.55 $26.89
Attic Floor-6"Open Blow Cellulose 1481 SF $2,399.22 $599.80
Kneewall Wall-2"Thermal Barrier Polyiso 50 SF $239.00 $59.75
Door Sweep(with AS hrs) 3 each $75.93 $0.00
Exterior Door Weather Stripping(with AS hrs) 3 each $90.21 $0.00
Total: $5,085.51
Program Incentive: -$4,179.70
Customer Total: $905.81
Payment
Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows:Payment#1:$301.93 as a
Deposit payable to CLEAResult upon signing the Contract(not to exceed 1/3 of the total retail costs). Mail check&contract to
CLEAResult, 50 Washington Street, ,Westborough, MA,01581.Final Payment:$603.88 as the final payment for the Work shall be
payable to the Home Performance Contractor(HPC)or Independent Installation Contractor(IIC)upon satisfactory completion of the
Work.Customer understands that he/she will not be required to pay the Utility Incentive Share of the Contract price in the amount of
$4,179.70.Changes to individual line items and/or previous incentives may increase or decrease the size of the Utility Incentive Share.
Dispute Resolution
The IIC and Customer hereby mutually agree in advance that in the event that the IIC has a dispute concerning this Contract,the IIC may submit such
dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and Customer shall be
required to submit to such arbitration as provided in M.G.L.c 142A.
Page 1 of 4
You may cancel this agreement if it has been signed by a party at a place other than an address of the seller,provided you notify the
seller in writing by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the
signing of this agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
Jarred, n4(Ibuaau 05 / 13 / 2022 301.93 j•ii•
Customer Signature Date Indicate your selected IIC here, if applicable Initial here if you
want the Program
to assign a
CtlbParticipating
F Kevin Cote Contractor
5/12/22
CLEAResult Signature Date Name of CLEAResult Representative
Page 2 of 4
41001(lii- Permit Authorization
mass save Form
Site ID: 4497158 Customer: JARRED BRINKMANN
Jarred Brinkmann
I, , owner of the property located at:
(Owner's Name,printed)
38 Longfellow Dr Northampton, MA 01062
(Property Street Address) (City)
hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed
below to act on my behalf and obtain a building permit to perform insulation and/or weatherization
work on my property.
Jar.n$raVid, auu
Owner's Signature:
Date: 05 / 13 / 2022
.000•***** t* •a***sa41100****41 s tir.040 00•00s4e00411410$14 ****'
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 For Office Use Only
• I
Commonwealth of Massachusetts
!1 Division of profep sional Licensure
Board of Building Regulations and Standards
®
Canstrutt�� jytyisor
•
CS-110804 •<
i Expires:06/28/2022
JOHN PRUNIER • •
• 21 N MAIN St �' f
NORTH GRAI=ON FRA1 36 •"44+.• i
n 4
Commissioner ( ip a A'.
•
•
Construction Supervisor
Unrestricted -Buildings of any use,group which contain
less than 35,000 cubic feet(991 cubic meters)of enclosed
space.
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
For information about this license
Call(617)727-3200 or visit www.mass.govldpl
E(MIVDD/YYYt�
AC`o i2021
• CERTIFICATE OF LIABILITY INSURANCE 1oro5 GATE(M
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 pollcy(les) 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
NAMF•
Moynihan Insurance Agency,Inc. PHONE,\F„p(508)863-8080FAX
N�(508)8634800
25 Bumcoat Street Eona�as mikeArnoynihanins.com
Worcester MA 01606 INSURER S1AEFOR 1NG COVR-RAC NAI;a
INSURER A: Nautilus Insurance Co.
INSURED INSURERS:Travelers Indemnity Co of America
NORTHEAST HOME&ENERGY INC. INSURER C:
21 North Main Street INSURER 0:
North Grafton MA 01536 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ly tt TYPE OF INSURANCE n q wvnR POLICY NUMBER IM POLICY
(MM OC/YYYYYYt LAMS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000
A CLAIMS-MADE []OCCUR PRA MIGE TO EFQ(pa�n RENTED
$100.000
NN1180808 10/04/21 10/04/22 MEO EXP JAM Pea oaraOfI ;5,000
,) PERSONAL&ADV INJURY ;1,000,000
GEM.Aoogg.Lv LIMIT AP• S PER: GENERAL AGGREGATE ;2,000.000
—�POUCY Ter. LOC PRODUCTS-COMP/OP AG6;2,000,000
I DINER $
AUTOMOBILE LIABILITY COMBINED LIMIT ;
ANY AUTO BODILY INJURY(Per parson) ;
—
OWNED —SCHEDULED— AUTOS ONLY — AUTOS BODILY INJURY(Per accident) ;
HIRED NON-OWNED PROPERTY DAMAGE ;
— AUTOS ONLY — AUTOS ONLY .(Pe.pp.-Went)
f
UltBRELIA UM _ OCCUR EACH OCCURRENCE $
EXCESS LIAR _CLAIM$.MADE AGGREGATE S
OED_ RETENTION$ $
WORKERS COMPENSATIONPER
AND EMPLOYERS'LIABILITY �sTAATimF I PR
B OFF ICERIMEM ANY HER EXCLUDED?ECUTiVE NIA 6HUB9F43401320 09/16/21 09/16/22 E.L.EACH ACCIDENT ;500,000
(Mandatory In NH) E.L DISEASE-EA 9.vsLoyeE ;500,000
If yes,dosenbe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $600,000
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 1a1,Additional Remarke Schedule,may be attached If more apace la required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE <MJM>
119P—
)1988.2015 ACORD CORPORATION. AU rights reserved.
ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD
V�—fGfi W047///220/12Wecta0///e
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: Corporation
1l ": Registration: 106353
NORTHEAST HOME&ENERGY, INC. for
21 N.MAIN STREET __ IY' Expiration: 07/21/2022
N.GRAFTON, MA 01536 V iE_=•-'
Update Address and Return Card.
SCA 1 G 20M-05/17
(4/1;f7,//n,,//.
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:Corporation before the expiration date. If found return to:
Registration Expiration Office of Consumer Affairs and Business Regulation
106353 07/21/2022 1000 Washington Street -Suite 710
NORTHEAST HOME&ENERGY,INC. Boston,MA 02118
21 N.MAIN STREET �� ! ' s'� �-
N.GRAFTON,MA 01536 Undersecretary Not valid without signature