31B-133 (2) BP-2022-0564
49 PROSPECT ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
31B-133-001 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-2022-0564 PERMISSIONIS HEREBY GRANTED TO:
Project# INSULATION Contractor: License:
Est. Cost: 6000 ENERGIA LLC CSL92540
Const.Class: Exp.Date:09/02/2023
Use Group: Owner: PECHT,JACOB & SENA, BLANCA
Lot Size(sq.ft.)
Zoning: URC Applicant: ENERGIA LLC
Applicant Address Phone: Insurance:
242 SUFFOLK ST (413)322-3111 ENWC162970
HOLYOKE, MA 01040
ISSUED ON:07/05/2022
TO PERFORM THE FOLLOWING WORK:
INSULATI ON/WEATH ERIZATI ON
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: P . >2 . TAIT
1y►
Fees Paid: S65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
f F O g+-T AFF I ow,i 4-
L f" ttik4 5-19 IC'e,Gt d 7(i (Loz-L
' `'ll cri\ L The Commonwealth of Massachusetts
1 Board of Building Regulations and Standards FOR
II" 2022 Massachusetts State Building Code,780 CMR MUNICIPALITY
SE
Building Pe it Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
, �rt n nh(;(NSFEG I iuN
•:,�Alte o,rfr, This Section For Official Use Only
- __ Building ermrt Number: 8A A a�L" �j0f ff D A lied:
Building
/1 �`/>.,/- "7
1-
1 Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
49 PROSPECT ST 3)6 13 3
1.1a 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❑ Zone: _ Outside Flood Zone? Municipal la On site disposal s1 stem ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:JACOB PETCH NORTHAMPTON MA 01060
Name(Print) City,State,ZIP
49 PROSPECT ST 804-514-6286
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building Owner-Occupied 0 Repairs(s) 0 Alteration(s) ❑ Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other IZ Specify:INSULATION
Brief Description of Proposed Work': INSULATION ATTIC FLOOR OPEN BLOW CELLULOSE
FG DAMMING - WALLS DENSE PACK CELL CLAPBOARD
RIM JOIST & HATCH 2" THERMAL BARRIER
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
I.Building $6000.00 1. Building Permit Fee:$ 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
Suppression) $ Total All Fees:$ C /,5
Check No.l M Check Amount: LA Cash Amount:
6.Total Project Cost: $6000.00 0 Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 92540 9003
THOMAS ROSSMASSLER License Number Expiration Date
Name of CSL Holder
242 SUFFOLK ST List CSL Type(see below) U
No.and Street Type Description
HOLYOKE MA 01040 U Unrestricted(Buildings up to 35,00Q 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
413-322-3111 I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 165169
24
Energia LLC 2/16/ir
g HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
242 SUFFOLK ST ivelice@energiaus.com
40aCYalk MA 01040 413-322-3111 Email address
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 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 JACOB PETCH
to act on my behalf,in all matters relative to work authorized by this building permit application.
JACOB PETCH 5/2/22
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 b of my knowledge and understanding.
Tom Rossmassler/Energia LLC 5/2/22
Print Owner's or Authorized Agent's Name(Electroni 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 nal 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 perch)
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"
Permit Authorization
mass save. Form
Sowings through enefgv e+f+coenc
Site ID: 4455809 Customer: JACOB PECHT
Jacob Pecht , owner of the property located at:
(owner's Name,onnted)
49 Prospect 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.
Owner's Signaturet7y4C08 PEC-/-r
Date:04 / 08 / ...
FOR OFFICE USE ONLY
We have assigned the following Mass Save Home Energy Services Participating Contractor to the
above referenced project:
61)eiLL.:—/4_
Participating Contractor Date
Name: CLEAResult
Phone: 800-480-7472
Email:
Page 1 of 1 G:r Office Use Only
Document Ref:4APBS-CRTCB-D6NUC-4B7EW Page 7 of 9
■
The Commonwealth of Massachusetts
Department of Industrial Accidents
AM
7-4
ill
rOffice of Investigations
1= ' Y Lafayette City Center
s 2 Avenue de Lafayette, Boston,MA 02111-1750
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: General Businesses
Applicant Information Please Print Legibly
Business/Organization Name: ENERGIA LLC
Address: 242 SUFFOLK ST.
City/State/Zip: HOLYOKE, MA 01040 Phone #: 413-322-3111
Are you an employer? Check the appropriate box: Business Type(required):
1.111 I am a employer with 16 employees (full and/ 5. ❑ Retail
or part-time).* 6. ❑ Restaurant/Bar/Eating Establis ent
2.❑ I am a sole proprietor or partnership and have no 7, 0 Office and/or Sales(incl. real a te, auto, etc.)
employees working for me in any capacity.
[No workers' comp. insurance required] 8. El Non-profit
3.0 We are a corporation and its officers have exercised 9. 0 Entertainment
their right of exemption per c. 152, §1(4),and we have 10.0 Manufacturing
no employees. [No workers' comp. insurance required]** 11.❑ Health Care
4.El We are a non-profit organization, staffed by volunteers, Insulation
with no employees. [No workers' comp. insurance req.] 12.® Other
*My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
**If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an
organization should check box#1.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information.
Insurance Company Name: GUARD INSURANCE GROUP
Insurer's Address:49 PROSPECT
City/State/Zip: NORTHAMPTON MA
Policy#or Self-ins. Lic. # ENWC203063 Expiration Date:7/01/2022
Attach a copy of the workers' compensation policy declaration page(showing the policy number and eIpiration date).
Failure to secure coverage as required under§25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office o Investigations of
the DIA for insurance coverage verification.
I do hereby certify, er the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date:
4/18/22
Phone#: 413-322-3111 Ext 122
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(check one):
1❑Board of Health 2.0 Building Department 3.❑City/Town Clerk 4.❑Licensing Board
50 Selectmen's Office 6.❑Other
Contact Person: Phone#:
www.mass.gov/dia
City of Northampton
0- -
Massachusetts
1# t
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 •
Property Address: 49 PROSPECT
Contractor
Name: Energia LLC Thomas Rossmasslef
Address: 242 Suffolk Si
City. State: Holyoke MA
Phone: 413-322-3111 ext 122
Property Owner ,nob Petch
Name:
Address: 49 PROSPECT St
City, State: NORTHAMPTON MA 01062
I, Tom Rossmassler (contractor) attest and affirm that the building I intend to
insulate does not have any open air (knob and tube) wiring in the spaces to be insulated and that I have
provided the property owner with a copy of this affidavit.
Contractor signature
Tom
Date /////