37-022 (11) BP-2022-1600
1 MOUNTAIN LAUREL COMMONWEALTH OF MASSACHUSETTS
PATH
Map:Block:Lot: CITY OF NORTHAMPTON
37-022-001
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2022-1600 PERMISSION IS HEREBY GRANTED TO:
Project# 2022 WEATHERIZATION Contractor: License:
Est. Cost: 310250 THE ENERGY MONSTER 102765
Const.Class: Exp.Date: 07/22/2024
Use Group: Owner: MAYHEW HUTT KIMBERLY A&JESSE S
Lot Size (sq.ft.)
Zoning: SR Applicant: THE ENERGY MONSTER
Applicant Address Phone: Insurance:
311 MAIN ST (508)796-5525 6S60UBSR71347322
WORCESTER, MA 01608
ISSUED ON: 12/09/2022
TO PERFORM THE FOLLOWING WORK:
INSULATION, WEATHERIZATION &AIR SEALING
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:
0 • V,
Fees Paid: S65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
_
-I f i •iuio- 2Oo0
c�.i The Commonwealth of Massachusetts
Aj,._ v o Board of Building Regulations and Standards FOR
N I MUNICIPALITY
�o i , Massachusetts State Building Code, 780 CMR USE
rill j i Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
i I W i One-or Two-Family Dwelling
o This Section For Official Use Only
. tuilding Permit Number: D(2-2022—1t,b c0 Date Applied:
if /ev►1.,.> f/�o5„ / /2- 4-ZOzz
_,
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 600 rLOlgeNLI= /eA 1.2 Assessors Map& Parcel Numbers
1 Mountain Laurel Path GrilZo / ,17 022—00 C
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Residential S
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® Private❑ Zone: Outside Flood Zone? Municipal® On site disposal system ❑
Check if yes®
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Kim Hutt Matthew Florence, MA 01062
Name(Print) Ci State,ZIP
1 Mountain Laurel Path � it Riii1 r -mI Lam\
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other El Specify:Insulation
Brief Description of Proposed Work2:
Insulation, weatherization, air sealing
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 3,102.50 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑ Standard City/Town Application Fee
-- ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire �.,
Suppression) $ Total All Fees: $ v°
Check No.OD�U(*Check Amount:4 Cash Amount:
6.Total Project Cost: $ 3,102.50 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CSSL-102765 7/22/24
Josh Leet License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) R
311 Main St
No.and Street Type Description
Worcester, MA 01608 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
508-796-5525 jcassani@myenergymonster.corn SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) I 188796 9/4/23
The Energy Monster MA, Inc
HIC Registration Number Expiration Date
HIC CompanyName or HIC Registrant Name
311 Main St
No.and Street Icassani(a�myenergymonster.com
Email address
Worcester. MA 01608 508-796-5525
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 l No 0
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 Josh Leet
to act on my behalf,in all matters relative to work authorized by this building permit application.
Kim Hutt Matthew (PAF attached) 12/7/22
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 best of my knowledge and understanding.
Josh Leet 12/7/22
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.fl.) 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
Energy Monster
311 Main St 2nd FL
Worcester,MA 01608 energym n st " r
Te1508-796-5525
INVOICE# 1MOUNTAIN 12.8.2022
WORK PERFOMED AT: BILL TO:
Kim Hutt Matthew
1 Mountain Laurel RISE Engineering
Path Division of Thielsch Engineering
Florence MA 1341 Elmwood Ave
Cranston RI
QTY DESCRIPTION UNIT PRICE TOTAL
10 AIR SEALING $65.00 $650.00
6 DUCT SEALING $65.00 $520.00
850 ATTIC FLAT R-19 $1.35 $1147.50
100 DAMMING $1.75 $175.00
1 ATTIC PULL DOWN STAIRS $250.00 $250.00
1 BATHROOM VENTILATION $135.00 $135.00
150 BASEMENT SILLS $1.50 $225.00
INVOICE TOTAL: $3,102.50
SIGNATURE:
Energy Monster
311 Main Street
2nd Floor
Worcester, MA 01608
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PERMIT AUTHORIZATION FORM
I, K- v ` 1 '4. M T -Cvt) , OWNER OF THE PROPERTY LOCATED AT:
M1V 12 ri • L__1
(PROPERTY STREET ADDRESS) (CITY/TOWN)
HEREBY AUTHORIZE
ICIPATING CONTRACTOR)
AN AUTHORIZED PARTICIPATING CONTRACTOR FOR THE MASS SAVE HOME ENERGY SERVICES
PROGRAM UNDER THE DIRECTION OF ENERGY MONSTER,TO ACT ON MY BEHALF TO OBTAIN A
BUILDING PERMIT AND TO PERFORM INSULATION AND/OR WEATHERIZATION WORK ON MY PROPERTY.
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Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Co nstruction:Stidiktispr Specialty
.,
CSSL-102765 ".• ", Kypires:07122/2024 '
JOSH LEET 7
311 MAIN STREET --
WORCESIIROA 01MI 21,
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Commissioner daia k Vennikk,
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.,,PR(0 V.t‘",C. TRACTOR Rewstrat•on eared tor ,d•r4tral,tse ohle
before the 6.1tpffiitiOrt data. tt fu-Old fthlril IV
'''1,MtKP L.Pff r IV Office of Consumer Affairs arab Business'try,
1)00 Wash°glob Street •Sues 710
Boston MA 02/111
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Not slid without signature
The Commonwealth of Massachusetts
I —4—, 1, Department of Industrial Accidents
=eel= 1 Congress Street,Suite 100
e e ,f_ Boston,MA 02114-2017
www.mass.gov/dia
''ttickers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Le&ibis
Name (Business/Organization/Individual):The Energy Monster MA, Inc
Address:311 Main St
City/State/Zip:Worcester, MA 01608 Phone#:508-796-5525
Are you an employer?Check the appropriate box: Type of project(required):
ID I am a employer with 50 employees(full and/or part-time).* 7. ❑New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in 8. Q Remodeling
any capacity.[No workers'comp.insurance required.]
3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
9. ❑Demolition
10 Q Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees. 12.0 Plumbing repairs or additions
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0Roof repairs
These sub-contractors have employees and have workers'comp.insurance.t
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other
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.
t Homeowners 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 attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
cmplo\ecs lithe 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*b site
information.
Insurance Company Name:Hartford Underwriters Ins. Co
Policy#or Self-ins.Lic.#:6S60UB5R71347322 Expiration Date:01/13/2023
Job Site Address:1 Mountain Laurel Path City/State/Zip:Florence, MA 01062
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 ,3 forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby ce tfy tin r the pai d penalties ' perj • that the information provided above is true and correct.
Signature: Allipp
` Date: 12/7/22
Phone#:508-796- 5
Official use only. Do not write in thi• ,yea,to he completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
"07.144
f ........
Massachusetts �4,t :�
t:
A. `t iz
�, w. ' DEPARTMENT OF BUILDING INSPECTIONS 7;
5
7►1 212 Main Street • Municipal Building
Northampton, MA 01060 rsV 16.11g
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:
(There will be no debris)
Location of Facility: 100 Lamartine St. Worcester, MA 01608
The debris will be transported by:
Name of Hauler: Energy Monster
Signature of Applicant: Date: 12/7/22