37-022-003 (2) BP-i022-1601
3 MOUNTAIN LAUREL COMMONWEALTH OF MASSACHUSETTS
PATH
Map:Block:Lot: CITY OF NORTHAMPTON
3 7-022-003
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2022-1601 PERMISSION IS HEREBY GRANT4D TO:
Project# 2022 WEATHERIZATION Contractor: License:
Est. Cost: 3102 THE ENERGY MONSTER 102765
Const.Class: Exp.Date: 07/22/2024
Use Group: Owner: L AMES, BETSY
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:
I
� 1
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
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�nri c
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c� g� cw 3 a The Commonwealth of Massachusetts
�. Board of Building Regulations and Standards FOR
MUNICIPALITY
(:-...5 U Ui Massachusetts State Building Code, 780 CMR USE
r w Bu trig Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 20I11
o One-or Two-Family Dwelling
I
This Section For Official Use Only
Buildin'g/ 0Permit Num�er:NP 2 Z2 (o- / 0 ( /Date/te Applied:
KEVil.) 1Z-s) fL 'E 1-2-9•ZozZ
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 4'42y Mfir /CE l� 1.2 Assessors Map&Parcel Numbers
3 Mountain Laurel Path Z/)f�7'3
1.1a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Residential
Zoning District Proposed Use Lot Area(sq ft) Frontage(It)
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 El Private 0 Zone: _ Outside Flood Zone? Municipal El On site disposal system 0
Check if yes®
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Betsy Ames Florence, MA 01062
Name(Print) City,State,ZIP
3 Mountain Laurel Path 1'7f--433-3013 R'ti Y.e9 war,( g . o
No.and Street 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) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other Ill Specify:Insulation
Brief Description of Proposed Work2:
Insulation, weatherization, air sealing
SECTION 4:ESTIMATED CONSTRUCTION COSTS i
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 Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) $ Total All� i
Check Npp io. Check Amount:�� Cash Amount:
6.Total Project Cost: $ 3,102.50 0 Paid in Full ❑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)
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) 188796 9/4/23
The Energy Monster MA, Inc
HIC Registration Number Expiration Date
HIC CompanyName or HIC Registrant Name
311 Main St jcassaniAmyenergymonster.com
No.and Street 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 I 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 Josh Leet
to act on my behalf,in all matters relative to work authorized by this building permit application.
Betsy Ames (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 foun j 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"
Energy Monster
311 Main St 2°d FL energy �����
Worcester,MA 01608
Te1508-796-5525
INVOICE# 3MOUNTAIN 12..8.2022
WORK PERFOMED AT: BILL TO:
Betsy Ames
3 Mountain Laurel Path RISE Engineering
Florence MA Division of Thielsch Engineering
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
225.
INVOICE TOTAL: $3,102.50
SIGNATURE: I -----
Energy Monster
311 Main Street
2nd Floor
Worcester, MA 01608
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PERMIT AUTHORIZATION FORM
I. ,OWNER OF THE PROPERTY LOCATED AT:
(PROPERTY STREET ADDRESS) (CITY/TOWN)
HEREBY AUTHORIZE /7e1 / oer
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.
713-
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OWNER'S SIGNATURE DATE
Commonwealth of Massachusetts
U,9 Division of Professional Licensure
Board of Building Regulations and Standards .
Constructiotr'S dJiVispr Specialty
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CSSL-102765 . *pints:
JOSH LEFT f
311 MAIN STREET =,
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wORCESTER.yAA 018011
Commissioner elybia , Deinttick..
Oft.d Carr Mani 1 amIscs*agt'rirm
MOPE MI M T CONTRACTOR Raatrtralion raid I ha>l+rla OW ill MOnly
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date.I Woad moan to.
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cVORCt STER.MA 0.0147 UPdl#S1CrONY id*ithout signature
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
C
y]1i-4tjatSys_..:j..:..S
Massachusetts ? �_ !t�• DEPARTMENT OF BUILDING INSPECTIONSy� F�°' 212 Main Street • Municipal Building V`'• '�'�
Northampton, MA 01060 �7``"�,i. „.%.%
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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
The Commonwealth of Massachusetts
1 =_-Ta` _ 1, Department of Industrial Accidents
=e
1
_ 1 Congress Street,Suite 100
0,4_;��= Boston,MA 02114-2017
www.mass.gov/dia
ow
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
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):
ICI 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. 0 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 ❑ Building addition
40 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.❑Electrical repairs r additions
proprietors with no employees.
12.❑Plumbing repairs r additions
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ROOF repairs
These sub-contractors have employees and have workers'comp.insurance.*
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14. 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
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'ob site
information.
Insurance Company Name:Hartford Underwriters Ins. Co
Policy#or Self-ins.Lic.#:6S60UB5R71 347322 Expiration Date:01/13/2023
Job Site Address:3 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$ ,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 r, forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby ce •r the pai :,id penalties ' perj r that the information provided above is true and correct.
iiiii
Signature: 4' 4111111 Date: 12/7/22
Phone#:508-796- 5
rr Official use only. Do not write in thi. •rea,to be completed by city or town official.
r
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#: