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36-326 (5) B :-2023-0096 224 CARDINAL WAY COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 36-326-001 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-2023-0096 PERMISSION IS HEREBY GRAN ED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 3143 BRUIN REMODELING GROUP LLC 053402 Const.Class: Exp.Date: 03/28/2023 Use Group: Owner: STEPHANIE STEELE, ELIZABETH Lot Size (sq.ft.) Zoning: WSP Applicant: BRUIN REMODELING GROUP LLC Applicant Address Phone: Insurance: 208 POND ST (508)881-8200 7PJUB-6R391059UB ASHLAND, MA 01721 ISSUED ON: 01/26/2023 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHERI ZATI 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 VI LATION OF ANY OF ITS RULES AND REGULATIONS. Signature: . 9 c Y v� Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner 4 1LrZcxD3 SS, The Commonwealth of Massachusetts! 2 6 .J FOB *160 Board of Building Regulations and'StanEbi Massachusetts State Building Code, 780-C ` �Q�o, C)PALITY tiq, OryE Building Permit Application To Construct,Repair,Renovate Orlignrii Revised Mar 2011 One-or Two Family Dwelling o�O is Section For Official Use Only j Buildini rmit Number: 3 3 - .-I Date Applied: 2� 3 / 1pJ45-5 /7 I ZD Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Pro ecy Address: Locuiibito1.2 Assessors Map&Parcel Numbers 1.1a Is this an accepted street?yes 1( 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 OWNERSHIP1 2.1 Owner'of Record: ttia 1( e 6-1-"c _(� rit c.e, WOE) i Name(Print) City,State,ZIP pay- C'cevc(v►Q Le,(i i 0, 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) Alteration(s) It Addition ❑ Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify Brief Description of Proposed Work': Ili{ 5.12LL1 i Vl ct ) OpP b(n-tt 7 CD ((u(DSO a i C— SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 3 (L43 .a_f 1 1. Building Permit Fee:$ Indicate how fee is determin : ❑Standard City/Town Application Fee 2.Electrical $ D ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ ) 2. Other Fees: $ 4.Mechanical (HVAC) $ 0 List: 5. Mechanical (Fire $ Suppression) Total All Fee Check No. U -I Check Amount: J Cash Amount: 6. Total Project Cost: $ (tI -2). ' ( CI Paid in hull 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 05 `7/fGZ -3 Ja S rf 5( (i,l i License Number ExiiiratiOn Date Name of CSL Holder 1 LA- a ti CL \i' i V�` List CSL Type(see below) No.and Street 'J Type Description f^ _ n w Ry' �/1Q c )J— 3 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,Z M Masonry RC Roofing Covering WS Window and Siding q N-� ("I �'� /K'_tq j_ SF Solid Fuel Burning Appliances ��- �' O2 D 12ku - he— I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement ontractor(HIC) b 12 i ' t -)-6).1 jy t V � oC� HIC Registration Number E . on Date HIC Corn an ame pr WC Re pa. , t Name ivo C.oU i(-F G 6,7,L n ct ✓c . 1I 4— N. and,S_ti e ci , 1 D Email address �`� 1 � C�11 -i 5 11 � 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 j!k No . 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize (�.VIAR 5 K655 i V, i to act on my behalf,in all matters relative to work authorized by this building permit application. Print 0 er'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. j---tt-VIAD 5 LvI ( 11)'31�)-3 Print Owner's or Authorized Agent's Name(Electronic Signature) D e 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 wider 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 _ � t '4 „ �� ' DEPARTMENT OF BUILDING INSPECTIONS.' 212 Main Street EsMunicipal Building Jv) , a � Northampton, MA 01060 ''41 3,,)1'° 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: 0 cidoii r5 The debris will be transported by: Name of Hauler: Signature of Applicant: Date: The Commonwealth of Massachusetts Department of Industrial Accidents tizi. t_ 1 Congress Street, Suite 100 ss .t Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual):Bruin Remodeling Group LLC Address:208 Pond St. City/State/Zip:Ashland, MA 01721 Phone#:508-881-8200 Are you an employer?Check the appropriate box: Type of project(required): l.®I am a employer with 10 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. u 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 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 1 l.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.EI I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ]3.❑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. 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 job site information. Insurance Company Name:AMGuard Policy#or Self-ins.Lic.#:7PJUB-6R30848-4-22 Expiration Date:4/29/2023 'n,,/Job Site Address: �,�� aU( 1Il�C� j(JcL( City/State/Zip: -I 6 j�cue Y Y 1 " Attach a copy of the workers'compensation policy dedlaration page(showing the policy numberL 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 be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: I P-.31)1)); Phone#:508-881-8200 Official use only. Do not write in this area,to be 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 / J Massachusetts A� • C- 1 DEPARTMENT OF BUILDING INSPECTIONS m+ \ ' 212 Main Street • Municipal Building yeti. 4D Northampton, MA 01060 ,rsf`y 3,0' ' HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, (insert full legal name), born _ (insert month, day, year), hereby depose and state the following: 1. 1 am seeking a building permit pursuant to the homeowners' exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s) who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one-or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent th t I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the roject or work on my parcel, I am not engaged in construction supervision in connection with any project or ork involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel, I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this day of , 20_. (Signature) BRUINRE-01 SHEALEY ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) �►� 10/14/2022 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 policy(ies)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 Sandy Healey NAME: Jewell Insurance Agency,Inc. PHONE FAX 1101 Worcester Rd (NC,No,Ext):(508)879-1310 208 (ac,Ne):(508)872-2764 Framingham,MA 01701 MAR"Ess,shealeya(D,'ewellinsurance.com _ INSURER(S)AFFORDING COVERAGE NAIC INSURER A:Norfolk&Dedham Group 23965 INSURED INSURER B:AMGuard 42390 Bruin Remodeling Group,LLC INSURERC: 208 Pond Street INSURER D Ashland,MA 01721 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: ' THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRDOD WVD (MMIDD/YYYY) IMWDWYYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ _ 1,000,000 CLAIMS MADE X OCCUR P012212513 4/29/2022 4/29/2023 PREMISES DAMAGE TO RE Ea ) $ NTED 50,000 ( occurrence _ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY ; 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY Fla LOC PRODUCTS-COMP/OP AGG ; 2,000,000 OTHER $ COMBINED A AUTOMOBILE LIABILITY Ea accidenntSINGLE LIMIT 1,000,000 ANY AUTO 92282328A 5/4/2022 5/4/2023 BODILY INJURY(Per person) ; X OWNED SCHEDULED AUTOS ONLY AUTOS WN BODILY INJURY(Per acciden0 ; X AUTOS ONLY X AUTOS ONLYEp TOPE DAMAGE ; A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE _ $ 1,000,000 EXCESS LIAB CLAIMS-MADE U2207879A 4/29/2022 4/29/2023 AGGREGATE $ 1,000,000 _ DED X RETENTION$ 10,000 $ B WORKERS COMPENSATION XOTH- AND EMPLOYERS'LIABILITY STATUTE ER IA AANYPROPRIETOR/PARTNER/EXECUTIVE YIN 7PJUB-6R391059 UB 4/29/2022 4/29/2023 E.LEACHACCIDENT $ 500,000 (Mend t/MEn NE) N EXCLUDED? NIA 50A,000 E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN tY P ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main Street Northampton,MA 01060 - AUTHORIZED REPRESENTATIVE IVY ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constructs-bti%Upervisor C S-053402 Expires:03/28/2023 JAMES E ROSSINI • 9 AZALEA DR = •' MEDWAY MA_02053141'' 1 . , 0 1. Commissioner claA i'. (21/&i ia_ .%�ffi`fle•+otZens+unerl Wair/8,BGaiaess-Rogulefon —HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 205013 04/10/2024 1000 Washington Street -Suite 710 BRUIN REMODELING GROUP,LLC Boston,MA 02118 JAMES ROSSINI • 208 POND ST �,,,,,,,{�,.����• • ASHLAND,MA 01721 Not valid without signature Undersecretary DocuSign Envelope ID:6A4B8098-E44A-48C3-BCBA-6650147E 1A88 WEATHERIZATION CONTRACT EVERS.:_ URCE CUSTOMER PHONE DATE CLIENT• WORK ORDER Stephanie Steele (508) 740-1225 12/01/2022 519659' 10202 SERVICE STREET BILUNG STREET PROPOSED BY: 224 Cardinal Way 224 Cardinal Way Heather Lieber SERVICE CITY.STATE.ZIP BILUNG CITY.STATE.ZIP Florence, MA 01062 Florence, MA 01062 DESCRIPTION QTY COST INCENTIVE TOTAL INCENTIVE 75% For eligible weatherization measures, Eversource is offering an incentive of 75%for insulation measures and 100%for the air sealing measures, both with no limit. You are eligible to apply for the 0% Heat Loan to finance your co-pay, applications must be submitted before the weatherization work begins. PERFORM AIR SEALING AT ESTIMATED 62.5 CFM50 PER HO 8 S754.64 S754.64 Seal areas of your home against wasteful, excessive air leakage. Materials to be used to seal your home can include caulks, foams and other products. Primary areas for sealing include air leakage to attics, basements,attached garages and other unheated areas (windows are not generally addressed.) DAMMING 160 S392.00 S294.00 S98.00 Provide labor and materials to install a 12"layer of R-38 unlaced fiberglass batts for damming purposes. ATTIC FLOOR OPEN BLOW CELLULOSE 10" 880 S1,830.40 $1,372.80 S457.60 Provide labor and materials to install a 10"layer of R-37 Class I Cellulose to open attic space. HATCH:THERMAL BARRIER POLYISO 2 INCH (ATTIC) 1 547.37 S35.53 $11.84 Provide labor and materials to insulate the back of an attic hatch with 2"rigid insulation board at R-10. f---DocuSigncd by cOocuSigned by. --081)75551A2F44P4 •—DFCM I SO I7A7420 Heather Lieber 12/30/2022 I 12:28 PM EST DocuSign Envelope ID:6A4B8098-E44A-4BC3-BCBA-6650147E1A88 • WEATHERIZATION CONTRACT EVERSURCE CUSTOMER PHONE DATE CLIENT S WORK ORDER Stephanie Steele (508)740-1225 12/01/2022 519659 10202 SERVICE STREET ROLLING STREET PROPOSED BY: 224 Cardinal Way 224 Cardinal Way Heather Lieber SERVICE CITY.STATE,ZIP SLUNG CITY,STATE,DP Florence, MA 01062 Florence, MA 01062 DESCRIPTION QTY COST INCENTIVE TOTAL PROPAVENT HALF 99 $118.80 $89.10 $29.70 Provide labor and materials to install ventilation chutes in the rafter bays to maintain air flow. Total: $3,143.21 Program Incentive: $2,546.07 Client Total: $597.14 I.DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the above work at the Client's Address in a professional manner and in accordance with the terms of this Contract: II.PAYMENT Client agrees to pay the Contractor for the Work,the Client Share of the Contract Cost is payable to the Independent Installation Contractor(IIC)upon satisfactory completion of the Work.Client understands that they will not be required to pay the Program Incentive Share of the Contract cost.Changes to the individual line items anc,/or previous e.---.6faigitodibly increase or decrease the size of the Program Incentive Share. -DocuSigned by: fillk7 0 351ifittve ,...mireqvg=sia RA7420 Heather Lieber 12/3Q/2022 1 12:28 PM EST Printed Name Date of Acceptance DocuSign Envelope ID:6A4B8098-E44A-4BC3-BCBA-6650147E1A88 RISE :::- ENGINEERING' OWNER AUTHORIZATION FORM I Stephanie Steele (Owner's Name) owner of the property located at: 224 Cardinal Way (Property Address) Florence, MA 01062 (Property Address) hereby authorize (Subcontractor) 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. Z.gecreAsiato. ,[•;t-:..i 'Mike 12/30/2022 112:28 PM EST Date RISE Engineering, a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335 www.RlSEengineering.com