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23C-036 (4) BP-2023-0497 648 RIVERSIDE DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23C-036-001 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-2023-0497 PERMISSION IS HEREBY GRANTED TO: Project# 2023 INSULATION Contractor: License: Est.Cost: 5244 SCOTT MCCRAY CS-117322 Const.Class: Exp.Date: 04/14/2026 Use Group: Owner: B ZUCCHINO ANDREW Lot Size(sq.ft.) Zoning: GI Applicant: PROSPECTIVE ENERGY SOLUTIONS INC Applicant Address Phone: Insurance: 14 PINEBROOK CIRCLE (413)424-3600 WC51000195406 GRANBY,MA 01033 ISSUED ON: 04/21/2023 TO PERFORM THE FOLLOWING WORK: INSULATATION/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. n n Signature: r Irv,_, 2 Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner The Commonwealth of Massachusetts APRFO�t 1 Board of Building Regulations and Standards MUNICIPALITY 2023 Massachusetts State Building Code,780 CMR USE Building Permit Application To Construct,Repair,Renovate Or Demolish aDE DiR ryiQ0i E 7mTIoNS One-or Two-Family Dwelling ;___NORTHAMF'TON,MA01060 This Section For Official Use Only Building Permit Number: ��ZQ23-00 7 Date Applied: 11—lA) 72,5 ,�� 2 y'Z/4025 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 848 Riverside Drive,Florence,MA 040� I .n .no 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: G/ 0.121 Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Andrew 2ucd Imo 4 Rorence,MA 010621 Name(Print) City,State,ZIP No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building 0 Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) 0 Addition ❑ Demolition ❑ Accessory Bldg.0 Number of Units Other ❑ Specify`l Brief Description of Proposed Work': Blown eeauloee inentad on to subs, blown iNudese inewletlmd kw wdk.lasnellaremus ww88181M680n inellsurek air Mew 4 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building #5,244 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ CIStandard 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 Fees:$ Check No.01.5 Check Amount: 46— Cash Amount: 6.Total Project Cost: $5,244 1 ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-117322 04/14/2026 Scott McCray License Number Expiration Date Name of CSL Holder 14 Pinebrook Circle List CSL Type(see below) Unrestricted No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) Granby, MA 01033 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-219-1304 scott.mccray@prospectivenrg.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 207208 12/15/2024 Prospective Energy Solutions, Inc. HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 14 Pinebrook Circle Rachel.hall@prospectivenrg.com No.and Street Email address Granby, MA 01033 413-424-3600 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 El 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 Prospective Energy.Solutions, Inc. to act on my behalf,in all matters relative to work a orized by this 'ding permit application. AnYeli Zwt[,hilA0 pq/2o/23 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 this ap lication' e and accurate to the best of my knowledge and understanding. 4/20/23 not Owner's or Authorized Agent's Name ectronic 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" THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration ^' _ ;'Type: Corporation PROSPECTIVE ENERGY SOLUTIONS, INC. IF: egiIration: 127208 14 PINEBROOK CIRCLE '^ E>pration: 12/15/2024 GRANBY, MA 01033 ,h Asti■ _ ` ti c; — —144 — 4v$ Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:Corporation Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 207208 12/15/2024 Boston,MA 02118 PROSPECTIVE ENERGY SOLUTIONS,INC. iN) 1 SCOTT MCCRAY ••• 14 PINEBROOK CIRCLE �. Lo "`'7 , ./r! GRANBY,MA 01033 ,y Undersecretary of valid without signature Commonwealth of Massachusetts te: Division of Occupational Licensure Board of Building Regulations and Standards Constttn IServisor 1S CS-117322 _� _,pires: 04/14/2026 SCOTT ANDIEEW MCCRAY 14 PINE BROAK CIRCLE` GRANBY MAJ1033 J l b•• -> Commissioner Claid21 K. C7Eirm , 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.gov/dp1 The Commonwealth of Massachusetts A Department of Industrial Accidents Office of Investigations Lafayette City Center 2 Avenue de Lafayette, Boston,MA 02111-1750 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/organization/Individual):izaar tionMdividual): Prospective Energy Solutions inc Address: 14 Pinebrook Circle City/State/Zip:Granby, MA 01033 Phone#:413-424-3600 Are you an employer? Check the appropriate box: Type of project(required): 1.Ell am a employer with 3 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ['Buildingaddition [No workers' comp.insurance comp.insurance.$ required.] 5• ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other insulation 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. tContractors 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: First Insurance Funding Policy#or Self-ins. Lic.#:WC51000195406 Expiration Date:02/1 7/24 Job Site Address: 648 Riverside Drive 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 Section 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 of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 4/17/2023 Phone#: 413-424-3600 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): 10Board of Health 20 Building Department 3.0City/Town Clerk 4.0 Electrical Inspector 5.E1Plumbing Inspector 6.0Other Contact Person: Phone#: ACOR[I CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `-� 03/06/23 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 NAME: Jenny Murdza Metras Insurance Agency IA/G No,Eat): 413-536-1491 FAX No): 413-532-8522 2030 Memorial Drive ADDRES S; jmurdza@metrasinsurance.com Chicopee,MA 01020 INSURER(S)AFFORDING COVERAGE NAIC# _ INSURERA: NGM Insurance INSURED INSURER B: Progressive Prospective Energy Solutions,Inc. INSURER C: LM INS CORP 14 Pinebrook Circle INSURER D Granby,MA 01033 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 ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE1O RENIED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 A MPJ2485L 10/18/22 10/18/23 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: • $ AUTOMOBILE UABILITY -COMBINED SINGLE LIMIT $ 1 000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED X SCHEDULED 96443070-0 12/22/22 12/22/23 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED x NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY X AUTOS ONLY (Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE CUJ2485L 12/19/22 12/19/23 AGGREGATE $ 1,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY C OFFICER/MEMBER EXCLUDED?XECUTIVEf I NIAE.L.EACH ACCIDENT $ 500,000 II WC51000195406 02/17/23 02/17/24 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I 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 THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Jenny Murdza ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD r . City of Northampton �i+" sr, F r. a +, = Cj Massachusetts *` t,.- . DEPARTMENT OF BUILDING INSPECTIONS °'a ti ' 212 Main Street • Municipal Building 12. Northampton, MA 01060 -"if)‘' 1 Property Address: (Duc /Q (velic,d �VIUt I-I v v 0 i C(QL02- Contractor Name: CIOSrC, 1U42_ EYt.¢ ,c. i�1.1,��1G1 Address: [ ()LKQtha0 V- et oil, City, State: .v/A n."✓"t AAR 61.02z Phone: Lip,(4)-q SLa CO Property Owner Name: �YID�,VQ,ui 4,te 0,h(01 6 Address: ✓-I c CA[iev ldJ OVLV`�s- GU`-[. - City, State: (1v-il.e 1 Mil DlO u I, 'v - me (- /11.q 11 (contractor) attest and affirm that the building I intend to insulate does not have any pen 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 signat e Date q (21173