43-023 (2) BP-2023-0558
549 PARK HILL RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
43-023-001 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-2023-0558 PERMISSION IS HEREBY GRANTED TO:
Project# INSULATION 2023 Contractor: License:
Est. Cost: 2000 HOMEWORKS ENERGY INC 106148
Const.Class: Exp.Date: 07/30/2024
Use Group: Owner: INGMANN MANDARO BRUCE &TINA
Lot Size (sq.ft.)
Zoning: WSP Applicant: HOMEWORKS ENERGY INC
Applicant Address Phone: Insurance:
235 ESSEX ST 781-205-4484 1847910
WHITMAN, MA 02382
ISSUED ON: 05/02/2023
TO PERFORM THE FOLLOWING WORK:
INSULATION/WETHERIZATI 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:
1 • )2 ��
I .
i
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax. (413)587-1272
Office of the Building Commissioner
FEE: $65.00 Pi.;i LT 193Z
Dep
er r; City of Northampton '' f R
fti F'` Y v) Building Department �y
4 , .* 212 Main Street MAY INSULATION
,`-t 3•F i,, ,, Northampton, MA 01060
,,r." phone 413-587-1240 Fax 413- 37-1272 ___ j +1 QJ _, Y
APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY
SECTION 1 -SITE INFORMATION INSULATION PERMIT
This section to be completed by office
1.1 Property Address:
Map Lot Unit
549 Park Hill Road Northampton MA 01062 Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Tina Ingmann 549 Park Hill Road Northampton MA 01062
Name(Print) Current Mailing Address:
See Attached (413)695-2127
Telephone
Signature
2.2 Authorized Agent:
Adam Glenn i 235 Essex Street, Whitman, MA 02382
Name(Print) Current Mailing Address:
781-205-4484
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 2,000 (a)Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) # 0�
5. Fire Protection
6. Total = (1 +2+3+4 +5) 2,000 Check Number f /6-3 2S
This Section For Official Use Only
A_ ] 55i Date
Building Permit Number: 6 °\� ' Issued:
Signature: // 6-z- 20 Z
3
Building Commissioner/Inspector of Buildings Date
wxpermitting @ homeworksenergy.com
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 4-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:Adam Glenn 106148
License Number
235 Essex Street, Whitman, MA 02382 07/30/2024
Addreroi\ Expiration Date
781-205-4484
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
HomeWorks Energy 181138
Company Name Registration Number
235 Essex Street, Whitman, MA 02382 03/02/2025
Address Expiration Date
9xi4) ✓�� Telephone 781-205-4484
SECTION 5-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 1 No ❑
Brief Description of Proposed Work
Residential weatherization/ Air sealing. No structural changes. SITE ID 4808106
Adam Glenn , as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Adam Glenn
Print Name ()alai\ ,,,..12;eid
4/24/2023
Signature of Owner/Agent Date
Tina Ingmann , as Owner of the subject
property
hereby authorize HomeWorks Energy
to act on my behalf, in all matters relative to work authorized by this building permit application.
See Attached 4/24/2023
Signature of Owner Date
City of Northampton
fir, Massachusetts
'
01-. 91
DEPARTMENT OF BUILDING INSPECTIONS
• P212 Main Street •Municipal BuildingNorthampton, MA 01060
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building
permit all debris resulting from the construction activity governed by this Building Permit shall be disposed
of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
549 Park Hill Road Northampton MA 01062
(Please print house number and street name)
Is to be disposed of at:
McNamara Waste Services LLC, 24 E Longmeadow Rd, Hampden,MA 01036
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
(A 4/24/2023
Signature of Permit Applicant or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
City of Northampton
tl,
•' Massachusetts �� x
a1 DEPARTMENT OF BUILDING INSPECTIONS
•
w "y 212 Main Street • Municipal Building
'y + Northampton, MA 01060 s -410 \
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation ("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes. Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing
at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered
Type of Work:Weatherization Est. Cost:2,000
Address of Work:549 Park Hill Road Northampton MA 01062
Date of Permit Application: 4/24/2023
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law(explain):
Job under$1,000.00
Owner obtaining own permit(explain):
Building not owner-occupied
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
4/24/2023 Adam Glenn 181138
Date Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
,..
.v.,„,,,, ,,,,,„. City of Northampton s . r�
r t It• Massachusettss..
' _ DEPARTMENT OF BUILDING INSPECTIONS y
/`ter' ii 212 Main Street • Municipal Building R-f
.-r'. Northampton, MA 01060 SdW 4,0%
MANDATORY FOR HOUSES BUILT BEFORE 1945
Property Address: 549 Park Hill Road Northampton MA 01062
Contractor
Name: HomeWorks Energy
Address: 235 Essex Street
City, State: Whitman, MA 02382
Phone: 781-205-4484
Property Owner
Name: Tina Ingmann
Address: 549 Park Hill Road Northampton MA 01062
City, State:
Adam Glenn (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 signaturecduA 130a,d- cte_
Date 4/24/2023
The Commonwealth of Massachusetts
Department of Industrial Accidents
3 _z = ' Office of Investigations
wlli
= Lafayette City Center
.•— t 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): HomeWorks Energy
Address: 235 Essex Street
City/State/Zip:Whitman, MA 02382 Phone #: 781-205-4484
Are you an employer? Check the appropriate box: Type of project(required):
I.0 I am a employer with 500+ 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. El New construction
2.El 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
workingfor me in anycapacity. employees and have workers'
p �' 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.*
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑ 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 Weatherization
employees. [No workers' 13.❑■ Other
comp. insurance required.]
*My applicant that checks box#I 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 job site
information.
Insurance Company Name: Federated Mutual Insurance Company
Policy#or Self-ins. Lic. #:#1847910 Expiration Date: 1/1/2024
Job Site Address: 549 Park Hill Road Northampton MA 01062 City/State/Zip:
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 und r the pains and permsilf es of perjury that the information provided above is true and correct.
Signature: �a'"4'J �' Date: 4/24/2023
Phone#: 781-205-4484
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. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing
Inspector 6. Other
Contact Person: Phone#:
E IMPANXINTYY)
ACCORD
CERTIFICATE OF LIABILITY INSURANCE 12/30/2022
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 POUCIES 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: CLIENT CONTACT CENTER
FEDERATED MUTUAL INSURANCE COMPANY PHONE 'FAX
HOME OFFICE: P.O.BOX 328 (A/C,No,EX1):888-333-4949 1(A/C.Not:507-446-4664
OWATONNA,MN 55060 EADDRESS:CLIENTCONTACTCENTER( FEDINS.COM
INSURER(SI AFFORDING COVERAGE NAIC#
INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 1't4'i5
INSURED 419-899-0 INSURER B:
HOMEWORKS ENERGY,INC. INSURER C:
101 STATION LNDG
MEDFORD,MA 02155-5134 INSURER O:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:0 REVISION NUMBER:1
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED Td THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT I(3R 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 ADOL SUBR POUCY NUMBER POUCY EFF POLICY EXP LIMITS
LTRINSR WVD IMMIDDPYYYY) IMMIDO,YYYY)
X COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE $1.000,000
CLAWS-MADE X OCCUR DAMAGE TO RENTED $100000
I PREMISES!Ea occurrence) ,
_ _
MED LOP(Any one person) EXCLUDED
A N N 1847909 01/01/2023 01/01/2024 PERSONALS ADV INJURY $1,000,000
XOA'L AGGRE E OMIT APPUES PER: GENERAL AGGREGATE $2,000,000
POLICYJECT ❑LDC PRODUCTS-COMMIE.AGG $2,000,000
OTHER:
AUTOMOBILE LIABIUTY COMBINED SINGLE UMIT $1,000,000
Ka ecddentl
X ANY AUTO
_ BODILY INJURY(Per person)
—
A OWNED AUTOS ONLY AUTOS OLED N N 1847908 01/01/2023 01/01/2024 BODILY INJURY(Per accident)
HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE
_AUTOS ONLY accident)(peraccident)
X UMBRELLA UAB X OCCUR EACH OCCURRENCE $1,000,000
A EXCESS UM CLAMS-MADE N N 1847911 01/01/2023 01/01/2024 AGGREGATE $1,000,000
DED 1 1 RETENTION
WORKERS COMPENSATION OTIE
AND EMPLOYERS'LIABILITY Y/N 1 X PER STATUTE ER
ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $500,000
n.n N 1847910 01/01/2023 01/01/2024 A OFFICER/MEMBER EXCLUDED? ---- -----
(Mandatory in NH) E.L DISEASE-EA EMPLOYEE $500,000
II yes.describe under I E.L DISEASE-POUCY LIMIT $5M� 0QQ DESCRIPTION OF OPERATIONS below
DESCRIPTION Of OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached)t more spate is required)
THIS COPY IS NOT TO BE REPRODUCED FOR ISSUANCE OF CERTIFICATES.
CERTIFICATE HOLDER CANCELLATION
01
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN
A CERTIFICATE HAS BEEN FILED WITH EACH OF YOUR CERTIFICATE ACCORDANCE WITH THE POUCY PROVISIONS.
HOLDERS. —...... . '
AUTHORIZED REPRESENTATIVE
O 1988-2015 ACORD CORPORATION.Al rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
Commonwealth of Massachusetts
it Division of Occupational Licensure Construction Supervisor Specialty
Board of Building Rt9ulaitians anti Stains/aids Rest,
id ed to
CSSL4C -,nsutation Contactor
Constructtiiil uperi tiff9c r Specialty
„:_ .y
CS St_-106148 r fib spires: 07/30/2024
ADAM GLEN) _ :.
19 CHARGE _
WAREHAM lA t:,r► .:
r
,r
?aaF Failure topossess a current edition of the Massachusetts
.v°14V ,'. State Ezuild,ng Code is cause forrevoration of this license
For information about this license
Call{61 7)727-3200 or visit www mass.gov/dp
Commissioner &Leila f°, Satsrtftit,
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
7'4
it ° %00 fir'...1.....,..... 471( it
� Type: Corporation
Ti HOME WORKS ENERGY, INC. =Z� Registration: 181138
= • Expiration: 03/02/2025
101 STATION LANDING STE 110 — � —•— r
MEDFORD, MA 02155 "" ONO de
a ..
t' _ ..t
1f...
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
181138 03/02/2025 Boston, MA 02118
HOME WORKS ENERGY, INC. ;3
ADAM GLENN :E
101 STATION LANDING S71-
/ c l., mGlo0°CC �1-3�' .c cif- �'�_-
MEDFORD, MA 02155
Undersecretary Not valid without signature
r ' GABIEE!END ,B�fR eta
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Page 1 of
tr-Ci))
HomeWorks 401101 Station Landing Ste 110,
mass save Medford,MA 02155
Energy PARTNER (781)305-3319
Customer Name:Tina Ingmann
Email: Not provided
Phone:413-695-2127
Premise Address:549 Park Hill Rd,Northampton,MA 01062
Mailing Address:549 Park Hill Rd,Northampton,MA 01062
Project ID:4817456
Date:April 19,2023
Job Description
Measure Description Location Quantity Unit Total Cost Customer Cost
Air Sealing at Estimated 62.5 CFM50 Per Hour Other 4 hr $377.32 $0.00
Door Sweep (with AS hrs) Other 4 each $104.44 $0.00
Exterior Door Weather Stripping (with AS hrs) Other 2 each $63.62 $0.00
Attic Floor- 10" Dense Pack Cellulose Other 68 SF $215.56 $53.89
Attic Floor-6"Open Blow Cellulose Other 352 SF $605.44 $151.36
Damming Other 40 each $98.00 $24.50
Recessed Light Enclosure Other 6 each $300.00 $0.00
Install Aluminum Soffit Vent Other 4 each $140.24 $35.06
Propavent Other 12 each $49.56 $12.39
Total Contractor Price and Payment Schedule
HomeWorks Energy, Inc.agrees to perform the abov esc ,ed work,furnishing the material and labor specified for the listed total
price. Payment of t tt ce oft s er contributi is expected upon completion of the work.
Customer Signature: _ _ g//4/12/143"
Customer Phone:
Specialist Signature: Date:
EOF
The prices and incentive n i ontra ar jec ange aao ance with o orm i ave Home Services Program offers.
Proposals con be sen nbox@HomeWorksEnergy.com
Page 2 of
liti
00111'1( HomeWorks may0 NR101 station tanding Ste 110.
ve
Medford,MA 02155
Energy PARTNER (781)305-3319
Customer Name:Tina Ingmann
Email:Not provided
Phone:413-695-2127
Premise Address:549 Park Hill Rd,Northampton,MA 01062
Mailing Address:549 Park Hill Rd,Northampton,MA 01062
Project ID:4817456
Date:April 19,2023
Project Total $1,954.18
Weatherization incentive ($831.60)
Air sealing incentive ($845.38)
Total Program Incentive -$1,676.98
Customer Total $277.20
Total Contractor Price and Payment Schedule
HomeWorks Energy, Inc.agrees to perform the abov described work,furnishing the material and labor specified for the listed total
price. Payment of th balance oft ustomer contribution is expected upon completion of the work.
Customer Signature:_ _ _ __ 4_ilZse3___
Customer Phone:
Specialist Signature: __ —
_ ___11 ate:
LIMI D TIME OOFff_ER
The prices and incentives in this contract are subject to change in accordance with the spon oring utility MassSave Home Services Program offers.
Proposals con be sent to:!nbox )HomeWorksE ergy.com