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03-027 (12) BP-2023-1134 595 COLES MEADOW RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 03-027-001 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-2023-1134 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 7000 SUPERIOR INSULATION 106237 Const.Class: Exp.Date: 06/15/2025 Use Group: Owner: G DENHART BRETT C&DEBORAH Lot Size (sq.ft.) Zoning: WSP Applicant: G DENHART BRETT C&DEBORAH Applicant Address Phone: Insurance: 595 COLES MEADOW RD NORTHAMPTON, MA 01060 ISSUED ON: 08/21/2023 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 VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: J . • AA Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner d� qGG FQ Af%uit-; Z603 1, The Commonwealth of Mass. us T 1 Board of Building Regulations and dsacik F e Massachusetts State Building Code, 780 i '<,'po,,�, r S ALITY c toffy 'VS. Building Permit Application To Construct,Repair,Renovate Or - ,.,•:y� Rev'.ed Mar 2011 One-or Two-Family Dwelling 'O60 '1'S IS This Section For Official Use Only Building Permit Number: N P 'd.3— 1139 Date Applied: 4,,,,„&:.... 8-z,..z-, Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Pro errtty Address: Q^��� 1.2 Assessors Map&Parcel Numbers I 1 rt Cotes Me01d ` 1.1 a Is this an accepted street?yes ✓ no Map Number Parcel Number 1.3 Zoning Information: N{ 1.4 Property Dimensions: NI 1 rs. Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) NI 101 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: NI rr Public 0 Private 0 N lei Zone: Outside Flood Zones Municipal 0 On site disposal system ❑ Check if yes❑ NFt SECTION 2: PROPERTY OWNRSHIP' Owner'of Record: Tent". eincur-1- Nor{h1ampror1, &AA o t oto a Name(Print) City,State,ZIP 515 Giles Meadow col• L l3- 321)-g054- 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 t Other gnSp Specify: M1(1 Air Brief Description of Proposed Work': r mu and ir �1`^- r, UJ4i G, SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ IWO 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fees: $ Suppression) ,�J Lei 6. Check N __ theck Amount: Lei 6.Total Project Cost: $ /0OD 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) I D� Z2-4 1 5 2-55 KL License Numbers Expi ation Da Name f SL Holder v 146 /-"r L r 1,y� List CSL Type(see below) "t r r � �� r ! Type Description So.and Street t p ytn tlIf i e ck I2 , O 7_9 , — U Unrestricted(Buildings up to 35,000 Cu.ft.) City/Town,State,rl ZIw4 t F `', R _ Restricted 1&2 Family Dwelling _ M Masonry C"r* J guipW ory s' . co m RC Roofing Covering WS Window and Siding -`11U t_ -1(' 1 t 1•t _ ? LA- F SF Solid Fuel Burning Appliances � � I 1 Insulation Telephone Email address D 1 Demolition 5.2 Registered yHome IImpprov ent Contractor(HIC) l 1.5 4' 1 5 ' zS en or I l 0� o� HIC Registration Number E iration ate IC y Name or HIC Registrant Name 1 � meter ri gG �..n . 3 Stpl✓Y'iDrtras . o• it tr t �� Ema address mt � IR-� Nail. -�I��u�?�-I Com City/Town,State, 1'P 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 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 ee a_-f1Qr^.ke to act on my behalf,in all matters relative to work authorized by this building permit application. 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 con ' ed in this appl' ation is true and accurate to the best of my knowledge and understanding. VDila Print w is or Aut rized Agent's Name(Electronic Signature) to 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" City of Northampton a[ A Mf>c,,, 0 i' Massachusetts k44-. k_ s�'. . e (d ,i (t $" DEPARTMENT OF BUILDING INSPECTIONS ;`. e g ` r `" 60 212 Main Street • Municipal Building OD �sv 1; Northampton, MA 01060 'r'.?JarD 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: 1�eDEitteirset_ri S1,,,,ii` l�'� leAd V--:1 The debris will be transported by: Name of Hauler: Ikerw-x-T..._rA5(A la Qn Signature of Applicant: 4,(A./CelDate: 5 The Commonwealth of Massachusetts --=� Department of Industrial Accidents z -I Office of Investigations 600 Washington Street .4 Si?mg ii, Boston, MA 02111 +'t`,= www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Superior Insulation, LLC _ Address: 140 Point Judith Rd,A7 City/State/Zip: Narragansett,RI 02882 Phone #: 401-515-4524 Are you an employer?Check the appropriate box: Type of project(required): 1.© I am a employer with 12 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. Ill New construction listed on the attached sheet. 7. ❑ Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' P tY 9. ❑ Building addition [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 13.x❑ Other Insulate 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 job site information. Insurance Company Name: Beacon Mutual Policy#or Self-ins. Lic.#: 67872 p,y�� Expiration Date: 8/2/23 Job Site Address: �'S CO\�5 M�SA�V(0 Pd. City/State/Zip: IV°r4ary} y iVA A. 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 underi the pains and penalties of perjury that the information provided above is true*� and correct. Signature: /1G4 L-0' /� Date: fi 10 6 Z� Phone#: 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#: i�....40 SUPEINS-01 MLONGOLUCCO '4�o CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 7/14/2023 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: Mansfield Insurance Agency Inc. PHONE Fax 115 High Street (A/C,No,Ext):(401)596-2096 I(A/c,No):(401)348-2060 Westerly,RI 02891 ADDRESS:info©mansfieldins.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Employers Mutual Casualty(EMC)Company 21415 INSURED INSURER B:Beacon Mutual Insurance Co. 30325 Superior Insulation LLC INSURER C:Evanston Insurance Company Michael O'Connor 140 Point Judith Road,Unit A7 INSURER D: Narragansett,RI 02882 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 LTR INSD WVD (MM/DD/YYYY1 IMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X x 6D23763 8/2/2023 8/2/2024 pREMISEs(OEa occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- LOC 2,000,000 JECT PRODUCTS-COMP/OP AGG $ OTHER:General Aggregate A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO X X 6B23763 8/2/2023 8/2/2024 BODILY INJURY(Per person) $ OWNED - SCHEDULED _ AUTOSO ONLY _ AUTOS SSWN BODILY INJURYp (Per accident) $ _ AUTOS ONLY AUUTOS ONLY (Per acEcident)AMAGE $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE X x 6N23763 8/2/2023 8/2/2024 AGGREGATE $ DED X RETENTION$ 10,000 $ 5,000,000 B WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N X 67872 8/2/2023 8/2/2024 500,000 OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Pollution Liability x x CPLMOL118083 7/6/2023 7/6/2024 Per Occurrence 250,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101 Additional Remarks Schedule,may be attached if more space Is required) Residential Insulation Contractor-14B Enterprise Lane,Smithfield,RI 02917 Pollution Liability Aggregate Limit$500,000 National Grid and all divisions are named as additional insured per written contract or agreement.Waiver of subrogation is provided in favor of National Grid and all divisions per written contract or agreement. Pollution Liability includes mold CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN National Grid 0 Sylvan Rd ACCORDANCE WITH THE POLICY PROVISIONS. 4Waltham,MA 02451 AUTHORIZED REPRESENTATIVE Norse lit.tor 444.•• ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Imo Commonwealth of Massachusetts ® Division of Occupational Licensure Board of Building Regulations and Standards Co nstructictorSu'1pe ibsgr Specialty CSSL-106237 Etpires:06115/2025 KYLE L LED4C 3750 DIAMONb HILL RD CUMBERLANI3 RI 02864 % • is Commissioner da t K. &maw- Construction Supervisor Specialty Restricted to: CSSL-iC•Insulation Contractor 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.govldpl THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affa0 and Business Regulation 1000 Washingtqa§irwt - Suite 710 Boston,-Massachusetts-_02118 Home Improvement a ,: -.sr Registration ,...,i'In .....,-"111111:.... -,---j, :„-(6- 1 r"' 1 ,`.' Type: Supplement Card -"' Registration: 175445 SUPERIOR INSULATION LLC. -= _�.� Expiration: 05/12/2025 140 POINT JUDITH RD UNIT A7 . .M ,�...,.. NARRAGANSETT, RI 02882 . .... f,,,, , ! -� t t S ._1 t/ lire.r MO /f'. . cf,s.,,ss ... ---7,: f l 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;_SurVeritent Card Office of Consumer Affairs and Business Regulation Registration- ==::Expiration 1000 Washington Street -Suite 710 1754415' 'T /12/2025 Boston, MA 02118 SUPERIOR INSULATION LL : tI --, KYLE LEDUC /' 140 POINT JUDITH RD OlNIT ..- a A. � ,,,,.n'CG.I/a NARRAGANSETT, RI 0288-,4--�;:,�,st,..! Undersecretary Not valid without signature _.w • CLEAResult CONTRACT CLEAResult 41 Brigham St., Customer Name:BRETT DENHART Marlborough,MA,01752 Email:bcdenhart@mac.com Phone:413-320-9057 Premise Address:595 Coles Meadow Rd,Northampton,MA 01060 Mailing Address:595 COLES-MEADOW RD LOT 5,Northampton,MA 01060 Project ID:4896955 Date:July 17,2023 Applicable Customer Required Actions: Notes: • Storage Removal -Remove boxes/storage in attic Job Description Contractor will perform or cause to be performed the following work on these"Premises"in a professional manner and in accordance with the terms of this Contract, including the attached recommendations/work order describing the work in detail(the"Work")which are incorporated herein by reference. Measure Description Location Quantity Unit Total Cost Customer Cost Attic Floor-6"Open Blow Cellulose 2121 SF $4,157.16 $1,039.29 Air Sealing at Estimated 62.5 CFM50 Per Hour 20 hr $2,131.80 $0.00 Recessed Light Enclosure 4 each $227.56 $0.00 Hatch-2"Thermal Barrier Polyiso 1 each $53.96 $13.49 Damming 68 each $189.04 $47.26 Vapor Barrier-6 mil Polyethylene(with AS hrs) 40 SF $47.20 $0.00 Total: $6,806.72 Program Incentive: -$5,706.68 Customer Total: $1,100.04 Payment Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows: Payment#1: as a Deposit payable to CLEAResult upon signing the Contract(not to exceed 1/3 of the total retail costs). Mail check&contract to CLEAResult,41 Brigham St., , Marlborough, MA,01752. Final Payment: as the final payment for the Work shall be payable to the Home Performance Contractor(HPC)or Independent Installation Contractor(IIC)upon satisfactory completion of the Work. Page 1 of 4 Document Ref:KRNMW-USXWU-U9YUN-oK3RJ Page 1 of 4 • Customer understands that he/she will not be required to pay the Utility Incentive Share of the Contract price in the amount of .Changes to individual line items and/or previous incentives may increase or decrease the size of the Utility Incentive Share. Dispute Resolution The IIC and Customer hereby mutually agree in advance that in the event that the IIC has a dispute concerning this Contract,the IIC may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and Customer shall be required to submit to such arbitration as provided in M.G.L.c 142A. You may cancel this agreement if it has been signed by a party at a place other than an address of the seller,provided you notify the seller in writing by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. j� n Bre�IflleathtQrf 07/27... Zl.•i/. Customer Signature Date Indicate your selected IIC here,if applicable Initial here if you want the Program to assign a Participating 61tti (tit, , lav 07/ 17... Kevin Cote CLEAResult Signature Date Name of CLEAResult Representative Page 2 of 4 Document Ref:KRNMW-USXWU-U9YUN-OK3RJ Page 2 of 4 • Permit Authorization mass save Form thro..gn energy c ic`ency Site ID: 4896955 Customer: BRETT DEN HART l� Brett Denhart , owner of the property located at: (Owner's Name,printed) 595 Coles Meadow Rd Northampton, MA 01060 (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. Owner's Signature: 8reff.Dafhart Date: 07 27... ••••••i•••••••i•Rl••••••/!•/•••••••••••••••l•/•/••s•ii••••••t•/••••• FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: 1//1 7c3 Participating Contractor Da e Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 For Office Use Cnly Document Ref.KRNMW-USXWU-U9YUN-OK3RJ Page 1 of 1