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34-007 (21) BP-2023-1468 158 TURKEY HILLRD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 34-007-001 CITY OF NORTHAMPTON Permit: Solid Fuel Appliance PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-1468 PERMISSION IS HEREBY GRANTED TO: Project# Contractor: License: Est.Cost: NORA WINE CSSL-106199 Const.Class: Exp.Date: 08/24/2024 WEINBERGER DOREEN A&CLAIRE Use Group: Owner: HUTTLINGER Lot Size (sq.ft.) MCKENNEY HEARTH&HOME/MCKENNEY Zoning: RR Applicant: ELECTRICAL CO INC Applicant Address Phone: Insurance: 100 NORTHAMPTON ST (413)586-5351 XWO2257872259. HOLYOKE, MA 01040 ISSUED ON: 10/20/2023 TO PERFORM THE FOLLOWING WORK: WOOD STOVE INSERT 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: $ • .; • .52 - Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner City of Northa ippa C 4" �'� Massachusetts / ~ � 1 sus, JrGl DEPARTMENT OF BUILDIN INS ECTIONa ' o r: 9 F r -<�r< 212 Main Street • Mun ipa1F�,-, - nq a Northampton, MA -'019,6Q4, (;p ii NA/ � l �°ti M SDP �j0 �3 ��-CO orospp4,S APPLICATION FOR SOLID FUEL APPLIANCE INS • - • ION Property Information Owners Name: C(,u4 rv {,�,� r Address: l --a4.A.A-y a (No.) CI (Street Address) Phone: L13.cl, G6 u 1 Cell: Email: • Date: c (? -r Z3 Contractor's Information (If Applicable) Name: Iil`lti-nr (e_<1Y\'z.,-(' Co_ 1(lc. Phone: 1113 Construction Supervisor's License #: CSSL- /o r'' Expiration: j Home Impr. Contractor License #: c 1,3 Y Expiration:—11c Stove Information Type of Fuel (check all that apply): Wood ✓ Pellet Coal Location: a_v. Freestanding Insert Manufacturer: Model: C1►� , --- ------_--------FOR BUILDING DEPARTMENT USE ONLY--- -------- ---- FP-I lLL L Permit# Date Applied: Total all Fees: $ 4" Building Official: 4 ! ?5 Date Issued: I/• ZO-20 23 (Print) "7"Z Signature of Building Official: The Commonwealth of Massachusetts 3_ Department of Industrial Accidents 9. _ i I^ Ofce of Investigations =�_— i' 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): McKenrey Electrical- Co Inc. - Address: 100 Northampton Street City/State/Zip: Holyoke, MA 01040 Phone#: (413) 536-5551 Are you an employer?Check the appropriate box: Type of project(required): 1.© I am a employer with 4 4. I am a general contractor and I 6. Li New construction employees(full and/or part-time).* have hired the sub-contractors 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. D Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp.insurance.: required.] 5. 0 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 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.®Other Solid Fuel comp.insurance required.] appliance install *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 ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Liberty Mutual Insurance Policy#or Self-ins.Lic.#: XWO(22)57 87 2259 Expiration Date: 07/2024 Job Site Address: /Si( !i.r X e,f 14 i)I \ 'C City/State/Zip: Rorer e e rM 19- Co 1 o 0., 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 i0 under the pains and penalties of perjury that the information provided above is true and correct Signatur' U9`' tA— Date: K ()73 Phone#: (413) 536-5551 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 3EICity/Town Clerk 4.0 Electrical Inspector 5EIPlumbing Inspector 6.DOther Contact Person: Phone#: I y.. II I Commonwealth of Massachusetts Division of Professional :_icensure {{' Board of Building Regulations and Standards } • - Const:ruct oi,5}7pervis" lr Specialty ;I .5. CSSL-106199 * �pires:08/02/2024 +I1 NORA E WINE 1r,., f r • 8 RUSSELLVIL•LE RD SOUTHAMPT0)1 MA 010 < - *° OJc :1(-1 Commissioner Gda Sj,sw, • THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affai gild Business Regulation 1000 Washingtotreet-Suite 710 Bosto 118 Home verxt Im roe e9istration �{{ 20Corporation0135 MCKENNEY ELECTRICAL CO,INC tt egis abon:Ration: 02105Y2025 D/B/A MCKENNEY HEARTH&HOME 1`':� 100 NORTHAMPTON STREET J HOLYOKE,MA 01040 w 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.f;Cdiporation Office of Consumer Affairs and Business Regulation Registrat er--,!=Exolration 1000 Washington Street-Suite 710 200$35 }" Boston,MA 02118 MCKENNEY ELECTRtCAL-CO-`INC D/B/A MCKENNEY HEARTht&HUMEI2 NORA WINE + ,� y 1 1 100 NORTHAMPTON STREET-` f;/ G„�<444-4e ,/ HOLYOKE,MA 01040 Undersecretary Not valid without signature Mc$eY e Contract Labor Agreement This agreement for contract labor services is made by and between: Contractor: Customer: McKenney Electrical Co. Inc. (jaiAe-9 CC en7er 100 Northampton Street Name /58 iClrky k9 Holyoke, MA 01040 Address(413) 536-5551 Gf/cr / V 0/O City, state, Zip Phone Number This contract is effective beginning ,/o74aW2-2) , and may be terminated by either Contractor and/or Customer without notice Description of Services: Install - labor: pellet/wood stove (Standard install). Deliver stove, install on hearth pad, or correct floor protection or inside an existing fireplace. Install required pellet/wood pipe or liner kit. Apply for Building permit. Properly grounded outlet must be located within 5' of stove location. I authorize McKenney Electrical Co. Inc. to install the pellet/wood freestanding/insert stove to the above address. They will install the stove/insert to building code and manual specifications. -d'I' '2-,-, A . (,-)z<-i-• k/o?00,2 3 Customer Signature Date .61,ile'd Y77ellAil_y kAl F I 2-0?_,3 Con tractor Name Date too Northampton Street,Holyoke, MA 01040 Find us Big P: (413) 536-5551 �uq Q ARE . ligkell/ Green on Facebook Egg info@mckenneyelectric.com NOTHING BURNS 11KE A QUAD www.mckenneyelectric.com