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16A-020-068 BP-2023-1528 504 FAIRWAY VILLAGE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 16A-020-068 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-2023-1528 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 1600 BRADSHAW ENTERPRISES LLC 108517 Const.Class: Exp.Date: 12/10/2024 Use Group: Owner: TRUST GOULD ARTHUR F&JUDITH S GOULD Lot Size (sq.ft.) Zoning: URA Applicant: BRADSHAW ENTERPRISES LLC Applicant Address Phone: Insurance: 246 CONNECTICUT AVE 413-310-8010 A0158300004 SPRINGFIELD, MA 01104 ISSUED ON: 10/30/2023 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHERIZATI 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: Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner REGEN ED , 1lUi� )9e7 The Commonwealth of Massac usett. Tf Board of Building Regulations and tand. ds 0 2 2023 F•R Massachusetts State Building Code, 80 C R IC PALITY U'E F 8 DING MA s80Gvise. A.ar 2011 Building Permit Application To Co struct,Repair, ' -no garpiSe t111'.AA._:� One-or _o-Famil Dwellin• This Section For Official Use Only Building ermit Number: 6- 0.1. Date Date Applied: dui Nu -77-Z 0-30-202_, Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 504 Fairway Lane,Leeds Ma 01053 NA 1.l a Is this an accepted street?yesYES no Parcel ID 1.3 Zoning Information: 1.4 Property Dimensions: NA NA NA NA 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 NA NA NA NA NA NA 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❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Judith Gould Leeds,Ma 01053 Name(Print) City,State,ZIP 504 Fairway Village 256-525-1861 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK' (check all that apply) New Construction 0 Existing Building 0 Owner-Occupied ® Repairs(s) 0 Alteration(s) 0 Addition El Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:_Insulation Brief Description of Proposed Work2Adding insulation to the attic.Air sealing wall plates Work Order attached. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 1600 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fees:$ Suppression) n- Check No.A 1C;heck Amoun LQ`' Cash Amount: 6.Total Project Cost: $ 1600 ❑Paid in Full 0 Outstanding Balance Due: Treasurer's Approval: _ Board of Health DPW Conservation Comm Approval: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS 108517 12/10/2024 SEAN MATTHEW BAILEY BRADSHAW License Number Expiration Date Name of CSL Holder 246 CONNECTICUT AVENUE List CSL Type(see below) U No.and Street Type Description SPRINGFIELD,MA 01104 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering Signature WS Window and Siding SF Solid Fuel Burning Appliances 413-301-8010 SEAN@BRADSHAWENTERPRISESLLC.COM I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 194456 02/07/2025 BRADSHAW ENTERPRISES,LLC HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name dorloop verified 246 CONNECTICUT AVENUE —CedrvOz(la1 10/24/2310:38AMEDT E8LL HH08.D%VJ-NDZO-GQ02 No.and Street Signature Email SPRINGFIELD,MA 01104 413-301-8010 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 8 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 to act on my behalf,in all matters relative to work authorized by this building permit application. Judith Gould Print Owner's Name 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 accura e to the best of my knowledge and understanding. d�� ZR U 10doop 10:8 AM EDT erified SEAN BRADSHAW K4GH-9UL3-BOVM-I66Q Print Owner's or Authorized Agent's Name 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 Official Website of the Executive Office of EOHED the E))vsion of Professional Licensure and the Division of Standards liar • Public Safety ,• • •-.. �u ome State A 'c,e5 b ` 17 Mass. . 1 Licensee Details Demographic Information Full Name: SEAN Matthew Bailey BRADSHAW Owner Name: License Address Information City: South Hadley State: MA Zipcode: 01075 Country: United States License Information License No: CS-108517 License Type: Construction Supervisor Profession Building Licenses Date of Last Renewal: 1/6/2023 Issue Date: 4128/2015 Expiration Date 12/10/2024 License Status: Active Today's Date: 1/9/2023 Secondary License Type: Doing Business As Bradshay.w Enterprises. LLC Status Change Reason. License Renewal Prerequisite Information No Prerequisite Information No Available Documents Close Window :ut t Commonwealth of lvtassachusett- Site Policies 1 Contact Us I E s i I Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC BRADSHAW ENTERPRISES, LLC Registration: 194456 Expiration: 02/07 246 CONNECTICUT AVE /� SPRINGFIELD, MA 01104 Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE: LLC before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 194456 02/07/2023 1000 Washington Street -Suite 710 BRADSHAW ENTERPRISES, LLC Boston,MA 02118 SEAN M.BRADSHAW 34 FRONT STREET , SPRINGFIELD,MA 01151 Undersecretary Not valid without signature dotloop signature verification:duo s/RpPP-6GzKdd8t • DEBRIS DISPOSAL. AFFIDAVIT In accordance with the provisions of MGL c.40,s.54,is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c.111, s.150A. ANY AND ALL DEBRIS PROUCED AS A RESULT OF WORK PERMITTED UNDER THE ATTACHED APPLICATION WILL BE DISPOSED OF IN: USA Waste Recycling Name of Licensed Solid Waste Disposal s/Facility 15 Mullen Rd, Enfield CT 06082 Address of Licensed Solid Waste Disposal Business/Facility USA Waste Recycling Name of Hauler Sean Bradshaw 9/20/2020 Print Applicant Name Date ❑ r,Sean Bradshaw do hereby certify under the pains and penalties of perjury that the Information provided above is true and correct,and that clicking this checkbox and typing my name in the,fiehl above will act as my signature. ���.40 BRADENT-01 BROOKE AFRO CERTIFICATE OF LIABILITY INSURANCE DA8/15/20 3TE YY) 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 I g ACT Brooke Barre Phillips insurance Agency,Inc. PHONE FAx 97 Center Street (A/c,No,Ext):(413)594-5984 (NC,No(413)592-8499 Chicopee,MA 01013 Mass;brookesaphillipsinsurance.com _ INSURER(S)AFFORDING COVERAGE NAIC# • INSURER A:Middlesex Insurance Company 23434 INSURED INSURER B:Sentry Insurance 24988 Bradshaw Enterprises,LLC INSURER C PO Box 944 INSURER D: Chicopee,MA 01021 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 R.EDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP UNITS LTR INSD WVD (MM/DD/YYYY1 i(MM/DD/YYYY1 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X A0158300 8J12/2023 8/12/2024 pREW SES(Ea occurrence) $ 500,000 MED EXP(Arty one person) S 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY X FRI: LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea esudern) $ X ANY AUTO X A0158300003 8/12/2023 8/12/2024 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ IRE foam �� AUTOS ONLY AUOTOS ONLY (Per acc dent) AGE $ S A X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE A0158300 8/12/2023 8/12/2024 AGGREGATE 44 2,000,000 DED X RETENTION$ 0 'S B WORKERS HANEEMOY 'LIABILITY X STATUTE_1 ER Y/N A0158300004 8/12/2023 8/12/2024 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ FFICER/M M EXCLUDED? Y N/A (Mandatory In NH) 1,000,000 EL.DISEASE-EA EMPLOYEE,$ If yes,describe under 1,000,000 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) Springfield Partners for Community Action,Inc:National Grid USA It's direct and Indirect parent and subsidiaries and affllliates;G.L.C.A.C,Inc.;and Eversource Gas of MA shall be named as Additional Insureds on the Commercial General Liability and Automobile Liability policies where required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE THEREOF, Springfield Partners for Community Action ACCORDANCE EXPIRAT(ON WITH TTHE ATE POLICY PROVIS ONSCE WILL BE DELIVERED IN 721 State Street Springfield,MA 01109 AUTHORIZED REPRESENTATIVE # ' 4 "34. inn,L,,<' ACORD 25(2016/03) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD e dotloop signature verification:uC.p.us/RpFp6GtK-Cd8t The Commonwealth of Massachusetts Deportment of industrial Accidents 1 Congress Street,Suite 100 C' K• >_ Boston!MA 021 1 4-201 7 -: Y'r. www.tnass.govfdio Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE HIED WITH THE PERMITTING AUTHORITY. Applicant Information Name{g�ness/Orgenisatienal/lndividual):Bradshaw Enterprises, LLC ___ 34 Front St Indian Orchard Mills Suite G60 any_ Springfield Address:State: MA Zip: 01051 Phone a: 413-250-4746 Are you an employer?Check the appropriate box: 1 1Type of Pr' t(regtdnd)t Ell. I am an employer with 11 ,employees(full and/or part time)• I 17. New construction n 2. I are a sole proprietor or partnership and have no employees working for roe in any 1-8. Remodeling capacity.{No workers'comp.insurance required.) t�-� I i9. Demolition 11 3. I am a homeowner doing ail work myself.(No workers'comp.insurance requlred)t tt 1110. Building addition 04. I am a homeowner and will be hiring contractors to conduct all work on my property. 11. Electrical repairs or additions I will ensure that all contractors either have workers'compensation insurance or are �-7 sole proprietors with no employees. I 112. Plumbing repairs or additions ❑5. I am a general contractor and I have hired the sub-contractors listed on the attached I 113. Roof Repairs sheet These sub-contractors have employees and have workers'comp.Insurance.± �� u6. We are a corporation and its officers have exercised their right of exemption per MGI. [ >14. Other c.152,§1j41,and we have no employees.[No workers'comp.insurance required.) • r Y 'Any applicant that checks box Cl must also WE out the section below showing their workers'compensation policy information. tHomeowners who submit this affidev,t indicating they ate doing all work and then hire outside contractors must submit a new affidavit indicating such. ±Contractors that check this box must attach an additional sheet showing the name of the st -contracto s and state wnetner or not those entities have employees.if the sub-contractors have employees,they mutt provide their workers'comp.policy number. I on,an employer that is providing workers'compensation insurance for ray employees. Below is the policy and job site information. Insurance Company Name: Sentry Insurance (Agent- Phillips Insurance 413-594-5984) Policy u or Salt-Ins.(lc.N: A0158300004 at 8/12/2024 bn Date: Job Site Address: Attatih a copy of the workers'compensation policy declaration page(showing the policy number 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 or the DIA for insurance coverage verification. Lv] I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct,and that clicking this rheckbax and typing my name in the field below will act as my signature. Name: Sean Bradshaw Data: 9/29/20 none d 413-250-�4746 ,sean'c�bradshawenterprisesic.com 1.0. 11 Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Regulations and Standards -, . i It ConsT.ictionSup, visor CS-108517 ; s Opires : 12/10/2024 BEAN MA 'IN BAILE'V r Dom!' ►HAW I r . IP igh "N lirlir /1%1(0 %. commissioner Occet K. L.Luks. 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. Crtr irwf,%w-wv +i1r1 ah,iu ir+ •h.c Iinonc© Call (617) 727-3200 or visit wnn w.mass.govldpl Permit Authorization mass save Form Site ID: 4900882 Customer: JUDITH GOULD Judith Gould , owner of the property located at: (Owner's Name,printed) 504 FAIRWAY VL LEEDS, MA 01053 (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. 6thid Owner's Signature: �t� aOZ{ Date: 07 / 31 / 2023 ••••••••••••••••••••••••••••••••••••••••••••i•••••••••••••••••••••••• FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 For Office Use Only CLEAResult CONTRACT CLEAResult 41 Brigham St., Customer Name:JUDITH GOULD Marlborough,MA,01752 Email:arthrgld@gmail.com Phone:256-525-1861 Premise Address:504 FAIRWAY VL,LEEDS,MA 01053 Mailing Address:504 FAIRWAY VL,Leeds,MA 01053 Project ID:4900882 Date:July 20,2023 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. Air Sealing at Estimated 62.5 CFM50 Per Hour 1 hr $106.59 $0.00 Rim Joist-2"Thermal Barrier Polyiso 14 SF $77.28 $19.32 Exterior Door Weather Stripping (with AS hrs) 2 each $72.64 $0.00 Damming 18 each $50.04 $12.51 Attic Floor-5"Open Blow Cellulose 704 SF $1,316.48 $329.12 Total: $1,623.03 Program Incentive: -$1,262.08 Customer Total: $360.95 Payment Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows: Payment#1:$120.00 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:$240.95 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. Customer understands that he/she will not be required to pay the Utility Incentive Share of the Contract price in the amount of $1,262.08. 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 DC 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. Page 1 of 4 Jt(eIN C7otitd 07 / 31 /2023 J G• Customer Signature Date Indicate your selected IIC here,if applicable Initial here if you want the Program to assign a Participating Contractor 6A.41A. C4 7/20/2023 Kevin Cote CLEAResult Signature Date Name of CLEAResult Representative Page 2 of 4