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37-108 (4) BP-2023-1560 50 ICE POND DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 37-108-001 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-2023-1560 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 5000 BRADSHAW ENTERPRISES LLC 108517 Const.Class: Exp.Date: 12/10/2024 Use Group: Owner: CARUNER, JORDAN &D'ANGELO, HEATHER Lot Size (sq.ft.) Zoning: SR Applicant: BRADSHAW ENTERPRISES LLC Applicant Address Phone: Insurance: 246 CONNECTICUT AVE 413-310-8010 A0158300004 SPRINGFIELD, MA 01104 ISSUED ON: 11/06/2023 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHERIZATION 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: cn\ehrtA.,_ cpit Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner RECE V e._.D „cr zcby The Commonwealth of Massachus: s Board of Building Regulations and Sta dard. FO' Massachusetts State Building Code,78 I CM• NOV — 3 20, M CIF"LITY US; Rev„ed 'r2011 Building Permit Application To Construct,Repair,R nova 'ke tsno r9�sa: TioNs One-or Two-Famil Dwellin. THAMnTON.MA O 060 This Section For Official Use Only Buildin Permit Number: 4649- Date A lied: -V00 /1 I/ G-Zdz3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 50 Ice Pond Drive,Northampton Ma 01062 NA l.la 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 0 On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Heather Dangelo Northampton,Ma 01062 Name(Print) City,State.ZIP 50 Ice Pond Drive 413-214-2687 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied ® Repairs(s) 0 Alteration(s) 0 Addition 0 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 $ 5000 1. Building Permit Fee:$ Indicate how fee is determined: - 0 Standard City/Town Application Fee 2.Electrical $ 0 Total Project Costa(Item 6)x multiplier x 3.Plumbing $ _ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Total All Fees:$ Suppression) /� Check No 1 Check Amount: 6.l Cash Amount: 6.Total Project Cost: $ 5000 0 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 List CSL Type(see below) U 246 CONNECTICUT AVENUE No.and Street Type Description l l Unrestricted(Buildings up to 35,000 cu.IL) SPRINGFIELD,MA 01104 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofmg Covering SignatureWS 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 dod p verified PM EDT ESLL 246 CONNECTICUT AVENUE -� 8� o/ 8CXA-XUGA-7FMX-EBEN 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. Heather Dangelo 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. O dodoo2verified SEAN BRADSHAW SeaU /23 12:05 PM EDT HFPA MOR7-GL6B-YGIP 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" CLEAResult CONTRACT CLEAResult 41 Brigham St., Customer Name:HEATHER DANGELO Marlborough,MA,01752 Email:cardunerfamily@gmail.com Phone:413-214-2687 Premise Address:50 Ice Pond Dr,Northampton,MA 01062 Mailing Address:50 ICE-POND DR,Florence,MA 01062 Project ID:4931889 Date:Sept.12,2023 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 12 hr $1,279.08 $0.00 Door Sweep(with AS hrs) 3 each $88.98 $0.00 Exterior Door Weather Stripping(with AS hrs) 3 each $108.96 $0.00 Duct Sealing-8 Hours(insulated,up to 200') 1 each $785.12 $0.00 Propavent 76 each $355.68 $88.92 Damming 24 each $66.72 $16.68 Attic Floor-6"Open Blow Cellulose 1216 SF $2,383.36 $595.84 Total: $5,067.90 Program Incentive: -$4,366.46 Customer Total: $701.44 Payment Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows:Payment#1:$233.81 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:$467.63 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 $4,366.46.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. Page 1 of 4 /, '' 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. .ItE47IffR IMNGELO 09/ 13/2023 Customer Signature Date Indicate your selected IIC here,if applicable Initial here if you want the Program to assign a Participating Contractor bL (Aft, 09/ 12/2023 Kevin Cote CLEAResult Signature Date Name of CLEAResult Representative Page 2 of 4 Document Ref ZDNOY-LQFSM-SY346-D59ZT ��' Permit Authorization mass save Form Site ID: 4931889 Customer: HEATHER DANGELO Heather DAngelo I, , owner of the property located at: (Owner's Name,printed) 50 Ice Pond Dr Northampton, MA 01062 (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. -l54r#ER D4NGELo Owner's Signature: Date: 09 / 13 / 2023 ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 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 Orly The Official Website of the Executive Office of EDHED the Dvsion of Professional Licensure and the Division of Standards leer • Public Safety • • Mass v Home Ssste ti ny,- � Mass. r«" 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-1085 t 7 License Type: Construction Supervisor Profession Building Licenses Date of Last Renewal: 1/6/2023 Issue Date: 4:28.20 t 5 Expiration Date: 12/10/2024 License Status: Active Today's Date: 1/9/2023 Secondary License Type: Doing Business As Bradsnx4,, Enterprises LLC Status Chan a Reason:. License Renewal Prerequisite Information No Prerequisite Information No Available Document.s Close Window ©2011 Commonwealth of Massachusetts Site Policies i Contact Us I 0 F a Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC Registration: 194456 BRADSHAW ENTERPRISES, LLC Expiration: 02/07411111 246 CONNECTICUT AVE SPRINGFIELD, MA 01104 Update Address and Return Card. Office of Consumer Affairs do 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:oup.,u4irf P rib.•K-Cc75t . 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 /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 ❑ I,Sean Bradshaw do hereby certify under the pains and penalties of parjary that dee information provided above is true and corm,and that clicking this checkbauc and typing my name in the field above will act as orgy signature. BRADENT-01 BROOKE ARL . CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDYYYY) 8/15/2023 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 LN¢(�2�NTACT Brooke Barre AME: Phillips Insurance Agency,Inc. PHONE FAx 97 Center Street �(A c,No,Ext):(413)594-5984 (A/c,No):(413) 592-8499 Chicopee,MA 01013 nI �� brooke@phillipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# iwsuRERA:Middlesex Insurance Company 23434 INSURED INSURER B:Sentry Insurance 24988 Bradshaw Enterprises,LLC INSURER C;_ PO Box 944 INSURER 0: 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 REDUCED BY PAID CLAIMS INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POUCY EFF POLICY EXP LIMITS LIR INSD WVD IMM/DD/YYYYI IMM/DDJYYYYI A x COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE S CLAIMS-MADE X OCCUR X A0158300 '. 81 2/2023 8/12/2024 pREM SESO(Ea ouu ante) $ 500,000 MED EXP(Any one person; S 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 3,000,000 POLICY X JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO X A0158300003 8/12/2023 8/12/2024 BODILY INJURY(Per person) $ OVVNED SCHEDULED AUTOSRE� ONLY AUTOS BODILYBODILY INJURY(Per accident) $ AUTOS ONLY AUUTOS ONL� (Per PROPERTY $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE A0158300 8/12/2023 8/12/2024 AGGREGATE $ 2,000,000 DED X RETENTION 5 0 $ B AND EMPLOYRKERS OERS'LIABILITY MPENSATION X PER H :.-STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN /A A0158300004 8/12/2023 8/12/2024 1,000,000 OFFICER/MEMBER EXCLUDED NE.L.EACH ACCIDENT $ (Mandatory In NH) E L DISEASE-EA EMPLOYEE $ 1,000,000 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 affilliates: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 ringfield Partners for Community Action THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Sp Sp State Street ACCORDANCE WITH THE POLICY PROVISIONS. 72Springfield, MA 01109 AUTHORIZED REPRESENTATIVE z'er.7.7 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD dotloop signature verification:dtip.us/tprP•6GzKdd8t The Commonwealth of Massachusetts Deportment of Industrial Accidents y 1 Congress Street Suite 100 Fl. Boston,MA 02114-2017 •'y,. ;se www.mass.gov/dio Workers'Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Name jBusrness/th;anizational/Individual):Bradshaw Enterprises, LLC Address: 34 Front St Indian Orchard Mills Suite G60 sty: Springfield State: MA Lip: 01051 Phone$: 413-250-4746 Are you an employer?Check the appropriate box: Type of pro)eet(required): ki(I1. am an employer with 1 1 employees(full and/or part timer 7. New constrt.cuoi 12. I am a sole proprietor or partnership and have no employees working for me in any —18. Remodeling capacity.jNo workers'comp.insurance required.) 1 19. Demolition 3. I am a homeowner doing all work myself.[No workers'comp.insurance requlred)t 1-110. Building addition ri4. I am a homeowner and will be hiring contractors to conduct air work on my property. rill. Electrical repairs or additions I will ensure that all contractors either have workers'compensation Insurance or are sole proprietors with no employees. 2. Plumbing repairs or additions Li5. I am a general contractor and I have hired the sub-contractors listed on the attached 1111 111113. Roof Repairs sheet. These sub-contractors have employees and have workers'comp.insurance.# �� I16. We are a corporation and its officers have exercised their right of exemption per MGt. i. 14. Other c.152,§T(4),and we have no employees.[No workers'comp.insurance required.] •lt "Any applkart that checks basal must also be out the section below showing their workers'compensation policy Information. relomernmers who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. IContracters that check this box must attach an additional sheet showing the name of the sub-contractors and state wttetner or riot those entities have employees.If the sub-contractors have employees,they must provide their workers'comp policy number. lam en employer that Is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Sentry Insurance (Agent- Phillips Insurance 413-594-5984) Policy u or Setf-Ins.l.ic.u: A0158300004 8/12/2024 Expiration Date:Job Site Address. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGI.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 of the DIA for insurance coverage verification. 1171 I do hereby certify under the pains and penalties of perjury that the information provided above Is true and correct,and that clicking this rheckbnx and typing my name in the field below will act os my signature. Name: Sean Bradshaw Date: 9/29/20 Phone lt: 413-250-4748 Email:sean@bradshawenterprisestic.com .._ Commonwealth of Massachusetts aliti c Division of Occupational Licensure Board of Building Re ulations and Standards l ItConstctkhonS5p, visor tki.s.:. 4.4 tt i CS-108517 4,v . , 1spires : 12/1OI2O24 SEAN MATTNEW BAILEY �.: DSHAW " .r' ? ice, • _ l 4?A i 4) ' 1 I.id V tt A !b. ' : commissioner 611ag,la K. & icb ,, 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 irifr►rsin +inh about this 1i,arices Call (617) 727-3200 or visit wv# w.rnass.gov/dpl