38C-003 (7) BP-2024-0270
194 GROVE ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38C-003-001 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-2024-0270 PERMISSION IS HEREBY GRANTED TO:
Project# INSULATION 2024 Contractor: License:
Est.Cost: 3214 HB SANTOS CORP 118463
Const.Class: Exp.Date: 08/29/2026
Use Group: Owner: GEIS BENTON DOUGLAS M&KATE J
Lot Size (sq.ft.)
Zoning: URB Applicant: HB SANTOS CORP
Applicant Address Phone: Insurance:
30 PROSPECT ST#2 WCMA000373901
WEYMOUTH, MA 02188
ISSUED ON: 03/14/2024
TO PERFORM THE FOLLOWING WORK:
INSULATION/WEATH ERI 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:
f:(2
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
•
�,� 4,,----;:-..„,,,, Dep
C
„�nsr4l' City of Northampton 44/7 - , �
Building Department /a�
> lip' 212Main Street�0T���� ('i p INSULA TION
, .,4...a Room 100 ti4, /) , •
"`' Northampton, MA 01060 � of:/,^'sp /
"-y'� phone 413-587-1240 Fax 413-5$7-1���°�so� / ONLY
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
CA L\ G�VONR \--Nr-CAMap Lot Unit
Zone Overlay District
Elm St. District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
D �)\a_) -�'C '� \C\y b Y(�\L-e (�-t-
rind Tr t a'' ddr /^�0 (\ ( ,-, ( 0
Te ep one
Signature
2.2 Authorized Agent: Q , l ( , Q,� 1(�
Luis C. Dos Santos/H Sant s Corp. ��bS? --r @'1Nt�I MC) v ` ` ',` ' F
Name( rint Current Mailing ddress:
(508)840-8338
Signature Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building $1)D2\A ` \A (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
)1*LO4
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) V52A , \ c - CheckNumber 01
This Section For Official Use Only
Building Permit Number:, g 4/A70 Date
Issued:
Signature: 7 3-0- 2O2 1
Building Commissioner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 4-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: Luis Claudio Dos Santos CS-118463
License Number
100 Mediterranean Drive#22 Weymouth,MA 02188 08/29/2026
Addr¢s —� Expiration Date
Sign ure Telephone
9.Realstered Home Improvement Contra tor: Not Applicable 0
\\, SW1 5 C y\ ° 203195
Company Name Registration Number
\ 1 V CA S\ u L-- A\Rr '1 t�� cL.\( )V 09/21/2025
Address ` CS(� 31 —36Expiration Date
hbsantoscorp@gmail.com Telephone
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 X No 0
Brief Description of Proposed Work NOTE: INSULATION ONL Y
•
P0c1C \ C t C\C caw\ Spo.0? , bcA -cp) Qtc-Nrk
s\ \ \\Thv\ o\ G r\
I, I ilk C nnc Rantne
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.
LuSo C�A'(�
Print Name
M Oj\ 6\-Zv-2-C\
Signature of r/t\ lAgent / Date
'C -
I, \v \ Ci t ' I l \ , as Owner of the subject
property U
hereby authorize l ,u \S1 C i akS ,C C tC2-C
to act on my behalf, in all m ers relative to work authorized by this uilding permit application.
OD\\u\7)3-2A
Signature of Owner Date
City of Northampton
oat ,.. S • S
"r.r.. ti,. SV
!j µ Massachusetts �v?
1 ".4.. ` DEPARTMENT OF BUILDING INSPECTIONS
w 212 Main Straat •Municipal Building '"),y .:
rAOP
." Northampton, MA 01060 ° rp. ..,1�
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:
\c\A bivuNt . Scee-1/4
(Please print house number and street name)
Is to be disposed of at:
Trojan Recycling Inc 71 Forest Street Brockton.MA
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
CL\J) '-/KID
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.
The Commonwealth of Massachusetts
Department of Industrial Accidents
=i=/];1= 1 Congress Street,Suite 100
_AL
Boston,MA 02114-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Leeibly
Name(Business/Organization/Individual): HB Santos Corp.
Address: 30 Prospect Street#2
City/State/Zip: Weymouth,MA 02188 Phone#: (5os)840-8338
Are you an employer?Check the appropriate box:
Type of project(required):
I.®I am a employer with 3 employees(full and/or part-time).* 7. ❑New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
r a I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
10 Q Building addition
4❑I am a homeowner and will be hiring contractors to conduct all work on my propc.ty. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees.
12.0 Plumbing repairs or additions
5❑i am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.EiRoof repairs
these sub-contractors have employees and have workers'comp.insurance.:
6.0 We arc a corporation and its officers have exercised their right of exemption per MGL c 14.®Other Insulation
152,§1(4),and we have no 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.
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 nun-ter.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: Tobman Partners Insurance Agency
Policy#or Self-ins.Licitn#: WCMA000377339011 Expiration Date: 01/06/2025
Job Site Address:\QVl C'1`&� 4 .A , City/State/Zip: (1(A1( n '(1,mP
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expirati date). to\bu
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 of the DIA for insurance
coverage verification.
I do hereby certify under the inns and penalties of peryuty that the information provided above is trueand(correct.
Signature; 0 \`1 V\7 or v7-"
Phone#: (608)840 8338
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#:
b�,r,X� City of Northampton
Massachusetts tip-\
'3 DEPARTMENT OF BUILDING INSPECTIONS i
•
'�;I� 212 Main Street • Municipal Building �j
(, Northampton, MA 01060 �� `.
MANDATORY FOR HOUSES BUILT BEFORE 1945
Property Address:
Contractor
Name: HB Santos Corp.
Address: 30 Prospect Street#2
City, State: Weymouth,MA 02188
Phone: (508)840-8338
Property Owner /� � Y
Name: ((��'\�� V�J�``\;a", n- u n
Address: \"�`-� ( J \ A
City, State: c� ( () O\ b`O N
I, HB Santos Corp. (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 signature crt,c/Y\`-/c
Date �\\ 0\f)___C\ 2_
WEATHERIZATION CONTRACT EVERS=URCE
CUSTOMER PHONE DATE CLIENT WORK ORDER
Douglas Benton (860) 249-9686 01/07/2024 557765 10302
SERVICE STREET BIWNG STREET PROPOSED BY:
194 Grove Street 194 Grove Street Ray Dickson
SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Program
Northampton, MA 01060 Northampton, MA 01060 EGMA-HES Page 1
DESCRIPTION QTY COST INCENTIVE TOTAL
INCENTIVE 75%
For eligible weatherization measures, Eversource is offering an
incentive of 75%for insulation measures and 1006/0 for the air sealing
measures, both with no limit.You are eligible to apply for the 0%Heat
Loan to finance your co-pay, applications must be submitted before
the weatherization work begins.
HOME AIR SEALING 6 $639.54 $639.54
Seal areas of your home against wasteful, excessive air leakage.
Materials to be used to seal your home can include caulks,foams
and other products. Primary areas for sealing include air leakage to
attics, basements, attached garages and other unheated areas
(windows are not generally addressed.)
TRANSITIONS 4 $29.92 $29.92
Provide labor and materials to air seal the transitions of your home
against wasteful,excess air leakage.
WEATHERSTRIP DOOR 4 $145.28 $145.28
Provide labor and materials to install Q-lon weatherstripping to
door(s)to restrict air leakage.
DOOR SWEEP 3 $88.98 $88.98
Provide labor and materials to install a doorsweep to restrict air
leakage.
ATTIC DAMMING 40 $111.20 $83.40 $27.80
Provide labor and materials to install an approved damming material
in the attic
ATTIC FLAT- 10"OPEN R-37 CELLULOSE 350 $826.00 $619.50 $206.50
Provide labor and materials to install a 10"layer of R-37 Class I
Cellulose to open attic space.
RECESSED LIGHT COVERS 2 $113.78 $113.78
Install recessed light covers over existing recessed light fixtures. Up
to 6 at no cost.
DOOR- INSULATE RIGID BOARD 1 $103.05 $77.29 $25.76
Provide labor and materials to insulate the back of a door with 2"rigid
insulation board.
PULL-DOWN STAIR-THERMADOME 1 $313.63 $313.63
Provide labor and materials to install an easily moved, insulating
cover for the attic access folding stair. The cover has integral weather-
stripping to restrict air leakage.
WEATHERIZATION CONTRACT EVERS=URCE
CUSTOMER PHONE DATE CUENTN WORK ORDER
Douglas Benton (860) 249-9686 01/07/2024 557765 10302
SERVICE STREET BILUNG STREET PROPOSED BY,
194 Grove Street 194 Grove Street Ray Dickson
SERVICE CITY,STATE,ZIP BILUNG CITY,STATE,ZIP Program
Northampton, MA 01060 Northampton, MA 01060 EGMA-HES Page 2
DESCRIPTION QTY COST INCENTIVE TOTAL
COMMON WALL-2" RIGID BOARD 80 $439.20 $329.40 $109.80
Install 2"rigid board to a common wall area.All seams will be sealed
with tape.
BASEMENT SILLS- RIGID BOARD INSULATION 20 $110.40 $82.80 $27.60
Provide labor and materials to install rigid board insulation to the
perimeter of the basement ceiling at the house sill.
CRAWLSPACE-6 MIL POLY GROUND COVER 80 $94.40 $94.40
Provide labor and materials to install 6 ml or greater polyethylene over
open ground in designated crawlspace/earthen basement areas.
VENT BATH FAN TO ROOF OR OTHER 1 $166.53 $124.90 $41.63
Install an insulated exhaust hose to a flapper vent to exhaust existing
bathroom fan(s). Fan will be vented through the roof or an acceptable
alternative if contractor cannot vent through the roof.
INSULATED BATH EXHAUST HOSE 4 INCH 1 $32.23 $24.17 $8.06
Provide labor and materials to install an insulated 4"exhaust hose to
existing bathroom fan(s).
Total: $3,214.14
Program Incentive: $2,766.99
Client Total: $447.16
I.DESCRIPTION OF WORK TO BE PERFORMED
Contractor will perform or cause to be performed the above work at the Client's Address in a professional manner and in accordance with the terms of this Contract;
R.PAYMENT
Client agrees to pay the Contractor for the Work,the Client Share of the Contract Cost is payable to the Independent Installation Contractor(IIC)upon satisfactory completion
of the Work.Client understands that they will not be required to pay the Program Incentive Share of the Contract cost.Changes to the individual line items and/or previous
incentives may increase or decrease the size of the Program Incentive Share.
gr9 2 Oou r 8eufjna
RISE Representative Client Signature
Ralean Dickson 01-08-2024
Printed Name Date of Acceptance
A4t
mass save
Savings through energy efficiency
PERMIT AUTHORIZATION FORM
I, Douglas Benton owner of the property located at:
(Owner's Name)
194 Grove Street Northampton
(Property Street Address) (City)
hereby authorize the Mass Save® Home Energy Services Program assigned Participating
Contractor to act on my behalf and obtain a building permit to perform insulation and/or
weatherization work on my property.
This form is only valid with a signed contract. The permit will be secured by the
subcontractor, at no additional cost.
..,PeN6,-rel3ezo,v
01-08-2024
Date
FOR OFFICE USE ONLY
We have assigned the following Mass Save Home Energy Services Participating Contractor
to the above referenced project:
HB Santos Corp. 03/01/2024
Participating Contractor Date
RISEClient# 557765
°COMPANY Work Order# 10302
RISE Rep: Ray Dickson Name: Douglas Benton
DESCRIPTION Qty Notes
1 HOME AIR SEALING 6
2 TRANSITIONS 4
3 WEATHERSTRIP DOOR 4
4 DOOR SWEEP 3
5 ATTIC DAMMING 40
6 ATTIC FLAT-10'OPEN R-37 CELLULOSE 350
7 RECESSED LIGHT COVERS 2
8 DOOR-INSULATE RIGID BOARD 1
9 PULL-DOWN STAIR-THERMADOME 1
10 COMMON WALL-2'RIGID BOARD 80
11 BASEMENT SILLS-RIGID BOARD INSULATION 20
12 CRAWLSPACE-6 MIL POLY GROUND COVER 80
13 VENT BATH FAN TO ROOF OR OTHER 1
14 INSULATED BATH EXHAUST HOSE 4 INCH 1
12
ib 2V!
1
4C 1` 0 4
10
tE 0 1€
,r
H 1 attic common wall
0
�--=-
A recessed lights
AF 10" OB
BF
1 �� �