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39A-075 (2) R L ' , ,.,. November 19, 2012 Mr. Louis Hasbrouck Building Commissioner City of Northampton 212 Main Street Northampton, MA 01060 Dear Mr. Hasbrouck I request that you grant a modification to waive the requirement for controlled construction for the insulation and weatherization of 35 Fruit Street (8 buildings total) because the work is of a minor nature, will not affect health, accessibility, life and fire safety, or structural requirements and is impractical in that the cost of controlled construction is considerable when compared to the cost of the proposed work. Please accept this stamped letter as an indication of my support for this request. Thank you for your consideration. Sincerely, 0A ��,�0 o Are y If (/ e.,,,Wri . i : s' S ', a o No. 10731 ti ! N ORTH EASTON, ; Wayne E. Benson, Jr. RA a �, - . ' ` ' : � Ix IA President RKB Architects .� —'^tf ADVAN -8 OP ID: PS ACCORD" DATE IMM /DDNYYY) k CERTIFICATE OF LIABILITY INSURANCE 06/21/12 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 be endorsed. If SUBROGATION 1S WAIVED, subject to the terms and condltions of the policy, certaln poiicies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). ONACT PRODUCER 781-642-9000 N C AM T E, Eastern States Insurance 1 781 647.3670 PHDNE . , Ext L FAX Agency, Inc. ,-(NC No 50 Prospect Street A DRESS: Waltham, MA 02453 INSURER(S) AFFORDING COVERAGE NAIC 11 INSURER A; Liberty Mutual Insurance Co. T INSURED Advantage Weatherization, Inc. INSURER B : Berkley Assurance Co 1150 West Chestnut Street INSURER c : Navigators Insurance Company Brockton, MA 02301 INSURER 0 ; _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 ADDL SUER POLICY EFF POLICY EXP : LTR TYPE OP INSURANCE INSR WUh POLICY NUMBER (MMIDD/YYYY) (44M(DDIYYYYI LIMITS GENERAL LIABILITY EACH O $ 1,000,000 i . B X COMMERCIAL GENERAL LIABILITY VUMA0000891 04/02112 04102113 PREMISES (Ea occurrence) $ 50,000 I CLAIMS -MADE X OCCUR MEDEXP (Any one person) $ 5,000 f PERSONAL &ADVINJURY $ 1,000,000 I GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/DP AGG $ 2,000,000 1 POLICY 1 ri LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000000 (Ea acc ;dent) $ r A ANY AUTO ASJ -Z11. 281011.032 06/20/12 06/20/13 BODILY INJURY (Par parson) $ OINNED X AUTOSULED BODILY INJURY (Peracoidenl) $ NON - OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS (Par accident) l - $ UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 0,000,000 A X EXCESSLIAB CLAIMS -MADE THC -Z91- 261011 -042 06/20/12 06/20/13 AGGREGATE $ 5,000,000 DED t I RETENTION$ $ WORKERS COMPENSATION STATUU• OTH- WC AND EMPLOYERS' LIABILITY X TORY LIMITR I ER Y/N A ANY PROPRIETOR /PARTNER/EXECUTIVE WC1-Z11.261011 -012 06/20/12 06/20/13 E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? n N/A (Mandatory In NH) E.L. DISEASE • EA EMPLOYEE $ 1,000,000 I( yy ees, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Excess Liability NYIIEXC71193IV 06/20/12 06/20/13 Excess 10,000,000 Excess 5 Million 5 Million DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Romarks Schoaule, 0 more space le required) CERTIFICATE HOLDER CANCELLATION EVIDENC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. — AUTHORIZED REPRESENTATIVE l © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 1 t • The Commonwealth ofMassachusetts , • _;�_. - D. eparttttentofIitdristt 'tatrAccidertts . • ' rj =Trip-- Vt • Office of Investigations y • • 600 Washington Street • . € 1411=7"..- f ti Boston, t 02xzx .. =�,�r► www.rttass.gov /rile, • • Workers' Compensation Insurance Affidavit: Builders / Contractors(CIectlic1ans /Plumbers • . ,Applicant Information Please Print Legibly Name ( Buainesslotgaulza /rt •' C�\tv - cdc\o �CC��c�2r zf. -�- \. \nom • • • Q • '.A.ddress :; ` \\ J \l. \ • (' by r Lk\• "j > mil,\ • ' ' • . City /State/Zip: .. '`';^ . 1( � u\ Phone.# c-��'i 5 \u 1 V Q,t,, C'S.1 . . • Are you an employer? Check the appropriate box! , ' of project (required) :, 1, Ul, I am a employer with 16 4. ❑ I am, a general contractor and a • employees (full and/or part limo).* have hired the'sUb- contractors 6, [] Ne constnrction 2. ❑ I am. a bole proprietor or partner - listed on the•attachedshect. 7. 0 Remodeling • ship and have no employees These sub - contractors have 8, D Demolition worldng for me in any capacity,- • . , employeos andltave workers'_._ . 9; '[]•Building addition • [No workers' comp, insurance comp. in surance,# ' . g 3 work offioers leave exercised their . 11. ❑ Phmtbi re aired, . 5, 0 We area corporation and its 10.0 -Electrical repairs or additions - n '3,0 X an a homeowner doing all repairs or additions ' , • 'myself, [No workers comp, ' right Of exeinptlon p er MGL • g re a 12.0 Roof Yr pairs insurance required.] t 0, 152, §1(4), anti woitave no • - .• employees, [NZ) workers' 13,0 Other • • • comp. insurance required ;] • *Any applicant that obooks box fl must also fill out the section below showing thoir workers' compensation information. 1 • t Homeowners who submit this affidavit Indicating they are doing all work and then hire outstrip contractors must submit a now affidavitind:eating such. , tConhactors that ohcok thin box must attaohcd en additional sheet shorting the nano of the sub- corttraotors and statowhother or not those entities havo employees, If the sub- contraotors havo employees, theymustprovidb their workora' oomp, po1iey nutter. • Y ant art etuployer that Is prov iding workers''eompensattou Insurance for rrty employees Below Is the policy and job sire In:formation. _ (� Insurance Company Name; \�1 �.• Policy # or Self-lus. Lio, #: 1.IC \\F(1\\ -U\ • PxpirationDato : ls\\z \ aCO 1 3 • v . Job Site Address: • 3 � .-- -■.0 --.. fi t - • •'( c \'t \ _ City /State /Zip: 1 iv \- , v�� or, ' o declaration the o' expiration e Attach a copy o£ tlto•workers eompensati n policy de aration pago'(shotiriug t e p lzey number and expire, lot date), • ratlure,to secure coverage as xequixed under Section 25A of MGL o, 152 can lead to the imposition of crlinlnat penalties of a fine tip 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 thq violator. 130 advisedthat a copy of this statement - may be forwarded to the Office of Investigations of the DIA. for insurance coverage verification. . /'do hereby certtlY larder the pahts•and penalties p of erJi that The Information provided above. Is true and correct • ' ,Signature: • ‘ Si() ` . • Date: • \ AK \ 1Z- • . . ?hone it: - ' • ._5'•\V •_L>_Ak - . • Official use only. bo not Write In tilt ea, lb be completed by city or town gfflclal. • City or Town: . Permit/License # Issuing Authority (circle one): .1. Board of Health 2.13trtiding Department 3. Cltyrrown Clerk 4. Electrical Inspector 5, Plumbing Inspector 6.Other . _ . . , Contact Person: Shone.#; • . - i $k$,, i ,1 trt Snit! ;i1 k,. a +.tier .g, .tr11 X14 . < , { . C,vY4str coon- Sup _. ,FIt r iotao ` t Licertste. CS 102978 Rtr=Wttri ter, 00 * BRIAN MACHADO 47 MALBONE ROAD" ASSONET, MA 02702 ,G._ " '... --- Exptra9ior ° 512612013 s k “.111rrisss114ter _ T : 102978 /ftr, tr -/„.,,,, , G7t'<,„0,(/,,,, its ffce of Consumer Affairs & Business Regulation License or registration valid for individul use only " ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: t t Office of Consumer Affairs and Business Regulation - "r egistration: 166075 Type: 10 Park Plaza Suite 5170 Expiration: 412112014 Supplement Card Boston, MA 02116' ADVANTAGE WEATHERIZATION, INC. BRIAN MACHADO 1150 WEST CHESTNUT STE d 7 .,....,:4—,,,63,„42, 1 _______ BROCKTON, MA 02301 undersecretary Not valid without signature NOTICE TO PROCEED Low - Income Multi- Family Retrofit Program The Low - Income Energy Affordability Network (LEAN). administrator of the utility - funded energy efficiency program for low- income multifamily properties. is hereby authorized to have its contractors, employees, and other representatives access the property and perform the work contained in the attached Work Order, including final inspections. A copy of this document shall be carried by LEAN's contractors. employees, or representatives and presented upon request. Site Name: ( / 2 , � � .a .)'Li',';'L: ' i z4' Street. City/Town, Zip: 3.9 )` i(. Sr .`� r / WY/4 /-/ 7:y1�1j G /! /71/74 Contact Name & Phone at Site: .. )D�/7 i , x //3 - %5 - I Signature: 0 6;e7 � Printed Name: can '--\∎ Title: P'c. ,,�� TT r- )t s Organization: l v��- G % *OV\ \ \c ». S q 0.Q 6 A Date: 16117 /17 V Acknowledged by LEAN's representative: U John Wells, Vice President for Energy Services, ABCD Please sign and date two originals. Retain one for your records and return the other to: James Collins Energy Services, 4 Floor ABCD 178 Tremont St Boston, MA 02111 fax: 617- 357 -4661 iames.collins(hbostonabcd.ori; Program Administrators: LEAN, Bay State Gas, Berkshire Gas, Blackstone Gas, Cape Light Compact, National Grid, New England Gas, NSTAR, Unitil, WMECO ,.,. 1150 W Chestnut St Suite 3 AD/AN'I "ACM; OWIA1111121/AII(N ' N Brockton, Ma 02301 I t' POIt A 1 I'. C> Date: 11/15/2012 AGENCY: Action for Boston Community Development, Inc. ABCD 178 Tremont St. Boston, MA 02111 PROPERTY: CAHILL APARTMENTS TOTAL 35 Fruit St. Work Order Building # H Unit(s): 8 $5,151.10 Date of Walk- Through: Auditors Report Rcvd. Jo s Copt #*14096 Work Order # 0 DESCRIPTION 1 QTY. I UNIT 'UNIT PRICE' TOTAL PRICE DOORS Weatherstrip w / Q -Ion or equal 1 6 1 ea 1 $45.50 1 $273.00 MISC. MEASURES Weatherstrip (Q -Ion or equal) & R -30 attic hatch 2 ea $33.50 $67.00 Attic / Basement sealing with two -part foam 14 man /hr $75.00 $1,050.00 Non -Attic Air Sealing 8 man /hr $55.00 $440.00 ATTIC INSULATION R -38 unrestricted - settled cellulose 384 sq.ft. $1.47 $564.48 R -18 -20 unrestricted - settled cellulose 2048 sq.ft. $1.29 $2,641.92 MISC.INSULATION Duct insulation R -5 1 37 I sq.ft. 1 $3.10 1 $114.70 Page 8 of 8 Version1.7 Commercial Building Permit May 15, 2000 SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Northampton Housing Authority I, , as Owner of the subject property Advantage Weatherization, Inc. hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. c - Signature of Owner Date Advantage Weatherization, Inc. , 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. Brian Machado Print Name 11/15/2012 Signature o Owner /Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : Brian Machado 102978 License Number 1150 West Chestnut St. Suite Brockton MA 02301 05/26/2013 Address Expiration Date • (401) 641 -1493 Signature Telephone SECTION 13 - 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 Version1.7 Commercial Building Permit May 15, 2000 SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name (Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name: Responsible In Charge of Construction Address Signature Telephone Version1.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW CD YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained 0 , Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Building Permit May 15, 2000 ` SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing E] Change of Use ❑ Other ❑ Brief Description Weatherization: Weatherstrip doors. Air Sealing. Of Proposed Work: SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A -1 ❑ A -2 ❑ A -3 ❑ 1A 1 ❑ A -4 ❑ A -5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B 1 ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S -1 ❑ S -2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): + Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) 1st 1sr 2�d 2 3rd 3rd 4th 4tn Total Area (sf) Total Proposed New Construction (sf) Total Height (ft) Total Height ft 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood ZoneD Municipal ❑ On site disposal system]] • Versionl .7 C s I ercial Buildi ermit May 15, 2000 Lu Department use only City of Northampto > tatus of Permit: Building Departme urb Cut/DrivelNay Permit - 212 Main Street 0 "'" s. Sewer /Septic Availability Room 100 C ► c _ WaterNVell Availability Northampton, MA 0 • • 1 1 Two Sets of Structural Plans phone 413- 587 -1240 Fax 4 3- : - Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Lot Unit A Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Northampton Housing Authority 49 Old South St Name (Print) Current Mailing Address: (413) 584-4030 Signature C.=;) Telephone 2.2 Authorized Agept: Advantag eatherization, Inc. 1150 West Chestnut St. Suite 3 Brockton 02301 Name (Print) Current Mailing Address: (508) 510 -6866 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building � Ji (•,; (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing $0.00, Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection $0.00 6. Total = (1 + 2 + 3 + 4 + 5) Check Number 3 ASS This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2013 -0577 APPLICANT /CONTACT PERSON ADVANTAGE WEATHERIZATION INC ADDRESS/PHONE 1150 W CHESTNUT ST SUITE 3 BROCKTON (508) 510 -6866 PROPERTY LOCATION 35 FRUIT ST MAP 39A PARCEL 075 001 ZONE URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out �' � Fee Paid 3 g 6 Typeof Construction: WEATHERIZATION, WEATHERSTRIP DOORS, AIR SEALING - BLDG H New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 102978 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFWI. ATION PRESENTED: Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND /OR Special Permit With Site Plan Major Project: Site Plan AND /OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management �// //- /-1 Sign of a uilding Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning & Development for more information. 35 FRUIT ST BP- 2013 -0577 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 39A - 075 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit # BP- 2013 -0577 Project # JS- 2013- 000923 Est. Cost: $5151.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADVANTAGE WEATHERIZATION INC 102978 Lot Size(sq. ft.): 93654.00 Owner: NORTHAMPTON CITY OF NORTHAMPTON HOUSING AUTHORITY Zoning: URC(100)/ Applicant: ADVANTAGE WEATHERIZATION INC AT: 35 FRUIT ST Applicant Address: Phone: Insurance: 1150 W CHESTNUT ST SUITE 3 (508) 510 -6866 WC BROCKTONMA02301 ISSUED ON:11/27/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:WEATHERIZATION, WEATHERSTRIP DOORS, AIR SEALING - BLDG H 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 11/27/2012 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner R K '3 ., U.a November 19, 2012 Mr. Louis Hasbrouck Building Commissioner City of Northampton 212 Main Street Northampton, MA 01060 Dear Mr. Hasbrouck I request that you grant a modification to waive the requirement for controlled construction for the insulation and weatherization of 35 Fruit Street (8 buildings total) because the work is of a minor nature, will not affect health, accessibility, life and fire safety, or structural requirements and is impractical in that the cost of controlled construction is considerable when compared to the cost of the proposed work. Please accept this stamped letter as an indication of my support for this request. Thank you for your consideration. Sincerely, � A '® a 0 AI ED1 i� ry * i a , y / i te2,-/-14-ffn, .1 a C N 10731 3 NORTH EASTON, ,i - Wayne E. Benson, Jr. RA F„� — f -*. , HOF1 ,A;> ` President RKB Architects . , .i -- "wil ADVAN -8 OP ID: PS ACORD" DATE (MM /ODNYYY) 4....,,.-- CERTIFICATE OF LIABILITY INSURANCE 06/21/12 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 pollcy(les) must 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). CONTACT PRODUCER 781-642.8000 NAME; Eastern States Insurance PH ONE U FAX Agency, Inc, 781.647.3670jac. No Exl): c o 50 Prospect Street EMAIL SS: Waltham, MA 02463 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Liberty Mutual Insurance Co. _ INSURED Advantage Weatherizatlon, Inc. INSURER B . Berkley Assurance Co 1150 West Chestnut Street INSURER 0: Navigators Insurance Company Brockton, MA 02301 INSURER 0 : 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 ADOL SUER POLICY EFF POLICY EXP INRR. Win, POLICY NUMBER (MM/DDNYYYI , (k1M/DP/YY1YI LIMITS , ■ GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 1 i I 13 X COMMERCIAL GENERAL LIABILITY VUMA0000891 04/02/12 04102113 DAMAGE TO RENTED 50,000 PREMISES (Ea occurrence) $ CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 ■ PERSONAL &ACV INJURY $ 1,000,000 I GENERAL AGGREGATE $ 2,000,000 GEN'LAGGRE�GA LIMIT APPLIES PER: PRODUCTS COMP1OPAGG $ 2,000,000 — 1 POLICY 1 S'RRi [1 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 ,000,000 1 (Ea accident) $ A ANY AUTO ASJ -Z11- 261011 -032 06/20/12 06/20/13 BODILY INJURY (Per person) $ ALLOSNED X SCHEDULED BODILY INJURY (Per accldenl) $ X HIRED AUTOS X NON•OWNED PROPERTY DAMAGE $ AUTOS (Pjr accident) I $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 6,000,000 A X EXCESS LIAO _ CLAIMS -MADE THC- Z91- 261011 -042 06/20/12 06/20/13 AGGREGATE $ 6,000,000 DED I l RETENTIONS $ WORKERS COMPENSATION X I WO STATU TH R ER I 0. AND EMPLOYERS' LIABILITY Y / N 1 TORY LIMIT A AN PROPRIETERIPARTNER /O ECUTIVE Fes'( N/A WC1 -Z11. 261011.012 06/20/12 06/20/13 E,L. EACH ACCIDENT $ 1,000,000 (Mandatory In NH) IV E.L. DISEASE • EA EMPLOYEE $ 1,000,000 :Auri describe under DESCRIPTION OP OPERATIONS below EL DISEASE - POLICY LIMIT $ 1,000,000 C Excess Liability NYIIEXC71193IV 06120/12 06/20/13 Excess 10,000,000 Excess 6 Million 5 MIIIIon DESCRIPTION OF OPERATIONS! LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Romarks Schedule, If more space Is required) CERTIFICATE HOLDER _ CANCELLATION EVIDENC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence Of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE l © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD • I t . - T he Commonwealth of Massachusetts • • D.epartritei t of Xndtistrial Accidents . • r f1 • O ff tce of Investigationd • 600 Wahiirnon Stret i � e T Q Boston, MA 02111 • • • =�` y ivww.uiass.gov /d i ' . Workers' Conipensation I»sa nice Affidavit: Builders/ Cont: ractol's/)ulectricians/Plumbers _ * Applicant Information . Please Print Legibly Name ( Business( Orgaulradon/rndtvidual): ,'� ` .1.)..�I�Cc n�q �cG_, ,,,_4Y\,_C.t-\ \„,,_ . . • ' 'Address: \\ \1J ( ),(-\ o7� Y1� �� _ '> S ' ' City /State/Zip: 0 1... Ai a colt of Phone.##: >4'i \u =t c� • Are an erirpioyer? Check the appropriate box: , '-type of pi•oJect (required 1, ant ) :, I a a em 10 er with \0 4, 0 I am a general contraotor audl a . employees (full and/or putt time),* have hired thus 'ub - contractors 6, 0 New construction 2.0 I am. a 'sole proprietor or partner - listed on the'attachedshect. 7. 0 Remodeling ship and have no employees Tires° sub - contractors have 8, C7 Demolition working for me in any oapacity, . . employees audhave workers'......_ '' 9', '[1 BdilSling addition [No workers' comp, .insurance imp• inaurance,t ' • required.] • 5. ❑ a We are corporation and its 10,0 •Electrical repairs or additions •3.0 X am. a homeowner doing all work officers leave exercised their • 11. ❑ Plumbing repairs or additions ' • myself, [No workers' comp, right bf exeinptionperMCiL 12,0 Roof repairs insurance required.] f c, 152, §1(4), and we leave no • 13 (� Other employees, [No workers' f • comp. insurance required, , • *Any applioant that dolts box #i must also fill out the scotion below showing choir workers' compensation pointy information, 1 • f Homeowners who submit this affidavit indicating they ate doing all work and then hire outside connectors must submit a new affidavit indicating such, 1 Conttactora thatoheck thia box must attached an additional sheet shotfdng the numb of the sub•oofttraotors and state whether or not those entities have • empioycw, If the aub- conitaoiors havo employee,, iheymustprovidb their workers' comp, polloy number. • ' . ' g • Yam nitentployerlltntIs providing workers compensralon Insurance for myemployees. Below Is the policy and Job site information. Insurance Company Name; i xL� . , . • Policy # or Self -ins. Lie, # :,.1 • Expiration Date: \A afJ t3 Job Site Address: • �� O •i* , E - - City /State /Zip: \ n c %t �Y-" rvN. -- U\rr R Attach a copy of tlto•workers' coinpensation policy deelaratlon�ge'(showing the policy number and expiration date), • Failure,to secure coverage as required under Section 25A of MGL o, 152 eon lead to the imposition of crlininat penalties of a fine tip to $1,500.00 and/or one -year imprisonment, as well as eiviipena sties in the form of a STOP WORK ORDER and a fine , • of up to $250,00 a day against the violator, Be advisedthat a copy of this statement be forwarded to the Offroe of Investigations of the DIA for insurance coverage verification. • , X hereby certify under the pains-and penalties of , er)z that the information prt%vlded above, is true mitt correct i_,aa e: ` 4 • .Q Al 4 .1 • Otte•' \\\L \I • • Morn t/: . > :_5 \v L--.Ak - . • Y Official use only. Do not write in th } ea, to' be corzrpleferfby city or loIpu official, • . • i I • City or Town: . • Permit/License # • • • Issuing Authority (circle one); .1, Board of Health 2. Building Department 3, City/Town Clerk 4, Electrical Inspector 5, Plumbing Inspector 6.Other _ . . , Contact Person: Phone•#; • • • • . ,, t AO it B041 j s,l I3t.t1 ia1t l t_t itif4tt • . CP f = • , bw" Lmerse: C3 102978 str;ctett :c; 00 BRIAN MACHADO 47 MALBONE ROAD ASSONET, MA 02702 -, Expirat an: 5126/2013 • Try: 10297$ �a f <i fr:frt trr.reft +rvlf /7 r'' 'ICJ <r.,rr r tr:rt'/7a 1 1 Ufiice of Consumer Affairs & Business Regulation License or registration valid for individul use only 1,4 i s ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 3y Office of Consumer Affairs and Business Regulation tegistration: 166075 Type: 10 Park Plaza - Suite 5170 Expiration: 4/21/2014 Supplement Card P pp Boston, MA 42116 ADVANTAGE WEATHERIZATION, INC. BRIAN MACHADO 1150 WEST CHESTNUT STE B BROCKTON, MA 02301 Undersecretary Not valid without signature NOTICE TO PROCEED Low - Income Multi- Family Retrofit Program The Low - Income Energy Affordability Network (LEAN). administrator of the utility - funded energy efficiency program for low - income multifamily properties. is hereby authorized to have its contractors, employees, and other representatives access the property and perform the work contained in the attached Work Order, including final inspections. A copy of this document shall be carried by LEAN's contractors. employees, or representatives and presented upon request. Site Name: ' 4 / � ;'1. 3'�r; R Street. City/Town, Zip: t39 fY //. r 6 '17 7- •7W G/! 0.6 Contact Name & Phone at Site: ,JIN Signature: Printed Name: Title: Px•er• - TN S-- Organization: JJ r).f • — - wr t. ,Np* ' v\ •S% Odi. Date: /A /17 l/Z Acknowledged by LEAN's representative: John Wells, Vice President for Energy Services, Al3CD Please sign and date two originals. Retain one for your records and return the other to: James Collins Energy Services, 4 Floor ABCD 178 Tremont St Boston, MA 02111 fax: 617- 357 -4661 james.collins c(bostonabcd.orr; Program Administrators: LEAN, Bay State Gas, Berkshire Gas, Blackstone Gas, Cape Light Compact, National Grid, New England Gas, NSTAR, Unitil, WMECO �ti a 1150 W Chestnut St A1)VAN'I`AC;E Suite 3 ..® w ' , "' "'' ' "' N Brockton, Ma 02301 CC'� It yO 1 f t k �'� . > Date. 11/15/2012 AGENCY: Action for Boston Community Development, Inc. ABCD 178 Tremont St. Boston, MA 02111 PROPERTY: CAHILL APARTMENTS TOTAL 35 Fruit St. Work Order Building # G Unit(s): 8 $5,151.10 d :of Walk- Through: Auditors Report Rcvd. ob'Cost #:14096 Work Order It 0 DESCRIPTION I QTY. I UNIT IUNIT PRICE' TOTAL PRICE DOORS Weatherstrip w / Q or equal I 6 I ea $45.50 $273.00 MISC. MEASURES Weatherstrip (Q -Ion or equal) & R -30 attic hatch 2 ea $33.50 $67.00 Attic / Basement sealing with two -part foam 14 man /hr $75.00 $1,050.00 Non -Attic Air Sealing 8 man /hr $55.00 $440.00 ATTIC INSULATION R -38 unrestricted - settled cellulose 384 sq.ft. $1.47 $564.48 R -18 -20 unrestricted - settled cellulose 2048 sq.ft. $1.29 $2,641.92 MISC.INSULATION Duct insulation R -5 1 37 I sq.ft. 1 $3.10 I $114.70 Page 7 of 8 ' Versionl .7 Commercial Building Permit May 15, 2000 SECTION 10 STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Northampton Housing Authority I, , as Owner of the subject property Advantage Weatherization, Inc. hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. c> Signature of Owner Date Advantage Weatherization, Inc. , 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. Brian Machado Print Name 11/15/2012 Signature o Owner /Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : Brian Machado 102978 License Number 1150 West Chestnut St. Suite 3, Brockton MA 02301 05/26/2013 Address Expiration Date (401) 641 -1493 Signature Telephone SECTION 13 - 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 0 No 0 Versionl.7 Commercial Building Permit May 15, 2000 SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name (Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name: Responsible In Charge of Construction Address Signature Telephone Versionl.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained 0 , Date Issued: C. Do any signs exist on the property? YES NO o IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES (2) NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing Change of Use ❑ Other ❑ Brief Description Weatherization: Weatherstrip doors. Air Sealing. Of Proposed Work: SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A -1 ❑ A -2 ❑ A -3 ❑ 1A I ❑ A-4 ❑ A -5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S -1 ❑ S -2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) 1st 1st 2 "d 2nd 3rd 3r 4 th 4 Total Area (sf) Total Proposed New Construction (sf) Total Height (ft) Total Height ft 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system[] Version! .7 Commercial Building Permit May 15, 2000 Department use only City of Northampton Status' f Permit: Building Departme ' Curb Cu p Driveway Permit 212 Main Streit C - " ew. /Se‘ lc Availability Room 10, w- el , ' vaitability Northampton, MA 106:' • s of Structural Plans phone 413- 587 -1240 Fax 4 3 -5 7 -12 „��o� - ot/Site Plans o ti? N o a �� P � Other Specify APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, E THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A 0 E OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Lot Unit Zone Overlay District - - Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Northampton Housing Authority 49 Old South St Name (Print) Current Mailing Address: (413) 584 -4030 Signature � �- C- L� - -i: �' Telephone 2.2 Authorized Agent: Advantage Weatherization, Inc. 1150 West Chestnut St. Suite 3 Brockton 02301 Name (Print) Current Mailing Address: (508) 510 -6866 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building �\ 3 (a) Building Permit Fee 2. Electrical $0.00! (b) Estimated Total Cost of Construction from (6) 3. Plumbing $0.00 Building Permit Fee 4. Mechanical (HVAC) $0.00 5. Fire Protection 6. Total =(1 +2 +3 +4 +5) Check Number 3 65 This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2013 -0576 APPLICANT /CONTACT PERSON ADVANTAGE WEATHERIZATION INC ADDRESS/PHONE 1150 W CHESTNUT ST SUITE 3 BROCKTON (508) 510 -6866 PROPERTY LOCATION 35 FRUIT ST MAP 39A PARCEL 075 001 ZONE URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out �jjl�jj� Fee Paid 3`>�`�" Tvpeof Construction: WEATHERIZATION, WEATHERSTRIP DOORS, AIR SEALING - BLDG New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 102978 3 sets of Plans / Plot Plan THE FOLL NG ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: pproved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND /OR Special Permit With Site Plan Major Project: Site Plan AND /OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission _ Permit DPW Storm Water Management Deg:' h1 Keay / L \ //X/ Signa a of Building O icial Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning & Development for more information. 35 FRUIT ST BP- 2013 -0576 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 39A - 075 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit # BP- 2013 -0576 Project # JS- 2013- 000923 Est. Cost: $5151.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADVANTAGE WEATHERIZATION INC 102978 Lot Size(sq. ft.): 93654.00 Owner: NORTHAMPTON CITY OF NORTHAMPTON HOUSING AUTHORITY Zoning: URC(100)/ Applicant: ADVANTAGE WEATHERIZATION INC AT: 35 FRUIT ST Applicant Address: Phone: Insurance: 1150 W CHESTNUT ST SUITE 3 (508) 510 -6866 WC BROCKTONMA02301 ISSUED ON:11/27/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:WEATHERIZATION, WEATHERSTRIP DOORS, AIR SEALING - BLDG G 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 11/27/2012 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner R K „„ November 19, 2012 Mr. Louis Hasbrouck Building Commissioner City of Northampton 212 Main Street Northampton, MA 01060 Dear Mr. Hasbrouck I request that you grant a modification to waive the requirement for controlled construction for the insulation and weatherization of 35 Fruit Street (8 buildings total) because the work is of a minor nature, will not affect health, accessibility, life and fire safety, or structural requirements and is impractical in that the cost of controlled construction is considerable when compared to the cost of the proposed work. Please accept this stamped letter as an indication of my support for this request. Thank you for your consideration. Sincerely, e .►.A.A 4 .4,� ��..R[D ARc„ i ii <<,c''' -pSONs iT 17 J a o No. 10731 ! f�ORTH EASTON, 1,- . Wayne E. Benson, Jr. RA A,,_ ✓� President RKB Architects .i- -'1 ADVAN -8 OP ID: PS A COR p" DATE (MM /ODNYYY) k.----- CERTIFICATE OF LIABILITY INSURANCE 06/21/12 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 pollcy(Ies) must 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 781-642-9000 NAMTACT Eastern States Insurance PHONE FAX Agency, Inc. 781- 647- 3670 No. EK(I; UNC,,W 50 Prospect Street EMAIL Waltham, MA 02463 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA; Liberty Mutual Insurance Co. _ INSURED Advantage Weatherizatlon, Inc. INSURER e : Berkley Assurance Co 1150 West Chestnut Street INSURER C: Navigators Insurance Company Brockton, MA 02301 INSURER 0 ; INSURER E : j. 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 AWL SUER POLICY EFF POLICY EXP LIR TYPE OF INSURANCE INSR Wvn POLICY NUMBER (MM/0D/YYYY) (jp/DPNY'fY1 LIMITS i ■ GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 AMAGETO RENTED B X COMMERCIAL GENERAL LIABILITY VUMA0000891 04/02/12 04102113 P G REMISES (Ea occurrence) $ 50,000 f CLAIMS -MADE 1 X I OCCUR MED EXP (Anyone person) $ 5,000 PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 )' POLICY M I I L00 _ _ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 V (Ea accldenD J A ANYAUTO ASJ -Z11- 261011.032 06/20/12 06/20/13 BODILY INJURY (Per person) $ AUT OWNED -----v AUTOSULED BODILY INJURY (Par accident) $ X HIRED AUTOS X NON -OWNED PROPERTY DAMAGE $ _ Al1TOS (Peraccidentl $ UMBRELLA LIAR X OCCUR EACH OCCURRENCE _ $ 5,000,000 ^ A X 1 EXCESS LIAO _ CLAIMS -MADE THC -Z91- 261011 -042 06/20/12 06/20/13 AGGREGATE $ 6,000,000 BED 1 1 RETENTIONS S7 $ 1 WORKERS COMPENSATION X 1 TORY LAMITR } l 1 O ER AND EMPLOYERS' LIABILITY IN A ANY PROPRIETOR /PARTNER/EXECUTIVE 1 N . N/ A WC1 -Z11. 261011.012 06/20/12 06/20/13 E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE • EA EMPLOYEE $ 1,000,000 if ee, describe under DESCRIPTION OF OPERATIONS below El. DISEASE • POLICY LIMIT $ 1,000,000 C Excess Liability NY11EXC71193IV 06/20/12 06/20/13 Excess 10,000,000 Excess 6 Million 5 Million DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schodule, If more space Is required) CERTIFICATE HOLDER CANCELLATION EVIDENC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence Of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ® 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD :� • . t r ' The Commonwealth of Massachmsetts • . • • • *_ ___, Depart rltelttofIrtdtisirialAccidertis . 1 .".----041 in ..- l.= f Office of Investigations • � 4 . 600 Washin Street . € -zi r d Boston, Mel 021)1 , •��.' Ivwwartas /dia • • Workers' Compensation Insurance Affidavit: Builders / Contractors /.Clectlicians/Plumbers _ • • ,Applicant information ' . Please Print Legibly Name ( Business /Orgaulzaflon/rndivldual); ,%Am �cG- c>. 2Ytz&\- \. \ \nom . . • • ll • • Address: \ t1.� , (' o\ �a ' >� �i { City/State/Zip: t Lp& _ = • � �, � cool of Phone. #; ��4'i • \u %t Q � . ,A.reyou an employer? Check the appropriate boil , ••'1pe ofpi•o]eet (required.) :, . 1,1 , X am a employer with '16 4, 0 T ama general. contractor midi 6 a • . employees (full and/or part limo),* have hired the stib- contractors Ne�v construction listed on the'attache&shoek 7. ❑ Remodeling 2, ❑ 1 am. a 'sole proprietor or partner- • ship and have no employees These sub - contractors have 8, 0 Demolition. • working for me in any oapaeity; • • . employees andhavo worker$' ,_ • • [No workers' comp, insurance ��. h?stuanco,$' 9; [�Btiilc�ing addition, rcquired,] . 5, [] We aro a corporation and its 10.0 Blectrical repairs or additions - '3,0 Tama homeowner doin . eft work officers have exercised their • 11,0 Plumbing repairs or additions ' , 'myself, [No workers' comp, right Of exeinptlon per 12,0 Roof repairs insurance required,] t c, 152, §1(4), and we have no • employees, [■o workers' 13.E1 Other comp. insurance required ;] , *Any applioant that cheeks box I 1 must also fill out the section below showing thotr workers' compensation information. i • 1 Homeowners who submit this affidavit Indicating they aro doing all work and then hire outside contractors must submit a new aff1davttindleatiag such, , lCoahactars that oh** this box must attached an additional sheet shoding the nemb of the sub•cohtraetors and Mato whether or not those entities have employees, If tho subcontractors havo employees, thaymust tnovidb their workers' comp. polldy numb* • 1 • I ani au euaployer'lrat is pro ildittg workers' cotltpensatton Insurance for my employees Below is the policy and Job site Information. Insurance Company Name, aQ,A.:l\ Policy # or Self -ins. Lie, #: , 1,�C � �(�j ' 4 \, \ -U\ �, Expiration Date: �.ZO` aC) V3 , . Job Site Address: • S i\-w-- • 7 • City /Stato /Zili: \ \C Nci.rn \ -\\/ o '� Attach a copy of the- workers' compensation policy declarationrge•(show the policy number and expiration date). • Failure, to secure coverage as =piled under Section 25A of MGL o, 152 oar lead to the imposition of crin:hal penalties of a fire tip 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, 13e advised that a copy of this staternentxnay be forwarded to the Office of Investigations of the DIA for insurance coverage veacation, • I'Vlo hereby (realty tinder the pains -and penalties of erJr that the Information pravlded above is true aril correct; ' • ' Sienature: \ {9)\ r►` e Date: ' \\ \ 1 \ 1� _ ` phone 11: •'`l 3 : '• \ -3- ak - - . Official rise only Do not write in 1h Tie ea, tb be completed by clty or WWII offlc1a1 - • • • City or Towni . Permit/License # • Issuing Authority (circle one): .1, Board of Health 2. Bu(lding Department 3, CitylTown Clerk 4, Electrical Inspector 5, Plumbing Inspector 6.Other ' . _ . • . , Contact Person: Phone•#: • • - • • . rt q flan ,, 14 a,m i B 11 d apt Etuil iiri , ass i_t ttifrr'i anti `ti,frr r ... . n tr&ict.cn Sup. .fscii t.i i, w . , » � � 1 Lmervse. Ca 102978 REstr€ ntitf IQ: 00 ye a BRIAN MACHADO 47 MALBONE ROAD ASSONET, MA 02702 , » '�._ --- Expiration: 5126/2013 s f Ie311011,ci1,4ier Tr=° 102978 . , 714 f ( ziliJlr. Jiff , l ri ✓ 1 7 1,1, tt 6 J j n _ ffiee of Consumer Affairs & Business Regulation License or registration valid for individul use only 7 S ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 1 , Office of Consumer Affairs and Business Regulation '' 166075 Type: 10 Park Plaza Suite 5170 Expiration: 4121/2014 Supplement Card Boston, MA 02116° ADVANTAGE WEATHERIZATION, INC. BRIAN MACHADO 1150 WEST CHESTNUT STE a --7 .....t4,---,..,61,..4), ,55 ____ r.0 BROCKTON, MA 02301 Undersecretary Not valid without signature NOTICE TO PROCEED Low - Income Multi - Family Retrofit Program The Low - income Energy Affordability Network (LEAN). administratorofthe utility - funded energy etTiciency program for low - income multifamily properties. is hereby authorized to have its contractors. employees, and other representatives access the property and perform the work contained in the attached Work Order, including final inspections. A copy of this document shall be carried by LEAN's contractors. employees, or representatives and presented upon request. Site Name: (��, /! �r�'rTl''GJ ";L " R14'. Street. City/Town, Zip: 13.7 h )'!(. 1 T 6 '17 /. 7:yi ew fiffi Contact Name & Phone at Site: , )1)/ /9 Hite:, Ti 4 /A L Signature: Printed Name: Title: P 7")t Organization: ,Jr."/".- rt %,,, -OA \ s vtq Date: /6 117 1/2 V Acknowledged by LEAN's representative: John Wells, Vice President for Energy Services, A13CI) Please sign and date two originals. Retain one for your records and return the other to: James Collins Energy Services, 4 Floor ABCD 178 Tremont St Boston, MA 021 I I fax: 617-357-4661 james.collins ct7i bostonabcd.or Program Administrators: LEAN, Bay State Gas, Berkshire Gas, Blackstone Gas, Cape Light Compact, National Grid, New England Gas, NSTAR, Unitil, WMECO 1150 W Chestnut St �~ ' Suite ADVANTAGE 00 N`c ��`,t`r 01 A I ` ` Brockton, Ma 02301 Date: 11/15/2012 AGENCY: Action for Boston Community Development, Inc. ABCD 178 Tremont St. Boston, MA 02111 PROPERTY: CAHILL APARTMENTS TOTAL 35 Fruit St. Work Order Building # F Unit(s): 8 $5,151.10 l ate ' Walk Auditors Report Rcvd. 10P Cost :14096 Work Order # 0 DESCRIPTION 1 QTY. I UNIT (UNIT PRICE' TOTAL PRICE DOORS Weatherstrip w / Q - Ion or equal I 6 I ea I $45.50 I $273.00 MISC. MEASURES Weatherstrip (Q -Ion or equal) & R -30 attic hatch 2 ea $33.50 $67.00 Attic / Basement sealing with two -part foam 14 man /hr $75.00 $1,050.00 Non -Attic Air Sealing 8 man /hr $55.00 $440.00 ATTIC INSULATION R -38 unrestricted - settled cellulose 384 sq.ft. $1.47 $564.48 R -18 -20 unrestricted - settled cellulose 2048 sq.ft. $1.29 $2,641.92 MISC.INSULATION Duct insulation R -5 1 37 I sq.ft. I $3.10 1 $114.70 Page 6 of 8 Version1.7 Commercial Building Permit May 15, 2000 SECTION 10 STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Northampton Housing Authority 1, as Owner of the subject property Advantage Weatherization, Inc. hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date Advantage Weatherization Inc. , 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. Brian Machado Print Name 11/15/2012 Signature of Owner /Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : Brian Machado 102978 License Number 1150 West Chestnut St. Suite 3, Brockton MA 02301 05/26/2013 Address Expiration Date (401) 641 -1493 Signature Telephone SECTION 13 - 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 Q No 0 1 Version1.7 Commercial Building Permit May 15, 2000 SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name (Registrant): .... Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name: Responsible In Charge of Construction Address Signature Telephone r Versionl.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Q , Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO Q IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing Change of Use ❑ Other ❑ Brief Description Weatherization: Weatherstrip doors. Air Sealing. Of Proposed Work: SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly A -1 ❑ A -2 ❑ A -3 ❑ 1A 1 ❑ A -4 ❑ A -5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S -1 ❑ S -2 ❑ 5B [ ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) st 1St 1 2nd 2 n d 3rd 3 rd 4 th 4 Total Area (sf) Total Proposed New Construction (sf) Total Height (ft) Total Height ft 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone[] Municipal ❑ On site disposal system 1 Versionl.7 Commercial Buildin &Permit May 15, 2000 Department use only City of Northamptdn‘°s.; --% tat s of °ermit: Building Depa` me \ `' Cu ). ut/D . eway Permit - 212 Main Str - t ; ,_ ' - ptic Availability Room 100 r ; ; o • '' • . terIWe Availability ■ to Northam X06 , s , ' �� Northampton, MA 01 q kQ �. 0 F � Two Sets of Situcturl Plans phone 413 - 587 -1240 Fax 413 .87 -1 '' Piot/Site Plans Other Specify APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office �s_JW` Map Lot Unit C)--1 .&C N- Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Northampton Housing Authority 49 Old South St Name (Print) Current Mailing Address: (413) 584 -4 Signature �� Cam— S' —� �\ Telephone 2.2 Authorized Agent: Advantage Weatherization, Inc. 1150 West Chestnut St. Suite 3 Brockton 02301 Name (Print) Current Mailing Address: (508) 510 -6866 Signature _..—eC — • Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building c - .\cj (a) Building Permit Fee 2. Electrical $0.006 (b) Estimated Total Cost of Construction from (6) 3. Plumbing $0.00' Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection $0.00 CC 6. Total = (1 + 2 + 3 + 4 + 5) Check Number 3 'g VS' This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date A. File # BP- 2013 -0575 APPLICANT /CONTACT PERSON ADVANTAGE WEATHERIZATION INC ADDRESS/PHONE 1150 W CHESTNUT ST SUITE 3 BROCKTON (508) 510 -6866 PROPERTY LOCATION 35 FRUIT ST MAP 39A PARCEL 075 001 ZONE URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out � �(� *- Fee Paid G Tvpeof Construction: WEATHERIZATION, WEATHERSTRIP DOORS, AIR SEALING - BLDG F New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 102978 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO TION PRESENTED: pproved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND /OR Special Permit With Site Plan Major Project: Site Plan AND /OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management 'la Signa i. of Building O ici Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning & Development for more information. 35 FRUIT ST BP- 2013 -0575 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 39A - 075 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit # BP- 2013 -0575 Project # JS- 2013- 000923 Est. Cost: $5151.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADVANTAGE WEATHERIZATION INC 102978 Lot Size(sq. ft.): 93654.00 Owner: NORTHAMPTON CITY OF NORTHAMPTON HOUSING AUTHORITY Zoning: URC(100)/ Applicant: ADVANTAGE WEATHERIZATION INC AT: 35 FRUIT ST Applicant Address: Phone: Insurance: 1150 W CHESTNUT ST SUITE 3 (508) 510 -6866 WC BROCKTONMA02301 ISSUED ON:11/27/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:WEATHERIZATION, WEATHERSTRIP DOORS, AIR SEALING - BLDG F 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 11/27/2012 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner RK November 19, 2012 Mr. Louis Hasbrouck Building Commissioner City of Northampton 212 Main Street Northampton, MA 01060 Dear Mr. Hasbrouck I request that you grant a modification to waive the requirement for controlled construction for the insulation and weatherization of 35 Fruit Street (8 buildings total) because the work is of a minor nature, will not affect health, accessibility, life and fire safety, or structural requirements and is impractical in that the cost of controlled construction is considerable when compared to the cost of the proposed work. Please accept this stamped letter as an indication of my support for this request. Thank you for your consideration. Sincerely, Te l• R 4 : (-!a rrix 7 e 4 o No. 10731 ® NORTH EASTON, � , �:' 0 MA Wayne E. Benson, Jr. RA < `r �r H OF IA President RKB Architects .,-- ADVAN -8 OP ID: PS ACORLJ" DA (MMlDDmYY) 44.---- CERTIFICATE OF LIABILITY INSURANCE 06/21/12 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 poilcy(les) must be endorsed. if SUBROGATION 1S WAIVED, subject to the terms and conditions of the policy, certaln policies may require an endorsement. A statement on thls certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER 781- 642 -9000 CONT Eastern States Insurance PH ONE FAX Agency, Inc. 781- 647- 36704aC. No, so); W c o 50 Prospect Street ADDRESS: Waltham, MA 02463 INSURER(S) AFFORDING COVERAGE NAIC N INSURER A; Liberty Mutual Insurance Co. INSURED Advantage Weatherizatlon, Inc, INSURER B: Berkley Assurance Co 1150 West Chestnut Street INSURER C : Navigators Insurance Company Brockton, MA 02301 INSURER 0 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 ADDL SUER POLICY POLICYEXP LTR TYPE OF INSURANCE , , ,, . POLI Y NUMBER M/DDIYY U ,,.L , !NY LIMITS ■ GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 1 DAAAMISES ( AtlE TO RENTED 1 (3 X COMMERCIAL GENERAL LIABILITY VUMA0000891 04/02/12 04/02/13 PREEa o $ 50,000 } CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL8,ADV $ 1,000,000 I GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGO $ 2,000,000 J POLICY I I Ft° + f L0C _ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ A ANY AUTO ASJ- Z11- 261011.032 06/20/12 06/20/13 BODILY INJURY (Per person) $ ■ ALLOWNED X SCHEDULED BODILY INJURY (Per accident) $ AUTOS X HIRED AUTOS X NON OWNED PROPERTY DAMAGE $ AUTOS (Per accident) $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 6,000,000 A X EXCESS LIAR CLAIMS -MADE THC -Z91- 261011 -042 06/20/12 06/20/13 AGGREGATE $ 5,000,000 DED I 4 RETENTION $ $ WORKERS COMPENSATION X 1 WC STATU• TH O- AND EMPLOYERS' LIABILITY TORY LIMITR ER Y/N A ANY PROPRIETOR /PARTNER/EXECUTIVE WC1 -Z11. 261011 -012 06/20/12 06/20/13 E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? l N , N / A (Mandatory In NH) E.L. DISEASE • EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Excess Liability NYIIEXC71193IV 06120/12 06/20/13 Excess 10,000,000 Excess 5 Million 5 Million DESCRIPTION OF OPERATIONS 1 LOCArIONS1 VEHICLES (Attach ACORD 101, AddltIonal Remarks Schedule, If more epee Ia required) CERTIFICATE HOLDER CANCELLATION EVIDENC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTH REPRESENTATIVE l ©1988 -2010 ACORD CORPORATION. All rights reserved, ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD • ;l • t ■ • • The Commonwealth of Massachusetts • .• . *___, - ,Oeparfineltt of Indusii'IaL'iccidents . =;'wall = F/ • Office of I vestigations • • - 600 Washington Street e =` T Boston, MA 02111 �,.- -- - -00 wwitunass.gov /dia ' . Workers' CompensationIiosurituceAffidavit: Builders/ Cont1 'actols/BIectt'icians/Plumbers . • • ,Applicant Information . Please Print Legibly • Name (Business/Organization/individual): ,%.t>tA\csa.�o cc� ctQY\z_c_t ,n \nc , , • • ' 0 ' • Address: \\-. \ $ 11J C h o� r l '1 • -) fit \P 3 • ' ' . • • City /State/Zip: - c.. '` ' , 01 Phone. #: �; j2 \L ' Q (`51 Are anetnpioyer ? Check the appropriate boxt ,'•lyrpeofpi•oJect(requirerl) :, • LEA I an a ernliloyer with, • 0 4, ❑ l: am. a general contractor and I: 6, 4 • employees (full and/or pact timo).* have hired the'sub- contractors New construction 2.01 an a 'sole proprietor or partner- listed on the•attachedshect. 7. ❑Remodeling • • ship and have no employees Those sub- contractors have 8, 0 Demolition • work-in fax ma in any oa aei . , employees andhave worker8' ,_.,._ B y � t3r $ • .' 9;'[]�Btiildtng addition • • [No workers' comp, insurance comp• insurance, re required.] • 5. [] We area corporation and its 10.0 Electrical repairs or additions . 3.1=1 X am a homeowner doin all g J work office rs have exerelse � their . 11, El Plumbing repairs or additions ' g 'myself.[Noworkers' right of exemption perMQL 12[]Roofmpairs • insurance required.) t .0, 152, §1(4), anti we have no - - employees, No workers' 13E1 Other • comp. insurance required ;J • Any appltoant that cheeks box IRt must also fill out the section below showing thou• workers' compensation polio)* information. 1 • t Homeowners who submit this affidavit Indicating they ara doing all work and thus hire outside contractors must submit a new affidavit indt ating such. tContractors thatcheak this box must attached an additional sheet shoridng tho namb of the subcontractors and atatowhether ornot those entities have employee , If thosubc ontmetors hem employees, theymust Dravida their workers' comp. polldynumber. • • % r m at employer //tat fsprovldiitg workers' conpetcsatlott insurance forttty employees Below k the policy and Job site information, PrA Insurance Company Name, 1,,,, b x J' ; \ (l Policy # or Self -tits. Lie, #: 1,1(,\ - ��- (n �\ -U� _• Expiration D ate: la\Zb a0 13 , . Job Site Address: • ` `.--- 19 -Cx `C - City /State /Zip: _ 1 V . `Grv\e )!� 0-1.) Attach a copy of theworkers' compensation policy declaration go'(showing the policy number and expiration date), • Failure,to secure coverage as required tinder Section 25A of MGL o. 152 can lead to the imposition of criminal penalties of a fine tip 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, 13e advisedthat a copy of this statement be forwarded to the Office of Investigations of the DIA. for insurance coverage veri8tcatiou. . X'do hereby certiO under the pains-and penalties of erJi that the information provided above is true acid corral • ' �'lenatute: t ,9N` ` •Date; • \' `1-L • . . ' �?hon : �5''�v_ .Vk - - • Official use only. Do not write in th It ea, tb be completed by city or town official • City or Town :, , ' Permit/License # Issuing Authority (circle one): .1. Board of Haalfh 2, Bu(lding Department 3. City/Town Clerk 4. Electrical In §pector 5, plumbing Inspector 6.Other • . r • . , Contact Person: t'hone•#: • • A $faa ,, l i 1 flu, in t! i 4.:“! Lity)tp4 Intl NkffisE #a f9.";T Z emote ; 's si0P'aj ...:E. % LEcense: CS 102978 str .ted t �: 00 a � BRIAN MACHADO 47 MALBONE ROAD ASSONET, MA 02702:; �"' — �-..-- Expo - Moon- 5/26/2013 t $0 >twr Try: 102978 E' A ' ` t:J C rtr i, "est r,114i1 r.14z r r./lei.0 : 3 tt nice of Consumer Affairs & Business Regulation License or registration valid for individul use only 1 •'`a = before the expiration date. If found return to: A r. le ME IMPROVEMENT CONTRACTOR t : Office of Consumer Affairs and Business Regulation ' Registration: 166075 - Type: 10 Park Plaza - Suite 5170 = ' Ex • Expiration: 4/21/2014 Supplement % P pp Boston, MA 02116 ADVANTAGE WEATHERIZATION, INC. BRIAN MACHADO 1150 WEST CHESTNUT STE; d � - - - - / BROCKTON, MA 02301 n at u Undersecretary Not valid without signature NOTICE TO PROCEED Low - Income Multi - Family Retrofit Program • The Low - Income Energy Affordability Network (LEAN). administrator of the utility- funded energy efficiency program for low - income multifamily properties, is hereby authorized to have its contractors, employees, and other representatives access the property and perform the work contained in the attached Work Order, including final inspections. A copy of this document shall be carried by LEAN's contractors. employees, or representatives and presented upon request. Site Name: ( : A / l // �� Street. City/Town, Zip: t3.•5 Yd. ( . `l t . � l.1$ / ./ .7 ;- G/! l/' Contact Name & Phone at Site: , )Di /? F_, 4 /4 Signature: Signature: /0 Printed Name: Title: AA '' Py•er 7 T Organization: v Oft Date: /6 /17 1/2 V Acknowledged by LEAN's representative: John Wells, Vice President for Energy Services, ABCI) Please sign and date two originals. Retain one for your records and return the other to: James Collins Energy Services, 4 Floor ABCD 178 Tremont St Boston, MA 02111 fax: 617- 357 -4661 i ames.col l i nsr'ir)bostonabed.ore, Program Administrators: LEAN, Bay State Gas, Berkshire Gas, Blackstone Gas, Cape Light Compact, National Grid, New England Gas, NSTAR, Unitil, WMECO 1150 W Chestnut St a ova G Suite 3 4V1 A(t` "` ` C " ` "' > Brockton, Ma 02301 11/15/2012 AGENCY: Action for Boston Community Development, Inc. ABCD 178 Tremont St. Boston, MA 02111 PROPERTY: CAHILL APARTMENTS TOTAL 35 Fruit St. Work Order Building # E Unit(s): 8 $ 5,151.10 date owalk- Through Auditors Report Rcvd Q Cost #:14©x6 Work Order # 0 DESCRIPTION ( QTY. UNIT ( UNIT PRICE TOTAL PRICE DOORS Weatherstrip w / Q - Ion or equal I 6 I ea I $45.50 1 $273.00 MISC. MEASURES Weatherstrip (Q -Ion or equal) & R -30 attic hatch 2 ea $33.50 $67.00 Attic / Basement sealing with two -part foam 14 man /hr $75.00 $1,050.00 Non -Attic Air Sealing 8 man /hr $55.00 $440.00 ATTIC INSULATION R -38 unrestricted - settled cellulose 384 sq.ft. $1.47 $564.48 R -18 -20 unrestricted - settled cellulose , 2048 sq.ft. $1.29 $2,641.92 MISC.INSULATION Duct insulation R -5 I 37 1 sq.ft. 1 $3.10 1 $114.70 Page 5 of 8 Versionl.7 Commercial Building Permit May 15, 2000 SECTION 10 STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Northampton Housing Authority as Owner of the subject property Advantage Weatherization, Inc. hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date Advantage Weatherization Inca , 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. Brian Machado Print Name 11/15/2012 Signature of Owner /Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Brian Machado 102978 Name of License Holder : , License Number 1150 West Chestnut St. Suite 3, Brockton MA 02301 05/26/2013 Address Expiration Date (401) 641 -1493 Signature Telephone SECTION 13 - 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 s Version1.7 Commercial Building Permit May 15, 2000 SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name (Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility .._ Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name: Responsible In Charge of Construction Address Signature Telephone Versionl.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Versionl .7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑ Brief Description Weatherization: Weatherstrip doors. Air Sealing. Of Proposed Work: SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly A -1 ❑ A -2 ❑ A -3 ❑ 1A 1 ❑ A -4 ❑ A -5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B L ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) 1St 1 st 2nd 2 nd 3rd 3 r d 4th 4 th Total Area (sf) Total Proposed New Construction (sf) Total Height (ft) Total Height ft 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system E] Versionl.7 Commercial Building Permit Ma 15, 2000 Department use only City of Northampton � ° Sfatus cif Pe t: Building Department • 9,9,01 Cu#1Dri - way Permit - 212 Main Street N 4 riS' tic ' vailability Room 100 Water IAv_ lability Northampton, MA 010; - �� : ructurai Plans phone 413- 587 -1240 Fax 413- 87- '. anifc ° ./ rte i�lans No Other Specify APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: Northampton Housing Authority 49 Old South St Name (Print) Current Mailing Address: (413) 584 -4030 Signature C f t L ' L' Telephone 2.2 Authorized Agent: Advantage Weatherization, Inc. 1150 West Chestnut St. Suite 3 Brockton 02301 Name (Print) Current Mailing Address: (508) 510 -6866 Signature "� Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building M' (a) Building Permit Fee 2. Electrical $0.00. (b) Estimated Total Cost of Construction from (6) 3. Plumbing $0.00 Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection $0.00 6. Total = (1 + 2 + 3 + 4 + 5) Check Number 3 S 5 This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2013 -0574 APPLICANT /CONTACT PERSON ADVANTAGE WEATHERIZATION INC ADDRESS/PHONE 1150 W CHESTNUT ST SUITE 3 BROCKTON (508) 510 -6866 PROPERTY LOCATION 35 FRUIT ST MAP 39A PARCEL 075 001 ZONE URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid G`! Typeof Construction: WEATHERIZATION, WEATHERSTRIP DOORS, AIR SEALING - BLDG E New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 102978 3 sets of Plans / Plot Plan THE FOLLO NG ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ION PRESENTED: proved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND /OR Special Permit With Site Plan Major Project: Site Plan AND /OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission _ Permit DPW Storm Water Management Demolit� -1a . Signa'�� - I Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning & Development for more information. 35 FRUIT ST BP- 2013 -0574 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 39A - 075 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit # BP- 2013 -0574 Project # JS- 2013- 000923 Est. Cost: $5151.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADVANTAGE WEATHERIZATION INC 102978 Lot Size(sq. ft.): 93654.00 Owner: NORTHAMPTON CITY OF NORTHAMPTON HOUSING AUTHORITY Zoning: URC(100)/ Applicant: ADVANTAGE WEATHERIZATION INC AT: 35 FRUIT ST Applicant Address: Phone: Insurance: 1150 W CHESTNUT ST SUITE 3 (508) 510 -6866 WC BROCKTONMA02301 ISSUED ON:11/27/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:WEATHERIZATION, WEATHERSTRIP DOORS, AIR SEALING - BLDG E 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 11/27/2012 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck— Building Commissioner R K : 9 November 19, 2012 Mr. Louis Hasbrouck Building Commissioner City of Northampton 212 Main Street Northampton, MA 01060 Dear Mr. Hasbrouck I request that you grant a modification to waive the requirement for controlled construction for the insulation and weatherization of 35 Fruit Street (8 buildings total) because the work is of a minor nature, will not affect health, accessibility, life and fire safety, or structural requirements and is impractical in that the cost of controlled construction is considerable when compared to the cost of the proposed work. Please accept this stamped letter as an indication of my support for this request. Thank you for your consideration. Sincerely, � s�. ®� G ,FuE.o AR 1 ‘/(y ep ' i' . s ,0,, t 4 o No. 10731 " 4 ? c NORTH EASTON, �-, r Wayne E. Benson, Jr. RA v�� ,,,,,,z)-- r �� ' � \� rH OF ,.;, k,,, President RKB Architects „-- -"1 ADVAN -8 OP ID: PS Al CCAR'!)” ' DATE (MM/ODmYY) 4.___-- CERTIFICATE OF LIABILITY INSURANCE 06/21/12 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 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 781 - 642.9000 NAM ACT Eastern Agency, Inc. tes Insurance 781- 647 -3670 jA"/a Ne,Fxt1' �FAC o: 50 Prospect Street ADDRESS: Waltham, MA 02453 INSURER) AFFORDING COVERAGE NAIC B INSURERA; Liberty Mutual Insurance Co. INSURED Advantage Weatherization, Inc, INSURER 8: Berkley Assurance Co 1150 West Chestnut Street INSURER C ; Navigators Insurance Company Brockton, MA 02301 INSURER 0 : 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, MsR ADDL SUER POLICY EFF POLICY EXP 1 TR TYPE OF INSURANCE sR 1Mtn POL15Y NUMBER (�1M/OD....M.414/0 P LYY 1 LIMITS ■ GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 t I B X COMMERCIAL GENERAL LIABILITY VUMA0000891 04/02/12 04/02/13 DAMAGE TO RENTED 50 000 PREMI$E3(Eaoccurcenc�) $ , CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL& ACV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT. AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 PRO - POLICY JFGT 0". $ ' AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) g 1,000,000 A ANY AUro _ ASJ -Z11- 261011 -032 06/20/12 06/20/13 BODILY INJURY (Per person) $ AUTO OWNED X SCHEDULED AUTOS BODILY INJURY (Per eccldenl) $ X HIRED AUTOS X NON•OWNE PROPERTY DAMAGE $ AUTOS (Per accident) $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A X EXCESS LIAR CLAIMS -MADE THC -Z91- 261011 -042 06/20/12 06/20/13 AGGREGATE $ 6,000,000 DED I ( RETENTION$ U OER $ WORKERS COMPENSATION X 1 TORY LINT ?S [ AND EMPLOYERS' LIABILITY A ANY PROPRIETOR /PARTNER/EXECUTIVE Y!N WC1 -Z11. 261011 -012 06/20/12 06/20/13 EA. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? I N j NIA (Mandatory In NH) El. DISEASE • EA EMPLOYEE $ 1,000,000 it d escribeund er DESG� OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Excess Liability NYIIEXC71193IV 08/20/12 06/20/13 Excess 10,000,000 Excess 6 Million 5 Million DESCRIPTION OF OPERATIONS 1 LOCATIONS VEHICLES (Attach ACORD 101, Additional Remarks Schedule, II more epees Is required) CERTIFICATE HOLDER CANCELLATION EVIDENC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE "----- L _ 0 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD • . • • t t • The Commonwealth of Massac1uisetts • • _� - D. epartmerttofIrtdtistrtalAcctde rtts . •` = F. Office of Investigations , 14 y • • 600 Washington Street € zei: a Hermit, M1 0 2111 . • \' =:.t�' ivww.rnass.gov /diz ' . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers - ,Applicant Information . Please Print Legibly Naci.e ( Business /Orgaelzaflon/rndlv1dual): ,'c*1\U.i1 1 \O\-\ - .r ■ \nC. • . • ' A.ddress \ • ' _ ` - • - . • - - - .• • City /State /Zip; t r r.. \ fr\'P O S Phhon0,it: -� \ L Q.\ 4�.\ Are you an. employer? Check the appropriatebozl • ,' -Type ofpi.°Ject(required) :, 1, I I am. a ernliloyer with \0 4. 0 X am. a general contractor and l 6 t employees (full and/or part titne),e have hired the sUb- contractors Q New construction. 2.0 I atn. a'so[e proprietor or partner - Listed on tha'attachedshcot. 7. ❑ Remodeling • ship and have no employees Those sub - contractors have 8, [] Demolition • working forma in any oapaeity,• , . . employees antihave waken' ..._ .. . �. _�13tiilcling addition . • [No workers' comp. insurance comp. insurance,t' , required. 5, 0 We area corporation and its 10.D Electrical repairs or additions '3.0 I am a homeowner dais all work of6tcera have exercisect their • 11.E1 Plumbing repairs or additions ' •myself, [Noworkers' comp, right bfexeinptloxi erMGL 12,0 Roof repairs • • insurance rc uired. t o q I employees, [No workers' 13,[1 Other • comp. insuuanve required:] • • *My appl1eant thatoheoks box #1 must also fill out the section botow showing thou workers' compensation iafomration, i • t Homeowners who submit this affidavit Indicating they ate doing all work and then hire outsldo contrectors must submit a now affidavit indt attag such. , 1 Contractors that chock this box must attached an additional shed shotiv1ng the name of the sub•cofitraotors and statowhotherornot those entitim havo • employees, If rho sub - contractors havo employees, thoymust providb their workers' comp. polldy number. . y • X qm au etrtployer•tlrat isprov!ldiag workers' corpensallon Insurance for aty employees Below is the porky and Job site information. � � i Insurance Company Name; l \c Policy # or Self -ins. Lie, #',11_1(_,A,_ \\ (4 -0\ ___• Expiration Date : la\Zb\ 3 _ , . Job Site Address: • _ cl. .. s - • . • , - City /State /Zip: \ VA as,ry -T , - ti1jYV Attach a copy of tho•workers' coinpensatlon policy declaratl .4 . ago•(showing the policy number and expiration date), • Failure, to saeur6 coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to $1,500.00 and/or oue -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 thq violator. 13e advised that a copy of this statement - maybe forwarded to the Office of Investigations of the DIA. for insurance coverage verification. I'do hereby cog?" trader thepalus•and penalties of erft that the information provlded above, Is true acid correct • ' ,Signature: �N` t Da te; �� i\ • • • p.hon : . Le, :_5'•\-- 1.. - " - • Official use only, Do not Write In tli a ea, tb be completed b, city or forest official . • • City or Townt . . Permit/License # Issuing Authority (circle one): .1. board of Health 2. Bui Department 3. City /Town Clerk 4. Electrical Inspector 5, plumbing Inspector 6.Other . . •• . } i Contact Person: 'hone. #: . - - • • i x1s ' z p s 4t ,mss° s � s sal Sili ti Rt utati»rry anrt truct,er S€ }, v &wi• 3 l • r Licefice: C3 102978 R r t1 to, 00 4 1 BRIAN MACHADO 47 MALBONE ROAD ASSONET, MA 02702 Exp €rnl €on. 5/26/2013 • i 4ntaeai,441tet° Try; 102978 `l /trr rrrt' rttr vrt r I%<r xsrd+rr,f .11: 4:‘ ?ffice of Consumer Affairs & Business Regulation License or registration valid for individul use only 111 .' : gi n ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation i , egistration: 166075 Type: 10 Park Plaza - Suite 5170 Expiration: 4/21/2014 Supplement Card Boston, MA 02116. ADVANTAGE WEATHERIZATION, INC. BRIAN MACHADO 1150 WEST CHESTNUT STE 13�� -- vnr, BROCKTON, MA 02301 Undersecretary Not valid without signature NOTICE TO PROCEED Low - Income Multi - Family Retrofit Program The Low - Income Energy Affordability Network (LEAN). administrator ofthc utility- funded energy efficiency program for low - income multifamily properties. is hereby authorized to have its contractors. employees, and other representatives access the property and perform the work contained in the attached Work Order, including final inspections. A copy of this document shall be carried by LEAN's contractors. employees, or representatives and presented upon request. Site Name: ('8� f� � ' ,l r' '''.'� /7"5' Street. City/Town, Zip: 3.'l )7(. ( 4: Y. A 7/ • 7W, Contact Name & Phone at Site: , )z9�/7 / 4 //. - r�i fiV - 4 /4,32) Signature: Printed Name: -\ Title: AA '' cjr•er Organization: ► ,,1 ) A4if7A 15 �,�►q �'Q�'f�t.� Date: it) /17 1/7 Acknowledged by LEAN's representative: /: John Wells, Vice President for Energy Services, AI3CI) Please sign and date two originals. Retain one for your records and return the other to: James Collins Energy Services, 4 Floor ABCD 178 Tremont St Boston, MA 02111 fax: 617-357-4661 james.collins cei bostonabcd.org Program Administrators: LEAN, Bay State Gas, Berkshire Gas, Blackstone Gas, Cape Light Compact, National Grid, New England Gas, NSTAR, Unitil, WMECO 1150 W Chestnut St A )VAN. Suite 3 H <: �, �� > .� E �> Broc Ma 02301 Date: 11/:5;/2x12 AGENCY: Action for Boston Community Development, Inc. ABCD 178 Tremont St. Boston, MA 02111 PROPERTY: CAHILL APARTMENTS TOTAL 35 Fruit St. Work Order Building # D Unit(s): 8 $5,151.10 Date of Walk-through: Auditors Report Rcvd. Job��Cost #:14096 Work Order # 0 DESCRIPTION I QTY. I UNIT IUNITPRICEI TOTAL PRICE DOORS Weatherstrip w / Q -Ion or equal 1 6 f ea I $45.50 I $273.00 MISC. MEASURES Weatherstrip (Q -Ion or equal) & R -30 attic hatch 2 ea $33.50 $67.00 Attic / Basement sealing with two -part foam 14 man /hr $75.00 $1,050.00 Non -Attic Air Sealing 8 man /hr $55.00 $440.00 ATTIC INSULATION R -38 unrestricted - settled cellulose 384 sq.ft. $1.47 $564.48 R -18 -20 unrestricted - settled cellulose 2048 sq.ft. $1.29 $2,641.92 MISC.INSULATION Duct insulation R -5 1 37 1 sq.ft. 1 $3.10 1 $114.70 Page 4 of 8 Versionl.7 Commercial Building Permit May 15, 2000 SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No Q SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Northampton Housing Authority 1, as Owner of the subject property Advantage Weatherization, Inc. hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date Advantage Weatherization Inca , 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. Brian Machado Print Name 4416"" _ 11/15/2012 Signature of Owner /Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : Brian Machado 102978 License Number 1150 West Chestnut St. Suite 3, Brockton MA 02301 05/26/2013 Address Expiration Date (401) 641 -1493 Signature Telephone SECTION 13 - 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 u Versionl.7 Commercial Building Permit May 15, 2000 SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name (Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name: Responsible In Charge of Construction Address Signature Telephone Version1.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: . R: L R:. Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DON'T KNOW 0 YES IF YES: enter Book Page. and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW YES (2) IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Q , Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: '? D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Version1.7 Commercial Building Permit May 15, 2000 ' SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS TI-IAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑ Brief Description Weatherization: Weatherstrip doors. Air Sealing. Of Proposed Work: SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A -1 ❑ A -2 ❑ A -3 ❑ 1A 1 ❑ A -4 ❑ A -5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B 1 ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S -1 ❑ S -2 ❑ 5B I ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) 1st 1St 2nd 2nd 3 � 3r 4th 4 th Total Area (sf) Total Proposed New Construction (sf) Total Height (ft) Total Height ft 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone Municipal ❑ p ❑ On site disposal system ❑ Versionl.7 Commerci. 14in Permit May 15, 2000 > Department use only City of Northam. on S tus of P - rmit: Building Departm -nt 7rrts t/Drveway Permit - 212 Main Stree Sevye epti Availability Room 100 �� , A vaiiabiiity Northampton, MA Olt .0 �` Rj a ° wo Sets of Structural Plans phone 413 - 587 -1240 Fax 413 .87- " Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Northampton Housing Authority 49 Old South St Name (Print) Current Mailing Address: (413) 584 -4030 Signature � CA.1E' s � Telephone 2.2 Authorized Agent: Advantage Weatherization, Inc. 1150 West Chestnut St. Suite 3 Brockton 02301 Name (Print) Current Mailing Address: (508) 510-6866 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building c' (a) Building Permit Fee 2. Electrical $0.00 (b) Estimated Total Cost of Construction from (6) 3. Plumbing $0.00' Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection $0.00 g 6. Total = (1 + 2 + 3 + 4 + 5) Check Number 3gD This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2013 -0573 APPLICANT /CONTACT PERSON ADVANTAGE WEATHERIZATION INC ADDRESS/PHONE 1150 W CHESTNUT ST SUITE 3 BROCKTON (508) 510 -6866 PROPERTY LOCATION 35 FRUIT ST MAP 39A PARCEL 075 001 ZONE URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid J lll1-- lS �J Tvpeof Construction: WEATHERIZATION, WEATHERSTRIP DOORS, AIR SEALING - BLDG D New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 102978 3 sets of Plans / Plot Plan THE FOLL NG ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND /OR Special Permit With Site Plan Major Project: Site Plan AND /OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission _ Permit DPW Storm Water Management of De A efr Signa a of Building Offi 'al - Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning & Development for more information. 35 FRUIT ST BP- 2013 -0573 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 39A - 075 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit # BP- 2013 -0573 Project # JS- 2013- 000923 Est. Cost: $5151.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADVANTAGE WEATHERIZATION INC 102978 Lot Size(sq. ft.): 93654.00 Owner: NORTHAMPTON CITY OF NORTHAMPTON HOUSING AUTHORITY Zoning: URC(100)/ Applicant: ADVANTAGE WEATHERIZATION INC AT: 35 FRUIT ST Applicant Address: Phone: Insurance: 1150 W CHESTNUT ST SUITE 3 (508) 510 -6866 WC BROCKTONMA02301 ISSUED ON:11/27/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:WEATHERIZATION, WEATHERSTRIP DOORS, AIR SEALING - BLDG D 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 11/27/2012 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner November 19, 2012 Mr. Louis Hasbrouck Building Commissioner City of Northampton 212 Main Street Northampton, MA 01060 Dear Mr. Hasbrouck I request that you grant a modification to waive the requirement for controlled construction for the insulation and weatherization of 35 Fruit Street (8 buildings total) because the work is of a minor nature, will not affect health, accessibility, life and fire safety, or structural requirements and is impractical in that the cost of controlled construction is considerable when compared to the cost of the proposed work. Please accept this stamped letter as an indication of my support for this request. Thank you for your consideration. Sincerely, 1 01.4‘.4.4,A 4 �' BRED A � 4ti ��4 �� ( iSON 4,\ /(,), * S � a o No. 10731 I 4 NORTH EASTON L ( I ' I ! h� t -2 Wayne E. Benson, Jr. RA a of President RKB Architects .-----'" ADVAN -8 OP ID: PS ACOR[7" DATE (MMIDDJYYYY) 1/4.------ CERTIFICATE OF LIABILITY INSURANCE 06/21/12 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 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 Ileu of such endorsement(s). PRODUCER 781 - 642.9000 NaMEACT Eastern States Insurance PH ONE FAX Agency, Inc. 781- 647- 3670 No. Ex(); uNc„,tto 50 Prospect Street ADDRESS: Waltham, MA 02453 INSURER(S) AFFORDING COVERAGE NAIC N INSURERA : Liberty Mutual Insurance Co. INSURED Advantage Weatherization, Inc, INSURER e : Berkley Assurance Co 1150 West Chestnut Street INSURER C: Navigators Insurance Company Brockton, MA 02301 --- INSURER D ; 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 ADDL SUER POLICY EFF POLICY EXP .TR TYPE OF INSURANCE INSR WVn POL NUMBER JMMIDD/YYYY) 1b1MIDDMY7Y1 LIMITS 1 ■ GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 i DAMAGE TO RENTED E3 X COMMERCIAL GENERAL LIABILITY VUMA0000891 04/02/12 04102/13 M gES (Ea0 en„). _ s 50,000 1 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 f ' PERSONAL & ACV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 — I POLICY n PRO n $ IFGT - LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 000 000 j (Ea accident) $ , r A ANYAUrO ASJ -Z11- 281011.032 06/20/12 06/20/13 BODILY INJURY (Per person) $ ALL OWNED ' SCHEDULED BODILY INJURY (Per accident} $ X HIRED AUTOS X AUTOS WNED PROPERTY DAMAGE $ AUTOS (Par accident) $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 6,000,000 A X EXCESS LIAO CLAIMS -MADE THC- Z91- 261011 -042 06/20/12 08/20/13 AGGREGATE $ 5,000,000 BED l i RETENTIONS $ WORKERS COMPENSATION X I TIM - Ms WC 0TH - AND EMPLOYERS' LIABILITY STATU• S I ER A ANY PROPRIETOR /PARTNER/EXECUTIVE 1 WC1 -Z11- 261011.012 05/20/12 06/20/13 el. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N l N / A (Mandatory In NHI E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If Ea, describe under DESCRIPTION OE OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Excess Liability NY11EXC71193IV 06/20/12 06/20/13 Excess 10,000,000 Excess 5 Million 5 Million DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is requlrod) CERTIFICATE HOLDER CANCELLATION EVIDENC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence Of insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE .---- -r I @ 1988-2010 ACORD CORPORATION, All rights reserved, ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD • i 1 • • • ti s t t , The Cominotiwealth of Massaehlisetts • , • • w : ,, Departrrtertt of Irtdtistrlal Accidents • • P � (1-A Office ofhivestigations - 4 • - 600 Washington Street . • e 45.T= ti Boston, M4 02111 . �'' •_: i4 - www.rttass,gov /die ' . • . Workers' Compensation I1 sara1Lce Affidavit: Builders /Contractors(EIectl idaus /Plumbers - • ,Applicant Information • Please Print Legibly Name ( Business / Organization /Individual); ,'( -�9 `?� ier\ - e_r_t vt� 1n� , . • • Address: 1 • , > - • City /State /Zip, ` - .. ''.. ' ; zu' Phono.t: _ 'i \ 4^ :51 • Are you an employer? Check the appropriate box: ••7:ype of pi•oject (required) ;, 1, f [ 1 ant a erngioyer with 16 4, ❑ 1 am a general covtraotor and' • + • employees (full and/or part lino),* have hired thasub- contractors Q Nett/ construction 2. ❑ I am a 'sole proprietor or partner - listed on ibe•attaohedsheot 7. ❑ Remodeling , ship and have no employees These sub - contractors have g, o Demolition • working for me in any oapaeity; . , employees andhavo workere......._ • [No workers' comp, insurance comp, insurance,$' 9;'[] Buiilc�ing addition required,) S. 0 We are . a corporation and its 10,0 Electrical repairs or additions '3, 0 I am a homeowner doing all work officers Dave exercisedtheir . i1.❑ Plumbing repairs or additions ' •myself. [No workers' comp, rightbfexetnptLonperMGL 12,[JRoofrepairs insurance required.] t o, 152, §1(4), and. wallow no • - = employeos, [No workers' 13.[1 Other • comp. insurance required] _ • • *Any appllartnt that (Areas box #1 must also 611 out th a station below showing tholi workers' compensationpulieyinformation. • 1 • t Homeowners who subndt this affidavit indicating they aro doing all work and then hire outside contractors must submit a now afdavitinditating such, , ;Contractors that chock this box must attached an additional sheet shoWing the ramie of tha sub-cafikaators and stato whether ornot those entitles have ' cmpioyees, If lho subcontractors have employees, thoymustprovidb their workers' comp, polloy number. • • Irian au employer thaU Isproi;ldlag workers' compensation insurance for my employees. Below is the policy and Job site Ittforivatlon. ^� (l InssuranceCompany Na•me, ,&Ln; Mtn 1�V ' Policy #or'Seif- ts. Lie, # : I1,>( ,\ -7 \ \'1 -01,, • ExpirationDate: kn. \VAatJi3 . • Job Site Address: • c T VA,.. t. I )N • <-- City /Stato /Zip; 1 ' ia II rte' s Attach a copy of tho•workers' eoinpensatlon policy declaration p •(showing the pol'lo' number and expiration . ate), • Failtre,to secure coverage as required tender Section 25A of MGL o. 152 can lead to the imposition of minded penalties of a fine tip 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 $250.00 a day against tllq violator. Be advisedthat a copy of this statement be forwarded to the Office of Investigations of the DIA for insurance coverage verification. . X'do hereby oert f y trader ihepatus -mid penalties of 'ell: that the Information provided above, is true aril correct • • i.ial._e• • ■ R - Ai Ald • 1 to• \\ \t. 'fit - , • _ p?h • one f1; • i-e ' 5'• \v LL ` I - • . • - Official me only. Do not write In 111 ea, lb be completed by elty or 1011 official • • - • City or Town: . . Per.ndt/License # • Issuing Authority (circle one): • .1. Board of Health 2, But Department 3, City(fown Clerk 4, Electrical Inspector 5, Plumbing Inspector 6, Other _ . • . • Contact Person: . • - Phone•#: • - • . . „.cl1 c a € :`,, a Fs E 1 i "' po. €3 zsq ;a fat Bui1 =air #r l «,$;€ 3tsi'tr9! rt t �sS,4 #4r : . ns to u;,,,P i4f. - License: CS 102978 Restr_ct t3 to 00 BRIAN MACHADO 47 MALBONE ROAD ASSONET, MA 02702 r - -� -- ” Expirat 5/26/2013 s i ..iimli,.10iii ^3` Tr": 102978 �a /Ift t f wi /PI i #:; (/' fler Ife, IV, Cif f ce of C onsumer Affairs & Business Regulation License or registration valid for individul use only 3 Cr before the expiration date. If found return to: ME IMPRQVEMENT CONTRACTOR 1 ffice of Consumer Affairs and Business Regulation ' ; F ./ Registration: 156075 Type: 10 Park Plaza - Suite 5170 4 e)4 Expiration: 4) 2112014 Supplement C:ard Boston, MA 02116 ADVANTAGE WEATHERIZATION, INC. BRIAN MACHADO 1150 WEST CHESTNUT STE B -,gam— �,. BROCKTON, MA 02301 �-�� Undersecretary Not valid without signature NOTICE TO PROCEED Low - Income Multi - Family Retrofit Program The Low- Income Energy Affordability Network (LEAN). administrator of the utility - funded energy efficiency program for low - income multifamily properties. is hereby authorized to have its contractors. employees, and other representatives access the property and perform the work contained in the attached Work Order, including final inspections. A copy of this document shall be carried by LEAN's contractors. employees, or representatives and presented upon request. Site Name: � : 4 // � ;`jl'L /':L r /7/c Street. City/Town, // /Town, Zi .`7 � Yi/. � .`� rt$ �1 G/I 1/ S Zip: 3 l � Contact Name & Phone at Site: , /2 ira x// - %iRS/ -1 /43e' Signature: 0 6t7 Printed Name: \--\.4..e Title: 7) (er 7)t Organization: }J- .4•- -r, e k i e r + 0 � 4:5Q S vt dt .� Date: /6 /17 Acknowledged by LEAN's representative: John Wells, Vice President for Energy Services, Al3CI) Please sign and date two originals. Retain one for your records and return the other to: James Collins Energy Services, 4 Floor ABCD 178 Tremont St Boston, MA 02111 fax: 617-357-4661 iames.collins chi bostonabcd.org Program Administrators: LEAN, Bay State Gas, Berkshire Gas, Blackstone Gas, Cape Light Compact, National Grid, New England Gas, NSTAR, Unitil, WMECO 1150 W Chestnut St ® `` Suite 3 AL)VAN "I AC�k A1111 Ett;, °` "'" Brockton, Ma 02301 D 11/15/2012 AGENCY: Action for Boston Community Development, Inc. ABCD 178 Tremont St. Boston, MA 02111 PROPERTY: CAHILL APARTMENTS TOTAL 35 Fruit St. Work Order Building # C Unit(s): 8 $5,151.10 Date of " faIk- Through Auditors Report Rcvd. lob,Cst #:14096 Work Order # 0 DESCRIPTION I QTY. I UNIT IUNIT PRICE' TOTAL PRICE DOORS Weatherstrip w / Q - Ion or equal 1 6 1 ea 1 $45.50 1 $273.00 MISC. MEASURES Weatherstrip (Q -Ion or equal) & R -30 attic hatch 2 ea $33.50 $67.00 Attic / Basement sealing with two -part foam 14 man /hr $75.00 $1,050.00 Non -Attic Air Sealing 8 man /hr $55.00 $440.00 ATTIC INSULATION R -38 unrestricted - settled cellulose 384 sq.ft. $1.47 $564.48 R -18 -20 unrestricted - settled cellulose 2048 sq.ft. $1.29 $2,641.92 MISC.INSULATION Duct insulation R -5 I 37 1 sq.ft. 1 $3.10 1 $114.70 Page 3 of 8 Versionl.7 Commercial Building Permit May 15, 2000 SECTION 10 STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No 0 SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Northampton Housing Authority I, , as Owner of the subject property Advantage Weatherization, Inc. hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date Advantage Weatherization, Inc. , 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. Brian Machado Print Name 11/15/2012 Signature weer /Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of t icense Holder : i Brian Machado 102978 License Number 1150 West Chestnut St. Suite 3, Brockton MA 02301 05/26/2013 Address Expiration Date (401) 641 -1493 Signature Telephone SECTION 13 - 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 a Versionl.7 Commercial Building Permit May 15, 2000 SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name (Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name: Responsible In Charge of Construction Address Signature Telephone Versionl.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: _ R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained 0 , Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑ Brief Description Weatherization: Weatherstrip doors. Air Sealing. Of Proposed Work: SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly A -1 ❑ A -2 ❑ A -3 ❑ 1A I ❑ A -4 ❑ A -5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B 1 ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S -1 ❑ S -2 ❑ _ 5B ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) 1st 1st 2nd 2nd 3rd 3r 4th 4 Total Area (sf) Total Proposed New Construction (sf) Total Height (ft) Total Height ft 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood ZoneD Municipal ❑ On site disposal system❑ Versionl.7 • ay 5, 2000 Department use only City of Northampto o Pe lit: Building Departmen r dkiPtku iriv: ay Permit - 212 Main Street Sew A ailability 54 ® Room 100 or - ;�u �_ f • _lability Northampton, MA 0106 o�p wo Sets of Structural Plans phone 413 - 587 - 1240 Fax 413 - 272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Northampton Housing Authority 49 Old South St Name (Print) Current Mailing Address: (413) 584 -4030 Signature `—y \ Telephone 2.2 Authorized Agent: Advantage Weatherization, Inc. 1150 West Chestnut St. Suite 3 Brockton 02301 Name (Print) Current Mailing Address: (508) 510 -6866 Signature c7 Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing $0.00 Building Permit Fee 4. Mechanical (HVAC) $0.00 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) Check Number 32g3 This Section For Official Use Only a Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2013 -0572 APPLICANT /CONTACT PERSON ADVANTAGE WEATHERIZATION INC ADDRESS/PHONE 1150 W CHESTNUT ST SUITE 3 BROCKTON (508) 510 -6866 PROPERTY LOCATION 35 FRUIT ST MAP 39A PARCEL 075 001 ZONE URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 5(i 8 ,� Fee Paid �8L'S �J Typeof Construction: WEATHERIZATION, WEATHERSTRIP DOORS, AIR SEALING - BLDG C New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 102978 3 sets of Plans / Plot Plan THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION PRESENTED: Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND /OR Special Permit With Site Plan Major Project: Site Plan AND /OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission _ Permit DPW Storm Water Management De , b el. Signature of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning & Development for more information. 35 FRUIT ST BP- 2013 -0572 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 39A - 075 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit # BP- 2013 -0572 Project # JS- 2013- 000923 Est. Cost: $5151.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADVANTAGE WEATHERIZATION INC 102978 Lot Size(so. ft.): 93654.00 Owner: NORTHAMPTON CITY OF NORTHAMPTON HOUSING AUTHORITY Zoning: URC(100)/ Applicant: ADVANTAGE WEATHERIZATION INC AT: 35 FRUIT ST Applicant Address: Phone: Insurance: 1150 W CHESTNUT ST SUITE 3 (508) 510 -6866 WC B ROCKTO N MA02301 ISSUED ON:11/27/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:WEATHERIZATION, WEATHERSTRIP DOORS, AIR SEALING - BLDG C 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 11/27/2012 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner R K November 19, 2012 Mr. Louis Hasbrouck Building Commissioner City of Northampton 212 Main Street Northampton, MA 01060 Dear Mr. Hasbrouck I request that you grant a modification to waive the requirement for controlled construction for the insulation and weatherization of 35 Fruit Street (8 buildings total) because the work is of a minor nature, will not affect health, accessibility, life and fire safety, or structural requirements and is impractical in that the cost of controlled construction is considerable when compared to the cost of the proposed work. Please accept this stamped letter as an indication of my support for this request. Thank you for your consideration. Sincerely, m&i �FtEDARc �1 e.-3, .1 * * <Z DSON � ETC, ® No. 10731 4 NORTH EASTON, Le-/ Wayne E. Benson, Jr. RA �` `y '° y C '� �.� t* ®® President RKB Architects -- - "N ADVAN1-8 OP ID: PS ACORO- DATE (MMIDDNYYY) 4fto,,-_---- CERTIFICATE OF LIABILITY INSURANCE 06/21/12 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 pollcy(les) must be endorsed. If SUBROGATION 1S 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 Iteu of such endorsement(s). PRODUCER 781-642-9000 NAME ACT Eastern States Insurance 781 PHONE ii FAX - 647 -3670 Agency, Inc. 1Na. tto. EM L(A+C,,No1): 50 Prospect Street ADDRESS: Waltham, MA 02453 INSURER(S) AFFORDING COVERAGE NAIL N _ INSURER A; Liberty Mutual Insurance Co. INSURED Advantage Weatherizatlon, Inc, INSURER 8 : Berkley Assurance Co 1150 West Chestnut Street INSURER a ;Navigators Insurance Company Brockton, MA 02301 INSURER 0 : _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 ADDL SUER POLICY EFF POLICY EXP � LTR TYPE OF INSURANCE INSR WVh. POLICY NUMBER IMMJD9IVYYYI FMM/DPIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 i B X COMMERCIAL GENERAL LIABILITY VUMA0000691 04/02/12 04102/13 OAMAGE TO RENTED 5O 000 PREMISES (Eao $ , j CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 r PERSONAL & ADV INJURY $ 1,000,000 I GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 — 1 POLICY MS 1 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I (Ea aeeldan0 ..$ 1,000,E A ANY AUTO ASJ -Z11- 261011 -032 06/20/12 06/20/13 BODILY INJURY (Par person) $ ALL OWNED X SCHEDULED BODILY INJURY (Par accident) $ AUTOS X HIRED AUTOS X NON•OWNED PROPERTY DAMAGE $ AUTOS (Per accident) $ UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 6,000,000 A X EXCESS LIAR 1 CLAIMS -MADE THC -Z91- 261011 -042 06/20/12 06/20/13 AGGREGATE $ 5,000,000 DM 1 1 RETENTION$ �T U $ r WORKERS COMPENSATION X 1 TORYTATU . I 0 ER AND EMPLOYERS' LIABILITY A ANY PROPRIETOR /PARTNER/EXECUTIVE 1 N 1 NIA WC1 -Z11. 261011 -012 06/20/12 06/20/13 E,L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE • EA EMPLOYEE $ 1,000,000 If yea describe under DESL OF OPERATIONS below E,L DISEASE • POLICY LIMIT $ 1,000,000 C Excess Liability NYIIEXC71193IV 08/20/12 06/20/13 Excess 10,000,000 Excess 5 Million 5 Million DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addltlonal Ramada Schedule, If more apace to requlrod) CERTIFICATE HOLDER CANCELLATION _ EVIDENC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE I ©1988 -2010 ACORD CORPORATION, All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD • • • / • 1 � . I t 7 The Corr :monwvealth of Massdc1uisetts • ., • w bepartrreertt aflrcdtistr'tal �iccid . i!i • �!; 1._ Office of Investigations • Icy ` ►�! y 600 Washington Street • • e E rr a Basalt, Mel 021 . �'' ' 4, •_�� ,0 ' 1vwlv.mass.gov /die ' . • , Workers' Compensation Insur'a ice Affidavit: Builders / Contractors /,EIectriciaus/Plumbers - ,Applicant; Information ' Please Print Legibly Name ( Business /organtxation/rndividual)i ,%A.V*.C51 \o\-\\ . \nom . . • • • ' • Address: \ • • . . s, ∎ „• - '> - • • • City/State/Zip: k La it D t' •r ul Phone. #: ' \ 1 ' c.Q Are Q • A eou an erhpioyer7 Check the appropriate boat , 'Type of piroJect (regrniretl):, 1, fl, I am, a em 10 er with 10 4. ❑ 1 am a general contractor and 1 a • • employees (full and/or part limo),* have hired tha'strb- contractors 6, Q Ne construction 2, ❑ 1 am a 'sole proprietor or partner- listed on the'attachedsheet. 7. [] Remodeling , ship and have no employees Those sub - contractors have 8, [l Demolition . . . . employees andhave workerrL._ working forma in an y o act ' 9', • '[�' Building addition • No workers' comp, insurance comp. insurance,$' • required.] - • 5. 0 Wo arc a corpotation and its 10.0 Electrical repairs or additions - '3, ❑ 1 att a homeowner doing alt work officers lave exercised their • 11,0 Plumbing repairs or additions ' • - 'myself, [No workers' comp, right OfexaMption per MGL 12,[]Roofrepairs insurance required] t o, 152, §1(4), anti we lave no • - employees, [Nit workers' 13,0 Other • comp. insurance required] . . I *Any impitoant that cheeks box 111 ntust also fi it out tho scotion bolow showing tholi• workers' compensation policy information, • 1 • t Homeowners who submit this affidavit Indicating they are doing all work and then hire outside contractors must submit a now affidavitindltating such, 1 Contractors that check this box must attached an additional sheet shorilna the name of tho sub•oohtraotors and state whother or not those entities havo cmployeea, If tho subcontractors havo employees, thoymustprovidb their workers' comp, po1I y number. • • Yarn ua employer'llral Is pro viding workers' conpensadon Insurance for my employees Below Is thepoltcy and Job site Information. Insurance Company Name, ‘....0C\111\. , • \L • # or Self -ills. Lic, #: . - - , a '' -U Expiration Ua`Zt�, Policy Y � 1. . • Job Site Address: . �--L� A >..-A • ' 6 • C1ty /State /Z1p: \(\ • .a w•'V i. . _ a• . , O Attach a copy of tlro•workers' coinpensation policy declaratlo�tge'(showing the policy number and expiration date), • Failtue,to secure coverage as required tinder Section 25A of MGL o, 152 can lead to the imposition of criminal penalties of a fine tip to $1,500.00 and/or one -year iotprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fuze • • of up to $250,00 a day against thq violator. Be advisedthat a copy of this statementxnay be forwarded to the Oface of Investigations of the DIA for insurance coverage verification. TWO hereby cei'I/)' under the palus -and penalties of , erJz that the Information proylded above Is true acid carrect. i:.a ` t_o: \ 1 • . _ .4 . • D te'' \\V-5 I --- • . ` )?hone t#: - ' :5•'\ 3 - LLyk - . • Official use only. .Do not write In al ea, tb be completed by city or MOM offlcial • • • City or own . Permit/License # • Issuing Authority (circle one); • .1, Board of Health 2, Ilu(Iding Department 3, Cityflown Clerk 4, Electrical Inspector 5, plumbing Inspector 6, Other _ . ' . , Contact Person: )'hone•#: • • u �:; Y 1 13 t d t 1 Bttikfitr2 iic21.11,ti ibis- and , `, - nstruc.. t w ;.rt h p � License_ : CS 102978 Restr:ctet ic: 00 BRIAN MACHADO .K 47 MALBONE ROAD ASSONET, MA 02702 Exprrat €o v 5/26/2013 a t' ,anrsaai.*:ias¢44 r TM 102978 sa `f%" rrt.rrr- ��fi +evfr/ /t r�`' „ rlcz..'trrr.f%rE. !(,s OOffice of Consumer Affairs & Business Regulation License or registration valid for individul use only t• ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: x ;r Office of Consumer Affairs and Business Regulation %`Registration: 166075 Type: 10 Park Plaza - Suite 5170 Expiration: 4121/2014 Supplement Card Boston, MA 02116- ADVANTAGE WEATHERIZATION, INC. BRIAN MACHADO 1150 WEST CHESTNUT STE 13 BROCKTON, MA 02301 signature Undersecretary Not valid without signature NOTICE TO PROCEED Low - Income Multi - Family Retrofit Program The Low - Income Energy Affordability Network (LEAN). administrator of the utility - funded energy efficiency program for low - income multifamily properties. is hereby authorized to have its contractors, employees, and other representatives access the property and perform the work contained in the attached Work Order, including final inspections. A copy of this document shall be carried by LEAN's contractors. employees, or representatives and presented upon request. Site Name: C ,4 / l l)'L'; %'L�'//5' Street, City/Town, Zip: 39 fry-it 1" .6. . 4 4?4 //,'4w /Oh/ Contact Name & Phone at Site: . )D7 /7 i�, F. x// - %� FSi - ��✓�� Signature: /0 Printed Name: CA" kA■Af Title: A Per 't T Organization: .JrP./• r I. A 4 % • 3 S%vtq Datc: /6 /17 1/2 V Acknowledged by LEAN's representative: /Y11, iffir John Wells, Vice President for Energy Services, Al3Cl) Please sign and date two originals. Retain one for your records and return the other to: James Collins Energy Services, 4 Floor ABCD 178 Tremont St Boston, MA 02111 fax: 617-357-4661 iames.collins tnibostonabcd.oru Program Administrators: LEAN, Bay State Gas, Berkshire Gas, Blackstone Gas, Cape Light Compact, National Grid, New England Gas, NSTAR, Unitil, WMECO .-%^ 1150 W Chestnut St A DVANTAGE Suite 3 WI 0 � N� >N, >k B Ma 02301 Date: 11/15/2012 AGENCY: Action for Boston Community Development, Inc. ABCD 178 Tremont St. Boston, MA 02111 PROPERTY: CAHILL APARTMENTS TOTAL 35 Fruit St. Work Order Building #* B Unit(s): 8 $5,151.10 ate € f Walk- Through Auditors Report Rcvd Job Cost :14©96 Work Order # 0 DESCRIPTION 1 QTY. I UNIT IUNITPRICEI TOTAL PRICE DOORS Weatherstrip w / Q - Ion or equal I 6 il ea I $45.50 1 $273.00 MISC. MEASURES Weatherstrip (Q -Ion or equal) & R -30 attic hatch 2 ea $33.50 $67.00 Attic / Basement sealing with two -part foam 14 man /hr $75.00 $1,050.00 Non -Attic Air Sealing 8 man /hr $55.00 $440.00 ATTIC INSULATION R -38 unrestricted - settled cellulose 384 sq.ft. $1.47 $564.48 R -18 -20 unrestricted - settled cellulose 2048 sq.ft. $1.29 $2,641.92 MISC.INSULATION Duct insulation R -5 1 37 I sq.ft. 1 $3.10 1 $114.70 Page 2 of 8 Versionl.7 Commercial Building Permit May 15, 2000 SECTION 10 STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Northampton Housing Authority I, , as Owner of the subject property Advantage Weatherization, Inc. hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date Advantage Weatherization, Inc. 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. Brian Machado Print Name 11/15/2012 Signature of Owner /Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : Brian Machado 102978 License Number 1150 West Chestnut St. Suite 3, Brockton MA 02301 05/26/2013 Address Expiration Date (401) 641 -1493 Signature Telephone SECTION 13 - 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 Versionl.7 Commercial Building Permit May 15, 2000 SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name (Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name: Responsible In Charge of Construction Address Signature Telephone Version1.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained , Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO Q IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑ Brief Description Weatherization: Weatherstrip doors. Air Sealing. Of Proposed Work: SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly A -1 ❑ A -2 ❑ A -3 ❑ 1A I ❑ ❑ A -4 ❑ A -5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 36 ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S -1 ❑ S -2 ❑ 5B I ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) 1s 1sc 2nd 2nd 3 rd 3r 4th 4th Total Area (sf) Total Proposed New Construction (sf) Total Height (ft) Total Height ft 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system El Versionl.7 Co • ' , Pe , it ,.y 15, 2000 ✓ Department use only City of Northampton ofP. it Building Depart -nt ti< Cur* ,°t/Dri - way Permit 212 Main Stree` • ic Ayailability ,,o Room 100 o Yg <eco , ater/Well Ava Northampton, MA 010:0 D.- \`' Two Sets of Structural Plans phone 413- 587 -1240 Fax 413 -' ,: 72 Plot/Site Plans Other Specify, APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Lot Unit 1( � \G Zone Overlay District EIm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Northampton Housing Authority 49 Old South St Name (Print) Current Mailing Address: (413) 584 -4030 Signature ? ( A 4 = Telephone 2.2 Authorized Agent: Advantage Weatherization, Inc. 1150 West Chestnut St. Suite 3 Brockton 02301 Name (Print) Current Mailing Address: (508) 510 -6866 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building ct� (a) Building Permit Fee 2. Electrical $0.00', (b) Estimated Total Cost of Construction from (6) 3. Plumbing $0.00' Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection $0.00 6. Total = (1 + 2 + 3 + 4 + 5) Check Number 3i Of This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2013 -0571 APPLICANT /CONTACT PERSON ADVANTAGE WEATHERIZATION INC ADDRESS/PHONE 1150 W CHESTNUT ST SUITE 3 BROCKTON (508) 510 -6866 PROPERTY LOCATION 35 FRUIT ST MAP 39A PARCEL 075 001 ZONE URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out �- Fee Paid �jl Tvpeof Construction: WEATHERIZATION, WEATHERSTRIP DOORS, AIR SEALING - BLDG B New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 102978 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF RM2 TION PRESENTED: Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND /OR Special Permit With Site Plan Major Project: Site Plan AND /OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management _digi Ale/ / P - 77 Signature of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning & Development for more information. 35 FRUIT ST BP- 2013 -0571 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 39A - 075 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit # BP- 2013 -0571 Project # JS- 2013- 000923 Est. Cost: $5151.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADVANTAGE WEATHERIZATION INC 102978 Lot Size(sq. ft.): 93654.00 Owner: NORTHAMPTON CITY OF NORTHAMPTON HOUSING AUTHORITY Zoning: URC(100)/ Applicant: ADVANTAGE WEATHERIZATION INC AT: 35 FRUIT ST Applicant Address: Phone: Insurance: 1150 W CHESTNUT ST SUITE 3 (508) 510 - 6866 WC BROCKTONMA02301 ISSUED ON ::11/27/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:WEATHERIZATION, WEATHERSTRIP DOORS, AIR SEALING - BLDG B 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 11/27/2012 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner RK November 19, 2012 Mr. Louis Hasbrouck Building Commissioner City of Northampton 212 Main Street Northampton, MA 01060 Dear Mr. Hasbrouck I request that you grant a modification to waive the requirement for controlled construction for the insulation and weatherization of 35 Fruit Street (8 buildings total) because the work is of a minor nature, will not affect health, accessibility, life and fire safety, or structural requirements and is impractical in that the cost of controlled construction is considerable when compared to the cost of the proposed work. Please accept this stamped letter as an indication of my support for this request. Thank you for your consideration. Sincerely, �,�.► (( are `1 v i No. 10731 I t , 4 NORTH EASTON ! ;-1 I. j O� MA J l - Z- 4 '� Wayne E. Benson, Jr. RA ° /7-F -1 ! �`?,' 4A President RKB Architects .--- ADVAN -8 OP ID: PS A COR0" DATE (MM /DD/YYYY) 3 CERTIFICATE OF LIABILITY INSURANCE 06/21/12 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 pollcy(ies) must be endorsed. If SUBROGATION 1S WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on thls certificate does not confer rlghts to the certificate holder In lieu of such endorsement(s). PRODUCER 781 - 642.9000 NAME Age Agency, Inc tes Insurance 781- 647 -3670 _1348. NU e , EKt 50 Prospect Street EMAIL � FAX ( Waltham, MA 02453 INSURER(S)AFFORDING COVERAGE NAIC 8 i INSURER A: Liberty Mutual Insurance Co. INSURED Advantage Weatherizatlon, Inc, INSURER B : Berkley Assurance Co 1 i 1150 West Chestnut Street INSURER C : Navigators Insurance Company Brockton, MA 02301 INSURER 0 ; INSURER E : I 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, I L7R TYPE OP INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS INSR W In POLICY NUMBER IMM/09/YYYY) Ij!IM/Dpm7Y1 GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 B X COMMERCIAL GENERAL LIABILITY 0000891 04/02112 04102/13 DAMAGE TO RENTEO VUMA PREMISE3 (Ea occurrencg) $ 50,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & AOV INJURY $ 1,000,000 _ GENERAL AGGREGATE $ 2,000,000 GEM. AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2,000,000 — 1 POLICY , f] LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) . $ A ANY AUTO ASJ -Z11- 261011 -032 06/20/12 06/20/13 BODILY INJURY (Per person) $ ALL OWNED X AUTOSULED BODILY INJURY (Per accident) $ AUTOS X HIRED AUTOS X NON•OWNED PROPERTY DAMAGE $ AUTOS (Per accIdentl — $ UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 6,000,000 A X EXCESS UAB CLAIMS -MADE THC- Z91- 261011 -042 06/20/12 06/20/13 AGGREGATE $ 5,000,000 DED 1 l RETENTION$ _ ( $ WORKERS COMPENSATION X I TORY �T LIM OER AND EMPLOYERS' LIABILITY A ANY PROPRIETOR /PARTNER/EXECUTIVE 1 WC1 -Z11. 261011.012 06/20/12 06/20/13 E.L. EACH ACCIDENT $ 1,000,000 N OFFICER/MEMBER EXCLUDED? I N I NIA (Mandatory In NH) E.L. DISEASE • EA EMPLOYEE $ 1,000,000 1ryea, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE • POLICY LIMIT $ 1,000,000 C Excess Liability NYIIEXC71193IV 06/20/12 06/20/13 Excess 10,000,000 Excess 6 Million 5 Million DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addltlonal Remarks Schedule, II more space Is required) CERTIFICATE HOLDER CANCELLATION EVIDENC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE - l © 1988-2010 ACORD CORPORATION. All rights reserved, ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD I' t ' . The Commonwealth of Massdcltrrsetts • , . � :,___, bepartment of Industrial Accidents • -Nl ft • Office oflnvestigattoits • _.= • • 640 Washington Street € itin- a Boston, Mel 02111 . �''�•_�•o• 7vwlvanass.gov /d • ' Workers' Conipensation Insurance Affidavit Builders/Contractors/Electrician's/Plumbers . ,Applicant Information ' - Please Print Legibly Name ( Busingssrorgautxattont >ndividuat); ,'(�c�\tv-\csai \i c��114y k v , \ nc Nta..c. . . , ' . . ' .Address: \\ 3 \ K \ C) (' o7�stml `a ) ' . • City /State /Zip: ' ` r o1 Phone.# : c- c e> \v'egL.0 t t■SJ Are you an employer? Cheek the appropriate box; , '•'.pe of pi•o ject (required.) :, 1,M I am a employer with 1Q 4, 0 I am. a general contractor and I 6 + • omployee,s (full and/or part timo)•e have hired the-stab-contractors New construction 2. ❑ I am a bole proprietor or partner - listed on the•attachedsheot 7. 0 Remodeling ship and have no employees These sub - contractors have g, [ Demolition workinh for me in any oapaeity; , . , employees ainihave work..... .. , 9 ._ gull addition • [No workers' comp, insurance con . Vance,$' Q g required.] S. 0 We are a corporation and its 10.[l Electrical repairs or additions '3, 0 I am. a homeowner doing all work officers have exercised their . 11.0 Plumbing repairs or additions • ' 'myself, [No workers' comp, right df exeinptlonperMGL 12,❑ Roofrepairs insurance required.] t c, 152, §1(4), and we havo no • - employees, [No workers' 13,[] Other • • • comp. insurance regdired;l , • *My applicant that cheeks box ill tnustalso all out the - notion botow showing Mali. workers' aompcnsationpolley information, • t Homeowners who submit this affidavit Indicating they are doing all work and then hire outsldo contractors must submit a now affidavit indltating such. 'Contractors thatoheak this box must attached an additional sheet shoVeing the name of tit* sub- coetraators and stabswhothcr ornot those entities havo cmpioycp, If tho aubconlra°tors havo employees, thaymusthrovldb their workers' °Drop, polkiy number. • • Y am an employer litat iiprovldtng workers' compensation lust:ranee for my employees, Below is the policy and Job site information. • . Insurance Company or Self- ins, Name,` �xLn \ Y 1� \�y -- Policy /F i C �� \\ �ln`C1 \\ -G\ • Expir ation Date: ■�`ZiAao\3 Job Site Address: S. � � I� • _ City(State /Zip: �uei , Attach a copy of tho•workers' eoinpensation policy declaration p • :• (showing the policy number and expiration date), • ltailure,to secure coverage as required under Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of ft fuse tip 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 thq violator. 13o advised that a copy of this statement forwarded to the Office of Investigations of the DIA for insurance coverage verification. . X'do hereby eert*" fader the palns•aud penalties of ' erJ that the information provided above is true a+ correcti I:,at_e• \ R . _ .1 J - / .rte• \ \\ —\ _ - . . ii. ` ?hone fF: :5'•\V' LQ . . . • - Official use only. Do not write In 1, ea, tb be completed by city or town official, • • City or Town; . Permit/License # Issuing Authority (circle one): • .1,13oard of Health 2, Building Department 3, CitylTown Clerk 4, Electrical Inspector 5, Plumbing Inspector 6, Other ' . . • ' . , Contact Person: 'hone#: • • - • 1- €t id %t ut tiiI .t dii2 i ui,a iltp, attd- ' �i N 7 I License.. CS 102978 , , - , . , .. R str. <cted to: 00 I ' BRIAN MACHADO i.-44' s 47 MALBONE ROAD ASSONET, MA 02702 -- -- - Exptratio€r 5/26/2013 s i .t titrai.siotier Trit- 102978 '`:72n 'ti "r- elf itt,,+ +r /l /r r f ' i rrr/re, I7 Office of Consumer Affairs & Business Regulation License or registration valid for individul use only ham -' s ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation k Registration: 156075 Type: 10 Park Plaza - Suite 5170 4� s Expiration: 4)21)2014 Supplement Card Boston, MA 02116� ADVANTAGE WEATHERIZATION,INC. BRIAN MACHADO 1150 WEST CHESTNUT STE B - --- g d BROCKTON, MA 02301 Undersecretary Not valid without signature NOTICE TO PROCEED Low - Income Multi - Family Retrofit Program The Low- Income Energy Affordability Network (LEAN). administrator of the utility - funded energy efficiency program for low- income multifamily properties. is hereby authorized to have its contractors. employees, and other representatives access the property and perform the work contained in the attached Work Order, including final inspections. A copy of this document shall be carried by LEAN's contractors. employees, or representatives and presented upon request. Site Name: ' gf9 ; �r / Street. City/ Town, Zip: t •7 . ' ..� ., f // f 7 -7;y' G/' Contact Name & Phone at Site: . Mk? /4 r'/, , ' //. - it y' 4//),3e) Signature: /0- Printed Name: cAn 'C'\ Title: fy. Ir �� T Organization: }Jr,AP-4-v x., rov\ .a.S% QQ t Date: /n /17 1/2 V Acknowledged by LEAN's representative: John Wells, Vice President for Energy Services, AI3CD Please sign and date two originals. Retain one for your records and return the other to: James Collins Energy Services, 4 Floor ABCD 178 Tremont St Boston, MA 02111 fax: 617- 357 -4661 iames.collins cni.bostonabcd.org Program Administrators: LEAN, Bay State Gas, Berkshire Gas, Blackstone Gas, Cape Light Compact, National Grid, New England Gas, NSTAR, Unitil, WMECO 1150 W Chestnut St Suite 3 ADNiANTA(.i I ' 0 Brockton, Ma 02301 Date: 11/15/2012 AGENCY: Action for Boston Community Development, Inc. ABCD 178 Tremont St. Boston, MA 02111 PROPERTY: CAHILL APARTMENTS TOTAL 35 Fruit St. Work Order Building # A Unit(s): 8 $ 5,151.10 Date t f Walk rough: Auditors Report Rcud. Job Cast #:14096 Work Order # DESCRIPTION I QTY. I UNIT I»T I PRICE! TOTAL PRICE DOORS Weatherstrip w / Q - Ion or equal 1 6 1 ea 1 $45.50 1 $273.00 MISC. MEASURES Weatherstrip (Q -Ion or equal) & R -30 attic hatch 2 ea $33.50 $67.00 Attic / Basement sealing with two -part foam 14 man /hr $75.00 $1,050.00 Non -Attic Air Sealing 8 man /hr $55.00 $440.00 ATTIC INSULATION R -38 unrestricted - settled cellulose 384 sq.ft. $1.47 $564.48 R -18 -20 unrestricted - settled cellulose 2048 sq.ft. $1.29 $2,641.92 MISC.INSULATION Duct insulation R -5 1 37 I sq.ft. 1 $3.101 $114.70 Page 1of8 Versionl.7 Commercial Building Permit May 15, 2000 SECTION 10 STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Northampton Housing Authority I, , as Owner of the subject property Advantage Weatherization, Inc. hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date Advantage Weatherization, Inc. , 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. Brian Machado Print Name 11/15/2012 Signature of Owner /Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : Brian Machado 102978 License Number 1150 West Chestnut St. Suite 3, Brockton MA 02301 05/26/2013 Address Expiration Date (401) 641 -1493 Signature Telephone SECTION 13 - 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 Version1.7 Commercial Building Permit May 15, 2000 • SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name (Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name: Responsible In Charge of Construction Address Signature Telephone Version1.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DON'T KNOW 0 YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained o , Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO IF YES, describe size, type and location: E. WiII the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO Q IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Version1.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LE$ THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑ Brief Description Weatherization: Weatherstrip doors. Air Sealing. Of Proposed Work: SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly A -1 ❑ A -2 ❑ A -3 ❑ 1A . ) ❑ A-4 ❑ A -5 0 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B 1 ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S -1 ❑ S -2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) 1st 1st 2 nd 2' d 3 d 3rd 4th 4 th Total Area (sf) Total Proposed New Construction (sf) Total Height (ft) Total Height ft 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system Versionl .7 Com + t ui • ing ' ; it May 15, 2000 Department use only City of Northampto' 4' % atus f Permit: Building Depart ' i * r utlDriveway Permit - 212 Main S ee . wer /S'epticAv�ailablilty Room 1 00 .�� Water/Well Availability, Northampton, 01 1. • •�� Two Sets of Structural Plans phone 413 587 - 1240 Fax • 3 - 5. e Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CH • GE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Lot Unit `d Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Northampton Housing Authority 49 Old South St Name (Print) Current Mailing Address: (413) 584 -4030 g c_ C _> , Si nature �:_..� �- - {rC' � Telephone 2.2 Authorized Agent: Advantage Weatherization, Inc. 1150 West Chestnut St. Suite 3 Brockton 02301 Name (Print) Current Mailing Address: (508) 510 -6866 Signature �� G_�� Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 2. Electrical $0.00 (b) Estimated Total Cost of Construction from (6) 3. Plumbing $0.00 Building Permit Fee 4. Mechanical (HVAC) $0.00 5. Fire Protection 6. Total= (1 +2 +3 +4 + 5) Check Number jnOJ 5 This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2013 -0570 APPLICANT /CONTACT PERSON ADVANTAGE WEATHERIZATION INC ADDRESS/PHONE 1150 W CHESTNUT ST SUITE 3 BROCKTON (508) 510 -6866 PROPERTY LOCATION 35 FRUIT ST MAP 39A PARCEL 075 001 ZONE URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out ` rL c6 Fee Paid Tvpeof Construction: WEATHERIZATION, WEATHERSTRIP DOORS, AIR SEALING - BLDG A New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 102978 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOI ATION PRESENTED: pproved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND /OR Special Permit With Site Plan Major Project: Site Plan AND /OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission _ Permit DPW Storm Water Management olitio D ela Si attune of Building 0 icial Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning & Development for more information. 35 FRUIT ST BP- 2013 -0570 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 39A - 075 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit # BP- 2013 -0570 Project # JS- 2013- 000923 Est. Cost: $5151.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADVANTAGE WEATHERIZATION INC 102978 Lot Size(sq. ft.): 93654.00 Owner: NORTHAMPTON CITY OF NORTHAMPTON HOUSING AUTHORITY Zoning: URC(100)/ Applicant: ADVANTAGE WEATHERIZATION INC AT: 35 FRUIT ST Applicant Address: Phone: Insurance: 1150 W CHESTNUT ST SUITE 3 (508) 510 - 6866 WC BROCKTONMA02301 ISSUED ON:11/27/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:WEATHERIZATION, WEATHERSTRIP DOORS, AIR SEALING - BLDG A 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 11/27/2012 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner