17C-002 (8) 111 f. C�Jll.�yf f/11 tCf£'f+•'1 12 O InAfIJ IfIC'l1ll�P. �
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 167827
Type: LLC
Expiration: 11/5/2016 Tr# 258839
VICTORY ENERGY SOLUTIONS LLC.
RAQUEL KENNEDY _
1 HARTFORD SQUARE SUITE 206
NEW BRITAIN, CT 06052
Update Address and return card.Mark reason for change.
Address Renewal Employment Lost Card
Office of Consumer Affairs&Business Regulation License or registration valid For individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: 167827 Type: Office of Consumer Affairs and Business Regulation
Expiration: 11/5/2016 LLC 10 Park Plaza-Suite 5170
Boston,MA 02116
TORY ENERGY SOLUTIONS LLC.
TF C
KENNEDY '
AR
AP,'i GC)RD SQUARE SUITE 206
aV EdRiTAIN.CT 06052 Undersecretary `ot valid without signature
qAx.
CS-108212
MICHAEL GION` RIDDO
15 NICHOLS AVENUE APT I
Watertown MA 02472
1
w.. 06/2012018
Unrestricted-Buildings oCam use group which
contain less that=35,O00 cubic fect (991mi)of
enclosed space
Failure to possess a current edition:of the Massachusetts
State Building Lode ss cause for revocation of this license.
For DPS Licensing inforrnatiort visit: www.Mass.Gov/DPS
The Commonwealth of Massachusetts
Department of Industrial Accidents
a I Congress Street, Suite 100
Boston, MA 02114-2017
M J '' www.mass.gov/dia
NVorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Le ibl
Name (Business/Organization/Individual):
Address: 1( 8r(� ,
City/State/Zip: 6Yl� b Phone 4: - Z 0(0
11r you an employer?Check the appropriate box: Type of project(required):
1.0I am a employer with�oemployees(full and/or part-time).* 7. []New construction
In I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3.[:][am a homeowner doing all work myself.[No workers'comp. insurance required.]t
10 0 Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees. 11 a Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance.' fl 0
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14OtheC`�
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such,
Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. if the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: �°�__�-m _��,lr
Policy#or Self-ins. Lic.#: Q 3 (n(p qS Expiration Date: d
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby eertif nder the pains penalties of perjury that the information provided above ' true and correct.
Si Date: -5 112.
Phone#: r7 J
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
. . ^
Federal ID 0
MA Caftactor Registration No
I Ho r&rd-Square,New Britaim,Cr W053 CONTRACT
page
PROGRAM
PHONE DATE CUEMrt VXM ORDER
Ize Feldscher (845)323-8574 05116/2)0 15 415934 000D]
46 Oak Street 46 Oak Street
Florence, MA 01062 Florence,MA 0)062
JOB DESCRIPTION
AM SEALM:Provide labor and materials to scal areas ofyour home against wasteful,c=ss air Icaltage. This wort will be
performed in concert with the use ofspocial Ws anddispestiz tests to ass=thai your hornewill be lefi with a hcaltitrflull Level of
air exchanp and indoor air quality.Materials to be used to scal yow home can include caiulks,foams and other products. Primary
am for scaling include air lc*ap to atfics,basements,anziellicil garages and other unheatod arms(windows are not generally
addiiessod.) (6)working hours.A reduction in cubic feet per minute(cfm)ofair infiluation will occur,but the actual number ofcfin
is not guamtecd.
AL:hc completion ofthe weal[WrizatiOn WWK and at no additional coa to the howwwrier,a final blower door and/or combustion
safety analysis will be coo by d=sub-contractor to ensun:dic saft:ty ofthe indoor air quality.
AIR SEAUNG:Provide labor and materials to install Q4on weatheimirip0jog to(2)d0OF(s)to restrict air ECaka.SV.
ATnC ACCESS:ftovidt labor and materials to insulate the buck offt affic door with 2"rigid Thermax bowd and scal the door's
edge with weztborsaripping to restrict air Icaltagge.
BASEMENT CMILING:Provide labor and materials to insaalll(106)fincer fact ofR-19 unlaced fiberglass insulation to the perimeter
ofthe basement ceiling at thabouscitill.
BASEMFW DOOR-provide labor arid nuncials to insuluc dic back of the bascr=L door leading to the bulkhead with 2"rigid
board that meets the sections R-3165.4 and 316.6 requirements of building code. Seal ail edges:and scanis with FSK tape.
Total: $957.63
Program Incentive: $845.72
Custonwr Total: $111.91
WE AGM HOMEBYTOVURNM SERMCM-CORWILMIMACIMMAME WMAWVE SPEMCATM&FM TM SUN OF
***One Hundred Eleven&911100 Dollars $111.91
ONIM
SECTION 8-CONSTRUCTION SERVICES 7
8.1 Licensed Construction Supervisor: ff Not Applicable ❑
Name of License Holder: IIAt C-V%c V
I 8 1 DF! Z 12-
License mber
15 NIGhokS Ave. wc,.JeY*b'y'Vn , MA (0 2o11Qi
Address /� ��- Expiration Date
�8-1'7- 3Ub L4LiT3
Signature Z�— Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
V l�tor� �r,e►-,c�,v �Jo\ -ho tnS ICo�
12--7
Company Name Registration umber
I 5 11 b
Address Expirati n Date
One- 1-iar-'rFv"d S "c&V. Telephone`�I-SO(O '4w y3
New Br�4-0,*-n T 5
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.162,§2SC(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....... IV' No...... ❑
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellinlis of one(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the buildins permit.
As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153(Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature Se-e- 0,i}0-G1h201 Con-li-r ac+
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [M Siding [a] Other[or
Brief Description of Proposed ,
Work:Air Sec-,%,nA, Q—Xow,. Aft ic. Acc:.eas Z' r"� .d F3coe,r�ne.�t C e;i':1� (;ob�►,ner fee i- of 2 kq
'�l 6Z-3i �-`j� <XrsC1 tv
Alteration of existing bedroom 'Yes � No Adding new bedroom Yes ✓ No
Attached Narrative Renovating unfinished basement Yes V" No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing, complete the following:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, Le-e i Fe iAsehe r as Owner of the subject
property
hereby authorize Mir%-NQ e 1 G wnFr`cka o
to act on my behalf, in all matters relative to work authorized by this builZZ ermit application.
See. o��}�ac_i-,ec� Ccr, c. + ) Is
Signature of Owner l3ate
M�e ina e i d a O 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.
%C.rn A e. i O In TY r p-D
Print Nam \ // If
Signature of Owner/Agent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
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 0 YES 0
IF YES, date issued:'
IF YES: Was the permit recorded at the Registry of Deeds?
NO aC> DON'T KNOW 0 YES C
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO e DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 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 Z
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
C)C)
Department use only
City of Northampton Status of Permit:
uilding Department Curb Cut/Driveway Permit
I ( 212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
No hampton, MA 01060 Two Sets of Structural Plans
44&- 87-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
"-!(o Oa K S1"ree-{- Map Lot Unit
t= i ore nc e, mai ss y D 10(o Z Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Lee field sClr,e1.0
Name(Print), C:-_ "tailing Address: 0 t C4 2
Cse.e cxi-to.ched Can*-r-0LC-t- Telephone
Signature
2.2 Authorized Agent:
M 'vonar-1 Gtonf N'C-C\�Is Ave., W(..+e r+0-Wrj t MIN
Name(Print) .� 7 Current Mailing Address:
L44193
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building 01 ko s (a)Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection n
6. Total=0 +2+3+4+5) 5j-7 i✓3 Check Number r
This Section For Official Use Only
Building ermit Number: Date
g Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2016-0233
APPLICANT/CONTACT PERSON VICTORY ENERGY SOLUTIONS LLC
ADDRESS/PHONE 1 HARTFORD SQ SUITE 206 NEW BRITAIN06052(877)306-4483 Q
PROPERTY LOCATION 46 OAK ST
MAP 17C PARCEL 002 001 ZONE URB000)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: INSTALL ATTIC INSULATION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included• -
Owner/Statement or License 108212
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF MATION 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
Demolition Delay
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.
46 OAK ST BP-2016-0233
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C-002 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-2016-0233
Project# JS-2016-000389
Est. Cost: $958.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group VICTORY ENERGY SOLUTIONS LLC 108212
Lot Size(sq. ft.): 12545.28 Owner: MINTZ LISA S&LEE FELDSCHER
Zoning. URB(100)/ Applicant: VICTORY ENERGY SOLUTIONS LLC
AT. 46 OAK ST
Applicant Address: Phone: Insurance:
1 HARTFORD SQ SUITE 206 (877) 306-4483 O WC
NEW BRITAINCT06052 ISSUED ON.812612015 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL ATTIC INSULATION
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 Siznature:
FeeType: Date Paid: Amount:
Building 8/26/2015 0:00:00 $55.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner