41-045 1352 WESTHAMPTON RD BP-2017-0746
GIS#: COMMONWEALTH OF MASSACHUSETTS
:B
Maplock:41 -045 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-2017-0746
Project# JS-2017-001240
Est.Cost: $1731.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JOHN PERRIER 105319
Lot Size(sq. ft.): 40685.04 Owner: LINDSTROM ASTRID J&CECELIA F SCOTT
Zoning: Applicant: JOHN PERRIER
AT: 1352 WESTHAMPTON RD
Applicant Address: Phone: Insurance:
18 BROADWAY POND RD (860) 930-7794 WC
STAFFORD SPRINGSCT06076 ISSUED ON:12/2/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:ADD & IMPROVE R VALUE INSULATION IN
HOME FOR WEATHERIZATION PURPOSES
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/4 Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: O1: 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 12/2/2016 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0746
APPLICANT/CONTACT PERSON JOHN PERRIER
ADDRESS/PHONE 18 BROADWAY POND RD STAFFORD SPRINGS (860)930-7794
PROPERTY LOCATION 1352 WESTHAMPTON RD
MAP 41 PARCEL 045 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Bee Paid
Building Permit Filled out
Fee Paid
TypeofConstruction: ADD&IMPROV., UE INSULATION IN HOME FOR WEATHERIZATION
PURPOSES
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 105319
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORJIIATION 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
ol 'on lay /
Signatur of il.mg 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.
liThe Commonwealth of Massachusetts
NBoard of Building Regulations and Standards FOR
W I '1/4 Massachusetts State Building Code,7$O CMR MUNICIPALITY
E3USE
g Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
M Ra / One.or 7{vo-Family Dwelling
'o ill) ( /w'Ih,jy IStJron For Official Use Only (,
BuBalag Patmit Nam 1 -,Z/� J pate Amnia I/
BuddisaancW(Print Name) Signature • the
. SECTION I:SITE INFORMATION
LI Property Address: 1,2 Assessors Map&Parcel Numbers
I.la Is this en accepted strut/yes no Map Number Pastel Number
2 do ma..,,fl �. '. lir a I ( 1.4 Property nlma
..� yi {'�r eaeaer
.ging panda ..,.... Use Let Ares(sq ft) Prunus*(l0
LS Bulkllag Setbacks(ft)
Not Yard Side Yuds Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.O1 c.40,154) 1,7 flood Zone Information: LS Sewage Disposal System:
Pubiic0 Pan&0 Zonal — Outside Floud Zoo/ 0 On Stedls nal
Cheek Eyes0 Municipal Po system 0
SECTION 2: PROPERTY OWNERSHIP'
2t (,jn„met Recy{d.CH,- ' -"11J)�,[in u Jif OiCXa2.
Nmta�Orlon Y City Stere,ZIP
) 350 14012, 1�17h�rr L) 1 Ill -.52 .--.0205?i 3
No.and Street Telephone Emelt Addrem
SECTION 3t DESCRIPTION OF PROPOSED WORK'(cheek as that apply)
New Construction 0 Existing Building 0 Owner-Occupied O Repairs(a) C A te*tton(s) 0 1 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify:
Brief Description of Proposed Worm:
To Add & Improve R-Value Insulation in !tome for weatberization purposes.
SECTION 4:ESTIMATED CONSTRUCTION UThIS
Estimated CofU: Misled Use Only
Item (Labor end Materials)
1.Building S I. Building Permit Fee:S Indicate howfeo U detrmined:
2.Ekrniut S 0 Standard Citytrown Application Fee
O Total Project Case Met b)x multiplier ,x,
3.Plumbing S2. Other Pees: S_........._.
—
4.Mechanical (UN/AC) S List:
5,Mechanical (Fee $ Taal AItF
Suppression)
�._ n.,-)71 on Check No j CMnk Amount�Cash Amount:
d.TotalprojectCost $ \ �, �U J O Paid to Full 0 Outstanding Balance Due:
` NEGB 7
— 2$Spellman rd
Please Submit Surtros Spreau,Ct
Permits to: aa7d�
0241 l(f phMt ...oP .
SECTIONS: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
JohnPonder 105319 12-12-2017
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) 1
18 Bradway Pond rd
Type Description
No.and Street U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
_ RC Roofing Covering
Stafford Springs Ct 06076 WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
860-930-7794_ Eerrier6Qyahoo.com D Demolition
Telephone Email address
5.2 Registered Home Improvement Contractor(HIC)
HIC Company Name or HIC Registrant Name 173021 8-27-2018
HIC Registration Number Expiration Date
John Perrier
No.and Street
IS Bradway Pond rd jperri Email6ddress .cam
Stafford Springs,Ct 06076 address
City/Town,State,ZIP Telephone 860-930-7794
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes No......_..,❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize New England Green Homes to act on my behalf,in all matters
relative to work authorized by this building permit application.
John Perrier
1//2016
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
Lynn Ford
11/g/2016
Prim Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
- 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www mass.Eov/oca Information on the Construction Supervisor License can be found at www mess¢ov/dos
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq. ft.) Habitable room count_
Number of fireplaces _ Number of bedrooms
Number of bathrooms Number of halUbaths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
i— III NEWENGL•20 APALMISANO
A COR a
CERTIFICATE OF LIABILITY INSURANCE DATE
MWDONTIr
7/12)2016
THIS CERTIFICATE IS ISSUE() 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(les)must be endorsed. If SUBROGATION IS WAIVED,subject la
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(sl.
PRODUCER CONTACT tucker
AP Intego Insurance Group,LLC PHONE
1601 Trapelo Rd.Suite 174 NC.No fain. (em ND:
Waltham,MA 02451 I ADDRESS:oservice@apintego.com
_ INSURERfSAFFORDING COVERAGE NNCI
INSUREDI
N,URER A:Gua rd Insurance Group*" 25844
INSURER e:
NEW ENGLAND GREEN HOMES LLC .INSURER C:
1(I Brsdway Pond Road INSURER O:
Stafford Springs,CT 06076
SURER 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,
LTEI IMPEDE INSURANCE 450 GAT, POLICY NUMBER PURI Ell MMDDYaYp
COMMERCIAL GENERAL LIABILITY
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CUIMS.MADE IOCCUfl • DAMAGE
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CERTIFICATE HOLDER CANCELLATION
SHOULDANYTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
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ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
I
OD 1888.2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
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ACORO 2!42014711 701 AMID ONnn a d N100 N nlslks a ACOM
AThe Commonwealth of Massachusetts r
— Department of Industrial Accidents
=- -
coy -` :/ Office of-Investigations
1 Congress Street,Suite 100
• _ Boston,AU 021141017
www.massgovidia
Wotiters' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
4r,: sant Information Please Print Legibly
Name(Business/Organization/Individual): NEW ENGLND GREEN HOMES
Address: 18 BRADWAY POND RD
City/State/Zip: STAFFORD SPRINGS CT Phone#: 413-244-2003
Are you as employer?Cheek the appropriate box:
1.❑ I am a employer with 4 4. ❑ I am a general contractor and 1 Type of, oJec (required):
employees(full and/or part-time).• have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7, ❑Remodeling
ship and have no employees These subcontractors have B. ❑Demolition
working forme in any capacity. employees and have workers'
y Building addition
[No workers'comp.insurance comp. insurance.; 0 8
required.) 5. 0 We am a corporation and its I0.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself.[No worker'comp. right of exemption per MOL
Insurance required.]t c. 152, §1(4), and we have no 12,❑Roof repair
13.0 OdrerINSULATION
employees, (No workers'
comp. Insurance required.]
*Any swami That checks box#1 must also fill out the section below showing their workers'eompeowaon policy Nfonudon.
t Romeownen who submit this affidavit indicating they are doing all work and then Nr onside tennteters must introit a new affidavit Indluang such
:Contractors that check this box must mechcd an addmoml sheet showing the nn of the submnaaeton sad Ste whether ornat thoseentities hew
employes. If the sub-m*wten have employee, they must provide their worker,'comp.policy number,
I am an employer that Is providing workers'compensation Insurance for my employees. Below G the policy andJob site
Information.
Insurance Company Name:INTEGO
Policy#or Self-ins.Lic.0:N EWC634866 Expiration Date:°81°112017
lob Site Address•:ALL STREETS IN City/State/Zip: 06151.nth LUlr
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
Ido herd c , under the pains and sahibs • perjury that the Information provided above is due and correct
i•,:, • to // .CPI a-A: / . /2016
Phone 013• i 2003
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/Liceose#
Issuing Authority(circle°me):
1.Board of Health 2.Building Department 3.CIty/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
1tulii il.-¢i rJ -
(:sI -1053(9
JOHN A PtRRIFif
16 BROADWAY POND ROAU
STAFFORD SPRINGS CT 06076
t i' �. ..
12(1212017
'/fit m r AffairstSillu (�/ C2''Rigul tlo
4
Office of Consumer Affairs & Huai ess R2gala190 I
"..a _.:,;NOME IMPROVEMENT CONTRACTOR 1,-,,„,--k: ';;.1 {
' — 7 Regi stration: 173021 TYPO:�x =, i1
Y 'I 5. , Wii.
-� Expiration: 8/2712018 ;ndivid�a' ,fir
s ..;
„0HM11PERRIER
A�
1K=4
JOHN PERRIER ,,; ,
18 BRADWAY POND RD y w,.t. t.
STAFFORD SPRINGS,
CT'66D76 ,.t.'5 t 'rr ' "•
ea
w µ
New England Green Homes
Permit Authorization Form
I, (-Eta-1141 S t r I \ Owner of the property located at:
(Owner's Name, printed)
1352
W9.3-11114-vvI6P tO e o gg J 1
(Property Street Address) (City/Town)
herby authorize New England Green homes to act on my behalf and obtain a building permit to
perform insulation and/or weatherization work on my property.
a4;C.,
(Owners Signature)
II l Z3���
(Date)
mass SSW al*
PARTNER Customer Contract Gtsr
H`bMES
18 Medway Pond Rd
Stafford Springs,Ct.0507$
413-244-2003 Office
Cecelia Scott
1352 Westhampton Rd
Florence,MA 01062-9783
Site ID:S00050245378
Project ID:P00050281687
Customer ID:C00050247070
Contract ID:20161010 ASEAL
Desc iPdon Quantity Location
Perform Air Sealing al Estimated 025 CFM50 Per Hour 8 Lyng Space 467456
Sub Total: $67456
Utility incentive Share $674.$6
Customer Contribution 3000
TOTAL PRICE AND PAYMENT SCHEDUSE n�p t
the Contractor tom to perform the above described work,fumisMng the materials andtabor speeille�a���e fla BRLOla6 erke used.Page s oe a
Payment of the full amount Is expected by Cqaarrrrsh or check Upon completion of the lob on the contractualdate.
Deposit may one third of total ball
oepaYramvum: tsppndr Owes
Final aalente:_ y.y Deism.owupon conviction or work seep.
Customer Signature' OYd.e Date: I I z3 b f_
Contactor 5lgnature:� / 6 �.... Dote:11/73 11.4
WAITEDIIMWOFFER The pines rad incentives offered In this contractaresubject tocnange l n auomaaoe with the CLEAneNn m.as save skews aver y3.Mce
program offers.
Terms and Conditions on review.
Aalle aitt
maPARTNERCustomer Contract GitiBnitAUS
18 Bradwey Pond Rd
Stafford Springs,Ct.06076
413-244-2003 Office
Cecelia Scott
1352 Westhampton Rd
Florence,MA 01062-9783
Site ID:S00050245378
Project ID'P00050281687
Customer ID:C00050247070
Contract ID. 20161123 WORK
Description Quantity Location
Attic Flom Open Blew Cellulose 8" 635 Living Space $101600
Hatch:Tnennai Bather Podyiio 2 inch(Attic) t Living Space 64670
Sub Total: $1057.71
Unity incentive Share ;79326
Customer Contribution ;264.43
TOTAL PRICE AND PAYMENT SCHEDULE printed:111]]312018Pa e2ot2
The Contractor weft to perform the above described work,furnishing the materiels and tabor specified abovefor Me total price listed. 0
Payment of the full amount 15 expected by cash or cher)upon completion of aleph on the mntratvaidate.
Depusitt'/ 4
Rmay not exceed one third of total balange.
molt:t: y I/+ _oeporil Date: /vf (
OWnal Balance: 417 t/ q 3 ellanet due upon Completion of Went scope
Customer Signature' lJ..ettiihk. P • Date: 'I 123l//fk
Contractor SlgnMorc 4." Datef 2
j/ 3/t
WANED TIM OffEt The Dices end incentive.Offered M this NnUact are subfER to change Inestadan t with the CILMewit Masse/in Home Energy Service
program offers.
Terms and Conditions on ravine.