32A-216 (5) 71POMEROYTER BP-2017-1208
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:32A-216 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 H BP-2017-1208
Project# JS-2017-002036
Est. Cost: $2000.00
Fee: 5100.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ENERGIA LLC 92540
Lot Size(sq.ft.): Owner: BOLDEN MECHELLE
Zoning: URC Applicant: ENERGIA LLC
AT: 71 POMEROY TER
Applicant Address: Phone: Insurance:
242 SUFFOLK ST (413) 322-3111 WC
H O LYO K E M A01040 ISSUED ON:4/25/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:INSULATION -ATTIC FLOOR OPEN BLOW
CELLULOSE 4" TO R49 WALLS DENSE PACK CELLULOSE
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 q 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 4/25/2017 0:00:00 $100.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File H BP-2017-1208
APPLICANT/CONTACT PERSON ENERGIA LLC
ADDRESS/PHONE 242 SUFFOLK ST HOLYOKE (413)322-3111
PROPERTY LOCATION 71 POMEROY TER
MAP 32A PARCEL 216 001 ZONE URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
OSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Tyoeof Construction: INSULATION-ATTIC FLOOR OPEN BLOW CELLULOSE 4"TO R49 WALLS DENSE
PACK CELLULOSE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 92540
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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 Nan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Pennit 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
p Cela
lfri Buil,i • Ovial 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
Nanning& Development for more information.
Version!.7 Commercial Buildin• Permit May 15,2000
Depa tMent use only
^ \ City of Northampton Status of Permit:
\ Building Department Curb Cut/Driveway Permit -
2 2�Q 212 Main Street Sewer/Septic Availability
i\ '. 0\L Q \` Room 100 WaterANell Availability
Northampton, MA 01060 Tyro Sets of Structural Plans
-phone 413-587-1240 Fax 413-587-1272 PIoUStte Plans
Other Specify
APRLICATION 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
71 Pomeroy Ten. Map TJ Lot A* Unit
Northampton, MA 01060 Zone Overlay District
Elm SL District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Mechelle Bolden 71 Pomeroy Ten. Northampton,MA 01060
Name(Print) Current Mailing Address'.
f.�( /yam ���--t
(413) 210-1959
Signature Sei=� i 1M-t I RKtr/0 Telephone
2.2 Authorized Ment:
Tom Rossmassler/Energia LLC 242 Suffolk St. Holyoke,MA 01040
Name(Print) Current Mailing Address:
(413)322-3111
Signature Telephone
SECTION 3-ES MATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building $2,000.00 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
$0.00 Construction from (6)
3. Plumbing $0.00 Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection $0.00 / (/ n
6. Total=(1 +2+3+4 +5) Check Number ill ea ZD/ (/
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
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 0 Existing Wall Signs ❑ Demolition 0 Repairs Additions 0 Accessory Building 0
Exterior Alteration ❑ Existing Ground Sign 0 New Signs 0 Roofing❑ Change of Use❑ Other 0
Brief Description Insulation - Attic Floor Open Blow Cellulose 4" to R49 Walls Dense Pack Cellulose
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 0
A-4 D A-5 0 1B 0
B Business 0 2A ❑
E Educational ❑ 2B ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard 0 3A ❑
I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 38 ❑
M Mercantile 0 4 ❑
R Residential ❑ R-1 ❑ R-2 0 R-3 ❑ 5A 0
S Storage ❑ S-1 0 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)
1 n 1,
2nd 2a
3re
4m 41"
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 0 Private 0 Zone Outside Flood Zone❑ Municipal 0 On site disposal system
Version 1.7 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)
k of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW 0 YES 0
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 g
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES O NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O
IF YES, describe size, type and Location:
E. WII the construction activity disturb(clearing,grading,excavation, or filling)over 1 acre oris it part of a common plan
that will disturb over 1 acre? YES O NO O
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Version 1.7 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:
N/A Not Applicable 1
Name(Registrant):
N/A Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
N/A
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
Tom Rossmassler Not Applicable 0
Company Name:
Energia LLC
Responsible In Charge of Construction
Tom Rosssslemp r
Address
(413) 322-3111
Signature Telephone
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 O No 0
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Mechelle Bolden , as Owner of the subject property
hereby authorize Tom Rossmassler/Energia LLC to
act on my behalf, i :II matters relative to work authorized by this building permit application.
A A See 0i A, -r ►ttlZH o 04/21/2017
Signature of O •-rgr •
Date
Tom Rossmassler 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.
Tom Rossmassler
Print Name
JA---------- 04/21/2017
Signatu f Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Homer: Tom Rossmassler 92540
License Number
242 Suffolk t. Holyoke, MA 01040 09/02/2017
Address Expiration Date
�—� (413)322-3111
Signature Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(8))
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 O No O
1„,,,;_„.. na . nerv,a, .corn
BUILDING PERMIT AUTHORIZATION FORM
I. 114 rp {�-- ��` l.� l ,owner of the property located at:
(Owner's Name,printed)
-77 Po reiL,
Mai fru
(Property Street Address) / (City/Town)
hereby authorize Thomas Rossnrassler of Energia, LLC. to act on my behalf and obtain a building
permit to perform insulation/weatherization work on the above named property.
0' ej ? — (771
�7
nesSignature Telephone Number
//9 /
Date /
The Commonwealth of Massachusetts
Department of Industrial Accidents
=—.
Til, it Office of Investigations
e 'r
_; t,_ 600 Washington Street
=i vr. Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/individual): Energia, LLC.
Address: 242 Suffolk Street
City/State/Zip: Holyoke, MA 01040 _ Phone#: 413-322-3111
Are you an employer?Check the appropriate box:
Type of project(required):
I.® I am a employer with 24 4. ❑ I am a general contractor and I
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 sub-contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers'
[No workers' comp.insurance comp.insurance.: 9. ❑ Building addition
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL
12.11j Roof repairs
insurance required.]e c. 152,§1(4),and we have no
employees. [No workers' 13.® Other Insulation
comp. insurance required.]
'Any applicant that checks box 41 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: HDI - Gerling America Insurance Company
Policy#or Self-ins.Lic.#: EWGCR000186816 Expiration Date: 7/1/2017
Job Site Address: 11 ?orn-P 'r-o TCfr• City/State/Zip: tJOr-c-Yv urnc0-ctmn MW
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). o to(p 0
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.
I do hereby certifii under the pains and penalties of perjury that the information provided above is ire and correct.
Si. attire: I� Date: y/2 /7
Phone#: A - -
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License if
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone k:
A RO- LIABILITY INSURANCE CERTIFICATE OF DATE IMMIDOttTYYI
�.�O7/5/2016
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),
PRODUCER NAME:
�Mary Conroy
James S. Dowd and Sone Insurance Agency Inc. PHONE FAX
14 Bobala Road IAJONo,E
5qAX4:413-538-7444 INC,Nor
Holyoke MA 01040 E•0 EBB:Incorrov dowel.Com
CUsSOMERID a:ENERLLC-01
INSURERISI AFFORDING COVERAGE NAIL/
INSURED INSURER A:RDI-Geri int; America Insurance Compa,
Energia, LLC INSURERS:Torue National Insurance Company 25496
1242 Suffolk Street
:Holyoke NIA 01040 INSURER C:
INSURER 0:
INSURER E:
INSURERF:
COVERAGES CERTIFICATE NUMBER:2034052479 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICES 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 MAYA�� HAVEBEENREDUCEDRuI�eyxppWI PAID CLAIMS.
ILTR TYPE OF INSURANCE G• A SR A4 POLICY NUMBER IMMNWYYYYI IM�IDOIYYYYI LIMITS
A GSIETALLIABIIJTY Y Y =G.CR0001e6816 7/1/2016 7/1/2017
EACH OCCURRENCE 21,Oo0,000
FvX COMMERCIAL GENERAL UABILITY PREMISESI as occurrence, $100.000
CLAIMS-MADE n OCCUR MED EXP(Any ow Perwnl 5
•
PERSONAL SADVINJURY $1.000,000
GENERAL AGGREGATE S2,000,000
(SEN':AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPAP AGG 52.000,000
—1 PODGY IA IDGYJP% fLOC ff
A AUTOMOBILE UABILJTY Y Y EAGCR000166a16 7/1/2016 7/1/2017 COMBINED SINGLE LIMIT 51,000,000
ANY AUTO (Ea accident/
BODILY INJURY(Per person) S
ALL OWNED AUTOS BODILY INJURY(Per accident) 5
X SCHEDULED AUTOS
PROPERTY DAMAGE
X HIRED AUTOS (Per MHOS')
NON-OWNED AUTOS
•
S
B x UMBRELLA LMB _ OCCUR Y Y 85391115OAtI 7/1/2016 7/1/2017 EACH OCCURRENCE 51,000,000
EXCESS DAB CLAIMS-MADE
AGGREGATE 51,000.000
_ DEDUCTIBLE 5
X RETENTION 510,000
WORKERS COMPENSATION Y EHaCR000166616 7/1/2016 7/1/2017 X WC STATUU OTH-
ANDEMPLOYERS'UABIIJYY yIN TORY UMIiS� ER •
ANY FROPRETORRAWNERJEX
EORIVE❑ E.L.EACH ACCIDENT 51,000,000
OFFICER/MEMBER
¢ EXCLUDED? NIA
IMendebrynNHI
f.L(WADE•EA EMPLOYEE 51.000,000
a eCPTIOeunper
CEaGRIPiION OF OPERATIONS below EL.DISEASE-POLICY LIMIT 61.000,000
DESCRIPION OF OPERATIONS 1 LOCATONSI VEHICLES IAIMOO ACORD 101,AddltlanatRemerke Schedule,amore specs 0 requiredl
•
CERTIFICATE HOLDER CANCELLATION 30
SHOULD ANY OF THE ABOVE DESCRIEED POLICIES BE CANCELLED
BEFORE 711E EXPIRATION DATE THEREOF,NOTICE WILL RE DELIVERED
IN ACCORDANCE WITH THE POLICY PROVISIONS,
AUTHORIZED REPRESENTATIVE
TB 1988.2009 ACORD CORPORATION. All rights reserved.
&CORD 25(2009109) The ACORD name and logo are registered marks of ACORD
•
/
Your LO,nl Energy Efficiency Experts. Fn tgr.US coni
April 18, 2017
Commissioner Hasbrouck
RE: Request for Waiver
I request that you grant a modification to waive the requirement for control construction
for 69-79 Pomeroy Terrace in Northampton 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 control construction is considerable when compared to the
cost of the proposed work. All work will be completed within the prescriptive
requirements of 780 CMR. Thank you for your consideration.
"Mass Amendments, sections 107.1 allows for an exclusion from control construction for
this project"
Please feel free to contact me by telephone at (413) 326-1860 or by email at
tomr@EnergiaUS.com.
Respectfully,
Torn Rossmassler
President & CEO
413 322-3111 242 Suffolk Street, Hol oke MA 01040 Ener.iaUS.com
•
rie'6oh,,,,,,,,,,_„&o ,-a/r,:;r r4,,..
Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
`�g--- OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
g, 91 egistration: 165189 Type: Office of Consumer Affairs and Business Regulation
y �� Expiration: 1/11/2018 LLC 10 Park Plaza-Suite 5170
"»y Boston,MA 02116
ENERGIA LLC
THOMAS ROSSMASSLER
242 SUFFOLK STREET t.,,,,,_„_,.‘,,,.____
HOLYOKE,MA 01040 Undersecretary Not valid without signature
' .
Massachusetts Department of Public Safety
®= Board of Building Regulations and Standards
License: CS-092540
Construction Supervisor
THOMAS B ROSSMASSLER
100 MAIN STREET
HATFIELD MA 0100 =
-M n Expiration:
Commissioner 09/02/2017