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32A-216 (7)
75 POMEROY TER BP-2017-1210 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# BP-2017-1210 Project# JS-2017-002038 Est.Cost: $2000.00 Fee:$100.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ENERGIA LLC 92540 Lot Size(sq. ft.): Owner: CROWLEY JOHN A&RACHANA P Zoning: URC Applicant: ENERGIA LLC AT: 75 POMEROY TER Applicant Address: Phone: Insurance: 242 SUFFOLK ST (413) 322-3111 WC HOLYOKEMA01040 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 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# 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#BP-2017-1210 APPLICANT/CONTACT PERSON ENERGIA LLC ADDRESS/PHONE 242 SUFFOLK ST HOLYOKE (413)322-3111 PROPERTY LOCATION 75 POMEROY TER MAP 32A PARCEL 216 001 ZONE URC THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT / Fee Paid Building Permit Filled out i)Fee Paid Tvpeof Construction: INSULATION- TT OOR OPEN BLOW CELLULOSE 4" TO R49 WALLS DENSE PACK CELLULOSE 4" TO R49 WALLS SE 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 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 D . �y Ai Y—a1s 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. Versionl.7 Commercial Buildin&Permit May 15,2000 Department use only • City of Northampton Status of Penult: Building Department Curb Cut/Driveway Permit - \ 212 Main Street Sewer/Septc Availability �p (\ Room 100 Water/Well Availability NT't� Northampton, MA 01060 Two Sets of&truderal Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other 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 75 Pomeroy Tern Map /' Lot 10 Unit Northampton, MA 01060 Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Rachana Crowley 75 Pomeroy Ten. Northampton,MA 01060 Name(Print) Current Mailing Address: I /�/, � ( 210-1959 Signature66 r t7'�r rTelephone 2.2 Authorized Anent: Tom Rossmassler/Energia LLC 242 Suffolk St. Holyoke, MA 01040 Name(Print) Current Mailing Address: (413)322-3111 Signature Telephone S CTI•. -E I„•T D •N -UCTI• •ST 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 , / ,, L1 ,Q 6. Total=(1 +2+3+4 +5) _ Check Number _ N 1C1 "'7Ue This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date Version].7 Commercial Building Permit May 15,2000 SECTIONS*CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wag Signs ❑ Demolition Repairs❑ Additions 0 Accessory Building Exterior Alteration ❑ Existing Ground Sign❑ New Signs 0 Roofing❑ Change of Use❑ Other 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 1 USE GROUP{Check as applicable) CONSTRUCTION TYPE A Assembly A-1 0 A-2 0 A-3 ❑ 1A j 0 A-4 0 A-5 ❑ 18 0 B Business 0 -„ 2A ❑ E Educational 0 28 I 0 F Factory 0 F4 0 F-2 0 2C 0 H High Hazard 0 3A ❑ I Institutional ❑ I-1 ❑ I-2 0 I-3 0 38 ❑ M Mercantile 0 4 ❑ R Residential 0 R-1 0 R-2 0 R-3 0 5A 0 S Storage 0 5-1 0 5-2 ❑ 58 0 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) 1r 2s 2nd 3° 3" 4m 4th -, Total Area(et) Total Proposed New Construction(sh 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 ❑ Zone Outside Flood ZoneD Municipal 0 On site disposal system Version!.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 O DONT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO 0 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. WI!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 O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. 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: N/A Not Applicable 0+ 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 Rossmassler Address (413) 322-3111 Signature Telephone Version].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 O SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT l Rachana Crowley as Owner of the subject property hereby authorize Tom Rossmassler/Energia LLC to act on my behalf, in all matters relative to work authorized by this building permit application. S ,4i-CD-1O 04/21/2017 Signature of Owner 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 Ro massler Print Name A 04/21/2017 Signatu - of OwnerlAgent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor Not Applicable 0 Name of License molder: Tom Rossmassler 92540 License Number 242 Suffolk St. Holyoke, MA 01040 09/02/2017 Address Expiration Date (413) 322-3111 Signature Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e.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 O No O t.4)-VaLac Your[OCR!Energy Efficiency Experts .if EnergipUScnn, BUILDING PERMIT AUTHORIZATION FORM 1, Rachana Crowley , owner of the property located at: (Owner's Name, printed) 75 Pomeroy Terrace Northampton (Property Street Address) (City/Town) hereby authorize Thomas Rossmassler of Energia, LLC. to act on my behalf and obtain a building permit to perform insulation/weatherization work on the above named property. 413 537 7558 Owner's Signature Telephone Number Date A CERTIFICATE OF LIABILITY INSURANCE DATzoiborwW) 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(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 endoreement(s). PRODUCER NAME; Mary Conroy James J. Dowd and Sons Insurance Agency Inc. PHONE1FAX 14 Hotels Road um2•BXM:413-538-7949 IAM,NoI: Holyoke MA 01040 AAOMSESs:.mconroWedowd.COm CUs66TTOOMMERRR ID#:ENERLLC-01 INSURERISI AFFORDING COVERAGE NAIC# INSURED INSURER A:HDI-Geri inci America Insuranlce Compo Energia, LLC INSURER a:Torus National Insurance Company 25996 '.242 Suffolk Street P Y Holyoke MA 01090 INSURER C: INSURER 0: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:2034052479 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 MAYA�� HAVE PPPBEEN p��REDUCED BY PAID CLAIMS. IL7RNOR - TYPEOF INSURANCE AVVLSMH POLICY NUMBER AAA' 161MIDDM(YYI LIMITS N9Y W 0 A GENERAL LIABILITY Y Y BLi.CR0o01d6816 7/1/20167/1/2019 _ EACH MAAALOCCURRENCE U NOMAD $1,000,000 X COMMERCIAL GENERAL UAlIUTY PREMISES(Ea NOMAD 5100,000 CLAMS.MADE n OCCUR MED EXP Wy one person) E PERSONAL ADV INJURY _ E1,000:000 GENERAL AGGREGATE S2,000,000 GEN%AGGREG^ATE LIMIT APP�LIEIS PER: PRODUCTS•COMPDPAGG S2,000,000 POLICY'+ JFCT 17LOCS A AUtOMOBILE UABILITY - Y Y EW3CR000166816 7/1/2016 7/1/2017 COMBINED SINGLE LIMIT $2000,000 ANY AUTO (Ea wades') PLLOWNEOAUi05 BODILY INJURY(Per person) S X ALLOW DAUTOs BODILY INJURY(ParaccMenr) S SCHEDPROPERTY DAMAGE HIRED AUTOS (Per Bc[Mern e NON`OWNfD AUTOS H x UMBRELLA um OCCUR Y Y 65393N150ALI 7/1/2016 7/2/2017 EACH OCCURRENCE 51,000,000 EXCESS LIAB CLAM&MADE AGGREGATE S1.000.000 _ DEDUCTIBLE 5 X RETENTION 510,000 A WORKERS COMPENSATOR Y Elr'GCR0001B6616 7/1/2016 1/1/2017 XWb Sl ATT iORV LIMITS ER OER AND EMPLOYERS'LIABILITY YIN ANTPROPRIETORRARTNEPJEXEOJTIVE ❑ NIA E.L.EACH ACCIDENT 51,000,000 OFFICERIMEMBER EXCLUDED? IMNtliNry In NHI E.L.DISEASE.EA EMPLOYEE S1,000,000 TsI,y Oe6ONe unCr .min Of OPERATIINS below E.L.DISEASE,POLICY LIMIT E1,000,000 - DESCRIPTION OF OPERATIONS I LOCATORS I VEHICLES (Atbch ACORD 101,Additional Remarks Schedule,Il more specs Is required! CERTIFICATE HOLDER CANCELLATION 30 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AMERCED REPREBENTATME ®1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD • ri/ t n tin„, /IA ./r licairtrAfr.irit ”. Office ofCons ARnn&Business Regulation License or registration valid for individul use only 0 OME IMPROVEMENT CONTRACTOR before the expiration date. If found return tu: egistmtIom 165169 Type: Office of Consumer Affairs and Business Regulation Exp[ration: tt11f20t8 LLC 10 Park Plaza-Suite 5170 +fin'¢" Boston,MA 02116 ENERGIA LLC 99 THOMAS ROSSMASSLER �Y�'// ' • 242 SUFFOLK STREET � — A//SjJ v..-.••".".."......----- HOLYOKE,MA 01060 Undersecretary Not valid without signature lot,. Department of Public Safety Board of Building Regulations and Standards License:CS-092540 Construction Supervisor THOMAS BROSSMASSLER too MA/N STREET tS1 A HATFIELD MA 01038 ` r"-/14.727. Expiration: Commissioner 09/02/2017 -C your Local Energy Efficiency Experts .r En erglaVS.corn 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, Tom Rossmassler President & CEO kw — 11 E u o ree , so o e ' , I 0 , i ner•ial .com The Commonwealth of Massachusetts n�=_ el Department of Industrial Accidents tars.; Office of Investigations ="o- ° 600 Washington Street CI: re vale= -. a Boston,MA 02111 u's www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/OrganizatioNlndividual): 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 g, E 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.❑ 1 am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.®Other Insulation 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 subcontractors 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: 1 Vov-narn3o TtxY • City/State/Zip: t-3Of1Y OMCI ICT:13p, tgtq Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).OA OLD 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 certify un r the pains and penalties of perjury that the information provided gbove it true and correct. Signature: Date: V am// Phone#: 413-322-3111 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#: