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34-025 (6) 105 TURKEY HILL RD BP-2017-1164 GIS#: COMMONWEALTH OF MASSACHUSETTS Man:Block: 34-025 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGLLc.1144/2�A) Category: INSULATION BUILDING PERMIT Permit# BP-2017-1164 Project# JS-2017-001965 Est.Cost: $3560.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: THE ENERGY STORE 106082 Lot Size(sq. ft.): 145926.00 Owner: FORTIER JOHN Zoning: Applicant: THE ENERGY STORE AT: 105 TURKEY HILL RD Applicant Address: Phone: Insurance: 97B E TAYLOR HILL RD WC MONTAGUEMA01351 ISSUED ON:4/20/2017 0:00:00 TO PERFORM THE FOLLOWING WORK AIR SEAL ATIIC AND BSMNT, INSTALL 4" OF BLOWN-IN CELLULOSE TO ATTIC FLOOR 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 ft Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: 001: 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 4/20/2017 0:00:00 $65.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File# BP-2017-I 164 APPLICANT/CONTACT PERSON THE ENERGY STORE ADDRESS/PHONE 97B E TAYLOR HILL RD MONTAGUE PROPERTY LOCATION 105 TURKEY HILL RD MAP 34 PARCEL 025 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid TVDWf Construction: AIR SEAL ATIIC AND BSMNT, INN TALL 4" OF BLOWN-IN CELLULOSE TO ATTIC FLOOR. New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 106082 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 Pemtit 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 �- i '. Delay 7 / Y—/9— /7 Sign. o :uil.m; 'a mi. Date . Note:Issuance of a Zoning permit does not relieve a applkant'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, Department use only City of Northampton Status of Permit: krl 14 -" Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Srtmchd Plans phone 413-587-1240 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 IDS TtJrtiCEI Hi Lt RD Map J / Lot a2,5-- Unit ReREAKE/ Mq Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: jotiwl FOB-TER log -toarce4 i{lLi- RP. Name(Print) Current Mailing Address: ill 3-3St -9251 5EF Perri't-ttED Telephone Signature 2.2 Authorized Anent: Grttzis t i-ccc ALLta for TzKEy NlLI eo, Name(I; / Current Mailing Address: 02144 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 35-0.r 9 o (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 2 6. Total= (1 +2+3+4+5) 3rk00. 90 Check Number 436 t.Jr This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date Section 4. ZONING Alt Information Must Be Compteted.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 °o Open Space Footage ,t (lot area minus bldg&gated parking) #of Parking Spaces Fill: (Volute&Lacaliimj A. Has a Special Permit/Variance/Findin ever been issued for/on the site? NO O DONT KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Re istry of Deeds? NO O DONT KNOW 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 C4 YES 0 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 07 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 Sgi 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. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors C '/ Accessory Bldg. ❑ Demolition ❑ New Signs [C] Decks i0 Siding OD] Other(�J WGATHERt EATor4 Brief Description of Proposed, r, Work: At e- sem_ Arfrc 3 85wtar- ir15 TALL 9 oF BLo 4eJ -Jai CELLULOSE is Arr,L Flog, Alteration of existing bedroom Yes )(.. No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes ye 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 Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor belowfiinished grade It 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, John) FORT(CC. , as Owner of the subject property hereby authorize CHRt5TDPi1€R to act on my behalf, in all matters relative to work authorized by this building permit application. SEE A-fTAc%t* ybol 14 Signature of Owner Date GNRi3Trnt{Ep A t.LEwl ,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. CHKtSTb1 at Arks Print ame /).df Si ure cif 0 ner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Clink,r>Ptte Ai.LL-,.,j ta{CCTi 7- License Number COO C. -7-114 LOU- 11(LL g' ¢, /1.,o meuE1 via a(3y 1 Nis-fro Address ^ Expiration Date Signature Telephone 9.Reoistered Home Improvement Contractor Not Applicable 0 11-8358Z- Company a-S3yZCompany Name Registration Number £aEW '1 Per LLC_ _ yflo(t8 Address g,,,"_'� Expiration Date jl OLD are. 7 BerosiELOicr d...t '} Telephone810'-3 -��1 SECTION 18-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,g 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 ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellinus of one(I1 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.CMA 780, Sixth Edition Section 1GS.3,$.1. Definition of Homeowner:Person(s)who own a parcel of land on which helshc resides or intends to reside,on which there is,or is intended to bc,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-veat 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 building permit. As acting Construction Supervisor your presence on the job site will he required from time to lime,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 City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: ter t 0.ice MILL Ro. The debris will be transported by: ND Deakts The debris will be received by: Building permit number Name of Permit Applicant Cftg t NEp_ A Li-ENI eLlpit (eat Date Signature of Permit Applicant Permit Authorization SOA mass Form a pArmaigamo P Site ID: 50283734 Customer: John Fortier 1, John Fortier - , owner of the property located at: (Owner's Name,printed) 105 TurkeyHill Rd Florence (Property Street Address) COM hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. Owner's Signature: ,,,, ///COit /, a 'edit y Date: , / " FOR CLEAResult OFFICE USE ONLY CLEAResult has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: - • Participating Contractor Date IE CLEAResult . 50 Washington Street,Suite 3000 • Westborough.MA olsal . 1900.480-7472 0 For Office Use Only Rev.102015 ��� .A OR(/ �' F 1 flairfzu m;M/YY) 1 CERTIFICATE- OF LIABILITY I fS4� tCE 4n2/2026 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY 10 CONFERS 540 RIGHTS UPON THE CrMMSIFHCA-iE HOLDER, THIS 5 AFFIRMATIVELYERTIFICA E DOES NOT OR NEGATIVELY Y AMSJD, ECIEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES HOT CONSTITUTE A CONTRACT SE1 WEEN THE ISSUING INSURER(S), AUThORIs ) REPRESENattVE OR PRODUCER AND TRE CER.;IFICATE HOLDER_ 1 I@i?ORTAis'T: i1 the cerdacate bolder is an ADDITOf4AL INSURED,1I0120S11/022) must 6s:3do 5ec-. t SUBROGATION IS WANED,subject tp ' the terms and conditions or the policy,certain policies may require an endorsement A statement an this certficate does n:::::::::the ccrtiiicate holder in lieu of such enaorsement(s). PR000CE2 —muracT Brian GallagherAsise __BMC Y;,susenee _3e:,_ , LRC. PHu`£ (n4)957_1 P30 �A;1&ICNn, .ikTarp _.._... _._. 111 So::kh Alicia SL_eat euaw 3 slieche>.Gb>'c,agzrca.com ApiaRe- Y SW/EMS{REFORMING COVEERRG •— NC:. Ry f 9259 ax o�.. - 20373 111.111/20 i ERH.Sr Ne` �svaanceo E a=sv 02:2701,111.21 100 5 92115202 PPS. TLC nisuaopc.11aPiiagk American %nsuzznce Co_ 33139.. aba ESE ETERGY STORK, - ojsoRERC _--_.._. _..__ $2 OLD ROUTE 7 IIISORE21: _ _ KKJJ>S-CLE CT 06804-1711 "USURER?: ROVERAGES EEr.TIFICATEi'W 3ERCL15 .05ii REViSlONNUMBER: THIS IS TOC IP/MAT m=poi EKES OF INSURANCE LISEED 00202.,HAVE- . MISSUED TO THE LJSUREU NM4ED ABOVE FOR THE PO.iCT PERIOD 2Tdaat ,.n55Y1.t 2222 ABSREQUIREMarr. TERM CR CO..p/Mx v-ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO'WHICH THIS CERTIFICATE MAY Re ISSUED OR MAY PERTAIN.THE INSUPANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUSJECT TO ALL L THE TERMS. e?USIONE ARO CONOITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. T .. .._. .. IIISO D (��'� �9 TR T( X'OPItiSItrTANt£ '11150 PNS" Po1,ICV NYM119Ert Agfa Ih1IM1alYYT^l1 BOWS N. COiti.:--_^RCIALGEII?PALLJABLLI? EACU OCCURRENCE 1,000,000 _ _ _ 22221/0270213:22.03- C(.21101122 cern. 'RE5 ra ssni..:1 1 _ 100,0150 _._ . K Con-oraconal 1222KR111T2- mantis nl"(?n-b 3/2712017 c:u se 1 S.OVO "_ ._... PEr 0 L 4TRJUIW 3 -,000.nyJ iI.,D E.tru a==L Esr.5R: GENERAL AC(ai{C 2,000,000 OG"Y X SCIP LIE Pe00UCr5 C9:JPfOPeG„-5 2,000,0pn1 ReIO2,0911ELMERMY ',i 2 ING�vir - 1,000,0001 ( a. ANT AUTO ROOKY a+uRY lP2-:2seni s Au.0O.\ n rv 'c -uSel. . ss `^ AVMS y ._ g? /2.120,5 / ,/°ei; 3002 LP .'% : _ -_.Ito. ':c. 1B _ 2 MORRR'cµA LIES C. EACH OCCURien E .. . s 5,000,000 E:CESS use CLASIS ABS :.GCR£C-A'IE5,000.000 ! 02E REIT-1.2200Ei °�5s'2 3/?7/20i 3/17/1017 __ .._ __ .. ' V.SOGEtPEMca¶QX - S_' UD P PP _err 1.06(1.000 1 .s_39e_^S sevintem 5.5i512017 £._i..us ='vi- AAAA_ O'6, ._ _ 3LBIP'10.'I OF 4CEFgi1CNS Ilya €L IS1Sc:�.T3L'C'I L4..T. a 1,000 A0o 22.-a`=_95in=_! L42N11i.:_ 5ai]563$3 3I2+(2e14 9)2]12027 Our 2,000,0041 I ;RERT(Oli OFOFEP nOWSI L0Ct7fnrt'a N'ERICi_`S (ACOS°WI.,BIBBBal Bemares iardnle,hNo=a cn' It BBB Specca"1byZE) ons of insurance. RTIFICA I%HOLDER DANCE!L;TION _ I SHOULD APE OF-THE ABOVE OSCRISEO P0E021262 orporuto BEFORE VROOM OF =NStiRA CE 1 THEFileATIO14 DATE THEREOF, NOTICE WILL SE neu WER=n 1r! WITH WITH THE PPUCY PROVISIDYS AMERCED Re E01E42E1N5 J. 0 CR1_label; /, //'--'�-r L0 4958-55010 ACOP CAI ORPORT Oia. AU ri0hts raser:ad. CEO 2-red/'2/QTY TneACO?,D name and logo are registered manus of AGORO 2^_I]A:6tO c c� ict p AV �{ ..,jam. � F �(`e.r%✓sf', 0/ ©� f',c Jaeitt eta Office of Consumer Affairs and Business Regulation to Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type: LW Registration: 178392 ENERGY PRZ, LLC. Expiration: 0410912018 31 Old Route 7 Brookfield, CT 06804 Update Address and return card. Mark reason for change. ❑ Address O Renewal 0 Employment 0 Lost Card orrice or Consumer Affairs&Business Regui hon - " - HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE Iic beforethe expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 178392 Pxo rot018 10 Park Plaza-Suite 5170 Boston,MA 02116 ENERGY PRZ,LLC. ROBERT NEAL 31 Old Route 7 , ' c=Ccit-- erookfield,CT 06804 - Undersecretary 'Not valid without signature '� " Displaying `ek y � your six-digit HlC registration number on all advertisements, contracts '';, and permits is required by the law. This includes but is not limited to business cards, 5}1itwebsites,working trucks,signs and online advertising in any form. If you have any questions please contact the dedicated HIC line at(617) 973-8788 kici„,,,;„ {I- ;ss: Or visit us at Mass.Gov/Homelmprovement The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www.moss.gav/dia Workers'Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant information Store lBusiness/Organizational/IndividualkThe EnergyStore Address: 31 Old Route 7 City: Brookfield State: CT zip_ 06804 Phone it: 888-840-6641 Are you an employer?Check the appropriate box: Type of project(required): 6/ 1. I am an employer with 3 employees(full and/or part time)' 7. New construction C2. lam a sole proprietor or partnership and have no employees working for me in any ' 8. Remodeling capacity.(No workers'comp.insurance required.] II�___III1 II 19. Demolition I3. i am a homeowner doing all work myself.[No workers'comp.insurance requiredjt TO. Building addition I4. am a homeowner and will be hiring contractors to conduct all work on my property. 11. Electrical repairs or additions I will ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. I 112. Plumbing repairs or additions n5. i am a general contractor and I have hired the sub-contractors listed on the attached j Fa. Roof Repairs sheet. These sub-contractors have employees and have workers'comp.insurance.± •n6. We are a corporation and its officers have exercised their right of exemption per MGL. $114. Other • c.152,§1(4),and we have no employees.[No workers'comp.insurance required.] .Any applicant that checks box PI must also MI out the section below showing their workers'compensation policy information, 'Homeowners who submit this affidavit indicating they are doing an work and then hire outside contractors most submit a new affidavit indicating such. ±Contractors that check this box must attach an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. tam an employer that is providing warders'con,pensat/on Insurance for my employees. Below is the policy and job site information. Insurance Company Name: BNC Insurance Agency, Inc. Policy it or Self-ins.Lic.h: BNUWC0131379 Expiration Date: 04/15/2017 lob Site Address: Ear -*yeti 14)IL Q�. i-acay$t"E/ ikl * 0iot02. 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$250OOa day against the violator. A copy of this statement may tie forwarded to the Office of Investigations of the DIA for insurance coverage verification. (✓ I do hereby certify under thepains and penalties of perjury that the information provided above is true and correct,and mat clicking this checkbox and typing my name in the fie. s. a signature. Name: Christopher Alien j" r Date: LI/10111- Phone 4: 475-204-4585 Email: chrisallen@the-energystore.com