31A-100 (2) 9 FEDERAL ST BP-2019-0979
GIs 4: COMMONWEALTH OF MASSACHUSETTS
M=Block: 3 1 A- 100 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
Cateeorv:INSULATION BUILDING PERMIT
Permit# BP-2019-0979
Proiect9 JS-2019-001610
Eat Cost: $1000.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const Class- Contractor. License:
Use Group: JAY BOLAND 101880
Lot Size(sg ft.)' 13721 40 Owner: MARTYN AMY
Zoning:URB(100 / Applicant: JAY BOLAND
AT: 9 FEDERAL ST
AonlicantAddress: Phone: Insurance:
233 COLLEGE HWY (413) 203-24540 WC
SOUTHAMPTONMA01073 ISSUED ON:3/11/2019 0.00:00
TO PERFORM THE FOLLOWING WORK:BLOWN IN INSULATION & AIR SEALING
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 sienature:
FeeTvne: Date Paid: Amount:
Building 3/11/20190:00:00 $65.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Depwbnont�only
City of Noruft of
i _
an MAR 7 20
d Room I
1e
s. Nonhamon 1 YS
y •I F
APPLICATIOR To CONSTRUCT ALTM REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWBJMG
SECTION I -SITE
Tble sectim to be by IS
2-1 9_wEM
� 11 , 11 / r cYl �
.: L
s
IV NO Tdepr"w
SECTION 3-ESTIMATED
2. Electical (b)EOmatsd Total Cost of
4. Mechanical(WAC)
�RiTiTi1�
�1 , .
SECTION S OEICRWMDN OF PROPO.SM WORK(ehrl all foefiohYl
New Nouse Addition ❑ :=,mmd QA�Nrafioa(sl ❑ Roofing E:]
Ioa Yens ❑ omwlitia+ ❑ \ New Sgm tCA Decks lO Siding= Dow
wak�. 1h I�un �r6i�0.��m and GiC Sea��n.e
Alteration of emosting bedroom__Yes_No Addkq new bedroom Yes No
Attached
Marraw"
Rel -Sheet unfinished basanent Vet No
Plans
a-If Now henseArm!or adc0cmeto e>ustum hansiea. cdolelefe dvalviHowt m
a. Use of bu&W%:Ore Fancy Two Fahy Odw
I
b. Number of moms in each fanrity unit Number of Bathrooms
a. Is#sea a garage attached?
d. PMPosad Swm fockge of naw construction DYneneiors
e. Nunhbarot stories?
f. Method of heetire? Fvepsoee or Woodstoves Number of each,
9. Energy Conservation OompGanca. Massdneck Energ)'OomWiance Tone arched?
h. Type of co sbtxfion
L lo wsbucOpn wit in 100 R ofwedands?__Yes —NQ Isconstrucddt wthkh 700 yr. ffoodpWn__Yes_No
j. Depth of basement or cellar floor below finished gmde
K. WN building co fwm to the Belding and Zoning regulations? Yes NO.
1. Sepbc Tank_, City Sewer` Prirate well_ City water Supply_
SECTION Ta-OVMMAUTHOPIIATION-TO BE COIPLETED We1FN
OWNBtSAGENT OR CONTRACTOR IAPPPLES FOR B1ADING PERINI'
1 \j M.� �'Y /I 1 as Owner of the subject
PAY II
S 1
hsrebyautl ri U IWw
to act on my bah@'sr al nrwNae receive k)work amnorhmd M this oultilin9 Deme[applraaon.
Signature of owner Date
l Sh��i}!� 1`/LiTP.�O 6� as Owner/AWsonzed
Agee hereby declare that the s and 6dorrnatorh on the bmgowg application are trace and accurate,to the best of my gwwledge
and belief.
Signed antis the pairs andpenabsi of 'ury.
ShQW I
Print Nana
i
Swasure of Dale
SECTION e-CONSTRUCTION SERVICES
8.1 Licensed ConsbocNaa a r: /1� Not Applicable ❑
Name of Ccense Holder. n V M /1180
License Number
I01c73 I ISG
Address Expiration Date
Signatureij Telephone
Not Applicable ❑
wee �n �c Inr. I9�8Rr
Cormpan Name Registration Number
I a QIo /a l y/6
Address ��jj Expiration Date
Telephone B,
SECTION 10-WORKERS'COVA"MTION-INSURANCE AFROAVR(MAL c.152,§25C(8))
Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide Nis affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yea....... No...... ❑
City of Northampton
' - - tdassaehnsetts
aIM,aaovr or avapas INSPaczzaav
212 a.ta srr..c .amintpu
w:JWm1W n, m oioso - o
Debris Disposal Affidavit
In accordance of the provisions of MOL c 40,S54. I adorowfedge that as a condition of the building
pemnit all debris remiliti ig from the construction acth*governed by this Bolding Permit shall be disposed
of in a properly loaned sold waste disposal facilty, as defined by MGL c 111, S 150A.
The debris from construction work being pariomred at
-�? L VO(
(Please pars horse rasMx and street name)
Is to be disposed of at ( rr
L0. 2 fYla�t®ccMen < �Yrin e+��dLm
(P+SS*e MU niiiine and locaeorr ofMcEwtv
Or will be disposed of in a dumpster onske rerded or based from:
(Company Name and Address)
Signature of Permit Applicant or Owner Date
if,for any reason,the debris will not be disposed of as indicated,the Applicant or Owner shall notify the
Bolding Depanmem as to the location where the debris will be disposed.
om.Sgn EnvNope ID:81FA0381-CFlD4A40-SBC&DWEC933D12
RISE
ENGINEERING
OWNER AUTHORIZATION FORM
1, Amy Marlyn
(Owner's Name)
owner of the property located at:
9 Federal Street
(Pmperty Address)
Northampton, MA 01060
(Property Address)
hereby authorize
(Subcontractor)
an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building
permit and to perform work on my property.This form is only valid with a signed contract.
Awy MaW'
ate£' re
1/6/2019 1 4:12 VM EST
Date
RISE Engineering,a Division of Thielsch Engineering, Inc.
60 Shawmut Road Unit 2 1 Canton, MA 020211339-502-6335
www.RiSEengineeri ng.com
2018 WEATHERIZATION
mass save BARRIER INCENTIVES
Samngx mrougn anargY eHiaenCy
Rased on your Energy Specialist's re memdahI Is you,home can benefit from program-eI.g.ble Insulation and/dr air si i-,g
unorevemonts.Before moving forward ploase follow all the Instructions below to remediate your weatherization barriers.
CUSTOMER INSTRUCTIONS
1. Hire a qualified.licensed venvactor to evaluate and/or remadets the weatherization barrier(s).
2.Submit signed and completed copies of this form and a copy of the paid contractor invoices)within 60 days of your Home Energy
Assessment to: RISE Engineering, 60 Shawmut Rd,Unit 2,Canton,MA 02021
Or small to ColumbiaG isMAlnfov RISEengineering.com.
3.The weather zat err Incentive will be deducted from the customer co-payment amount of t-e weatherizatlon work A record check
will be Issued In the event the amount exceeds the customer s Co-payment amount.
4.Complete the remmmentletl weatherization improvements.
CUSTOMER INFORMATION
Customer Name: Shannon Mokeon Client i dr std 1e: 459361
Site Address 9 Federal Street ,,ty, Northampton State. MA ZIP: 01060-
Phone Number. 774 364-4348 Email
GutomeyMwnapvmet Skinalare: Data..
KNOB AND TUBE WIRINQ
To determine If there is any active knob and tube wiring,the contractor wh evaluate the following areas where eligible Pass Save
weatherization recommendations have been made.
®Attic Hoor 3Attie Wall PlAttic Slope EdExterior Wall 28asement ❑Othar: ❑Othec
Ej I have performed my Inspection and determined there Is no active xnob and tube wiring in the areas selected below.
MAttic Floor DtAtbc Wall PlAttic Slope ✓✓Exterior Wall trBasement ❑Othec COthec
C I have read and agree to the Terms and Conditions on the back of this form.
Contractor Name Steven R.Keyes
Address.. 13 State Rd C.,ty South Deerfield State: MA ZIP. 01373
Company Name: S Keyes Electric. Inc /J License Numbed 21213A
Cpatfadhor$I9RaDMe: )(f/KJIi 10 XO//B6 pati: 4/18/2018
High Carbon Monoxide:Contractor Is to service and re-evaluate the selected mechanical systems)and reduce the carbon monoxide level.
as measured in the undiluted flue gas,to below 100 parts per million(ppm).
Draft Failure:Contractor is to correct the draft in the selected flue(s).Refer to table on reverse for acceptable draft ranges.
.v d�
NeatM9 System ',
:tlpa111fatlr Heats --_-_-
t DIAIY
Spillage:Contractor Is to correct the spillage of flue gases In the selected mechanical sy,t.m(a).Must not spill after 60 seconds of operatic^..
❑ Heating System C Hot Water Heater 0 Other.
C 1 have performed my Inspection and have corrected the Items noted In the areas selected above.
C I have read and agree to the Terms and Conditions on the back of this form.
Contractor Name-
Address: City: State. zl P.
Compary Name: License Number:
Contractor S19rtalwe: ta9ta:
Continued on back
(page 1 of 2)
f►coRd CERTIFICATE OF LIABILITY INSURANCE
0 20,9
THIS CERTIFICATE IS ISSUED N A MATTER OF INFORMATION ONLY AND CONFERS NO MGM UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOTAFFIRMATIVELY OR NEGATMELY AMEND,EXTEND OR ALTER THE COVERAGE WORM BY TME POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING WSUREMS),AUTHOM2ED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPOR ANT. NIM EartlMeaM holder i@ an ADDITIONAL INSURED.UM polky(Isa)must haw ADDITIONAL INSURED pnNalona a M Mldanad.
H SUBROGATION IS WAIVED,subject M ole Mlma and pond dons of Um polky,canal.paSck{nay rapuln an ondonan»rR A and IN on
Mla canIScaM d.rat collar NgAM W Ua EaNUleau MINT In Iku of such MMoraannaa).
mppuE@R Ehabkt C d:6110,CISR
El.&Fame.III..Ape 1. N (413)52]-5520 pa; I413j 52]39]0
E Campus Lene bESlbeHo®flndMbpenae.mm
BRURNARB
sfroRpxlm Epv@aAO6 WJCe
Eashammi MA 01027 INBUNERA. Admfla l...Gaop 17000
INUndw UWSUS : A UARD Insudanos Company 423W
Home Ercrgy Stlutipna Inc BUB E.,
M RUnNINie Rd Nawup:
INWRd@:
SDutivmpan MA 01073 pppp�p;
COVERAGES CERTIRCATENUMBER: CL191404002 REVLMNUMBER:
THIS IS TO CERTIFY THAT THE POUCIE6 OFINSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMEDABOVE FOR THE V ICY PERIOD
INDICATED. NOTWITHSTMMNGMYREQUIREMENT.TERMORCONDITIONMANYCONTRACTOROTHER[ UA1Et1'I'WRHRESPECTTOWHICHTHIS
CERTIFICATE MAYBE ISSUEDIXi MAV PERTMN,THE INSURANCE AFFORDED BY THE POUCIES OMIDUSED HERION IS SlN1JECi TO ALLTHETERMB.
F%CLUSIWJSAND CONORION3 SUCH PCiipE3.UMTS SHOWN MAY HAVE SEEN REDUCED BY PMO C4UM5.
LTR TV�QNiPM.VIpE IEUCYMIIW9 Oaddl
Epa1MIEMLpbMALUNIT' EKHG4AWRENGS S 'DED"
GLNMSM40E ®GCCVA f w'—
MEOE%P F 10.990
A BSC90fifie29 dlm o19 Olm2R020 PFAeaxALSNNNAIRv 1 1,000.000
vEHL AGGNEGATE rIWT.VR)ES PEP: QENENM.A69NEWTE 3 2'('I
POLICY
El GTLOc FNnp)LTs-CEMPpPAW 5 2.000.000
AVip10aILL LIIJIYIY I 6 1,000.000
NN ALTO B YNAIRYVNrp,mm E
A paNEp scHEouLED 102006,619 OUO2I20t9 01m212020 90GY.v INdIPrlPucry.Iwa) {
µROB ONLY MIRY
.E.
dB, LWLW Y Ps @
1
UMfRai . pI•F,I)a EAEN=URRENCE @ 2'00CM
A EXCm MM mpipap, 4800066831 0110211019 O1mmn AGONEBME T 2.000,000
.. I I NETEMIWS f
B0SIdH ICEMPENfldBH
ANO6YYLpYfMa'MN1M1YT E
B DrFi NA,EMaENNEAE%EEuiNE Y� NIA HOWC010506 01m4Y1019 01m4Y1020 EL EATN ACPDFRT 5 '�
IMv.Mwy In NN) EL... EAEANLOYEE E SW'0SE
OFSCNWlCN6 WFFAMMaS dbr EA.p86t8E.M1.lOYtWi { WOOD
pEDCMPiaM pF W9IATCW ItOCATgIe I V@Ipftn IAEMp 1M.AGWmN R�IwY 4NWW.mW W MUNa Xniweyw M�gI�WI
R fof Cp ge
CERTIFICATE HOLDER CANCELLATION
BMWLO NYOF TIM ABOVE OEBCRGFD POLIpEB BECANLELLED IEFORE
THE OIPMATN)N DAT!TNEPEO,XOTCE WLL B!DEtNVMISGM
pry oT Nwmempan AOCDRpANCE IRDI THEPMICY OROWNON&
212 Mein&reel
AInN0110DAMAINa p�y
Nodhawan MA 01060
®YESB•M15 ACOltp CORPORATON. N dplM reserved.
ACORD 26(20IM3) The ACORD name and logo an rspkbnd narks MACORD
City of Northampton
Massachusetts
IQ
ffiaaMmer or savunW �scxzoas
uz oars street . r oipal mitayny o;
AFFIDAVIT
Hone lnprovestrat CusmaaUer IAW
SRplenest to Per at Am6cades
The Office of Consun er AMm s and Business Regolabon("OCABR')regulates the registration of conbactors and
WkOahactots perfe®mg improvemants m renovations ou detached one to foss family homes.Prior m
perfocmmg work on such Fomes,a contractor must be regDtaed as a Home Improvement Contractor("MC").
M.Gd,.Cbapter 142A requires that the"mommPucdon,attaradm,teamoon,rww n odendmtlm,conmalm.
mrpmantent rarntmal,dmnctl lion.oromskoobon ofm addUm to anyPreeffisFrD owrwpocmplad buldrg mntahuV
at least one bed not mom than fasdsefrig ub.._mm str[dwm Which are acWentto such realdence orb~be
done by residamd contractors.
Now If Me Mo`srotrWo km conn acted w#A a corporation or LLC Mat ameiry mast be eegiuord
Type of Work 1 S �^ ( Fsc Cost:
Address of Work— J/7
Date of Permit Appliration: t In �l
I hereby certify that
Registration is not requited for the following reason(s):
_Work exchvied by law(cgAam):
—Job under$1,000.00
—Owner abtainntg own permit(explain):
,Building not owner-occupied
_Other(specify):
OWNERS OBTAINING THEIR:OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APP3lICABLE HOME EMPROVVdENT WORK ARE NOT
Er IGHI'p FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L CbWtw 142A.SUCH OWNERS AISO ASSUME THE R&4PONSIBi1dTE5 FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owe:
� OLUA M'cp l l
Date Contractor Name HIC Registration No.
OR
Notwithstanding the above notice,I hereby apply for a building permit as the owe of the above property:
Date Owner Natce and Sigoaam