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31D-224 (2)
67 OLD SOUTH ST BP-2021-1336 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31D-224 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-2021-1336 Project# JS-2021-002210 Est.Cost: $7500.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ENERGY PROTECTORS - JOSHUA DADA 101143 Lot Size(sq. ft.): 15420.24 Owner: HYNES ELIZABETH Zoning: URC(94)/CB(7)/ Applicant: ENERGY PROTECTORS - JOSHUA DADA AT: 67 OLD SOUTH ST Applicant Address: Phone: Insurance: 64 PAXTON RD (774) 253-0277 WC SpencerMA01562 ISSUED ON:5/13/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:INSULATION/WEATHERIZATION 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 5/13/2021 0:00:00 $65.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner s, The Commonwealth of Massachusetts '-RTA'��!rn� °1 Board of Building Regulations and Standards ` >.�',1>/,,, FOB Wt �. CWALITY Massachusetts State Building Code,780 CMR �o,�r,� USE Building Permit Application To Construct,Repair,Renovate Or Demolish-a,- -Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number:mb� teb O-a,' '/33(g Date plied: - , a, �� 5-15-246Z1 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property.70 td . Q V_%i 1"f-1 St 1.2 Assessors Map&Parcel Numbers,/ Ct A 31 D , "( Li a Is this an accepted sti eet?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Re y ` 1 O it`I Name(Print) City,State,ZIP 6 .7 (31 d Co.. S t 4+3 -S^7 5---124"( No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition ❑ Accessory Bldg.0 Number of Units Other 1 'Specify: XVI�4,/i C_t'Lc." Brief Description of Proposed Workz: L tY.N- S k+ (,..tit C., Ci VI Gk. r tcl't c..rC.,. 4$ SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ S C)t: 1. Building Permit Fee:S Indicate how fee is determined: 2.Electrical $ I ❑Standard City/Town Application Fee 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:$ 6.Total Project Cost: $ O Check No316 6 Check Amotmt: LA J Cash Amount: �f 0 Paid in Full 0 Outstanding Balance Due: { S ..-.-;� ..•.a...rv.d..t4 -y+,fi�s .. .. ... :- x,z�ri��--s .._ ..+ -z ..�.. ,.. s —. .. -. 5.1 C ssamdhn thopenlsar License(C 3 t dt t 61 2 Z :CO 1)c, q Lieematilmaber Expiration Date Name arcs.taolaQ Lit CSLlype tare below) G4 Peak-on No.and Street TzDomziptiqn aVerkC er t jAk LS-64- u Unninricied(Barrier up so 35,000 mr.It.) own State.ZIP ltithreemy -TN ° 1 RC Roofing Covering ws Va dswa id riding SF Said Awl Arming Iaka Ct ere,�tr*ti:I •c Appliances Telephone Enna address D Demofrua o 5.2 Registeredt Coo eear(RIC) , 7a ctbd t aj Di cc 1 v+1 Reginnat yIC R Number won Dace 14 IC��t-E Foci XIV0 a `r ka.S 7 sa4C es er <MPc ©kS 3-017 address City/TOwn,StrtZIPTdepboa .: c Workers Compensation Insurance affidavit must be completed and sobaainedwith its application. Paine to provide this affidavit will result in the dmiai oft he of the Wilding permit. Signed Affidavit Attached? Yes....._.__Bf No I,as Owner of the subject property,hereby aadwrbe e c� to act on my behalf;in all matters relative to wart a dtnwi ed by this building permit applicadon. Print Owls Nome(Mechanic Sim) Deere By entering my name below,I hereby allestasder the pain and penalties of pezjeay that all of the information gained in this • :.. a is true and acanate to the best of my knowledge and -1)S PI cam.-S- ci t 01 2 I Print Onuses orAsdso®d Agent's Neale(®aew—ie Dame _._... • NOTES: I. An Owner who chlis a b ndiing permit to de bis/hes own work,oran owner wlto hires an o■agis�e emirm er (not registmedintt allomeI>Y rovemeet Contractor(SIC)Provo*,will wit have access to the arbitration program errgoaresty ford under M.G.L.c.I42A.Other important information as the HIC Program can be found at wwwinassnovioca.formation ontbe Construction Supervisor License can be found at www.mass.gov/dos 2 When dial work is phoned,provide the iefnamstion below: Total flopr area(sq.ft.) (intinsfing garage,finished basement/attics,decks or porch) Cross fyjog area(sq.8.) Habitable room resat Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of system Number of decks/parches Type of cooing system Enclosed OPen 3. 'Tp l Prjec t Swore Footage'may be sabatituied for"Total Ptojeed Comae • G ` The Convnontrealth of fassaehusetts ( =a=414 Department ofIadusirialAccitlents 1 Congress Street Suite 100 %'t Roston,li 02114i 2017 • wwwRrnassgov/dla Workers'Conipensnticn insuranceA PIt:Builders/ContraetorsfElectriciens/i Innibeis. To BE FILED WWBTIME PERMITTING AUTHORITY. Applicant Information lease Print Legibly Name(Business/Organization/Individual): Met ton ?COTC.L'�'OC M c Address: t PcX+cY, na City/Statte/Zip: S pence( rif1pr 01 Sba- Phone 0:_ Y! 4 -7-5-3 " 0 21 7 Are you au employer?Cheek thelappropriate box: Type of project(required): h. I am a employer vdth I I employees(full and/or part-time).° 7. L]New construction 2.0 1 am a sole proprietor or partnership and have no employees working for me in u. Ei Remodeling any capacity.[No workers'comp.insurance required.] 3.❑1 am a homeowner doing all work myself.[No workers'comp.insurance required]t 9. Demolition 10[]Building addition 4.0 I um a homeowner and will be hiring contractors to conduct all work on my property. I wdl ensure that all contractors either have wnd:era compensation insurance or arcsole 11.0 Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached shed. 13.0 Roof repairs These sub-contractors have employees and Imo workers'cutup.inuuraw.e t 6.0 We area corporation and its officers have exercised their right of exemption per MGL o. 14.I Other #J AT 152,11(4),and we have no employers.[No workers'comp.insurance required.] OAny applicant that checks box a l must also fill oat the section balow 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. tContractors 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'tamp.policy number. I am au employer that is providing workers'compensation Insurance for my employees. Delon,is the policy and job site Information. Insurance Company Name: ACC Ar j 2 t t.t o Zvstdc G n Ce C 0 /�� t Policy#or Self-ins.Lie.#: (oS �V(OC R,poara 30 Expiration Date:`� S I I '1 Job Site Address: l� ? (9 t( V�"� S ' City/State/Zip: k.h't l:C'�� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MOL e.152,§25A is a criminal violation punishable by a fine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DiA for insurance coverage verification. I do hereby cer ti under the p • s and per !ties of perjury that the information provided above is true and correct. Signature: ,V� Date: 71 I 0 j 2—\ Phone#: 7 01— era-?) Official use only. Do not write la this ar eaa,to be completed by city or tower official. City or Town: Permit/License d Issuing Authority(circle one): 1.Board of Health 7_Building Department 3.City/Town Clerk if.Electrical Inspector 5.Plumbing,Inspector 6.Other Contact Person: Phone II: City of Northampton Z SysS0 Massachusetts ��}'` DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building a0�` Northampton, MA 01060 sy • 11 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: Pr) S pG C Iv\A C.)I The debris will be transported by: Name of Hauler: iCr.er(..) c— Signature of Applicant: '` ' Date: 2--I DocuSign Envelope ID:31800O3E-F 176-4823-9EDF-FC2FB5F91C39 RISE ENGINEERING OWNER AUTHORIZATION FORM I, Elizabeth Hynes (Owner's Name) owner of the property located at: 67 Old South Street (Property Address) Northampton, MA 01060 (Property Address) hereby authorize Pj4rr A-1 Z'' Subcontractor(to be filled in by office) 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. The permit will be secured by the subcontractor, at no additional cost. It is the homeowner's responsibility to close out this permit by contacting their municipality at the completion of this work. DocuSgned by. 1/23/2021 I 6:47 AM EST Date RISE Engineering,a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335 www.RlSEengineering.com City of Northampton /1- -, �S,y.. r SIG, '' Massachusetts �, �'" `e !d A r �, I !tt " '4, DEPARTMENT OF BUILDING INSPECTIONS % a .0;,,�, ' °212 Main Street • Municipal Building `f '^tip v , Northampton, MA 01060 IV ln\' Property Address: C 7 DM 5,�L .f Contractor Name LL;Pf,7 Vr)(7,(_) Address: C''/ IL k iV1 City, State: het- /ffL iZ 2_ Phone: 72tf-?S- v.)7-7 Property Owner �f �,fL 4k' s Name: R?c Address: C7 I4 541 f l- City, State: An it I, i5!1 0 (contractor)attest and affirm that the building I intend to insulate does not have any open air(knob and tube)wiring in the spaces to be insulated and that I have provided the property owner with a copy of this affidavit. Contractor signatur ii9 Date SA/2/ 441Ilk 1 mass save 2020 weatherization barrier incentive Haced on your Energy Specialist's recommendatior,.you, •eome can i:errofit'rom program-eligible insulation and/or air ce.:6nci irnpmvements.Before moving forward.please foItr,w ,-4tl•I inviuctions helow to remediate your weatherization barriers. CUSTOMER INSTRUCTIONS 1. Hire a qualified,licensed contractor to evaluate and/or .,,mediate the weather ization barriers). 2.Submit sig i.enti completed copes of this torm and <opy of the paid contractor invoice(s)within 69,days of your Home Energy m Assessent to:RISE Engineering,GO Shawmut Rd,Unit 2,Canton,MA 02021 or email to ColumbaaGasMAinfoURISEengineetingieorm 3. the weatherizatron.incentive will he deducted from the customer co-payment amount nt the weatherization work.A rebate check will be issued in the event the amount exceeds the custr.rner's co-Payment amount. 4.Complete the recommended weatherization improvemr nts. TOMER INFORMATION ii. :ustorrer Name. Elizabeth Hynes Client#or Site ID: 301749 site Address: 67 Old South Street _City: Ntirtha11ipton -crate: MA 71N. 31060.__ Phone Number .413-575-6404 _._ _ Email: erhynes@COmCaSt.net Customer/Homeowner Signature:_ fie'- i•KNOB AND TUBE WIRING To determine if there is any active knob and tube wiring.the contractor will evaluate the following areas where eligible Mass Save weal rerization recommendations have been made: ♦,Attic:Flour • Attic Wall • tete.Slope V.Lxt.'rtof ieliil er Basement ,Other .--- _ other. _ V.I have performed my inspection and determined there is no active knob and tt*rfe wiring in the areas selected below, ‹.Attic Floor Attic Wall .r Attic Slope X Exterior Wall x Basement • Other: Other _-- Contractor Name: ICt+17 A-I E/y'• I L A-ddress: 36 6'Q let 1 E71# City: ,?v-�C�+o+" fee% State: !Y1,- ZIP: IntU~-43�+ Company Name: ate c-( - Le License Number 4'- '/?G kV Contractor Signature: -— - Date: PP( t-y sigi:ature eontirms that I ha ;As rf r,:me 'inspection,of the electrical systems listed above and have corrected any barriers as indicated.My signature also confirms thatT read and •-gree to the Terms and Conditions outlined on the back of this form. 1 ECHANICAL SYSTEM BAkidERS<1n befitted d nut by wcnii9 7 Hrgn Carbon Monoxide:Cuni r eN tv, is to se:vice and re-. !,...att.. tn:r6 sEt.3z r":'n rECF.]reKdl,.V-<•:-'.,`.`aria reduce the carbon mono,Nip InV4l. inea:,uret1 in the undiluted flue ga't,to below 100 twoF., •••::r million(opra). Draft Failure:Contractor is to correct the draft in the sek3:t eel flue(s).Refer to table on reverse for acceptable draft ranges. High Carbon Monoxide Draft Failure I Existing CO ppm Revised CO ppm. Existing Draft Pa: _,___ Revised Draft Pa:. . . i , Heating System i _.____r__. Hot Water Heatsr Other : _ __ Spillage:Contractor is to correct the spillage of flue cersr: n the selected mechanical system(s).Must not spill after 60 records of operatior, Heating System • ,Hot Water Heater , Or:,:r. -- Conti ctor Name. .e c _.._.-._- — __.`ity:__..__. Stater ZIP*.__-- -----' Company Name. . ._. License Number: Contractor Signature: ______ _ -- My signature confirms that I have performed my inspectrc.0 of the mechanical systems listed above and have corrected any barriers as ii„-ii.-area/ M„cin.- Ps we,Mtn lnnfirmc that 11-,ssin roam an,i.airier•to the Twmc and Cnnriitinnc ru dhrwri run tha hark rut thrc firm I 1 T 0 *ail rmerui (i ox wil r i 1 1 1 iiiii:A:x" 10 hi 11 ilitii. 1 ii oro i 1 1 1 oil 0 1 RN ok 1 RI- 111 1 . i i, ; h4 .4 •.; 10111 a ft! . 0111 i ii It 1 I 1 1111111 litiqk I ! lig 01110 ' i f gll '4 - Im i * I i 51171 10 - i f Ali il " bi i 1 01 iiir 11 111111V -: 11,11 I idil . # I lj ' ili 1 ii -i IN a 9 14 Ili " " " " " " " " " ' •- ACCoRlar CERTIFICATE OF LIABILITY INSURANCE DATE " Y) 08/31/2020 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 POUCIES 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 eertifieale holder is an ADDITIONAL INSURED,the policy(les)mud 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 Nide DeCastro COONAN INSURANCE AGENCY PHONEl=- No.etc (508)957--7122 FAX *mans- Nidat2coonaninsurance.00m 267 MAIN ST INSURER(S)AFFORDING COV GE NAtc• OXFORD MA 01540 INSURER A: ACE AMERICAN INSURANCE CO 22667 INSURED INSURER 9 ENERGY PROTECTOR INC INSURER C: INSURER D 64 PAXTON RD INSURER E: SPENCER MA 01562 INSURERF: COVERAGES CERTIFICATE NUMBER: 569858 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. NOTVVITHSTANDING 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 POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILLTR —ACM-SUER POLICY EFF TYPE OF I SURRANCE POUCY NUMBER (gip tl'I LIMITS COYBERCIAL GENERAL UAISIJTY EACH commerceS C'.ma...M n OCCUR ID ve,Oaf one per) S N/A PERSONAL a ADV INJURY S GaiL AGGREGATE LIMIT APPLMB PER: GENERAL AGGREGATE S POl1f:Y❑ IOC PRODUCTS-COMPOOP AGG S OTHER 1 S AUToNomeUBLITY `pis BINEID MOLE Y) LIMIT S ANY AUTO GODLY INJURY(Per person) S — AU.OWNED SCHEDULEDAUTOS AUTOS N/A BOOLY INJURY(Par aemont) S HIRED AUTOS AUTNON�OVYNED (PerPer a¢ddI+l) S IJIMIRELUI _ L/AB OCCUR I EACH OCCURRENCE S EXCESSLMB CLAIMS-MADE N/A AGGREGATE S DEO I RETSJrnoNs i s WORKERS coaponArow X ` rTE_l I Y YIN A FI EXa�t n NIA NIA 6S62U8 0 20 09/01/2020'09/01/2021 E.L EACH ACCOENT S 500,000 thykasNabrlrinNH) +I E1.n{Ireex-EAEMPLOYEE s 500,000 «OF. CAPTtoNelcf"OF OPERATIONSbalm, 1 E.L.DISEASE-POLICY Lahr _s 500,000 N/A DESCRIPTION OF OPERATIONS!LOCATIONS 1 VEHICLES(ACORD 101,Addiibnal Remarks Scandals,may be el a het Smo,e spew Is reent.d) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in stales other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance stows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at wvw.mass. vlvestigations/. Sole proprietor has not elected coverage. CERTIFICATE HOLDER ER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN Enemy Protectpr Inc ACCORDANCE WITH THE POLICY PROVISIONS. 64 Paxton Rd AUTHORIZED REPRESENTATIVE Spencer MA 01562 Dani el M.Croadey,CPCU,Vice President—Residual Market—WCRIBMA C 1988-2014 ACORD CORPORATION. All lights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD • Commonwealth of Massachusetts ' Division of Prolessional Licensure Board of Building Regulations and Standards Construdtibfl'$upprrisor CS 101143 .. BMpkss:OW1 2022 JOSHUA t;DADA 04 PAXTON RD SPENCER Md,01862. Commissioner '•/l x b/cona.>v, Office of Consumer Affairs and Business Regulation 1000 Washington Street M SuIte 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Ca n 1721180 ENERGY PROTECTORS INC. xplrutlan: 0811912022 84 PAXTON RD, SPENCER, MA 01682 Update Addrsea and Return Cart oNia.of Consumer Mire C Ilwhuaaa NeitiotIon HONE IMPROVIVISNT CONTRACTOR „ b tstndlon valid for hidtvidu use only TYPE Corporation M r oxpiration data. If found return to C es of Consumer Affairs And Business Regulation 1Bt 72900 00/�� 1000 Wraith Street a Sub 710 ENERGY PROTECTORS INC,• Sostan. MA oils JOSHUA DADA SPENCER, 010d2 U�� Not valid without signature