25C-173 (9) 125 NORTH ST BP-2022-0033
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25C- 173, 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-2022-0033
Project# JS-2022-000057
Est.Cost:$4000.00
Fee,: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ENERGY PROTECTORS - JOSHUA DADA 101143
Lot Size(sq. ft.): 6098.40 Owner: TEMES KATIE
Zoning: URC(100)/ Applicant: ENERGY PROTECTORS - JOSHUA DADA
AT: 125 NORTH ST
Applicant Address: Phone: Insurance:
64 PAXTON RD (774) 253-0277 WC
SpencerMA01562 ISSUED ON:7/12/2021 0:00;00
TO PERFORM THE FOLLOWING WORK:INSULATE EXTERIOR WALLS
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. ` ;g
• •
Certificate of Occupancy Signature: l j
FeeType: Date Paid: Amount:
Building 7/12/2021 0:00:00 $65.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
f RECEI
JUL 9 2021.
IS, The Commonwealth of Massa,hus-.
Board of Building Regulations • i i Stan 1 <<� BUILDING OR
W Massachusetts State Building Code,7:t "', 'HAMpro INs o so CIPALITY
n4AUSE
Building Permit Application To Construct,Repair,Renovate Or Demolish a ' ,:•d Muir 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: ' '. Date___45,6,riiclmu
Applt
Building Ofiicial.(Print Name) Signature
:,;SECTION--I:..Si"r'E INFORMATION ..Y.
1.1 Prope 'ddress: 1.2 Assessors Map&Parcel Numbers
l a 11/4)01-+h Si- .zs e 7
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
13 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 ❑
Check if yes❑
. ;.- SECTION:2 .PROPERTY OWNERSHIP'
2.1 Owner'of Record:
1-Z,a,-k-t C T e.v`.,t S ,K)of A-1tc,,s.n.0 t—Vwl t PIA- b 10 6 0
Name(Print) ►►""__ C City,State,ZIP 05-6
vis
1.
No.and Street Telephone Email Address
'' SECTION 3:`DESCRIPTION OF PROPOSED WORK'(check,all that apply) ''
New Construction 0 Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition 0 AccessoryBldg.❑ Number of Units Other I j ecify: ' 5u V4. c"
Brief Description of Proposed Work2: r,1n 5 V 1 c, F P K-4-2 i'"a r` c...-4.1 t, S'
SECTION 4i ESTIMATED CONSTRUCTION;COSTS
Item Estimated Costs:
(Labor and Materials) OMeinl Use Only
1.Building $ L\r o 00 I :Building Permit Fee $ .Indicate how fee is determined:
2.Electrical $ 0 Standard�Ctty/Town Application:Fee --
0•Total Project Costa(Item 6)x multiplier , .x
3.Plumbing $ 2. OtherFees $,
4.Mechanical (HVAC) $ Ltst
5.Mechanical (Fire $
Suppression) Total All Fees:$
O. CheckNo 3 eck Amount.:. Cash Amount.
6.Total Project Cost $ l '0 Paid in Full • ,0 OutstandingBalance Due: .
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CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40,554,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: P6' act Spi.Art C-e-('ept A- o iSI
The debris will be transported by:
Name of Hauler: cr i P p Cr '
•
Signature of Applicant: Date: 7!G c 2-(
Decusign Envelope ID:13F6FA88-02BD-4DEE-8C0C-eA1230818A2F
RISE
ENGINEERING
OWNER AUTHORIZATION FORM
Katie Temes
(Owner's Name)
owner of the property located at:
125 North Street
(Property Address)
Northampton, MA 01060
(Property Address)
hereby authorize ei4e111.1 Y .P
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 homeowners responsibility to close out this permit by contacting their municipality at
the completion of this work.
cDocaSioaed or.
is
Ow 's�` 9re
7/1/2021 l 12:56 PM EDT
Date
RISE Engineering,a Division of Thielsch Engineering,Inc.
60 Shawmut Road Unit 2 I Canton,MA 02021 1339-502.6335
www.RlSEengineering.com
DATE
Ata CERTIFICATE OF LIABILITY INSURANCE I ,�
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 ADDIRONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or 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 CONTACT cT Cindy Davis
PHONE
Coonan Insurance Agency,Inc. mirk Esc: 508-987-7122 I Dia Nor 508-987-1090
267 rain
Street cindy@Coonaninstuance.com
INSURER(S)AFFORDINGCOVERAGE NAKCS
INSURER A: Capital Specialty
INSURED INSURER B: Safety
Energy Protector,inc. INsuRER C: Starstone
64 Paxton Road
INSURER
Spencer,MA 01562
UISUREtE:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NSR ''L:'.1. POLICY ErF POLICY DIP
LIR TYPE OFINSURANCE MD VIVO POLICYNUMS j$TWOD(YYYY) IMMIDDIYYYY) IDRIS
1 cor um:N.Ga.ERALLA MM EACHOCCUIRRENCE $ 1,000,000
I
RENTED CLA MADE 0 OCCUR RE ISEs
IMS ) $ 100,000
MEDBP(Any one Pelson) $ 5.000
A y C516001320-05 08131120 08131121 PERSONAL&ADV IN URY $ 1,000,000
GENT.
AGGREGATELTAFPLESPER GENERAL AGGREGATE $ 2,000,000
1^'POLICY inc PRODUCTS-COMP/OP AGG $ 2,000,000
OTtEit $
_ ���� COMBINED SINGLE umrr
$ 1,000,000
ANY AUTO BODILY INJURY(Per person) $
—OWNED
B Auros oNLY X SCHEDIJLED AUTOS y 6236519 12123119 12/23120 BODILY ItUURY(Pm=tided) $
X AUTOS ONLY X NONO ON DPROPERTY DAMAGE(Per accident) $
$
X p UMBRELLA X OCCUR EACH OCCURRENCE s 3,000,000
C —EXCESS LIAR CLAMS-MADE y 89362T193ALI 08r31r20 08131/21 AGGREGATE $ 3,000,000
DED I I RETENTION$ $
WORKERS CONPENSAMON AND BfPLOYERI'LIABRRY YIN IP TAATUTE I I i
ANY PROPRIETORIPARTN RIEXECUTIVE❑ NfA EL EACH ACCIDENT S
OFFICERII�EXCLUDED?
(Uaiebeouy in NH) EL ruciPAQF_FAHAPLOYEE$
DEST�NOFFOOPERATIONSbelow EL DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be aged if more apace is required)
Workers Compensation insurance certificate to follow under seperate cover.
emailed josh
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
THE EXPIRATION DATE TIFF,NOTICE WILL BE DELIVERED IN
Evidence of Coverage ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
vat..a..... LaaDaith.fri
I
Q 191)11.7n15 atn1Rn t`S1RPfRL71t1N All rFnhfc eacanrad
AaR i CERTIFICATE OF LIABILITY INSURANCE DATE(DINDONTYVI
1/2920
THIS CERtlFICATE 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 een6 holder is an ADDITIONAL INSURED,the poticy(ies)must be endorsed. if SUBROGATION IS WAIVED,subject to
the terms and conditions ofthe policy,certain policies may require an endorsement. A statement on ads certificate does not confer rights to the
certificate holder In Iles of such endersememt(s).
PRODUCER mcomer
em Hide DeCastro
COONAN INSURANCE AGENCY PHONE
waya (yes)687 71s2 I N,,
hildia@cormaninsurance.com
267 MAIN ST ONSURERIs)APPoitnmccov6tAGE HMCO
OXFORD MA 01540 I( A: ACE AMERICAN INSURANCE CO 22667
BRED INSURER El:
ENERGY PROTECTOR INC mac:
INSURER D:
64 PAXTON RD INSURER a:
SPENCER MA 01562 USURER F:
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. NOTWITHSTANDING ANY REQUIREMENT,TERM OR COMMON OF ANY CONTRACT OR OILIER 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 CONDITIONS OF SUCH POLICIES.LIMNS SHOWN MAY HAVE BEEN REDUCE)BY PAID CLAIMS
ULTRR TYPEOFUISVAANOE -ADUp Wen POIJCYNUYaER nisconnmrn munteravn LOWS
COIu RaAl.GENSIAI.UAEUJTV EACH OCCURRENCE S
PAIMSJMDE OCCUR P AMAGE TO
RENTED
I 1E8 towielneet S
MED EMI(Area* ) S
NIA PERSONALS,ADV INJURY S
GEM AGGREGATE UMITAPPLIE.SPEit+ GENERAL AGGREGATE S
POLICY D JEPR81 DLOC PRODUCTS-COUPRIPAGO S
EM S
AUTOMDBaauABodtY COMBINED SINGLE`I UTrozeklealt
S
—
ANYAU=O BODILY INJURY(Per persan) S
ALL OWNED =Mtn=
AUTOS --AUTOS NIA GODLY INJURY(PermeateQ S
NON-OWNED PROPERDALIAGE
_ HIRED AUTOS A (Per td tt
S
uumast
A GEGUR EACHOCtURRENCE S
EXCESS EXCESSL1RB CLAIMS-MADE RWA AGGREGATE
DED I I RETENTIONS S
woRl�scouwommoN XI° UtT i I ER
AND EMPLOYERS'LIABILITY
ANYPROPRIETORIPAAT ip rlVE YIN El-EACH ACCIDENT S 500,000
A OFRCERAIEIMEREXCLUDED, LEN NIA NIA 6S62UB0G29828020 09/0112020 0910i/2021
MyCoengd,stomInNH) EL.DISEASE-EAEMPLOYEE.s MAW
OES NDF0FERAIIONs tmlaa El-DISEASE-POUCYLOW S 500.000
N/A
nescePTIDNOFOAERATIORBrL mAntererinsucLes(ADORDIOI.Pstainoodti a EtehedgMt.ersybs aUeduslifmorespaner )
Workers'Compensation benfIts will be patdtoMassachuseusernp!oyeas only Pursuant toEndoisemant WC2003069 aDa thw on Is giren to pay daims for benatils to
employees instates other than MassechUsetts R uin Insured tires,or has It3red those employees outside of Massadmsetts.
This certificate of insurance shlauS the policy Infarce(MUM date thatthiscertifimtewas Issued(antess the etrphadon date on the above pDrry precedes the issue dale of this
cerEcate ofinsruance). Theestairrs alibis coverage can be daily by assessing the Proof ei{bverege_Coverage Ver+Eca ion Search tool at
vivo mass. tionsl_
Sole proprietor has not elected fie.
C)ncrtriCATE HOLDER CANCELLATION
SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
Enerty Pfotec r Inc ACCORDANCEINUH THE POUCYPROVISIONS.
64 Paxton Rd
AUntrute OREPRESerraram
Spencer MA 01562
I QattTel M Ceaoy,CPCU,Vice President—Residual Market—WCRIBMA
O 1988.2014 ACORD CORPORATION. All rights reserved.
ACORD 25(20141101) The ACORD name and logo are registered marks of ACORD
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Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
•
Home Improvement.Contractor Registration,
O
Type: Corporation
ENERGY PROTECTORS INC. Registration: 172960
64 PAXTON RD. Expiration: O8/'19/20?2
SPENCER, MA 01562
Update Address and Return Card.
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR 4 Registration valid for Individual use only
TYPE:Corporation before the expiration date. If found return to:
Registration )rxpiratloq Office of Consumer Affairs and Business Regulation
172960 08/.19/2022 1000 Washington Street •Suite 710
ENERGY PROTECTORS INC, Boston,MA 02118
JOSHUA DADA
B4 PAXTON RD . 1a, a'
SPENCER,MA 01582 Not valid without signature
Undersecretary