17A-245 (10) BP-2022-0216
86 LAKE ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
17A-245-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2022-0216 PERMISSION IS HEREBY GRANTED TO:
Project# INSULATION Contractor: License:
GOLD STAR INSULATION &
Est.Cost: 1580 CONSTRUCTION LLC 065992
Const.Class: Exp.Date:03/16/2023
Use Group: Owner: LEMESHOW, STEVEN & ENGEL, HANNA
Lot Size (sq.ft.)
Zoning: URB Applicant: GOLD STAR INSULATION &CONSTRUCTION LLC
Applicant Address Phone: Insurance:
1 CONGER RD (774)329-4664 65620B5N23815620
WORCESTER, MA 01602
ISSUED ON:03/10/2022
TO PERFORM THE FOLLO WING WORK:
INSULATI ON/WEATHERIZATI ON
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:
Gas: Final: Final: Rough Frame:
Rough: Fire Department Driveway Final: Fireplace/Chimney:
Final: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: Lerot (�
XX� '
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
Slic.-1- 1'7°0 x.A.,z„.1 . -rala.g.r____fr.-744-46-,3-t:1-2-z_
—eitl I
The Commonwealth of Massachusetts / '''. '''s'
W Board of Building Regulations and Standards MAR
780 CMR 3 C►E I Y
Massachusetts State Building Code, �
/Building Permit Application To Construct,Repair,Renovate Or; I'. s a Revise, Mar 011
?icy in
One-or Two-Family Dwelling '4 `^'`..-
This Section For Official Use Only , ,;0`.°tis
Building Permit Number: Se- a.A"'" -ZIt4 Date Applied:
i 77 _____2(2
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Pro Address:t 1.2 AsseAm2 Map& Parcel Numbers
1.1 a Is this an accepted street?yes V 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 0 Private❑ _Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
/-/wrlitq (Ar19,0 } tor s-( (( MOi v\c7 L 2.Name(Print) City,State,ZIP
go fake (\-ree-1 S.CR-?34-1+C,i,L1- �tl0_,,l`'�aoIoi,c\ou8•( A
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK' (check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 1Er Specify: ;r\Sv,VA 1or,
Brief Description of Proposed Work2: A-!-t c_ oQer\ 1btoco Ce-llouys
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2.Electrical $ ❑Total Project Cost3(Item 6)x multiplier x --
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ ( , F.,cd 0 s 20 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
1 &-";g012_ 03 -i6 -Z5
Ke vi',,1 , ?. , q\ 1&n License Number Expiration Date
Name of CSL Holder
a ( t\-1 PC, (\ Q\C e_0 ' List CSI,Type(see below) l
No.and Street Type Description
__-- U - Unrestricted(Buildings up to 35,000 cu.It.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
t' (Jt , 1 1 °^ a p 1 0 G RC Roofing Covering
WS Window and Siding
_ SF Solid Fuel Burning Appliances
gbppp-139-4Uok q\tr. .k0t Ot;Cloyti. COK I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
old' aiv ‘if &o,\A.;on � Cove rv,C ion IC 2,vo2�� m2- o3 z2.
HIC Registration Number Expiration3 Date
HI Cmpany Name HIC Re 'strant Name
Lon k/ d0‘ ell I€-n y i ASkor 01 L\o�U• C o t
No.and Street Email address
Lk)rLesFer r\-tr, b1 ( 07_ goZ -259-14 0.14-
City/Town, State,ZIP Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 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 Ye' No .0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize el o\aisrkr j r\S u1\P.-L',o n Co1n f W C ;0r
to act on my behalf,in all matters relative to work authorized by this building permit application.
'-k , \AQ2i r3z - zS-Z7.-
Print Owner's Name(Eteeetttonic Signature) Date
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
o2 - ZS - 2.2-
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system _ Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
City of Northampton
s�c�
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS y,
212 Main Street • Municipal Building
Northampton, MA 01060
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:
S� 1 oft he-c- irt 4 0/ Gt-
Location of Facility: ' 'GA1�L �«"
The debris will be transported by:
Name of Hauler: = `>' + A3t-kcrA
Signature of Applicant: Toui-7e-Al Date: ( 7
0 uSign Em.topo IQ 72C63EAE-221E7-4338-8455.9395EAS2806£
RISE
FNGiN11 kiN
OWNER AUTHORIZATION FORM
1, Hannah Engel
(Owner's Name)
owner of the property located at:
86 Lake Street
(Property Address)
Florence, MA 01062
(Property Address)
hereby authorize
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.
uocasar+ee bit
re
2/17/2022 16t16Am PST
Date
RISE Engineering,a Division of ThieIsch Engineering,Inc.
60 Shawmut Road Unit 2 I Canton.MA 02021 1339-502-6335
www.RISEengineering.com
DormSten Envelope 10:72C63EAE•23E7-4338-8455.9395EAf 2BA88
Fedrnl Fel105-04O5e2s
RISE Engineering l I Contractor Ragistraean Mo Sion
MA Contractor Rai slration Nti 120e79
R' CT Contractor Registration No e20120
SE
rt.,5iNff F,Mc. eo shllwlntit Unit O.Canton,MA 02021 CONTRACT - WZ
339-502-4335 FAX 33e502.6345
Page 2
PROGRAM TNscw1AlCT a!NNW NTa MINIMA NW
i S MIRK Foot AI
CMA-HES
moonI. . woiaMERX
Hannah Engel (614)657-9729 0211612022 338454 61902
86 Lake Street 86 Lake Street JeffLedoux
�fmvic ary7InTii.ra IBERIO rof STATE For
Florence,MA 01062 Florence,MA 01062
DESCRIPTION QTY COST INCENTIVE TOTAL
PREPARE YOUR HOME ,...—
Homeowner is responsible for the removal of any items stored in the
areas where the weatherization measures will be installed. The L 'tiRlri�l,l
workers will need the space cleared to safety tmrg Mew tools and
materials into these work areas
If you have any questions or specific concerns,please bung them to
the attention of your subcontractor when they call to schedule your
work.
Total: $1,580.20
Program Incentive: $1,248.90
Customer Total: $331.30
WE AGREE HEREBY TO rusmsH SERVICES.COUPLET(BF ACCORDANCE MN ABOVE SPECIFICATIONS roe THE SUM OF
***Three Hundred Thirty-One&301100 Dollars S331.30
URON morn Of TOUR Rat LNONitURIIO INVOICE COS EWE AORE ES 1O AUNT AMOUNT OM RITUEI.0111A011 of IS Nrll RS CHARaeD*ROW ON MY
WOW IA,WI AFTER 3ROAYS.RUE RCYERSE R]R IMPORTANT,NTORMA TON ON OUARANTIrI Melts Or MOWN RCl1lWALIANS Ale CONIRACIOR RLONTAAteeN.
,•— o.cosiRnedbf'. OOCY$i0Mdbr
da G41.44 tkd
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Wit ISO CONTRACT MAY ItERtAeAA*$IYUIRNO1e3lninallWWI OATS OfACCtRIAaCE 2/17/2022 6:16 AM PST
RIGN OATS
30 .DAM. ACCEFTARCE Of CONTRACT-THE MOVE FUELS.IIPACIFICATIONS ARO C0NDO001f
AU
a►f*PACIORY'roue AO ARE MUM ACCEPTED IOU ARK AUTHOR►EO TO 00 'NO IR
As RPECE130"AMEN*WILL RE:YAMS as OUILRFEO AROVR
The Commontveai'lh of Massachusetts
-�-= Department of Industrial Accidents
" --�«:�►�--- I Congress Street,Suite 100
+ , ► Boston,MA 02114 l017
-.:- ' wwncmoss.gov/dla
Workers'Compensation ts+xuranet Affidavit:Bunders/ContraetorsfElechiciamMumben.
TO RE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print L exibly
Name fHusitws <'Organirattoi Individual l t?1c J �f i c�sulA ga n Cc fv,< +on l l
Address: i L c, c ►1 co,n�
City/Statefzip: o r LS\Q( M A cif Lp2, Phone 4: C2? -, s cl- kL 4t-
Art yiti.r employer?tbh the appropriate box:
TYPe edPrOieei(required):
1.11'al a a entplaytrwith ':enl 4oy (1 ill arobot parkeirute)_• 7. 0 New construction
20 t am a sale proprietor or part mesh"and have nu employees working ilbt titre in g. 0 Remodeling
any capacity.fNoworkers'conm.insurance enquired"
3 i ant a bomeaw,wx an t myself.(No workers' 9. Demolition
dui, y>fa c`�4.see r+egtiinati�t
4. 1 saga homeowner and will he hires youruetars to rooduet all work an my property_ t will
100 Building addition
rtaury that all contractors either have workers*compensation insurance or are stile ILO t]Electrical repairs or additions
pruprietw'with rio evapioyees. 12.0 Plumbing repairs or additions
501 am a general contrarior and 1!save heed the tub-contractors list d on the attached sheet I 30 Roofrepairs
Thew subaantrsctors have employees and have*miters'cop.maurtnce.t
14.gather 6.0Vita are a ratio and its atoms have as rc iaed their right oferxa +lion per 7146E e.
i r\Su\w-4Ic:5
152,i 1(4).and late have no empl r.(No worker?con*issuraace rexlraged.j
"Any applicant that chocks hos o1 mtnt also fill out the stun below showing Chair workers'compemation palm information.
Hogneowtscrs who submit this affrdas t indacistrety they are doing all weak and then hire.&orb de contractor%Monte subrsat a new aftidas it indsu-clang Much.
contractors that clerk this box most art bc4 an additional sheet showing the name of the tears and saw whether or nut those entities have
employcu. lCthesub-cu ratturt.has..eiripiusecs,theyratpsutiicketheirwurlors xstnp.whey number
.
am an employer that is providing wort ors'compensation insurance for my employees. Below is the!relic!'and job site
information.
Insurance Company Name: U(1\o n M( uoA\
Policy#or Self ins.Lie.#: 6s 4-2(.4"R5 n),.3 \5 Expiration Date: \\
Job Site Address. 8 z r t City/State/Zip:\ 1c t ILA A 0 b t Z
Attack a copy of the workers'compensation policy declaration page(showing the policy somber and expiration date).
Failure to secure coverage as required under MCGL,c. 152, 425A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as welt as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 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 certify under the pains and penalties ofperjuty that the information provided above is true and correct
Signrature: rOo uo k tare:: O 2.2 -25- .2.-
Phone#: O% -Z.Sq --14-U0 k-
rOfficial use only Do not write in this area,to be completed by city or town official
City or Town: Permit/Lk-ease ri
IIs'.ulug Authority(circle one):
I. Board of Health 2.Building Department 3,CityfTown Clerk 4.Electnicsl Inspector S.Plumbing Inspector
ii.Other
f ontact'Person: Phone#:
9:12 AM Thu Mar 10 w as III ® 100%
riseengineering.force.com fit—Pneete
a e.Q
mass ve Weatherization barrier incentives
:•Jscd cs:-VO L'?e'g1 rinec+.a"is-s r_com tanda ons,your home can benefit from prvtjrar-e gIibie.nsdi s or:aitnior or eal;nr)
improvements,Before nkavrrtg forward.please follow all the irntructiees below to remetliate your weetherixatibn barriers.
CUSTOMER INSTRUCTIONS
1.Hire a Qualified,licensed contractor to evaluate endjear rernodiate the weatherization barrier(s).
2.Submit signed and completed copies of this form and a copy of the paid contractor invoice(s)within 60 days of your Home Energy
AsSessment;to:RISE Engineering,SCE Shaw/nut Rd,belt;,Canton.MA 02n21 or email to P.verrsourceinIne:PISEenelneering.com.
3.The weetherization incentive will be deducted from the customer co-bayment amount of the weatherization work.A rebate check
will be issued in the event the amount exceeds the customer's c;o'oayment amount.
4.Complete the recommended weatherization improvements.
5.The Mass Save NEAT Loan offers interest free financing opportunities that may be used to remediate trigibke weatherization
barriers. Learn more at masssaye.ccmlerttsavinglresidendat-rebatesfheat-barb-program
IMUSTUaR9412ORMAT/ON e a
Customer Nao'o. Hannah,._Engei_ - (i?,w,,LL,..1g Client a or Site ID: 338454 0_..
Site Address 86_LakeStreet Florence_. State: MA zip' 01062
•...rn E 51,4-8$7-9729 rmac stevenlemeshow@gmail.com
Customer/Hometwner Signature: " Date:
iota&Ate,TOPE WIPttel t'ta rae5 0 ewae);
To determine if there is any active knob and tube wiring,the contractor wily evaluate tie fol,owing areas where eligible Mass Save'
wooer c iratdctn recommendations nave been made:
1/ laor ,Attic.Was Attic Slope : Exterior Wail ";Basement Other: Other.
Or/
.r; r.,n n,it ;rc:on and determined there is no active knoo and tube wiring in the areas selected below:.
Attic r;oa° Attie Wall Attic Slope G,�adenor Wall 8ase<nent a
Contractor Narne;'
Address___ j&51. (n:(I ?1n-c•.< _ City. �3 t "'` Stare r ZIR.__ator
z4'1
Company Name: G G '24 Licenser Number.
Contractor Signature: - Date:
My signst,'e confirm„that I t pe ed my inspection of t^e electrica`systems listed above and have corrected any barriers as
,nclicated My signature also n`ir.its that 1 have read and agree to tile Terms and Conditions outlined on the back of this form.
High Carbon Monoxide:Contractor-is to service-and. tc d eeNamcal-syst t(s)-r redi t Ehe-eor aoft-rnorta=ide4eyef,
cram ompa-e in the.ua Rill€tell-fife-gasrfo elow40U parts perf«»liiort-{ rfq-
Draft Failure:Coratreator-is-te-ebrreet-thevdrah-iret#re selu;?t.f flues}..3•te€er-te tableon reversefor-aceeettiible-draft raneges-
xittind CO pout: Revised-C--G-dree Evlstireze at#-Pa t 44-wised-Draft-Pat
Heating Sy^sttrs
Hot WaterHcriter
Other:
Spillage:Contractor-is-te correct-the-spillage-of flue gases in the sel cted mechanieo4-systems)eMust rot-spill-after-60-secondx-otoperateen:
;•Hecting-6y;tem Hot Water-Heater 3tda
€ ntw icter-Nomt:--
f.,dress _ Ott
errm1 as Nont _._., - €rse-Nur ,oer=--
Contractor Signatum:
r`,rs,rt„-tariftf+'t'iStdfat_i•haY+'?perforineti-my-rF?`_+fectrt3r*of-the neeha?icc7.-systernsfistsd-abbvbend-tewecorrecte'd S"y**fY""'e's-e'
}dicxatetf My:riyntstur eilses•Ctrrtfirfr tleat-4•#3ae-naiad-ul d-Agree-te-trle-Termthand-EOndtbetis-ebtilferloft'thebackeft-this-forme.
.
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