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23D-024 (8)
BP-2023-1018 492 ELM ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23D-024-001 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-2023-1018 PERMISSION IS HEREBY GRANTED TO: Project# " INSULATION 2023 Contractor: License: Est. Cost: 2000 SUPERIOR INSULA ION 106237 Const.Class: Exp.Date: 06/15/202 GREN T CARMEN TRUSTEE&JOSEPH & Use Group: Owner: CARM N GRENAT TRUSTEES Lot Size (sq.ft.) GREN T CARMEN TRUSTEE &JOSEPH & Zoning: URB Applicant: CARMEN GRENAT TRUSTEES Applicant Address Phone: Insurance: 2960 ROCKRIDGE PL THOUSAND OAKS, CA 91360 ISSUED ON: 08/01/2023 TO PERFORM THE FOLLOWING WORK: INSULATION/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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NO THAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I , O I � � ' I Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner ijEE.0 K;T A F 11)40)T /21c -50._,r el-talc— 3-I Z A.., I9Z5 o `'� L- • The Commonwealth of Massachusetts G°9pm '� 3: Board of Building Regulations and Standards 1-9 G� FOR IPAL ,� -, Massachusetts State Building Code, 780jMR `Building Permit Application To Construct,Repair,Renvate Or Demolish 9tQ 'evised , 2011 One-or Two-Family Dwelling s�'o This Se ion For Official Use Only �s' Building Permit Number: 6-i22 3-, A7 1I Date Applied: 4#...., (Z.,_ i/ 6.1-2.(2-3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1 Pr pe Addre 1.2 Assessors Map&Parcel Numbers q ' Im �-�Ye�t 2.3D �4 - I 1.1 a Is this an accepted street?yes _.- no Map Number Parcel Number 1.3 Zoning Information: `^ n 1.4 Property Dimensions: ilia) Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard I W 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:nh 1.8 Sewage Disposal System: In i Public 0 Private 0 ►�1 ,0 Zone: _ Outside Flood Zone. Municipal 0 On site disposal systemll`v❑V l l 1�. Check if yes❑ ',�,� SECTION 2: PROPERTY OWNERSHIP' 2s llOvyI erQ�'�Re�J(.111 i t 1 V Qr � �/�l A A Name(Print) �1.� City,State,ZIP I 'v1 LK2 Elm -. l413- 231-- 0352 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WO1tK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Rei airs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units 1 ,Other N.Specify: Z�1 suiC liO an Brief Description f Proposed Work': P(►r �'� a lnsl.^^ t Col • r �o \ Y OJt t ° r-Ct pat- SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials) Official Use Only 1.Building $ 20 0 D 1. Building Permit F e: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/To Application Fee ❑Total Project Cost (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) NTotal All Fees,... ,4_, _ Check c3,.3heck Amount: U 6.Total Project Cost: $ 1000 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) I n(4)I 15� . f Ce a 5 Kt)le, `.,4t License Number Exp lion D Nam o CSL Holder 1� f �,t rs`��, Lv-) List CSL Type(see below) loin.and Street t Type Description is „`,1 't e A c I l b2q t 1- U Unrestricted(Buildings up to 35,000 Cu.ft.) UI Y t (' 1 1 J1 / IV v R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry cIeomq -eiria rrno s .C RC Roofing Covering WS Window and Siding �O1 (� �'_1l` SF Solid Fuel Burning Appliances ( l I Insulation Telephone Email address D Demolition ' Registered Home Im rove�+m�e�nt/C�onnttractor(HIC) I 5I 1/ 1 T V1 l�l Or Olti�6 J 1 HICRegistra`tion"Number Ex ration ate itToran Name or HIC Regi rant Name WirYTO I�>°AI SXuu Y [t Email address ity/Town,State,Z IY Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6)) i Workers Compensation Insurance affidavit must be completed and submi d with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit Signed Affidavit Attached? Yes otiNo ❑ SECTION 7a:OWNER AUTHORIZATION TO B COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize Sew o.. j t-oc1' 1 ed to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic 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 conta. in this appli 'on is true and a curate to the best of my knowledge and understanding. 3 Print — -7/' or Auth rued Age s Name(Electronic Signature) Da er� 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.) Habita51e 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"maybe substituted for"Total Project Cost" City of Northampton /0" ��S S S r' v� � Massachusetts � tro DEPARTMENT OF BUILDING INSPECTIONS " 4 212 Main Street • Municipal Building /- O: \ yr. Northampton, MA 01060 �s�ly 3,D‘'‘ 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: 1L12 , Encr lngc Ln ,p The debris will be transported by: Name of Hauler: e►bi --na/k ta)FiDn "iiSignature of Applicant: ()e.Vj Date: y2.5/z5 The Commonwealth of f Massachusetts Department of Industrial Accidents l__ =1 I Office of Investigations ei _= 600 Washington Street '3,- ,� '1 Boston,MA 02111 :r`r=tom; www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Superior Insulation,LLC Address: 140 Point Judith Rd,A7 City/State/Zip: Narragansett, RI 02882 Phone#: 401-515-4524 Are you an employer?Check the appropriate box: I am ageneral contractor d I Type of project(required): 4. 1.® I am a employer with 12 ❑ 6. ❑New construction employees(full and/or part-time).* have hired the sub-contras ors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' P h 9. ❑ Building addition [No workers'comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per M L 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.E Other Insulate comp. insurance required. *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside c ntractors must submit a new affidavit indicating such. *Contractors 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'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Beacon Mutual Policy#or Self-ins.Li]c.#: 67872�^ I Expiration Date: 8/2/23 .L /1\Ayi Job Site Address: M 2 U m SI a City/State/Zip: D Y-Vhanlpf-b n Attach a copy of the workers' compensation policy declaration page(sho ing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can 1 ad to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties• the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this stat ent may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify10- uunnder the pains and penalties of perjury that the information provided above is true and correct. Signature: //-�e%/C_% Date: �/2 s/23 Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: SUPEINS-01 MLONGOLUCCO coRCP" CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY) `—� 7/14/214/2023 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 ADDITIONAL 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 NAME: Mansfield Insurance Agency Inc. PHONE FAx /C 115 High Street (A/c,No,Eat):(401)596-2096 (A ,No):(401)348-2060 Westerly,RI 02891 ADDRESS:info@mansfieldins.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Employers Mutual Casualty(EMC)Company 21415 INSURED INSURER B:Beacon Mutual Insurance Co. 30325 Superior Insulation LLC INSURER C:Evanston Insurance Company Michael O'Connor 140 Point Judith Road,Unit A7 INSURER D: Narragansett,RI 02882 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X X 6D23763 8/2/2023 8/2/2024 RENTED DAMAGE SESO(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JE LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER:General Aggregate $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) X ANY AUTO X X 6B23763 8/2/2023 8/2/2024 BODILY INJURY(Per person) $ OWNED SCHEDULED _ AUTEO�S ONLY AUTOS SSVyN BODILY INJURY(Per accident) $ _ AUTOS ONLY _ NON-OWNED ONLY (Per PROPERTY DAMAGE $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE X x 6N23763 8/2/2023 8/2/2024 AGGREGATE $ DED X RETENTION$ 10,000 $ 5,000,000 B WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATUTE OTH- ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N X 67872 8/2/2023 8/2/2024 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Pollution Liability x x CPLMOL118083 7/6/2023 7/6/2024 Per Occurrence 250,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Residential Insulation Contractor-14B Enterprise Lane,Smithfield,RI 02917 Pollution Liability Aggregate Limit$500,000 National Grid and all divisions are named as additional insured per written contract or agreement.Waiver of subrogation is provided in favor of National Grid and all divisions per written contract or agreement. Pollution Liability includes mold CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE National Grid THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 40 Sylvan Rd Waltham,MA 02451 - - AUTHORIZED REPRESENTATIVE I _ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts r Division of Occupational Licensure Board of Building Regulations and Standards constructConstructii2Ot uperUia9r Specialty CSSL-106237 z Etpires:06/15/2025 KYLE L LEDtt,C 3750 DIAMOND HILL RD CUMBERLAND RI 02864 < 1 '# t.INA;1- Commissioner ria t K. '& - Construction Supervisor Specialty Restricted to: CSSL-IC-Insulation Contractor Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.govldpl THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affair$and Business Regulation 1000 Washingtd t - Suite 710 BostorkMassachusetts 02118 Home Improvement Cbntract©r Re istration 4,Ye‘z Er ________, i t .., 1u 1r" _i , '� rType: Supplement Card � ' '�..• � 7eg, istration: 175445 SUPERIOR INSULATION LLC. �, iftwiliiiiiiiiift foie=' --, Expiration: 05/12/2025 140 POINT JUDITH RD UNIT A7 """•"� - , NARRAGANSETT, RI 02882 .� I or #','�`)) emir awsisisi`-- te *IMF 111 _ it at i Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs & Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE._Su0plem ent_Card Office of Consumer Affairs and Business Regulation RegistratiCon- - Expiration 1000 Washington Street -Suite 710 175/115.- T 5/12/2025 Boston, MA 02118 SUPERIOR INSULATION t� -- == . P is KYLE LEDUC Y ^ �J /� f( )6141 140 POINT JUDITH RD(INIT . �r,„,,,..0(a.i'Leo'k NARRAGANSETT, RI 02 ."f'" •, �` ,.--.' Undersecretary Not valid without signature / WEATHERIZATION CONTRACT EVERS=URGE -ow CUSTOIlR PHONE DATE CUE.NT I WORK ORDER Melissa Salva (413)237-0352 07/05/2023 542210 61602 SERVICE STREET &LUNG STREET PROPOSED BY. 492 Elm Street 492 Elm Street Jeff Ledoux SERVICE CITY.STATE.OP HI'1ING CITY.STATE.,ZS Prou'am Northampton, MA 01060 Northampton, MA 01060 EGMA-HES Page 1 DESCRIPTION QTY COST INCENTIVE TOTAL INCENTIVE 75% For eligible weatherization measures, Eversource is offering an incentive of 75%for insulation measures and 100%for the air sealing measures,both with no limit.You are eligible to apply for the 0%Heat Loan to finance your co-pay,applications must be submitted before the weatherization work begins. KNOB&TUBE WIRING SIGN-OFF 1 $250.00 $250.00 We have identified the existence of Knob&Tube wiring in your home. A licensed electrician will conduct an evaluation of your home to identify whether the knob&tube wiring is inactive. Insulation cannot be instailed in areas where knob&tube wiring is active. HOME AIR SEALING 2 $188.66 $188.66 Seal areas of your home against wasteful,excessive air leakage. Materials to be used to seal your home can include caulks,foams and other products. Primary areas for sealing include air leakage to attics,basements,attached garages and other unheated areas (windows are not generally addressed.) DUCT SEALING 2 $174.18 $174.18 Provide labor and materials to seal healing and/or cooling ducts within designated unheated areas. PULL-DOWN STAIR-THERMADOME 1 $277.33 $277.33 Provide labor and materials to install an easily moved,insulating cover for the attic access folding stair. The cover has integral weather- stripping to restrict air leakage. COMMON WALL-3.5"FIBERGLASS BATTING 86 $169.42 $127.07 $42.35 Provide labor and materials to install R-13 faced fiberglass to a common wall. Insulation will be fastened in place, CRAVVLSPACE-6 MIL POLY GROUND COVER 120 $122.40 $122.40 Provide labor and materials to install 10 ml polyethylene over open ground in designated crawlspacelearthen basement areas, CRAWLSPACE WALL-2"RIGID BOARD 86 $417.10 $312,83 $104.27 Provide labor and materials to install 2"rigid insulation board to the open wall. • WEATHERIZATION CONTRACT EVERSvURCE CUSTOMER PHONE DATE CLRNTI WORK ORDER Melissa Salve (413)237-0352 07/05/2023 542210 61602 SERVICE STREET BILU 4G STREET PROPOSED BY: 492 Elm Street 492 Elm Street Jeff Ledoux SERVICE CITY,STATE;ZIP BILLING)CITY,STATE.ZIP Prop run Northampton, MA 01060 Northampton, MA 01060 EGMA-HES Page 2 DESCRIPTION QTY COST INCENTIVE TOTAL PREPARE YOUR HOME Homeowner is responsible for the removal of any items stored in the S (initials) areas where the weatherization measures will be installed. The workers will need the space cleared to safely bring their tools and materials into these work areas. If you have any questions or specific concerns, please bring them to the attention of your subcontractor when they call to schedule your work. Total: $1,599.09 Program Incentive: $1,452.47 Client Total: $146.62 I.DESCRIPTION OF WORK TO EE PERFOR MED Contractor will perform or cause to be performed the above work at the Client's Address in a professional manner and in accordance wth the terns of this Contract, II.PAYMENT Client agrees to pay the Contractor for the Work,the Client Share of the Contract Cost is payable to the Independent Installation Contractor(lig upon satisfactory completion of the Y.brk_Client understands that they will not be required to pay the Program Incentive Share of the Contract cost.Changes to Inc individual line items and/or previous incentives mar increar . he size of the Program incentive Shari. SE SE Rave Client Signature / / o Data of,�c7/s� . i. I Aft mass save s.-ti-�_;tfro:.r:'i energy efficiency ency PERMIT AUTHORIZATION FORM 1, Melissa Salve owner of the property located at: (Owners Name) 492 Elm Street Northampton (Property Street Address) (City) hereby authorize the Mass Save® Home Energy Services Program assigned Participating Contractor to act on my behalf and obtain a building permit to perform insulation and/or weatherization 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. ilUali-c— S LA.c..._ Owner's Signature /5/23 Date FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Sape,h 0r TrgA ictkt on 2512.3 Partici ating Contractor 1 Date City of Northampton �� Massachusetts A' A ', ilf r_ fIIt ,a 4,Aeot DEPARTMENT OF BUILDING INSPECTIONS b 212 Main 8traat • Municipal Building f o h,,"`" Northampton, MA 01060 rV r,` � Property Address: W2- oryi arec ` Contractor Name: IC:p\1e_. LOkc Address: "T En"1/4-c `p r'I sci t.,-f • k ,..City, State: 1 7 t ckoi t_1 Phone: LID) 5 l 5 Lt 2H PName:roperty Owner' "„oxt ct� 1 sal aj � Address: 1-1q 2-- at -i U. City, State: fVDu1O4rYpTti1), ri- I, 1,-.-c L,--c-3(A.c., (contractor)attest and affirm that the building I intend to insulat d es not have any open air(knob and tube)wiring in the spaces to be insulated and that I have provide the property owner with a copy of this affidavit. Contractor signature 7a6-,/bZ.,---- Date 7/