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29-596 (2) 56 MATTHEW DR BP-2020-0859 GIS#: COMMONWEALTH OF MASSACHUSETTS MV.-Block:29-596 CITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit# BP-2020-0859 Project# JS-2020-001469 Est.Cost: $1600.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: BAYSTATE ENERGY REDUCTION LLC 102811 Lot Size(sq.ft.): Owner: DERRICO THOMAS zoning: Applicant. BAYSTATE ENERGY REDUCTION LLC AT: 56 MATTHEW DR Applicant Address: Phone: Insurance: 83 MORSE ST UNIT 4E (401) 523-6805 WC NORWOODMA02062 ISSUED ON.1/28/2020 0:00.00 TO PERFORM THE FOLLOWING WORK:ATTIC & INSULATION 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: FeeTvpe: Date Paid: Amount: Building 1/28/2020 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans_ ' phone 413-587-1240 Fax 413-587-127 it °' " APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVA E O DEMOLIS ONE ORT+O F MILY DWELLING SECTION 1 -SITE INFORMATION JAIN 1.1 Property Address: DFPT OtfsI9l9 r OHTHArar O .A } t ple ed by office Map vMY- Lot �& Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT yi3 - 2.1 Owner of Record: C� D � ✓� Name(Printj Current Mailing Add r-7 �( �/ r�• 0� fir/ Telephone b Signature 2.2 Authorized A ent: Name(Print) Current Mailin�g Addre ss : 5Q 1 - 349- Q U3O¢`7 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars)to be Official Use Only completed by permit applicant _ 1. Building b (a)Building Permit Fee. DO 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee r 4. Mechanical (HVAC) 5. Fire Protection 6. Total = 0 + 2+ 3 +4 + 5) Q Q Check Number Q This Section For Official Use Only Building Permit Number: 61n/' O(y (J�� Date Issued: Signature: Lao Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) F. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors ID Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks Siding [0] Other[aj Brief Description of opo ed C Work: 9i&l Y-��.[,GCX�C f/-I Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Its. If New house and or addition to existing housing,complete the following: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. A ature of Owner Date I, U as Owner/Authorized Agent hereby declare th the statements and information on the regoing application are true and accurate,to the best of my knowledge and belief. Signedugder the pains and penalties of perjury. G Gn Print Na Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ / Name of License Holder: D O—S-5 /J License Numb r D✓ S o,2u � l3 �� Address Expiration 6ate Signature Telephone 9 Realstered Home Improvement Contractor: °` Not Applicable ❑ / J Company ame I Registra ion u ber S�3 in a Address I Expiration at Telepho03 CL�iD ne SECTION 10-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....... No...... 11 City of Northampton Massachusetts w' x s4 `} DEPARTMENT OF BUILDING INSPECTIONS # V 212 Main Street •Municipal Building Northampton, MA 01060 S91 � Debris Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from construction work being performed at: J% m"LAJ-UD J�i ✓C (Please print house number and street name) Is to be disposed of at: �r 0A-S(/e-- In Y9 (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) L /X�Ijkv Sig ature o pplicant or Owner ate If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. Insulation/Air Sealing Permit Authorization Specialist: Benjamin Anton Company: HvmeVVor��EnmrOy Email: beniamin.anton@homeworksenergy.omm Address: 1D1Station Landin8 Cell: 802-236-5104 Medford,yWaO2155 Phone: 781-305-3319 Customer: Thomas Derrico Address: 56 Matthew Dr. Email: 0 Northamptpn,MAU1O63 Site ID: 493769 Phone: SO8- 48-0826 1,the owner of the property identified above hereby authorize HomeWorks Energy Inc.,or their Partner tuact onmybehalf|nobtaining any building permit that maybe required tn perform insulation and/or Weatherization work on my property and all matters related to the work authorized bysaid permit ifone iaobtained. Any related permit application cost will come at no additional charge provided that the agreed VVeathehxationwork iscompleted. Customer Date: 11/18/2019 Signature: � ' � 1 ' � / � i / | ! � ' ' , ` ' � HomeWorks Energy 101 Station Landing,Medford,MA 02165 CONTRACT - AUDIT 781-M-3319 FAX 0 HorneWok Page I PROGRAM CMA-HPC CURTOME11 POW DATE CUENTO MAKORDER Krishnan Denico (413)896-0722 11/18/2019 492769 00001 SrAvicr ATART MUM STREET KOPOMO Wf. 56 Matthew Drive 56 Matthew Drive HomeWorks Energy P 1AWNG CMY,STATE,ZW Florence, MA 01062 Florence,MA 01062 DESCRIPTION QTY COST INCENTIVE TOTAL ATTIC DAMMING-R-38 FIBERGLASS 20 $41.00 $30.75 $10.25 Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass batts for damming purposes. ATTIC FLAT-7"OPEN R-26 CELLULOSE 608 $839.04 $629.28 $209.76 Provide labor and materials to install a 7"layer of R-26 Class I Cellulose to open attic space. ATTIC HATCH INSULATE ONLY 1 $35,00 $26.25 $8.75 Provide labor and materials to insulate the back of an attic hatch with 2"rigid insulation board at R-10. VENTILATION CHUTES 29 $72.50 $54,38 $18,12 Provide labor and materials to install ventilation chutes in the rafter bays to maintain air flow. HOME AIR SEALING 6 $510,00 $510.00 Provide labor and materials to seal areas of your home against wasteful,excess 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.) A reduction in cubic feet per minute(cfm)of air infiltration will occur,but the actual number of cfm is not guaranteed. At the completion of the weatherization work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the sub-contractor, WEATHERSTRIP AND ADD DOOR SWEEP 1 $80.00 $80.00 Provide labor and materials to install Q-ton weatherstripping and a doorsweep to door(s)to restrict air leakage. HorneWorks Energy o troDn 101 Station Landing,Medford,MA 02165 CONTRACT - AUDIT [ioMewok 781-306-3319 FAX 0 Page 2 PROGRAM CMA-HPC RE DATF CUFNT 4 WORK ORDER Krishnan Derrico, (413)896-0722 11/18/2019 492769 00001 �'ERVTF STREY BILL146 PAM PROMMI1 By: 56 Matthew Drive 56 Matthew Drive HorneWoft Energy SERIACE CITY,RTVE,ZIP INLLM MY,STATE,ZIP Florence, MA 01062 Florence,MA 01062 DESCRIPTION QTY COST INCENTIVE TOTAL WALLS WOOD SIDED 20 $39-00 $29.25 $9.75 Furnish and install blown in Class I Cellulose to shingle and/or clapboard exterior walls.The butt of the upper course of your wood siding is cut to drill holes into the wall sheathing behind.The holes are then plugged and the wood siding is reinstalled using stainless steel finish nails.Touch-up painting,if needed,will be the customer's responsibility. Invoicing will occur upon completion of installation. Homeowner has received a copy of the EPA's Renovate Right Lead- Safe information guide explaining the potential risk of the lead hazard exposure from the weatherization work to be performed.Your signature is your acknowledgement of receipt and agreement to proceed. Total: $1,6116.64 Program Incentive: $1,369.91 Customer Total: $256.63 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Two Hundred Fifty-Six&63/100 Dollars $256.63 LD _TM NOTE!THIS CONTRACT KAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE DAYS. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name (Business/Organization/Individual): Baystate Energy Reduction Address: 83 Morse St City/State/Zip: Norwood, MA 02062 Phone #: 401-523-6805 Are you an employer?Check the appropriate box: Type of project(required): LE I am a employer with 8 4. ❑ I am a general contractor and 1 employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition workingfor me in an capacity. employees and have workers' Y P h'• 9. E] Building addition [No workers' comp. insurance comp. insurance.$ 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 MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.EOther Attic Insulation 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 contractors 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: Berkshire Hathaway Guard Policy#or Self-ins. Lic.#: BAW`C054403 Expiration Date: 3/2020 Job Site Address:_� �Q, h.aw �l.Y,�� City/State/Zip:� �� ,U► 1 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that 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 ofperjury that the information provided above is true and correct. Signature: Date: 10/28/19 Phone#: 401-523-6805 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#: Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: Supplement Gard 84541 BAYSTATE ENERGY REDUCTION LLC Re) tion: W01/ 83 MORSE STREET UNIT 4E ExOrapiration: 0 O210112020 NORWOOD,MA 02062 Update Address and Return Card, SCA t +CFN-O!&1? t/^f ��// - r *t.'Nt7DtQlbC[!FY��IP 0/-irR a.'4 t j Offla!at Consumer Affairs 8 Business Regulation HOME IMPROVEMENT CONTPACTOR Registration valid for individual use only TYPE:Suool~Card before the expiration data. If found return to: Office of Consumer Affairs and Business Regulation 181541 02101;2020 id Pant"Plaza-Suite S170 BAYSSTATE ENERGY REDUCTION LLC Boston,MA 02148 3 ROGER OUELLETTr Cc. 83 MCIASE STREET UNIT 4E v} NORWOOD,MA 02082 Undersecretary Not valid without signature Commonwealth of Massachusetts Division of Professional Licensure Board of Butlldirlg Regulations and Standards ConAructio*S*i4fV vqr Specialty C BSL 102811 :, E_xpires:D911312020 ' I ROGER AOYELLETTE=' 83 MORSE STrel1T ANORWOOD MA*082 Commissioner "" AC40 CERTIFICATE OF LIABILITY INSURANCE D.TE(MM/DDIYYYY) #61i 01/06/2020 THIS CERTIFICATE IS ISSUED ASA 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 Keiko Gianfriddo NA Southeast Agency,LLC PHONE (860)376-2535 (860)376-8505 A/C No Extl: AIC,No 108 Main Street t:-MAIL keikog@seagencies.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC N Jewett City CT 06351 INSURER A: Arch Specialty Insurance Company 21199 INSURED INSURER B: Utica National Ins.Company Of Texas 43478 Baystate Energy Reduction LLC INSURER C: Nautilus Ins Co 17370 83 Morse Street,Unit 4E INSURER D: Berkshire Hathaway Homestate 20044 INSURER E: Norwood MA 02062 INSURERF: COVERAGES CERTIFICATE NUMBER: CL196708023 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 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDIYYYY) (MMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE ORIENTED '. CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 10,000 A AGLOO52287-01 03/01/2019 03/01/2020 -PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 X POLICY F PRO JECT ❑LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANYAUTO BODILY INJURY(Per person) $ B OWNEDX SCHEDULED 4941834 03/14/2019 03/14/2020 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY X AUTOS ONLY Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 C EXCESS LIAB CLAIMS-MADE AN063957 03/01/2019 03/01/2020 AGGREGATE $ 2,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATIONX STER ATUTE EORH AND EMPLOYERS'LIABILITY Y/N 500,000 D ANYPROPRIR/PARTNER/EXECUTIVE ❑ NIA BAWC054403 03/01/2019 03/01/2020 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (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 $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Homeworks Energy is named as Additional Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Homeworks Energy ACCORDANCE WITH THE POLICY PROVISIONS. 101 Station Landing AUTHORIZED REPRESENTATIVE Medford MA 02155 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD