24C-077 (3) 16 MASSASOIT ST BP-2021-1495
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24C-077 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-2021-1495
Project# JS-2021-002480
Est.Cost: $12000.00
Fee: $78.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: CLEAN TECH CONSTRUCTION LLC 106150
Lot Size(sq. ft.): 15594.48 Owner: NARAM APARJIT
Zoning: URB(100)/ Applicant: CLEAN TECH CONSTRUCTION LLC
AT: 16 MASSASOIT ST
Applicant Address: Phone: Insurance:
190 FEDERAL AVE (617) 271-0768 WC
QUINCYMA02169 ISSUED ON:6/16/2021 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 NORTHAMPTO UP VIOLATION OF
ANY OF ITS RULES AND REGULATIONS. I i I
I' • V • •
l
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 6/16/2021 0:00:00 $78.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
/6?S'
tZ.. The Commonwealth of Massachusetts ,/ /fr
Board of Building Regulations and Standards r!
�� Massachusetts State Building Code, 780 CMR �` UN �TY o
USE s
Building Permit Application To Construct, Repair, Renovate Or Demolish.a.,..., t •s Mar 201 J
One-or Two-Family Dwelling °Rt TygoMn�/��i
br
This ion For Official Use Only ,04!;� x,
CfC
Building Permit Number: 0..di 0/y q 5 Date plied: 67Os7/
o4's
4.110 )5 i /' ' --....„,
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
16 MASSASOIT ST NORTHHAMPTON MA 01060 L/C-- Q 77
1.la Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use I,ot 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 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
APARJIT NARAM NORTHHAMPTON MA 01060
Name(Print) City,State,ZIP
16 MASSASOIT ST 989-714-4993
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 0 Accessory Bldg. 0 Number of Units Other CS Specify: INSULATION
Brief Description of Proposed Work2: INSULATION WEATERIZATION FOR MA SAVE PROGRAM
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 12000 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Costa (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:_
5.Mechanical (Fire $
Suppression) Total All Fees: $ Th
Check No.3(3 Check Amount: r g Cash Amount:
6.Total Project Cost: $ 12000 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
106150 5/24/2022
PATRICK MCDONOUGH License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) 1
105 MARSHHAWK WAY
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
MARSHFIELD MA 02050 R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
Pat 7e�� RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
617-271-0768 CLEANTECHCONSTRUCTIONO3@GMAIL_.COM I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
196071 6/23/2023
TECH CONSTRUCTION
HIC Registration Number Expiration
on Date
HIC Company Name or HIC Registrant Name
40 MESSINA DRIVE CLEANTECHCONSTRUCTIONO3@GMAIL.COM
No.and Street Email address
BRAINTREE MA 02184 617-271-0768
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 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
to act on my behalf,in all matters relative to work authorized by this building permit application.
SIGNED AUTORIZATION FORM ATTACHED
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
contained in this application is true and accurate to the best of my knowledge and understanding.
PGZu 7rIcz7.10.tezvA 6/11/2021
Print Owner's or Authorized Agent' ame(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"
DocuSign Envelope ID:ECF74D85-850E-48B5-9A6D-9188618998A0
Federal ID#05-0405629
RISE Engineering RI Contractor Registration No 8186
MA Contractor Registration No 120979
CT Contractor Registration No
RISE60 Shawmut Road.Canton,MA 02021
[�.':INEERII,G CONTRACT - WZ
339-502-6335 FAX 339-502-6345
Page 1
PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE
C MA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS
DESCRIBED BELOW
CUSTOMER PHONE DATE CLIENT N WORK ORDER
Aparajit Naram (989)714-4993 09/08/2020 507332 57302
SERVICE STREET BILLING STREET PROPOSED BY:
16 Massasoit Street 16 Massasoit Street Devon Arnold
SERVICE CITY.STATE.ZIP BILLING CITY.STATE ZIP
Northampton, MA 01060 Northampton, MA 01060
DESCRIPTION QTY COST INCENTIVE TOTAL
INCENTIVE 100%2020
For a limited time, Columbia Gas is offering an incentive of 100%on
qualifying weatherization measures. This contract must be signed
and returned within 20 days and the weatherization must be installed
by November 30, 2020. Eligible LED lightbulbs, programable
thermostats,and hot water saving items are also incentivized at
100%.WiFi-enabled thermostat incentives vary by type of thermostat.
ASBESTOS HAZARD
A blower door diagnostic test will not be conducted at your home.due
to the possible presense of asbestos.
•
KNOB&TUBE WIRING US
We have identified the potential existence of Knob&Tube wiring in
your home. The following contract is not valid unless accompanied by
the Pre-Weatherization Barrier Incentive form, signed by your licensed
electrician. Work will not proceed with this work until we receive a copy
of the form.
COMBUSTION SAFETY TEST "J
Prior to the installation of the recommended weatherization 11N {initials)
measures,we will need to conduct a Combustion Safety Test of all
the combustion appliances present in your home. Upon receipt of this
signed proposal, RISE Engineering will reach out to schedule this
test, at no cost to you.
ATTIC DAMMING- R-38 FIBERGLASS 150 $307.50 $307.50
Provide labor and materials to install a 12"layer of R-38 unlaced
fiberglass batts for damming purposes.
ATTIC FLAT- 13"OPEN R-45 CELLULOSE 512 $890.88 $890.88
Provide labor and materials to install a 13"layer of R-45 Class I
Cellulose to open attic space.
KNEEWALL-3"FG +RIGID BOARD 512 $2,744.32 $2,744.32
Provide labor and materials to install R-13 faced fiberglass to the
kneewalls,covered with 2" rigid board insulation. All seams will be
sealed with FSK taping.
KNEEWALL FLOOR-13" DENSE R-42 CELLULOSE 320 $915.20 $915.20
Provide labor and materials to install a 13"layer of dense packed R-
42 Class I Cellulose to a kneewall floor.
DocuSign Envelope ID:ECF74D85-850E-4885-9A6D-91BB618998A0
Federal ID#05-0405629
RISE Engineering RI Contractor Registration No 8186
RISE60 Shawmut Road,Canton,MA 02021 MA Contractor Registration No 120979
CT Contractor Registration No
ENGINEERING CONTRACT - WZ
339-502-6335 FAX 339-502-6345
Page 2
PROGRAM THIS CONTRACT IS ENTERED I TO BE TWEEN RISE
CMA-HES ENGINEERI NG G AND THE CUSTOMER FOR WORK AS
CUSTOMER PHONE DATE CLIENT PI WORK ORDER
Aparajit Naram (989)714-4993 09/08/2020 507332 57302
SERVICE STREET BILLING STREET PROPOSED BY:
16 Massasoit Street 16 Massasoit Street Devon Arnold
SERVICE CRY.STATE ZIP BILLING CITY.STATE.ZIP
Northampton, MA 01060 Northampton, MA 01060
DESCRIPTION QTY COST INCENTIVE TOTAL
ATTIC HATCH -SEAL& INSULATE 1 S60.00 S60.00
Provide labor and materials to insulate the back of an attic hatch with
2"rigid insulation board. Weatherstrip the perimeter.
KNEEWALL HATCH-INSULATE &WS 2 $120.00 $120.00
Provide labor and materials to insulate back of the kneewall hatch
with 2"rigid board, and seal the edge of the hatch with
weatherstripping.
VENTILATION CHUTES 96 $240.00 $240.00
Provide labor and materials to install ventilation chutes in the rafter
bays to maintain air flow.
INSULATED BATH EXHAUST HOSE 4 INCH 3 $180.00 $180.00
Provide labor and materials to install an insulated 4"exhaust hose to
existing bathroom fan(s).
HOME AIR SEALING 24 $2,040.00 $2,040.00
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.)
WEATHERSTRIP AND ADD DOOR SWEEP 2 $160.00 $160.00
Provide labor and materials to install Q-lon weatherstripping and a
doorsweep to door(s)to restrict air leakage.
WALLS WOOD SIDED 1,472 $2,958.72 $2,958.72
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.
WALLS 3RD STORY ADDER 320 $32.00 $32.00
A portion of your walls is three stories above ground level. Cost is an
adjustment for work at this height.
DocuSign Envelope ID:ECF74D85.850E-4885-9A6D-91BB618998A0
Federal ID#05-0405629
RISE Engineering RI Contractor Registration No 8186
MA Contractor Registration No 120979
CT Contractor Registration No
RISE60 Shawmut Road.Canton.MA 02021 ENGINEER INC, CONTRACT - WZ
339-502-6335 FAX 339-502-6345
Page 3
PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE
CMA-HES ENGINEERING AND CUSTOMER FOR WORK AS
DESCRIBED CUSTOMER PHONE DATE CLIENT WORK ORDER
Aparajit Naram (989)714-4993 09/08/2020 507332 57302
SERVICE STREET BILLING STREET PROPOSED BY:
16 Massasoit Street 16 Massasoit Street Devon Arnold
SERVICE CITY STATE.ZIP BILLING CITY,STATE.ZIP
Northampton, MA 01060 Northampton, MA 01060
DESCRIPTION QTY COST INCENTIVE TOTAL
BASEMENT SILLS RIGID BOARD INSULATION 130 $514.80 $514.80
Provide labor and materials to install rigid board insulation to the
perimeter of the basement ceiling at the house sill.
Total: $11,163.42
Program Incentive: $11,163.42
Customer Total: $0.00
WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF
***00/ Dollars $0.00
UPON RECEIPT OF YOUR RISE ENGINEERING INVOICE.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY
UNPAID BALANCE AFTER 70 DAYS.SEE REVERSE FOR NPORTANT INFORMATION ON GUARANTEES.RIGHTS Of RECISION.SCHEDULING.AND CONTRACTOR REGISTRATION.
--DocuSigncd by.
—DocuSigned by;
RISE REPRE sat,.
TATNE CUSTOMER SIGNATURE
`—,TI It7F 79SI-C.HAI)I- o 7
NOTE THIS CONTRACT MAY BE WITHDRAWN BY USE NOT EXECUTED WITHIN DATE OF ACCEPTANCE 9/o�2020 1:13 PM CDT
SIGN DATE
30 DAYS. ACCEPTANCE OF CONTRACT-THE ABOVE PRICES SPECIFICATIONS AND CONDITIONS ARE
SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK
AS SPECEED.PAYMENT WILL BE MADE AS OUTLINED ABOVE
DocuSign Envelope ID:ECF74D85-850E-48B5-9A6D-91BB618998A0
RISE
ENGINEERING
OWNER AUTHORIZATION FORM
Aparajit Naram
(Owner's Name)
owner of the property located at:
16 Massasoit Street
(Property Address)
Northampton, MA 01060
(Property Address)
hereby authorize CLEAN TECH CONSTRUCTION
(Subcontractor)
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.
�, --nocuSgned by
'LO42t igrt ture
9/8/2020 11:13 PM CDT
Date
RISE Engineering, a Division of Thielsch Engineering, Inc.
60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335
www.RISEengineering.com
Commonwealth of Massachusetts
IV Division of Professional Licensure
Board of Building Regulations and Standards
Constructiott=tiip6ivisoar Specialty
CSSL-106150 � Expires: 05/24/2022
p
;
PATRIGK E MCDONOUG - 11.
105 MARSHHAWK WAY +
MARSHFIELD MA 02050 at` 54
Commissioner
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: LLC
CLEAN TECH CONSTRUCTION LLC Registration: /2196071
Expiration: 0 06/27/2023
190 FEDERAL AVE
QUINCY, MA 02169
Update Address and Return Card.
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE: LLC before the expiration date. If found return to:
Registration Expiration Office of Consumer Affairs and Business Regulation
196071 06/27/2023 1000 Washington Street -Suite 710
CLEAN TECH CONSTRUCTION LLC Boston,MA 02118
WILLIAM DAVIDSON (at.e m, b4wW av i v
190 FEDERAL AVE 2 i/4//6,04.
QUINCY, MA 02169 Undersecretary Not valid without signature
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: Supplement Card
CLEAN TECH CONSTRUCTION LLC Registration: 6/2 71
190 FEDERAL AVE Expiration: 0 06/27/2023
QUINCY, MA 02169
Update Address and Return Card.
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE: Supplement Card before the expiration date. If found return to:
Registration Expiration Office of Consumer Affairs and Business Regulation
196071 06/27/2023 1000 Washington Street -Suite 710
CLEAN TECH CONSTRUCTION LLC Boston,MA 02118
PATRICK E. MCDONOUGH Gt 4 2 i 7// BAZ.&
190 FEDERAL AVE �L. %Gl (/
QUINCY,MA 02169 Undersecretary Not valid without signature
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.gov/dpl
DEBRIS DISPOSAL AFFIDAVIT
In accordance with the provisions of M.G.L. c. 40, s. 54, Building Permit
was issued with the condition that all debris resulting
from this work shall be disposed of in a properly licensed solid waste
disposal facility as defined by M.G.L c. 111, s. 150A.
The debris will be disposed of in:
TROUPE WASTE DUMPSTER
Name of Waste Facility
40 MESSINA DR BRAINTREE MA 02184
Address of Waste Facility
111.5 Debris: As a condition of issuing a permit for the demolition, renovation,
rehabilitation or other alteration of a building or structure. M.G.L. c.40 s. 54 requires
that the debris resulting therefrom shall be disposed of in a properly licensed solid waste
disposal facility as defined by M.G.L.c. III s. 150 A.Signature of the permit applicant,
date and number of the building permit to be issued shall be indicated on a form provided
by the Building Department and attached to the office copy of the building permit
retained by the Building Department. If the debris will not be disposed of as indicated,
the holder of the permit shall notify the building official, in writing,as to the location
where the debris will be disposed.
780 CMR—6`b Edition
PATRICK MCDONOUGH
I
Signature of Permit Applica
6/11/2021
Date
The Commonwealth of Massachusetts
►` _ Department of Industrial Accidents
1 Congress Street,Suite 100
r 34j_ '1 Boston,MA 02114-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Aenlicant Information Please Print LeelbIv
Name(Business/organ atiotdlndividual): CLEAN TECH CONSTRUCTION
Address: 40 Messina Dr
City/State/Zip: Braintree,Ma 02184 Phone#: 617-271-0768
Are you ao employer?Cheek the appropriate box: Type of project(required):
1.6 I am a employer with 6 employees(full and/or part-time).' 7. ❑New construction
20I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling
any capacity[No workers'comp.insurance required]
3.0I am a homeowner doing all wait myself.[No workers'camp.insurance required.]t 9. ID Demolition
4.0I am a homeowner and will be hiring contractors to conduct all work on my property.I will 10 Q Building addition
etstre that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
pnuprietors with no employees. 12.❑Plumbing repairs or additions
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet
These sub-contractors have employees and have wakens'camp.iruuaance.t 13.0 R7cof repairs INSULATION
6.0 We are a corporation and its officers have exercised their right of exemption per Min a 14.Q other
152,1 It 41,and we have no employees.[No workers'comp.insurance ran ce required.]
'Arty applicant that c}a]a box#1 aunt also fill out the section below showing their workers'compensation policy information.
1 homeowners who submit thins affidavit indicating they are doing all work nod then hire outside contractors must submit a new affidavit indicating such.
tContradors that check this box must attached an additional shed 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 member.
I am an employer that is providing markers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: TRAVELERS
Policy#or Self-ins.Lic.#: 6HUB4N60130820 Expiration Date: 9/1 R/7021
Job Site Address: 16 MASSASOIT ST City.State/Zip:NORTHAMPTON MA 01060
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby dattda�f per. that the information provided above is true and correct.
6/11/2021
Signature: Date:
Phone#: 617=271-0768
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):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5,Plumbing Inspector
6.Other
Contact Person: Phone#:
re
DATE(MM/DOMlYY)
ACIC)REP CERTIFICATE OF LIABILITY INSURANCE 5/13/2021
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:
Tobman,Molignano&Weiner Ins Agency (A/C,No,Eat): 617-471-1123 ONE FAX
Tobman, No): 617-773-2474
21 McGrath Highway,Suite 303 E-MAIL
Quincy,MA 02169 ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A: Norfolk&Dedham Mutual
INSURED INSURER B: Traveler's Indemnity Co of America
Clean Tech Construction LLC INSURER C:
190 Federal Ave
Quincy,MA 02169 INSURER D
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 ADDLSUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) OMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE TO REN rho
CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 100,000
MED EXP(Any one person) $ 500,000
A P012011894 09/18/20 09/18/21 PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000
X POLICY n PRO-
JECT II LOC PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER $
AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT $ 1,000,000
(Ea accident)
ANY AUTO BODILY INJURY(Per person) $
A -- OWNED X SCHEDULED
AUTOS ONLY AUTOS 91972894A 09/16/20 09/16/21 BODILY INJURY(Per accident) $
_
HIRED
NON-OWNED PROPERTY
X AUTOS ONLY X AUTOS ONLY Per accident]DAMAGE $ 1,000,000
$
X UMBRELLA UAB OCCUR EACH OCCURRENCE $ 1,000,000
A -- EXCESS LIAB CLAIMS-MADE U20003464A 09/18/20 09/18/21 AGGREGATE $ 1,000,000
DED RETENTION$ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'UABIUTY y/N STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE 1 A 6HUB4N60130820 E.L EACH ACCIDENT $ 500,000
B
OFFICER/NEWER EXCLUDED 9/18/20 9/18/21
(Ma
ndatory 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/VEHICLES (ACORD 101.Additional Remarks Schedule,may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
NORTHAMPTON BUILDING DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED R ENTATIVE
I
01 -2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
''
. ,
2020 weather1, tZatl0n barrier incentives
Lam¢
;a�ciZslrst's recommendations,your horns can benefit from program-e}i rbls�Itlsuitatiart and/or air seailr=<g
w �.e
'mavin forward,please follow ati the lnstructians below to rerrtediate your v;ettthrnxatlon barriers,
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4
�• sed contraclor to evaluate and/or remedi4t�the wenttteriZatiorr barriar(s).
-� �t'tpleted cat�ees of t�t4S form and a copy a,' the paid contractor invoice(s)within 60 days of your Home EncrgY
�tneerirrc,60 Sh wrnut Rd,Unit 2,Caretc,i,MA 02021 or email to CoColumbieGasMAInfo'0 4 ISEenc irtreering.,:;csre
�,� :•.�„�' incentive lS'tfl be deducted from the custom r co-payment amount Of the weatherization work A rebate chcheckCC
' * amount.nt the amount.exceeds the customer's co-payment arnoumt.
e 3 t corrsrsiended weatherization improvements.
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Client#Or Site ID: 5073
, /ddr - Massasoit Street Cc?S.. Northampton Stater ZIP0 68
PiNcyrs.um r -714-4993 Eas t, � r ti t, ram@c Tiai .cow
Number
r„ ::..._. - at ail. _ ,, Date: 1 L , :.i')-13,
' n.g i'y"3 ,,i F theiV is any active knob end tube wiring.the contrw,tor wilt evaluate the roUowirc areas where elegebte Matz Sava"
e,n r r,rt orronandations have been made_
'' ev Attic Wail :Attic Slope (om')Exter or V,flt tom,Basement °Other, (Other
- �:my Inspection and determined there es no ace_ve knob and tube wiring en the areas selected below
:-*Attic Wall i)Attic Slope t Exterior At 4, Basement 0 Other ri Other
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; S �. 5 A r r-, } e.. /''2. ity Cf'�..rii'f e,.. states iP; CY ' ''^-ice"
F
' Ai— ( ,-._, t�.j+/‹."-- „,--- 1 .. , License Number. _.. trs 'C3
" ""that I have performed my Irv:p ton at the otectrical systems tilted above ane have corrected any barrier:e
, also c reflrms that i have read and agree t the Terms and Coscdrtions outisned en the back of that form
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4" <. STEM r. ' ;t .•. :. ;.. -.. . ,,
fit- ,. ` idi:Contractor is to senesce and re-evav to tree selected mechanacar s tem(s)and reduce thy careen monoxide levy:,
t tg the undiluted flue r s,to below 10 pens per r.^, on(Ppm)
- 'COn` etor is to correct the draft in the selected flu, s} Refer to table on reverse for aeetab d fl Far,cie:
CO p
1 Roitser5 prn. ,,.I
existing porn: Exes"tt Draft Caa.e oed Oran."o:,
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iS ttl G4rr'>@Ct T.#+P...s "+; X ��" `^ � spin_ tit'rt:,re Cta"�++e`%to the+^ tted rreCtutirrtCal',rytt'rrr!x3 M'-.st n4i st1ti7 sere'fit?"recoad of t5Pf+raMrs.
v'.r'1.; ,,,V`. s,Ystim Sat Water Neater
Other
_ Ctt : (State. ZIP
N - .. Ucenae Number: _ . —
�- that t have perrorrnad rr y rr� ,,cite,of t`,
�� _ rrtttr'sSctdt w3t¢;"k^sY tr3tOd aabCztrar arm two txarcectad wri tukrtion as
,:z11104turee also Cr7 nfIrr'raa,that t Mho*read Deed Wet. es,.,the Terms sir#Cemittlara outened rat the basis,of rhos form