35-134 (12) 14 WESTWOOD TER BP-2022-0121
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:35- 134 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-2022-0121
Project# JS-2022-000210
Est.Cost: $5000.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: ENERGY PROTECTORS - JOSHUA DADA 101143
Lot Size(sq.ft.): 9670.32 Owner: WILD KATHLEEN
Zoning: Applicant: ENERGY PROTECTORS - JOSHUA DADA
AT: 14 WESTWOOD TER
Applicant Address: Phone: Insurance:
64 PAXTON RD (774) 253-0277 WC
SpencerMA01562 ISSUED ON:8/2/2021 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 NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
I • To
Certificate of Occupancy Signature:I I
FeeType: Date Paid: Amount:
Building 8/2/2021 0:00:00 $65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
The Commonwealth of Manatchaaetts
'960 'vs'
. ) Board of Building Regulations and Standards
Massachusetts State Building Code,780 CMR
USEALITY
%Ming Permit Application To Construct,Repair,Renovate Or Demolish a RevetedAger 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building ,..Number: 6 0-„Al),/ Date Applied:
KEMP (Zy5 I/Z 6-2-zoz
Building Official(Print Name) Signaturepet
SECTION 1:SITE INFORMATION
1.1 Property Addretie 1.2 tarn Map&Pavel Numbers
1.1a Is this an accepted Mere yes no Map Number Pareel Number
1.3 Zemin lhafonnatime IA Property Dimendome
Zoning Distric' t Proposed Use Lot Area(sq ft) Frontage(It)
13 Rulklimg Setbacks(11)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(MG.L c_40,§S4) 1.7 Flood Zone Information: 1.8 Sevrage Disposal System:
Zoom Outside Flood Zone?
Public 0 Private CI — Municipd 0 Oa rite disposal systau 0
Cheek if pun
SECTION 2: PROPERTY OWNEILSHIP1
2.1 Omni'sf Record:
le c.c-k-h 1-e evx '1/4k) . Lk Ky..r.401c,1,106,4 t iv\ A- 01 06 4
Name(Thie) Gty,State,ZS' ..--
Rk r.-LeS-4^ L..,L. ct_ ---t er
No.and Street Telephone En Address
SECTION 3:DESCRDITON OF PROPOSED WORK1(cheek all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessary Bldg.0 _Number of Unils I Other ktl-Sperify: tr—, 0...
Brief Description of Proposed Work2: t---
4_%.,‘, i---i % c—, •1 ,--)
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Offichd Use Only
(Labor and MateriaAs)
1.Building $ S- 000 1. Building Permit Fee:$ Indicate how fee is determined:
_Electrical $ 1 0 Standard City/Town Application Fee
2
0 Total Project Cost (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4_Medsmical (HVAC) $ List
5.Mechnoicd (Fin Suppression) $ Total All Fees:S #($Check No301/5 Check Amount: Cash Amount
6.Tistri Project Coot S I i c,0 0 0 Paid in Full 0 Outstanding Balance Due:
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The Commonwealth of Massachusetts
t `h!l. Department of Industrial Accidents
• _ �J= 1 Congress Street,Suite 100
_ Boston,MA 02114-2017
,41r www mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant information Please Print Legibly
Name (Business/Organization/individual):Energy Protectors Inc.
Address:64 Paxton Rd
City/State/Zip:Spencer, MA 01562 Phone#:774-253-0277
Are you an employer?(leek the appropriate boa:
Type of project(required):
11
1.Q l am a employer with employees(full and/or part-time).* 7_ ❑New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in $. ❑Remodeling
any capacity.[No workers'comp.insurance required.]
30 I am a homeowner doing all work myself.[No workers'comp.insurance require] 9. ❑Demolition
t0❑Building addition
4.0 lain a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees. 12.Q Plumbing repairs or additions
5.0 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance. Insulation
14.2 Other
60 We are a corporation and its officers have exercised their right of exemption per MGL c.
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy mformaton.
t Homeowners who submit this affidavit indicating they arc 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:ACE AMERICAN INSURANCE CO
Policy#or Self-ins.Lic.#:6S62UB0G29826020 Expiration Date:09/01/2021
Job Site Address: I e S Ci.c, City/State/Zip: k Lf A.31 ct"A()rZ✓1 t-1 1 A" c' 106
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 certify under the pains and penalties of perjury that the information provided above is true and correct
Signature: CZ)c// � Date: ( Z 7 f 2.
Phone#:774-253-0277
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#:
City of Northampton
?^ 1,
�M s`5 c
t, Massachusetts 4�?
c.
►ax rr OF WI DING rIMPNcrICZ s; M
ar ' _ ^. ` 212 Main Street • Municipal Building
Northampton, Mir 01060 spn `^�O
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: y Qct K.-'a S p e nc cc o lc.,
The debris will be transported by:
Name of Hauler: F Y` 'r 9 \i Pit) c- CS
Signature of Applicant: () ""1 Date: ) I Z 7f 2_- 1
Permit Authorization
mass save Form
Site ID:4273710 Customer: KATHLEEN WILD
Kathleen M. Quinn-Wild ,owner of the property located at:
(Owner's Name.printed)
14 Westwood Terrace Northampton, MA 01062
(Property Street Address) (City)
hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed
below to act on my behalf and obtain a building permit to perform insulation and/or weatherization
work on my property.
Owner's signature: Kai, leea� Jul. 4uikk-Wild
Date: 07/ 19/2021
FOR OFFICE USE ONLY
We have assigned the following Mass Save Home Energy Services Participating Contractor to the
above referenced project:
Pokt4
Partii t Contractor / Date
Name: CLEAResult
Phone: 800-480-7472
Email:
Page 1 of 1 For Office Use Only
ACRof CERTIFICATE OF LIABILITY INSURANCE [ DATE( NDOIYYYY)
08/31/20
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 COMM.(
NAME: Cindy Davis
Coonan Insurance Agency,Inc. P�uC'o.ExD. 508--987 7122 FAX No); 508-987-1090
267 Main Street 1,IL
Oxford,MA 01540 ADDRESS: Cir>dy@Coonaninsurance-Corn
MISURERIS)AFFORDING COVERAGE NAIL M
INSURER A: Capital Specialty
INSURED INSURER B: Safety
Energy Protector,inc. usuMER C: Starstone
64 Paxton Road INSURER D
Spencer,MA 01562
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 ADOCBUBR —POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE gNSD WVD POLICY NUMBER fMMIDDIYYYY),(MMIDOIYYYY) UNITS
X CONWERCuu.GENERAL LIAB1UTY EACH OCCURRENCE $ 1,000,000
RENTED
CLAIMS-MADE I- 'I OCCUR PREMISEESO(Ea occurrence) $ 100,000
_ MED EXP(Any one person) $ 5,000
A y CS16001320-05 08/31120 08/31/21 PERSONAL S ADV NJURY $ 1,000,000
GENT AGGREGATE LIMIT APPLES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY! JECT I LOC PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER $
AUTOMOBILE LIABILITY ( SINGLE LIMIT Ea accident) $ 1,000,000
ANY AUTO BODILY INJURY(Per person) $
B owNEn Y X SC0HERULED y 6236519 12/23/19 12/23/20 BODILY INJURY(Per accident) $
X HIRED x NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY _ AUTOS ONLY (Per accident)
S
X UMBRELLA LIAR X OCCUR EACH OCCURRENCE S 3,000,000
C EXCESSu*B CLAMS-MADE y 89362T193ALI 08/31/20 08/31/21 AGGREGATE $ 3,000,000
DED I I RETENTION$ $
WORMERS COMPENSATION
EMPLOYERS'
AND LIABIIrY YIN I STATUTE I I ER
ANY PROPRIETOR/PARTNER/EXECUTIVE N/A EL EACH ACCIDENT S
OFFICERIMEMBER EXCLUDED?
(Mandalory In N H) EL fiLSFARF-EA EMPLOYEE $
If yes,desarbe under
DESCRIPTION OF OPERATIONS below EL fftSFARF-POLICY LMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(ACORD 1e1,Additional Remarks Schedule,stay be aledad Imore some Is regmked)
Workers Compensation insurance certificate to follow under seperate cover.
emailed josh
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
Evidence of Coverage ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Liapcit �.
1E)UM-WI An:nRrl(ARPrTRATKIM AH rinhls ratarvad
•
ACQ III CERTIFICATE OF LIABILITY INSURANCE DATE Y)
�..- 08/31/2020
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 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 corder rights to the
certificate holder in lieu of such endorsement(s)_
PRODUCER corium. Nid a DeCastro
COONAN INSURANCE AGENCY t;_Ekt, (508)987a122 1(Nc.Not:
EaALL Nidia m
ADortEss: ( �rance.co
267 MAIN ST NIII AFFCIm NSCOIERIIBE macs
OXFORD MA 01540 INSURER A: ACE AMERICAN INSURANCE CO 22667
INSURED INSURER B:
ENERGY PROTECTOR INC INSURER C
INSURE D:
64 PAXTON RD INSURER E:
SPENCER MA 01562 INSURER F:
COVERAGES CERTIFICATE NUMBER: 569858 REVISION NUMBER:
THIS IS TO COMFY THAT THE POLICES 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.
eSUBFT POLICY EFF POLICY DIP
LTRR TYPE OF INSURANCE .wvo POLICY NUMBER ( OIYYYTY) Billoornin Ewa
COOMEREMIL GENERAL LIMILITY EACH OCCURRENCE S
AI,{S.MADE n OCCUR TO ENTED
O. occurrence) $
WED EXP(Any one person) $
N/A PERSONAL&AwINJURY S
GENL AGGREGATE LpBT APPLIES PER GENERAL AGGREGATE S
1 POLICY l PI& n LOC PRODUCTS-COUP/OP AGG S
on+E
COWSHED SesGLE LOST
AuloOoetEldaeltm (Ea accident)
ANY AUTO BODILY INJURY(Per Person) $
ALL OWNED SCHEDULEDAUTOS N/A BODILY INJURY(Per acaddhra) S
MIRAGE
HIRED ,ms (Pa aocie PROPERTY s _
S
UCLA UPS OCCUR EACH OCCUR S
MESS UMI CLANS-MADE N/A AGGREGATE $
OW I I RETENTION$
nrommesCOlMPEreATION X STATUTEOTH-
ANDEIMOVE S'UABIJT( Y/_N ANYPROPRIETORAPARTNEWIDIECURNEt
ER
A TWA6s62uBoG29826020 09/01Q020 09/01/2021 EL EACH ACCIDENT $ SOQ000
AI.+.r.f►auR EL.DISEASE-EAEirLVYus S S00,000
Ifyes�aaaote radar
DESCIvT,ON OF OPERATIONS Belau EL DISEASE-POLICY LMIT i 500,000
N/A
DESCaPDI U OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule.may be attached r more span Is required)
Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B.no authorization is given to pay claims for benefits to
employees iv sides other than Massachuseds if the insured tares,or has Ned those ernplayees outside of Massachusetts_
This certificate of insurance shows the poficy in force on the date that this certificate was issued(unless the expi,utiur i date on the above policy precedes the issue date of this
certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at
www.mass.govitediworkers-compensationfinvestigations/.
Sole proprietor has not elected coverage-
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CNICBIID BEFORE
THE EXPIRATION DATE THEREOF, NOTICE BILL BE DELIVERED IN
Enerty Protector Inc ACCORDANCE WITH THE POLICY PROVISIONS.
64 Paxton Rd
AUTHORIZED REPRESENTATIVE
Spencer MA 01562
Daniel M.Crowley,CPCU,Vice President—Residual Market—WCRIBMA
Cry 19RA-2014 ACORO CORPORATION. AU riaMR reserved_
it
•
Commonwealth of Massachusetts
Division of Professional Licensuro
it/
Board of Building Regulations and Standards
Conatructlbilli ipprvlsor
CS 101143 Expires;00/1. 2022
JOAHUA S DADA
114 PAXTON aP
SPINCLA MA;016I2,
Commissioner da
I
•
t` •
1
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home improvement Contractor Registration
Type: Corporation
172960
•
ENERGY PROTECTORS INC. Registration:Expiration: 08/19/2022
84 PAXTON RD,
SPENCER, MA 01 582
{
Update Address and Return Card.
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR . Registration valid for Individual use only
TYPE:Corporation before the expiration data. If found return to:
Registration gairitiaa Office of Consumer Affairs and Business Regulation
172980 08/19/2022 1000 Washington Street •Suite 710
ENERGY PROTECTORS INC. Boston,MA 02118
JO8HUA DADA iPlk `,�. .66<
34 PAXTON RD. ge*.met a. "C `•
SPENCER,MA 01562 Undersecretary t7t valid without signature