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18-002-005 BP-2023-0334 20 PINES EDGE DR COMMONWEALTH .OF MASSACHUSETTS Map:Block:Lot: 18-002-005 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-2023-0334 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 1600 ENERGY PROTECTORS INC 101143 Const.Class: Exp.Date:06/16/2024 Use Group: Owner: BAKER, ROBERTA J.&GERALD N. Lot Size (sq.ft.) Zoning: RI/RR Applicant: ENERGY PROTECTORS INC Applicant Address Phone: Insurance: 64 PAXTON RD (774)253-0277 6S6211B0G29826021 Spencer,MA 01562 ISSUED ON: 03/22/2023 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHERI ZATI 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 NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: f ' 1 Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner MAR 1 5 2023 e slc r 1(ill Z The Commonwealth of Massachusetts t Board of Building Regulations and Standards _ FOR Massachusetts State Building Code,780 CMR MUNTCTPALTTY USE Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: ✓i" dZ 3-33 C/ Date Applied: g 3 ZZ ZOZ3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 1.1a Is this an accepted street'?yes 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❑ Private❑ Zone: _ Outside Flood fyesO.une? Municipal 0 On site disposal system 0 Check if yes SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Ki c1 t c l%C. '43 a Ae r hoe i-hrctAA(p l , id iht O c 0 6 0 Name(Print) City, State,ZIP Do ,\e ecl%e 'R� - ‘1- Eck -.3 b No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other LhrSpecity: XhSu(y-k.Of\ Brief Description of Proposed Work2: Air S e c., ci..A.ck 1 kiN, So \ 41(., \—Ke.._ CO-1-.` 'FO '2"t-e,y SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only I (Labor and Materials) 1. Building $ i Y 0 d 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ < 0 Standard City/Town Application Fee 0 Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: — 5. Mechanical (Fire — Suppression) $ Total All Fee • ,` Check No./w i Check Amoutt 0 Cash Amount: 6.Total Project Cost: $ 1 47 D D ❑Paid in Full 0 Outstanding Balance Due: 1 — • SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS•101143 6116/24 Joshua Dada License Number Expiration Date Name of CSL Holder 64 Paxton Rd List CSL Type(see below)u No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.II.) Spencer,MA 01562 R Restricted 1&2 Family Dwelling City/Town,State.ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 774-253-0277 jdada79@hotmall.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 172960 8/19/24 Energy Protectors Inc HIC Registration Number Expiration Date HIC Company Name or H1C Registrant Name 64 Paxton Rd idada79ahotmail.com No.and Street Email address Spencer.MA 01562 774-253-0277 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 D 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. 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. SOSVN 4. 3! to( a-3 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(H IC)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 wvvw.mass.govidps 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 halfbaths 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" The Commonwealth of Massachusetts E-. 1, Department of Industrial Accidents :el_ 1 1 Congress Street,Suite 100 �?Isi_ Boston, MA 02114-2017 :M. wwx.ntass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH TILE PERMITTING AUTHORITY. Applicant Information Please Print Legible 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?Check the appropriate box: Type of project(require;): 1.0 I am a employer with 1 employees(full and/or part-time).* 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.Insurance required.] 9. ❑Demolition 3.0 I am a homeowner doing all work myself.[No workers'comp.Insurance require] 10 l Building addition 4.0 I am 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 MO Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance. insulation 1-1.❑✓ Other 6.0 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 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;National Liability& Fire Insurance Company Policy#or Self-ins.Lic.#:V9WC383933 Expiration Date:9/1/23 Job Site Address: -d P s n( . DISC_ in-ck City/State/Zip: k)of k.-11\c.ov1/4404-4el "A Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration da4). U l0(r,0 Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to S 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 corre•t. Signature: '% cda-41 5&‘)•-sk._ Date: 3 I (d( ..3 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 oac N 1Mr`: "�4 -. �` Massachusetts ��`, �c> + { ` DEPARTMVT OF BUILDING INSPECTIONS 7 as * Jy 4 212 Main Street • Municipal Building yeti ct. . .4.r.. Northampton, MA 01060 ssiW ar��,��� 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 1S0A. The debris will be disposed of in: GM p .tx+oh 24 Location of Facility: Spe.ncer4 vv\+4- o (q-Ga' The debris will be transported by: ehtr<3y 0(4.)A C.0 ca $ ,�A)c_ Name of Hauler: Signature of Applicant: � Date: 3� t.°I' 1-3 DocuSign Envelope ID:C3415C77-E2FA-4E6B-A161-A05355E2C87E • • WEATHERIZATION CONTRACT EVERS °URCE CUSTOMER PHONE DATE CLIENT II WORK ORDER Natalie Baker (317)698-2326 01/10/2023 5278690 104020 SERVICE STREET BILLING STREET PROPOSED BY. 20 Pines Edge Drive 20 Pines Edge Drive Seth Main SERVICE CITY.STATE.ZIP BILLING CITY.STATE,ZIP Program Northampton. MA 01060 Northampton, MA 01060 EGMA-HES age[] 1] DESCRIPTION QTY COST INCENTIV '" TOTAL] INCENTIVE 75% For eligible weatherization measures, Eversource is offering an incentive of 75°40 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 weathenzation work begins. PERFORM AIR SEALING AT ESTIMATED 62.5 CFM50 PER HO 4 $377.32 $377.32 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.)D EXTERIOR DOOR WEATHER STRIPPING 1 $31.81 $31.81 i Provide labor and materials to install Q-Ion weatherstripping to door(s)to restrict air leakage. DOORSWEEP 1 $26.11 $26.11: Provide labor and materials to install a doorsweep to restrict air leakage. DAMMING 58 $142.10 $106.58! $35.52 Provide labor and materials to install an approved damming material in the attic ATTIC FLOOR OPEN BLOW CELLULOSE 9" 320 $636.800 $477.60f $159.20 Provide labor and materials to install a 9"layer of R-33 Class Cellulose added to open attic space. HATCH:THERMAL BARRIER POLYISO 2 INCH (ATTIC) 1 $47.37. $35.53 $11.84 Provide labor and materials to insulate the back of an attic hatch with 2"rigid insulation board at R-10.1: VENTILATION CHUTES':_ 30 $123.90 $92.93i $30.97,.� Provide labor and materials to install ventilation chutes in the ratter bays to maintain air flow from the soffit ventilation. DocuSign Envelope ID:C3415C77-E2FA-4E6B-A161-A05355E2C87E • WEATHERIZATION CONTRACT EVERSSU CE CUSTOMER PHONE DATE CUENT WORK ORDER Natalie Baker (317)698-2326 01/10/2023 527869 10402 SERVICE STREET BILLING STREET PROPOSED BY: 20 Pines Edge Drive 20 Pines Edge Drive Seth Main SERVICE CITY,STATE.ZIP BILLING CITY.STATE,ZIP Program Northampton, MA 01060 Northampton, MA 01060 EGMA-HES !age 2 DESCRIPTION QTY COST INCENTIVE TOTAL VENT BATH FAN TO ROOF OR OTHER 1 $146.78 $110.09 $36.69 Install an insulated exhaust hose to a flapper vent to exhaust existing bathroom fan(s). Fan will be vented through the roof or an acceptable alternative if contractor cannot vent through the roof. Total: $1,532.19 Program Incentive: $1,257.97 Client Total: $274.22 I.DESCRIPTION OF WORK TO RE PERFORMED Contractor wit perform or cause to be performed the above work at the Client's Address in a professional manner and in accordance with the terms 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(ItC)upon satisfactory completion of the Work.Client understands that they will not be required to pay the Program Incentive Share of the Contract cost.Changes to the individual line items and/or previous incentives may increase or decrease the size of the Program Incentive Share. Lit& DccuSlg/n�B,d by: ,--DocuSigned by: Q foptsgAstAbmo2. lien §0414 /P0o84A9 Seth Main 2/9/2023 1 4:34 PM EST Printed Name Date of Acceptance DocuSign Envelope ID:C3415C77-E2FA-4E6B-A161-A05355E2C87E • it mass save Savings through energy efficiem.; PERMIT AUTHORIZATION FORM 1, Natalie Baker owner of the property located at: (Owner's Name) 20 Pines Edge Drive 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. DocuSigned by: OO1151A770004A0 Owner's Signature 2/9/2023 4:34 PM EST Date FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Particip i g Contractor Date A��® DATE(MMIDD/YYYYI CERTIFICATE OF LIABILITY INSURANCE 8/31/2022 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 Coonan Insurance Agency, Inc. PHONE NAME: Nlna Arroyo FAX 267 Main Street (Arc.NQ Exu:508-987-7122 FAX Not 508-987-7152 Oxford MA 01540 ADDRIESS: nina@coonaninsurance.com INSURERS)AFFORDING COVERAGE NAIL/ License#:1782985 INSURER A:AIX Specialty Insurance Co INSURED ENERPRO-01 INSURER a:Safety Insurance Company Energy Protectors, Inc. 64 Paxton Road INSURER C:Capitol Specialty Insurance Corporation ------ ------- --- Spencer MA 01562 INSURER D:National Liability&Fire Insurance Company _ — INSURERE: Philadelphia Ins Companies - INSURER F: COVERAGES CERTIFICATE NUMBER:2132532233 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 DL TYPE OF INSURANCE ADIlanSUER------------- "------`POLICY EFF POLICY EXP LIMIT LTRID WWI POLICY NUMBER (MMDD/YYYY)�(MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y LIN-H714840-01 8/31/2022 8/31/2023 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED j CLAIMS•MADE X OCCUR PREMISM gctlgransag50,000__-__.___________ MED EXP(Any one parson) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLES PER' GENERAL AGGREGATE S 2,000,000 X POLICY PR COT LOC PRODUCTS-COMP/OP AGG $1,000,000 OTHER- f B AUTOMOBILE LIABILITY N 6236519 , 12/23/2021 12/23/2022 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) ANY ALTO BODILY INJURY(Per person) -$ OWNED x SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS x HIRED Xy NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _AUTOS ONLY (Per accident) S C X ;UMBRELLALIAB X OCCUR Y CCP1070516 8/31/2022 8/31/2023 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED X I RETENTIONS tnpnrl $ D WORKERS COMPENSATION V9WC383933 9/1/2022 9/1/2023 X AND EMPLOYERS'LIABILITY ""N� ---"— ER ANYPROPRIETOR/PARTNER EXECUTIVE Y/N N/A E.L.EACH ACCIDENT $500,000 OFFICER/MEMBEREXCLUDED7 - (Mandatory In NH) E.L.DISEASE•EA EMPLOYEE $500,000 If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $500,000 E Pollution Liability PPK2366760 1/6/2022 1/6/2023 Each Occurence 1,000,000 General Aggregate 2,000,000 Products-Completed 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Eversource 247 Station Drive Westwood MA 02090 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Requlattons and Standards '�7�[t Cons` Svlsor CS-101143 153plres:06/16/2024 JOSHUA S DODA a •f 64 PAXTON RD SPENCER MA' 01662 k •tir�l.lt'rl:l Commissioner ° THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration 110 10 Type. Corporation ENERGY PROTECTORS INC. Registration: 172960 64 PAXTON RD. ^ Expiration: 08/19/2024 SPENCER, MA 01562 41/4 t f - 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:Corporation - Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 172960 08/19/2024 Boston,MA 02118 ENERGY PROTECTORS INC. "-DieziL DADA 64 PAXTON 64 PAXTON RD. � ; . • SPENCER,MA 01562 Undersecretary of valid without signature