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32A-205 (11) BP-2023-1038 36 BUTLER PL COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 32A-205-001 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-2023-1038 PERMISSIO IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 16061 5C ENERGY INC 106162 Const.Class: Exp.Date: 04/26/202 GRE RY, PATRICK BOLTON &JUSTINA W Use Group: Owner: GREGO Y Lot Size (sq.ft.) Zoning: URC Applicant: 5C ENE GY INC Applicant Address Phone: Insurance: 3820 DIAMOND HILL RD 774-203-3704 WC928038765994 CUMBERLAND, RI 02864 ISSUED ON: 08/03/2023 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATH ERI 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 NO THAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: (0 �I. )1 • '• I Fees Paid: $110.50 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner iLr /1r`c.e- `iI tat _ 8-3 The Commonwealth of Massachu•- s Board of Building Regulations and :tan.• s it. FOR CIPALITY Massachusetts State Building Code, ' :0' ,.` . b E °°� '•,'sed •r2011 Building Permit Application To Construct,Repair,Ren. ::-.� s- One-or Two-Family Dwelling .e)%� This Section For Official Use Only Building Permit Number:t `. 3 " /0 3 4 Date Applied: ' '�°6oT'Q(s. Wk.--kno 72" f‘2 -3-Z0Z3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 36 Butler Place 32A 205-001 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 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 CI Private 0 —Zone: Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Ann Talarico Northampton,MA.p 1060 Name(Print) City,State,ZIP 36 Butler Place 413-374-1785 ATALARICO 12@GMAIL.COM 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) ❑ Addition ❑ Demolition ❑ Accessory Bldg. 0 Number of Units Other 0 Specify: INSULATION Brief Description of Proposed Work': PLEASE SEE ENCLOSED CONTRACT SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 16,060.0 I 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑ Standard City/Town A lication Fee 0 ❑Total Project Cost'(Ite 6)x multiplier x 3.Plumbing $ 0 2. Other Fees: $ 4.Mechanical (HVAC) $ 0 List: 5.Mechanical (Fire $ 0 Suppression) Total All Fee o 60 Check No. k k) Check Amount: << Cash Amount: 6.Total Project Cost: $ 16,060.01 0 Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVIC S 5.1 Construction Supervisor License(CSL) Matthew Russell 106162 04/26/2025 License Number Expiration Date Name of CSL Holder List CSL Type(see below) R 3820 Diamond Hill Road No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) RI.02864 Cumberland, R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 774-203-3704 Maryann@SCEnergyinc.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 04/18/2025 Matthew Russell 195:09 HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 3820 Diamond Hill Road ;Maryann(C75CEnergyinc.com No.and Street Email address Cumberland.RI.02864 774-203-3704 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 wi#h this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .......... 0 No ❑ 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 Matthew Russell to act on my behalf,in all matters relative to work authorized by this building permit application. Please see enclosed owner authorization form 7/27/23 Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION By ent- • my name below,I hereby attest under the pains and penalties of perjury that all of the information co• - this application is true and accurate to the best of my knowledge and understanding. ItI Matthew Russell 7/27/23 •4+ er—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(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" mass save Savings through energy efficiency PERMIT AUTHORIZATION FORM I, Ann Talarico owner of the property located at: (Owner's Name) 36 Butler Place 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. >L}aa TalariCX1 Owner's Signature 07-10-2023 Date FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: 5C ENERGY INC. 7/27/23 Participating Contractor Date mass save 2022-23 Weatherization Barrier Incentives kriti ,f. F. • 0 1 , :�,an°& '" 1 sr 4 a w • " W.IN 0 wareA „ • £. ^ iC �-� s M — ., � "a @ t a t a� ��� � e" "'s,A•..�r�..a"«,.�t auu%,',ms`[,w..a,w..r...au .,...�..w. .. a.,... ... .. <. @x�. ..«-.�.£ "S r > WEATHERIZATION CONTRACT EVERS=URCE CUSTOMER PHONE DATE CUENT• WORK ORDER Ann Talarico ; (413)374-1785E:. 07/10/2023` 540544 61602. SERVICE STREET BALING STREET PROPOSED BYE 36 Butler Place 36 Butler Place %; Jeff Ledoux_ SERVICE CITY,STATE.MP SLUNG CITY,STATE.MP Program 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._ We have identified the potential existence of knob&tube wiring in your 4.c (Initials) home.The following contract is not valid unless accompanied by the Weatherization Barrier Incentive form,signed by your licensed electrician.Work will not proceed until we receive a copy of this form. HOME AIR SEALING 8 $754.64. $754.64 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.) TRANSITION AIR SEALING. 30_ $194.70 $194.70. Provide labor and materials to air seal the open kneewall transitions of your home against wasteful, excess air leakage._ WEATHERSTRIP DOOR._ 2.. $63.62 $63.62 Provide labor and materials to install Q-lon weatherstripping to door(s)to restrict air leakage. DOOR SWEEP 2 $52.22_ $52.22_ Provide labor and materials to install a doorsweep to restrict air leakage. ATTIC DAMMING 100 $245.00 $183.75 $61.25 Provide labor and materials to install an approved damming material in the attic ATTIC FLAT- 15"OPEN R-49 CELLULOSE 554 $1,401.62 $1,051.22 $350.40 Provide labor and materials to install a 15"layer of R-49 Class I Cellulose to open attic space. ATTIC FLAT- 13"OPEN R-45 CELLULOSE. 286 $672.10 $504.08 $168.02. Provide labor and materials to install a 13"layer of R-45 Class I Cellulose to open attic space. SLOPE-7"DENSE R-22 CELLULOSE. 375 $1,072.50 $804.38 $268.12 Provide labor and materials to install a 7"layer of R-22 Class I Cellulose to sloped ceiling area. WEATHERIZATION CONTRACT EVERSURCE CUSTOMER PHONE DATE CLIENTS WORK ORDER Ann Talarico (413)374-1785 07/10/2023 540544 61602 SERVICE STREET BILLING STREET PROPOSED BY: 36 Butler Place 36 Butler Place Jeff Ledoux SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Program Northampton, MA 01060 Northampton, MA 01060 EGMA-HES Page 2 DESCRIPTION QTY COST INCENTIVE TOTAL KNEEWALL-2" RIGID BOARD 120 $577.20 $432.90 $144.30 Provide labor and materials to install rigid board at R-10 or greater with the required fire rating to a kneewall area. KNEEWALL-3"FIBERGLASS R13 120 $235.20 $176.40 $58.80 Provide labor and materials to install 3.5" R-13 faced fiberglass Batt insulation to the kneewalls. KNEEWALL SLOPE-2"RIGID BOARD 185 $897.25 $672.94 $224.31 Provide labor and materials to install rigid board at R-10 or greater with the required fire rating to the sloped rafter area behind a kneewall. BALLOON FRAMING BLOCKING 60 $85.80 $64.35 $21.45 Install blocking in the open balloon framing for the proper installation of insulation. RECESSED LIGHT COVERS 14 $700.00 $700.00 Install recessed light covers over existing recessed light fixtures. Up to 6 at no cost. HATCH- INSULATE RIGID BOARD 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. TEMPORARY ACCESS 1 $96.36 $72.27 $24.09 Provide labor and materials to make a temporary access through roof or interior sheathing to an attic area. The opening will be closed with materials similar to those existing. Finish sanding and painting is not included. WALLS-WOOD SIDED 4" 3,223 $8,154.19 $6,115.64 $2,038.55 Furnish and install blown in Class I Cellulose to Wood shingle 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 exterior grade nails. Touch-up painting, if needed,will be the customer's responsibility. 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. BASEMENT SILLS-6"FIBERGLASS 102 $274.38 $205.79 $68.59 Provide labor and materials to install R-19 unfaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. WEATHERIZATION CONTRACT EVERSURCE CUSTOMER PHONE DATE CLIENT N WORK ORDER Ann Talarico (413)374-1785 07/10/2023 540544 61602 SERVICE STREET BILLING STREET PROPOSED BY: 36 Butler Place 36 Butler Place Jeff Ledoux SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Program Northampton, MA 01060 Northampton, MA 01060 EGMA-HES Page 3 DESCRIPTION QTY COST INCENTIVE TOTAL BASEMENT SILLS- RIGID BOARD INSULATION 60 $292.20 $219.15 $73.05 Provide labor and materials to install rigid board insulation to the perimeter of the basement ceiling at the house sill. GABLE VENT 2 $243.66 $182.75 $60.91 Provide labor and materials to install an aluminum attic vent in the gable. ASBESTOS PRECAUTION A blower door diagnostic test will not be conducted at your home, as a precaution for the presense of steam heating (past or present)that was most likely insulated with asbestos. INACCESSIBLE ATTIC AREA We have identified an opportunity to insulate an attic area in your 4,/. (initials) home that is not presently accessible. We are making our recommendations based upon an educated understanding of your home's construction, but upon gaining access to this space,your home's work-scope might need to be modified. The insulation contractor will guide these changes and discuss them with you prior to proceeding. PREPARE YOUR HOME Homeowner is responsible for the removal of any items stored in the 4 1. (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. WEATHERIZATION CONTRACT EVERSURCE CUSTOMER PHONE DATE CLIENTS WORK ORDER Ann Talarico (413)374-1785 07/10/2023 540544 61602 SERVICE STREET BILLING STREET PROPOSED BY: 36 Butler Place 36 Butler Place Jeff Ledoux SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Program Northampton, MA 01060 Northampton, MA 01060 EGMA-HES Page 4 DESCRIPTION QTY COST INCENTIVE TOTAL Total: $16,060.01 Program Incentive: $12,486.33 Client Total: $3,573.68 I.DESCRIPTION OF WORK TO BE PERFORMED Contractor will 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(IIC)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. Jeffytedocfi RISE Representative Client Signature 07-10-2023 Printed Name Date of Acceptance r The Commonwealth of Massac , setts _'`= 1, Department of Industrial Acci' 'nts _ 1 Congress Street, Suite 10 7.2I!=_ w Boston,MA 02114-2017 ' ,� ww mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Cont actors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING A II ORITY. A 1 1 licant Information Please Print Le.'b1 Name(Business/Organization/Individual):5C Energy, Inc Address:330 Victor Rd. Bldg A City/State/Zip:Attleboro, MA 02703 Phone #: 774-203-3704 Are you an employer?Check the appropriate box: Type of project(required): 1.112 I am a employer with 25 employees(full and/or part-time).* 7. 0 New construction 2.01 am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] ;.OI am a homeowner doing all work myself.[No workers'comp.insurance required.]I 9. ❑Demolition 10❑Building addition 4❑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 11.Q Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions s.❑I 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.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. in Other Insulation 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *My 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 co tractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contactors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy tuber. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ARGONAUT INSURANCE COMPANY Policy#or Self-ins.Lic.#: WC928038765994 Expiration Date:12/27/2023 X Job Site Address: 36 BUTLER PLACE City/State/Zip: NORTHAMPTON,MA.0I060 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 certi 'u ler the p ins and penalties of perjury that the information provided above is true and correct. Signature: Date: 7/27/23 Phone: 774-203-3704 i 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#: A`D® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YWY) 12/28/2022 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 Rosalynn Davila NAME: Loiselle Insurance Agency PHONE Eat): (401)723-8510 FAX No): (401)728-1820 279 Dexter Street E-MAIL rosalynn@loiselleinsurance.com ADDRESS: P.O.Box 1148 INSURER(S)AFFORDING COVERAGE NAIC• Pawtucket RI 02862-1148 INSURER A: Employers Mutual Casualty Co 21415 INSURED INSURER B: EMC Prop&Cas Ins Co 25186 5C ENERGY,INC. INSURER C: Argonaut Insurance Co ARGO 330 VICTOR RD-BUILDING A INSURER D: RISCO RISCO INSURER E: ATTLEBORO MA 02703-6294 INSURER F: COVERAGES CERTIFICATE NUMBER: Master:2022 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 ADDLSUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 500,000 - MED EXP(Any one person) $ 10,000 A 5D98024 12/27/2022 12/27/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY jEa n LOC PRODUCTS-COMP/OPAGG $ 2'00B'000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ 20,000 B OWNED X/ SCHEDULED 5Z98024 12/27/2022 12/27/2023 BODILY INJURY(Per accident) $ 40,000 AUTOS ONLY /� AUTOS XHIRED ts/ NON-OWNED PROPERTY DAMAGE $ 5,000 AUTOS ONLY AUTOS ONLY (Per accident) Uninsured motorist BI $ 1,000,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LIAB ^ CLAIMS MADE 5J98024 12/27/2022 12/27/2023 AGGREGATE $ 3,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N 1 O ANY PROPRIETOR/PARTNER/EXECUTIVE Y N/A WC928938765994 12/27/2022 12/27/2023 E.L.EACH ACCIDENT $ , , OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Contractors Pollution LiabilityD CPLMOL107038 06/16/2021 06/16/2023 Aggregate $250,000 Eeach Occurrence $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Addttlonal 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. AUTHORIZED REPRESENTATIVE 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD City of Northampton o0.tr6��P>p\. ? ti SAS... SAC i �'' \ Massachusetts Q4 .1A. ._ de ,� r DEPARTMENT OF BUILDING INSPECTIONS 4w t �'"' 212 Main Street • Municipal Building yeti CDC ..e� .l Northampton, MA 01060 `rS ��`� 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: 330 VICTOR ROAD,ATTLEBORO,MA.02703 The debris will be transported by: 5C ENERGY,INC. Name of Hauler: Signature of Applicant: Sad) Date: 7/27/23 MATTHEW RUSSELL Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Regulations and Standards Construct ) p+ r ' or Specialty a CSSL-106162 riyires: 04/26/2025 MATTHEW JitUSSELL 3820 DIAMOND D HILL RD lie la CUMBERLAND RI 02864 .00 ski, Commissioner dal 411# Constructi0n Supervisor Specialty Restricted to: CSSL4C • 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 0$17) 72 -3200 or visit virva iramass.govfdpl THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Individual Registration: 195309 MATTHEW RUSSELL Expiration: 04118I2025 3820 DIAMOND HILL RD CUMBERLAND,RI 02884 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:Individual Office of Consumer Affairs and Business Regulation 1000 Washington Street -Suite 710 19 041 Boston,MA 02118 MATTHEW RUSSELL FAATTH3820D M DIAMOND 3820 DIAAAOND HILL RD ��,,,,,,,�� 2/Grlc" CUMI3ERLAND,RI 02864 Undersecretary Not valid without signature THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Impro'ement Contractor Registration z - Type: Corporation y Registration: 194390 5C ENERGY, INC. _- a Expiration: 01/30/2025 0,0 330 VICTOR ROAD ATTLEBORO, MA 02703 * S. 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 194390 01/30/2025 Boston,MA 02118 5C ENERGY,INC. WALTER R.COLWELL - 18GREYSTONE ROAD ��,,,.,r�. ,c�,lw�c MARBLEHEAD,MA 01945 Undersecretary Not valid without signature