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29-427 BP-2023-1069 79 GOLDEN DR COMMONWEALTH OF ASSACHUSETTS Map:Block:Lot: 29-427-001 CITY OF NORTH MPTON Permit: Solar Build PERSONS CONTRACTING WITH UNRE ISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-1069 PERMISSIO IS HEREBY GRANTED TO: Project# 2023 SOLAR Contractor: License: Est. Cost: 31985 EMPOWER ENER Y SOLUTIONS 019944 Const.Class: Exp.Date: 12/01/2 23 Use Group: Owner: C M GINNIS WILLIAM T JR&TERESA Lot Size (sq.ft.) Zoning: WSP Applicant: EMP WER ENERGY SOLUTIONS Applicant Address Phone: Insurance: 30 OLD KINGS HWY S#1001 (475)221-2356 WC533SB2191Q011 DARIEN, CT 06820 ISSUED ON: 08/10/2023 TO PERFORM THE FOLLOWING WORK: INSTALL 15 PANEL 5.925 KW ROOF MOUNT SOLAR SYSTEM (NO STRUCTURAL NO BATTERY) 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 NOITHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: • >2 . '1 • I , Fees Paid: $75.00 212 Main Street,Phone(413)587-1240,Fax (413)587-1272 Office of the Building Commissisner Jk0 F The Commonwealth of Massac . ettsFA / Gc I Board of BuildingRegulations and Sta •.• ••• 9 �•rt, E 1 •• �O ICIP ITY Massachusetts State Building Code, 780 C Building Permit Application To Construct,Repair,Renovate • t : a evise' Mar 2011 One-or Two-Family Dwelling �>4sc, �99 This Section For Official Use Only Building Permit Number: cry}-3'' /00 Date Applied: /1C-oiki l 3 8. 10-2023 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 79 Golden Drive Northampton Massachusetts 01062 1.1a Is this an accepted street?yes ./ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: .70oiolt.17.gtriot Proponent tine ,.Lot..A non 4aw::Ad: F.rr orngf.(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.$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: William Maginnis Northampton MA 010I62 Name(Print) City,State,ZIP 79 Golden Drive (413)320-7519 tmags17@comcast.net No.and Street Telephone — Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ 1 Existing Building 0 • Owner-Occupied 0 I Repairs(s) ❑ I Alteration(s) 0 ! Addition El Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Bi ivf Description-of Proposed Worl& Installation of a safe and code compliant,grid-tied PV solar system on an existing residential roof.15 Panels/5.925 kw(dc) SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: OffiIcial Use Only (Labor and Materials) 1.Building $ 19,191.00 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ 12,794.00 0 Standard City/Town Application Fee 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) Total All Check N I - ' Check Ainoun : Cash Amount: V. 1 VLall 1 1 VJV%.L I.VAL. .;•:2 I 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CSL-109944 12/1/207n Lando Bates License Number Expiration Date Name of CSL Holder List CSL Type(see below) 51 Assabet Dr No.and.Street Type Description Northborough MA 01532-2600 U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 203-493-2977 permits@empowerenergy.co L I I Insulation Telephone Email address D Demolition 5.2 Registered Home improvement Contractor(MC) 4/5/2024 Empower Energy Solution Inc HIC-198351 Registration Number Expiration Date HIC Company Name or HIC Registrant Name 30 OLD KINGS HWY S#1001 permits@empowerenergy.co No.and Street Email address DARIEN CT 06820-4551 (203)-493-2977 -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 ..�L.:...-.nf7(-.-t...-:w-...-:.M..........M.:....J.... 74.....:.h t.aC.J..... ...............-.+C-+1........ttui..i uuo aiuuavu Wau awulI ua W w uaw vi W%.•aouaui�n w u►l..uutiutua jit.►uuI.. Signed Affidavit Attached? Yes 0 No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT •w�c.Clcvw«r.r.f w--al..-jezt-- y-T erty;.1►wwL.sc-na»s'ss,wn:vs� rwwew et-Srww.wr.G14.4 F..,.v y.«, v....v. v. . »Jvv.t..vr.v..�,..v.v'J »»r. .... �...�.-..�. �..�.YJ . .. .....� to act on my behalf,in all matters relative to work authorized by this building permit application. _ William Maginnis (/Jj//i4„1iM , _08/03/2023 Print Owner's Name(Electronic Signature) Date SECTION 71):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. Asim Hafeez 08/03/2023 Print-Owner's,or.Authorized Awent'.s.Name.(Electronic.Sienature) 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 nt 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 r 'Mien 4 4 'i '• i 4 '4 a4 '• 4- 4 L. WllGll�uUJl----al Wl- 1J jJ1a1111W, .—•-G'Chu -- - --- l-_ UC1UW. Total floor area(sq.ft.) (including garage,finishod 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 I. 3. "Total Project Square Footage"may be substituted for"Total Project Cost" CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK I � FRONTAGE City of Northampton ?•' Massachusetts { DEPARTMENT OF BUILDING INSPECTIONS �` a. 1 212 Main Street • Municipal Building Northampton, MA 01060 Ps' t,Y -)N�� 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 detined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: 720 S Washington street North Attleboro,MA 02760 The debris will be transported by: Name of Hauler: Empower Energy Solution Inc :e► .r,.r. � y4FesE�.Safi ,ra m 08-03-2023 .)i5IIULui vi r�NNII�.aIIL. I/ d va«: The Common wewin of etrassucnpsei[. Department of Industrial Accidents zit„»fi. 1 Congress Street,Suite 100 . a'ti Boston, MA 02114-2017 <: www.ntass.gov/dia aa.•..:.a-.rz'l:,,,,._. - -'..........,... ...«»>....«tria..:... _:a..aa t.. ilet.-Z...�.. ...........:aa..... '"a.,...".?+t.....�....., ♦I V.a t.a 4Vmr{.Y.auu...MS......n�c.....a..l.uYUY..a`Vu..•L,V.rasa►u NMMa...Y.uu..a. TO BE FiLED WITH THE PERMI rrl1\C;AUTHORITY. Annlicant Information Please Print .Leeiblv Name(Business Orgaiuzat ion l nil lv:dual): Empower Energy Solutions Inc. Address 30 OLD KINGS HWY S#1001 City/State/Zip: DARIEN CT 06820-4551 Phone#: 203-493-2977 Are yN AD employee Cheek the appropriate box: Type of project(required): I",lama employer south_."10 employers(full and±or past-lime)' 7. Q New construction 2n 1 am a stale proprietor or partnership and have no employers working for rile in 8. f Remodeling any capacity"(No workers'comp.uaunmix requrred.l 30 i am a homeowner doing all work myself.[No workers'comp_insurance requvaad_)' 9. Demolition wn 4.0 I am a homeowner and will be luring contractors to conduct all work on ray property_ i will iB 0 Building additive ensure that all contractors either have workers'ctxtapensatmon Mummer or ate sole 11.0 Electrical repairs or additions proprietors with no employers. 12.0 Plumbing repairs or additions Sr,lam a general contractor and I have hired the sub-contractors fisted on the steadied sheet. ;e r ,wa_.c . r�i 1 J rwW 1 14 r.111 J These sub contractors have employees and have workers'comp.1120S anie.• 14.inOther PV Solar Installation 6.0 We are a corporation and its officers have exercited their right of exemption per brae c. 152.*1(4).and we has.:no employees.[No workers"comp.insurance requital *Any applicant that cheeks has u 1 mutt atsn fill out the section below showing then workers'compensation policy information, Homeowners who submit this atltdasit indicating they an:doing all work and then hire uut..uk colitractors must submit.1 new affidavit indix-atar:s such. untuactors that cheek this bop must atts;hed an additional sheet showing the name of the sub-:s.mtra:0.x,and state whether ur not those ent°atl,I131: L1111,1u)es If the sub-contractors lime emtploycc..lhe'} must pry.idetheir workers"comp.NI, number. I ant an employer that is providing workers'compensation insurance for my employees. Below is the puller and job site infornuitiutt. Insurance Company Name: LM Insurance Corporation Policy#or Self-ins.Lic.#: WC533S82191Q012 Expiration Date: 11/03/2023 Job Site Address: 79 Golden Drive city/State:Lip: Northampton MA 01062 Attach a copy of the workers'compensation policy declaration page(showing the policy number and elpiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to 51.500.00 and/or one-year imprisonment,., as well as civil penalties in the form of a STOP ORK ORDER and a fine of up to$250.00 a etas:"g424.rsct el.M.xriw,a tr,tww_. o...- .F rda+c It.ttnttr•..n...sa 1,1`ftr.gae*1.00t d,e°n'Ott.f]#nr .w a" ' '„a;..,ar:ss.+r.wf*i n PIA f inf**►+wee coverage veritic:it ion. I saes hereby certify ander the trains and penalties ajperjury that the iaforutatlaaa pru►riur-e1 above is true and correct. Signature: 54Vsiow7(449.. Rite: 08-03-2023 Phone N: 203-493-2977 Official use only. Do nut write in thick area.to be completed by city or town a//icial ) City or Town: Permit/License# Issuing Authority (circle one): 1.Board of Health 2.Building Department 3.CityiTown Clerk 4.Electrical Inspector 5.Plumbing Inspector . 6.Other El ( (intact Person: Phone#: I� ..______. h Commonwealth of' Massachusetts 6, Division o OccupationalLicensure Board of Building Fie uIations and Standards r1 -71 i si_., Co ns :6 i E Vi sor CS - 109944 , ,:,., ,, - ''v, , pires : .„....., . t , L Are ao BAT s ` 51 ASSAI3ET: RIV tVille NOI TH;B4DRc GH M a x01532 '- ..."‘„, .. , , ,...,... I �, ‘,„ ) , , - - j„y3'�� ���f i 1. Commissioner i ■ smiiimiiiii / ® I_ DATE(MM/DD/YYYY) I ��'� VCR VM 1 Iri 1 c yr LII111ZOIL1 I 1 11`11,0VRN111%.rG I 11/07I2022 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. .tf 91LSr.0Cu..4113 lItl:,1.R.:1A44l)f:-C1,-...:410n4:y,.4..6.0-t.am'. +,oersl.n.>rrafifrnna.:-f 90.0.•:0Iia,r.-oar area.pnliain.......nny:vary-Are m+,-0ne1h+r.anaanl. _4 atathala.a++h_..ar+_. this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Brandy Jenkins WORLD INSURANCE ASSOCIATES LLC A/C"o.Ext); (508)699-7511 FAX INC.No); E-MAIL brand enkins ADDRESS: y) (gInrorldinsurance.com 656 Shrewsbury Ave suite 200 *WRENS) NAM# Tu tw Falls NA .0.7.7111, .mouliora:n<• .LM.IAL$.,C.d1RP 33Fi a INSURED INSURER B: EMPOWER ENERGY SOLUTIONS INC INSURERC: INSURER D: 30 OLD KINGS HWY S 1001 INSURER E: DARIEN CT 06820 INSURER F: COVERAGE, .C.EPTIFIICAXF.NU:IMRFR' :832RA7 ,PFMISlfN 1 1,4F3PR: 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 ADDL SUER POLICY EFF POLICY EXP LIMITSLTR INSD WVD POLICY NUMBER (MMIDD(YYYY) (MM/DD/YYYY) I COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ DAMAGE TO RENTED:n.:61MNP.lMAIPF L J rak irz :-:o•'f41 � ' f' Ill- MED EXP(My one person) $ N/A .PERSONAL.&.ADV INJURY .$. GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ECOT- LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMORILFLIABILIZ t COMBINED SINGLE LIMIT I. • LiANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS N/A BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ DED RETENTION$ X $ WORKERS COMPENSATION STATUTE �RH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N EL.EACH ACCIDENT $ 500,000 A OFFICER/MEMBEREXCLUDED? N/A N/A N/A WC533SB2191Q012 11/03/2022 11/03/2023 (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 N/A DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space 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 in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. T,...i,.c-a. aer.f..iintr-w v-• •�., sa-.K.*r .:r,..Fsw.. ,ae,rH., .Mtw,thrdsHsirt-w.av ik.wdw.•.,.erar+.,7vo...ml sl.r.....N....::-"1rv't-;rlM•--"•.2 111.m.;":,..liz".,....a...d.,o:N.',- 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.gov/Iwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION I. SHO.UID..ANYJOF THE.AB(l.1LEJ FSCRIRED:POI ll`IFS BECA(df_FI I FfBEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Empower Energy Solutions Inc 10 Ramblewood Drive AUTHORIZED REPRESENTATIVE Rocky Hill NJ 06067 Daniel neM.Crosyjey,CPCU,Vice President-Residual Market-WCRIBMA 4.s 1. -21111.^.::::v AC..r+"Ilf"V"-TICtl A rrg w rc�cr icw ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD I_, DATE(01311/DD/YYYY) ►1--LJ/C ILA lCER'1'1N'ICA'1'1: Ur LIABILITY IN S U KAN CE err...''" 05/08/2023 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:I the certificate holder Is an ADDITIONAL INSURED,the polcy(les)must have ADDITIONAL INSURED provisions or be endorsed.IfSUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does on confer rights to the certificate holder in lieu of such endorsement(s). . PRODUCER .I,,CQBiTALC T.NAME:. Millennial Specialty Insurance LLC dba Founder Shield PHONE(A/C No.Eat):646-854-1058 I FAX(A/C No): 114 E 25th St,Floor 4 -E-MAIL ADDRESS:coi(a?fonndershield.rom New York,New-York,10010 - INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Wilshire Insurance Company INSURED INSURER B:Hartford Underwriters Ins Co(Hartford) 30104 INSURER C:HYcoz Instance Company Inc. 10200 : Smarm,.Lmrc.s., 146014 nt. 30 OLD KINGS HWY S INSURER D: Darien,Connecticut,06820 INSURER E: -INSURER-P: I I 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 ORI 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 *CA MEW qPi/VIF,AINOrarwFPMF.NA9Nr.PT9/air/,WFa9RerrrAn49r./7.7E.C..r.MHP'Fca{rilA,IICAM AxIMI.r1RIi'++tnr➢nlle3RgaR^,41,ARR:YarG, 11„ INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EVE POLICY EXP LIMITS LTR INSD WVD (1►BIl/OD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000.00 CLAIMS MADE 1IOCCUR DAMAGE TO RENTED $100,000.00 PREMISES(Ea occurrence) •MED EXP(Any one penes) $5,000.00 - _— ,osws,e•ucscrfarma,,nrommty.unnre.ra„irrnn.. mntsmerseennewne_ :.e.oaf etes*O- .te.apartn0aa_ - A.r:.44-.A,101,,TIkuame A1,401.11MAa.. vIPOLICY PROJECT LOC GENERAL AGGREGATE $2 OW.01111.00 PRODUCTS-COMP/OP AGG S2,000,001i.00 �,.:OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT . ANY AUTO (Ea accident) . BODILY INJURY(Per person) OWNED AUTOS SCHEDULED ONLY BODILY INJURY(Per accident) HIRED AUTOS ONLY : NON-OWNED AUTOS PROPERTY DAMAGE(Per ONLY accident) UMBRELLA LIAB EXCESS IJAB Each occurence ill.4iix iLnurio-riiiAua • Aggregate WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ' --ER STATUTE ANYP ROPRIETOR/PARTNER/EXECUTIV UN OTHER OFFICER/MEMBER EXCLUDED? N (M.ndstnry to NH) E.L.EACH ACCIDEN $1,000,000.00 B If yes,describe under DESCRIPTION OF OPERATIONS below N/A 6S611I11-6R 19294-9-2� 12/116/2022 12/06/2023 V r.DISEASE-EA 51,000,000.00 EMPLOYEE LIMIT I .. C . Errors&Omissions P100.259.633.2 05/10/2022 05/10/2023 S 1,000,000 per ore $1,000,000 in egg r.,.. .,.s s,.... ,....t .rn x r. l DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If enure space is required) Evidence only CERTIFICATE HOLDER CANCELLATION •lanoAun, :44,p4 Anfa wrmennamitommagme.TANroarmumiRRwurmunr. a.n...a•:rnN.ra:rrs I. Es Weil.:only THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. .: iieevA)(.,/...Pr CIO AUTHORIZED REPRESENTATIVE �,��G/' �� ©1911F2A16 ACOIWt OEPOStA'1'lON.All rights reserved. Arson'CC cyst‘/1120 Tl..Arnnn e.ama,...,I l,.n,.ara raertatarad marl.:of Arf1QI1 THE COM MONWEALI H OF MASS,ACHUSETTS Office of Consumer Affairs & Businoss Regulatiim Registration valid for individual use only before the HOKE IMPROVEMENT CONTRACTOR expiration date. If found return 0: TYPE: Out of State''Corporation Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Sheet - Suite 710 198351 04/05/2(124 Boston, MA 02118 EMPOWER ENERGY SOLUTIONS INC :.' ) ' ASIN HAFEEZ 30O-_D KINGS HWYS 4* ,,.,,,„ `/ram SUIT 1001 '` I• VirrAfj," UAR EN, CT 06820a Undersecretary Not valid without signature ��� I•� I• . . * CCMMONWEALTH OF MASSAkCHUSE-......r1-S. -1.: DI MEN 0 • OC UP 4, TIO AL EEMMIEil,311111 - .. . . .. . BOARP OF .. .. . . .:. . . . . ELECTRICIANS . . • — • .• , . . • . • •:.:ISSUES THE FOLLOWING --.LICENSE ELECTRI A41-BSIPIES-• S :1•',If f-.-,....N•....:.:.;::...:.:„:•.N:•.: ..-..:...:.-, :......•.:...:....:.-.,-.:....:.::.., RFGIS .EREI) U •:.:..,...::::.::•..•„::-.f:':,..•:.:wiI.t2..-.....,..•..-.: .:: . . . . . -. Z EMPOWER ENERGY SOLUTIONS; INC. 3D OLD KINGS EllNY S ta . . . .,- tu- ...... . . . •.... . . .. . .. ... ... .. • (0 #1 001 .. . . ...... ...... .. . . ... ..... ...•.• ....• .. .... ..... .. .,... ". . . . . . . . . . . . ::-.••••.• .:•:.: .•• •• ..:....... ... : ; z ; ILI -: -:- -:-.- :•:-.. ::::i: ::::::. . .. : 4) DARIEN, CT 0682.0 ::: :: ••• •::::::...:::. •• -•:•- ••• •:.....-::-::: - -.• -• . ... . . ,::::•:::. .. . i :3 • .... .. . .... .. ..-4, - .•-• ...... . . .. .. -. --.:. .-..: -.............. . . -: - ... .. . . . . . .: .:. i . . -:. - • -: . 7 . . . • 6 8209 Al :: - •-:::.::: „... • .. . : .•:.:. '''''.; • 07/31 /2025. . ::-:.::-,--...:- ..-?..-,: :-::-•:•- 306586 : . ••• • . , .. „„,... _- .• . . . . . '',.---6,. 4fi, 0 , 0 !MEM UMBE 31111111 EXPI 'DATION DATE IIIIIE E R I A L rvy...iyiB ‘1„„,„.„,„ ...,•, / ,"Alm tftn"N DIVISION OF OCCUPATIONAL LICENSURE BOARD OF ELECTRICIANS lbbUt:b I HE FOLLOWING Liu- REGISTERED MASTER ELECTRICIAN LANDO BATE '___ '-' �i��BE�� EX�� �� ��FE ������ ��KK������- _ - _ ��- .~.� "��~"°"==�" _-__ , � ~ � �