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29-549 (5) BP-2024-0876 13 INDIAN HILL COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 29-549-001 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-2024-0876 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2024 Contractor: License: Est.Cost: 3000 ENERGIA LLC 108421 Const.Class: Exp.Date: 02/19/2025 Use Group: Owner: INC STIEBEL PROPERTIES Lot Size (sq.ft.) Zoning: WSP Applicant: ENERGIA LLC Applicant Address Phone: Insurance: 242 SUFFOLK ST (413)322-31 1 1 A0255555005 HOLYOKE, MA 01040 ISSUED ON: 07/11/2024 TO PERFORM THE FOLLOWING WORK: I NSULATI ON.WEATH ERIZATI 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: 7Z__ Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner V G ty ofAoqpmpton De pF0 `` uildin(g Drtnlerrjt L , 21i Stre et'eet �024 Room 100 INS ULA TION Northampton, MA 01060, • phone 413-587-1240 Fax 413- gA)172 ONLY APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INSULATION PERMIT 1.1 Property Address This section to be completed by office 15-17 INDIAN HILL Map Lot Unit NORTHAMPTON, MA 01062 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: STIEBEL PROPERTIES 15-17 INDIAN HILL NORTHAMPTON, MA 01062 Name(Print) Current Mailing Address41 3-222-7776 SEE PERMIT AUTHO Telephone Signature 2.2 Authorized Agent: BENJAMIN BORDEN/ENERGIA LLC 242 SUFFOLK ST HOLYOKE MA 01040 Name(Print) Current Mailing Address. 413-322-3111 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 3000.00 (a) Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee /n 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) 3000.00 Check Number 5Ci IJ ]' L Q-7/ This Section For Official Use Only Building Permit Number: ��-Gi`7 " o /(,{ Date JIssued: 7 Signature: / -7- ,)- Z)Z 61 Building Commissioner/Inspector of Buildings Date • ivelice @energiaus.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder BENJAMIN BORDEN/ENERGIA LLC 108421 License Number 242 SUFFOLK ST HOLYOKE MA 01040 2/19/25 Address Expiration Date 413-322-3111 Signatur Telephone 9.Registered Home Improvement Contractor: Not Applicable D ENERGIA LLC 165169 Company Name Registration Number 242 SUFFOLK ST HOLYOKE MA 01040 2/16/26 Address Expiration Date Telephone413-322-3111 SECTION 5-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 0 No 0 Brief Description of Proposed Work Insulation NOTE: INSULATION ONLY INSULATION TO ATTIC FLOOR OPEN BLOW CELLULOSE FG DAMMING - PROPAVENTS l BENJAMIN BORDEN/ENERGIA LLC , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. BENJAMIN BORDEN Print N me 7/01/24 Signature of O er/Agent Date ERICA GEES/STIEBEL ELTRON as Owner of the subject property BENJAMIN BORDEN/ENERGIA LLC hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. 7/01/24 Signature of Owner Date City of Northampton Massachusetts �`:' k '/ i,ti . ,)-1 DEPARTMENT OF BUILDING INSPECTIONS ,x, �� 212 Main Street •Municipal Building 'gyp Ca Northampton, MA 01060 1 ,;k0 Debris Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from construction work being performed at: 15-17 INDIAN HILL NORTHAMPTON, MA 01062 (Please print house number and street name) Is to be disposed of at: BOSTON RD WILBRAHAM (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: USA WASTE (Company Name and Address) 7/01/24 Signs re of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. City of Northampton �0Crir `ti �. Massachusetts .� G aa It - `.i"6.� DEPARTMENT OF BUILDING INSPECTIONS P.yJ, �� lw. tea! 212 Main Street • Municipal Building V, • ,`Q,C Northampton, MA 01060 MW MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 70 FERN ST NORTHAMPTON, MA 01062 Contractor ENERGIA LLC Name: Address: 242 SUFFOLK ST City, State: HOLYOKE, MA 01040 Phone: 413-322-3111 Property Owner STIEBEL PROPERTIES Name: Address: 15-17 INDIAN HILL • City, State: NORTHAMPTON, MA 01062 Type text here BENJAMIN BORDEN/ENERGIA LLC (contractor) attest and affirm that the building I intend to insulate does not have any open air (knob and tube)wiring in the spaces to be insulated and that I have provided the property owner with a copy of this affidavit. Contractor signature • __ _,E:2__tS,____. Date 7/01/24 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: T PE.:`J C Office of Consumer Affairs and Businoss Regulation Registfattnn :� xpinition 1000 Washington Street -Suite 710 165169 • 02/16/2026 Boston,MA 02118 ENERGIA LLC ' • BENJAMIN BORDEN • 242 SUFFOLK STREET HOLYOicE,MA 01040 Undersecretary of valid without signature Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Re ulations and Standards Conss4AAV W a"?v isor CS-108421 fires: 02/19/2025 BENJAMINRD1 �i i 242 SUFFa ST,r k , HOLYOKE vat 01840 '.1 • _ f� �� C..;,arniSo'a..^;;2r d y'a'S. 6/Iw.f�4 !1 :�yii� • C .FICAIT- - D� LIA%k "--C �..� S�R�� cE s - -BACK ENERLLC-01 JOCELYN ,4coRO CERTIFICATE OF LIABILITY INSURANCE DATE 7/1/2 D/YYYY) 7/1/2024 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 Jocelyn M Douglas NAME: Phillips Insurance Agency,Inc. PHONE I FAX 97 Center Street (AIC,No,Eat): (A/C,No): Chicopee,MA 01013 Mkss:Jocelyn@phillipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC 0 INSURER A:Middlesex Insurance Company 23434 INSURED INSURER B: Energia LLC INSURERC: 242 Suffolk Street INSURER D: Holyoke,MA 01040 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP OMITS LTR INSD WVD IMM/DD/YYYYI.(MM/DD/YYYYI A X COMMERCIAL GENERAL LIABIU Y EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE n OCCUR A0255555001 7/1/2024 7/1/2025 DAMAGE TO RENTED 500,000 PREMISES(Fa occurrecicel $ MED EXP(Any one persdnl $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 �,€NLAGGREsthLEJIIMITAP ) SPER: GENERAL AGGREGATE $ 3,000,000 POLICY P X LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER • $ A AUTOMOBILE LIABIUTY (EaacccINED SINGLE LIMIT $ 1,000,000 ANY AUTO A0255555004 7/1/2024 7/1/2025 BODILY INJURY(Per person) $ OWNED ONLY X SCHEDULED BODILY INJURY(Per accident) $ X AUTOS ONLY X ;PAW ( PE nti/AMAGE 1 $ A X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE A0255555007 7/1/2024 7/1/2025 AGGREGATE $ 2,000,000 DED X kETENTION S 0 _ $ A WORKERS COMPENSATION X STATUTE OOTH FR AND EMPLOYERS'UABIUTY Y/N A0255555005 7/1/2024 7/1/2025 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? N N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE,$ 1,000,000 If Yes descnbe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedu)e,may be attached M more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Energia LLC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 ACCORDANCE WITH THE POLICY PROVISIONS. 242 Suffolk St. Holyoke,MA 1040 AUTHORIZED REPRESENTATIVE I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Name(Business/Organizational/Individual):ENERGIA LLC Address: 242 SUFFOLK ST City: HOLYOKE State: MA Zip: 01040 Phone#: 413-322-3111 Are you an employer?Check the appropriate box: Type of project(required): IX 1. I am an employer with 14 employees(full and/or part time)* 7. New construction 2. I am a sole proprietor or partnership and have no employees working for me in any 8. Remodeling capacity.[No workers'comp.insurance required.] 9. Demolition 3. I am a homeowner doing all work myself.[No workers'comp.insurance required]t 10. Building addition 4. I am a homeowner and will be hiring contractors to conduct all work on my property. 11. Electrical repairs or additions I will ensure that all contractors either have workers'compensation insurance or are sole 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 13. Roof Repairs sheet. These sub-contractors have employees and have workers'comp.insurance.± 6. We are a corporation and its officers have exercised their right of exemption per MGL. X 14. Other c.152,§1(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box fil must also fill out the section below showing their workers'compensation policy information. tHomeowners 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 attach 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: MIDDLESEX INSURANCE CO Policy#or Self-ins.Lic.#: A0255555005 Expiration Date: 7/01/25 Job Site Address: 15-17 INDIAN HILL NORTHAMPTON MA 01040 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,and that clicking this checkbox and ping my name in th field bel w will act as my signature. Name: Date: 1 t 2� Phone#: 413-322- 111 Email: ivelic @ nergiaus.com 40144fi Permit Authorization mass save Form Savwrgs;nrovgnenergy srrxn,niy Site ID: 5239200 Customer: STIEBEL PROPERTIES INC Stiebel Properties, Inc CR CA C EE__S ,owner of the property located at: (Owner's Name,printed) 15 Indian Hill 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: E-a Gear Date: 06/25 / 2024 -:*••••••••••••••••r,•••••••••••••••••••••••••••••••••••••••• FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date P g Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 For Dffice Use Crly Document Ref:4FYKR-65ESK-U83A6-DJRW3