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38D-018 (16) BP-2024-0907 25 HAMPDEN ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38D-018-001 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-2024-0907 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2024 Contractor: License: ATHENA BUILDING Est. Cost: 5680 PERFORMANCE INC 118644 Const.Class: Exp.Date: 09/28/2026 Use Group: Owner: B ROUNDS CALEB M & MARGARET Lot Size (sq.ft.) Zoning: URB Applicant: ATHENA BUILDING PERFORMANCE INC Applicant Address Phone: Insurance: 75 BROWNELL ST (508)266-5359 6HUBOW74339523 WORCESTER, MA 01602 ISSUED ON: 07/18/2024 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATH E R I 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: 172. Fees Paid: $75.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner bat s,if ( q 6-() % / 7k. Erna l 1 h teak f + pio woe /fr The Commonwealth of Massachusetts 0,k), 1 �� . Board of Building Regulations and Standards Ai0Q a(,� FO' Massachusetts State Building Code,780 CMR y'9,t yoti0 MUNICI.ALIT \U� oti iik E 'Building Permit Application To Construct,Repair,Renovate Or Demolis qw ,•. Mar 011 One-or Two-Family Dwelling % This Section For Official Use Only Building P 't Number: Ej1P. � 0907 Date Applied: Evil a , // -7-17 ZOz' y Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 25 Hampden St Northampton MA 01060 1.1 a 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 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: Caleb and Margaret Rounds Northampton MA 01060 Name(Print) City,State,ZIP 25 Hampden 413-559-1698 caleb.rounds@gmail.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building El Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other ® Specify:weatherization Brief Description of Proposed Work2:air sealing and insulation SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Official Costs: Official Use Only (Labor and Materials) 1.Building $5,680 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee 0 Total Project Cost (Item 6)x multiplier x 3.Plumbing $0 2. Other Fees: $ 4.Mechanical (HVAC) $0 List: 5.Mechanical (Fire Suppression) $0 Total All F Check Nc IA .Check Amo 16 6.Total Project Cost: $5,680 0 Paid in trtf ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-118644 9/28/2026 Margaret Valdes License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 75 Brownell St No.and Street Type Description Worcester MA 01602 U Unrestricted(Buildings up to 35.000 cu.It) R Restricted I&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 508-266-5359 margo@athenabp.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(MC) 209367 8/2/2025 Athena Building Performance,Inc. HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 75 Brownell St imargo@athenabp.com No.and Street Email address Worcester MA 01602 508-266-5359 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? Ycs ® No .D 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 Athena Building Performance,Inc. to act on my behalf,in all matters relative to work authorized by this building permit application. Signed affidavit attached 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. Margo Valdes 7/12/2024 Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: I. 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. I42A.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" WEATHERIZATION CONTRACT EVERS=URCE CV31b11ER PHONE DATE CUENTI WORK ORDER Caleb Rounds (413)559-1698 06/18/2024 417783 • 10304 SERVICE STREET SLUNG STREET PROPOSED BY'. 25 Hampden Street 25 Hampden Street . Seth Main. SERVICE CITY.STATE,ZIP BLUNG CITY,STATE,DP n°r.m Northampton, MA 01060 Northampton, MA 01060. EGMA-HES. Page 1 DESCRIPTION❑ QTY COST INCENTIVE TOTAL INCENTIVE 75%1 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 weathenzation work begins.: KNOB &TUBE WIRING SIGN-OFF-FSC The wiring in the areas weatherization work is proposed will be reviewed by a licensed electrician to determine if there is any existing live knob&tube wiring. HOME AIR SEALING 10 $1,065.90 S1,065.90 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.) WEATHERSTRIP DOOR 3 $108 96 $108.96 Provide labor and materials to install 0-Ion weatherstripping to door(s)to restrict air leakage. DOOR SWEEP 3 $88.98 $88.98: Provide labor and materials to install a doorsweep to restrict air leakage. ATTIC DAMMING 42- $116.76 $87.57 $29.19 Provide labor and materials to install an approved damming material in the attic, ATTIC FLAT-3"OPEN R-11 CELLULOSE 807. $1,323.48. $992.61 $330.87 Provide labor and materials to install a 3"layer of R-11 Class I Cellulose to an open attic space.: PULL-DOWN STAIR-THERMADOME: 1 • $313.63 • $313.63 Provide labor and materials to install an easily moved,insulating cover for the attic access folding stair. The cover has integral weather- stripping to restrict air leakage.- BASEMENT CEILING-6"FIBERGLASS' 989 $2,630.74. $1,973.06 $657.68' Provide labor and materials to install R-19 faced fiberglass batt cp (f 111111 ) insulation to the basement ceiling. This will be installed with the paper backing up against the floor above.The un-papered fiberglass side will be facing the basement,and these exposed fiberglass fibers will be the visible side when standing in the basement. Your initials are your agreement and understanding of this measure Document Ref:QIDKH-YFC8K-R99VR-Q0NSE Pogo 1 of4 WEATHERIZATION CONTRACT EVERSeURCE CUSTOMER PHONE DATE CLIENTS WORK ORDER Caleb Rounds (413)559-1698 06/18/2024 417783 10304 SERVICE STREET BILLING STREET PROPOSED BY: 25 Hampden Street 25 Hampden Street Seth Main SERVICE CITY,STATE,ZW BILLING CITY,STATE,ZW Program Northampton, MA 01060 Northampton, MA 01060 EGMA-HES Page 2 DESCRIPTION QTY COST INCENTIVE TOTAL INSULATED BATH EXHAUST HOSE 4 INCH 1 $32.23 $24.17 $8.06 Provide labor and materials to install an insulated 4"exhaust hose to existing bathroom fan(s). 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. PREPARE YOUR HOME Homeowner is responsible for the removal of any items stored in the C.R. (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. Total: $5,680.68 Program Incentive: $4,654.88 Client Total: $1,025.80 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 mamer 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 incrr�°or decrease the size of the Program Incentive Share. Hatt( arid Roar RISE Representative Client Signature Seth Main 06-19-2024 Printed Name Date of Acceptance Docaurtment'Ref:QIDKH-YFC6K•R99VR-QDNSE '` t1 ii I ; ,,. TERMS&CONDITIONS, continued III.EVERSOURCE INCENTIVE X.ENERGY BENEFITS Client acknowledges the Program Incentive amount is made possible by Eversource's The local sponsoring Utility Is entitled to 100%of the energy benefits associated with all energy efficiency programs and is subtracted from the total cost. energy conservation measures,excluding the value of energy cost savings by the Client, but including all rights to all associated ISO-NE Energy,Capacity and Reserves Products IV.ASSIGNMENT OF CONTRACT BY RISE (as defined by ISE New England),and the IIC agrees to provide the Utility with such Client acknowledges that RISE will,and Client hereby requests RISE to,assign this further documentation as the Utility may request to confirm the Utility's ownership of Contract to the IIC to undertake the Work on the terms set forth in the Contract.After such benefits and Products. such assignment.(a)RISE shall no longer be a party to this Contract,and(b)Client shall have no recourse against RISE for any of the performance.non•performance or deficient XI.IIC REGISTRATION performance of the Work or any obligations under this Contract performed by,or on The IIC and any subcontractors must be registered by the director and any inquiries about behalf of,the IIC.Notwthstanding the foregoing,Client shall provide RISE with(i)such the IIC or any subcontractor relating to a registration should be directed to:Office of information regarding the IIC's performance as RISE may reasonably request;and(ii) Consumer Affairs and Business Regulation,Home Improvement Contractor Registration, reasonable access to the Site Address as RISE may request to permit RISE to inspect the 1000 Washington Street,Suite 710,Boston,Massachusetts 02118,617-973-8787 IIC's Work;and(c)Furthermore,Clent agrees that they(i)shall notify RISE of any dispute between the Client and the IIC concerning the Contract;Di)shall provide RISE XII.IIC WARRANTIES with such information regarding the dispute as RISE may reasonably request;and(la) The IIC warrants as follows: consent to RISE's participation,at its sole election,in any arbitration or other dispute A. Materials and proficiency will meet or exceed the specifications in RISE's resolution proceeding between Client and the IIC. Materials and Installation Standards. B. The Work and the materials furnished by the IIC will conform to the V.LIMITED TIME OFFER requirements of this Contract.If there be a defect in the installation or The terms,prices and any incentive offered in this Contract are valid for only thirty(30) materials,ur any damage caused by its subcontractors or employees,and it days from the date of RISE's presentation of this Contract to the Client.In the event the Is discovered within one year after completion of the Work(including Client does not execute this Contract and return it to RISE within the thirty(30)day cleanup),the IIC will,at its own expense,at its option,remedy,repair, period,the terms,prices,and any incentive offered by RISE are NULL and VOID.A new correct,replace,or cause to he remedied,repaired,corrected,or replaced contract may be requested by client,at current costs/availabilities such defect or damage. Executed Contract is subject to cancellation after sixty(60)days if the work has not been XIII.CLIENT RIGHTS UNDER M.G.L.C.142A completed due to delays from the Client.If any barriers are discovered during the The Client has the following rights under M.G.I.c.142A installation of the contracted measures that prevent some or all of the measures A. At the time of signing this Contract.the Client shall be furnished with a from being installed,Client has thirty(30)days from first installation date to resolve copy of the Contract.No Work shall begin prior to the signing of this barriers and have the installation completed under the original contracted terms, Contract by the Client and RISE. pricing,and incentive.A new contract may be requested by Client,at current 8. Any party may bring an action to enforce any provisions of M.G.L c.142A costs/a va i la b i l i t i e s. or to seek damages or the Client may request that a dispute be decided VI.COMMENCEMENT AND COMPLETION under the terms of a private arbitration program approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations. The IIC will not begin the Work or order the materials before the sixth(6th)day after C. Client may have the right to be compensated from the Residential the execution of this Contract by RISE and Client.Subject to availability of Contractor's Guaranty Fund for actual losses incurred as a result of a subcontractors/materials and to delays attributable to the weather or"acts of God",the registered contractor's or subcontractor's conduct found by a court to be IIC shall begin performing the Work as soon as practical after the Contract Execution work performed In a poor or improficient manner or which violates certain Date,and the IIC shall substantially complete Work no later than sixty(60)days after the laws for the protection of consumers within 6 months after the Client has Contract Execution Date,barring delay caused by circumstances beyond the IIC's obtained a judgment or arbitration award and has exhausted customary control,including but not limited to any delay resulting from the Client.Each of RISE and reasonable efforts to collect the judgment or award. the IIC reserve the right to advise the Client of changes in the projected start and completion dates,based upon availability of materials and subcontractors.Upon XIV.DISPUTE RESOLUTION completion of the Work,the IIC will leave the Site in a neat and orderly condition but shall not be responsible to correct conditions outside the scope of its Work. The IIC and Client hereby mutually agree in advance that In the event the IIC has a dispute concerning the Contract,the IIC may submit such dispute to a private arbitration VII.MODIFICATION service which has been approved by the Office of Consumer Affairs and Business Prior to RISE's assignment of this Contract to the IIC set forth Section IV(above),this Regulation and Client shall be required to submit to such arbitration as provided by Contract cannot be changed except in writing,signed by RISE and the Client After RISE's M.G.L.c.142A assignment of this Contract to the IIC set forth in Section IV(above),this Contract cannot be changed except inventing,signed by the IIC and the Cent and that has been You may cancel this agreement if it has been signed by a party of a place other than on approved in writing by RISE. address of the seller,provided you notify the seller in writing by ordinary mail posted not later than midnight of the third business day following the signing of the Contract. VIII.PERMITS In connection with the Work to be performed at the Site by the IIC Under Contract,the following permits maybe required for this project depending upon the judgment of local inspectors:Electrical,Plumbing/Gas,Mechanical,Building.The IIC shall be responsible to,and shall obtain any and all permits required for performance of the Work.The IIC shall inform the Client of the permits required and any Client co pay or cost of the required permit acquisitions.If Client chooses to secure their own work- related permits,and/or deal with an unregistered contractor,Client will be excluded from the Guaranty Fund provisions of M.G.L.c.142A. IX.DISCLAIMER OF LIABILITY OF RISE AND UTILITY Client understands and acknowledges that the IIC is not an agent,vendor nor sub- vendor of the Utility or RISE with respect to the installation of any energy efficiency measures.In the event of the failure of any energy conservation device to perform as expected,Client agrees that Client's sole recourse is to the IIC and not to RISE or the Utility The Utility and its operating companies shall not maintain,remove,or perform any work whatsoever on the energy conservation measures installed.Client understands and acknowledges that its participation in the Mass Save Home Energy Services Program is voluntary and that it has consented for the IIC to install the proposed energy conservation measures.Client agrees that it shall not hold RISE,the Utility,their affiliates,or operating companies liable for the IIC's failure to perform its oblgations under this Contract,for failure of the energy conservation measures to function,for any damage to Client's property caused by the IIC of for any and all damages to property or injury to persons caused by the energy conservation measures. Document Rof:OIDKH-YFC6K-R99VR-ODNSE Peps 444 Alft mass save Savings though energy efficiency PERMIT AUTHORIZATION FORM I, Caleb Rounds owner of the property located at: (Owner's Name) 25 Hampden Street 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. add- gar Owner's Signature 06-19-2024 Date FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date The Commonwealth of Massachusetts Department of Industrial Accidents Imtiirm, Office of Investigations Lafayette City Center 2 Avenue de Lafayette, Boston,MA 02111-1750 ..: tt'ww mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Athena Building Performance Inc. Address:75 Brownell St City/State/Zip:Worcester MA 01602 Phone#: 508 266 5359 Are you an employer? Check the appropriate box: Type of project(required): 1.❑■ I am a employer with 5 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6 ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' P h' 9. 0 Building addition [No workers' comp. insurance comp. insurance.. required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152,§1(4),and we have no weatherization employees. [No workers' l3.®Other 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: Travelers Indemnity Co of America Policy#or Self-ins. Lic. #:6HUB0W74339523 Expiration Date: 10/23/2024 Job Site Address: 25 Hampden St City/State/Zip:Northampton MA 01060 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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 inf. rmatiou provided above is trice and correct Signature: Date: 7/12/2024 Phone#: 5082665359 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority(check one): 10Board of Health 20 Building Department 3❑City/Town Clerk 4.0 Electrical Inspector 5Elumbing Inspector 6.DOther Contact Person: Phone#: City of Northampton / 01 ��`` * Massachusetts tS'�* 'c'. ;c DEPARTMENT OF BUILDING INSPECTIONS ?` 212 Main Street • Municipal Building yJ�`. c0 �� Northampton, MA 01060 ,• ^O 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: WM dumpster Company shop in South Hadley MA Location of Facility: The debris will be transported by: Name of Hauler: Site crew to shop WM dumpster v a 7/12/2024 Signature of Applicant: Date: Commonwealth of MassachuSells Division of Occupational Lkensurc Board of Building fk_ghe ulations and Standards ConstofttOlVtiDeAviS°r • fekoires: W23/21:126'1 ... ., CS-118644 *' .'' '" ,, --z htARGARET k V 76 BROWNEld.S WORCES itlith„ , . , t+ 'VOUVitiVj r F Commissioner Construction Supervisor Urirestricted-Buildings of any use group which contain less than 35,000 cubic feet(ell cubic meters)of endoseifspace , &State Aiding Code is COOS*for revocation of this tic- . .-For information about this license , Call(617")727-3200 or visit www.erwass.govidpf ' , ,.. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Aff. l . Business Regulation 1000 Washing L.„ : - Suite 710 Bosto 118 Home Im.ro ` -- - •ii- - - iGn yirt,-.is tration illar #II�tt� 'v ' f = _ Type: Corporation ATHENA BUILDING PERFORMANCE INC —MIA T. ation: 209367 75 BROWNELL ST _-- t � E ,-lion: 08/02/2025 WORCESTER, MA 01602 LEA 7r C.io1 M Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVE TcONTRACTOR expiration date. If found return to: TYP Office of Consumer Affairs and Business Regulation Be. ,.0.0... '!! - e 1000 Washington Street -Suite 710 A•c.; -- T +:.Hr,ric+. Boston,MA 02118 l--- - ma's ATHENA BUILDING '-- ;,1 k' tWI'41,1±. . 1 MARGARET L VALDE s -=_t ft- // _ 75 BROWNELL ST a " r a,,,Ki ".cgos �✓ v WORCESTER,MA 0160 '. Undersecretary Not valid without signature ACO® DATE(MM/DDIYYYY) �� CERTIFICATE OF LIABILITY INSURANCE 07/09/2024 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 NAME: Kristin Dean Berlin Insurance Grou PHONE 508 459-1226 I FAX P (e-/C,No,-EXI).( ) (NC,No) 61B MILTON ST E-MAIL ADDRESS: servi @ gp.coceteam berlininsurance rou ry - . _.... --- com m Suite B INSURER(S)AFFORDING COVERAGE ____ NAIC k WORCESTER MA 01606-2819 INSURER A: Scottsdale Insurance Company 41297 INSURED INSURER e: SAFETY INDEMNITY INSURANCE COMPANY 33618 Athena Building Performance INSURER_C: Evanston Insurance Company _ 35378 75 Brownell St. INSURER G: INSURER E: Worcester MA 01602 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 1 ''.ADDLISUBR POLICY EFF POLICY EXP LTR' TYPE OF INSURANCE INSD I WVD POLICY NUMBER (MMIDD/YYYYI (MM/DDIYYYYI, LIMITS X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _$ 1,000,000 -f �!CLAIMS-MADE I/�/�OCCUR DAMAGE TO RENTED (Ea occurranncol $ 100,000 MED EXP(Any one person) $ 5,000 A 1 X CPS7888670 10/24/2023 10/24/2024 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 1 GENERAL AGGREGATE $ 2,000,000 POLICY I PRO- JECT ' LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 _(Ea accident), I ANY AUTO BODILY INJURY(Per person) $ B I OWNED SCHEDULED _Xi AUTOS ONLY X Auros X 5931972 10/23/2023 10/23/2024 BODILY INJURY(Per accident) $ X�/ HIRED \/ NON-OWNED PROPERTY DAMAGE �~ I AUTOS ONLY AUTOS ONLY (Per accident) $ _.. $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 A X EXCESS LIAB CLAIMS-MADE CXS4011847 10/24/2023 10/24/2024 AGGREGATE $ 1,000,000 DED RETENTION$ I $ WORKERS COMPENSATION 'MUTE EMPLOYERS'LIABILITY Y/N (STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? --- - - ----(Mandatory In NH) 'E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below ! E.L.DISEASE-POLICY LIMIT S Contractors Pollution Liability Per Occurrence r 1,000,000 C CPLMOL120718 12/06/2023 12/06/2024 General Aggregate j 1,000,000 1 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) National Grid USA,Action for Boston Community Development,Inc.and Eversource Energy Service Company as well as their direct and indirect parent, subsidiaries and affiliates are included as additional insured on a primary and non-contributory basis with respects to General Liability,Contractors Pollution Liability and Auto Liability as required by written contract. 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. Springfield Partners for Community Action Inc. AUTHORIZED REPRESENTATIVE 721 SpringfieldState Street 2nd floor Sp MA 01109 kran ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACC RD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 03/07/2024 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 Kristin Terves NAME: BERLIN INSURANCE GROUP LLC PHONE (508)459-1226 FAx (A/C.Ns,E)tU: I(A/C,Nor EMAIL brittan ADDRESS: 0/08/11I insurancegroup.Com 61B MILTON ST INSURER(S)AFFORDING COVERAGE NAIC/ WORCESTER MA 01606 INSURER A: TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED INSURER B: ---- -- ATHENA BUILDING PERFORMANCE INC INSURER C: INSURER 0 75 BROWNELL ST INSURER E WORCESTER MA 01602 INSURER F: COVERAGES CERTIFICATE NUMBER: 984790 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 SUER ---------- POLICY EFF POLICY EXP LIMITSLTR INSO NND POLICY NUMBER (MMIDD/YYYY) (MM/DDIYYYY) COMMERCIAL GENERAL UABILITY EACH OCCURRENCE—DAMAGE TO S _ NTED CLAIMS-MADE OCCUR PREMIES Ea ocarrencel_, S MED EXP(Any one person) $ N/A PERSONAL a ADV INJURY S GENt AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 'S 1 POLICY I E a I I LOC PRODUCTS-COMP/OP AGG S O S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED _ AUTOS ONLY AUTOS N/A BODILY INJURY(Per accident) S HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident)__ 5 S UMBRELLA LIAR OCCUR EACH OCCURRENCE _S EXCESS LIAB CLAIMS-MADE N/A AGGREGATE S -- DED RETENTIONS S WORKERS COMPENSATION X S ATUTE OTH- ER_ _ AND EMPLOYERS'LIABILITY Y/N ANYP ROPHIL)ORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBEREXCLUDED? WA WA N/A 6HUB0W74339523 10/23/2023 10/23/2024 (Mandatory In NH) I E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under If DESCRIPTION OF OPERATIONS helm E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached N 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. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration 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.gov/Iwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BOAC ACCORDANCE WITH THE POLICY PROVISIONS. 1531 East St AUTHORIZED REPRESENTATIVE Pittsfield MA 01201 \.1 4, L` Daniel M.Crow'y,CPCU,Vice President—Residual Market—WCRIBMA t(1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD tip,,.; City of Northampton �' Massachusetts %` c. y T DEPARTMENT OF BUILDING INSPECTIONS + '`'•`n �Sr 212 Main Street • Municipal Building Northampton, MA 010E0 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: Contractor 4 LL II / Name: T'tce1 et_ (6- 0(d i r")G poac)�:4-s Address: 75 b i�c L,,,�►-) �-- 1 ( J s+ City, State: 1.A,b r C. c C 1--rr- Y9 O ) Lo v - Phone: JOg_ aC°Lf `3 3 S9 Property Owner (� Name: Ca-IC �j / rYYJ r9c:_rtzl- Ind ut S Address: a 5 Pl {JG"C 0 5 City, State: !v or•-i- 1 h«,rry- iv)' - I, W 1 LSO r) 5-lc c c. /i (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 Date 7/1 7/A, n Da 1 J