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24C-146 (3) BP-2024-1053 17 ARLINGTON ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24C-146-001 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-2024-1053 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2024 Contractor: License: Est.Cost: 13279 CLEAN TECH CONSTRUCTION 106247 Const.Class: Exp.Date:01/05/2026 Use Group: Owner: D POPKIN DAVID E& GRACE Lot Size(sq.ft.) Zoning: URB Applicant: CLEAN TECH CONSTRUCTION Applicant Address Phone: Insurance: 38 ELLIS AVE 508-663-7847 6hub4n60130823 WEYMOUTH,MA 02190 ISSUED ON: 09/09/2024 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHERIZATION 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: 7,1/2_ Fees Paid: $99.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner • 14eo , coz The Commonwealth of Massachusetts �' _ 1� •er W Board of Building Regulations and Standards FOR-10 in Q W Massachusetts State Building Code, 780 CMR MUNIc*A tilTY c`-' LID j CT) G Building Permit Application To Construct, Repair,Renovate Or Demolish a Revised Mai.2011 r E One-or Two-Family Dwelling 101 ..D_ c i This Section For Official Use Only 'List Q c � Building Permit Number: 'a a y• 1O. 3 Date Applied: I :_ .o z S-g Fi/leZo wi�-�.� 8"� - Building Official(Print Name) ignature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 17 Arlington Street 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: Zone: _ Outside Flood Zone? Public❑ Private 0 Check if yes❑ Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Grace Popkin Northampton,MA,01060 Name(Print) City,State,ZIP 17 Arlington Street 413-584-8151 Not Provided 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) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Insulation Brief Description of Proposed Work2: Residential weatherization and air sealing with the Mass Save Program.No structural changes. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $13279.54 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ElStandard City/Town Application Fee ❑Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fti(t9 6.Total Project Cost: $ 1 79.54 Check No. Check Amount: Cash Amount: 0 Paid in Full 0 Outstanding Balance Due: !!,,,, f�\ fiL kil ti 40 /- "1-t/L I 4 ' q SECTION 5: CONSTRUCTION SERVICES >.1 Construction Supervisor License(CSL) 106247 09/26/2026 Arianna Davidson License Number Expiration Date Name of CSL Holder List CSL Type(see below) Insulation 38 Ells Ave No.and Street Type Deception U Unrestricted(Buildings up to 35,000 cu.ft.) Weymouth,MA 02190 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 508-663-7847 cleantechconstruction48(agmail.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 196071 09/26/2026 Clean Tech Construction HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 38 Ells Ave cleantechconstruction480somail.com No.and Street Email address Weymouth,MA 02190 508-663-7847 City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes 0 No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. 4ua.t a- Pat/ a sem/ 8/14/2024 Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(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" City of Northampton oa,HAM jo... ‘.�' Massachusetts if? Si''<<, t r.; c /� W' t: 1 ' ;I t r,_ gt DEPARTMENT OF BUILDING INSPECTIONS S. ligi x 212 Main Street • Municipal Building yv`. CSC '. - L>."* Northampton, MA 01060 '�SNh �1� 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: 40 Messina Drive Braintree, MA 02184 The debris will be transported by: . Name of Hauler: Clean Tech Construction Signature of Applicant: "11iza.uca- Pa A,Aisei Date: 8/14/2024 The Commonwealth of Massachusetts _„_, Department of Industrial Accidents ztr►_ Office of Investigations "mil ' Lafayette City Center momosi 2 Avenue de Lafayette, Boston,MA 02111-1750 :.x www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Clean Tech Construction Address:40 Messina Drive City/State/Zip:Braintree,MA 02184 Phone#:508-663-7874 Are you an employer?Check the appropriate box: Type of project(required): I.❑■ I am a employer with 30 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 tY # 9. ❑Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ 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.❑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 Insulation employees. [No workers' 13.© 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. tContractors 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:Traveler's Indemnity Co of America Policy#or Self-ins. Lic.#:6HUB6R60053223 Expiration Date:9/18/2024 Job Site Address: 17 Arlington Street 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. l do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: 44. IZa- Pa.G bit Date:8/14/2024 Phone#: 508-663-7874 Official use only. Do not write in this area, to he completed by city or town official. City or Town: Permit/License# Issuing Authority(check one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: WEATHERIZATION CONTRACT EVERS - URCE CUSTOMER PHONE DATE CLIENT/I WORK ORDER Grace Popkin (413) 584-8151 05/22/2024 487462 38504 SERVICE STREET BILLING STREET PROPOSED BY- 17 Arlington Street 17 Arlington Street Daniel Diaz SERVICE CITY,STATE.ZIP BILLING CITY,STATE,ZIP Program Northampton, MA 01060 Northampton, MA 01060 EGMA-HES Page 2 DESCRIPTION QTY COST INCENTIVE TOTAL ATTIC FLAT-8"OPEN R-30 CELLULOSE 436 $937.40 $937.40 Provide labor and materials to install an 8" layer of R-30 Class I Cellulose to open attic space_ ATTIC FLAT-6" FLOORED R-19 DENSE CELLULOSE 629 $1,792.65 $1,792.65 Provide labor and materials to install a 6" layer of R-19 Class I Cellulose to floored attic space. SLOPE-8" INT DRILL R-26 DENSE CELLULOSE 24 $84.00 $84.00 Provide labor and materials to install blown in Class I Cellulose to vaulted walls through an interior surface drill and plug method. Plugs will be spackled and left with a rough finish. Finish sanding and touch- up priming/painting will be the customers 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 acknowedgement of receipt and agreement to proceed. BALLOON FRAMING BLOCKING 85 $138.55 $138.55 Install blocking in the open balloon framing for the proper installation of insulation. RECESSED LIGHT COVERS 1 $56.89 $56.89 Install recessed light covers over existing recessed light fixtures. Up to 6 at no cost. HATCH-INSULATE RIGID BOARD 1 $53.96 $53.96 Provide labor and materials to insulate the back of an attic hatch with 2"rigid insulation board at R-10. DOOR- INSULATE RIGID BOARD 1 $103.05 $103.05 Provide labor and materials to insulate the back of a door with 2"rigid insulation board. WALLS-CLAPBOARD SIDED 4" 1,528 $4,492.32 $4,492.32 Install blown in Class I Cellulose to clapboard sided exterior walls. 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 acknowedgement of receipt and agreement to proceed. COMMON WALL-2"RIGID BOARD 40 $219.60 $219.60 Install 2"rigid board to a common wall area. All seams will be sealed with tape. WEATHERIZATION CONTRACT EVERSI URCE CCSTOMER PHONE DATE CLIENT WORK ORDER Grace Popkin (413) 584-8151 05/22/2024 487462 38504 SERVICE STREET BILLING STREET PROPOSED BY: 17 Arlington Street 17 Arlington Street Daniel Diaz SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Progrem Northampton, MA 01060 Northampton, MA 01060 EGMA-HES Page 1 DESCRIPTION QTY COST INCENTIVE TOTAL 100%WALL INCENTIVE As a sponsor to the Mass Save program, Eversource Is offering this enhanced incentive of 100%off the cost of eligible insulation and air sealing measures when exterior wall insulation is also being installed. Contract must be signed by May 31, 2024 and the weatherization work installed by September 30, 2024. KNOB&TUBE WIRING (Northhampton) We have identified that your home might have Knob&Tube wiring OP (Initials) present.The following contract is not valid unless accompanied by the Weatherization Barrier Incentive form,signed by your licensed electrician. Work will not proceed with this work until we receive a copy of the form. MOLD AND/OR MILDEW MUST MITIGATE We have discovered what appears to be a mold and/or mildew-like lir (initials) substance in your home. Homeowner received a copy of the EPA's Mold Guide and is responsible for correcting this concern, prior to the installation of any weatherization work. By initialing you are agreeing to not hold RISE,or its Participating Contractors, responsible for any mold and/or mildew in your home. HOME AIR SEALING 10 $1,065.90 $1,065.90 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 1 $36.32 $36.32 Provide labor and materials to install Q-Ion weatherstripping to door(s)to restrict air leakage. DOOR SWEEP 2 $59.32 $59.32 Provide labor and materials to install a doorsweep to restrict air leakage. ATTIC DAMMING 24 $66.72 $66.72 Provide labor and materials to install an approved damming material in the attic ATTIC FLAT- 15"OPEN R-49 CELLULOSE 414 $1,188.18 $1,188.18 Provide labor and materials to install a 15"layer of R-49 Class I Cellulose to open attic space. WEATHERIZATION CONTRACT EVERSURCE CUSTOMER PHONE DATE CLIENTS WORK ORDER Grace Popkin (413) 584-8151 05/22/2024 487462 38504 SERVICE STREET BILLING STREET PROPOSED BY! 17 Arlington Street 17 Arlington Street Daniel Diaz SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Proprom Northampton, MA 01060 Northampton, MA 01060 EGMA-HES Page 3 DESCRIPTION QTY COST INCENTIVE TOTAL BASEMENT CEILING-6"FIBERGLASS 1,064 $2,830.24 $2,830.24 Provide labor and materials to install R-19 faced fiberglass batt G07) (initials) 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 VENTILATION CHUTES 33 S154.44 S154.44 Provide labor and materials to install ventilation chutes in the rafter bays to maintain air flow from the soffit ventilation. LEAD PAINT Your home was built prior to 1978 and might have lead-based paint , (initials) present.You have received a copy of the EPA's Renovate Right pamphlet informing you of the potential risk of a lead hazard exposure from the renovation activity to be performed at your home. PREPARE YOUR HOME Homeowner is responsible for the removal of any items stored in the 0/0 _(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: $13,279.64 Program Incentive: $13,279.64 Client Total: $0.00 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 Contractoe 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 ? - Dae ie'.Df4? - % a1 / fl° '.-1 RISE Representative Client Signature Dan Diaz sy/; Printed Nun Date of Acceptance mass save Savings through energy efficiency PERMIT AUTHORIZATION FORM 1, Grace Popkin owner of the property located at: (Owner's Name) 17 Arlington 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. tV1/ %A' Owner's ignatG Date FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: , te•artrt Z7G .erL 8/14/2024 Participating Contractor Date \Ut Client# 487462 RISE Work Order# 38504 RISE Rep: Daniel Diaz Name: Grace Popkin DESCRIPTION Qty Notes 1 HOME AIR SEALING 10 AMC AND BASEMENT 2 WEATHERSTRIP DOOR 1 ATTIC DOOR 3 DOOR SWEEP 2 ATTIC DOOR aFRONT DOOR 4 ATTIC DAMMING 24 FOR BATH FANS AND HATCH 5 ATTIC FLAT-8"OPEN R-30 CELLULOSE 436 NEWERADDmON 6 ATTIC FLAT-4"OPEN R-14 CELLULOSE 414 7 ATTIC FLAT-6"FLOORED R-19 DENSE CELLULOSE 629 UNDERFLOOR 8 ATTIC FLAT-9"R-30 FIBERGLASS BATTING 629 OVER FLOOR 9 SLOPE-8"INT DRILL R-26 DENSE CELLULOSE 24 STAIR SLOPE 10 BALLOON FRAMING BLOCKING 85 OPEN EXT WALLS TOATTIC 11 RECESSED LIGHT COVERS 1 12 HATCH-INSULATE RIGID BOARD 1 13 DOOR-INSULATE RIGID BOARD 1 14 WALLS-CLAPBOARD SIDED 4" 1,528 15 COMMON WALL-2"RIGID BOARD 40 STAIR CASE WALLS AND CATHEDRAL WALL 16 BASEMENT CEILING-6"FIBERGLASS 1,064 17 VENTILATION CHUTES 33 lsac 18 TURBINE ROOF VENT 2 1,4,5,15,17 VAULTED CEILIN 12 BF ( F1 1,4,6,11,16 1,7,8,10.14,16,18 TEST HIOLE 9,13,15 mass save 2022-23 Weatherization Barrier Incentives Based on your Energy Specialist's recommendations,your home can benefit from program-eligible insulation and/or air sealing improvements.Before moving forward, please follow all the instructions below to remediate your weatherization barriers CUSTOMER INSTRUCTIONS 1.Hire a qualified. licensed contractor to evaluate and/or remediate the weathenzation barrier(s). 2.Submit signed and completed copies of this form and a copy of the paid contractor invoices)within 60 days of your Home Energy Assessment to:RISE,766 Attucks Lano,Hyannis,MA 02601 or email to MassSavo@RISEongineering.com. 1.Complete the recommended weatherization improvements. 4.The weathenzation incentive will be issued as a rebate check upon completion and invoicing of the weatherization project. CUSTOMER INFORMATION Customer Name Grace Popkin Client#or Site ID: 487462 S,te Address: 17 Arlington Street City. Northampton State: MA ZIP: 01060 phone Number 413-584-8151 Email dpopkin@gmail.com• �L Custom. Homeowner Sign*we: 6i4. 1 l µ414 J Date: 7/$/Z+T KNOB AND TUBE WIRING To determine if there is any active knob and tube wiring,the contractor will evaluate the following areas where eligible Mass Save' weathenzation recommendations have been made: attic stair slope Attic Floor Attic Wall CT)Attic Slope te Exterior Wall 60 Basement t,Other:~ Other :attic have performed my inspection and determined there is no active knobnob and tube wiring in the areas selected below /Attic Floor Q(Attic Wall r)Attic Slope ( xterior Wall C✓ Basement (Other� " _ 'Other: is stair slope Contractor Name: , rn 0E-1/1 y 1"1. Poi.c i o r6l4- (� L��1 r1/��] (� Address' ( 5 ) /O sty: (1 a 1- ! State: /I ii ZIP: DiD3V T se Number: Ao...3 ) /3gg7 J /Company Narrle: I - - , _ 1/q My signature confirms that I have performed my inspection of the electrical systems listed above and have corrected any barriers as indicated.My signature also confirms that I have read and agree to the Terms and Conditions outlined on the back of this form. MECHANICAL SYSTEM BARRIERS(To be hued out by licensed contractor.) High Carbon Monoxide:Contractor is to service and re-evaluate the selected mechanical system(s)and reduce the carbon monoxide level, as measured in the undiluted flue gas,to below 100 parts per million(ppm). Draft Failure:Contractor is to correct the draft in the selected flue(s).Refer to table on reverse for acceptable draft ranges. High Carbon Monoxide Draft Failure Existing CO ppm Revised CO ppm Existing Draft Pa • Revised Draft Pa Neadrq System Hot Water Heater Other Spillage:Contractor is to correct the spillage of flue gases in the selected mechanical system(s).Must not spill after 60 seconds of operation. Heating System J Hot Water Heater 0 Other: Contractor Name: Address: City: _ State: ZIP: Company Name: License Number: Contractor Signature: Date: My signature confirms that I have performed my inspection of the mechanical systems listed above and have corrected any barriers as indicated.My signature also confirms that I have read and agree to the Terms and Conditions outlined on the back of this form. in- Commonwealth of Massachusetts Construction Supervisor Specialty Division of Occupational Licensure Board of Buiirs;-- -",-Aulrations and Standards Restricted to: Construe per or Specialty CSSL-IC-Insulation Contractor CSSL-106247 93ires: 09/26/2026 ARIANNA JAMES DAVIDSON 38 ELLS AVE-- r WEYMOUTH MA 02190 ky • f y1)/.1,t d.1 �` V. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Commissioner ' a.,,, �` fi' 4 A ,701.ca._ For information about this license ' Call(617)727-3200 or visit www.mass.govldpi THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affai and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Im•rovenne- • tractor Registration w . - ' =�"•_. - - Type: Supplement Card CLEAN TECH CONSTRUCTION LLC = � anon: 196071 38 ELLS SVE E .'eation: 06/27/2025 .. WEYMOUTH,MA 02190 a, _ = Q! 14 —\ SV 0N' 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:Supplenient Card Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 196071 06/27/2025 Boston,MA 02118 CLEAN TECH CONSTRUCTION LLC "t 17: _ > ARIANNA DAVIDSON !2 38 ELLS AVE ,. C �v,..N!.'/:a4 ' ,4,enGt rt-e-Gi I�G.ti. ,e AIL WEYMOUTH,MA 02190` , Undersecretary Not valid without signature CORO DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 09/15/2023 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: 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 Gary Hebsch TOBMAN PARTNERS INSURANCE AGENCY INC PH No.Ext): (617)471-1123 FAX No): E-MAIL hebsch tmwins.com _ ADDRESS: 9 C 21 MCGRATH HIGHWAY SUITE 303 INSURER(S)AFFORDING COVERAGE _ NAIC# QUINCY MA 02169 INSURERA: TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED INSURER B CLEAN TECH CONSTRUCTION LLC INSURERC: INSURER D: 40 MESSINA DRIVE INSURER E: BRAINTREE MA 02184 INSURERF: COVERAGES CERTIFICATE NUMBER: 931330 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 AWL SUBR 7 POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ --- N/A PERSONAL&ADV INJURY $- - GEM.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY E T LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY , AUTOS ONLY (Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE S DED RETENTION$ $ WORKERS COMPENSATION N/ PER XH STATUTE ER AND EMPLOYERS'LIABILITY A OF ICER/MEMBEREXCLU ED?ECUTIVE N/A N/A N/A 6HUB6R60053223 09/18/2023 09/18/2024 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 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. 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/lwd/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 Clean Tech Construction. LLC ACCORDANCE WITH THE POLICY PROVISIONS. 40 Messina Drive - --- AUTHORIZED REPRESENTATIVE Braintree MA 02184 ) Daniel M.Cro y,CPCU.Vice President-Residual Market-WCRIBMA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD A DATE(MM/DD(YYYV) Rl7- CERTIFICATE OF LIABILITY INSURANCE 09/M!DD/ 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: Tobman Partners Insurance Agency Inc. ace No.Ertl: 617-471-1123 FAX No): 617-773-2474 21 Mayor Thomas J McGrath Highway E-MAIL Suite 303 ADDRESS: Quincy,MA 02169 INSURERS)AFFORDING COVERAGE NAIC I INSURER A: Nautilus Insurance Company INSURED INSURER B: Safety Insurance CO Clean Tech Construction LLC INSURER C: 40 Messina Drive INSURER D: Braintree,MA 02184 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 ADDLSUBR POUCY NUMBER /YPOUCY EFF POLICY EXP OMITS LTR INSD WVD (MM/DDYYY) (MWDD/YYYY) X COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE $ 1.000,000 CAMAGE10 RENTED CLAIMS-MADE X OCCUR PREMISES(Ea ocwrrenoe) S 300,000 MED EXP(Any one person) $ _ 5,000 A NN1562513 09/18/23 09/18/24 PERSONAL a ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED X SCHEDULED 5931459 09/16/23 09/16/24 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) __ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS UAB CLAIMS-MADE AN1293596 09/18/23 09/18/24 AGGREGATE $ 2,000,000 DED RETENTION$ S WORKERS COMPENSATION I PER OTH- AND EMPLOYERS'UABIUTY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED', N!A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes.descnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Clean Tech Construction,LLC ACCORDANCE WITH THE POLICY PROVISIONS. 40 Messina Drive Braintree,MA 02184 AUTHORIZED R ENTATIVE ©1 -2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD DEBRIS DISPOSAL AFFIDAVIT In accordance with the provisions of M.G.L. c. 40, s. 54, Building Permit was issued with the condition that all debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L c. 111, s. 150A. The debris will be disposed of in: Clean Tech Construction Name of Waste Facility Not Applicable - No Debris Address of Waste Facility 111.5 Debris: As a condition of issuing a permit for the demolition, renovation, rehabilitation or other alteration of a building or structure, M.G.L. c.40 s. 54 requires that the debris resulting therefrom shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L.c. 1 l 1 s. 150 A.Signature of the permit applicant, date and number of the building permit to be issued shall be indicated on a form provided by the Building Department and attached to the office copy of the building permit retained by the Building Department. If the debris will not be disposed of as indicated, the holder of the permit shall notify the building official, in writing,as to the location where the debris will be disposed. 780 CMR—6w Edition .4teaIt►ti2 Z7arAedaert. Signature of Permit Applicant Date