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31B-188 (2)
76 GOTHIC ST-UNIT 2 BP-2019-1146 GIs 9: COMMONWEALTH OF MASSACHUSETTS MawBlock:31B- 188 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Petmie Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:INSULATION BUILDING PERMIT Permit# BP-2019-1146 Project# JS-2019-001856 Est Cost:$3269.0 Fee: 55.00 PERMISSION IS HEREBY GRANTED TO: Const.Class Contractor: License: Use Group: AFFORDABLE BUILDING & WEATHERIZATION - TODD LEDUC 106019 Lot Sizc(su ft.): 13808 52 Owner: GUHA ARJUN Zoning:URC(1001/ Applicant: AFFORDABLE BUILDING &WEATHERIZATION -TODD LEDUC AT: 76 GOTHIC ST- UNIT 2 Applicant Address: Phone: Insurance: 330 VICTOR RD (401) 965-8578 WC ATTLEBOROMA02703 ISSUED ON:4/19/2019 0:00:00 TO PERFORM THE FOLLOWING WORK:INSULATION 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occuoancv Si ature• FeeTvpe: Date Paid: Amount: Building 4/19/2019 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner �N i�Gf,Cf�i i0� City of Nort amp Dj�C�clt /— W11FLLING Building De(�art L V212 MainStreetRoom 00 6d p ) 6 7019Northampton, MA 010phone 413-587-1240 Fax413�_587-1272oF�T n=e.al oi�s iw=:'�r.APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATEORDEMOLISHAONEOR TWO F SECTION 1 -SITE INFORMATION z/" 7-a Thls section to be couniqlated by office 1.1 Property Address: - T. C�a 11l l G St �, MSP � Lot—42 ung &''01thamptbn mA 6) ouo zone GYerby Pt Elm Sc DIddd_ - CB Deeded — SECTION 2-PROPERTY OWNERSHIPJAUTHORRED AGENT 2.1 Owner of Record: A r� cn i h n Na/m�e( nQ Curren Mailing Address:14) ,3 ) I --7 JM ,(�Qp �,r,t,i016K..d Telephone LL Signature 2.2 Authorized Agent: Tadd I-tfjacl 33O Yic#a> RSI SteA �tNeborb�l�} oa7o Name(Print) Current Mailing Address, /—/l 4L) I 91nS fS 'J8 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Oficial Use Only completed by permit applicant 1. Building n to p 1!5I (a)Building Permit Fee 2. Electrical ' Ol / (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6, Total= (1 +2+3+4+5) Check Number a� This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissionedlnspector of Buildings Data 1-fi/Smda6& bw @ gmcuQ • Car�L EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filed In by Building Department Lot Size l Frontage Setbacks Front IC�__._� �r— Side L1—.--1 R:�__� LL --1 R:[ Rear Building Height —� Bldg. Square Footage Open Space Footage I (Lo,arca into bid,ffipaved l_ amain #of Parking Spaces �— � —' d Fill' vnhime&larsron -- `— —"- A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW NU YES O IF YES, date issued:_ .IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'TKNOW O YES O _. IF YES: enter Book E______, Page[_. J, and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW ® YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO Q IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO 10 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs jO] Decks [[] Siding[o) Other[ ] Brief Description of Propose Work' nn i � epirilyiCA Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet a. Use of building: One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? I, Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain_Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank_ City Sewer Private well City water Supply SECTIONTa-OWNER AUTHORIZATION•TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ,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. Signature of Owner / J / Date I, Tbd LP.ai ( as Owner/Authorized Agent hereby declare that the statemeanI 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. 7—odd Izdu� Print Name�� Signature of Owner/Agent Date 'SECTION 6-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: ,�,, ,, NotApplicable ❑ Name of License Holder: TOd C.1 L�AUL , [came Number 33n Yictor �l Sh° 41t11e4�rc� oZ�o3 Noe /aD Addre66 Expiration Dat Signature Telephone NIIO iV- •i „t ' Ilrti - Not Applicable ❑ /7gJz1!� AFFORDABLE BUILDING a Registration Number WFATIFERIZATION,INC. /'� — 330 Victor Road,S¢.A I o Aedchum,MA02703 Eapirtion Date Te1ephone`01p/.5S5!2v SECTION 10-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....... No-_. ❑ City of Northampton _ Massachusetts s- DEPAETKENT OF BUILDING INSPECTIONS 212 Main Street a Municipal Building Northampton, MA 01060 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the-reconstruction, alteration, renovation, repair, modemization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than/our dwelling units__or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC, that entity must be registered. TypeofWork: l�dnA/l_dat7Or) p1 Est. Cost: 3,qtp Address of Work: l CY &D h I COQ 's I Date of Permit Application: 9 /1 / I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): _Job under$1,000.00 Owner obtaining own permit(explain): _Building not owner-occupied _X Other(specify):: 1.1'1C)JAV II h on OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: 4 ( R119 Todd Ls-AttiL 1 -M-5 Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton Massachusetts L. DEPARTMENT OF BUILDING INSPECTIONS JJp} 212 Nein Street aMunicipal Building Northampton, NA 01060 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: ��P c7nI h ) (-. s5t (Please print house number and street name) Is to be disposed of at: AFFORT,.,., BUII.DmG& Wr11.F IZA9'10N,INC. 330 V1cmr Road,Sm.A Attleboro,MA 02703 Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) �`� Sign 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. CLEAResult' CONTRACT CLEAResult 50 Washington Street, Customer Name:ARJUN GUHA West6urougb,MA,01581 Emall:family@Bona-andersgn..rP Phone:413584-6750 Premiss Address:76 Gothic 31,2,Ncdhampton,MA 01060 Mailing Address:76 Gothic St 2,Northampton MA 01060 Project 10:3584507 Date:Oct.26,2018 Applicable Customer Reguired Actions: Notes: • Other Before weatherization contracts can be issued customer is responsible for adding ventilation equal to or exceeding 2.4 square feet of net free area to the main attic and 1.28 square feet of net free area to the attic above the kitchen.Before weatherization contracts can be customer is responsible for repairing the hole in the chimney in the attic. Job Description Contractor will perform or cause to be performed the following work on these"Premises'in a professional manner and in accordance with the terms of this Contract,including the attached recommendations/work order describing the work in detail(the'Work")which are incorporated herein by reference. Air Sealing at Estimated 62.5 Cl Per Hour 1 D hr $925.80 $0.00 Hatch-2'Thermal Barrier Polyiso 1 each $46.28 $11.57 Cut and Finish Access 1 each $124.53 $31.13 Damming 54 each $129.06 $32.27. Attic Floor-10'Open Blow Cellulose 720 SF $1,368.00 $342.00 Attic Floor-W Open Blow Cellulose 384 SF $675.84 $168.96 Total: $3,269.51 Program Incentive: -$2,683.58 Weatherization Barrier Incentive: -$500.00 Customer Total: $85.93 Payment Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as[allows:Payment#1:$BBO as a Deposit payable to CLEAResult upon signing the Contract(not to exceed 11 of the total retail costs). Mail check 8 contract to CLEAResult,50 Page l D[a Washington Street,,Westborough, MA,01581.Final Payment:$95,93 as the final payment for the Work shall be payable to the Home Performance Contractor(HPC)or Independent Installation Contractor(IIC)upon satisfactory completion of the Work.Customer understands that he/she will not be required to pay the Utility Incentive Share of the Contract price in the amount of$3,189:58. Changes to individual line items and/or previous incentives may increase or decrease the size of the Utility Incentive Share. Dispute Resolution The IIC and Customer hereby mutually agree in advance,that In the event that the IIC has a dispute concerning this Contract,the IIC may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Pegulation and Customer shall be required to submit to such arbitration as provided in M.G.L.c 142A. You may cancel this agreement if it has been signed by a party at a place other than an address of the seller, provided you notify the seller in writing by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. {�,�j�f Yah'yCNc7 /Q MH Feb 27,2019 "71V Customer Signature Dale Indicate your selected IIC here. if applicable Initial here if you want the Program to assign a Participating Contractor t�Zw+ 'V'-Zlf/nUf✓Iiv� 2/26/19 Noam Perlmutter CLEAResull Signature Date Name of CLEAResult Representative Page 2 of 4 Permit Authorization VWM amass saves' Form Site ID: 3584507 Customer: ARIUN GUHA I, Patrick J. Melnik ,owner of the property located at: (l .e,Name,pfi ed) 76 Gothic St 2 Northampton, MA 01060 (Property Street Mdrem) ic") hereby authorize the Mass Save Home Entergy Services Program assigned Participating Contractor fated below to act on mybehalf and obtain a building permit to perform insulation and/or weatherization work on my property. Owner's SignaWre: f�at�i�lrt7/�/elrrik Off: Feb 27,2019 W BWWBpYYW6We WWO®diYiS80;8fl$8,5 JiMIIieG Y<.dtlb'WYWetl ie U.'.ea et0gg6Me ys,v'JM tiN uFtld uolaY iR M1B FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Todd CeJucc Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: P",1 of 1 Far Office Used,ty Rev.102015 DEBRIS FORM I In accordance with the provisions of MGL c.40,s.54,a condfUon of Buildirig Permit Number +� is that the debris resu@ing from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c.111,s.150A. This Debris will be disposed of in: � :3D LLr Rd , 5t fI _ 14t lebl� o l4� C•'Z`I , 3 (LOCATION OF FACILITY) Signature of Permit Applicant - 41gI19 Date IF DUMPSTER IS USED IN EXCESS OF SIX(6)CUBIC YARDS A PERMIT FROM THE FIRE DEPARTMENT IS RMUNtED FOR COMMERCIAL,INDUSTRIAL,INSTITUTIONAL.AND MULTI-FAMILY RESIDENTIAL OVER 20 UNITS DEMO, RENOVATIONS OR ALTERATIONS OF THE E7(ISTING BUILDING: CIRCLE ONE "`HAVE YOU 51LIBMITED THE AGN NOTIFICATION TO THE MASSACHUSETTS DEP? YES NO DESCRUMON OF WORK TO BE PERFORMED: USE GROUP: TYPE: ) Commercial: Residential: X Mixed Use: Accessory: Maintenance: New Structure on vacant land: Change of Use: Change of Occupancy: Addition: A►teration: Renovation: Repair. Demolition: Type of Foundation: I1 Ci T)Te of Frame:n I r• Wood: Manufactured: Steel: Heat: (11::" Gas: OR: Electric: Other: Style of structure: #of units: Owner Occupied: Structure#1 Dimensions: Square Footage: Straeture#2 Dimensions: Square Foots e: Structure#3 Dimensions: Square Footage., Bedrooms#• Baths#: Number of Decks: f`I ri Dimensions: §juare foot e: Number of Porches: (` -i Dimensions: Square foo e: Garage: #of cars: Dimensions: Square footage: (1 1" Under: Ground level: Pool: Depth: Dimensions: Square footage: (" 16 Heated: Above xround In und: Shed: ('\ I Dimensions: Square footage: Detail Description: Estimated Value of Pro'ect: $ .32ln 9 51 Official Use Only: Revised 07/2015 The Commonwealth ql Massachusetts Department bill lndustrial Accidents ul� I Congress Street,Suite 100 Boston, MA 02/14-1017 wlyw,mass.gop/dia \Corkers'Compensation Insurance.Affidavit: BnilderslContractors/Electrieians/Plumbers. TO RE PILED WITH THE PERMITTING ALTHORITY. Arafficantlifforractim Picasc Print Lcnibly NBllle (Rusiocxs/Oreeniaalion/L drvtduall ��r 1 '1 { .)i Il 1. �I I -. I'_7,_ J 1 1 . . �T— Address: -"� ">: b1I t, h. I has City/State/Zip f TI,1 H i r Phone it: Are mu an cmnloyer'Chex the ipyrovdnm n 'Type of project(required)'. I_MImna cmPloyer with_ _ amployccalnJl anNm Patl-limed 7 ❑ Nov,celistNetinn 2 1 o solupmynaoror potlnerzhlyavtlhuvcnncmPloyco wmking Nrmcio %. ❑ Remodel ing any capxdp_[No workoc c inn.1 �murce r,r-d.l u. ❑Demolition ho Iama0eomnadaiIBell,,)"myclf_horvorken.'camp ou-n-vucourld) 70❑ Budding addition 4❑I / 'III oull, , . ;I d 'Ilk P'ry'_ Iwill r:In�1pn oma-: imwl non.u, I_❑ 2l ectrmel rcpays or addiGora pnq,nacis wus oo yea. 12.❑Plumbing rcpuirs or additions s I - al 11 nl r vl n<nI I: lona -ncarbenl. mu.cul a. tach Axl mN s dl ewokL ' iva 13 ]Rood repairs orn14.©Other I (\'M 'I_,=1 - 6❑tv-im—awlforatio,,ol nIofr h rdsetl If .camp onMGtc 152.pg4).and we hwoao omylovcu.INn wolkui mop.inewnncc mgmmJ.i .As, pph—o fti,1w,k,h l ilve Ill Lo Ihe,,,i....b l i s P r Y f f IHomelwnr:11s,Ilwn,s Incandavl f-'liag lhy arid ' call workanl h ror lz duv I 1 caInk,Inbnl I a a1FAa lied argmch. drs Ifoannothat check it...box au,had an IMIllonal xheet,hs,,,u-It,name of fse subcnmracmrn anJ slate vhnhot ornm Ilmac emetics have mrplayc... Jihcxub-conrcvuorx M1avcm^ylaycm,Ihcy muq Prev4lolndr workers coeip.pollcynnmbcr I am an employer that isprovfiing workers'compensation insurancefar an,emplapees. Below is the policy andjob site information. ) Insurance Company Name.—, : Name , 1�I' Policy4orSelfms11c I rli Li Ixpuanon Date Job Site Addrt<sC %BlZip' ]/& /7ha � / _4!/ M( / fifi mA oiotoo Attach a copy of the workers'compensation policy declaration page(shoeing the policy number and expiration date). Failure In secure coverage as inquired under MGL c_ 152,Z25A is a edntinal violation punishable by a Gnc up to$1,5fq.IH1 and/or one-year imprisonment.as well as civil penalties in the Joint of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. A cope ofthis statement maybe forwarded to the Office of Investigation ofthe DLA for insurance coverage verification. I do hereby ceidip ander are pains and penalties nfperjury/hat the information pro•idedu wee i true �arnica rrera Si nature: 1__/.�L ��. tri � _-- —Date'-. .`T ,1ueI —.— Phone . (•:,iLtf�-.. —j�_—— _ --. _— —. _—. Official use only. Do not write in this area,hr be corrtpletedby city or torn ofjiciat. City nr Town: Permit/License q issuing Authority (circle one): I.Rowdofflealth 2.Rnilding Deportment 3-City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone q: s. R� �a CERTIFICATE OF LIABILITY INSURANCE 1221 NIDD"""' (+� 1/2/2019 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: N the carilRcata holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WANED,subject to the tsmis and condl8ons of the policy,certain policies may require an endorsement A statement on this cedl0cre does not confer rights to Me Certificate hostler in lieu of such andonsamem(s). PRODUCER CONTACT NAGE: Rosalyn Ddvila Loiselle Insurance Agency vxoxy (a01)T23-8510 FA .Aau 7xe-v9zD 279 Dexter Street 'Ms .roealymlBloiselleinsurance... P. O. Box 1148 INSURERS AFFORDING COWRAGE ZINC• Pawtucket RI 02862-1148 IN,UNEN, a to ere Mutual Csualt Co 21415 INSURED NSURER B' 5C ENERGY, INC' INSURER G' DBA AFFORDABLE BUILDING S NEELTBERIT.ATION INSURER D: 330 VICTOR RD-BUILDING A INSDRER E: AT I,EBORO NA 02703-6294 1 INSURER F: COVERAGES CERTIFICATE NUMBERMastar 2018 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 REOWREMENT. 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. INax TYPEOF NBVMXCE M PoLICVN UAm EN MEFF MGLKYEIIP MenS GENERALLJAINUIT EACH OCCURRENCE f 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMI*05 LEA Twopl f 500,000 A CIAIMSMADE O DLCUR D98029 2/2//2018 2/27/2019 MET EXE(My we persm) f 10,000 PERSONAL L ACU INJURY f 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT AFT ES PER: PRCOUCTS.C(MIPICP AGG $ 2,000,000 x PDMCY PxG LOC f AVIOMONLE LAIATTY .eNED LELI a mJeIt A ANY ALTO EMILY INJURY(Pw Pere-) s 20,000 ALLAUTO.PEC X AUTO.AC 898029 3/27/2010 2/27/2019 SOOILY INWRY IPeramtlelM1) f 40,00 X NIREOALT05 X NAHTNyI TPo �RT'0— IAM4GE f 5000 Uninsured M0yxW BIS IIInk f 1,000,000 X WORELIA Lay OCCUR EACH OCCURRENCE f 21000,000 A "CM LAB CIANSIUOE AGGREGATE f 2,000,DO CEO I x I BETEMIOH 10,00 J 8024 2/27/2018 2/27/2019 f A WORNERSCOMPFNSATON WCTAN OT4 AND SMPLOYERS'Mass TY YIN TXTYANY PROPRIETOWPAAINEACKEWTIVE E.L.EACH AWIDENT f 500,000 OFFICEWMEMBER EXCLU0E02 ❑ NIA rye,Wlory lnxp 8 s9802• 2/27/2018 L2/27/2019 EL DEFINE-EA FMFLOYE 500 000 x ndel DscRIPHONIPrwN OFmERATmNs xn. EL.TisEASE-Poucr uen S 500 000 DEBCRNlMN OPE VMBILOCATMNSIVEHMUS IAga[gpCORD I01,Addlgo,ul RenuM aeM1edule,Nmon epee N,pulnd) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 5C Energy, Inc. ACCORDANCE WITH THE POLICY PROVISIONS. DBA Affordable Building 6 Neatherization 330 Victor Road, Building A AUTHORIZED REPRESENTAmE Attleboro, RI 02703-6294 �L RnBal,nn Darile/ROSA ` C{W14. ACORD 26(2010/06) ®1988-2010 ACORD CORPORATION. All rights reserved. IN30251'mm— TFn el:rlpn nvme vM Innn aw renlerow,f M-b-M eLFlnn m -- HOME IMPROVEMENTCONTRACTOR ReSfabation valid far bldMOwl use only TYP Caoora3m beforadararpkslbndeM, lfbwW ads m: Taal IM Vh CoMbmlrA -Sulad BuefnYa RapdMlm - 0N772020 1000 Mhaldrgbrl3baal-Srlea 710 AFFORDASIE _ THERUATION INC BoshowLMA ONES tc; - TODD LEDUC 330 VICTOR RD. 1 ,, U ' NOS v011d WItlMul slgnilYro ATTLEBORO,MA - UndefeSCm�ly CorrenonweaHh of Massachusetts DNI9on of PlofesslOnal LCBnsnre Board of Building Regulations and Standards Construction Supervisor Specialty CSSL-106018 Expirea: 0226/2020 TODD LEDUC 33QVr330 VICTOR RD S7EA ATMESIORD MA M]0] n Commissioner /� 4/19/2019 Smn2019-04-19_073828.1Pg City of Northampton Massachusetts DEPARTMENT OF BCSLDZNG INSPECTIONS f atr 2:2 tlaic Street r Hunic2Fa: enild:nc �i� `a,.. 9o[thamp<on. KA 01050 Property Address. + �_r c Contractor Name. Address \ . ' e 1 City, State f�i—i t X ,r. ` j, Property Owner Name' Address'. tt City. State. r4' ! fel 111' I �rt� v _ (contractor) attest and affirm that the building I intend to insulate does no: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:his affidavit. Contractor signature Date http5'.I/mail.900911.11m/maiVu/0/#inb0x/FMfcgxwCgLnAKrmZgJgFwDwKrjmVpTk?projector=l&messagePanld=0.1 Vt