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15B-001 (11) 380 CHESTERFIELD RD BP-2021-1113 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 15B-001 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit# BP-2021-1113 Project# JS-2021-001876 Est.Cost: $3000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ENERGIA LLC 92540 Lot size(sq.ft.): 2073456.00 Owner: MCGAUGH ZACH Zoning: RR(100)/ Applicant: ENERGIA LLC AT: 380 CHESTERFIELD RD Applicant Address: Phone: Insurance: 242 SUFFOLK ST (413) 322-3111 WC HOLYOKEMA01040 ISSUED ON:4/2/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:INSULATIONNVEATHERIZATION 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 NO 'THI• PTO UP 1 IOLATION OF ANY OF ITS RULES AND REGULATIONS. I` • ,, , • Certificate of Occupancy Signature: ' I FeeType: Date Paid: Amount: Building 4/2/2021 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner r ( R i • c0? / The Commonwealth of Massachuseft§z o- Vi Board of Building Regulations and StandgMn h,o�n�,, 'MUNICIOPALITY Massachusetts State Building Code, 780 CMR N.r� F^ri..,.,� 0 0 u,,,s, USE Building Permit Application To Construct, Repair, Renovate Or DemolisE a- Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Builddii g Permit Number: b P.4 lI --i l 1 3 Date Applied: 7,/ /1FJ1/.� l as -1/-& ` -Z'ZOZI Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 AsseAors Map& Parcel Numbers 380 CHESTERFIELD RD. S b 6'0 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.I,c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: Outside Flood Zone? Municipal❑ On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: ZACH MCGAUGH NORTHAMPTON,MA 01053 Name(Print) City, State,ZIP 380 CHESTERFIELD RD. 210-454-3662 ivelice@energiaus.com 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 la Demolition 0 Accessory Bldg.❑ Number of Units Other 0 Specify:INSULATION Brief Description of Proposed Work2: INSLULATION TO ATTIC FLOOR OPEN BLOW CELLULOSE Kneewall Wall Thermal Barrier Polyiso-Damming SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $3000.00 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List:_ 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No.70hOCheck Amount: (�P'5 Cash Amount: 6.Total Project Cost: $3000.00 ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 92540 9/2/21 TOM ROSSMASSLER License Number Expiration Date Name of CSL Holder List CSL Type(see below) u 242 SUFFOLK ST No.and Street Type Description Holyoke,MA 01040 U Unrestricted(Buildings up to 35,000 Cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-322-3111 I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 165169 1/10/22 ENERGIA LLC HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 242 SUFFOLK ST ivelice@energiaus.com No.and Street Email address Holyoke, MA 01040 413-322-3111 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 .❑ 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 TOM ROSSMASSLER\Energia LLC to act on my behalf,in all matters relative to work authorized by this building permit application. SEE PERMIT AUTHO 3/31/21 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 applic ion is true and accurate to the best of my knowledge and understanding. 3/31/21 Print Owner's or A orized 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/dos 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 ,�.of T� !4r!/. Massachusetts , -*7. --..\\\ f , I 1�,\ ;,> K DEPARTMENT OF BUILDING INSPECTIONS {�S I � � 212 Main Street • Municipal Building IF � Northampton, MA 01060 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: Rose St Springfield MA _ The debris will be transported by: Name of Hauler: ALLIED WASTE Signature of Applicant: Date: 3/31/21 DocuSign Envelope ID:D88F479E-F29C-4D0E-9236-8F695C0FF27B rk Permit Authorization mass save Form Site ID: 4124190 Customer: ZACH MCGAUGH 1, zach McGaugh ,owner of the property located at: (Owner's Name,printed) 380 Chesterfield Rd Northampton, MA 01053 (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. —DocuSigned by: Owner's Signature: iiAA. ,AlAiit, `---A9746FD7675846R.. Date: 2/11/2021 FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: ecutkom_ Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page l of l ;Li Jffi.=e'- e Cr-I; Rev. 102015 �,......1, ENERLLC-01 CHRISTINE ,4�oRo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDnYYY) 6125/2020 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 pollcy(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 NapleCT Christine Sullivan Phillips Insurance Agency,Inc. PHONE ) (A/C,No,Ext):(413)594-5984 I FAX No1:(413 592-8499 97 Center Street Chicopee,MA 01013 Aob iss;christine@phillipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:State Automobile Mutual Ins Co INSURED INSURER B:Guard Insurance Group Energia LLC INSURER C: 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 ADDL SUBR POLICY EFF POUCY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD(YYYY1 IMMIDD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PBP2870943 7/1/2020 7/1/2021 PREMISES(aoccu encc $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE i --� LIMIT APPLIES LOC PER: GENERAL AGGREGATE $ 2,000,000 I POLICY Te ul PRODUCTS-COMP/OP AGO $ 2,000,000 OTHER: $ COMBINED SINGLE LIMIT 1,000,000 A AUTOMOBILE LIABILITY (Ea accident) $ X ANY AUTO BAP2477206 7/1/2020 7/1/2021 BODILY INJURY(Per person) $ — — OWNED SCHEDULED AUTOS ONLY _ AUTOS y�.� p BODILY INJURY(Per accident) $ _ AUTOS ONLY _ AUTNOS ONLY (Per accident)DAMAGE $ $ A X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS UAB CLAIMS-MADE PBP2870943 7/1/2020 7/1/2021 AGGREGATE $ 1,000,000 DED X RETENTION$ 0 _ 1 $ B AND EMPLOYERS'UABIUTY X STATUTE I I EERH ANY PROPRIETOR/PARTNER/EXECUTIVE YIN ENWC162970 7/1/2020 7/1/2021 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED, N N 1 A 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 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 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 46/i4 - 1 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constivtlitin Sipervicor CS-092540 spires:09/02/2021 THOMAS B ROSSMA SLER' 100 MAIN STREET .y,:G" HATFIELD MA.01038� r ri Commissioner .TF Ke:menewe ff ,/.ieee<s zeik fella Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: Reaistrattbit Expiration Office of Consumer Affairs and Business Regulation 185169 01/10/2022 1000 Washington Street -Suite 710 ENERGIA LLC Boston,MA 02118 THOMAS ROSSMAS$LER 242 SUFFOLK STALtEP n.4e4 t'cGGr�i HOLYOKE,MA 01040 Undersecretary Not valid without signature \ The Commonwealth of Massachusetts �B Department of Industrial Accidents _L Office of Investigations ={ =w�1._ Lafayette City Center � Sb�� ,,,, 2 Avenue de Lafayette, Boston,MA 02111-1750 www.mass.gov/dia Workers'Compensation Insurance Affidavit: General Businesses Applicant information Please Print Legibly Business/Organization Name: ENERGIA LLC Address: 242 SUFFOLK ST. City/State/Zip: HOLYOKE, MA 01040 Phone#: 413-322-3111 Are you an employer? Check the appropriate box: Business Type(required): 1.® I am a employer with 16 employees (full and/ 5. ❑Retail or part-time).* 6. ❑Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7. ❑Office and/or Sales(incl. real estate,auto,etc.) employees working for me in any capacity. [No workers' comp. insurance required] 8. ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemption per c. 152, §1(4),and we have 10.0 Manufacturing no employees. [No workers' comp. insurance required]** 11.❑ Health Care 4.❑ We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp. insurance req.] 12.11 Other INSURANCE *Any applicant that checks box#1 must also fill out me section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#1. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name: GUARD INSURANCE GROUP Insurer's Address: R >o G E/2-�1 1 oe, , City/State/Zip: A/a1rn Z'// ,/'¢ Policy#or Self-ins. Lic. # ENWC162970 Expiration Date:7/01/2021 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under§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, unde a pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 3 g Zit Phone#: 413-32 111 Ext 122 I 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): I.DBoard of Health 2.0 Building Department 3.❑City/Town Clerk 4.❑Licensing Board 5.0 Selectmen's Office 6.DOther Contact Person: Phone#: www.mass.gov/dia