Loading...
25C-195 (9) 11 HIGHLAND AVE BP-2021-1411 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:25C- 195 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-2021-1411 Project# JS-2021-002350 Est.Cost: $600.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: MODERN ENERGY LLC 106112 Lot Size(sci. ft.): 4181.76 Owner: CHRISTINA RYAN Zoning: URC(100)/ Applicant: MODERN ENERGY LLC AT: 11 HIGHLAND AVE Applicant Address: Phone: Insurance: 12 HYCREST RD (508) 449-0449 WC CHARLTONMA01507 ISSUED ON:6/1/2021 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 NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. , 1 Q i 51- 1 • Certificate of Occupancy Signature:. FeeType: Date Paid: Amount: Building 6/1/2021 0:00:00 $65.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner /%•• IL, The Commonwealth of Massachusetks°F.o), ,C2/1 W Board of Building Regulations and Standar4.•,o� Massachusetts State Building Code, 780 CM'9'9,1 0, (2 IINI PALI USE ti Building Permit Application To Construct,Repair,Renovate Or 0 T' elb R ised Mar 2011 One-or Two-Family Dwelling -Io700e; Z ). This Section For Official Use Only S Buildin ermit Number: 6A-1 I"i ell i D e A ' d: EU/04S5 6'i"20Zi Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Number 11- 13 o�h l an d A-VP_ _2;.C. I�j'' 1.1a Is this an acceptedstreet?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❑ Zone: Outside Flood Zone? Municipal 0 On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Chr5-hno- ayOn Lk)(4h�a.rinp-k-on i MI\ Name(Print) City,State,ZIP 1 1-1 3 kishljnd Ave_ 413-535-772S c.r an 3rnl+h.e hi No.and Street Telephone tmail Adaess 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 specify: 1 n SU`Q+-i do Brief Description of Proposed Work': In5Ula4e C1+11C, wi-lh CeiluIOSP SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ i 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ DO" ❑ Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: r o A / Check No0 O Check Amount: Cash Amount: 6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 31ao J a oa3 5e Frey \J L ► oc� lla License Number Expiration Date Name of CSL Holder ID, ores ` q List CSL Type(see below) CSS No.and Street r Type Description C \ r,I4-on {(� ;l A o t 5 o� U Unrestricted(Buildings up to 35,000 Cu.ft.) Q "1 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry 5O O I.E L -1 _ lJ`t tI 1"1 1 q RC Roofing Covering 1 WS Window and Siding jecv6 moderneneray nouw•Corn SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) ql I4Iaoai HodeYn Ener�' LlC. HIC Registration Number Expiration Date HIC Company Name or HIC Registrant m a 1y c re_s+- R.d r-a( 18 8e105 No.and Street C_harl-bn _ MR 0156 i-oh1u Email address ? q �e�v6 modern ener134 now,cot" 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 DV No .❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDINGI/ PERMIT Z I,as Owner of the subject property,hereby authorize e ( Y ELf ILA v' to act on my behalf,in all matters relative to work authorized by this building perfnit application. See. Print Owner's Name(Electronic Signature) c,-N-(j(.h.d, Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest der the pains and penalties of perjury that all of the information contained in this application is true and acc e t e best of my knowledge and understanding. -3-ea Ulf 51-7 laoa�► Print Owner's or A thorize Agent's Name(Elec of c Si ature) 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 ,0:L1'f,ir IQ l. S Massachusetts 47_ !<< �% '•G pp✓ , k �:r t 1 DEPARTMENT OF BUILDING INSPECTIONS UJ, x . 4IV -o' 212 Main Street • Municipal Building yJd (•. gip^,-" Northampton, MA 01060 ssfh ��\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: (0 +, \--bpik\M-nn fZ.d \)\)QSThOYDUh , MA The debris will be transported by: Name of Hauler: L L Q.rv-e.� Signature of Applicant: qDate: 7 Lill-1 0 \\ The Commonwealth of Massachusetts i Department of Industrial Accidents --I Office of Investigations =� l Lafayette City Center _ \"; 2 Avenue de Lafayette, Boston,MA 02111-1750 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/organi7ation/lndividual):MODERN ENERGY LLC Address: 12 HYCREST ROAD City/State/Zip: CHARLTON, MA 01507 Phone#:508-449-0449 Are you an employer? Check the appropriate box: Type of project(required): 1.© I am a employer with 8 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 g. Demolition working for me in any capacity. employees and have workers' 9. Buildingaddition [No workers' comp.insurance comp. insurance.$ required.] 5. El We are a corporation and its 10.❑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 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no 13.❑ OtherINSULATION employees. [No workers' 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: TRAVELERS Policy#or Self-ins. Lie.#: 1 K07706-5 Expiration Date:12/06/2021 Oln0D Job Site Address: \ ` — 13 g - a�c A V� City/State/Zip: J 3(A-lam p ivn M A 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 pen ties of perjury that the information provided above is true and correct. Signature: Date: 5 7/a 0 i Phone#: 508-449-0449 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 31:City/Town Clerk 4.0 Electrical Inspector 5.alumbing Inspector 6.0Other Contact Person: Phone#: City of Northampton Massachusetts * <r A;.,' DEPARTMENT OF BUILDING INSPECTIONS ; 212 Main Street • Municipal Building Northampton, MA 01060 3i'h 3, l�. Property Address: \^'j }-� \(-)\ c C\ 1O V C. Contractor `} Name: Address: t 2_ lltc vc(.c'\- gct City, State: Cr)Q( \v fl i M Phone: 50 S" - 9 y q ` O1 q Property Owner Name: C rl Y i S-\ C7 -1.46 Gl'() Address: ( 7j h i r 1 f\C\ ltVV (; City, State: N 6-\Atl C mV"O C) 0 10(9 0 (contractor) attest and affirm that the building I intend to insulate dries 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 si Date (D 1 \ zoz\ DocuSign Envelope ID:D6725413-C468-43FA-BF58-4B5C04A97218 CLEAResult CONTRACT CLEAResult 50 Washington Street, Customer Name:CHRISTINA RYAN Westborough,MA,01581 Email:cryan@smith.edu Phone:413-535-7725 Premise Address:13 Highland Ave,Northampton,MA 01060 Mailing Address:13 HIGHLAND AV APT 2,Northampton.MA 01060 Project ID:4049659 Date:Aug.21,2020 Applicable Customer Required Actions: Notes: • Other The customer agrees that the masonry/foundation work in the basement will happen prior to the insulation contractor arriving. 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. • Location Q ntity _ Unit Total Cost• Air Sealing at Estimated 62.5 CFM50 Per Hour 6 hr $555.48 $0.00 Door Sweep(with AS hrs) 3 each $75.93 $0.00 Exterior Door Weather Stripping(with AS hrs) 3 each $90.21 $0.00 Hatch-2"Thermal Barrier Polyiso 1 each $46.28 $0.00 Damming 22 each $52.58 $0.00 Attic Floor-6"Open Blow Cellulose 518 SF $839.16 $0.00 Walls-Clapboard-4" Dense Pack Cellulose 728 SF $1,820.00 $0.00 Total: $3,479.64 Program Incentive: -$3,479.64 Weatherization Barrier Incentive: -$250.00 Customer Total: $-250.00 Payment Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows: Payment#1: as a Deposit payable to CLEAResult upon signing the Contract(not to exceed 1/3 of the total retail costs). Mail check&contract to CLEAResult,50 Washington Street, ,Westborough, MA,01581. Final Payment:-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 Page 1 of 4 DocuSign Envelope ID:D6725413-C468-43FA-BF58-4B5C04A97218 understands that he/she will not be required to pay the Utility Incentive Share of the Contract price in the amount of-. 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 Regulation 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. f DS —DocuSgned by: /h 11/10/2020 1 5:42 PM EST riitut 3f84fl'@N9 ature Date Indicate your selected IIC here,if applicable Initial here if you want the Program to assign a Participating kVi'A Contractor V� Colt 11/10/20 Kevin Cote CLEAResult Signature Date Name of CLEAResult Representative Page 2 of 4 DocuSign Envelope ID.D6725413-C468-43FA-BF58-4B5C04A97218 CLEAResult` CONTRACT CLEAResult 50 Washington Street, Customer Name:SUSAN LYNN MILLER Westborough,MA,01581 Email:Not provided Phone:413-535-7725 Premise Address:11 Highland Ave,Northampton.MA 01060 Mailing Address:11 HIGHLAND AVE,Northampton,MA 01060 Project ID:4049657 Date:Oct.21.2020 Applicable Customer Required Actions: Notes: • Other The customer agrees that the masonry/foundation work in the basement will happen prior to the insulation contractor arriving. 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. vocation Quantity Unit • Total Cost CustOmt bo , • Air Sealing at Estimated 62.5 CFM50 Per Hour 1 hr $92.58 $0.00 Door Sweep(with AS hrs) 2 each $50.62 $0.00 Exterior Door Weather Stripping(with AS hrs) 2 each $60.14 $0.00 Walls-Clapboard-4" Dense Pack Cellulose 832 SF $2,080.00 $0.00 Rim Joist-2"Thermal Barrier Polyiso 60 SF $286.80 $0.00 Rim Joist-6"Fiberglass Batting 86 SF $232.20 $0.00 Total: $2,802.34 Program Incentive: -$2,802.34 Weatherization Barrier Incentive: -$250.00 Customer Total: $-250.00 Payment Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows:Payment#1:I=as a Deposit payable to CLEAResult upon signing the Contract(not to exceed 1/3 of the total retail costs). Mail check&contract to CLEAResult,50 Washington Street, ,Westborough, MA,01581. Final Payment:®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-. Changes to individual line items and/or previous incentives may increase or decrease the size of the Utility Incentive Share. Page 1 of 4 DocuSign Envelope ID:D6725413-C468-43FA-BF58-4B5C04A97218 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 Regulation 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. os e--oocusgn.E by: /1 ._,L• 11/10/2020 I 5:42 PM EST t° 1 t,1'1itP I ture Date Indicate your selected IIC here, applicableInitial here if you if l uswant the Program 64:1.14.0 to assign a Participating Contractor 11/10/20 Kevin Cote CLEAResult Signature Date Name of CLEAResult Representative Page 2 of 4 DocuSign Envelope ID:D6725413-C468-43FA-BF58-4B5C04A97218 Permit Authorization mass save Form SaveYes&wou 1 energy MRci nc Site ID: 4049659 Customer: CHRISTINA RYAN Christina Ryan I, ,owner of the property located at: (Owner's Name,printed) 13 Highland Ave Northampton, MA 01060 (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: atiiStika, rya& arne1170eatnne Date' 11/10/2020 1 5:42 PM EST ••••••eee•*••e•ee•••••••••••••••• ••••••••••e•••••••••••••••••••••••• FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 For Office Use Only Rev.102015 A�® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 12/03/2020 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 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 Melissa Lotter NAME: Hometown Insurance Center,LLC PHONE FAX A/C.No,Ext): (508)347-9394 (A/C,No): (508)461-2035 590 Main Street E-MAIL mlotter@htownins.com ADDRESS: PO Box 541 INSURERS)AFFORDING COVERAGE NAIC to Sturbridge MA 01566 INSURERA: Maxum Indemnity Company INSURED INSURER B: Preferred Mutual Insurance Co. 15024 Modem Energy LLC INSURER C: Nautilus Insurance Company P 0 Box 88 INSURER D: Travelers Prop.Casualty Group TPC001 INSURER E: Northborough MA 01532 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2012203975 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 SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE ,INSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) UMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 CLAIMS-MADE XI OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 A BDG 3024078 12/06/2020 12/06/2021 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2.000,000 O- X POLICY JET LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ 20,000 B OWNED SCHEDULED PCA0100300844 09/01/2020 09/01/2021 BODILY INJURY(Per accident) $ 40,000 AUTOS ONLY _ AUTOS HIRED X NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY (Per accident) Underinsured motorist BI $ 1,000,000 X UMBRELLA UAB OCCUR EACH OCCURRENCE $ 5,000,000 C EXCESS UAB CLAIMS-MADE AN077914 12/06/2020 12/06/2021 AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN 000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1, ,000 D OFFICER/MEMBER EXCLUDED? n N/A 7PJUB-1K07706-5-19 12/06/2020 12/06/2021 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 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) Jeffrey Vlk is exempt from Work Comp coverage CLEAResult,Eversource and National Grid are listed as additional insureds on a primary and noncontributory basis,when 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 CLEAResult Attn:Contractor Services Dept ACCORDANCE WITH THE POLICY PROVISIONS. 50 Washington St AUTHORIZED REPRESENTATIVE pp�� � I Westborough MA 01581 (J©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD C?lite WOM-112494tWeelagitadaark- Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type LLC Registration: 188905 MODERN ENERGY LLC f. Expiration: 09/14/2021 12 HYCREST RD — t wstk 11111. CHARLTON,MA 01507 '0,,= r ___. ,fir 'fi r Update Address and Return Card. SCa . 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: R giatration Expiration Office of Consumer Affairs and Business Regulation 188905 09 14'2021 1000 Washington Street - Suite 710 MODERN ENERGY t_LC Boston.MA 02118 2 VLK 12 HYCREST RD �{�,.r.•o' ���+'�' CHARLTON,MA 01507 Undersecretary No lid without signature Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constructi\aorVisar Specialty CSSL-106112 fpires:03/20/2023 JEFFREY VIK 12 HYCREST RD CHARLTON MA 01507 f , . 1°0 4rirl:�l,/ Commissioner j�,0. K. pErnar.A..