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38C-055 (3) 372 SOUTH ST BP-2021-1458 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:38C-055 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-2021-1458 Project# JS-2021-002419 Est. Cost: $6728.00 Fee: $45.50 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: MATTHEW RUSSELL - 5C ENERGY 106162 Lot Size(sq.ft.): 6011.28 Owner: ARBOUR PATRICK Zoning: URB(100)/ Applicant: MATTHEW RUSSELL - 5C ENERGY AT: 372 SOUTH ST Applicant Address: Phone: Insurance: 3820 DIAMOND HILL RD (401) 651-0003 () WC CUMBERLANDR102864 ISSUED ON:6/8/2021 0:00:00 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: 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. Q . , Certificate of Occupancy Signature:�JrA FeeType: Date Paid: Amount: Building 6/8/2021 0:00:00 $45.50 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner / /i• C T d•CQmmonwealth of Massachusetts FOR • ✓14/ : .:�•i of Building Regulations and Standards MUNICIPALITY �.{ 's J 42iot ,Mas achugetts State Building Code, 780 CMR USE -�. Noo�Q; . •'ng Permit •pplicgion To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 �rtiAM '°�c/isi, 'One.or Two-Family Dwelling .'61 o'ioNs This Section For Official Use Only Building Permit Number: 64 • /../V5S' Date Applied: LU1e-) (Z5 /// 6.a zoz Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Prop rty Address:, 1.2 Assessors Map & Parcel Numbers 3'1/ So fi h -ef-Y 9)Q C. 0c5 —(551 1.1a Is this an accepted street?yes y no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 24 Owner'of Record: D� O \(AC A )WY' I\IO1 1U..m�tcx`� MA D Name(Print) City,State,ZIP 3-12 gou.kh S . 4 3-L'q1-q l C)NUI)A On &6 WO"ceM No.and Street Telephone *OWNER'S Email Address MUST BE INCLUDED SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building❑ 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 Work: SEE CONTRACT SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ U 1rl 74s 1 zi-T 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fees: �.7 Suppression) !� Check No.37(J Check Amount: Cash Amount: 6.Total Project Cost: $ li3 2,/� 0 Paid in Full ❑ Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 106162 04/26/2023 MATTHEW RUSSELL License Number Expiration Date Name of CSL Holder R 3820 DIAMOND HILL ROA D List CSL Type(see below) No.and Street Type Description CUMBERLAND, RI 02864 U Unrestricted(Buildings up to 35,000 cu.ft) City/Town,State,ZIP R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 774-203-3704 Maryann @5CEnergyinc.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 195309 04/18/2023 MATTHEW RUSSELL HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 3820 DIAMOND HII I ROAD Maryann@5CEnergyinc.com No.and Street Email address CUMBERLAND, RI 02864 774-203-3704 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 MATTHEW RUSSELL to act on my behalf,in all matters relative to work authorized by this building permit application. 47e-t aft\ma G‘cre1,1 °Athol Om o&I 651D62_-1 _ 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 con •-. this application is true and accurate to the best of my knowledge and understanding. Ao' MATTHEW RUSSELL v(p 10-52-02--I 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.massgov/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" DESCRIPTION OF WORK TO BE PERFORMED: USE GROUP: TYPE: (X) Lk U CiM on Commercial: Residential: x . Mixed Use: A saucy: Maintenance:_._._ _ New Structure on vacant land: Change of Use: Change of Occupancy: Addition: Alteration: Renovation: Repair: Demolition: r Type of Foundation: n Q ripe of Frame:n La Wood: Manufactured: Steel: _ Heat: NCI Gas: Oil: Electric: Other: Style of structure: n(R #of units: Owner Occupied: , Structure#1 Dimensions: Square Footage: , Structure#2 Dimensions: Square Footage: Structure#3 Dimensions: Square Footage: , Bedrooms#: Baths#: Number of Decks:rlir1 Dimensions: Square footage: Number of Porches: l IC) Dimensions: _ Square footage: Garr #of cars: Dimensions: Square footage: f)1 G1 Under: Ground level: Pool: Depth: Dimensions: Square footage: n J O Heated: Above ground _ In ground: Shed: (1 i r Dimensions: Square footage: Detail Description: u t i1 1can bE . aD t-fQc Minuted Value of Project: $ (4) IT/ 2 S L ___ 1 Official Use Only: Revised 07/20 t 5 DocuSign Envelope ID:BF218F1F-9DB7-47BC-9915-9632ED7699C8 RISE ENGINEERING- OWNER AUTHORIZATION FORM I, Patrick Arbour (Owner's Name) owner of the property located at: 372 South Street (Property Address) Northampton, MA 01060 (Property Address) hereby authorize 5C- EnfYC -i \Y)L__ Subcontractor(to be filled Pn by office) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform 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. It is the homeowner's responsibility to close out this permit by contacting their municipality at the completion of this work. ceDocuSignod by: afvttc Qviiewr Owns 3t6`Pi tore 12/2/2020 111:21 PM EST Date RISE Engineering, a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335 www.RlSEengineering.com DocuSign Envelope ID:BF218F1F-9DB7-47BC-9915-9632ED7699C8 Federal ID#05-0405629 RISE Engineering RI Contractor Registration#8186 MA Contractor Registration#120979 RISE60 Shawmut,Canton,MA ENGINEERING CONTRACT - WZ (401)784-3700 FAX(401)784-3710 Page 1 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE ENGINEERING AND THE CUSTOMER FOR WORK AS CMA-HES DESCRIBED BELOW CUSTOMER PHONE DATE CLIENT• WORK ORDER Patrick Arbour (413)687-9359 11/30/2020 302630 38502 SERVICE STREET BILLING STREET PROPOSED BY: 372 South Street 372 South Street Daniel Diaz SERVICE CRY,STATE,ZP BILLING CITY,STATE,ZP Northampton, MA 01060 Northampton, MA 01060 DESCRIPTION QTY COST INCENTIVE TOTAL INCENTIVE 75% For eligible weatherization measures, Columbia Gas of Massachusetts is offering an incentive of 75% for insulation measures and 100%for the air sealing measures, both with no limit. You are eligible to apply for the 0% Heat Loan to finance your co-pay, applications must be submitted before the weatherization work begins. ASBESTOS HAZARD A blower door diagnostic test will not be conducted at your home,due to the possible presense of asbestos. KNOB&TUBE WIRING(Northhampton) us We have identified that your home might have Knob&Tube wiring Pa (initials) present.The following contract is not valid unless accompanied by the Pre-Weatherization Barrier Incentive form, signed by your licensed electrician. Work will not proceed with this work until we receive a copy of the form. ATTIC DAMMING-R-38 FIBERGLASS 80 $164.00 $123.00 $41.00 Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass balls for damming purposes. ATTIC FLAT- 12"OPEN R-42 CELLULOSE 576 $967.68 $725.76 $241.92 Provide labor and materials to install a 12"layer of R-42 Class I Cellulose to open attic space. ATTIC HATCH-SEAL& INSULATE 1 $60.00 $45.00 $15.00 Provide labor and materials to insulate the back of an attic hatch with 2"rigid insulation board. Weatherstrip the perimeter. VENTILATION CHUTES 24 $60.00 $45.00 $15.00 Provide labor and materials to install ventilation chutes in the rafter bays to maintain air flow. INSULATED BATH EXHAUST HOSE 4 INCH 1 $60.00 $45.00 $15.00 Provide labor and materials to install an insulated 4"exhaust hose to existing bathroom fan(s). SOFFIT VENTS 6 X 16 4 $115.64 $86.73 $28.91 Provide labor and materials to install 6"X 16"rectangular aluminum soffit vents to increase ventilation in attic areas. Specify color:White or Gray. uocuwgn tnveiope Iu:t31-21W-1F-91)b1-47E3C-9915-9632tU7699G8 Federal ID#05-0405629 RISE Engineering RI Contractor Registration#8186 MA Contractor Registration 4120979 RISE60 Shawmut,Canton,MA ENGINEERING" CONTRACT - WZ (401)784-3700 FAX(401)784-3710 Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE ENGINEERING AND THE CUSTOMER FOR WORK AS CMA-HES DESCRIBED BELOW CUSTOMER PHONE DATE CLIENT WORK ORDER Patrick Arbour (413)687-9359 11/30/2020 302630 38502 SERVICE STREET BILLING STREET PROPOSED BY: 372 South Street 372 South Street Daniel Diaz SERVICE CITY,STATE,ZIP BILLING CITY.STATE,ZS' Northampton, MA 01060 Northampton, MA 01060 DESCRIPTION QTY COST INCENTIVE TOTAL HOME AIR SEALING 7 $595.00 $595.00 Provide labor and materials to seal areas of your home against wasteful,excess 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 AND ADD DOOR SWEEP 3 $240.00 $240.00 Provide labor and materials to install Q-lon weatherstripping and a doorsweep to door(s)to restrict air leakage. WALLS ALUMINUM SIDED 1,773 $4,290.66 $3,218.00 $1,072.66 Provide labor and materials to install blown in Class I Cellulose to aluminum-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. BASEMENT SILLS R19 FIBERGLASS BATT 90 $175.50 $131.63 $43.87 Provide labor and materials to install R-19 unfaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. DocuSign Envelope ID:BF218F1F-9DB7-47BC-9915-9632ED7699C8 Federal ID#05-0405629 RISE Engineering RI Contractor Registration#8186 MA Contractor Registration#120979 RISE60 Shawmut,Canton,MA ENGINEERING` CONTRACT - WZ (401)7843700 FAX(401)784-3710 Page 3 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE ENGINEERING AND THE CUSTOMER FOR WORK AS CMA-HES DESCRIED BELOW CUSTOMER PHONE DATE CLIENT 0 WORK ORDER Patrick Arbour (413)687-9359 11/30/2020 302630 38502 SERVICE STREET BILLING STREET PROPOSED BY: 372 South Street 372 South Street Daniel Diaz SERVICE CITY,STATE,ZP BILLING CITY,STATE,ZIP Northampton, MA 01060 Northampton, MA 01060 DESCRIPTION QTY COST INCENTIVE TOTAL PRE-TEST WORK-SCOPE REVIEW-RISE TECHNICIAN Prior to the installation of any of the weatherization measures, your home will need to have a work-scope verification conducted by a RISE Technician,and a combustion safety test to check all the combustion appliances.This test will check the existing carbon monoxide levels in each appliance, how well the fumes exhaust out of your home, and the amount of available air-flow in your home. Total: $6,728.48 Program Incentive: $5,255.12 Customer Total: $1,473.36 WE AGREE HEREBY TO FURNISH SERVICES•COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***One Thousand Four Hundred Seventy-Three & 36/100 Dollars $1,473.36 UPON RECEIPT OF YOUR RISE ENGINEERING INVOICE,CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHE DUIINO,AND CONTRACTOR REGISTRATION. —DocuSigncd by: ,,—DocuSigned by: Ply P Qvi,ol,w 12/2/2020 I 11:21 PM EST NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE SIGN DATE 30 DAYS. ACCEPTANCE OF CONTRACT•THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTUNED ABOVE City of Northampton CD :' Sic Massachusetts mow? .. '<< DEPARTMENT OF BUILDING INSPECTIONS . r • .r`� �� 212 Main Street • Municipal Building Jti -'aes , e ' Northampton, MA 01060 sf XI* ,. ,' CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, 554, 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: 330 Victor Road, Attleboro, MA. 02703 Location of Facility: The debris will be transported by: 5C Energy, Inc. Name of Hauler: ie Signature of Applicant: 1 Date: Bv1 G-7jl217,---\ oa- -o City of Northampton jt ii Massachusetts a�d "'�, lc f": { L`%1 0 DEPARTMENT OF BUILDING INSPECTIONS ilZ �'1P",e„ / 212 Main Street • Municipal Building ��w���.�•�� Northampton, MA 01060 444 . A Property Address: A� �(A,0 V 1 WR Q�t Contractor j t C(` LkC7:"C- k 11 Name: �/� Itl Address: ')%-�`1) ( -\\\\ 2L City, State: 4 't�-� (I251 Oq Phone: -11`-C ' _ — (loll Property Owner � _ Name: A VIODU r' Address: 0)11. xyrnSAYQe.1- City, State: kV O A haxi,,ip 1Un I V1C(Ad Matthew Russell ,` I, (contractor) attest and affirm that the building I intend to insulate does not have any open -ib and tube) wiring in the spaces to be insulated and that I have provided the property owner w" a copy of this affidavit. Contractor signature le Date L, \71)\ L__L _� The Commonwealth of Massachusetts At Department of Industrial Accidents = 51- 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual):5C Energy, Inc Address:330 Victor Rd. Bldg A City/State/Zip:Attleboro, MA 02703 Phone #:401-651-0003 Are you an employer?Check the appropriate box: Type of project(required): l.0 I am a employer with 30 employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. ID Remodeling any capacity.[No workers'comp.insurance required.] 3.0I am a homeowner doing all work myself.[No workers'comp.insurance required.]' 9. El Demolition 10❑ Building addition 4.0I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.EI Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.1 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.pother Insulation 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box 141 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. `*Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Employers Mutual Casualty Co. Policy#or Self-ins.Live. #:5,H98024 Expiration Date:12/27/2021 X Job Site Address: ? Il- ()11.C� , 7Iv.�-� City/State/Zip:1\101,t- (Amc X \ MA 010(CO Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiracion date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi u er thep ins and penalties of perjury that the information provided above is true and correct. Signature: • Date: b(-P -262-1 Phone: 857-334-4693 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: DATE(MM/DDNWY) ACoRIJ CERTIFICATE OF LIABILITY INSURANCE 12/30/2020 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 Rosalynn Davila NAME: Loiselle Insurance Agency PHONE Ezt): (401)723-8510 (NC,No): (401)728-1820 279 Dexter Street E-MAIL rosal nn loiselleinsurance.com ADDRESS: y P.O.Box 1148 INSURER(S)AFFORDING COVERAGE NAIC# Pawtucket RI 02852-1148 INSURER A: Employers Mutual Casualty Co 21415 INSURED INSURER B: Evanston Ins Co 35378 5C ENERGY,INC. INSURER C: 330 VICTOR RD-BUILDING A INSURER D: INSURER E: ATTLEBORO MA 02703-6294 INSURER F: COVERAGES CERTIFICATE NUMBER: Master 2020-2021 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 POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO CLAIMS-MADE X OCCUR PREM SES Ea occuE ence) $ 500,000 MED EXP(Any one person) $ 10,000 A 5D98024 12/27/2020 12/27/2021 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY n jE T n LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ 20,000 A OWNED v SCHEDULED 5Z98024 12/27/2020 12/27/2021 BODILY INJURY(Per accident) $ 40,000 AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ 5,000 X AUTOS ONLY X AUTOS ONLY (Per accident) Uninsured motorist BI $ 1,000,000 X UMBRELLA LIAB """ 2,000,000 _ OCCUR EACH OCCURRENCE $ A EXCESS LIAB CLAIMS-MADE 5J98024 12/27/2020 12/27/2021 AGGREGATE $ 2,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER v 1 N 500'000 A ANY OFFICER/MEMBER PROPRIETOR/PARTNER/EXECUTIVE N/A 5H98024 12/27/2020 12/27/2021 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Contractors Pollution Liability B CPLMOL103296 06/16/2020 06/16/2021 Aggregate $250,000 Each Occurrence $250,000 DESCRIPTION OF OPERATIONS/LOCATIONS I 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 5C Energy, Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 330 Victor Road,Building A AUTHORIZED REPRESENTATIVE /� �a�� Attleboro MA 02703-6294 Lte M �p T, ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Con struction,Sud4Mapr Specialty CSSL-106162 Expires : 04/26/2023 MATTHEW J RUSSELL Adintiois, 3820 DIAMOND HILL RD CUMBERLAND RI 02864 I * at ( le Commissioner itjhAA,4)4( � - - Construction Supervisor Specialty Restricted to: CSSL-IC - Inst 3tion Contractor Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call (617) 727-3200 or visit www.mass.gov/dpl 1 4/15/2021 Office of Consumer Affairs&Business Regulation-Mass.Gov Mass.gov Office of Consumer Affairs and Business Regulation (UCABR) HIC Registration Complaints Registration 195309 Registrant Matthew Russell Name Matthew russell Address 3820 Diamond Hill Rd City, State Cumberland, RI 02864 Zip Expiration 04/18/2023 Date Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search Site Policies Contact Us ©2018 Commonwealth of Massachusetts. Mass.Gov®is a registered service mark of the Commonwealth of Massachusetts. https://services.oca.state.ma.us/his/licdetails.aspx?txtSea rchLN=195309 1/1 1/22/2021 Office of Consumer Affairs&Business Regulation-Mass.Gov Mass.g4i office of Consumer Affairs and Business Req u ati on (OCABR) HIC Registration Complaints Registration 194390 Registrant 5C ENERGY, INC. Name Walter Colwell Address 18 Greystone Road City, State Marblehead, MA 01945 Zip Expiration 01/30/2023 Date Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search Site Policies Contact Us ©2018 Commonwealth of Massachusetts. Mass.Gov®is a registered service mark of the Commonwealth of Massachusetts. https://services.oca.state.ma.us/hic/licdetails.aspx?txtSearchLN=194390 1/1