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44-094 (5) 450 ROCKY HILL RD BP-2021-1504 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:44-094 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-2021-1504 Project# JS-2021-002500 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.): 32670.00 Owner: BERUBE TAMMY J&STEPHEN C Zoning: Applicant: ENERGIA LLC AT: 450 ROCKY HILL RD Applicant Address: Phone: Insurance: 242 SUFFOLK ST (413) 322-3111 WC HOLYOKEMA01040 ISSUED ON:6/16/20210:00:00 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. I 1 I ,� • U Certificate of Occupancy Signature:, 1(J FeeType: Date Paid: Amount: Building 6/16/2021 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner / /5) The Commonwealth of Massach W1S `/ Board of Building Regulations and`St. : ?0 FOR Massachusetts State Building Code, 78'O A'O/ �� USEeIPA ITY �nr�i USE Building Permit Application To Construct, Repair, Renovate 1$* s`• h a Revised Mar 2011 T One-or Two-Family4 Dwelling °'asAtc This Section For Official Use Only Buildin Permit Number: 6 f 'O,f r/sue Date Applied: EJraJ ' Kct-3 / /L_ A Za Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors1VIap&Parcel Numrs-.j 450 ROCKY HILL RD. (f 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: Public 0 Private❑ Zone: Ou Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: NORTHAMPTON MA 01062 STEPHEN BERUBE Name(Print) City, State,ZIP 450 ROCKY HILL RD. 413-214-4463 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: Attic Floor Open Blow Cellulose-hatch thermal barrier oolyiso-FG 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 Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees:$`i Check No.111k" Check Amount. 4- Cash Amount: 6.Total Project Cost: $3000.00 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 92540-U 9/02/21 TOM ROSSMASSLER License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 242 SUFFOLK ST No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) Holyoke,MA 01040 City/Town, 1 ZIP R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413 322 3111 ivelice@energiaus.com 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 Ah'h IDAVIT(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 mattersat relative to work authorized by this building permit application. -01 V 5 j = .�',t 6/09/21 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' this application is true and accurate to the best of my knowledge and understanding. 6/09/21 Print wner'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 S d:'I4*t‘'' ' t. A. :f.' Yy s• i Massachusetts % t (� DEPARTMENT OF BUILDING INSPECTIONS - 14 i �_;(71.-- 212 Main Street • Municipal Building C1� Northampton, MA 01060 '-fl't,ti. ..j,'10 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: USA Waste Signature of Applicant: - Date: 6/09/21 T. Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards CS-092540 • E fires:0210212021 THOMAS B ROSSMASSLER t 100 MAIN STREET . HATFIELD MA�01038 ` �1 • l• �'. r S C0MMISSiciSfli. /t/..t / ✓/r• �rvlr/lrrvrrpr(///, r,/ /6r44r7��ri4,-/4 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: Registration Expiration Office of Consumer Affairs and Business Regulation 165169 01/10/2022 1000 Washington Street -Suite 710 ENERGIA LLC Boston,MA 02118 I J M (r THOMAS ROSSMASSLER h....„- --. 242 SUFFOLK STREET ,,,,,#{&.1a'4' ��` HOLYOKE,MA 01040 Not valid without signature Undersecretary The Coasomomeselth qfhlassachasettr Dtparbtstnet qf Industrial AaaWesets .....--A,,.T...7,,. .........., Office of lavestigadon v LajilyeNe CV&Cotter --- ,g7 2 Avenue de Lafayette,Boston,MA 02111-17.51 ,...2.....," WWW.meass.goWdir Workers'Compensation Insurance Affidavit:General Businesses Appliquitinttrtnation Please Print Legibly Business/Organization Name:, ENERGIA LLC Address: 242 SUFFOL(ST, City/State/Zip: HOLYOKE,MA 01040 phone t 413-322-3111 Are you an employer?Check the appropriate box: Rosiness Type(reamilred). I,II I am a employer with 16 employees(full and' 5- 0 Retell or part-time).* 6. 0 Restaurant Establishment 2.0 1 am a sole proprietor Or partnership and have no 7, 0 Office and,or Sales(incl.real estate,auto,etc.) employees working for me tit any capacity. [No workers' comp.insurance required] t 0 Non-profit 3,Q We are a corporation and its officers have exercised 9. 0 Entertainment their right of exemption per c. 152,§1(4),and we have ion Manufacturing no employees, [Tt4o workers'comp. in.surance required]" 11.0 Health Care 4.0 We are a non-profit organization,staffed by volunteers, with no employee& No workers' comp.insurance req.] nil other INSURANCE *Any applicant that avecks taN 4 1 nitai.ai.44 BA out the w4aire Exit)*showing Briar Again'compensation pokey akimbo& "V the 4ozparate ofbeers have exempted thuasaires,bet the teeperatieel laas other araployees.a workers*co mpeasation policy a required and such an anal-loam=sae414 chows beat 11i.. I am a*employer that kprooleliqr workers'compeassarkter insoressoefir my entilloyees. Dokter is the pokey iolihresetials. insurance Company Name: GUARD 114SURANCE GROUP Insurer's Address: S 44.ill •_.1 r eity,State2ip: i ) (1,-4 c)/d ot2._ policy*orSens-ins,Lit.* ENWC162970 Expiration Date:741/2°21 Attach a copy of the woriten'compensation policy declarable.page(showiag the poky amber sad expiration date). Failure to secure coverage as required under§25A of MCI,c..152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as welt as civil penalties in the%cm of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a cop, of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification, Ida kerehy certify, pair sad pomades',pejo**et the hilbsisfilimproviisi above is , ad correct, Signature: Dana V Phone : 413-32 3111 Ext 122 P 1 Official mse only. Da not write in this area,is be coarkted by tip mime Wide City or Town: Permilltietase# Issuing Authority (check one): 1.DBoard of Health 2.0 Building Department 30 Cityrro'nn Clerk 4.0Liteasiug Board 5C Seirctinen's Office 6.DOther Contact Person: Mae it `4 N%A mass rlictia ENERLLC-01 CHRISTINE ACORCP CERTIFICATE OF LIABILITY INSURANCE OATEIMM/°DAYYY, 6/25/2020 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 Christine Sullivan NAME: Phillips Insurance Agency,Inc. PHONE 97 Center Street IAiC,No,Est):(413)594-5984 jia,No(413)59243499 Chicopee,MA 01013 Ar DBEs,christine FiFDphillipsinsurance.com INSURERS)AFFORDING COVERAGE NAIL* INSURER A:State Automobile Mutual Ins Co INSURED .INSURER a: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. LYRRSR 'ADDL.SUBR POLICY NUMBER TYPE OF INSURANCE INSD,wvO, POLICY EFF PWDD/EXP tMMtDDlYYW) tMM/OD/YYYYL, LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE I X I OCCUR PBP2870943 7/1/2020 7/1/2021 PREMtSEa aoNTEOenca) $ 100,000 — MED EXP(Any one person) A 5,000 PERSONAL tS ADV INJURY S 1,000,000 _Mt AGGREGATE LIMIT ARMS PER: GENERAL AGGREGATE $ 2,000,000 POLICY 0 Ta LOC PRODUCTS-COMP/OP AGO 3 2,000,000 OTHER: A Auromeme LIABILITY S COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X ANY AUTO _ BAP2477206 7/1/2020 7/1/2021 BODILY INJURY(Per person) $ AUTOS ONLY AUTOS H(�� yip BODILY INJURY(Per accident), S AUTOS ONLY A ONLY (Per accident)DAMAGE $ .$ A X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAR CLAIMS MADE P13P2870943 7/1/2020 7/1/2021 AGGREGATE $ 1,000,000 DED X RETENTIONS 0 $ B WORKERS COMPENSATION X I PERTUTE I I iRH. AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/EXECUT)VE Y/N ENWC162970 7/1/2020 7/1/2021 1,000,000 QFFlCERIMEMBER EXCLUDED? N NIA EL.EACH ACCIDENT S (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under E DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 i DESCRIPTION OF OPERATIONS t 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 Energia LLC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 242 Suffolk St. ACCORDANCE WITH THE POLICY PROVISIONS. Holyoke,MA 1040 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988.2015 ACORD CORPORATION. AR rights reserved. The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID:241541 B3-01A8-4D16-9517-CA20803DAE8E Alrft Permit Authorization mass save Form Swings:rrougts enemy.a: Site ID: 4208835 Customer: STEPHEN BERUBE l� stephen Berube , owner of the property located at: (Owner's Name,printed) 450 Rocky Hill Rd Northampton, MA 01062 (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 Signatur Sty p�/a�. l,,t,�1vr- 1E2267DD5EB74C1.. Date: 4/26/2021 ••••••••••••••••••••••••••••••••: *••••••••••••••i•••••••••••••••••••• 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 Fcr Office Use Orly