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18C-166 51 WARBURTON WAY BP-2021-1564 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18C- 166 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-2021-1564 Project# JS-2021-002594 Est.Cost: $5000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: NEWBURY INSULATION LLC 106113 Lot Size(sq. ft.): 0.00 Owner: RYAN JANET Zoning: URB(100)/ Applicant: NEWBURY INSULATION LLC AT: 51 WARBURTON WAY Applicant Address: Phone: Insurance: 34 MEADOW ST APT 6 (401) 309-2685 WC WOONSOCKETRI02895 ISSUED ON:6/30/2021 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. I �/• y g . I"1 Certificate of Occupancy signatu 1a • • ♦� I FeeType: Date Paid: Amount: Building 6/30/2021 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner / Jai/ C:0 The Commonwealth of WMassachusetts c'B Board of Building Regulations and Statldar8�r 4/ FO Massachusetts State Building Code, 780 C ,y vizn • M id ALITY Q 4ti, 4/(3 U.E Building Permit Application To Construct, Repair, Renovate Or ^! Pk7.1 <evise, Mar 2011 One-or Two-Family Dwelling n705004/s This Section For Official Use Only BuildingPermit Number: �j�-,4�/5"& Y Date Applied: rrt,1N' lax ,/i2- 6-aO-zpZ 1 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Asses r Map& Parcel Numbers 51 L )Qebvr$on WAuJ MOriMarn�}pNn f (. 6 (jli' 1.1 a Is this an accepted street?yes no Map Nuchl r Parcel Number P 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 la Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: a-ane'r RT►n Ivorkinampirx\ , MA G t( O Name(Print) City,State,ZIP 51 WGrbur�or, U...4.9411 2.50 3Q$'-1 ff,zzo2Q chco.co 0^ 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 CiSpecify:WtoeOnteme,+104% Brief Description of Proposed Work': f l r .i1 C t U u lost- a K<e- r too r a (t4q +• .1 S.meil C.rtc. op b)OWh Gt,\lut6u +oeximrk,r lMc..\\ SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ CJ 0jV I. 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 4,[ Check No.o heck Amount: 7 Cash Amount: 6. Total Project Cost: $ ej)60O 0 Paid in Full 0 Outstanding Balance Due: City of Northampton `fiti.►,ISl44 Ji: SNs....f s10 Massachusetts ��„ !i- X \, ' «iS DEPARTMENT OF BUILDING INSPECTIONS y hy 212 Main Street •• Municipal Building Jti b Northampton, MA 01060 r:bW 4,7SC PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW 1 & 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES, FENCES, GROUND MOUNTED SOLAR, ETC. I. Building Permit Application signed by legal owner and filled out by owner or authorized agent. • 2. One set of plans and specifications of proposed work. (Digital and hard copy) 3. Site plan with location of proposed structure(s) and set backs. • 4. Construction Debris Affidavit filled out and signed by applicant. • 5. Worker's Compensation Insurance Affidavit filled out and signed by applicant. • 6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance. 7. Energy Conservation Compliance Certificate (new/ replacement windows). 8. Home Owner's License Exemption Form filled out and signed by Homeowner (if applicable). 9. Note any Conservation and/or special permit requirements (if applicable). 10. Driveway Permit (if applicable). 11. Proof of Water and Sewer entry fees paid (if applicable). 12. Trench Permit - public land by DPW/ private land by Building Dept. 13. Stretch Energy Code - all new construction will require a HERS Rater Affidavit to be submitted with permit application before issuance of permit. 14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton. SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 1 OG 13 2 3 2 G- l �llt^!f1dk ti l , License Number Expir ion Date Name of• SL Holder `-' 34 �12c,clot� Road ap+ 6 List CSL Type(see below) No.and Street [� Type Description U.) nS0 G�-� '`T �2Y3Q S U Unrestricted(Buildings up to 35,000 Cu.ft.) 1 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry Si-r,r5ct.1 1 ( htWbu,r j 1 4St/�(C*` In .co M RC Roofing Covering `J WS Window and Siding SF Solid Fuel Burning Appliances 4 0 l '3aq 2675 Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 143% 7 8 1� z 3� z AJ'c(AA9k(_CA LncIA t Gi;oil HIC Registration Number Expiration Date HIC Company Nar►tts or HIC Registrant Name 3't NV2adow (2 tip+ 6 34r'„.ya1', @vle:,,,bv,ry;h1(Alw4-i(k).aim No.and Street Email address cA4on SaGke,4, RI O2$G S 40\3 vct 2685 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 Issu ce of the building permit. Signed Affidavit Attached? Yes ir No ..0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize Ai-ety ,��..Zi4 to act on my behalf,in all matters relative to work authorized by�uilding permit application. nt Owner's Name(Electronic Signature) 0y/D di r 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 application is true and accurate to the best of my knowledge and understanding. Co(at\-11 ner or Auth ' d 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 SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE City of Northampton Han'p, Massachusetts t" DEPARTMENT OF BUILDING INSPECTIONS % x 212 Main Street • Municipal Building Northampton, MA 01060 00NSTRUCTION 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: Li n EAV,a rinrntrvi-&.1 Location of Facility: Co,ra1 k)0rtr The debris will be transported by: Name of Hauler: f\lc' d (AJCCAn C4c) (:r Signature of Applicant: Date: C4/2-1/2 The Commonwealth of Massachusetts Department of Industrial Accidents _ =lc1 congress Street,Suite 100 =.;: Boston,MA 02114-2017 • www.massgov/dia IS takers'Compensation Insurance Affidavit:Builders/('ontractori''ElrctriciansFPluntbers. 14)BE l ll..Ll)V.I'fH IRE PERMIT171G Al'1 HORIT l_ Annikant Information � _ Please Print forcible Name(Busincss'Or�;anwation indiudual): '} )���V�{6 �n S\'Q4 vtM Address: ) Aivts„f;C/l.,.s R. 0/P4 6 Cityistaterzip:wb o nso Lk<r3 ( 62.Q cS Phone ii: {61 3 9'1 2-6 c S Are yea an aarple)rr?Chem the appropriate hoe: Type of project(required): l Ism a employca with Z , cmpluyees(full and-orport-time).• 7. p New construction 0 I am a wale proprietor in pwtncnhip and have no empkwees working for me ur S. Remodeling any capacity.(lvo workers'comp.urwrancx required.) 9. ❑Ikemolition 3FJ I am a honwowncr doing all work myself.[No wotke7.'comp.n utrawc napurcal.j I Q Building addition 4.0 I am a homeowner and will he hiring contractor%to conduct all work on my property.. I will emo a that all eunttactun either hate workers"curripLi satrun insurance or arc wale 11.0 Electrical repairs or additions per pnetaxs with no employee*. 12.0 Plumbing repairs or additions 50 I am a general contrackor and I hat c hired the+ub-conirackm hated on the auacired%hett 130 Roof repairs Thew sub-contractor,hone employee%and have workers'comp.insurance 14.[113tbertk)QC.iti.D We are a emptxation and its officer have examined their right of exemption per NU&c. ,u. "v 152,¢1(4).and we have no cirrployees.[No wnekcn'comp insurance requirevt j *Amy applicant that checks Isis n l mum clan fill out the whoa below showiq*air workers oaalpaemien policy iahttttniemi. *liomsowaien who NUN-AM 1110.atlitlnvii irelimairg they are dole all hark ad ire bine onside emtt>tmielem earn mill a mien affidavit iedicetityl sari :Contractors that check this boy must attached ae addition)ahem sttotriep tie ease edit 1111164.10110MCOONS amid Mee vibeiber or not ioar aotit ca haw employer?. It the.+ub-sonar cti.a hake erirloyccr.tbcV mot provide their worker*"comp.policy'number. I ant an employer that is providing weaken"compensation insurance for my employees: Below is the policy and job site information. Insurance Company Name: \--SR G.(QYI riftAk IA C. Pulu� »or Sell-ins.Lic.z: 81(4.14 Expiration Date: (Z(S/2,1 _. Job Site Address-5/ (/)C4 k (PeN i^' City/State2ip:N CJt c16't 0 It0,^I Mf N Ol O 66 Attach a copy of the workers'compensation patky declaration page(showing the policy number and expiration date). Failure to secure coverage as required under 144(iL 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. l do hereby certify under the pains and penalties ofpe►Jsert•that the information provided above'is true and correct. Signature: Date: 6124 2 CZ-I Phone»: yol Oct3 7465 Official use onit. Do not►►rite in this area.to be completed by city or town ofcial. City or Town: Permit/License# issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town(lark 4.Electrical Inspector 5. Plumbing Inspector 6.Other t'ontact Peison: Phone#: j _ y City of Northampton "Am, 0\ SAS s'„c, Massachusetts ��' 'e c ` �1 I�• {�f.,�1 DEPARTMENT OF BUILDING INSPECTIONS %. r 212 Main Street • Municipal Building d cD \ '!'�y"r:_ ` Northampton, MA 01060 ssNJy ar)\'‘J HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT `� y T�� (insert full legal name), born 2 1 '(insert month, day, year), hereby depose and state the following: 1. I am seeking a building permit pursuant to the homeowners' exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one-or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualifij for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel, I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this a Y day of 3 r'-. , 20 L( . (Signature) City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste 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. Address of the work: kiarbr-k,n wG y 1�r+i,,,,rfo,, , The debris will be transported by: l0.wbu�z The debris will be received by: L,^k ��,:orv\ww,. ,1 Building permit number: Name of Permit Applicant Gt C12.H 1Z ► Date Signature of Permit Applicant CONSTRUCTION CONTROL WAIVER From: To: Jonathan Flagg Building Commissioner City of Northampton 212 Main Street Northampton, MA 01060 The Massachusetts Building Code, section 107.1 allows for an exclusion from requirements for construction control in certain situations. In accordance with code section 104.10, I request that you grant a modification to waive the requirement for construction control of the project at because the work is of a minor nature, will not affect structural elements, health, accessibility, life or fire safety, and will be done in accordance with the prescriptive requirements of the code. Thank you for your consideration. Respectfully, G T`b,(A hot burc, ',4- -1,4^:s :< uns,ed1 ? RCS PLANVIEW DIAGRAM ___it e rno.to 1-1 EA __ _.. Customer: -SaAG+ 1Yai6- Home Phone: ( )- - \5 I ctl(.bur1 W Address: Work Phone: ( )- - Town: Cell Phone: ( -1 l3 )- 25.0 _ 09$1f Any limitations for access by large truck? No Yes If yes.describe ______ —_ Any specific directions or landmarks? No Yes If yes,describe. Site ID:—___ Energy Specialist: 3 I + Reviewed by: 0 At seealt"� - v WS'. ( t m 4- ie;fkt .- CUStonler "s SeCCnc{ fir= floor. 12~ torn blow Ceti- 7Yd 0 -frti n fk ei4 0 Aa+ C4- ? -tAerma( barrirr �IY -I f7jrnt7 a•rt.►i •te4 204 ' 7ia dr hd+s2 - c lap/ t/CLGors (i z rii7?6t V�eq:4 S- �d k f JKM%E- C(v l:oorpf Y icor z 6) gat* -Ca.. - ven+ +d rod- I (J alit hand- 12. 4iwse pock crit too l'. Walls - C!atboard- yr'd.ense pock cell- 4500 VW specto Mitt- Cosion+cr cocker rid# 8 e7--aCcras.- --- ----____-------.-------_----- Isluck of this she is bosom ore `fp' Wo urfcn Wars coal work order. Mr cos-fa/nee nee wfxud like use tine Sam- I/C.. r E---40---> Ogg OR o 32 O `� let SS- 0 . E11 =--7 1 . - VIEK 26 I'k V 0 For Office Use Only *1 tp ilk lyl►prkittle foto Y4',tts QLle 1 insaa,k 11.2 Xlcrr'cr c(opborz Qlls ei o, olar. Bushes Ladder Neighbor Proximity I Pocket Doors Insert Radiators I rence(s) Existing Conditions X=Access 0=Vents Note Inside Square R=Roof S=Soffit G=Gable RV=Ridge Vent CS=Continuous Soffit CDE=Continuous Drip Edge T=Triangle Install O=New Access Note in Circle C=Ceiling W=Wall S=Sheathing Temp Unless Noted Otherwise A=Vents Note in Triangle R=S"Roof S=Soffit G=Gable M=12"Mushroom For Access 2200-10-1/15 AR. 20 $32` ( o * 2) t�{ t" 26 noel .limpti C.N tG' CS d is er(e $FC{9 I� roraorn O ` . '` gY' Get. 1/4:0 itnyr Overt" 4 s 20 ' X Zo= /00A Wads 201 Yd X 7-S` Sod ' 2c yt7 c 5 /SU ' cfSd • I _ Recommended Ventilation Calculation WO/SCIo c 2•L47 ( EX;54p4t t-? Recommended Ventilation Calculation Air Sealing Work Hour Calculation 7Y0 Ci.2SJ = 1250 •Work Hours 4 6 8 10 12 14 16 (+2) Attic Sq.Footage <500 501-800 801-1100 1101-1400 1401-1700 1701-2000 2001-2300 Every 3008 Exceptional AFL Hours Primarily Floored Attics Chimney or BF=1 Hour Multiple Chimney/BF=2 Hours Prefab/Modular Hours No Chimney=4 Hours Chimney=6 Hours Exceptional KW Hours X<20 feet=1 Hour 20 ft<X<40 ft=2 Hours X>40 ft=4 Hours Rim Joist Only Hours RJ<150 ft=1 Hour RJ>150 ft=2 Hours WIT Ceiling Only Hours Ceiling Area<2.000 sq ft=1 Hour Ceiling Area 2.000 sq ft=2 Hours "'NOTE:You MUST be INSULATING RJ or Basement Ceiling to specify RJ or BMT Ceiling ONLY Air Sealing Hours"' CO,. ultipliers _>6"Loose Insulation Cross Batt Insulation — ---- - tl h. ` >6"Mix Batt&Loose insulation Truss Construction For Office Ilse Only 1 ..9z ro,r/xenog„.t6/ o;e)e.iae..,a.),w.; Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration A , :- ,�,1 Type: LLC _ r r Registration: 193878 NEWBURY INSULATION LLC = ..'`zz.- ' Expiration: 12/03/2022 MEADOW ROAD A i_ PT 6 ). WOONSOCKET,RI 02895 z i i raira 't 4, b ' sv, Update Address and Return Card. SCA 1 0 20M--00 5t17 .1r Miui„ ,:.iwrf14 ,/. l6'7linfival/' 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 Exoiration Office of Consumer Affairs and Business Regulation 193878 12.03,2022 1000 Washington Street -Suite 710 NEWBURY INSULATION LLC Boston.MA 02118 GUY J.TRINGALI 82 WENDELL AVE.STE 100 r� .+'l 'I '' APT 6 Undersecretary Not valid without signature PITTSFIELD,MA 01201 • • Commonwealth of Massachusetts Division of Professional Licensure BUILDING PERFORMANCE INSTITUTE, INC Board of Building Regulations and Standards 107 Hermes Road. Suite 210 Constructipoill*Wept Specialty Malta.NY 12020 �i l (877)274.1274 ! AR CSSL-106113 ,4' ..,. *pores:02/03/2023 wwwboi org '* GUY TRINGALI 34 MEADOW ROAD APT 3F '' 4_ WOONSOCKET RI 02895 - + `kY i fkv b* Guy Trill oils-43 �,t ii BP110e: Commissioner ,ti° o&nd.ra... CERTIFIED PROFESSIONAL * (sfE REVERSE SIDE,013 DfAM'')N"ANC E XP,ATi its;',A' Aco' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �� 1 isi2021 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 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). ACT PRODUCER cNAAME: Sandra Niederwimmer Hunter Insurance, Inc. PHONE FAX 389 Old River Road, P.O. Box 1 (A/c.No.Em):401-769-9500 (A/C.No):401-769-9502 IL Manville RI 02838-0001 AADDREss: sandy(cilhunterinsurance.net INSURER(S)AFFORDING COVERAGE NAIC t INSURER A:Ohio Mutual Insurance Company 25950 INSURED NEWBU-1 INSURER B:Beacon Mutual Insurance Co 24017 Newbury Insulation, LLC INSURER C:WESTCHESTER SURPLUS LINES INS CO 10172 Guy Tringali 34 Meadow Road INSURER D: Woonsocket RI 02895 INSURERS: INSURER F: COVERAGES CERTIFICATE NUMBER: 1257147215 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 TYPE OF INSURANCE N W SR, VD POLICY NUMBER MIPOLICY EFF POLICY EXP (MDOVYYYY) (MM/DDNYYY) LIMITS A GENERAL LIABILITY Y BP 0035443 9/14/2020 9/14/2021 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurrence) S 50,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $5,000 PERSONAL 8,ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 —1 POLICY n JEt° 1 LOC $ A AUTOMOBILE LIABILITY Y CPP0027300 9/14/2020 9/14/2021 COMBINED SINGLE LIMIT (Ea accident) $1.000.000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS _ AUTOS (Per accident) $ A X UMBRELLA LIAB OCCUR Y CX 0004015 9/14/2020 9/14/2021 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION 84427 12/5/2020 12/5/2021 WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 C Polution Liability G28338703 001 12/17/2020 12/17/2021 Limit 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Insulation CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Williamsburg No 1 Condominiums 185 Dudley Street AUTHORIZED REPRESENTATIVE Boston MA 02119 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID:3AA3ED36-3596-40E6-B620-36E825A3D723 CLEAResult CONTRACT CLEAResult 50 Washington Street, Customer Name:JANET RYAN Westborough,MA,01581 Email:Ibirdafh@a aol.com Phone:413-250-0954 Premise Address:51 Warburton Way.Northampton.MA 01060 Mailing Address:51 WARBURTON WA.Northampton,MA 01060 Project ID:4148091 Date:Jan.20,2021 Applicable Customer Required Actions: Notes: • Storage Removal 1.Please make sure the closet where the attic hatch is • Other located is free of storage 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. Measure Description Location Quantity Unit Total Cost Customer Cost Air Sealing at Estimated 62.5 CFM50 Per Hour Other 8 hr $740.64 $0.00 Door Sweep(with AS hrs) Other 2 each $50.62 $0.00 Exterior Door Weather Stripping (with AS hrs) Other 2 each $60.14 $0.00 Attic Floor- 12"Open Blow Cellulose Other 740 SF $1,509.60 $377.40 Hatch-2"Thermal Barrier Polyiso Other 1 each $46.28 $11.57 Damming Other 20 each $47.80 $11.95 Propavent Other 40 each $166.40 $41.60 Bath Fan- Vent to Roof Other 1 each $141.30 $35.32 Overhang- 12" Dense Pack Cellulose Other 100 SF $540.00 $135.00 Walls-Clapboard-4" Dense Pack Cellulose Other 450 SF $1,125.00 $281.25 Total: $4,427.78 Program Incentive: -$3,533.69 Customer Total: $894.09 Payment Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows:Payment#1:MUM 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:$596.09 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 Page 1 of 4 DocuSign Envelope ID 3AA3ED36-3596-40E6-B620-36E825A3D723 Work.Customer understands that he/she will not be required to pay the Utility Incentive Share of the Contract price in the amount of $3,631.69. 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 78 signing of th ne®nnet ,DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. rtO 3/2/2021 Newbury Insulation 8F2C8rD4036476... Customer Signature Date Indicate your selected IIC here, if applicable Initial here if you want the Program to assign a V V ceitt, Participating , ....4..m.it Contractor 1/21/2020 Kevin Cote CLEAResult Signature Date Name of CLEAResult Representative Page 2 of 4 DocuSign Envelope ID:3AA3ED36-3596-40E6-B620-36E825A3D723 Permit Authorization mass save Form Site ID: 4148091 Customer: JANET RYAN Janet Ryan I, , owner of the property located at: (Owner's Name,printed) 51 Warburton Way 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. 1----DocuSigned by: ialAV Owner's Signature: ..88F2C8FD40ff36476 3/2/2021 Date: 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 1of1 Fc ,i1ieUse r"=w