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25C-013 (5) BP-2021-2093 14 DAY AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 25C-013-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2021-2093 PERMISSIONIS HEREBY GRANTED TO: Project# INSULATION Contractor: License: Est. Cost: 12000 ENERGIA LLC Const.Class: Exp.Date: MCLAUGHLIN, LORELEI E &REBECCA C WRIGHT Use Group: Owner: &MYLES L DAKIN &BENJAMIN M SACHS-HAMIL Lot Size (sq.ft.) ENERGIA LLC MCLAUGHLIN, LORELEI E& REBECCA C WRIGHT&MYLES L DAKIN & Zoning: URB Applicant: BEN.JAMIN M SACHS-HAMIL Applicant Address Phone: Insurance: 242 SUFFOLK ST (413)322-3111 ENWC162970 HOLYOKE, MA 01040 14-16 DAY AVE NORTHAMPTON, MA 01060 ISSUED ON:10/28/2021 TO PERFORM THE FOLLOWING WORK: 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. Signature: 4 )2 9-1 Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner 1% � The Commonwealth of Mas�achu tts� C . Board of Building Regulatio and and�d�,. FOR "� ,� M s' CIPALITY W Massachusetts State Buildinode 80 CM .e� USE o�, D�1 Building Permit Application To Construct, it-:.ir, ... .te Or DeI orish a R.,ised Mar 2011 One-or Two-Family Dwel 1 : ryq _ito�tio This Section For Official Use On �°N'"1SA _ Buildi Permit NNuumber: L '?-)' ?t 3 Date Applied: °'�soONs 6 Building ,./Z Official(Print Name) Signature Date gn SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 14 DAY AVE � C.,, 01) 1.1 a Is this an accepted street?yes no Map N um r 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' 2.1 Owner'of Record: REBECCA WRIGHT NORTHAMPTON MA 01060 Name(Print) City, State,ZIP 14 DAY AVE. 802-999-1021 ben.sachshamilton©gmail.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 0 Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify:INSULATION Brief Description of Proposed Work':INSULATION WALLS VINYL SIDED DENSE PACK CELLULOSE SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $12,000.00 1. Building Permit Fee: $ Indicate how fee is determined: 2 Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ I Suppression) Total All Fees: f Check No.1 !Check Amount: Cash Amount: 6.Total Project Cost: $12,000.00 0 Paid in Full 0 Outstanding Balance Due: I I 1 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 92540 9/2/23 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.) City/Town,State,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 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 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 Energia LLC Thomas Rossmassler to act on my behalf,in all matters relative to work authorized by this building permit application. 10/8/21 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 ication is true and accurate to the best of my knowledge and understanding. 10/8/21 Print 0 s or Authorized Agent's Name(Electronic Signature) Date NOTES: I. 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(H1C)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. I42A.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 Massachusetts �47 j rDEPARTMENT OF BUILDING INSPECTIONS ,'�r 212 Main Street • Municipal Building �[-�!r~ Northampton, MA 01060 f't,i. t-)%V'D 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: 10/8/21 Permit Authorization mass save Form Site ID: 4275199 Customer: REBECCA WRIGHT I, Rebecca Wright , owner of the property located at: (Owre-'s Name,arintedj 14 Day 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. Owner's Signature: Rebecca GJrtyhf Date: 09 / 09 / 2021 FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: - &7(212,./A L Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 FcrOffice Use Orly Document Ref:KYK2P-RQ7EP-4BTYE-QF4FP Page 6 of 7 1 Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Onst$ pt$ i$or S 0925d0 - Eufpires:09/02/2023 THOMAS B ROSS `1 100 MAIN STREET FIELD MA 0 • Commissioner Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:LLC Registration valid for individual use only Registration Expiration before the expiration date. If found return to: Registration 01/10/Lion Office of Consumer Affairs and Business Regulation ENERGIA LLC 1000 Washington Street -Suite 710 Boston,MA 02118 242 SUF RLK STREET R 242 SUFFOLK STREET ,,��.��• ; HOLYOKE,MA 01040 Not valid Without signature Undersecretary ��..IN ENERLLC-01 JOCELYN AAcCAREP• CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/Yrvv) 16.-- 6/4/2021 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 Jocelyn M Douglas Phillips Insurance Agency,Inc. PHONE I FAX 97 Center Street (A/C,No,Ext): (A/C,No): Chicopee,MA 01013 E-MAILDSS:Jocelyn@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 TYPE OF INSURANCE ADDL SUER W POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD VD -(MM/DDM'YY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PBP2870943 7/1/2021 7/1/2022 DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 I GEN'L AGGREGATE LIMIT APPLIES PER: - GENERAL AGGREGATE $ 2,000,000 POLICY X PET LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO BAP2477206 7/1/2021 7/1/2022 BODILY INJURY(Per person) $ — OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED ONLY NON-OWNETOS D PROPERTY DAMAGE) $ $ A X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE PBP2870943 7/1/2021 7/1/2022 AGGREGATE $ 1,000,000 DED X RETENTION$ 0 $ B WORKERS AND EMPLOYERS'LIABIII X PER 1 ER LIITY STATUTE I Y/NH ANY PROPRIETOR/PARTNER/EXECUTIVE ENWC203063 7/1/2021 7/1/2022 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (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) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,Energia LLC ACCORDANCE WITH THE POLICY PROVISIONS. CE WILL BE DELIVERED IN 242 Suffolk St. Holyoke,MA 1040 AUTHORIZED REPRESENTATIVE i/�v..rY `-^-tom ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • • !3 .. i• t r a - ... j' .! " The Commonwealth of Massachusetts Department of Industrial Accidents { Office of Investigations fi Lafayette City Center 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• U 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. nNcn-profit 3.❑ We are a corporation and its officers have exercised 9. n Entertainment their right of exemption per c. 152, §1(4),and we have 1 0.n Manufacturing no employees. [No workers' comp. insurance required]** 1 I. Health Care 4.❑ We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp. insurance req.] 12.M Other Insulation *My applicant that checks box#1 must also fill out the 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: 14 day ave City/State/Zip: Northampton MA 01060 Policy#or Self-ins. Lic. # ENWC203063 Expiration Date: 7/01/2022 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, un r the pains and penalties of perjury that the information provided above is true and correct Signature: Date: 10/8/21 Phone#: 41 22-3111 Ext 122 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): 1,❑Board of Health 2,❑Building Department 30 City/Town Clerk 4.0Licensing Board 50 Selectmen's Office 6.❑Other Contact Person: Phone#: www.mass.gov/dia , THE IZATI0I mass save BARRIER INITIATIVE ContracAor Ev8luation During your Home Energy Assessment,your Energy Specialist noted that your home features recessed lighting.If you decide to have any lighting fixtures covered or made in contact with insulating materials,a Massachusetts licensed electrician must certify that all fixtures located in the areas indicated below are insulated contact(IC)rated. If you choose not to cover the recessed lighting with insulation,electrician certification is not required and they will be left exposed. You will receive 100%of the cost of the evaluation(up to$250),which will be deducted from the customer co-payment amount of the weatherization contract.A rebate check will only be issued in the event that the incentive amount exceeds the customer co-payment amount. Once your Energy Specialist and electrician have completed their inspections and filled out the information below, please send this completed form with completed copies of the dated and itemized contractor invoice to: Pre-Wx Barrier Incentive, d o CLEAResuit 50 Washington St. Suite 3000 Westborough, MA 01581 Or email to prewxoffer@clearesuit.com .. .Z .r-anA1.l.�..t .r.w.z..s,LTE....c.L.k7 s%... ��K :+i.''�s',' ,-S45M.,.»7-��,'xk;.�#W »,�».z:;�„e, a��.. s .�4._�..,1K7.. Project ID:4268228 Customer: REBECCA WRIGHT Address:.16 Day Ave _ __ City, Northampton State MA ZIP 01060 Phone Number: 802-9994021 Email: IC rated recessed light verification Is needed in the following areas: Open attic Enclosed floor cavity 1~Enclosed interior slope D All recessed lights 5 recessed lights above the kitchen Notes: _._.__.__._...._......._.._....._._.___ ........_..._..__......_...__.__..._..__. s ... .a.00.»&`,.ws.,e n"i' a M �a�a." i3;CgEg' .. Company Name: . ti✓ n 1.1�,►.g YVt cif te,G4 i- i C _ __._.... �tc�f1 (✓V i Y''lQ,l __.._...._........._...... License#: ....._..... .Jill/l5� Electrician's Name: - .. Address: P:M) W QS+ Cc"►Yl etytart�:d City: �U W}!''?r nc�d,•-t State: `OA ZIP01O Phone Number: .._ '?/ 3 4"O _ _._.__.______._ v t efte-4 ti l ec4C I ( &►Ytct`1 1.CO m ______. ..__.___. . __ Email:_-- .... .. I have performed an inspection of the lighting fixtures and have either replaced and/or verified that all recessed lights are IC rated in the j following areas: Open attic Enclosed floor cavity Enclosed Interior slopes All recessed lights 11 Yes 7No Ycs No Ycs l No /Yes ii No The licensed electrician is responsible for properly identifying the specific locations of all IC rated and non IC rated lighting in the area(s)being insulated. Failure to do so will make this form invalid. Notes: g• Electrician Signature: t ____ _ __ _ ___.___._.._..__ Date: Page 1 of 2rnntin,tnrt nn harp .401kt.. 2019 WEATHERIZATION mass save BARRIER INCENTIVES Based on your Energy Specialist's recommendations.your home can benefit from program-eligible insulation and/or air sealing improvements.Before moving forward. please follow all the instructions below to remediate your weatherization barriers. CUSTOMER INSTRUCTIONS 1. Hire a qualified. licensed contractor to evaluate and/or remediate the weatherization barrier(s). 2.Submit signed and completed copies of this form and a copy of the paid contractor invoice(s) within 60 days of your Home Energy Assessment to: Pre-Wx Barrier incentive, clo CLEAResult, 50 Washington St. Suite 3000, Westborough, MA 01581 or email to: prewxoffer@clearesult.cam 3. The weatherization incentive will be deducted from the customer co-payment amount of the weatherization work.A rebate check will be issued in the event the amount exceeds the customer's co-payment amount. 4.Complete the recommended weatherization improvements. ass. . , ��m�.z . ..<< .d , Customer Name REBECCA WRIGHT Client#or Site ID; 4268228 Site Address:.... 16Day_AVe.._. ____._._...._..__..._._._... _ •_._..._.__....... City:. Northampton__...._....._.._..._.._.._......__ state: .MA ZIP:01060 _ Phone Number: 802-999-1021 Email: Customer/Homeowner Signature: Date: To determine if there is any active knob and tube wiring. the contractor will evaluate the following areas where eligible Mass Save weatherization recommendations have been made: VAttic Floor \ttic Wall Attic Slope f1yExterior Wall ...IBasernent :.:JOther: UOther. I have performed my inspection and determined there is no active knob and tube wiring in the areas selected below. Attic Floor Attic WallAAttic Slope yFxterior Wall 'JBasement 210ther: UOther: I have read and agree to the Terms and Conditions on the back of this form. Contractor Name: .�( ..Wen_._._._0 v!rb'!. ___._... _. Address: P3& 0-416.# C(Jw►m+rty)en C) r City: Cuw7rv►1rc404N /��--SState: .A ZIP: Cif V?v Company Name: U2n t� QJ i P'"�f_ I2e.4 rte. License Number: cc0 I C97 Contractor Signature: Date: `' 1-21 ,^�..��.��+;•r�sa� s "��.rF� .3xldn,' a' � .,.e a°.�a s r"a..�"ac•.c`a°.�w�..� m w�Ys+a.;t:.'� .1aa... High . Monoxide:Contractor is to service and r ate the selected mechanical system(s)and reduce the carbon monoxide level. as me the undiluted flue gas.to below 1.; r million(ppm). Draft Fails -actor is to correct the draft ' cted flue(s).Refer to table on reverse for acceptable draft ranges. Monoxide Draft Failure .� 0 ppm: Revised CO ppm: Existing Draft Pa: Revised Draft Pa: Heating Syste Hot Water Heater Other: Spillage:Contractor is to lage of flue gases in the selected mechanical system(s).Must not spill after 60 seconds of operation. 0 Heating System A r 0 Other: 0 I have perform . ection an ected the items noted in the areas selected above. U I have read o the Terms an+ ns on the back of this form, Contracto Addr City: State: ZIP: Comp. 'ame: License Number Contractor Signature: Page 1 of 2 Continued on back