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24B-015 (3) BP 2022-1069 26 DENISE CT COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24B-015-00I 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-2022-1069 PERMISSION IS HEREBY GRANT I TO: Project# 2022 INSULATION Contractor: License: Est. Cost: 8000 ENERGIA LLC CSL92540 Const.Class: Exp.Date:09/02/2023 Use Group: Owner: J. WIENER, DANIEL Lot Size (sq.ft.) Zoning: URB/WP Applicant: ENERGIA LLC Applicant Address Phone: Insurance: 242 SUFFOLK ST (413)322-31 1 1 WMZ-800-8008072-2022A HOLYOKE, MA 01040 ISSUED ON:09/01/2022 TO PERFORM THE FOLLOWING WORK: INSULATE ATTIC FLOOR, CLAPBOARD WALLS & KNEE WALLS 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I I„7, • ir .>.R Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner n IL1 1CI% g4 N The Commonwealth of Massachusetts T c;z Board of Building Regulations and Standards FOR '' ' Massachusetts State BuildingCode,780 CMR MUNICIPALITY u I� USE S Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 a One-or Two-Family Dwelling I7 , This Section For Official Use Only Building Permit dumber:/3P—20Z—/0 6 ! Date Applied: 05)(24/20 YZ ),—.1/Z5g .// 9- I •ZOZZ Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: r 1.2 Assessors Map&Parcel Numbers 26 DENISE CT 2y13-ois= oO / 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Uwe/4)P . 24 g a c.4-e. 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❑ Private CI Municipal_ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: DANIEL WIENER NORTHAMPTON MA 01060 Name(Print) City, State,ZIP 26 DENISE CT 413-687-9416 none provided No.and Street Telephone Email Address SECTION 3:DESCRIPTION- / OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building'ZJ Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition D Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:INSULATION Brief Description of Proposed Work2:INSULATION INSULATION ATTIC FLOOR OPEN BLOW 10"CELLULOSE WALLS CLAPBOARD DENSE PACK CELLULOSE KNEEWALL WALLS 2"THERMAL BARRIER POLYISO SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $8500.00 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ 0 Standard City/Town Application Fee 0 Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ s Suppression) Total All Fees: $ u. Check No.7721/Check Amount: ' Cash Amount: 6.Total Project Cost: $8500.00 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 92540 9/2/23 THOMAS 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.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP 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 2/16/2024 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 242 SUFFOLK ST 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 Tom Rossmassler& Energia LLC to act on my behalf,in all matters relative to work authorized by this building permit application. See Permit Autho 8/12/22 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 a cation is true and accurate to the best of my knowledge and understanding. 8/12/22 Print Owne or uthorized 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 ✓a�H Mp>o�� sus . . St, •'' Massachusetts mow? !<< I• N � DEPARTMENT OF BUILDING INSPECTIONS 1. x y 212 Main Street • Municipal Building O •a Northampton, MA 01060 �sd' .... s�0c 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: d STo N 7R;to W( (mi l f(L( The debris will be transported by: Name of Hauler: GCS A. W YSTC Signature of Applicant: Date: rA, City of Northampton [( Massachusetts �°3' DEPARTMENT OF BUILDING INSPECTIONS 9 f ;,�;, 212 Main Street • Municipal Building ,�y,,�� 0' Northampton, MA 01060 'YY Property Address: 26 DENISE CT Contractor Tom Rossmassler & Energia LLC Name: Address: 242 SUFFOLK ST City, State: HOLYOKE MA 01040 Phone: 413-322-3111 Property Owner Name: DANIEL WIENER Address: 26 DENISE CT City, State: NORTHAMPTON MA 01060 I, Tom Rossmassler (contractor) attest and affirm that the building I intend to insulate does not have any open air (knob and tube) wiring in the spaces to be insulated and t at I have provided the property owner with a copy of this affidavit. Contractor signature Date 8/12/22 41044t- Permit Authorization mass save Form Site ID: 4519729 Customer: DANIEL WIENER l� Daniel J Wiener , owner of the property located at: (Owner's Name,printed) 26 DENISE CT 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: Date: 06 / 16 / 2022 •••••••••••••••••i••••••••••••••••••••••••••••••••••••••••••••••••••• FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: N.62L2 / 4,c-c Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 For Office U#e On I v Document Ref:KENFP-NZJ2D-X2WKZ-QYPHN Page 7 of 18 _____....", ENERLLC-01 JOCELYN AcoMo CERTIFICATE OF LIABILITY INSURANCE DATED/YYYY) �-� 7/5/2022 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 ) FAX 97 Center Street (A/c,No,Ext): I(A/C,No): Chicopee, MA 01013 MaEss:Jocelyn@phillipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC it INSURER A:State Automobile Mutual Ins Co INSURED INSURER B:A.I.M. Mutual Insurance Company Energia LLC INSURER C:Markel Insurance Company 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER IMM/DDIYYYYI IMM/DD/YYYYI UMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PBP2870943 7/1/2022 7/1/2023 DAMAGETORENTED 500,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) , $ 5,000 PERSONAL&ADV INJURY: $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X spaX LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 IEa accident) _ $ X ANY AUTO BAP2477206 7/1/2022 7/1/2023 BODILY INJURY(Per person) $ AUTOS ONLY SCHEDULED BODILY INJURYp (Per accident) $ AUTOS ONLY AUTOS ONNLY (Peer acc dent)AMAGE $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE PBP2870943 7/1/2022 7/1/2023 AGGREGATE $ 2,000,000 DED X RETENTION$ 0 $ B WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N WMZ-800-8008072-2022A 7/1/2022 7/1/2023 X STATUTE ER 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE N NIA E.L.EACH ACCIDENT $ OFFICE'M MBE EXCLUDED? 1,000,000 E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Equipment Floater PBP2870943 7/1/2022 7/1/2023 Leased/Rented 35,000 C Pollution Liability CPLMOL106305 4/19/2021 4/19/2023 Pollution 1,000,000 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 Evidence of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIV E y , ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. 1 The ACORD name and logo are registered marks of ACORD ComnaoOwealth of Massachusetts Oitredoft of Professional LUcensure Ltd of Bu h:long Regutattons and Standards COftstNNbtlt t`Sttpt►ry f sor S-092.540 ki pares.09,0212023 THOMAS Et Ross t.°;, ,.; , 10.0 MAIN STET "4 1 II i 01p3'< ' THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:LLC Registration valid for individual use only Registration Expiration beforo the expiration date. If found return to: 165169 02J15t2024 Office of Consumer Affairs and Business R stion ENERGIA LLC 1000 Washington Street -Suite 710 Boston,MA 02118 THOMAS ROSSMASSLER 242 SUFFOLK STREET , r ----- — HOLYOKE,MA 01040 r ' Not valid without signature Undersecretary • p I The Commonwealth of Massachusetts Department of Industrial Accidents ,� _ — Office of Investigations =��1= Lafayette City Center �I �,m. 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. ❑ Retail or part-time).* 6. ❑ Restaurant/Bar/Eating Establishment 1 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. ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemption per c. 152, §1(4),and we have 10.0 Manufacturing no employees. [No workers' comp. insurance required]** 1 l.❑ Health Care 4.❑ We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp. insurance req.] 12.❑■ 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: A.I.M. Mutual Insurance Insurer's Address: ) 1 /� City/State/Zip: r V° ( 14.44 'd ,c `(/r— oLcoCQ 0 , Policy#or Self-ins. Lic. #WMZ-800-8008072-2022A Expiration Date:7/01/2023 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 In estigations of the DIA for insurance coverage verification. I do hereby certify, der the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 71/ 2� Phone#: 413-32 -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): 10Board of Health 2.0 Building Department 30 City/Town Clerk 4.❑Licensing Board 50 Selectmen's Office 6.❑Other Contact Person: Phone#: www.mass.gov/dia