25A-132 (9) BP-, 022-1142
39 DAY AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
25A-132-001 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-2022-1142 PERMISSIONIS HEREBY GRANTE ii TO:
Project# INSULATION Contractor: License:
Est. Cost: 6600 ENERGY PROTECTORS INC 101143
Const.Class: Exp.Date:06/16/2024
Use Group: Owner: LLC PIONEER DEVELOPMENT
Lot Size (sq.ft.)
Zoning: URB Applicant: ENERGY PROTECTORS INC
Applicant Address Phone: Insurance:
64 PAXTON RD (774)253-0277 6S62UB0G29826021
Spencer, MA 01562
ISSUED ON:09/13/2022
TO PERFORM THE FOLLOWING WORK:
INSULATION/WEATHERI ZATI ON
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 VIOL: TION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: ,
I )2 3-1
• '1 •
Fees Paid: $65.00
•
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
r
RECEIVED
The Commonwealth of Massachuse s
:.it 1, Board of Building Regulations and Sta dards SEP 1 2 2i22 moil
I Massachusetts State Building Code, 78 CM h "i
th butt n
Building Permit Application To Construct,Repair, Re ovat Qrd?c�c
One-or Two-Family Dwelling --------
This �THAh,�70N,tMA E��ONS
l`Section For Official Use Only
Buildin Permit Number: ) P )..›�(ci } Date Applied:
) 6'14-> a, i/a 9 13 Zoz
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Pro_perty Address: 1.2 Assessors Map& Parcel Numbers
1.1a 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 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
U et h t i t k C_ YNNL,K.C. NN ik1 01 L4144o t-2,44 1 " Pt' V 1.0 Co 0
Name(Print) City.State,ZIP
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:
Brief Description of Proposed Work': (- - v c .g P.c%.`t h- 4,h,a t to S,_,lc-4-e-
4- '•C__ c., VA' . t; A--o Nrt- Lc., .....k_ i h % t 4 t
-t---4Ap e'ic 4-e ( tc.)t/` ti y L L S
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials) ,
I. Building S b (P cc-c, I. Building Permit Fee:S Indicate how fee is determined:
2. Electrical $ ( 0 Standard City/Town Application Fee
0 Total Project Cost3(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: S
4. Mechanical (HVAC) S List:
5. Mechanical (Fire —
$ Total All Fees:
Suppression)
Check No 1 Check Amount: Cash Amount:
6.Total Project Cost: S 6 1 6(y7 J 0 Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor Lkenes(CSL) CS-101143 &1 I(t 2-k{
Joshua Dada License Number Expiration Date
Name of CSL Holder U
List CSL Type(see below) ___- .. .. _.
64 Paxton Rd
No.and Street — __ — Type Description
Spencer MA 01562 —rl�� ' U Unrestricted(Buildings up to 35,000 cat.ft.)
R Restricted 1&2 Family Dwelling
City Town,State,ZIP—
___ M Masonry
RC Roofing Covering
-------- ---- WS Window and Siding
774-253-0277 SF Solid Fuel Burning Appliances
jdada79@1tOtmall.Com I insulation
Telephone `- ' "__Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 172960 $,4-9f22'- c j K i r 1.4
_Energy Protectors Inc. ___ .-_-___e_. _ �'�
_ _ _ _ __.____._..-. _.._...—.._ HIC Registration Number Expireti Date
HIC Company Name or HIC Registrant Name
64 PaxtenBd_.______ ______________________.__ jdada79@hotmail.com
No and Street _____ Email address
City/Town,
MA 01562 ,__ 774-253-0277
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 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 er No 0
SECTION 7s:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT {
I,as Owner of the subject property,hereby authorize____ _
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print 0‘‘flees Name(Electronic Signature) i Date
i
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.
75-2)-S1e ‘11C alS. 1 )—
Print Ouner's or Authorized Agent's Name(Electronic Signature) Da4e
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 GEf have access to the arbitration
program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program oan be found at
wwwinks,tgokcji Information on the Construction Supervisor License can be found at«n+w mmps,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
OPen
Type of cooling system Enclosed_
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
_ '\ The Commonwealth of Massachusetts
1 _el. Department of Industrial Accidents
r =;le.a 5 1 Congress Street,Suite 100
''_it "y Boston,MA 02114-2017
' � www.mass.gov/dia
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):Energy Protectors Inc
Address:64 Paxton Rd
City/State/Zip:Spencer, MA 01562 Phone#:774-253-0277
Are you an employer?Check the appropriate boti:
Type of project(required):
1.0 I am a employer with 11 employees(full and/or part-time).` 7. 0 New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling
any capacity.[No workers'comp.insurance required.]
3.0 I am a homeowner doing all work myself.[No workers'comp.insurance require] 9. Demolition
10 Q Building addition
4.0 I 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 11.0 Electrical repairs or additions
proprietors with no employees. 12.0 Plumbing repairs or additions
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs
These sub-contractors have employees and have workers'comp.insurance. insulation
14.2 Other
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c.
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
f 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 hove
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:National Liability& Fire Insurance Company
Policy#or Self-ins.Lic.#:V9WC383933 IN Expiration Date:9/1/23
�Job Site Address: \ �'. J\'- 'C City/State/Zip: ki ill LA.t^'4 t . '1114"
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiratio dote). C)l0 6 C
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1, 00.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$ 50.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for ins ce
coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
Signature: � '1 <' ` `� Date: et(S ( r
Phone#:774-253-0 77
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#:
City of Northampton
' Massachusettsc.j.7**N.
i �• DEPARTMENT OF BUILDING INSPECTIONS
?v r 212 Main Street • Municipal Building s, +�►
�Jc; Northampton, MA 01060 E a4 yY
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:
Energy Protectors Inc
64 Paxton Rd
Spencer, MA 01562
Location of Facility:
The debris will be transported by:
Name of Hauler: E A c ec l 0 (4, L , S �" C—
Signature of Applicant: �' 1�� e - Date: Ct( S i
mass save' Weatherization 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:RISE Engineering 1341 Elmwood Ave,Cranston,RI 02910 or email to Eversourceinfo@RISEenglneering.com.
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.
6. The Mass Save'HEAT Loan offers interest-free financing opportunities that may be used to remediate eligible weatherization
barriers. Learn more at masssave.com/enjsaving/residential-rebates/heat-loan-program
CUSTOMER INFORMATION -
Customer Name: Danielle Mckahn Client#or Site ID: 510505
Site Address: 39 Day Avenue City: Northampton state: MA DP: 01360
' e--e senoce s to be oe r^
Phone Number: 413-320-7208 Email:
Cuatonweftionreowner Signature Date:
KNOB AND TUBE WIRING(up to 525C incentive)
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:
Qf Attic Floor 0 Attic Wall O Attic Slope Q'Exterior Wall Q'Basement 0 Other O Other:
ce tee ou:try:ee Energy Soeae,,s.
I have performed my Inspection and determined there is no active knob and tube wiring in the areas selected below.
fe Attic Floor O Attic Wall O Attic Slope Q,Exterior Wall Q Basement ()Other 0 Other:
jea ot.a,•the i ea
Contractor Name V"&\ Do t oet h �C'� IC mA✓1
Address: 3,YC W45-1 L`.1" JN YT *1�Gya 2-a C f1 .tsret'w • State: .l ZIP: CIO o 20
Company Name: Of)i r41-4 1�G4 n License Number. S611 7
Contractor Signature: Date: eS!-I GP-114
My signature confirms that I have performed my inspection of the electrical systems listed above and have corrected any barriers as
indicated.My signature also confirms that I have read and agree to the Terms and Conditions outlined on the back of this form.
MECHANICAL SYSTEM BARRIERS(up to 5250 Incentive)(To be filled out by licensed contractor.)
Breit-Failure:
High Carbcr:Manarida Drcft rr o;l::rz
SeistinfrGeyomf -GO-pane Existing-Weft-Per I Revised-Dreft-Par
i
Neeting-System
Net Wit e-Healer
AUman
SPIµage'
-5ystef* 0 Other.
Centrocter-Nafnr
AekIress ---—_ — — — -City: Statc:
CEsr pa,y-Name: Lkeftse-Number
Dabs
.. -
�! Commonwealth of Massachusetts
Boartl of Division
of Occupational Licen
sure
Cons �iling ahons Standards
tlards
CS-101143 -. ,visor
JOSHUq S :'
•s
64 p, T��CAPtres:06/16/2024
SPENCER M�0
r4I )
2
i Cornmtsstoner : , (2. ,. ri,�:
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
?"? ► *� Type: Corporation
ENERGY PROTECTORS INC. '"`"' Registration: 172960
64 PAXTON RD. Expiration: 08/19/2024
SPENCER, MA 01562 ..Y«..
e
Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the
HOME IMPROVEMENT CONTRACTOR expiration date. If found return to:
TYPE:Corporation Office of Consumer Affairs and Business Regulation
Registration Expiration 1000 Washington Street -Suite 710
172960 4 08/19/2024 Boston,MA 02118
ENERGY PROTECTORS INC.
JOSHUA DADA �. 72
64 PAXTON RD. �a,lG�s„ri"
SPENCER,MA 01562 °""'� Undersecretary Not valid without signature
AoRo CERTIFICATE OF LIABILITY INSURANCE DATEENIIN
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 POUCIES
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 provisional 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
Coonan Insurance Agency, Inc. PHONE Nina Arroyo FAX
267 Main Street _.(A/C.No.Es*,508-987-7122 1 WC.No1;.508-987-7152
EMAIL
Oxford MA 01540 ADOREss: nima@coonaninsurance.00m
INSURERS)AFFORDING COVERAGE NAIC a _
-__- —License#:1782985 INSURER A:AIX Specialty Insurance Co
INSURED -... ENERPRO-01 INSURER a:Safety Insurance Company
Energy Protectors,Inc.
64 Paxton Road INSURER c:Capitol Specialty Insurance Corporation
Spencer MA 01562 MAsURERD:National Liability&Fire Insurance Company
INSURER :Philadelphia Ins Companies -------
INSURER F
COVERAGES CERTIFICATE NUMBER:2132532233 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 LTR TYPE OF INSURANCE ABDSDI SUMINVO POLICY NUMBER —POLICY EFF POLICY Lis
MMIDDlYY11Y1,(MOVDD/YYYTY YI
A X COIIIIBtCIAL GENERAL LIABILITY Y L1N-H714840-01 8/31/2022 8/31/2023 EACH OCCURRENCE 11,000,000
CLAIMS-MADE I X 1 OCCUR DAMAGE TO RENTED
PREMISES(Es occurrence) $50.000
MED EXP(Any one person) $5,000
PERSONAL N ADU NUURY $1,000,000
GENL AGGREGATE UNIT APPLIES PER: GENERAL AGGREGATE $2,000,000
X POLICY LOC PRODUCTS-COMROPAGO 11,000,000
OTHER: I
8 AUTOMOBILE LIABILITY N 6236519 12/23/2021 12/23/2022 maCC=SINGLE LIMIT t 1,000,000
ANY AUTO BODILY INJURY(Par person) $
OWNED X SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
y HIRED X NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY (Per accident)
C X MORELLA LAB X Oyu Y CCP1070516 8/31/2022 8/31/2023 EACH OCCURRENCE t 1,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE tl
DED X RETENTION$atom $
D AND WORKERS A Y V9WC383933 9/12 M 022 911/2023 X EER Y/N
ANYPROPRIETORIPARTNERIEXECUTIVE EL EACH ACCIDENT 1500,000
OFFICER/MEMBER EXCLUDED? NIA
(Mandatory M NH) EL.nLSFLCP-EA EMPLOYEE 1500,000
I desaibe undo
DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT f 500,000
E Pollution LiabFity PPK2366760 1/62022 1/62023 Each Occurence '1,000,000
General Aggregate 2,000,000
Products-Completed 2,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional wenr0s Sdndeds,way be Washed I sera spate is required)
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.
Eversource
247 Station Drive
Westwood MA 02090 AUTHORIZED REPRESENTATIVE
iF)1988-2015 ACORD CORPORATION. AN rights reserved.