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24C-195 (3) BP 2022-1288 78 NORTH ELM ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24C-195-001 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-2022-1288 PERMISSIONISHEREBYGRANT I TO: Project# INSULATION Contractor: License: Est. Cost: 4000 ENERGY PROTECTORS INC 101143 Const.Class: Exp.Date:06/16/2024 Use Group: Owner: MURPHY DAVID A Lot Size (sq.ft.) MURPHY DAVID A ENERGY Zoning: URB Applicant: PROTECTORS INC Applicant Address Phone: Insurance: 78 NORTH ELM ST NORTHAMPTON, MA 01060 64 PAXTON RD (774)253-0277 6S62UB0G29826021 Spencer, MA 01562 ISSUED ON:10/11/2022 TO PERFORM THE FOLLO WING WORK: INSULATION/WEATH ER I ZTION 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: (4. , 1' y9 . 3-11 •6. 1 � Fees Paid: $65.00 • 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Buildine Commissioner l `\ / /fir. __ The Commonwealth of Massachusetts% ��. ,, Board of Building Regulations and Stai ards�"/ . -°' Massachusetts State Building Code, 7 . ;,T R NICIP ITY '� 0 '' °'� evise Mar?011 Building Permit Application To Construct,Repair,Rey° molish� One-or Two-Family Dwelling �' ���in, ,).. / This Section For Official Use Only - 1 orio , r "1u 'iS f Buildin Permit Number: 6P- 2^ 3-5)S1 Date Applied: t / 6040 .5 10.11-26ZZ Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1ProperytU Address: 1.2 Assessors Map&Parcel Numbers • $= 101 S.r - - _ Li 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 0 Zone: _.- Outside Flood fvesO..one? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: L r V'i pc C-k-r m_n Z.✓l f fv1 A V\,O6 U Name(Print) City,State,ZIP 1 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 I Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other (:"Specify: ‘ v :k.flci. . Brief Description of Proposed Work: ( - t r' S c c� `, l ,_- �� �� e,C r C q-_1__C` �. , h 5>,, t1 '�-e v\�1"t _ �c CLOT SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ Li i 00 0 1. Building Permit Fee:$ Indicate how fee is determined: 0 Standard City frown Application Fee 2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ ._ 4. Mechanical (IIVAC) $ List: ' 5. Mechanical (Fire $ Total All Fees: $ Suppression) Check No3y3 Check Amoun ciiL Cash Amount 6.Total Project Cost: $ kl 1 000 ❑Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) cs-101143 a tsrz4 Joshua Dada License Number Expiration Date Name of CSL Holder List CSL Type(see below)u 64 Paxton Rd No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) Spencer,MA 01582 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonr y RC Rooting Covering WS Window and Siding SF Solid Fuel Burning Appliances 774.253-0277 Jdada79@hotmaf.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 172960 8/19/24 Energy Protectors Inc HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 64 Paxton Rd jdada79ahotmall.com No.and Street Email address Spencer,MA 01562 774-253-0277 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 to act on my behalf,in all matters relative to work authorized by this building permit application. 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 application is true and accurate to the best of my knowledge and understanding. hD(4x.k t,vl i � zvPrint wner's or Authorizent'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(H IC)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 halfbaths 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" _� The Commonwealth of Massachusetts IM—�� r_�,�_�l, Department of Industrial Accidents ;�-= 1 Congress Street,Suite 100 �-=_@iii' Boston, MA 02114-2017 •?,;�Y , www massgov/dta Workers'Compensation Insurance Affidavit:Builders/Co.tractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Name(Business/Organization/Individual):Enel9Y Protectors Inc Address:64 Paxton Rd City/State/Zip:Spencer, MA 01562 Phone#:774-253-0277 Are you an employer?Cheep the appropriate box: Type of project(required): 1.0✓ I am a employer with 1 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. EI Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.(No workers' p.insurance require] 9. ❑Demolition comp. 10❑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 attadted sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'romp.insurance. 14.[]✓ other insulation 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 Ill must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they arc 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 have employees. lithe sub-contractors have employees,they must provide their workers'comp.policy number. 1 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 Expiration Date:9/1/23 Job Site Address: - �1 WI l''t City/State/Zip: kj L i T`v�tli"1Q t1✓ji 11/i'�.a'r"l7CJ Attach a copy of the workers'compensation policy declaration page(showing the policy number and expire tin date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1 300.00 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. I do hereby certify under the ins and penalties of perjury that the information provided above is true and correct Signature; � �'t �. Date: `L' l 1 2 2-'- #Phone , 774-253=0277 ' Official use only. Do not write in this area,to be completed by city or town offrcieL 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 r & Massachusetts ��s ct . DEPARTMENT OF BUILDING INSPECTIONS ? • 212 Main Street • Municipal Building Northampton, MA 01060 -j4W 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: 7 \wS + Location of Facility: The debris will be transported by: Energy Protectors Inc 64 Paxton Rd Spencer, MA 01562 Name of Hauler: Signature of Applicant: �� L( = Date: \Dl I / 2 z R1SE ENGINEERING OWNER AUTHORIZATION FORM I David Murphy (Owner's Name) owner of the property located at: 78 N Elm Street (Property Address) Northampton, MA 01060 r(Property Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property.This form is only valid with a signed contract. The permit will be secured by the subcontractor, at no additional cost. r— Owner's Signature S//2/2 Z. _ Date RISE Engineering, a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335 www.RlSEengineering.com V mass save Weatherization barrier incentives Based on your Energy Specialist's recommendations,your home can benefit from program-eligible insulation and/or air 5:ling 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 Eversourcelnfo@RISEengineering.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. 5. The Mass Save'HEAT Loan offers interest-free financing opportunities that may be used to remediate eligible weatherization barriers. Learn more at masssave.com/en/saving/residential-rebates/heat-loan-program CUSTOMER INFORMATION Customer Name. David Murphy Client#or Site ID: 513150 Site Address. 78 N Elm Street City Northampton State MA ZIP: 09 60 IA hwo snn s .S:n Oa perfumvki Phone Number. 413-530-2275' a Email mail(c davidmurp�.com ..,Itiyr 4;' -r fr.— k-'4�',1��. '_5,-.-7 . ,. ,k; 'k�vii-'4��,, &.�y P.'I.F �'i r`l.,-71nyA6,-;.- ,4, .1^".:'r 7.`., �• :.. -� • KNOB AND TUBE WIRING(i.p to 5250 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: fie Attic Floor to Attic Wall V Attic Slope Qs Exterior Wall fie Basement 0 Other. _^Q Other �ro i re.0 cur cv its'nergy Sc'�c+ • +aice uixTti aFiaii.CF.. i (36/.k6014P .ariii" I Tlie aecrrartilD o(Ar is--miza -Fitiai 0 Other. . 0 Other; .,ha',eV rut by t'ie I.r'onten -,•ct,r-a.' sR(.PAaIiY :.• -- .r .. .Y,..-,.-.,. ». -4 sniiiiiii-- :2 l Z'fS' #' - a ;,.`.tin • ,TJ^+f. 4�1 .1. 1<Fi:::4r ,.♦ ♦ ..fai+..tf4::.v:i tMzItlLS.'jt. ' :-6,; .t rE_ a'!1 � ,s.n j'r'sagriil uf'"fe fonu'rms tbai"C-liaire:pe-r7ormed my,insp„e;Ftlon fie e�e�tdcal+systerfns tistd a n iave.corte"ct'4dT .ie ,.,d,4 Gr�1GAI;gef:IY'�lg[15tNri RS`4firiT14tt>4C'1,j1+1Y•@A40,dI} .p3 „i&.tt)T7. .alsson012d,tailARsA1tlgt:: lt.tbe124c15.RJd1it r7t MECHANICAL SYSTEM BARRIERS(up to 52s3.wei'i );To a e'Ji:d o.t rr.i.:ei,:,cd&J^•,dlt Ji: High Carbon Monoxide:Contractor is to service and re-evaluate the selected mechanical system(s)and reduce the carbon monoxide level, as measured in the undiluted flue gas,to below 100 parts per million(ppm). Draft Failure:Contractor is to correct the draft in the selected flue(s).Refer to table on reverse for acceptable draft ranges. High Carbon Monoxide Draft Failure Ex tfnn CO ppm. ' • ""'ReJised CO'ppifi:•`' •Eitlstih j Draft.Pi..:,-: i2evreed Oraft Pa: Heating System _ Hot Water Heater Other. t —~ J Spillage:Contractor Is to correct the spillage of flue gases in the selected mechanical system(s).Must not spill after 60 seconds of operation. Q Heating System Q Hot Water Heater 0 Other: Contractor Name. Address: City State ZIP: Company Name: License Number _ ....a w.,-.a...........- ..�9--.rw.•.�.,�..-�'-__ ..a.n..-+w.+ .o.,�.,y... Y. .�..,........-...Tr. ,+ r.-w.w+ Y.r ^•; •-•♦ v^• Contractor Signaturo: . .. • ....... .. �abC .. ... i . . . My signature confirms that I have performed my Inspection of the mechanical systems listed above and have corrected any as indicated.My signature also confirms that I have read and agree to the Terms and Conditions outlined on the back of this form. mot- Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Reg'Cations and Standards Cons oitSI,wtso► , CS-101143 * 63pires:06/1612024 JOSHUA S D*DA ;. s 64 PAXTON RD i it; AC SPENCER M 0 Commissioner . , ,';. c?.`r:::4:2 DATE(MM/OD/YYYY) ACCoRD® CERTIFICATE OF LIABILITY INSURANCE 8/31/2022 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 B 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 NAME: Nina Arroyo Coonan Insurance Agency, Inc. PHONE FAX 267 Main Street (A/C.No.E •508-987-7122 (A/c,No):508-987-7152 Oxford MA 01540 ADDE-MARESS: nine@coonaninsurance,com INSURER(S)AFFORDING COVERAGE NAIC S License#:1782985 INSURER A:AIX Specialty Insurance Co INSURED ENERPRO-01 INSURER B:Safety Insurance Company Energy Protectors, Inc. 64 Paxton Road INSURER C:Capitol Special y Insurance Corporation Spencer MA 01562 INSURER D:National Liability&Fire Insurance Company INSURER E: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. jADDL'SUBR POLICY EFF T POLICY EXP LTR TYPE OF INSURANCE I INSD WVD POLICY NUMBER NMM/DD/YYYY) (MM/DDIYYYYI L1MIT>f A X COMMERCIALGENERALLIABILITY I Y LIN-H714840-01 8/31/2022 8/31/2023 EACHOCCURRENCE $1,000,000 AGTOM CLAIMS-MADE l X J OCCUR PRM PREMISES(EaoccurreD nCe) $50,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLES PER: GENERAL AGGREGATE S 2,000,000 X POUCY F2ei LOC PRODUCTS-COMP/OP AGG $1,000,000 OTHER: B AU AUTOMOBILE LIABILITY N 6236519 12/23//2021 12/23/2022 C(EOMaaccidentlBINED SINGLE LIMIT $1,000,000 ANY AUTO BODILY INJURY(Per person) $ AUTOS ONLY X AUTOS BODILY INJURY(Per accident) $ X HIRED y NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY (Per accident) $ C X UMBRELLA LIAR X OCCUR Y CCP1070518 8131/2022 8/31/2023 EACH OCCURRENCE S 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED X RETENTION S i n JIM $ D WORKERS COMPENSATION V9WC383933 9/1/2022 9/1/2023 X g ARTUTE gr. AND EMPLOYERS'LIABILITY IN ANYPROPRIETOR/PARTNER,EXECUTIVE Y NIA E.L.EACH ACCIDENT $500,000 OFFICERIMEMBEREXCLUDED? (Mandatory In NH) E;L DISEASE-EA EMPLOYEE $500,000 It yes describe under DESCRIPTION OF OPERATIONS balms E.L DISEASE-POUCY LIMIT S 500,000 E Pofuticnliebipry PPK2366760 1/8/2022 1/6/2023 EachOccurence 1,000,000 General Aggregate 2,000,000 Products-Completed ' 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more apace 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 AUTHORIZED REPRESENTATIVE Westwood MA 02090 4"°tL ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration 4. �„J ^o - _ ...,.,:...t � ype: Corporation ENERGY PROTECTORS INC. "expiration: 172960 64 PAXTON RD. , Expiration: 08/19/2024 SPENCER,MA 01562 , ' : - ---7-7-..,:::-EL---7' .. sfe \ill,. 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 08/19/2024 Boston,MA 02118 ENERGY PROTECTORS INC. JOSHUA DADA 64 PAXTON RD. .f.,,,,,sta, ' SPENCER,MA 01562 Undersecretary Not valid without signature