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18C-056 (2) BP-2022-1584 51.5 HATFIELD ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 18C-056-001 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-2022-1584 PERMISSION IS HEREBY GRANT:D TO: Project# INSULATION 2022 Contractor: License: Est. Cost: 2143 THE ENERGY MONSTER 102765 Const.Class: Exp.Date: 07/22/2024 Use Group: Owner: K BROWN SHEREE Lot Size (sq.ft.) Zoning: URB Applicant: THE ENERGY MONSTER Applicant Address Phone: Insurance: 311 MAIN ST (508)796-5525 6S60UBSR71347322 WORCESTER, MA 01608 ISSUED ON: 12/07/2022 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHERIZATION 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: c''1 Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner 1 The Commonwealth of Mass'ch s AFC Board of Building Regulations an ggi, �r OR UNIF PAirITY Massachusetts State Building Code, 7$l`. ' Off? /7 SE Building Permit Application To Construct,Repair,Renovafie i ' olish a R sed Mar 2011 One-or Two-Family Dwelling \ This Section For Official Use Only Building Permit Number: - . 15 Date Applied: ilsr4th,.1 1 � ►►• ID 7 Building Official(Print Name) Signature 1 D e SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 51 1/2 Hatfield St. Unit 1 18C-055-001 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Residential 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® On site disposal system 0 Check if yes® SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Sheree Brown Northampton. MA 01060 Name(Print) City,State,ZIP 51 1/2 Hatfield St. Unit 1 413-297-6284 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORKS(check all that apply) New Construction ❑ Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other NJ Specify:Insulation Brief Description of Proposed Work2: Insulation, weatherization, air sealing SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 2,143.33 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) $ Total All Fees: ti Check No. 1 1 Check Amount: i f Cash Amount: 6.Total Project Cost: S 2,143.33 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CSSL-102765 7/22/24 Josh Leet License Number Expiration Date Name of CSL Holder List CSL Type(see below) 311 Main St No.and Street Type Description Worcester, MA 01608 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 508-796-5525 jcassani@myenergymonster.com SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 188796 9/4/23 The Energy Monster MA, Inc HIC CompanyName or HIC Registrant Name HIC Registration Number Expiration Date 311 Main St jcassaniAmyenergymonster.com No.and Street Email address Worcester. MA 01608 508-796-5525 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 Josh Leet to act on my behalf,in all matters relative to work authorized by this building permit application. Sheree Brown (PAF attached) 11/30/22 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 application is true and accurate to the best of my knowledge and understanding. Josh Leet 11/30/22 Print Owner's or Authorized 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 Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 ''t%rti,• �tti 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: (There will be no debris) Location of Facility: 100 Lamartine St. Worcester, MA 01608 The debris will be transported by: Name of Hauler: Energy Monster Signature of Applicant: Date: 11/30/22 „,.. "ie.. The Commonwealth of Massachusetts Department of Industrial..4ccidents 1 Congress Street,Suite 100 Boston, A12102114-2017 WWII;mass.gor/din !I orkers'Compensation Insurance Affidavit:Buiklers/ContractorsfElectriciansTlumbers. TO BE FILED WITH THE PERNIIIITING AUTHORITV. Applicant Information Please Print Lei...Hill Name(ilusitiesa Organizatioalndtridual): Address: I CityState2ip: Phone 11: _. . . Are vow an 4:11'phi:set?Cheek the apprisfornitc Imit: ! Type of project(req red): lam a employer with _employees Ifni!and,or part-time).* [.. 7. 0 New construction LID 1 am a sole pniprietin or partnership and have no employees wanting for Me M ' 8. a Remodeling capacity,[No weaken'comp.insuranix ropariati 9. 0 Demolition 1 am a itM17/MNIT1M doing all urk myself.[No workers'corm.insurance n.-quinall* 100 Building addition 4.0 I sit a borravtviter and will is hum;aim-odors to conduct all work on Ir. property. I ensure that all contractors other have workers”coeripensaticai iresurari or are sole 11.0 Electrical repairi.or additions proprietors with no npIuees 1 12_E]Plumbing repairs or additions I sin a general contractor and I have hired the sub-contractors lists.Nid on the attached she,: 13.0 Root repdvs niese sub-contractors have employees and have um-kers'comp.insurance.: 1., l 4.Ei Othin n.[D We are A oomporlthott and its officers bate exercised then right of exemption per M(ti e. 152,*14 4.1..and we have nu crrirlovees.No*otters comp insurance required.) An applicant that ehcas t.v.,..s.:".. 2riL4-;,“ I.oi.1 litc sVetten below*hoo.in them',.4 Of i...,::.5 ,:oinpensation polies inforinatiorL 1-FliorTICOWIltaN who subarea tins affidavit indicating they are doing all work and then hue outside covitractcrs mint submit a new affidavit indicating os±. :Contrnetors that cheek this bus must attarzhed an*Minimal sheet%b(,wing the name of sah-eontractors and state whether or riot those enuluch haN e ernployerh If the sub-contractors have Orr k,}12M.the must provide their workers"cutup.',Labe) nuiriher I am an employer that is providing worliers'compensation insurance for my entployees. Below is the policy ad job site information. Insurance Company Name: _ Policy#or Self-ins.Lic.#: Expiration Date Job Site Address: City ISta'telZip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,*25A is a criminal violation punishable by a fine up ii. S1,5I)0.00 andfor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up o S250.00 a day against the violator.A copy of this statement may be forwarded to the Office of In.,,:,•ligations of the DIA fo insurance coverage verification. /(hi hereby certify under the pains and f?enrrItics ofperiut:I that the information provided abort'is frIlf'rind eivrect. <II:nature: Date: ' Official wit.mill. Dr,Mir writ,'in tiers area. to be completed by city or town official City or Town: PermitfLicense# Issuing Authority(circle one): I. Board of Health 2.Building Department 1 Cityflown Clerk 4.Electrical Inspector 5.Plumbing Inspector G.Other Contact Person: Phone*: —�� ACCEENE-01 JRUGGIERO ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/28/2022 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 INSUFtER(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: Smith Brothers Insurance, LLC PHONE 300 Main Street (A/c,No,Ext):(508)987-0333 F4X 652-3236 (ae,No):(860 Oxford, MA 01540 A R SS:generaimaiibox@smithbrothersusa. m INSURER(S)AFFORDING COVERAGE NAIC 0 INSURER A:EMC Property&Casualty Company 25186 INSURED INSURER B: Energy Monster MA Inc INSURERC: 311 Main Street 2nd floor INSURERD: Worcester, MA 01608 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 ADDLISUBR POLICY NUMBER POLICY EFF POLICY EXP UMITS LTR INSD WVD (MMIDDIYYYY) (MMIDDIYYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE j $ 1,000,000 CLAIMS-MADE X OCCUR ,6D05384 6/1/2022 6/1/2023 PREMISES°(Ea occ r ence) $ 500,000 MED EXP(Any one persona $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO 6Z05384 6/1/2022 6/1/2023 BODILY INJURY(Per person) $ OWNED SCHEDULED AURTEO�S ONLY AUTOSS BODILYO INJURYp (Per accident) $ AUTOS ONLY NON-OWNED ONE (Per a dent)AMAGE A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE 6J05384 6/1/2022 6/1/2023 AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OT}i- AND EMPLOYERS'LIABILITY YIN STATUTE E- ANY PROPRIETOR/PARTNER/EXECUTIVE. I E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I $ 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 Northampton CityHall THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN p ACCORDANCE WITH THE POLICY PROVISIONS. 210 Main Street Northampton, MA 01060 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DATE(MM/DD/YYYY) ACORO® CERTIFICATE OF LIABILITY INSURANCE `..�" 10/28/2022 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 NAME: Joshua Ruggiero SMITH BROTHERS INSURANCE LLC (A/cc.No.Eat): (860)652-3235 FAX (A/C,No): E-MAILSS: iruggiero@smithbrothersusa.com smithbrothersusa.com ADDRE 68 NATIONAL DRIVE INSURER(S)AFFORDING COVERAGE NAIC# GLASTONBURY CT 06033 INSURERA: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER B: ACCELERATED ENERGY INC & INSURERC: INSURER D: C 0 ENERGY MONSTER 311 MAIN STREET 2ND FLOOR INSURER E: WORCESTER MA 01608 INSURERF: COVERAGES CERTIFICATE NUMBER: 829479 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 iADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) UNITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 'E T LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS N/A BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB • OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X I PER STATUTE ERH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? N/A N/A N/A 6S60UB5R71347322 01/13/2022 01/13/2023 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Northampton City Hall ACCORDANCE WITH THE POLICY PROVISIONS. 210 Main Street AUTHORIZED REPRESENTATIVE Northampton MA 01060 Daniel M.Crowley,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD