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11C-007 (6)
B 2023-0100 8 HEFFERNAN ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 11C-007-001 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-2023-0100 PERMISSION IS HEREBY GRAN ED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 3900 ENERGIA LLC 108421 Const.Class: Exp.Date: 02/19/2023 Use Group: Owner: JACKE, EMILY M. &WOOD, JAKE '. Lot Size (sq.ft.) Zoning: URA Applicant: ENERGIA LLC Applicant Address Phone: Insurance: 242 SUFFOLK ST (413)322-3111 WMZ-800-8008072-20►2A HOLYOKE, MA 01040 ISSUED ON: 01/27/2023 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 VI I LATION OF ANY OF ITS RULES AND REGULATIONS. Signature: 1' ).9 Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner . � a- r, - - / J44, {' I, lay 8 The Commonwealth of Massachusetts C)? �� ': Board of Building Regulations and Standards �3 FOR � Massachusetts State Building Code, 780 CMR MUNICIPALITY Vyr USE Building Permit Application To Construct, Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling ueo-'"y 1 This Section For Official Use Only Buildin Permit Number:�P' ?Y%'— j �t� L"VIiJ Jtibss Date Applied: --___,, y I- 11 Z/23 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION j 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 8 HEFFERNAN ST 1.1 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- 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: EMILY JACKE LEEDS MA 01053 Name(Print) City, State,ZIP 6 HEFFERNAN ST 603-831-1414 jacketofwood@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 i❑ Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:INSULATION Brief Description of Proposed Work2:INSULATION-ATTIC FLOOR 9"OPEN BLOW-HATCH THERMAL BARRIER POLYISO FG DAMMING-ATTIC DOOR THERMAL BARRIER POLYISO-KNEEWALL SLOPE DENSE PACK CELLULOSE SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item (Labor and Materials) Official Use Only 1.Building $3900.00 1. Building Permit Fee:$ Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costa (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ •Total otal All Few Check No. � eck Amount Cash Amount: 6. Total Project Cost. $3900.00 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 108421 2/19/23 BENJAMIN BORDEN 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.it.) 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 2/16/24 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 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 0 No 0 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 BENJAMIN BORDEN/ENERGIA LLC to act on my behalf,in all matters relative to work authorized by this building permit application. S� Al.-rTACE4E-45 1/8/23 Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER1 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 tru and accurate to the best of my knowledge and understanding. 1/8/23 Print Owner' 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 1iAMpo`, �$ ., Massachusetts II/ ( • N t yrp A ^ E Y DEPARTMENT OF BUILDING INSPECTIONS , ' 212 Main Street • Municipal Building v4,, CD x' Northampton, MA 01060 .. `10 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: USA WASTE BOSTON RD WILBRAHAM MA The debris will be transported by: Name of Hauler: USA WASTE Signature of Applicant: Date: 1/8/23 DocuSlgn Envelope ID:40669A93-CGB0-49F0-B9EF-D1 B4454C6207 a RISE ENGINEERING- OWNER AUTHORIZATION FORM I, Emily Jacke , (Owner's Name) owner of the property located at: 8 Heffernan Street (Property Address) Leeds, MA 01053 (Property Address) hereby authorize EA Ez./A_ LLB_ , (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. p—DocuSigbed by: C.nuga Oa" Own69'9Y 6fcYre 11/29/2022 1 1:29 PM EST Date RISE Engineering, a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335 www.RlSEengineering.com The Commonwealth of Massachusetts Department of Industrial Accidents ,!= Office of Investigations =316i= Lafayette City Center a ' 2 Avenue de Lafayette, Boston,MA 02111-1750 �V• wwx.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 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]** 11.❑ Health Care 4.❑ We are a non-profit organization, staffed by volunteers, Insulation with no employees. [No workers' comp. insurance req.] 12.❑� Other *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:8 HEFFERNAN ST City/State/Zip: NORTHAMPTON MA 01053 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 ar'd 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, under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 1/8/23 Phone#: 413-322-3 11 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,ne): 1.❑Board of Health 2.❑Building Department 30 City/Town Clerk 4.❑Licensing Board 50 Selectmen's Office 6.❑Other Contact Person: Phone#: www.mass.gov/dia THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Commonwealth of Massachuse'ts Division of Professwna' Licensure board of Building Regulations and Standards Co nstructibnSuperviso. ENERGIA LLC 242 SUFFOLK STREET CS-108421 Expires:02/19/2023 HOLYOKE,MA 01040 BENJAMIN BORDEN f' 112 RYAN ROAD FLORENCE MA 01062 "— Commissioner a? . n G1a • 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:LLC Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 165169 02/16/2024 Boston,MA 02118 ENERGIA LLC BENJAMIN BORDEN 242 SUFFOLK STREET ��,.N�.`�aGGr�c" HOLYOKE,MA 01040 Undersecretary Not va id without signature �`m""lEk ENERLLC-01 JOCELYN 4WRD' DATE(MM/DD/YYYY) �� CERT[HCATE F UAB LIITY [NSUL yANCE DATE 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 ONT CT Jocelyn M Douglas Phillips Insurance Agency,Inc. PHONE FAX 97 Center Street (A/C,No,Ext): ,(A/C,No): Chicopee,MA 01013 ADDRESS:jocelyn@phillipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# 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 10 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMIIrS LTR INSD WVD JMM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE X OCCUR PBP2870943 7/1/2022 7/1/2023 DAMAGE TO RENTED 500,000 PREMISES(Ea occurrent q) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 1._GEN'L AGGREGATE LIMIT APPLIES PER: _GENERAL AGGREGATE $ 2,000,000 POLICY X PRO" X LOC 2,000,000 JECT PRODUCTS-COMP/OP AGG $ OTHER: _ , $ A AUTOMOBILE tJABlL1TY COMBINED SINGLE LIMIT 1,000,000 jEe accident $ X ANY AUTO _ BAP2477206 7/112022 7/1/2023 BODILY INJURY(Per person,' $ OWNED SCHEDULED AUTOS ONLY AUTOS y� BODILY INJURY(Per accide-t) $ ,_ AU1aa ONLY _ AUTOS ONLY (Per acuCentrMAGE $ $ A l X UMBRELLA LIAB X OCCUR `EACH OCCURRENCE $ 2,000,000 EXCESS LIAR CLAIMS-MADE PBP2870943 7/1/2022 7/1/2023 AGGREGATE $ 2,000,000 DED X RETENTION$ 0 $ B WORKERS COMPENSATION X PER OERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN WMZ-800-8008072-2022A 7/1/2022 7/1/2023 E.L.EACH ACCIDENT $ 1,000,000 FFICERIMEMBER EXCLUDED? N N/A 1,000,000 Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If es,descrbe 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 REPRESENTATIVE ACORD 25(2016/03) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD (---- 1,„,..,.Q,�yyn41001k City of Northampton s - s Massachusettssiit' 'SL <<� aa DEPARTMENT OF BUILDING INSPECTIONS SJ,� ;D�,° i„ - 212 Main Street • Municipal Building fs., ;•,��` Northampton, MA 01060 �Y-3D, Property Address: 8 HEFFERNAN ST LEEDS MA Contractor Name: ENERGIA LLC- BENJAMIN BORDEN Address: 242 SUFFOLK ST City, State: HOLYOKE MA 01040 Phone: 413-322-3111 Property Owner Name: EMILY JACKE Address: 8 HEFFERNAN ST City, State: LEEDS MA 01053 I, BENJAMIN BORDEN/ENERGIA LLC (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 that I have provided the property owner with a copy of this affidavit. Contractor signature Date 1/8/23