Loading...
25A-022 (7) BP-2023-0676 51 MARSHALL ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 25A-022-001 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-2023-0676 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 7658 5C ENERGY INC 106162 Const.Class: Exp.Date: 04/26/202 Use Group: Owner: ROSE I ELD NIGROSH, MAYA & HEATHER J. Lot Size (sq.ft.) Zoning: URB Applicant: SC ENE'GY INC Applicant Address Phone: Insurance: 3820 DIAMOND HILL RD 774-203-3704 WC928038765994 CUMBERLAND, RI 02864 ISSUED ON: 05/24/2023 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 VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I �, O . , 1 • • • A Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner 7` n lc S `2r �� \ UiLT ICI The Commonwealth of Massachusetts • ' Vti Board of Building Regulations and.Stand s / FOR Massachusetts State Building Cody,780, R qy? ,,MUNICIPALITY s. USE Building Permit Application To Construct,Repair,Re ° Demol'�' - Ivised iLlar 2011 One-or Two-Family Dwelling ti ' -'?%,,, f This Section For Official Use 0r4y .'4') Building Permit Number: ' ' -?3_G k Date Applied: �.70T0/°"s 41./i i.--$ 7 /12 ZLI 7_oZ Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 51 Marshall Street 25A 022-00I 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 CI Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Heather Rosenfeld Northampton,VA.01060 Name(Print) City,State,ZIP 51 Marshall Street 773-931-4480 Heather.Rosentron©gmail.com No.and Street Telephone *OWNER'S Email Address MUST BE INCLUDED SECTION 3: DESCRIPTION OF PROPOSED WORK"(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition ❑ Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify: INSULATION Brief Description of Proposed Work2: SEE CONTRACT SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 7,658.33 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire CA Suppression) $ Total All F 6.Total Project Cost: $ 7,658.33 Check No. .heck Amount: Cash Amount: 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 106162 04/26/2025 MATTHEW RUSSELL License'lumber Expiration Date Name of CSL Holder R 3820 DIAMOND HILL ROAD List CSL Type(see below) No.and Street Type Description CUMBERLAND, RI 02864 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1842 Family Dwelling City/Town,State,ZIP M Masonry RC Roofmg Covering WS Window and Siding SF Solid Fuel Burning Appliances 774-203-3704 Maryann@5CEnergyinc.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 195309 MATTHEW RUSSELL °°"82025 C Registration Number DM. HIC Company Name or HIC Registrant Name 3820 fIAMOND HII I ROAD Maryann@5CEnergyinc.com No.and Street Email address CUMBERLAND, RI 02864 774-203-3704 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 El 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 MATTHEW RUSSELL to act on my behalf,in all matters relative to work authorized by this building permit application. Please see enclosed owner authorization 5/18/23 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 con ., ' n this application is true and accurate to the best of my knowledge and understanding. 6Ali, MATTHEW RUSSELL _ 5/18/23 Print Owner's or Authorized Agent's Name(Electronic Signature) I)ate 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" t y ! Q r RESIDENTIAL PROPERTY RECORD CARD 2023 NORTHAMPTON di division Situs :51 MARSHALL ST Map ID:25A-022-001 ! Class:Single Family Residence Card:1 of 1 ] Printed: December 22,2022 ----- ----- r CURRENT OWNER 1 GENERAL INFORMATION ili 4 .," LivingUnits 1 ",ygou ` -f +.- NIGROSH, MAYA& HEATHER J.ROSENFELD �` ' ' Neighborhood 8 s` -: -'. 51 MARSHALL ST �.. 4 i`�� NORTHAMPTON MA 01060 Alternate Id .4, Vol/Pg 14196/40 District ^" -- Zoning Class Residential '- il if . +' ,-;:, �.�i' Property Motes ip ,. IMF Land Information Assessment Information Type Size Influence Factors Influence% Value Assessed Appraised Cost Income Primary Sf SF 6,600 137,160 Land 137.200 137,200 137,200 0 128,200 Building 231,900 231,900 199,200 0 171,400 Total 369,100 369,100 336,400 0 299,600 Manual Override Reason Base Date of Value 2023 Value Flag MARKET APPROACH Effective Date of Value 1/1/2022 Total Acres:.1515 Gross Building: Spot: Location: Entrance Information Permit Information Date ID Entry Code Source Date Issued Number Price Purpose %Complete 11/04/20 TO Not At Home Other 03/28/12 0837 57,500 BLDG Reno Kit/Bath/ 0 03/12/12 JCS Misc Reason Other 03/20/12 0804 15,000 BLDG Wind/Roof/Energ 10/23/99 SS Unoccupied Convert From Univers 10/14/99 SS Unoccupied Owner Sales/Ownership History ,. Transfer Date Price Type Validity Deed Reference Deed Type Grantee 07/23/21 385,000 Land+Bldg Valid Sale 14196/40 Quit Claim NIGROSH,MAYA&HEATHER J. ROSENFI 04/05/12 255,000 Bldg Only Valid Sale 10865/23 NIGROSH,MAYA&HEATHER J. ROSENFI t y l s r RESIDENTIAL PROPERTY RECORD CARD 2023 NORTHAMPTON �-/t divi.�ior. Situs : 51 MARSHALL ST Parcel Id:25A-022-001 Class:Single Family Residence Card: 1 of 1 I 1 Printed: December 22,2022 Dwelling Information 12c 12 11 ID Code Description Area 34 A Maineuitding 884 OFP Style Cape Year Built 1929 C 16 OY B 11 FOV S2 RH 12 Story height 1.5 Eff Year Built 1995 D II OFP 12 Attic None Year Remodeled 2011 E RG1 GARAGE-w0>1;B 320' Exterior Walls Asbestos Amenities Masonry Trim x Color Yellow In-law Apt No 3 Basement 4 D 4 26 A 26 3 Basement Part #Car Bsmt Gar FBLA Size r FBLA Type Rec Rm Size x Rec Rm Type Heating&Cooling Fireplaces Heat Type Basic Stacks 1 Fuel Type Oil Openings 1 System Type Steam Pre-Fab 34 12 Room Detail 5 B 5 Bedrooms 3 Full Baths 1 12 Family Rooms Half Baths Kitchens 1 Extra Fixtures Outbuilding Data Total Rooms 5 Kitchen Type Bath Type Type Size 1 Size 2 Area Qty Yr Blt Grade Condition Value Kitchen Remod Yes Bath Remod Yes Det Garage 1 x 320 320 1 1935 C A 5.950 Adjustments Int vs Ext Same Unfinished Area Cathedral Ceiling x Unheated Area Grade& Depreciation Grade B- Market Adj Condition Good Functional CDU GOOD Economic Cost& Design 0 %Good Ovr Complete Dwelling Computations Condominium/Mobile Home Information 7 Base Price 231.083 %Good 86 Complex Name Plumbing %Good Override Condo Model Basement -10.875 Functional Heating 0 Economic Unit Number Attic 0 %Complete Unit Level Unit Location Other Features 10,007 C&D Factor Unit Parking Unit View Adj Factor 95 Model(MH) Model Make (MH) Subtotal 230,220 Additions 5.120 Ground Floor Area 884 Total Living Area 1,559 Dwelling Value 193.240 Comparable Sales Summary Parcel ID Sale Date Sale Price TLA Style Yr Built Grade 25A-022-001 23-JUL-21 385,000 1,559 3 1929 B- Building Notes 25A-142-001 12-JAN-21 340,800 970 3 1948 C+ 25C-243-001 17-JUN-21 395,000 1,768 1 1900 B- 25C-173-001 28-MAY-21 439,000 2,089 1 1900 B J 25C-159-001 15-JAN-21 540,000 2,044 1 1900 B mass save Savings through energy efficiency PERMIT AUTHORIZATION FORM Heather Rosenfeld owner of the property located at: (Owner's Name) Marshall ctraat NInrthamntnn MA (Property Street Address) (City) hereby authorize the Mass Save® Home Energy Services Program assigned Participating Contractor to act on my behalf and obtain a building permit to perform insulation and/or weatherization 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. thninar'e --r-o Cirrnafi, --------- -- ---------- 05-03-2023 Date FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: 5C ENERGY INC. 5/18/23 i"di i.ii.ipdiii iS,A)i iii ci LWi Udi.i: WEATHERIZATION CONTRACT EVERSURCE CUSTOMER PHONE DATE CLIENT/I WORK ORDER i-teatner Kosenrelo'.: (/1.5)ysi-44oU..; 04/uii2U i ,i bb40 UUOUi_ SERVICE STREET BILLING STREET PROPOSED BY: 51 Marshall Street i 51 Marshall Street SERVICE CITY.STATE.ZIP BILLING CITY,STATE,ZIP Program Northampton, MA 01060. Northampton, MA 01060, EGMA-HES. Page 1 DESCRIPTION QTY COST INCENTIVE TOTAL INCENTIVE 75% For eligible weatherization measures,Eversource is offering an incentive of 75%for insulation measures and 100%for the air sealing measures, both with no limit.You are eligible to apply for the 0%Heat Loan to finance your co-pay, applications must be submitted before the weatherization work begins. CARBON MONOXIDE-HEATING SYSTEM undiluted flue gasses do not exceed 400 parts per million(ppm)air- free of carbon monoxide. Weatherization work cannot proceed until this is fixed. KNOB&TUBE WIRING (Northhampton) We have identified that your home might have Knob&Tube wiring H.R. (initials).. present.The following contract is not valid unless accompanied by the Weatherization Barrier Incentive form, signed by your licensed Gl�i l.�l I lilCll1. Y VrIlt YY lJi1\llll -lYG I CiV41Y4 CI liVM)' of the form. HOME AIR SEALING 4 $377.32 $377.32. Seal areas of your home against wasteful, excessive air leakage. Materials to be used to seal your home can include caulks,foams and other products. Primary areas for sealing include air leakage to attics, basements,attached garages and other unheated areas (windows are not generally addressed.) TRANSITION AIR SEALING. 68:_ $441.32. $441.32 Provide labor and materials to air seal the open kneewall transitions of your home against wasteful, excess air leakage. WEATHERSTRIP DOOR 2: $63.62 $63.62 Provide labor and materials to install Q-Ion weatherstripping to door(s)to restrict air leakage. DOOR SWEEP 2 1179 27 Cr-.2 22 Provide labor and materials to install a doorsweep to restrict air leakage. KNEEWALL-2"RIGID BOARD, 60, $288.60 $216.45 $72.15 Provide labor and materials to install rigid board at R-10 or greater with the required fire rating to a kneewall area. KNEEWALL FLOOR- 12"DENSE R-38 CELLULOSE 136 $473.28 $354.96 $118.32. • .-F..II .. 1')"1.........F'22r. .. ..I....•! I 38 Class I Cellulose to a kneewall floor. WEATHERIZATION CONTRACT EVERSURCE CUSTOMER PHONE DATE CLIENT Y WORK ORDER Heatner Kosentela (//3) U31-44tSU U4/U 6/2 UZS 32t5 4t 00003 SERVICE STREET BILLING STREET PROPOSED BY, 51 Marshall Street 51 Marshall Street SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Program Northampton, MA 01060 Northampton, MA 01060 EGMA-HES Page 2 DESCRIPTION QTY COST INCENTIVE TOTAL KNEEWALL SLOPE-2" RIGID BOARD 476 $2,308.60 $1,731.45 $577.15 Provide labor and materials to install rigid board at R-10 or greater with the required fire rating to the sloped rafter area behind a kneewall. HATCH -INSULATE RIGID BOARD 1 $47.37 $35.53 $11.84 Provide labor and materials to insulate the back of an attic hatch with 2" rigid insulation board at R-10. \NAI I S-ASRFSTC.SICIFCI 4" clan VA 7R3 9n S7 4F7 4n $R?n 80 Provide labor and materials to install blown in Class I Cellulose to asphalt-sided exterior walls. Touch-up painting, if needed, will be the customer's responsibility. Homeowner has received a copy of the EPA's Renovate Right Lead-Safe information guide explaining the potential risk of the lead hazard exposure from the weatherization work to be performed. Your signature is your acknowedgement of receipt and agreement to proceed. RASFMGItlT sl ! S-F"FIRFRri AS �_ Rn rt')4') 111 gRn 7fl Provide labor and materials to install R-19 unfaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. Total: $7,658.33 Program Incentive: $5,977.37 Client Total: $1,680.96 I.DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the above work at the Client's Address in a professional manner and in accordance with the terms of this Contract: II.PAYMENT �.IIVI rl agrees'W pay'ine"LUrlU acrui'wr(Ile WOIE,tile"Cileiil Jlrare Urinewrit/aci LOST Is payaLre w lne lnuepenuenl IIISIduallOrI LOnuauvr(nL)upon StUSI.CNIy LUIlI Ielwn of the Work.Client understands that they will not be required to pay the Program Incentive Share of the Contract cost.Changes to the individual line items and/or previous incentives may increase or decrease the size of the Program Incentive Share. )//� • RISE Representative iakek Go-tare Client Signature 05-03-2023 Printed Name Date of Acceptance City of Northampton ?. Massachusetts ��5 �';yy f.. *J0 DEPARTMENT OF BUILDING INSPECTIONS ; v =+', r . f.' 212 Main Street • Municipal Building yeti �b� , Northampton, MA 01060 rSNh 3,3° 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: 330 VICTOR ROAD, ATTLEBORO,MA.02703 The debris will be transported by: Name of Hauler: SC ENERGY,INC. Signature of Applicant: Date: 5/18/23 The Commonwealth of Massachusetts r Department of Industrial Accidents in= 1 Congress Street, Suite 10Q _ti-=_ Boston,MA 02114-2017 4' www mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contt•actors/Electricians/Plumbers. It)BE FILED Willi THE YERMI'1'TI1'4t AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual):5C Energy, Inc Address:330 Victor Rd. Bldg A City/State/Zip:Attleboro, MA 02703 Phone #: 774-203-3704 1i Are you an employer?Check the appropriate box: Type of project(required): 1.13 I am a employer with 25 employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 30I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9 El Demolition 10 ❑Building addition 4.01 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.Q Electrical repairs or additions 12.U Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance? 6.ElWe are a corporation and its officers have exercised their right of exemption per MGL c. 14.Bother Insulation 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contactors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contactors and state whether or not those entities have -..,..,:„__.,. If el,...uu-_:;::u.:-t.::c :.,--::a::v:,c..o,:::::, i::..c.ry iu-:.._.. ............ _.,.::ii.r.:::::�:»....._.. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: ARGONAUT INSURANCE COMPANY — Policy#or Self-ins.Lic.#: WC928038765994 Expiration Date:12/27/2023 X Job Site Address: 51 MARSHALL STREET itv/State/Zip: NORTHAMPTON,MA.01060 Attach a copy of the workers'compensation policy declaration page(show' g the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal vi lation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP ORK 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 c L ti uptlert eminns and ppenakies of perjury that the infor ''n provided above is true and correct. Phone: 774-203-3704 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.Elec rical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: mass save save Weatherization barrier incentives Based on your Energy Specialist's recommendations,your home can benefit front program-eligible insulation and/or air sealing improvements.Before moving forward,please follow ail the instructions below toi remediate your weatherization barriers. CUSTOMER INSTRUCTIONS 1. Hire a qualified,licensed co,'tractor 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,60 Shawmut Rd,010,Canton,MA 02021 or email to EversourceInfoi PISEengineering,corn. 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 ambunt. 4.Complete the recommended weatherization improvements. S.The Mass Save*HEAT Loan offers ihterest-free financing opportunities that may be used to remediate eligible weatherization barriers. Learn more at masssave.comientsaving/residential-rehates/heat-loan-pr,agram Customer Name: Heather Rosenfeld Client#or Site ID: 326646 Site Address: 51 Marshall Street City: Northampton State: MA ZIP: 01060 Phone Number: 773-931-4480 Email: heather.rosentrongmaii.com Customer/Homeowner Signature: Date: KNOB AND TUBE WIRING 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: 0 Attic Floor 0 Attic Wall 0 Attic Slope 0 Exterior Wall 0 Basement a'D Other: a Other: I have performed my inspection and determined there is no active knob and tube wiring in the areas selected below. PlAttic Floor /Attic Wall (7ttic Slope ,,_/.,Cxterior Wall ,,._t<C3asernent Other: Other: At NA4 iLe6: ;A,4rtis,t,„4411 4-4,0cy ovi,ke Accesow< 4.4 4ii 40.0 Contractor Name: rh„).1 ii",9c-;Zr rek Acidress:4—t) 4-th tot( City: griitta4iVilei State: MA ZIP: Oitigir Company Name: Pik;brect c License Number: 2s.01 Contractor Signature* _ Date: 'gin/207'1 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 Coaditions outlined on the back of this form. 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 minion(ppm). Draft Failure:Contractor is to correct the draft in the selected flue(s).Refer to table• reverse for acceptable draft ranges. High Carbon Monoxide Draft Failure Existing CO ppm: Revised co ppm: I Existing Draft Pa: Revised Draft Pa: • Heating System 2000+ -6A Hot Water Heater Other;Spillage:Contractor Contractor is to correct the spillage of flue gases in the selected mechanical stem(s).Must not spill after 60 seconds of operation. )Heating System 0 Hot Water Heater 0 Other. Contractor Name: Address: City: State:_. ZIP: Company Name: License Number: Contractor Signature: Date: ' My signature confirms that I have performed my inspection of the mechanical system, 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. i„,at. Ele ct . Invoice ... .....; Date Invoice# ►4° ' 3/13/2023 9192 65D Elm St. Ste 104,Hatfield MA 01038 49 Phone(413)247-0334 !' ,,ep License#20318 Ati! � Maya Nigrosh 0 ` Heather Rosenfeld Be sure to check us out on the web @ 51 Marshall Street PaciorekElectric.com Northampton,MA 01060 Job Start Date Job Name Job Description Terms 3/10/2023 51 Marshall K&T Inspection t)ue on reco ipt Qty Description Cost Total 1 Knob and Tube Inspection: 250.00 250oO Perform inspection to make sure there is no live knob and tube wiring in areas to be insulated. See MassSave form for details.Lucas. Paid by credit card(Visa)3/13/2023$250 Thank you for your business! Total Due is due and payable upon receipt of invoice. An amount of 1.5%per month of the Subtotal $250.00 unpaid balances of all invoices paid after our net 15 terms will be assessed as late payment service charges. Returned check fees will be$39.00 and new payment will require cash, money order,or bank check. Should collection or legal action become necessary to obtain Sales Tax (6.25%) $0.00 payment,all costs of collection,including but not limited to collection agency and Sheriffs fees,attorney or other legal fees,court costs,lien filing fees,and any other collection costs Total $250.00 will be paid by the customer. Any parts or fixtures supplied by the Customer will not be covered by any warranty from the Payments/Credits -$250.00 Electrician. Customer shall be responsible for extra labor or material costs should the parts or fixtures provided by the Customer be broken,have missing pieces,or require assembly by Electrician. Balance Due °,00 A`ORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/D DIYYYV) 12/28/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS 1 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 1111D...e111111-ate UUeb IIUt I.UI IICI I Iy IIIJ lU Um Lei III II-ate IIVIUeI III IIeU VI.b UI.II el IUJVI bellle/11(6j. PRODUCER CONTACT Rosalynn Davila NAME: Loiselle Insurance Agency PHONE Eat): (401)723-8510 FAX No): (401)728-1820 279 Dexter Street E-MAIL rosalynn@loiselleinsurance.com ADDRESS: P.O.Box 1148 INSURER(S)AFFORDING COVERAGE _ NAIC# Pawtucket RI 02862-1148 INSURER A; Employers Mutual Casualty Co 21415 INSURED INSURER B: EMC Prop&Cas Ins Co 25186 5C ENERGY,INC. INSURER c: Argonaut Insurance Co ARGO wv ViL.i vi<iSU=uviL'Jirvvn INSURER D; i�i:a'vV i<iGvV - INSURER E: ATTLEBORO MA 02703 6294 INSURER F: COVERAGES CERTIFICATE NUMBER: Master:2022 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. ILTR TYPE OF INSURANCE INSD IS POLICYPOLICY NUMBER POLICY EFP POLICY EXPYY LIMITS {MM/DD/YYYY) (MM/DD/ YY) " LUIVIIVIEILIML GENERAL LIAbILI I I' EACH OCCURRENCE $ i,i UU,000 CLAIMS-MADE 13 OCCUR PREM SESO(Ea occur re $ 500,000 11 _ MED EXP(Any one person) $ 10,000 A 5D98024 12/27/2022 12/27/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2'000'000 H POLICY PRO- 2,000,000 JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 I (Ea accident) ANYAUIU bOUILY INJURY(Her person) $ 20,000 B - OWNED )/ SCHEDULED 5Z98024 12/27/2022 12/27/2023 BODILY INJURY(Per accident) $ 40,000 AUTOS ONLY X AUTOS XHIRED *se NON-OWNED PROPERTY DAMAGE $ 5,000 AUTOS ONLY AUTOS ONLY (Per accident) Uninsured motorist BI $ 1,000,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 3,000,000 A - EXCESS LIAB CLAIMS MADE 5J98024 12/27/2022 12/27/2023 AGGREGATE $ 3,000,000 DEC X RETENTION$ 10,000 $ WORKERS COMPENSATION X PER ' ()TH- IN ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ I,UUU,000 C OFFICER/MEMBER EXCLUDED? n N/A WC928938765994 12/27/2022 12/27/2023 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Contractors Pollution Liability D CPLMOL107038 06/16/2021 06/16/2023 Aggregate $250,000 Eeach Occurrence $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION I I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I TUC CYPICATIr1N r1ATC TUCCCr c NJnTir=IA/II I GC rim It/CGC11 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 5Jj/��,y/, I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NO DEBRIS INSULATION ONLY DEBRIS DISPOSAL AFFIDAVIT In accordance with the provisions of M.G.L. c. 40, s. 54, Building Permit # n/a was issued with the condition that all debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L c. 111, s. 1.50A. The debris will be disposed of in: 5C Energy, Inc. Name of Waste Facility 330 Victor Road, Attleboro, MA 02703 Address of Waste Facility 111.5 Debris: As a condition of issuing a permit for the demolition, renovation, rehabilitation or other alteration of a building or structure, M.G.L. c.40 s. 54 requires that the debris resulting therefrom shall be disposed of in a properly licensed solid waste .1:.._......I C.._:,...:.... ....R_...I by 1f f'i .. III .. 1 c/I A c:.—..,. ..c IL.._..tea .. _I:...._i date and number of the building permit to be issued shall be indicated on a form provided by the Building Department and attached to the office copy of the building permit retained by the Building Department. If the debris will not be 'sposed of as indicated, the holder of the permit shall notify the building official, in 'ting, as to the location where the debris will be disposed. 780 CMR—6th Edition O. fá'i1 (thfL Si ture of Permit Applicant ra 5/18/23 Date Commonwealth of Massachusetts ivDivision of Occupational Licensure Board of Building a ulations and Standards t Construct per ?r Specialty CSSL-106162 04/2612025 51 }2 it MAT THEW J: U SS LL '��� ;' tf."Illks1/4 3820 DIAMOND HILL RD A 7 tJ MRFR AP/11 RI ►14 g " , , 4 ' s'... 411 if ,R 3 ‘ 1 'f 4«' L r '1 Construction Stifle/vigor Stifle/vigor Specialty 4 Restricted to: CSSL-IC - Insulation Contractor Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license h. Noun tv if I fa.,-�a Anr� vi VIM% www.ui aa�a.yuvxup THE COMMONWEALTI I OF MASSACHU:ETTS Office of Consumer Affair; and Business R;gulation 1000 Washington Street-Suite 710 Boston, Massa c+husetts 02118 Hcme Improvement Contractor Registra,bon Type Individual 195309 MATTHE USSELL R Expiratt W Iion ion 04/18/2025 3820 DIAMCIND HILL RD CUMBERLAIVD,RI 02884 Upd Address and Return C.rd. THE COMMONWEALTH OF MASSACHUSE''TS Office of Consurm r Affairs&Business Regu rutIon Raglan Iltlon valid for Individual u u only before the HOME IMPR.)VEMENT CONTRACTOR sxpkat.,an date. N found return to TfPE Individual Office c II Consumer Affairs and Bi IsIness Regulation Basiotottisio Expiration 1000 Waushington Street -Suits 7'10 19530 04/18/2025 Boston,MA 02119 MATTHEW RUSSELL I/ MATTHEW RUSSELL 3820 DIAMOND HILL RD •,,,., /�/, i � CUMBERLAND,RI 02864 Under:ncretary Not valid without signature THECOMMONWEALTH OF MASSACHUSETTS Office of Consumer Afairs and Business Regulation 1000 Washinriton Street - Suite 710 Boston, Massachusetts 021'I 8 Home Improvement Contractor Registration so Type: Corporation egi;Iration: 194390 5C ENERGY INC. Ex E iration: 01/30/2025 330 VICTOR ROAD - ATTLEBORC, MA 02703 y - T -- f Update Address and '4eturn Card. THE COMMONWEALTH OF MASSACHUS TTS Office of Consumer Affairs&Business Reg Illation Re;;llatration valid for indly'dual use only before th HOME IMPROVEMENT CONTRACTOFI ex;:dragon date. If found n rqurn to: TYPE:Corporation Office of Consumer Main and Business Regulat1''n Registratl m Expiration N0 Washington Street -':.�ulte 710 194390 01/30/2025 Bo ston,MA 02118 iC'ENERGY,INC. • .TER R.COLWELL `Y 18 :IREYSTONEROAD ...+ 4.,�i6G MpRBLEHEAD,MA 01945 Uncle secretary Not valid witl'tout signature