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24A-027 (11) BP-2023-0917 92 RIDGEWOOD TERR COMMONWEALTH OF M SSACHUSETTS Map:Block:Lot: 24A-027-001 CITY OF NORTHA PTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGI TERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARA TY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-0917 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 3500 ENERGIA LLC 108421 Const.Class: Exp.Date: 02/19/202 Use Group: Owner: S GLE HILL JUDD R&KAREN Lot Size (sq.ft.) Zoning: URA Applicant: ENER A LLC Applicant Address Phone: Insurance: 242 SUFFOLK ST (413)322-3111 WMZ-800-8008072-2022A HOLYOKE, MA 01040 ISSUED ON: 07/14/2023 TO PERFORM THE FOLLOWING WORK: INSULATION/W EATH ERI Z ATI 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 VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I • )2 T'. it I Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commiss oner N '1 C�� J� 1{/, l�vr�r Ig30 The Commonwealth of Massachus w s ,3 • W Board of Building Regulations and St. •.rt . `�� Massachusetts State Building Code, 780 C tUNI AL SE Building Permit Application To Construct,Repair, Renovate Or ►• `i'�;i 4,, Revi ed M. 2011 One-or Two-Family Dwelling • �ao�c- This Section For Official Use Only Building Permit Number: '.►L 3 9/7 Date Ap lied: 44->&),5 7 j Li- LO�3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 92 RIDGEWOOD TERR 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 I Required Provided Required Provided Required Provided f 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Public 0 Private 0 Check •if yes❑ Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: JUDD GLEDHILL Northampton Name(Print) City, State,ZIP 92 RIDGEWOOD TERR 781-996-9270 JkJDDRGLEDHILL@GMAIL.COM No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(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 1 Other 9 Specify:INSULATION DescriptionBrief of Pro osed Work2: INSULATION TO WALLS DENSE PACK CELLULOSE RI JOIST AND DOOR I HEKMAL 1:bAKKIEK IOLYlSO SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $3500.00 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost' (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Total All F s: $ Suppression) Check No. Ueck Amount: U Cash Amount: 6.Total Project Cost: $3500.00 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 108421 2/19/25 BENJAMIN BORDEN/ENERGIA LLC 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.ft.) State,ZIP R Restricted 1&2 Family Dwelling City/TovvM 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 EIERGprovement Contractor(HIC') LLC 165169 2/16/24 HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 242 SUFFOLK ST ivelice(genergiaus.com No.and Street Email address HOLYOKE MA 01040 413-322-3111 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 ENERGIA LLC-BENJAMIN BORDEN to act on my behalf,in all matters relative to work authorized by this building permit application. JUDD GLEDHILL 7/1/23 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 contained in this application is true and accurate to the best of my knowledge and understanding. � 592 7/1/23 Print Ow is 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 i of 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 dcks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total'Project Cost" City of Northamp on •?•--- Massachusetts , �. `?� t .4. :. 4. 1 " DEPARTMENT OF BUILDING INSPECTIONS Sk ,'. 212 Main Street • Municipal Building in, N Northampton, MA 01060 ja. dtt �0C 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: USA WASTE BOSTON RD WILBRAHAM MA Location of Facility: The debris will be transported by: USA WASTE Name of Hauler: Signature of Applicant: � � �� "� Date: 7/01/23 The Commonwealth of Massac1usetts Department of Industrial Accidents ,�w+=Imo— tflb Office of Investigations =ai= Lafayette City Center zi 2 Avenue de Lafayette, Boston,MA 02111-1750 % www.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. El 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.❑ Manufacturing no employees. [No workers' comp. insurance required]** 11. Health Care 4.❑ We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp. insurance req.] 12.❑■ Other INSULATION *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 Insurancec , C� Insurer's Address: ?2. —Q t 106TGw O0 I) i ' P City/State/Zip: NO/L7 �/,�-r/' /D,t/ �7 Policy#or Self-ins. Lic. #WMZ-800-8008072-2023A Expiration Date:7/01/2024 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 and 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, u der the pains and penalties of perjury that the information provided above is true and correct. Si ature: Date: // 2-2 Phone#: 413-322-31 1 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 one): 1.0Board of Health 2.0 Building Department 3.0 City/Town Clerk 4.❑Licensing Board 50 Selectmen's Office 6.['Other Contact Person: Phone#: www.mass.gov/dia ____......, ENERLLC-01 ALYSSA ,4�./- CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 6/20/2023 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(les)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 Alyssa Perusse NAME: Phillips Insurance Agency,Inc. PHONE FAX 97 Center Street (A/C,No,Ext): I(A/C,No): Chicopee,MA 01013 ADDRESS:alyssa@phIllipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# _ INSURER A:State Automobile Mutual Ins Co INSURED INSURER a:A.i.M.Mutual Insurance Company 33758 Energla LLC INSURER C: 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 TO 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 LIMITS LTR INSD WVD (MM/DD/YYYY1 (MMIDD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PBP2870943 7/1/2023 7/1/2024 DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X S2 F X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY (Ea OMB acclident)SINGLED LIMIT $ 1,000,000 X ANY AUTO BAP2477206 7/1/2023 7/1/2024 BODILY INJURY(Per person) $ OWNED SCHEDULED — AUTOSRREE�� ONLY _ AUTOS BODILY p BODILY INJURYD (Per accident) $ At I S ONLY AUTOS ON Y (Perr agent)AMAGE $ $ A X UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LAB CLAIMS-MADE PBP2870943 7/1/2023 7/1/2024 AGGREGATE $ 2,000,000 DED X RETENTION$ 0 $ B WORKERS COMPENSATION LIABI�LITNY Y/N X STATUTE ERµ WMZ-800-8008072-2023A 7/1/2023 7/1/2024 1,000,000 ANY NYIPROPRIE OR/PARTNERDE7 ECUTIVE N N/A E.L.EACH ACCIDENT $ Mandatory In�iFF�j 1,000,000 E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 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 Energia LLC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 ACCORDANCE WITH THE POLICY PROVISIONS. 242 Suffolk St. Holyoke,MA 1040 AUTHORIZED REPRESENTATIVE Ili'"kl 11"u i ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 440ft Permit Authorization mass saw Form r:,tYUrlph Vwcuyh energy e4M1Crency Site ID: 4779433 Customer: JUDD GLEDHILL l� Judd Gledhill , owner of the property located at: (Owner's Name,printed) 92 Ridgewood Terrace Northampton, MA 01060 (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. �A Owner's Signature: Date: 05 / 31 / 2023 FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: EKW67//1 7 / 2-5 Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 For Office Use Orly „ ,., City of Northampton f Massachusetts i * ` 1r ' DEPARTMENT •OF BUILDING INSPECTIONS •V, s °', 1,V 47; 212 Main Street • Municipal Building 4$,,,,� „%__” Northampton, MA 01060 44 0. Property Address: 92 Ridgewood Terrace Contractor ENERGIA LLC Name: Address: 242 SUFFOLK ST City, State: HOLYOKE MA Phone: 413-322-3111 Property Owner Name: JUDD GLEDHILL Address: 92 Ridgewood Terrace City, State: NORTHAMPTON MA I, BENJAMIN BORDEN (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 paltaz, L6,2.cee Date 7/14/23