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22B-041 (33) BP-2023-1464 176 PINE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 22B-041-001 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-2023-1464 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 8000 ENERGIA LLC 108421 Const.Class: Exp.Date: 02/19/2025 Use Group: Owner: PUN FAMILY LLC Lot Size (sq.ft.) Zoning: GB Applicant: ENERGIA LLC Applicant Address Phone: Insurance: 242 SUFFOLK ST (413)322-31 1 1 WMZ-800-8008072-2022A HOLYOKE, MA 01040 ISSUED ON: 10/19/2023 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATH ERI ZATI 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: • 6 yQj cs-j657 Fees Paid: $110.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner _ Versionl.7 Commercial Buildin_ Permit May 15,2000 ' i�,r--► ) 7q R E C E I V E Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit OCT 1 8 2023 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability orthampton, MA 01060 Two Sets of Structural Plans r)8PT OF riUILr)I0:IOfi I, -587-1240 Fax 413-587-1272 Plot/Site Plans Or3THA.11" Other Specify APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office 176 PINE ST FLORENCE MA Map Lot Unit Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ROBERTO SARAVIA 176 PINE ST FLORENCE MA Name(Print) Current Mailing Address: (413)2.30-0812 Signature SEE- I)G1.1k1 T MATH d Telephone 2.2 Authorized Agent: BENJAMIN BORDEN -ENERGIA LLC 242 SUFFOLK ST HOLYOKE MA 01040 Name(Print) Current Mailing Address: (413) 322-3111 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $8,000.00 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) SOD 5. Fire Protection $8,000.00 6. Total=(1 +2+3+4+5) Check Number 7( 7f This Section For Official Use Only Building Permit Number Date Issued Signature: /7 / ra- I8.2L23 Building Commissioner/Inspector of Buildings Date Versionl.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs El Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing Change of Use❑ Other ❑✓ Brief Description INSULATION ATTIC FLOOR OPEN BLOW CELLULOSE FG DAMMING Of Proposed Work: - INTERIOR WALLS DENSE PACK CELLULOSE- NO CONSTRUCTION INSULATION ONLY SECTION 5-USE GROUP AND CONSTRUCTION TYPE /✓A — wo CON5T Rt&C T to- USE GROUP(Check as applicable) M I CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ElA-3 El l ❑ A-4 ❑ A-5 ❑ 1 B ❑ B Business ❑ 2A ❑ E Educational 0 2B I ❑ F Factory ❑ F-1 ❑ F-2 0 2C ❑ H High Hazard Cl 3A ❑ I Institutional ❑ I-1 ❑ 1-2 0 1-3 0 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 0 R-2 0 R-3 ❑ 5A ❑ S Storage ❑ S-1 0 S-2 0 5B l ❑ U Utility ❑ Specify: J M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND/OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1st i 15t ----- 2nd _.... 2'1 3d 3rd 4tb 4�h Total Area (sf) Total Proposed New Construction(sf) Total Height(ft) Total Height ft 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system Versionl.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: J Rear Building Height �? Bldg. Square Footage Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW 0 YES 0 IF YES, date issued: r IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW 0 YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW © YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading, excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Version1.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: —/ /C/ i1 Not Applicable gd' Name(Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): N/A Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor E %J& G/A LL L Not Applicable ❑ Company Name: 'Sar 5AJ tt k1 RZD6I I Responsible In Charge of Construction .M2 SUPco1.1c ST H-01-4 0 KE /Acit- d l o'l o Address `413-322-31i1 Signature Telephone Version1.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes © No 0 SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ROBERTO SARAVIA , 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. SEE- A &rt * 10/09/2023 Signature of Owner Date BENJAMIN BOTFRN as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. BENJAMIN BORDEN Print Name 10/ 23 10/09/2023 Signature Owner/Agent Da SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable E Name of License Holder: BENJAMIN BORDEN 108421 License Number 242 SUFFOLK ST HOLYOKE MA 01040 02/19/2025 Address Expiration Date (413) 322-3111 Signature Telephone SECTION 13-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 :, The Commonwealth of Massachusetts Department of Industrial Accidents ''—';- Office of Investigations Lafayette City Center k- ,, '�,M�' 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: ENERG1A 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): 1.0 I am a employer with 16 employees(full and/ 5. 0 Retail or part-time).* 6. ❑Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7. Q 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. 0 Entertainment their right of exemption per c. 152, §1(4),and we have 10.0 Manufacturing no employees. [No workers' comp.insurance required]** 4.❑ We are a non-profit organization,staffed by volunteers, 1 i.❑Health Care with no employees. [No workers' comp. insurance req.] 12.111 Other INSULATION *Any applicant that checks box#I 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 far my employees. Below is the policy information. Insurance Company Name: A.I.M. Mutual Insurance Insurer's Address: I We 12)( t4EST City/State/Zip: Fto L.1 ACC At 4- Policy#or Self-ins. Lie.#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 cert fy, under the pains and penalties of perjury that the information provided above is true and correct. Signature: gei-t. ' ' ' Date: q/19/2023 Phone#: 413-322-3111 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.DBoard of Health 2.0 Building Department 3.0 City/Town Clerk 4.OLicensing Board 5.0 Selectmen's Office 6.DOther Contact Person: Phone#: www.mass.gov/dia ENERLLC-01 ALYSSA ACORO DATE(MM/DD/YYYY) `..� CERTIFICATE OF LIABILITY INSURANCE 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 pollcy(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 (aC,No,Ext): (A/c,No): Chicopee,MA 01013 E-MAIL DRESS:ayssa@phIllipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# _ INSURER A:State Automobile Mutual Ins Co INSURED INSURER B:A.I.M.Mutual Insurance Company 33758 Energia 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 SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD IMM/OD/YYYYI IMM/DDIYYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PBP2870943 7/1/2023 7/1/2024 PREMISES(Eaoccu ence) $ 500,000 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 IMF X LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ A AUTOMOBILE IJABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X MY AUTO BAP2477206 7/1/2023 7/1/2024 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOSONLY AUTOSBODILY INJURY(Per accident), $ A lRlEO pp AU T N y Ep S ONLY _ OS VONNLY (Peer amdent�AMAGE $ $ A X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LUAB CLAIMS-MADE PBP2870943 7/1/2023 7/1/2024 AGGREGATE $ 2,000,000 DED X RETENTION$ 0 $ B WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABIY Y/N STATUTE ER Ln ANY PROPRIETOR/PARTNER/EXECUTIVE WMZ-800-8008072-2023A 7/1/2023 7/1/2024 1,000,000 OFFICER/MEMBER EXCLUDED? N N/A E.L.EACH ACCIDENT $ (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 $ 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 g ACCORDANCE WITH THE POLICY PROVISIONS. 242 Suffolk St. Holyoke,MA 1040 AUTHORIZED REPRESENTATIVE i ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. 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 Commonwealth of Massacnuse'is Division of Profession: Licensure Board of Building Regulations and Standards Construction Supervisor ENERGIA LLC 242 SUFFOLK STREET CS-108421 Expires:0211912025 HOLYOKE,MA 01040 BENJAMIN BORDEN 112 RYAN ROAD • FLORENCE MA 01062 • • • Commissioner •:/ ` 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 HOLYOKE,MA 01040 Undersecretary Not va id without signature dflai Your o = ner. - - M nerg atUS.com BUILDING PERMIT AUTHORIZATION FORM I, a o e.C f-a ( $rr.,/\ Vi , owner of the property located at: (Owner's Name, printed) ( I& cr`n(' 5frem4-- Flore' C( AM c2/oC, Z (Property Street Address) (City/Town) hereby authorize Energia, LLC. to act on my behalf and obtain a building permit to perform insulation/weatherization work on the above named property. f‘e (Li f_3 -Z3o --05/� Owner' ignature elephone Number