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18C-082
BP-2023-1463 250 JACKSON ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 18C-082-001 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-2023-1463 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est.Cost: 7630 5C ENERGY INC 106162 Const.Class: Exp.Date: 04/26/2025 Use Group: Owner: ANDERSON FERRY, STEVEN R. &KIMBERLY M Lot Size (sq.ft.) Zoning: URB Applicant: 5C ENERGY INC Applicant Address Phone: Insurance: 3820 DIAMOND HILL RD 774-203-3704 WC928038765994 CUMBERLAND, RI 02864 ISSUED ON: 10/23/2023 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: cs-, • r . • Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner ' 5 w- Sr+A 10- 4 i(i' ooj4.70 The Commonwealth of Massachu a o��T T� W Board of Building Regulations and Standa s-) �tigG/4o �0 CIPFR • ITY Massachusetts State Building Code, 780 CMR 1i„T 4,�,.;� Building Permit Application To Construct, Repair, Renovate Or De �wc,, evise,Mar 2011 One-or Two-Family Dwelling °��o This Section For Official Use Only Building Permit Number: 'a " Hu u 3 Date Applied: • ##—) ,, //./ V-Z3-aoz3 BuildingOfficial(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Pronerty Address: 1.2 Assessors Map&Parcel Numbers 250 JACKSON STREET 18C 082-001 1.la 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 ElZone: _ Outside Flood Zone? Municipal❑ On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: STEVEN FERRY Northampton,MA.01060 Name(Print) City,State,ZIP 250 JACKSON STREET 508-769-6422 STEVENFERRY2793@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 0 Demolition 0 Accessory Bldg. 0 Number of Units Other D Specify: INSULATION Brief Description of Proposed Work2:_ PLEASE SEE ENCLOSED CONTRACT SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 7,630.38 1. Building Permit Fee: $ Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ 0 0 Total Project Cost3 (Item 6)x multiplier x 3. Plumbing $ 0 2. Other Fees: $ 4. Mechanical (HVAC) $ 0 List: 5. Mechanical (Fire $ 0 Suppression) Total All Feee,$' /3.Gn Check No , A Check Amount: . ash Amount: 6. Total Project Cost: $ 7,630.38 � Cl Paid in •. 1 0 Outst :vv-4 _- Due: 0 16'6° . SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Matthew Russell 106162 04/26/2025 License Number Expiration Date Name of CSL Holder List CSL Type(see below) R 3820 Diamond Hill Road No.and Street Type Description Cumberland,RI.02864 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 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) 04/18/2025 Matthew Russell 195309 HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 3820 Diamond Hill Road Maryanna5CEnergyinc.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 form 9/27/23 Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By en . my name below,I hereby attest under the pains and penalties of perjury that all of the information /1/ •-, this application is true and accurate to the best of my knowledge and understanding. 9/27/23 Matthew Russell 'IMFVit.er-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 Projec Cost" City of Northampton rMassachusetts „2S�s • s�%: A. '+ r, _ DEPARTMENT OF BUILDING INSPECTIONS 9 jj 212 Main Street •• Municipal Building vy OD • Northampton, MA 01060 Xsb,y �,�0 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: 5C ENERGY,INC. Name of Hauler: 11 Signature of Applicant: _ �, Date: 9/27/23 MATTHEW RUSSELL T Y i e r RESIDENTIAL PROPERTY RECORD CARD 2023 NORTHAMPTON • di division Situs :250 JACKSON ST 1 Map ID: 18C-082-001 I Class: Single Family Residence Card:1 of 1 —Printed: December 23,2022 - 'I GENERAL INFORMATION 7 - > r FERRY,STEVEN R.&KIMBERLY M ANDERSON Living Units 1 250 JACKSON ST Neighborhood 12 ' NORTHAMPTON MA 01060 Alternate Id Vol/Pg 9920/36 District sat Zoning L Class Residential Property Notes ` :.-..:.,,,,:",,, 41:,,.., Land Information = "" Assessment Information Type Size Influence Factors Influence% Value Assessed Appraised Cost Income Primary Sf SF 16,875 137,210 Land 137.200 137,200 137,200 0 128,400 Building 103,600 103,600 94,500 0 62,800 Total 240,800 240,800 231,700 0 191,200 Manual Override Reason Base Date of Value 2023 Value Flag MARKET APPROACH Effective Date of Value 1/1/2022 Total Acres:.3874 Gross Building: Spot: Location: Entrance Information - hermit Intorma Date ID Entry Code Source Date Issued Number Price Purpose %Complete 10/05/20 JRA Not At Home Other 10/14/99 MC Unimproved Convert From Univers Sales/Owr ership History Transfer Date Price Type Validity Deed Reference Deed Type Grantee 03/22/21 281,000 Land+Bldg Valid Sale 14024/158 Quit Claim FERRY,STEVEN R.&KIMBERLY M ANDE t y l e r RESIDENTIAL PROPERTY RECORD CARD 2023 NORTHAMPTON tit division Situs :250 JACKSON ST I Parcel Id: 18C-082-001 Class:Single Family Residence Card: 1 of 1 Printed:December 23,2022 - — I' -- -- - - -- - -- -- - - ---- Dwelling Information ID Code Description Area 32 A Main Budding 76$ 12 so Style Cape Year Built 1940 B RG1 GA ,n C GARAGE-WO/CB 240*40* Story height 1 Eff Year Built 1970 Attic Full-Fin Year Remodeled Exterior Walls Asbestos Amenities Masonry Trim x Color Natural In-law Apt No Basement Basement Full #Car Bsmt Gar 24 A 24 FBLA Size x FBLA Type 8 Rec Rm Size x Rec Rm Type Heating&Cooling Fireplaces Heat Type Basic Stacks 10 8 1D Fuel Type Oil Openings System Type Hot Water Pre-Fab Room Detail a Bedrooms 2 Full Baths 1 32 Family Rooms Half Baths Kitchens Extra Fixtures ! -- - Outbuilding Data Total Rooms 6 Kitchen Type Bath Type Type Size 1 Size 2 Area Qty Yr Blt Grade Condition Value Kitchen Remod No Bath Remod No Det Garage 1 x 240 240 1 1940 C A 5,120 Adjustments • Int vs Ext Same Unfinished Area Cathedral Ceiling x Unheated Area Grade&Depreciation Grade C Market Adj Condition Average Functional CDU FAIR Economic Cost&Design 0 %Good Ovr Yo Complete - — Dwelling Computations I Condominium!Mobile Home Information Base Price 146,645 %Good 50 Complex Name Plumbing %Good Override Condo Model Basement 0 Functional Heating 0 Economic Unit Number Attic 25,040 %Complete Unit Level Unit Location Other Features 0 C&D Factor Unit Parking Unit View Adj Factor I Model(MH) Model Make(MH) Subtotal 171,690 Additions 3,550 Ground Floor Area 768 —--------------- Total Living Area 1,075 Dwelling Value 89.400 Comparable Sales Summary J Parcel ID Sale Date Sale Price TLA Style Yr Built Grade 18C-082-001 22-MAR-21 281,000 1,075 3 1940 C Building Notes E 38A-042-001 01-MAR-21 300,500 1,190 2 1954 C 38C-030-001 12-AUG-21 299,000 1,717 3 1947 C+ 38C-055-001 28-OCT-20 250,000 1,177 1 1928 C+ • 38C-043-001 01-JUL-20 287,250 1,203 1 1925 C+ mass save® Savings through energy efficiency PERMIT AUTHORIZATION FORM Stem Femf I, owner of the property located at: (Owner's Name) 250 Jackson street Northampton, 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. Sfetretc Ferri Owner's Signature 06-09-2023 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. 9/27/23 Participating Contractor Date WEATHERIZATION CONTRACT EVERSIURCE CUSTOMER PHONE DATE CLIENTS WORK ORDER Steven Ferry. i (508) 769-6422. 05/11/2021 537796[ 10302i SERVICE STREET BILLING STREET PROPOSED BY: 250 Jackson Street [ 250 Jackson St[, Aaron Rittlinger SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Program Northampton, MA 01060, Northampton, MA 01060 [ EGMA-HES, Pagel 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. KNOB&TUBE WIRING (Northhampton), We have identified that your home might have Knob&Tube wiring : s.i (initials)::' present.The following contract is not valid unless accompanied by the Weatherization Barrier Incentive form, signed by your licensed electrician.Work will not proceed with this work until we receive a copy of the form. HOME AIR SEALING 2 $188.66 $188.66 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 64 $415.36 $415.36 Provide labor and materials to air seal the open kneewall transitions of your home against wasteful, excess air leakage. WEATHERSTRIP DOOR 4 _ $127.24 $127.24 Provide labor and materials to install Q-Ion weatherstripping to door(s)to restrict air leakage. DOOR SWEEP 4 $104.44 $104.44 Provide labor and materials to install a doorsweep to restrict air leakage. KNEEWALL-2"RIGID BOARD. 192 $923.52 $692.64 $230.88 Provide labor and materials to install rigid board at R-10 or greater with the required fire rating to a kneewall area.. KNEEWALL FLOOR- 10"DENSE R-32 CELLULOSE 192. $602.88 $452.16 $150.72 Provide labor and materials to install a 10"layer of dense packed R 32 Class I Cellulose to the kneewall floor. KNEEWALL GABLE WALL-2" RIGID BOARD INSULATION 44 $213.84 $160.38. $53.46 Provide labor and materials to install 2"rigid insulation board to the open gable wall in a kneewall attic region. WEATHERIZATION CONTRACT EVERSURCE CUSTOMER PHONE DATE CLIENT WORK ORDER Steven Ferry (508) 769-6422 05/11/2023 537796 10302 SERVICE STREET BILLING STREET PROPOSED BY: 250 Jackson Street 250 Jackson St Aaron Rittlinger 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 222 $1,076.70 $807.53 $269.17 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. DOOR-INSULATE RIGID BOARD 2 $181.22 $135.92 $45.30 Provide labor and materials to insulate the back of a door with 2" rigid insulation board. WALLS-ASBESTOS SIDED 4" 1,022 $3,495.24 $2,621.43 $873.81 Install blown in Class I Cellulose to asbestos 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. BASEMENT SILLS-6" FIBERGLASS 112 $301.28 $225.96 $75.32 Provide labor and materials to install R-19 unfaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. ASBESTOS HAZARD A blower door diagnostic test will not be conducted at your home, due to the possible presense of asbestos. LEAD PAINT Your home was built prior to 1978 and might have lead-based paint s.F (initials) present. You have received a copy of the EPA's Renovate Right pamphlet informing you of the potential risk of a lead hazard exposure from the renovation activity to be performed at your home. STORAGE-BASEMENT Homeowner is responsible for the removal of the stored items S.r: (initials) blocking the installation of weatherization work in the basement. Removal must occur prior to the scheduled work start. WEATHERIZATION CONTRACT EVERSaURCE CUSTOMER PHONE DATE CLIENT# WORK ORDER Steven Ferry (508) 769-6422 05/11/2023 537796 10302 SERVICE STREET BILLING STREET PROPOSED BY: 250 Jackson Street 250 Jackson St Aaron Rittlinger SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Program Northampton, MA 01060 Northampton, MA 01060 EGMA-HES Page 3 DESCRIPTION QTY COST INCENTIVE TOTAL STORAGE-KNEEWALLS Homeowner is responsible for the removal of the stored items sx (initials) blocking the installation of weatherization work in the kneewall attic. Removal must occur prior to the scheduled work start. If you have any questions or specific concerns, please bring them to the attention of your subcontractor when they call to schedule your work. Total: $7,630.38 Program Incentive: $5,931.72 Client Total: $1,698.66 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 Client agrees to pay the Contractor for the Work,the Client Share of the Contract Cost is payable to the Independent Installation Contractor(I IC)upon satisfactory completion 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. Oat R &aft pp si Representativeti • • Client Signature l � a+ytil 06-09-2023 Printed Name Date of Acceptance The Commonwealth of Massachusetts P, it Department of Industrial Accidents _ ,1= 1 Congress Street, Suite 100 =;iW f j Boston,MA 02114-2017 ' ,41 w ww mass goy/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Anulicant 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 Are you an employer?Check the appropriate box: Type of project(required): 1-12 I am a employer with 25 employees(full and/or part-time).* 7. 0 New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3.[:I I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 10 Q 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 MO Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. p ❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other Insulation 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any 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 contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ARGONAUT INSURANCE COMPANY Policy#or Self-ins.Lic.#: WC928038765994 Expiration Date:12/27/2023 X Job Site Address: 250 JACKSON STREET City/State/Zip: NORTHAMPTON,MA.01060 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 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi 'u ler the p ins and penalties of perjury that the information provided above is true and correct. Signature: Date: 9/27/23 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.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Aco® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) `„../ 12/28/2022 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 Rosalynn Davila NAME: Loiselle Insurance Agency PHONE (401)723-8510 FAX (401)728-1820 (A/C.No.Ext): (A/C,No): 279 Dexter Street E-MAIL rosal nn loiselleinsurance.com ADDRESS: y P.O.Box 1148 INSURER(S)AFFORDING COVERAGE NAICir Pawtucket RI 02862-1148 INSURER A: Employers Mutual Casualty Co 21415 INSURED INSURER B: EMC Prop&Cas Ins Co 25186 SC ENERGY,INC. INSURER C: Argonaut Insurance Co ARGO 330 VICTOR RD-BUILDING A INSURER D: RISCO RISCO 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM!DD/YYYY) (MM!DD!YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 A 5D98024 12/27/2022 12/27/2023 PERSONAL&ADV INJURY $ 1,000,000 2,000,000GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PE n 00"1POLICY TLOC PRODUCTS-COMP/OPAGG $ , 0 ,OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ 20,000 B OWNED s/ SCHEDULED 5Z98024 12/27/2022 12/27/2023 BODILY INJURY(Per accident) $ 40,000 AUTOS ONLY AUTOS X HIRED ONLY %/ NON-OWNED^ AUTOS ONLY PROPERTY DAMAGE AUTOS (Per accident) $ 5,000 Uninsured motorist BI $ 1,000,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LIAB CLAIMS-MADE5J98024 12/27/2022 12/27/2023 AGGREGATE $ 3,000,000 DED X RETENTION $ 10,000 $ WORKERS COMPENSATION X PER H PEATUTE ER AND EMPLOYERS'LIABILITY Y/N 1 C ANY PROPRIETOR/PARTNER/EXECUTIVE N/A WC928938765994 12/27/2022 12/27/2023 ( E.L.EACH ACCIDENT $ , , OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory In In N NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , D Contractors Pollution Liability 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 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©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. 150A. 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 disposal facility as defined by M.G.L.c. 111 s. 150 A.Signature of the permit applicant, 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 disposed of as indicated, the holder of the permit shall notify the building official, in writing, as to the location where the debris will be disposed. 780 CMR—6th Edition IP. Signature of Permit Applicant 9/27/23 Date Commonwealth of Massachusetts IIDivision of Occupational Licensure Board of Budding Re ulat►ons and Standards ConstructisliderAilroor Specialty CSSL-106162 ires: 04/26/2025 MATTHEW J ftUSSELL 3820 DIAMOND HILL RD14.111 ipti CUMBERLAIV RI 02864 Commissioner ,*: L,;. 1 & ) ►. r 1 Construction Supervisor Specialty 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 Call (617) 727-3200 or visit www.rnass.govldpl THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Individual Registration: 195309 MATTHEW RUSSELL 3820 DIAMOND HILL RD Expiration: 04/18/2025 CUMBERLAND,RI 02884 Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Busimss Regulation Registration valid for Individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:Individual Office of Consumer Affairs and Business Regulation 011 1000 Washington Street -Suits 710 105309 04/1�8�25 Boston,MA 02118 MATTHEW RUSSELL MATTHEW RUSSELL 3820 DIAMOND HILL RD �Lrw=rlll, cuMt3ERLANo,w 02864 Undersecretary Not valid without signature THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor egi(stration ` f to Type: Corporation im= Registration: 194390 5C ENERGY, INC. M Expiration: 01/30/2025 330 VICTOR ROAD �•a ATTLEBORO, MA 02703 iga Update Address and Return Card. 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:Corporation Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 194390 01/30/2025 Boston,MA 02118 5C ENERGY,INC. WALTER R.COLWIELL 18 GREYSTONE ROAD .n'a.,14'4'4. MARBLEHEAD,MA 01945 Undersecretary Not valid without signature