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23B-010 (3) BP-2023-1536 209 LOCUST ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23B-010-001 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-2023-1536 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 6000 ENERGIA LLC 108421 Const.Class: Exp.Date: 02/19/2025 Use Group: Owner: LATTES THAYER DOUGLAS B&JAIN Lot Size(sq.ft.) Zoning: OI Applicant: ENERGIA LLC Applicant Address Phone: Insurance: 242 SUFFOLK ST (413)322-3111 WMZ-800-8008072-2022A HOLYOKE, MA 01040 ISSUED ON: 11/01/2023 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: • V • ,2r I , Fees Paid: $110.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner $' N f 500r^ RECEIVED m- NO The Commonwealth of Massachusetts OCT 3 1 2023 li' Office of Public Safety and Inspections it Massachusetts State Building Code(780 CMR) I. Building Permit Application for any Building other than a On$-ortIrvit il�l el,�irsgovs Olt NC1RTHq�t.-•�,�D; 41.101( 0 11 (This Section For Official Use Only) Building Permit Numbed✓' /C30 Date Applied: Building Official: SECTION 1:LOCATION 209 LOCUST ST NORTHAMPTON 01062 No.and Street City/Town Zip Code Name of Building(if applicable) Assessors Map# Block#and/or Lot # SECTION 2 PROPOSED WORK Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below Existing Building L7 Repair❑ Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other v/Specify: /1f$a t 0 tL Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No Et Is an Independent Structural Engineering Peer Review required? Yes 0 No 0 Brief Description of Proposed Work: INSULATION ONLY - NO CONSTRUCTION insulation to attic floor open blow cellulose attic stair cover thermal barrier polyiso SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0 Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5❑ B: Business 0 E: Educational 0 F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0 I: Institutional I-1 0 I-2 0 I-3 0 I-4 0 M: Mercantile 0 R: Residential R-ID R-2 0 R-3 0 R-4 0 S: Storage S-1 0 S-2 0 U: Utility 0 Special Use 0 and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA 0 IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV 0 VA CI VB 0 SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Water Supply: Flood Zone Information Sewage Disposal: Trench Permit Debris Removal: Public 0 Check if outside Flood Zone 0 Indicate municipal 0 A trench will not be Licensed Disposal Site 0 Private 0 or indentify Zone: or on site system 0 required 0 or trench or specify: permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable 0 Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No 0 Yes❑ No 0 SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Does the building contain an Sprinkler System?: Special Stipulations: Design Occupant Load per Floor and Assembly space: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner DOUGLAS THAYER 209 LOCUST ST NORTHAMPTON MA 01062 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: OWNER 413 530 4785 - - DOUGLASTHAYER@GMAIL.COM Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: BENJAMIN BORDEN/ENERGIA LLC 242 SUFFOLK ST HOLYOKE MA 01040 Name Street Address City/Town State Zip to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1) If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here❑. Otherwise provide construction control forms(see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals) N/A - - N/A Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor ENERGIA LLC Company Name BENJAMIN BORDEN 108421 Name of Person Responsible for Construction License No. and Type if Applicable 242 SUFFOLK ST HOLYOKE MA 01040 Street Address City/Town I State Zip 413 322 3111 - _ ivelice@energiaus.com Telephone No. (business) Telephone No.(cell) e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AAFFIDAVIT(M.G.L c.152.§25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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. Is a signed Affidavit submitted with this application? Yes El No U SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 1.Building $6000.00 Building Permit Fee=Total Constru on Cost x AA Insert here 2.Electrical $ appropriate municipal f ctor)=$ 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $6000.00 (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMTT APPLICANT 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. BENJAMIN BORDEN GC 413 322 3111 10/01/23 Please print and sign name Title Telephone No. Date 242 SUFFOLK ST HOLYOKE MA 01040 ivelice@energiaus.com Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: "j "Z04, Name Date City of Northampton OQS.N_ MY/�. S *" S �� Massachusetts ��2 �c,�` n G » �b DEPARTMENT OF BUILDING INSPECTIONS y F, 212 Main Street • Municipal Building Jd OD \ . per," Northampton, MA 01060 �s/q1' `� 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: 10/01/23 . ,.. The Commonwealth of Massachusetts Department of Industrial Accidents . '�� Office of Investigations (\k, 4 �`l Lafayette City Center r 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): 1.0 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. 0 Entertainment their right of exemption per c. 152, §1(4),and we have 10.❑Manufacturing no employees. [No workers' comp. insurance required]** 11.0Health Care 4.El We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp. insurance req.] 12.©Other INSULATION *Any 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: 201 L oc 451. T. City/State/Zip: No ' -7 Irk 0 -44)T d 'cL ,-%.,4 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, under the pains and penalties of perjury that the information provided above is true and correct. Signature: 5ai amtz yen Date: /C119/2023 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): 1.0Board of Health 2.0 Building Department 30 City/Town Clerk 4.['Licensing Board 5.0 Selectmen's Office 6.['Other Contact Person: Phone#: wu w.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 Professlona: Licensure Board of Building Regulations .nd Standards Construction Supervisor ENERGIA LLC 242 SUFFOLK STREET CS•108421 Expires:02/19/2025 HOLYOKE,MA 01040 BENJAMIN BORDEN 112 RYAN ROAD FLORENCE MA 01062 - • Commissioner •:f,c A.:: /. _,. 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 '--mil ENERLLC-01 ALYSSA "4�RI 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 Phillips Insurance Agency,Inc. PHONE FAX 97 Center Street (NC,No,Ext): (A/C,No): Chicopee,MA 01013 E-MAIL al ssa hills sinsurance.com _ADDRESS: Y @P P INSURER(S)AFFORDING COVERAGE NAIL# 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 O: Holyoke,MA 01040 INSURER S: 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 LTRINSR MD IMM/DDIYYYY) (MM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PBP2870943 7/1/2023 7/1/2024 pREMI ES EaOccurrencel $ 500,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIESPER: GENERAL AGGREGATE $ 2,000,000 POLICY X JEC X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY __(Ea accident)DSINGLE LIMIT 1,000,000 X ANY AUTO BAP2477206 7/1/2023 7/1/2024 BODILYINJURY(Perperson) $ OWNED SCHEDULED AUTOSRE� ONLY _ AUTOS yy p BODILY INJURY(Per accident)J _ AUTOS ONLY _ AUTOS ON V (Perr aEcciidentDAMAGE $ A X UMBRELLALIAB 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 AWORKERS D EMPLOYERS LIABILITY Y!N TION X STATUTE ERFr ANY PROPRIIETgORR/PARTNER/EXECUTIVE WMZ-800.8008072-2023A 7/1/2023 7/1/2024 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER Mandatory In UE EXCLUDED? N N/A 1,000,000 H yes,describe under E.L.DISEASE-EA EMPLOYES _ DESCRIPTION OF OPERATIONS below _ _ _E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more apace 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 ACCORDANCE WITH THE POLICY PROVISIONS. 242 Suffolk St. Holyoke,MA 1040 AUTHORIZED REPRESENTATIVE 1 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD City of NorthAmpton 4-Z maccadhovott= DUFAIMIZIST OF aurrzm...., zrErs,..--riatra CLreAkt * 'A,,rt Property Address 2C LOCUST ST Contractor Narra Boniamin Borden I ENERGIA LLC Address: 242 stitioA St ctty, I-IcIy „Ao MA 01040 Phone 412-322-3111 Property Owner Name AdcreSS- .21:43`,2jCLit,' '- City, State. IN4)1iTi4AMP'_•`• BENJAMIN BORDEN contractor)attest and affirm that the building t'intend to insulate does not have any open air kno and tube)wiring in the spaces to be maulated and that I naVC provided the property=tier**Oh a copy cff-:tts affidavit. 371'..7aLIO Sig!"ature DocuSign Envelope ID:7CABDC2A-35F2-43FF-8F3E-4C48FDF15959 w 11- CENTER FOR U ECOTECHNOLOGY Contract for Energy Efficiency Work Under the Commercial Mass Save Energy Efficiency Program The Center for EcoTechnology,Inc. (CET)is providing program services which include recommending and arranging for the installation of certain energy efficiency measures for commercial electric and natural gas customers on behalf of the Program Administrators of the Mass Save Energy Efficiency Program.The Customer and the Contractor listed have • signed and entered into this legally binding Agreement below for the installation of certain energy conservation measures under the Mass Save Energy Efficiency Program at the Customer's place of business: 209 Locust ST, Florence MA 01062 CUSTOMER'S BUSINESS NAME(Referred to as"Customer") Douglas Thayer woodworking CUSTOMER'S BUSINESS ADDRESS r--DocuSIgned by: y b ' tt,1^ CUS'1'6 ORIZED SIGNATURE, rn'LE AND DATE AGREEING TO BE BOUND BY ALL PROVISIONS HEREOF. , —DocuSigned by: BUIL(151NegER APPROVAL SIGNATURE PLEASE PRINT ENERGIA LLC CONTRACTOR'S BUSINESS NAME(Referred to as"Contractor") c r—DocuSignedby:: 1_,r, CONt'vS AUTHORIZED SIGNATURE,TITLE AND DATE AGREEING TO BE BOUND BY ALL PROVISIONS HEREOF. 242 SUFFOLK ST HOLYOKE MA 01040 CONTRACTOR'S BUSINESS ADDRESS A.CONTRACTOR'S RESPONSIBILITIES 1. Contractor will carry out the work described in the contractor estimate,which is attached by reference and made a part of this Agreement. 2. Contractor will follow manufacturer's instructions where applicable.All work performed shall be of good quality and shall be carried out in a professional manner.Contractor will not knowingly use any damaged materials. 3. Contractor will not perform work if it discovers any wiring,structural,moisture,or other problems,which may adversely affect or may be adversely affected by this work. 4. Contractor will comply with all applicable laws,ordinances,codes,regulations,permitting requirements and standards that apply to the work. 5. Contractor will keep Customer's place of business as free as possible from waste materials while working. After completion,Contractor will clean the work area,removing all waste materials,tools,and supplies.