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25C-264 (3) BP-2023-1709 54 OLD FERRY RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 25C-264-001 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-2023-1709 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 10000 ENERGIA LLC 108421 Const.Class: Exp.Date: 02/19/2025 HAMPSHIRE FRANKLIN & HAMPDEN Use Group: Owner: AGRICULTURAL SOCIETY Lot Size (sq.ft.) Zoning: SC Applicant: ENERGIA LLC Applicant Address Phone: Insurance: 242 SUFFOLK ST (413)322-31 1 1 WMZ-800-8008072-2022A HOLYOKE, MA 01040 ISSUED ON: 12/06/2023 TO PERFORM THE FOLLOWING WORK: ADD INSULATION TO ALL SPORT ARENA 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 ' ' �, . � , y . 'I • I Fees Paid: $110.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner /tp..,&,7. ,, / ,' 7 oF�, ` , I�T IgBo S T, e Commonwealth of Massachusetts Vw'n`//,► �' Office of Public Safety and Inspections r` /k, . Massachusetts State Building Code(780 CMR) ati G,n, , rmit • pplication for any Building other than a One-or Two-Family Dwelling V,,-r�rUAIs� r n (This Section For Official Use Only) Building Permit Number:?3' 701 i Date Applied: Building Official: SECTION 1:LOCATION 54 OLD FERRY RD 1\1oQTf,4MPToA! Of b Cp 0 ALL S"P6 c&-r A 1Rr__IVA No.and Street City/T + .Q0ci 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 t;' Repair 0 Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other V Specify:INSULATION Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No 0 Is an Independent Structural Engineering Peer Review required? Yes 0 No 0 Brief Description of Proposed Work:INSULATION TO FLOORS DENSE PACK FG-ATTIC BATHROOMS CELLULOSE OPEN BLOW-ATTIC DAMMING FG NO CONSTRUCTION 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 0 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 H4 0 H-5 0 I: Institutional 1-1 0 I-2❑ 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 ❑ HA CI IIB 0 IIIA ❑ IIIB ❑ IV 0 VA 0 VB 0 SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Trench Permit: Debris Removal: Water Supply: Flood Zone Information: Sewage Disposal: Licensed Dis osal Site 0 Public 0 Check if outside Flood Zone 0 Indicate municipal 0 A trench will not be P Private 0 or indentify Zone: or on site system 0 required 0 or trench or specify: permit is enclosed 0 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 0 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 JEFF DAN -TMJ2J LLC 54 OLD FERRY RD NORTHAMPTON 01060 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: OWNER 413.587.9797 - - jeffd@allsportsoccer.com Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: ENERGIA LLC BENJAMIN BORDEN 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) �. /'/D C D'S TakC—T[ o n/ Name egistrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor ENERGIA LLC BENJAMIN BORDEN 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 State Zip 413_322_ 3111 - - ivelice@energiaus.com Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(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 0 No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 1.Building $10,000.00 Building Permit Fee=Total Construction x ert here 2.Electrical $ appropriate municipal factor) 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (con r municipality) 5.Mechanical (Other) $ Enclose check payable to ` 6.Total Cost $10,000.00 (contact municipality)and write check number here a�7 SECTION 13:SIGNATURE OF BUILDING PERMIT 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 11/30/23 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: _� 1�" /Z-C.-ZQZ3 Name Date City of Northampton Massachusetts 4"�?s� x_ G'e 1t n4 $ DEPARTMENT OF BUILDING INSPECTIONS y 212 Main Street • Municipal Building v� Oa ' ` '. Northampton, MA 01060 • jN". r 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: WILBRAHAM MA The debris will be transported by: Name of Hauler: USA WASTE Signature of Applicant: Date: 11/30/23 The Commonwealth of Massachusetts Department of Industrial Accidents (:IPr Office of Investigations Lafayette City Center : 2 Avenue de Lafayette, Boston, MA 02111-1750 -4 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. ❑ Entertainment their right of exemption per c. 152, §1(4), and we have 10.❑ Manufacturing no employees. [No workers' comp. insurance required]** 4.❑ We are a non-profit organization, staffed by volunteers, 11.0 Health Care 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: 54 OLD FERRY RD City/State/Zip: NORTHAMPTON MA 01060 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: 1 . ��.ri�J�► Date: 4("tit 23 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): 1.1=IBoard of Health 2.0 Building Department 3.1=1 City/Town Clerk 4.['Licensing Board 50 Selectmen's Office 6.❑Other Contact Person: Phone #: Commonwealth of Massachusetts �; Division of Occupational Lkensure Board of Building Regulations and Standards 1i COR Df1 (viaor CS-108421 3 fires:02/1912025 ,);of.cvd O. Commissioner ff. �..'�n !•, Registration# 165169 Registrant ENERGIA LLC Name Benjamin Borden Address 242 SUFFOLK STREET City,State Zip HOLYOKE,MA 01040 Expiration Date 02/16/2024 �—mgil ENERLLC-01 ALYSSA ,4`oRO" 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(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 NAME CT Alyssa Perusse Phillips Insurance Agency,Inc. PHONE H NNo,Ext): (A FAX No): 97 Center Street a Mna Chicopee.MA o1013 ADDRESS:ayssa@phillipsinsurance.eom INSURER(S)AFFORDING COVERAGE — NAIC# INSURER A:State Automobile Mutual Ins Co INSURED INSURERB:A.I.M.Mutual Insurance Company _ 33758 Energia LLC NSURERC: 242 Suffolk Street INSURER 0 Holyoke,MA 01040 1 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 :ADDL SUER POLICY EFF POLICY EXP LIMITS LTR E TYPE OF INSURANCEINSD WVD POLICY NUMBER IMM/DD/YYYYI IMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY • EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 151( OCCUR iPBP2870943 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 nGEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JECT X I LOC PRODUCTS-COMP/OP AGO $ 2,000,000 $ OTHER: Ea COMBINED SINGLE INGLE LIMIT $ 1,000,000 A AUTOMOBILE LIABILITY X I ANY AUTO BAP2477206 7/1/2023 7/1/2024 ,BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOSRE� ONLY AUTOS BODILY p� INJURY(Per accident) $ AUTOS ONLYfl VMS (Per accident)DAMAGE $ $ A X UMBRELLA LUB X OCCUR i I I EACH OCCURRENCE $ 2,000,000 EXCESS LIAB I CLAIMS-MADE PBP2870943 7/1/2023 1 7/1/2024 1 AGGREGATE $ 2,000,000 •DED I X RETENTION S 0 i $ B WORKERS COMPENSATION 1 X STATUTE PER i ,EERH AND EMPLOYERS'LIABILITY Y/N WMZ-800-8008072-2023A 7/1/2023 7/1/2024 1,000,000 ANY OFFICER/MEMBER EXCLUDED?ECUTIVE I N 1 I N/A EL.EACH ACCIDENT I$ (Mandatory In NH) I E.L.DISEASE-EA EMPLOYEE'$ 1'000'000 If yes,describe under I 1,000,000 DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT :$ I 1 1 I 1 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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Energia LLC ACCORDANCE WITH THE POLICY PROVISIONS. 242 Suffolk St. Holyoke,MA 1040 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A DocuSign Envelope ID:8B3FFD67-63F0-4531-9F4B-97069C8823E1 W , N CENTER FOR 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 riogrdin Aanunts-rrators of the Maso 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: TM2J, LLC DBA Allsport Arena CUSTOMER'S BUSINESS NAME(Referred to as"Customer") 54 Old ferry rd, Northampton, MA CUSTOMER'S BUSINESS ADDRESS e—Docusi nedby: CUS A HORIZED SIGNATURE, TTILE AND DATE AGREEING TO BE BOUND BY ALL PROVISIONS HEREOF. —DocuSigned by: BUIID `ONER APPROVAL SIGNATURE PLEASE PRINT ENERGIA LLC CONTRACTOR'S BUSINESS NAME(Referred to as"Contractor") / I1—DocuSigned by: to CoNtntiverrAUTHORIZED SIGNATURE, ITI'LE 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.