31A-046 (4) BP-2024-0081
253 CRESCENT ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
31A-046-001 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-2024-0081 PERMISSION IS HEREBY GRANTED TO:
Project# 2024 INSULATION Contractor: License:
Est.Cost: 1300 ENERGIA LLC 108421
Const.Class: Exp.Date:02/19/2025
Use Group: Owner: AUGARTEN MARK S&ELLEN M TUSTEES
Lot Size(sq.ft.)
Zoning: URB Applicant: ENERGIA LLC
Applicant Address Phone: Insurance:
242 SUFFOLK ST (413)322-3111 WMZ-800-8008072-2022A
HOLYOKE,MA 01040
ISSUED ON: 01/26/2024
TO PERFORM THE FOLLOWING WORK:
INSULATE ATTIC SPACE&HATCH
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: ,tsAk. , t
.>2 ; 1
Fees Paid: S65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
DeP
" F<'r._.�r47 City of Northampton
.' 'j Building Department
212 Main StreetJNSULATJON
Room 100Northampton. MA 01060
" phone 413-587-1240 Fax 413-587-1272 fs&.,JL Y
.__
APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY
SECTION 1 •SITE INFORMATION INSULATION PERMIT
This sectionto be completed by office
1.1 Property Address
3M-01-f-te-0oi
253 CRESCENT ST Map Lot Unit
NORTHAMPTON, MA 01060 Zone (J I3 Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
ELLEN AUGARTEN 253 CRESCENT ST NORTHAMPTON, MA 01060
Name(Print) Current Mailing Address
SEE PERMIT AUTHO 413 320 7234
Telephone
Signature
2.2 Authorized Agent:
ENERGIA LLC - BENJAMIN BORDEN 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 1300.00 (a)Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee 6-2
4 Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2 + 3+4+ 5) 1300.00 Check Number 03
This Section For Official Use Only
I
Date
Building Permit Number:/3P-2A2i-/—002/ Issued.
Signature: / ) - Z L ZO2 ___
Building Commissioner/Inspector of Buildings Date
tve-( i ce @ en2r 3 jc S . Cow.
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 4-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder BENJAMIN BORDEN 108421
License Number
242 SUFFOLK ST HOLYOKE MA 01040 2/19/25
Address Expiration Date
413-322-3111
Signature 1 elephone
9.Registered Home Improvement Contractor: Not Applicable 0
ENERGIA LLC 165169
Company Name Registration Number
242 SUFFOLK ST HOLYOKE MA 01040 2/16/24
Address Expiration Date
Telephone413-322-3111
SECTION 5-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 VJ No ❑
Brief Description of Proposed Work NOTE: INSULATION ONLY
INSULATION -ATTIC FLOOR 9"OPEN BLOW CELLULLOSE - HATCH THERMAL BARRIER POLYISO
FG DAMMING - RIM JOIST FG BATT
BENJAMIN BORDEN 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 •—;:1& . 1/17/24
Signature of 0 r/Agent L Date
ELLEN AUGARTEN as Owner of the subject
property
hereby authorize BENJAMIN BORDEN/ENERGIA LLC
to act on my behalf,in all matters relative to work authorized by this building permit application.
SEE PERMIT AUTHO 1/17/24
Signature of Owner Date
City of Northampton
r 1' Massachusetts
Al r
k
DEPARTMENT OF BUILDING INSPECTIONSQ1,....i.
y �. 212 Main Street •Municipal Building
{'` Northampton, MA 01060 7:
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building
permit all debris resulting from the construction activity governed by this Building Permit shall be disposed
of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
253 CRESCENT ST NORTHAMPTON, MA 01060
(Please print house number and street name)
Is to be disposed of at:
USA WASTE BOSTON RD WILBRAHAM MA
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
USA WASTE
(Company Name and Address)
Signature Permit Applicant or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
ti,r_ r City of Northampton
{' A. <-
Ayi F -. Massachusetts 444"
,I*-..,,
G,\ 0"a$. " DEPARTMENT OF BUILDING INSPECTIONS S
\' r .}' 212 Main Street • Municipal Buildang
-'5" Northampton, MA 01060
MANDATORY FOR HOUSES BUILT BEFORE 1945
102 VERNON ST NORTHAMPTON
Property Address.
Contractor
Name ENERGIA LLC
Address: 242 SUFFOLK ST
City. State: HOLYOKE MA 01040
Phone 413-322-3111
Property Owner ELLEN AUGARTEN
Name
Address 253 CRESCENT ST
City. State NORTHAMPTON MA 01060
ELLEN AUGARTEN (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
Date 1/18/2024
410k Permit Authorization
mass save Form
Site ID: 5056642 Customer: HELENE STRACCO
Ellen Augarten , owner of the property located at:
(Owner's Name,printed)
253 Crescent St 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.
Owner's Signature: fPu ,40far4
Date: 11 / 29 / 2023
FOR OFFICE USE ONLY
We have assigned the following Mass Save Home Energy Services Participating Contractor to the
above referenced project:
�IJE G/A LLB
Participating Contractor Date
Name: CLEAResult
Phone: 800-480-7472
Email:
Page 1 of 1 For CMze Use Cnly
The Commonwealth of Massachusetts
Department of Industrial Accidents
i L
Office of Investigations
=r1- ' Lafayette City Center
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):
I.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 10.0 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.] 12.0 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#I.
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: 2513 cgE5ce&T ..7 1 • _
City/State/Zip: 0012-TtA{.AI1°TU M J4 v 10 (Q
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: Date:
12/1/23
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):
IEBoard of Health 2.0 Building Department 30City/Town Clerk 4.❑Licensing Board
50 Selectmen's Office 6.DOther
Contact Person: Phone#:
www.mass.gov/dia
�,.."'1 ENERLLC-01 ALYSSA
'`'��RL CERTIFICATE OF LIABILITY INSURANCE DATE(M/2023YY)
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 NAt r�,p.CT Alyssa Perusse
Phillips Insurance Agency,Inc. PHONE FAX
97 Center Street WC,No,E,i): I(A/C,No):
Chicopee,MA 01013 _nIDEss:alyssa@phillipsinsurance.com
INSURER(S)AFFORDING COVERAGE NAIC# _
INSURERA:State Automobile Mutual Ins Co
INSURED INSURER B;AIM.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_ ATYPE OF INSURANCE INSO SUBR POLICY NUMBER 1MMIUDCDYIYEYYF l IMOMIDDIYYY1^PL LIMITS
A X COMMERCIAL GENERAL LIABILITY 1,000,000
EACH OCCURRENCE $
CLAIMS-MADE 1 X OCCUR PBP2870943 7/1/2023 7/1/2024 pREMSEs EaaccaRence) $ 500,000
MED EXP(Any one person) $ 5,000
PERSONAL 8 ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICY I X 1 Ja X LOC PRODUCTS-COMPIOPAGG $ 2,000,000
OTHER: $
COMBINED SINGLE LIMIT 1,000,000
A AUTOMOBILE LIABILITY (Ea accident) $
X ANY AUTO BAP2477206 7/1/2023 7/1/2024 BODILY INJURY(Per person) $
OWNED -SCHEDULED
_ AUTOSRE� ONLY AUTOS BODILYppB�ODILY INJURYD (Per accident)_$
AUTOS ONLY A O ONLY (Per accident)AMAGE $
$
A X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 2,000,000
EXCESS UAB CLAIMS-MADE PBP2870943 7/1/2023 7/1/2024 AGGREGATE $ 2,000,000
w�p� DEED X RETENTION S 0 _
O
R reeg`giffYERS L1 taci 1' X I STATUTE ER _
WMZ-800-8008072-2023A 7/1/2023 7/1/2024 1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $
OFFICERIMEMU,$R EXCLUDED? N NIA 1,000,000
((Mandatory n nNH) E.L DISEASE-EA EMPLOYEE $
If yes,describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT, $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if mete apace Is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Ener la LLC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
9 ACCORDANCE WITH THE POLICY PROVISIONS.
242 Suffolk St.
Holyoke,MA 1040
AUTHORIZED REPRESENTATNE
✓,-mil". 1,^-(,,
I
Commonwealth of Massachusetts �� T
Division of Occupational Licen sure
Board of Building Reulations and Standards
Cons43164r1f f Stint,rv,ear
CS-108421 gilftires:02/19/2025
BENJAMIN 8�'•�'� .J�, '
242 SUFFOLK S
fiOLYOke hilt I 1
'Or,cvd O
Camrnisalanar
Registration# 165169
Registrant ENERGIA LLC
Name Benjamin Borden
Address 242 SUFFOLK STREET
City, State Zip HOLYOKE, MA 01040
Expiration Date 02/16/2024