37-083-024 BP-2024-0082
266 GROVE ST UNIT 24 COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
37-083-024 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-2024-0082 PERMISSION IS HEREBY GRANTED TO:
Project# 2024 INSULATION Contractor: License:
Est.Cost: 1700 ENERGIA LLC 108421
Const.Class: Exp.Date:02/19/2025
Use Group: Owner: CAREAU JORDAN MARK A&LISA M
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&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: v`AK..
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
U t.T 1 l 1I
City of Northampton Dep�0
"� ... Budding Department
t , +' 212 Main Street
t, INSULATION
Room 100
Northampton. MA 01060
hone 413-587-1240 Fax 413-587-1272 ONL Y
APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY
SECTION 1 -SITE INFORMATION INSULATION PERMIT
1.1 Property Address This section to be completed by office
'PV/T-#L Map 3�.- $3 of �L Unit
266 GROVE ST
NORTHAMPTON, MA 01060 Zone I 'i3 Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
LISA CAREAU 266 GROVE ST NORTHAMPTON, MA 01060
Name(Print] Current Mailing Address.
SEE PERMIT AUTHO 413 319 2768
Telephone
Signature
2.2 Authorized Agent:
ENERGIA LLC- BENJAMIN BORDEN 242 SUFFOLK ST HOLYOKE MA 01040
Name(Print) Current Mailing Address
413-322-3111
SiUnatUr* Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 1700.00 (a)Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
•
5. Fire Protection
6. Total= (1 +2 + 3+4+5) 1700.00 Check Number 1 8r3t)'-/
This Section For Official Use Only
Building Permit Number: /JI 20.24-•O o 22_ Date
Issued: /
Signature: //Cj - Z(o- ZOZLI
Building Commissioner/Inspector of Buildings Date
ivelice @ energiaus.com
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 4-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder BENJAMIN BORDEN 108421
t.icense Number
242 SUFFOLK ST HOLYOKE MA 01040 2/19/25
Address Expiration Date
-413-322-3111
Signature Telephone
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 Ve No ❑
Brief Description of Proposed Work NOTE: INSULATION ONL Y
INSULATION -ATTIC FLOOR 9" OPEN BLOW CELLULLOSE - HATCH THERMAL BARRIER POLYISO
FG DAMMING - RIM JOIST FG BATT
1 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 Na e
1/23/24
Signature of r/Agent Date
1 LISA CAREAU , 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 1/23/24
Signature of Owner Date
City of Northampton
Massachusetts
j DEPARTMENT OF BUILDING INSPECTIONS S.,
,.r ,,,.I} 212 Main Street •Municipal Building 4.
F"' Northampton, MA 01060 V )
May
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:
266 GROVE 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)
Sign ture o Permit Applicant or Ow LAA „:14ner 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.
1 .
The Commonwealth of Massachusetts
=!'l, Department of Industrial Accidents
_ [,1_ 1 Congress Street,Suite 100
- f_1 Boston,MA 02114-2017w
• �•,;` www.mass.gov/dia
\1,irkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WiTH THE PERMITTING AL'l iIORITY.
Applicant Information Please Print I egihls
Name(Business(hganizanon'Individual►:
Address:
City/State/Zip: Phone 11:
Are you an employer?Cheek the appropriate box:
Type of project (required):
I.❑I am a employer with employees(full and/or part-time)." 7. El New construction
2.0 1 am a sole proprietor or partnership and have no employees working for me in )i Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑ Demolition
30 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
10 ❑ Building addition
4.0 I 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 1 1.❑ Electrical repairs or additions
proprietors with no employees.
12.Q Plumbing repairs or additions
5.0 I am a general contractor and 1 have hired the sub-contractors listed on the attached slicer 1 3.1 [loaf repairs
These sub-contractors have employees and have workers'comp.insurance.:
6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
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.
:Contractors 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 numbei.
I am an employer that is providing workers compensation insurance for my employees. Below is the polies and job site
information.
Insurance Company Name: 4-.
Policy#or Self-ins.Lic.#: Expiration Date:
lob Site Address: City/State/Zip:
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 certify under the pains and penalties of perjury that the Information provided above is true and correct.
Signature: Date:
Phone#;
Official use only. Do not write in this urea,to he 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#:
sue.
�K�Mw.,, City of Northampton
Massachusetts
d )4
L
4 �"`.1 ' DEPARTMENT OF BUILDING INSPECTIONS ('-':
•+► ®�% 212 Main Street • Municipal Building
�� 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 LISA CAREAU
Name
Address 266 GROVE ST
City, State NORTHAMPTON MA 01060
LISA CAREAU
I. (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 xt here
.-j&ej-.______
Date 1/23/2024
Aft Permit Authorization
mass save Form
avow*Savories
Site ID: 4839310 Customer: LISA CAREAU
l� Lisa Careau , owner of the property located at:
(Owner's Name,printed)
266 Grove 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: L''cm
Date: 12 / 28 / 2023
•••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••
FOR OFFICE USE ONLY
We have assigned the following Mass Save Home Energy Services Participating Contractor to the
above referenced project:
Participating Contractor Date
Name: CLEAResult
Phone: 800-480-7472
Email:
Page 1 of 1 For Office Use Only
Commonwealth of Massachusetts
Division of Occupational Licensors
Board of Building Regulations and Standards
Coritu bi t8jlpe,v,so
CS-108421 J * spires:02/1912025
BENJAMIN fp ,..:
242 SUFFOL1i lr
HOLYOKE 844, I i
?t`O LLVda>>`
Commissioner is t.
•
Registration# 165169
Registrant ENERGIA LLC
Name Benjamin Borden
Address 242 SUFFOLK STREET
City,State Zip HOLYOKE,MA 01040
Expiration Date 02/16/2024
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
=rl- 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):
1.❑� 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, Insulation
with no employees. [No workers' comp. insurance req.] 12.❑� Other
*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: 2(e* G R o JE sT
City/State/Zip: /V d 47-144/c kP1 N /4 4 oro'ce a
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 perjuty that the information provided above is true and correct.
Signature: Date:
1211123
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 3.❑City/Town Clerk 4. Licensing Board
50 Selectmen's Office 6.❑Other
Contact Person: Phone#:
www.mass.gov/dia