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25A-113 (8) BP-2024-0096 54 SHERMAN AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 25A-113-001 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-2024-0096 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2024 Contractor: License: Est. Cost: 7000 HOME ENERGY SOLUTIONS INC 106188 Const.Class: Exp.Date: 12/28/2025 Use Group: Owner: AUNDREA MARSCHOUN FLORIAN & Lot Size (sq.ft.) Zoning: URB Applicant: HOME ENERGY SOLUTIONS IC Applicant Address Phone: Insurance: 233 COLLEGE HWY (413)203-2454 0 HOWC 140654 SOUTHAMPTON, MA 01073 ISSUED ON: 01/30/2024 TO PERFORM THE FOLLOWING WORK: INSULATION/W EATH ERI ZATI ON 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 Drip 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 . (NT Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner . iL-1" 1953 ' . .,_.. le City of Northampton . . -; 7,;,•. •'',5 '''; Building Depart 1 1" A I 212 ‘,1aintStr- - , Q.,Cb 4 . , INSULATiwiv phone 413-587—240 P*',418.7:072 .z ' ONLY ,_. L APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY OWELUNG ONLY SECTION 1 -SITE INFORMATION INSULATION PERMIT This section to be completed by office 1.1 Property Address, , Map_ Lot Unit _... Zone Overlay District Urn St.District_ CS District_ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT --.- 1 2.1 Owner of Record: Florian Marchoun .54hermaaAva.AcEthampiDnA4k01060 Name(Print) Current malting Address 808-2804588 Attached Telephone 'Skratve g,2 Authorized Agent: Shawn Mitchell _232SaAlege...1±64 ,Sauthamptan MA,(11073 Name(Print) Current Mailing Address 413-203-2454 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1, Budding (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of I Constricticiri friy•vi(6) 3 Plumbing Building Permit Fee 1 ip/(16 4. Mechanical(HVAC) , 5, Fire Protection i , 6 Total (1 +2+ 3 +4+ 5) 1 7,000 Chee!,t 1!49113,1" ..... This Section For Official Use Only r Building Permit Number: 4P-p3tf---9V i Date I issued: I _ Signature ______. //127-- 1. 36-24Z11 Building Commissioner/Inspect©r of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES ., . 8.1 Licensed Construction Supervisor: Not Applicable EJ Name of License Holder Shawn Mitchell _106188 License Number 68 Russellville Rd . 12/28125 Address Expiration Date 413:20-2454 Signature Telephone 9-Registered Home Improvement Contractor: Not Applicable L-2, I Home Energy Solutions Inc. 42388-5---_ - Company Name Registration Number 233 College Hwy Southampton MA, 01073 12/4/24 Address Expiration Date Telephone 413-203-2454 - . . 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.... ,. Cif No,..... 3 'Brief Description of Proposed Work NOTE. INSUL-. „ , . Blown in insulation and air sealing Shawn Mitchell , 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. Shawn Mitchell 1/20/24 Signature . eTii,4041.. (2 Date Florian Marchoun as Owner of the subject property hereby authorize Shawn Mitchell to act en my behalf,in all matters relative to work authorized by this building permit application. Attached 1/20/24 Signature of Owner Date City of Northampton 1�' Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 gsY � 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: Springfield, MA The debris will be transported by: Name of Hauler: Waste Management Signature of Applicant: 3 7 J T Date: 1/20/24 mass save Savings through energy efficiency PERMIT AUTHORIZATION FORM I, Florian Marschoun owner of the property located at: (Owner's Name) 54 Sherman Avenue Northampton (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. Flo?'law Ilarscho Owner's Signature mail@� 10-15-2023 Vt ; Date FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date \wit Client: Florian Marschoun RISE Address: 54 Sherman Avenue AN EMPLOYEE OWNED COMPANY Northampton, MA 01060 Energy Specialist: Heather Lieber Phone: (808)- Program: EGMA-HES Client# 484138 Work Order# 10107 Work Scope DESCRIPTION Qty Notes 1 INOPERABLE HEATING SYSTEM 1 2 VERMICULITE HAZARD MUST MITIGATE 1 3 HOME AIR SEALING 6 4 DUCT SEALING 2 in attic 5 ATTIC DAMMING 20 around hatch 6 ATTIC FLAT-15"OPEN R-49 CELLULOSE 640 all NW- 7 COMMON WALL-2"RIGID BOARD 163 8 COMMON WALL-3.5"FIBERGLASS BATTING 163 9 BASEMENT SILLS-RIGID BOARD INSULATION 103 10 CRAWLSPACE CEILING-6"FIBERGLASS 240 11 CRAWLSPACE CEILING-2"RIGID BOARD INSULATION 240 12 CRAWLSPACE-6 MIL POLY GROUND COVER 240 13 DUCT INSULATION 30 in attic 14 VENTILATION CHUTES 5 15 GABLE VENT 1 E-- 16 MOLD AND/OR MILDEW 1 customer to clean small amount in attic Diagram 32 1i« le' 1 le 30 30 A 3910 E 10*776 E 1s 3 16 ACORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) tii......---- 01/26/2024 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 Elizabeth Carballo,CISR,CPIA NAME: Finck&Perras Insurance Agency Inc. 1PpHjONN Extl: (413)527-5520 FA Not: (413)527-5970 6 Campus Lane E-MAIL bcarballo@fnckandperras.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Easthampton MA 01027 INSURERA: Arbella Insurance Group 17000 INSURED INSURER B: NorGUARD Insurance Company 31470 Home Energy Solutions Inc INSURER c: Russell Bond 68 Russellville Rd INSURER D: INSURER E: Southampton MA 01073 INSURER F: COVERAGES CERTIFICATE NUMBER: CL241207656 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 50,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 • A 8500066829 01/02/2024 01/02/2025 PERSONAL&ADVINJURY $ 1,000.000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO 2,000,000 POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: Employee Benefits $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ' -, A OWNED �/ SCHEDULED 1020061519 01/02/2024 01/02/2025 BODILY INJURY(Per accident) $ -" AUTOS ONLY /� AUTOS X HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY X AUTOS ONLY (Per accident) $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 A EXCESS LIAB CLAIMS-MADE 4620089819 01/02/2024 01/02/2025 AGGREGATE $ 4,000,000 DED X RETENTION $ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN 1'000,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE Y N/A HOWC536770 01/04/2024 01/04/2025 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 -___DESCRIPTION OF_OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Pollution per occurrence $1,000,000 C G283145890004 11/23/2023 11/23/2024 aggregate $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Proof of Coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main Street AUTHORIZED REPRESENTATIVE Northampton MA 01060 e ehlzx .,644ixtek 1 CO 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD