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52 WINTERBERRY LN BP-2022-0122 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:36-227 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit# BP-2022-0122 Project# JS-2022-000211 Est.Cost: $4000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ENERGY PROTECTORS - JOSHUA DADA 101143 Lot Size(sq.ft.): 60984.00 Owner: SPECTOR ABBY Zoning: Applicant: ENERGY PROTECTORS - JOSHUA DADA AT: 52 WINTERBERRY LN Applicant Address: Phone: Insurance: 64 PAXTON RD (774) 253-0277 WC SpencerMA01562 ISSUED ON:8/2/2021 0:00:00 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. BuildIn2 Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTO UP VIOLATION OF ANY OF ITS RULES AND REGULATIONS. I • • r • 0 Certificate of Occupancy Signature: I FeeType: Date Paid: Amount: Building 8/2/2021 0:00:00 $65.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner IN, The Commonwealth of M 9 2O�1 Board of Building Regulations and S lii Massachusetts State Building Code,780 CMR N inispFr, ' USE Building Permit Application To Construct,Repair,Renovate Or Demolish i . - Mar 2011 One-or Two-Family Dwelling - _) 'This Section For Official Use Only Building"emit Number: 16p-0,?�.0 01 Date Applied: KC:V10 7S ,j 8-z-Z07-t Date SECTION 1:SITE INFORMATION 1.1 r to_e(ry �L.k1 1.t� Mop it Pared 7 1.1a Is this an accepted street?yes no MP Parcel Number 1.3 Tuning Infarnentiom 1.4 Property Diane dome Zoning District Proposed Use La Area(sq ft) Frontage(ft) 13 BaiiB_I Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 16 Welber Stirlty:(MALL c 40,4$4) 1.7 Flood Zone Information: 1.g Sewage Disposal System: zoo= outside Flood zone? Public o Private 0 — Check if yrs0 0 On s disposal sy 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: b y City,.4 C-1v�' l 0( e� �C' ( *pi\'I 0106 .) Nome Milt)5a, wkhkert -eticki LA/ t) — 5 C1- iti)S No.and Skeet Telephone Fatah Address SBMON 3:DESCRIPTION OF PROPOSED WORK2(elmeelt all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Attesation(s) 0 Addition 0 De noWiaa 0 Accessory Bldg.0 Number of Units Other 1 -*ec ify: �'''S v L Description ofProposed Wore: R r S t c, k 1/4\•.-`1 C. cal t (nS.:` Et c -4- tc -k-i> q__ Cl SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Cash lion thdy (labor and Materials) Owl Use 1.Building $ Li(Z:%L 1 1. Building Permit Fee:S Indicate how fee is determined: 2 Electrical S 0 Standard City/Town Application Fee 0 Total Project Cost'(Item 6)x multiplier x 3.Pin g $ 2. Other Fees: $ 4_Memel (HVAC) S List: 5.Mechanical ( $ Total All Fos $ Suppression) Check N4321(J Check Amount~,0 4Cash Amount: 6.Total Project Cast $ U i 0 0 ) 0 Paid in Fa Outstanding Balance l mob Palacall woofs Ilimpasisaft salPaarPiPanalagrati mamas tilapotpaifL am_zla1 11111110DISCIalapplipplif ('g 3$ ous1moD amiP4 a riMa■d`PRINidR lmalatilAk Z JD comegavalassiosrumpribeirtgempsointvairalseaugpqiiitifielftitiliMEN ta Plargaimisimullkita3inAtupim,,-- . voingAgO VDI s-rtrwillaw peg Yale aatoliaod ae4el4:agataamsaw ia it7ffiPJOl aampsslaaaloffias JOPIEFIllefinoliftwilt SIMaqaminss z tposimeszawn op at wismilikeppittesiguppapiannow -i )alLLalollegTaikasp11114d - J C. z k. -v Al q ci 01l1011lI11100PEa «P Pingirli �1l SIPIIM Iasiololswailsii oiNINSO q. •,... . . .,-;-?+ s n -__ S :.., -s-•- _ -- . -..,.s dal c� u k.--- .i -.a- _�z+-...ems:' .+s,� x�.,.- 1P130111111geall an. thr4P Volk at fiS J gfsaoioeat .... .r1e't442 WO appa••pse 1 `s'tom j -":1 s, • - r - t E a z t ;X-' ti -- r' 11 o !DA irapeaVVANPIIIPTP0AB aniaia;alwl4i Imilleanalit44tIPPPIIM!■4mpIrPelh000atliarc-lRl9liavassslal.am a00 - � . f.a•.v. 7-, -v.. _-:.b..'X. - —r �axe_ -" _ .'=5. ,t,.... Lteo- -i,tL -e S1O cur' Jaa aa4ia �tz•• � Zikivoill41.‘gitl y '� "TEN tl5 09VtL. 1 s 3.) Q 1a � mall latallqW1 rs sagegiblVilaPINIWMIMS 3 laglitrailaaMt Si il°a2036/1651 3V Lceo *- ,St_- hLL rsa.gi Pt Aran brioinetf aids PmPaan !I T9S14 v A ,})aU 7; 3 _ — .:—y .ri,, ^., Pa vat c � � `(yam` .....,......... .... .. 1�I�Fi ' •amis©s --, ), ,1� c.hi Pi t� adiBa•ta ame3 rs The Commonwealth of Massachusetts ► = I=_C/ Department of Industrial Accidents !j. I Congress Street,Suite 100 _ Boston,MA 02114-2017 %.=" www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual):Energy Protectors Inc. Address:64 Paxton Rd City/State/Zip:Spencer, MA 01562 _ Phone#:774-253-0277 Are you an employer?Cheek the appropriate box: Type of project(required): 1.Q✓ I am a employer with 11 employees(full and/or part-time).' 7. ❑New construction 20 I am a sole proprietor or partnership and have no employees working for me in 8. D Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance require] 10 Q Building addition 4.1=1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11 Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet_ 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance. Insulation 14.Q✓ Other 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 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 arc 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 number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:ACE AMERICAN INSURANCE CO Policy#or Self-ins.Lie.#:6S62UB0G29826020 Expiration Date:09/01/2021 Job Site Address: SA h C '� �( `j LAJ City/State/Zip: fU(Y fil G Y 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: v�' 1 ��-�"� Date: -21 Z 7 f Z( Phone#:774-253-0277 Official use only. Do not write in this area,to be 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#: DocuSign Envelope lD:AB6FA852-A869-4FE3-868C-E830993F5B1EE RISE ENGINEERING' OWNER AUTHORIZATION FORM Abby Spector (Owner's Name) owner of the property located at: 52 Winterberry Lane (Property Address) Florence, MA 01062 (Property Address) hereby authorize I ,4 ,<) Subcontrtt6r(to be filled in by office) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform 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. It is the homeowner's responsibility to close out this permit by contacting their municipality at the completion of this work. DocuS.yne,/by. I 041 sr-cfor r'?RS`P teire 6/3/2021 I 1:11 PM EDT Date RISE Engineering,a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 j Canton, MA 02021 1339-502-6335 www.RlSEengineering.com i I ; i F AcoREP CERTIFICATE OF LIABILITY INSURANCE I DATE " 08/31/20 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 NAME: may Ci Davis AX Coonan insurance Agency,Inc. PHONE.Eat): 508-987-7122 fAx,No): 508-987-1090 267 Main Street EMAIL cindy@Coonaninsurance-com Oxford,MA 01540 INSURER(S)AFFORDING COVET GE NAIC a INSURER A: Capital Specialty INSURED INSURER B: Safety Energy Protector,inc. mime c: Stars-tone 64 Paxton Road Spencer,MA 01562 tNSUREFt D INSURER E: I 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 LTR TYPE OF INSURANCE )NASD lWVD POLICY NUMBER ( OO fYYY) (kMYDO&YYYY) LMITS X COMMERCIAL GENERAL LNABIfrY EACH OCCURRENCE S 1,000,000 DAMAGE EU CLAIMS-MADE ElOCCUR PREMISES(Ea ONEA'occurrence) S 100,000 _ MEo EXP(Any one person) S 5,000 A y CS16001320-05 08131/20 08131121 PERSONAL a Aov INJURY S 1,000,000 GENt AGGREGATE LIMIT APPLES PER GENERAL AGGREGATE S 2,000,E X POLICY I I 1 LOC PRODUCTS_COMP/OP AGG $ 2,000,000 OTHER S AUTOMOBILE LaeafIY COMBINED SINGLE LIMIT $ 1,000,000 (F-a accident ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY(Per aaudert) S B AUTOS ONLY X AUTOS Y 6236519 12123H9 12/23/20 BOO XHIRED X NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY (Per accident) S X (l .A LLAB X OCCUR EACH OCCURRENCE S 3,000,000 C ~EXCESS(JAB CLAMS- DDE y 89362T193AL1 08/31/20 08131/21 AGGREGATE S 3,000,000 DED ( I RETENTIONSWORKERS COMPENSATION $ EMPLOYERS'AND LIABLNTY YIN �STATUTE I �ER ANY PROPRIETORIPARTNERIEXECUTNEn N 1 A EL EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? (Mandatory in NH) EL DISEASE-EA EMPLOYEE S U yes,describe under DESCRIPTION OF OPERATIONS bete EL TasFaeF-POUCY UMrr S DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD tat,Additional Remarks Schedule,may be attached If more space Is required) Workers Compensation insurance certificate to follow under seperate cover. emailed josh CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Evidence of Coverage ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Q,1t1RR_9n1c scrum rtnavrxzsmN AN rinAsc rosnrvoc • ACCPR IJ CERTIFICATE OF LIABILITY INSURANCE DME 011131/2020 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 REPRESENTATWE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: I the prtificat•holder is an ADDITIONAL INSURED,the policy(ies)must 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 certiRc air bolder in lieu of such endorsement(s). PRE CONTACT KANE Nidia DeCastro COONAN INSURANCE AGENCY Eery: (508)987-7122 FAX WC,Not E-MAIL Nidie@coonaninsurance.com ADDRESS: 267 MAIN ST aIei !{bIAFFORD/1BCOVELAGE MICA OXFORD MA 01540 MUM'A: ACE AMERICAN INSURANCE CO 22667 INSURED INSURER B: ENERGY PROTECTOR INC INSURER C INSURER D: 64 PAXTON RD POURER E: SPENCER MA 01562 INSURER F: COVERAGES CERTIFICATE NUMBER: 569858 REVISION IAIIBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TIE 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_ UR ADDLISUBR POLICY TYPE OFINSURNrCE e ( POLICY OINYVY 1 yyYY1 UNITS OOeleRRlzNL GENERAL Laiw1TY EACH OCCURRENCE $ DAMAGE� RENTED CLAeiSJrMDE OCCUR PREMISES(Ea occurrence) $ I®EXP(My one pram) $ WA PERSON LaAweNJURY $ GEM.AGGREGATE LIMIT APPLES PER GENERAL AGGREGATE f POLICY n, LOC PRODUCTS-COAPIOP AGG $ AUTOMODIU L,aRem (COMBINED E9 SINGLE I NGLEL MIT $ ANY AUTO BODILY INJURY(Per person) S ALL oats) SCHEnuxaoAUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-ORMI3) PROPERTY DAMAGE �NMEDAUTOS Auyos (Per(Peraccident) UMBRELLA UM OCCUR EACH OCCURRENCE $ BICE=LUi6 CLARISALADE WA AGGREGATE f I I RETENftoNs $ WOlOr6SCOwH1eAT10N X STATUTE AIABIROV RS'UABIITY YIN ER A RRgpaass wwl wA tea 09101/2020 09101/2021�r` -EA $ 500,000 O1 f10R I7F OPERATIONS below EL DISEASE-POLICY LINT $ 500,000 WA t , OESCRPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Ad6tlonal Remarks Schedule,may he Machos!a awn specs is required) Workers'Compensation benefits era be paid to Massachusetts employees only.Pursuare to Endorserherk WC 20 03 06 B,no authorization is given to pay dams for benefits to employees in states other than Malasdarsells A the insured tries,or has hied those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at avaw.mass.govAwd/workers-curripensationiinvestigalionsi. Sole proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIED POLICES BE CANCELLED BEFORE TIE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Enemy Protectpr Inc ACCORDANCE WITH THE POLICY PROVISIONS. 64 Paxton Rd AYIIIOR®REPRESENTATIVE c . C Spencer MA 01562 Daniell M. y,CPCU,Vice President—Residual Market—WCRIBMA A 19RR-2014 ACORD CORPORATION Al rights rosnrvnrd_ , / . r i I • 1 / II il , • (f 1 I ,0":' Commonwealth of Mnsuachusstts DiviSlon of Professional Mansura ' Board of UtlNdlnq Re ulatlons end titandsrds i Constrat/it1 �t pprvtsr�r CS 101143 �� 8,plres;oal1; JO$HUA•D$DA .4 PAXTON� , IPeNal$1.0111411 '` Ir Commissioner egi/a. J1 tcrnara,, l i i / ; I r • Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contactor Registration Typ Gar ration liej le , 17 ' ' eNMI Y PROTECTORS INC, ExplrrNorn 08M012022 04 PAXTON RD, SPENCER, MA 01002 Update Adiffla and Ritum Ott, Moo r M hCtera pe wUa No aMan� p o on valid few 1p nun only bpi61b1141re iaolnat$on Oft If found Mum la Woof Consumer Affairs and a unhn►.M Regulation 7911264010 OI11M 1000 Washington Simi N Who 710 tSV PRCM4TOg0 INO,. eoatan,MA 01111 JOSHUA DADA$4 F X9"ON RRD. bewhis,Assif �..•«.-- . SPENDER,MA 01002 Undarnunl+ntnly vial signature City of Northampton G G`. \S �'..Si #"_' ti. Massachusetts �4,?S - '.k 4 , i:A g DYPBR MOLT OF BLIILDIDIG INSPECTIONS c y� :47, a 212 Main Street • Municipal Building v` '� ! .L �110F Northampton, MA 01060 ..�C 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: 6:`A P c,x-1--orl. act) S pc nc et- , M P 0 % S6,L The debris will be transported by: Name of Hauler: -tnc (-61 y Pcv-\ec, J S T.,,c , Signature of Applicant: '��c Date: )C Z-7/ L_t