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17A-299 (11) BP-2023-1149 157 HILLCREST DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17A-299-001 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-2023-1149 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 7200 ENERGY PROTECTORS INC 101143 Const.Class: Exp.Date: 06/16/2024 Use Group: Owner: WIDER LAUREL &MARLENE B RACHELLE Lot Size (sq.ft.) Zoning: URA Applicant: ENERGY PROTECTORS INC Applicant Address Phone: Insurance: 64 PAXTON RD (774)253-0277 6S62UB0G29826021 Spencer,MA 01562 ISSUED ON: 08/25/2023 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHERI ZAT I 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 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: iS 1 • Fees Paid: S65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner --�CJ ,L,— �q&j The Commonwealth of Massach etts A(/ FO k:9 Board of Building Regulations and '.'and ds G2 3 9n M : ICI ALITY Massachusetts State Building Code 780 Pc-ue U E r Building Permit Application To Construct,Repair, ttek tp ,; R rised far 2011 \ One-or Two-Family Dwelling ''TON. 11.v4gPE-er'3Ne This Se n For Official Use Only °aJ Building Permi Number: "d1 I I I Date Ap lied: alter i /2 _ 6 25-26z3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Ad,etss:C� e5+ 1.2 Assessors Map& Parcel Numbers 1.la Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq II) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private❑ /.one: _ Outside Flood Zone' Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Name(Print) City,State,ZIP N t t S" 1 ' t\ Ces4- y q�� ., ck.6 ...yS—cC.S'-- No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other Specify: L. R dk_A-n-C.nZ4\ .or\ Brief Description of Proposed Work`: A-\t^ S e_ r1 1 4- I✓x. S c.. k. C. k"'Q_ l----I'V_ et+— % L te, Y- —ti c‘. c-....n ck : S,. v c,_ 4 S e.vti.e i" c e, t oft 5 .-L.. 1 the C i4ss SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only (Labor and Materials) 1.Building $ `) �C,0 1. Building Permit Fee:$ Indicate how fee is determined: t 0 Standard City/Town Application Fee 2.Electrical $ 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fs:A"e � /�'9 Check No. Check Amount: l� Cash Amount: 6. Total Project Cost: $ 1 Zoo ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-101143 6;16/24 Joshua Dada License Number Expiration Date Name of CSL Holder List CSL Type(see below) u 64 Paxton Rd No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu. ft.) Spencer,MA 01562 R Restricted 1&2 Family Dwelling City/'l'own,State,`LIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 774-253-0277 jdada79@hotmall.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 172960 8/19/24 Energy Protectors Inc HIC Registration Number Expiration Date H1C Company Name or H1C Registrant Name 64 Paxton Rd jdada79thotmail.com No.and Street Email address Spencer,MA 01582 774-253-0277 City/Town,State,ZIP Telephone SECTION 6: 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 Issuuancce of the building permit. Signed Affidavit Attached? Yes tY No .❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION 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. 4bc - co-Qc ctI -L3 Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of halfbaths Type of heating system Number of decks!porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" _ The Commonwealth of Massachusetts =� Department of Industrial Accidents TAB1� 1 Congress Street,Suite 100 _ Boston, MA 02114-2017 =t,� www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH TIIE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/OrganizationrIndividual):Energy Protectors Inc Address:64 Paxton Rd City/State/Zip:Spencer, MA 01562 Phone#:774-253-0277 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 1 employees(full and/or part-time).* 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. ❑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❑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 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance. 14.0 Other insulation 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 If must also till out the section below showing their workers'compensation policy information. +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 subcontractors 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:National Liability& Fire Insurance Company Policy#or Self-ins.Lic.#:V9WC383933 Expiration Date:9/1/23 Job Site Address: t S 7 ft' ,' (fit S' )' City/State/Zip: t► ,Of.Cr CQ.t 6 .Z 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 ains and penalties of perjury that the information provided above is true and correct. Signature: - ' C'"—"L. Date: t'l\ Ctr Z3 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/I,icense# 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#: City of Northampton oar Mp d` 0 " Massachusetts d ° f k 1+ DEPARTNBNT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 444 .40,0 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, 554, 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: Sp _*.‘ C e r` dA- G t �� Location of Facility: The debris will be transported by: Name of Hauler: Signature of Applicant: '�'" Date: SC I ) 2- 3 WEATHERIZATION CONTRACT EVERSSURCE CUSTOMER PHONE DATE CLIENTS WORK ORDER Marlene Rachelle (917)968-4595 08/08/2023 544265 10302 SERVICE STREET BILLING STREET PROPOSED BY: 157 Hillcrest Drive 157 Hillcrest Drive Seth Main SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Program Florence, MA 01062 Florence, MA 01062 EGMA-HES Page 1 DESCRIPTION QTY COST INCENTIVE TOTAL INCENTIVE 75% For eligible weatherization measures, Eversource is offering an incentive of 75°/0 for insulation measures and 100%for the air sealing measures, both with no limit.You are eligible to apply for the 0% Heat Loan to finance your co-pay,applications must be submitted before the weatherization work begins. HOME AIR SEALING 10 $1,065.90 S1,065.90 Seal areas of your home against wasteful,excessive air leakage. Materials to be used to seal your home can include caulks,foams and other products. Primary areas for sealing include air leakage to attics, basements,attached garages and other unheated areas (windows are not generally addressed.) TRANSITIONS 46 $344.08 $344.08 Provide labor and materials to air seal the transitions of your home against wasteful,excess air leakage. WEATHERSTRIP DOOR 2 $72.64 $72.64 Provide labor and materials to install Q-Ion weatherstripping to door(s)to restrict air leakage. DOOR SWEEP 2 $59.32 $59.32 Provide labor and materials to install a doorsweep to restrict air leakage. ATTIC DAMMING 67 $186.26 $139.70 $46.56 Provide labor and materials to install an approved damming material in the attic ATTIC FLAT-11"OPEN R-40 CELLULOSE 700 $1,722.00 S1,291.50 $430.50 Provide labor and materials to install a 11"layer of R-40 Class I Cellulose to open attic space. KNEEWALL-2" RIGID BOARD 128 $697.60 $523.20 $174.40 Provide labor and materials to install rigid board at R-10 or greater with the required fire rating to a kneewall area. RECESSED LIGHT COVERS 10 $568.90 $568.90 Install recessed light covers over existing recessed light fixtures. Up to 6 at no cost. HATCH-INSULATE RIGID BOARD 1 $53.96 $40.47 $13.49 Provide labor and materials to insulate the back of an attic hatch with 2"rigid insulation board at R-10. Document Ref:Y5IE7-XNYYR-NECX8-ANT3M Page 1 of 4 WEATHERIZATION CONTRACT EVERS=URCE CUSTOMER PHONE DATE CLIENT# WORK ORDER Marlene Rachelle (917)968-4595 08/08/2023 544265 10302 SERVICE STREET BILLING STREET PROPOSED BY: 157 Hillcrest Drive 157 Hillcrest Drive Seth Main SERVICE CITY,STATE,ZIP BILLING CITY,STATE.ZIP Program Florence, MA 01062 Florence, MA 01062 EGMA-HES Page 2 DESCRIPTION QTY COST INCENTIVE TOTAL BASEMENT CEILING-9" FIBERGLASS 720 $2,174.40 S1,630.80 $543.60 Provide labor and materials to install R-30 faced fiberglass batt M.R. (initials) insulation to the basement ceiling.This will be installed with the paper backing up against the floor above.The un-papered fiberglass side will be facing the basement,and these exposed fiberglass fibers will be the visible side when standing in the basement. Your initials are your agreement and understanding of this measure VENTILATION CHUTES 14 $65.52 $49.14 $16.38 Provide labor and materials to install ventilation chutes in the rafter bays to maintain air flow from the soffit ventilation. VENT BATH FAN TO ROOF OR OTHER 1 $166.53 $124.90 $41.63 Install an insulated exhaust hose to a flapper vent to exhaust existing bathroom fan(s). Fan will be vented through the roof or an acceptable alternative if contractor cannot vent through the roof. STORAGE-CLOSET Homeowner is responsible for the removal of the stored items in the M.R. (initials) closet with the attic access. Removal must occur prior to the scheduled work start. If you have any questions or specific concerns, please bring them to the attention of your subcontractor when they call to schedule your work. Total: $7,177.11 Program Incentive: $5,910.55 Client Total: $1,266.56 1.DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the above work at the Client's Address in a professional manner and in accordance with the terms of this Contract- II.PAYMENT Client agrees to pay the Contractor for the Work,the Client Share of the Contract Cost is payable to the Independent Installation Contractor(IIC)upon satisfactory completion of the Work.Client u erstands th$t they will not be required to pay the Program Incentive Share of the Contract cost.Changes to the individual line items and/or previous incentives r{�y V�terette size of the Program Incentive Share. v (/((,(/l Harlow Rackdle RISE Representative Client Signature Seth Main Printed Name Date of Acceptance Document Ref:Y51E7-XNYYR-NECX8-ANT3M Page 2 of 4 S3" • mass save Savings through energy efficiency PERMIT AUTHORIZATION FORM I, Marlene Rachelle owner of the property located at: (Owner's Name) 157 Hillcrest Drive Florence (Property Street Address) (City) hereby authorize the Mass Saves 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. Marleue Raei e& Owner's Signature 08-14-2023 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 Document Ref:Y51E7-XNYYR-NECXB-ANT3M Page 4 of 4 A` DATE(MMIDDIYYYY) `..-� CERTIFICATE OF LIABILITY INSURANCE 8/31/2022 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: Nina Arroyo Coonan Insurance Agency, Inc. PHONE - FAX 267 Main Street (Arc.No.Est):508-987-7122 uuc.No):508-987-7152 Oxford MA 01540 ADDRESS: nine©coonaninsurance,com INSURER(S)AFFORDING COVERAGE NAIC t+ license#:1752685 INSURER A:AIX Specialty Insurance Co INSURED ENERPRO-01 INSURER B:Safety Insurance Company Energy Protectors, Inc. 64 Paxton Road INSURER C:Capitol Specialty Insurance Corporation Spencer MA 01562 INSURER D:National Liability&Fire Insurance Company INSURER E:Philadel JLhia Ins Companies INSURER F: COVERAGES CERTIFICATE NUMBER:2132532233 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 IDOL SUER POLICY EFF POUCY EXP LIMITS LTR TYPE OF INSURANCE I,jD w'm POUCY NUMBER (MMIDD/YYYYI,GAM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y L1N-H714840-01 8/31/2022 8/31/2023 EACH OCCURRENCE $1,000,000 I ` DAMAGE TORENTf`_i�_`"— -- CLAIMS-MADE L .I OCCUR F_PREM($E$(�$Qt lffNICFL_.._..$50.000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1.000,000 GEN'L AGGREGATE LIMIT APPLES PER: GENERAL AGGREGATE $2,000,000 X POUCY I(pi LOC PRODUCTS-COMP/OP AGO $1,000,000 _OTHER: $ B AUTOMOBILE LIABILITY N 8236519 12/23/2021 12/23/2022 CO(Ea eccWenMBINEDq SINGLE LIMIT $1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED X SCHEDULED BODILY INJURY(Per accident) $ V AUTOS ONLY AUTOS ----- y X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident) __-__-,—_----_---.._.-.--_—_--. C X UMBRELLA LIAR X OCCUR V CCP1070518 8/31/2022 8/31/2023 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE _ $ DED X RETENTION$1n fYtn `$ D WORKERS COMPENSATION V9WC383933 911/2022 9/1/2023 X gffAME OTH- ER AND EMPLOYERS'LIABILITY IN ANYPROPRIETOR/PARTNER/EXECUTIVE Y� N/A E.L.EACH ACCIDENT $500,000 OFFICER/MEMBEREXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 If Yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POUCY LIMIT $500,000 E Pollution Liability PPK2386760 1/6/2022 1/6/2023 Each Occurence 1,000,000 General Aggregate 2,000,000 Products-Completed 2.000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Eversource 247 Station Drive AUTHORIZED REPRESENTATIVE Westwood MA 02090 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts 11, Division of Occupational Licensure `+- Board of Budding Rel r ulationsr and Standards 1i COf16 i Q11$ ttYlsor CS-101143 * 6ipires:06116/2024 JOSHUA S DADA ,,,,,iii ~ 64 PAXTON itD J SPENCER MA 0156- i Commissioner ,,,7 /7, r ";,..: , d s . . •,. ,... ..... THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, tvlas-sactusetts 02118 _. Home improyeme91. Rep istration 41 ,. --r.--v •.'..-,.- . ."- ------.-,"" " .--•."" "-, - "'".......-7---11 f— "-,......" --Z...... .•. 1- Type: Corporation Registration; 172960 ENERGY PROTECTORS INC. tm- =:•.;— , ' ,- — - ‘, _ - t-xpinitIon: 08/19,2024 64 PAXTON RD. t.... SPENCER,MA 01562 \ =-.•.....- : ..-:=_- ••••••ff,er — r:, +NOM aeaao.a..a,,..aN•VM '.....vaim ... ..,, _. 4...,,,au.,,,,.." ' 144 , 4.%lik" 4,..•0..fr- '''' Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS 4 Office of Consumer Affeirs.4 Business Regulation Registration valid for Indlaidtml use only before the ., HOME IMPROVEMENT CON TRAC FOR expiration date. If found return to: TYPE:Corpor.ition CMGs of Consumer Affairs and Business Regulation BegtStralt2Vo. f..1.14EMIgn 1001111esotingtori Street i Suite-710 1 72160 0819.7.0241 Boston.via Inila ENERGY PROTECTORS NC. ----1 ... 1.s.4: 64 PAxTON RD. --,....• --ttt....--,-......-. *-0 /ed..,,......, - p-4:-....-0-4: SPENCER,MA 01562 ---— . Undersecretary rt valid without signature