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31B-263 (5) BP-2023-1379 6 CENTER CT COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31B-263-001 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-2023-1379 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est.Cost: 5700 ENERGY PROTECTORS INC 101143 Const.Class: Exp.Date: 06/16/2024 Use Group: Owner: A TROXELL MUNSON, JEANNE Lot Size (sq.ft.) Zoning: CB Applicant: ENERGY PROTECTORS INC Applicant Address Phone: Insurance: 64 PAXTON RD (774)253-0277 6S62UB0G29826021. Spencer,MA 01562 ISSUED ON: 01/03/2024 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATH ERIZATI 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: I � f Q . �► Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner k•C o Nk fit, 1gt0 The Commonwealth of Massac setts Cj Board of Building Regulations and o' , Q Massachusetts State Building Code,780 8/ "'k6, "i wit ,ey�'2 �0 t is hall( i Building Permit Application To Construct,Repair, Renovate t4, ish a One-or Two-Family Duelling oti 1„, A This Sec 'on For Official Use Only �'ab,�4o,� Building Permit Number: 4 1 ' /3_7� Date Applied: 4.0a,. ///� 1-3-2OZq Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Proerty Address: 1.2 Assessors Map& Parcel Numbers retn t-er Ct- 1.1a 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 ft) 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: Zone: ___ Outside Flood Zone? Public 0 Private 0 Check ifyes❑ Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: — 12-__ _q- --u S0_n— _1A,10(*-hCAwt, tz�rl J''�A- C'�c)6-6 Name(Print) City State,LIP _C evn -ve c' C - &1-(— -33 7, - 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) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other CILApccify: Brief Description of Proposed Work2: Q 1 e S Pay, 1 4 \(1(L,t 4 A- t et...4-%t C_ +v kit •-k-k Ct c vAcQ i" Su l c A-e -1/4--4`e, e K e r kcdr` '.vc& VVS SECTION 4:ESTIMATED CONSTRUCTION COSTS • Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ S-7 Oa I. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:5_A- _ Check No.401 ICheck Amount:406Cash Amount: 6.Total Project Cost: $ S —7 00 0 Paid in Full 0 Outstanding Balance Duc: 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.II.) Spencer,MA 01582 R Restricted l&2 Family Dwelling City/Town,State,ZIP Li Masonry RC Rooting Covering WS Window and Siding SF Solid Fuel Burning Appliances 774-253-0277 jdada79@hotmail.com I _ Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 172960 8l19/24 Energy Protectors Inc HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 84 Paxton Rd jdada79@hotmail.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 Issuance of the building permit. Signed Affidavit Attached? Yes 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. os h -bct d C(I -IRI1 2-3 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(H IC)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 halfibaths 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" • 11'' 'I41.'1 n i 1111 , Y. •1' rI' .. .i , _ ( ., 1•i1, „ ! , 1 1.4 +,r .I' I ,, C • ,. .. + :t• 11,1 . 11114 • ,.Na I r�' '�" '1 Y f 1! r' rl , 4, 1 1 r •ii!" r Y " I ' 1 ^ .'(- 1 O•///1 !� l%i+ Y fi' 'iSi\ St ",�l 1*./ I f)F' S ,'i:1di('� .. ._. i _ I,r-I' . 11 ••• n . jt.'. u,. ;. i' , _. r-1:1 (!i'1 r �.r , J'%; A.' `11 fil'. :yti;i'.!. '( • _ 'erg ? /('i-r � Oli(.(}'' H il .( , - . __.-__ _ .. ...___ .. ._. •''.T.IIt)/ _. 1 ��,'/Ill i ' 1,4)OI l '--i'�.' ��} }��"�(.(1'i'!1){ f t3.11 J�.{IFY :11r •r^. . Pi. 1.. II ,.r. 1T. . - . a.t'!i ;1, ., ,' v� �,, 1,' , , 1.ni;n�, . _ !I!./ t!- )t41r{ " • Y ,l)!!{�I':l / l1.,a" 1.•rt +iorAf .. r'{ { 11`(/ ft. {/l ..:'t • { :>' Sr.d.ltii' 1' - • lc,f.41/tr.t.111 Itt!il' •, :r?t.4yr..at.1►L( 4,1116,+t-f(t{.,{',S( ) _ + _ K, . • ,7 _ 1 :1.1:.f-•.i!.i; .. • ,s•,Y; 1.1, Pt eV( t,1( i- t"llls`,{{/ ., !.Itlt r1 ISLE( --' sue\ The Commonwealth of Massachusetts Department of Industrial Accidents '� ,,?; Office of Investigations :�e.s r i Lafayette City Center Ls 2Avenue de Lafayette, Boston, MA 02111-1750 4.=, -•• www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):Energy Protectors Inc Address:64 Paxton Rd City/State/Zip:Spencer,MA 01562 Phone #:77w-2_3 0277 Are you an employer?Check the appropriate box: Type of project(required): 1.11111 I am a employer with 11 4. 0 1 am a general contractor and 1 employees (full and/or part-time).* have hired the sub-contractors h. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition workingfor me in an •capacity. employees and have workers' y P ty 9. ❑ Building addition [No workers' comp. insurance comp. insurance.t required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ G officershave I am a homeowner doing all work exercisedtheir11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] ' c. 152, §1(4), and we have no weatherization employees. [No workers' 13.® Other comp. insurance required.] *Any applican•.that checks box tel 1 must also fill out the section below showing their workers'compensation policy information. t I lotneowners who submit this affidavit indicating they are doing Ell 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. I:he sub-contractors has a 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. #:V9VVC421284 Expiration DatIe:19/1/24 Job Site Address: Cc C e V\ �C C City.-State/Zip:43 r \ ' pal t.A1 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).6 66 Failure to secure coverage as required under Section 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 certtif�y under the pains and penalties of perjury that the information provided above is true and correct. Signature: }j cA,41, .. G. Date: Ct j j 2 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(check one): I❑Board of Health 20 Building Department 31:City/Town Clerk 4.❑Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone#: City of Northampton v " Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 r 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: Energy Protectors Inc 64 Paxton Rd Spencer, MA 01562 Location of Facility: The debris will be transported by: F.n zP(11 0 co cC?)I Name of Hauler: • Cs' 2_3 Signature of Applicant: Date: WEATHERIZATION CONTRACT EVERS=URCE CUSTOMER PHONE DATE CLIENT# WORK ORDER Jeanne Troxell Munson (616)337-7476 08/15/2023 528921 38502 SERVICE STREET BILLING STREET PROPOSED BY: 8 Center Court 23 Kelleher Drive Daniel Diaz SERVICE CITY,STATE.ZIP BILLING CITY,STATE,ZIP Program Northampton. MA 01060 Deerfield, MA 01373 EGMA-HES Page 1 DESCRIPTION QTY COST INCENTIVE TOTAL INCENTIVE: RENTERS For eligible measures, the Mass Save Program offers a renters incentive of 100%off insulation.air sealing, and duct sealing measures.To be eligible for the renter incentive,the unit must be rented year-round,seasonal rentals are not eligible. KNOB&TUBE WIRING We have identified the potential existence of knob&tube wiring in your J.i: (initials) home.The following contract is not valid unless accompanied by the Weatherization Barrier Incentive form, signed by your licensed electrician.Work will not proceed until we receive a copy of this form. HOME AIR SEALING 4 $426.36 $426.36 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.) 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 51 $141.78 $141.78 Provide labor and materials to install an approved damming material in the attic ATTIC FLAT-10"OPEN R-37 CELLULOSE 201 $474.36 $474.36 Provide labor and materials to install a 10"layer of R-37 Class I Cellulose to open attic space. ATTIC FLAT-4" FLOORED R-13 DENSE CELLULOSE 240 $590.40 $590.40 Provide labor and materials to install a 4"layer of R-13 Class I Cellulose to floored attic space. SLOPE-8" DENSE R-26 CELLULOSE 144 $492.48 $492.48 Provide labor and materials to install a 8"layer of R-26 Class I Cellulose to sloped ceiling area. PULL-DOWN STAIR-THERMADOME 1 $313.63 $313.63 Provide labor and materials to install an easily moved, insulating cover for the attic access folding stair. The cover has integral weather- stripping to restrict air leakage. Document Ref:J5YT7-Y9MGX-GJ2DG-7SJ2E Page 1 of 10 'r'. 1 .. ; t. '!• jc 1tu" • ' -I. ci i,t.. , "4,3 F; { , , . •• • ti Ill l•. 7❑ • .l'.. ... ,... .. '1C !Yi:. 41 fit• ...,=(. � !tl .:� �i. .:.I . . i,.i::r.• 'Ki:t45Q.7\, .. 1i: - ..:'EsC, .• !? 1' t i ("it',. "3l''.S',•7•�-.q ...•,f2t .•JI'. ..19{4 .,... 91. ,�:. • U .2! Klblli?4t i1l IF?C .01VE: 101`✓r cr.:, (' '•o0 ;��Cbi;Jr i'. }',� t' �? f''l;t'�'�', -�? LjC;1r: c 1.• • , .ii !t V.Vi17' i- �: ' .311'.i • 4'JN,4C:'•..• • E AEL 2 fEiCE WEATHERIZATION CONTRACT EVERS=URCE CUSTOMER PHONE DATE CLIENTa WORK ORDER Jeanne Troxell Munson (616)337-7476 08/15/2023 528921 38502 SERVICE STREET BILLING STREET PROPOSED BY: 8 Center Court 23 Kelleher Drive Daniel Diaz SERVICE CITY,STATE.ZIP BILLING CITY.STATE,ZIP Program Northampton, MA 01060 Deerfield, MA 01373 EGMA-HES Page 2 DESCRIPTION QTY COST INCENTIVE TOTAL WALLS-ALUMINUM SIDED 4" 776 $2,785.84 52,785.84 Provide labor and materials to install blown in Class I Cellulose to aluminum-sided exterior walls. Touch-up painting, if needed,will be the customer's responsibility. Homeowner has received a copy of the EPA's Renovate Right Lead-Safe information guide explaining the potential risk of the lead hazard exposure from the weatherization work to be performed.Your signature is your acknowedgement of receipt and agreement to proceed. RIDGE VENT 8 $288.00 $288.00 Install continuous ridge venting at the top ridge of your roof.Shingle age and integrity will affect the aesthetics of your new ridge vent.The new color may not be an exact match for your roof due to material availability and UV exposure. Before installing, the contractor will procure the shingles for your approval. ASBESTOS HAZARD A blower door diagnostic test will not be conducted at your home,due to the possible presense of asbestos. LEAD PAINT Your home was built prior to 1978 and might have lead-based paint .r (initials) present.You have received a copy of the EPA's Renovate Right pamphlet informing you of the potential risk of a lead hazard exposure from the renovation activity to be performed at your home. Document Ref:J5YT7-Y9MGX-GJ2DG-7SJ2E Page 2 of 10 WEATHERIZATION CONTRACT EVERSETURCE CUSTOMER PHONE DATE CLIENT I! WORK ORDER Jeanne Troxell Munson (616)337-7476 08/15/2023 528921 38502 SERVICE STREET BILLING STREET PROPOSED DVS 8 Center Court 23 Kelleher Drive Daniel Diaz SERVICE CITY.STATE.ZIP BILLING CITY,STATE.ZIP Program Northampton. MA 01060 Deerfield, MA 01373 EGMA-HES Page 3 DESCRIPTION QTY COST INCENTIVE TOTAL PREPARE YOUR HOME Homeowner is responsible for the removal of any items stored in the J r. (initials) areas where the weatherization measures will be installed. The workers will need the space cleared to safely bring their tools and materials into these work areas. 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: $5,644.81 Program Incentive: $5,644.81 Client Total: $0.00 I.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 tIIC)upon satisfactory completion of the Work.Cli t understands that they will not be required to pay the Program Incentive Share of the Contract cost.Changes to the individual line items and/or previous incen i a Ty' r d o f the Program Incentive Share. KJ eeee rm eJt HeV e RISE Representative Client Signature Printed Name Date of Acceptance Document Ref:J5YT7-Y9MGX-GJ2DG-7SJ2E Page 3 of 10 mass save Savings through energy efficiency PERMIT AUTHORIZATION FORM 1, Jeanne Troxell Munson owner of the property located at: (Owner's Name) 8 Center Court Northampton (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. Jeauue riv-ell Mtrusou Owner's Signature Date FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: .�,� ,��t. cr 2 (ZJ Participatin Contractor Date Document Ref:J5YT7-Y9MGX-GJ2DG-7SJ2E Page 5 of 10 AC�® DATE(MM/DO/YYYY( C CERTIFICATE OF LIABILITY INSURANCE 8/23/2023 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 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 PAX 267 Main Street Wc.No.ax1):508-987-7122 we.so):508-987-7152 Oxford MA 01540 AOOREss: nina@coonaninsurance.com _ INSURER(S)AFFORDING COVERAGE NAIC Y License#:1782985 INSURER A:AIX Specialty Insurance Co INSURED ENERPRO-01 INSURER a:Safety Insurance Company Energy Protectors, Inc. 64 Road INSURER c: National Liability&Fire Insurance Company 64 Paxton Spencer MA 01562 INSURER D:Philadelphia Ins Companies _ __ INSURER E:Century Insurance Company -- INSURER F: COVERAGES CERTIFICATE NUMBER:309612825 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. _ LIR TYPE OF INSURANCE POUCYNUMSER IMWD rDIYYYY1 (MMIDD ) LIMITS A X COMMERCIAL GENERAL LIABILITY Y `L1N-H714840-02 8/31/2023 8/31/2024 EACH OCCURRENCE $1,000,000 DAMAGE TO REIM CLAIMS-MADE X I OCCUR _ ISE .SFa9_ MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POUCY JPRO- ECT LOC PRODUCTS-COMP/OP AGO S 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY Y 6236519 12/23/2022 12/23/2023 COMBINED den SINGLE LIMIT j 1 000 000 (Ea ANY AUTO BODILY INJURY(Per person) $ — OWNED X SCHEDULED 1 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED x NON-OWNED PROPERr TY DAMAGE : AUTOS ONLY _ AUTOS ONLY S E X UMBRELLA LAB X OCCUR r CCP1188257 8/31/2023 8/31/2024 EACH OCCURRENCE $1,000,000 EXCESS MAR CLAIMS-MADE AGGREGATE $ DED X RETENTION$to jwt $ C WORKERS COMPENSATION V9WC421284 9/1/2023 9/1/2024 X PA�RR OTH- $TATUTE ER_ __ AND EMPLOYERS'LIABI..ITY _ ANYPROPRIETOR/PARTNER'EXECUTIVE YE NIA E.L.EACH ACCIDENT $500.000 _ OFF ICERIMEMBER EXCLU DED? (Mandatory In NH) E.L DISEASE-EA EMPLOYEE S 500,000 If yes,describe under -----_ DESCRIPTION OF OPERATIONS below El.DISEASE-POUCY LIMIT $500.000 o Pollution Liability r PPK2510236 1/8/2023 1/8/2024 AQprepats Limit 500.000 Ocourence 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Tiffany Circle Townhouses&Phoenix Company,Inc are named as additional insureds and coverage is primary and non-contributory.The additional insured applies to ongoing and completed operations. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Tiffany Circle Townhouses ACCORDANCE WITH THE POLICY PROVISIONS. c/o Phoenix Company Inc 650 Lincoln Street AUTHORIZED REPRESENTATIVE Worcester MA 01605 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD -- •''r&EI '..: ,-,.', 4ew•?, {,}i• •,,,,-,2,0trj dinitt r..10.(1 r d,,=1:.::-;I..:"..4,..,--,.;c.o. . -1,.4.,‘ , i ,col.,,r) , .,4 COL )C01$1.013VLICill° VII 310i.iti:Itf _ _ . ...• — . __ .._......__.__ 1 — ...—...„.....- — ....—.....--- —.1 ., r.. f-.- ic'..ses' 1 ViVits1AF; /I. , ) t.:'" ''' 1" !".' —.).) VC.C -'jr'siCt.sMtr rs 1.4-4-.bOVIC x 0,1•,'),`IPIC.4i141.2" 1 i .til, r•<rrt!'",r'ir".:1 • V.4.4;. i_iii itr..,t Or tJc,2 Mirr 97, r tAii.sE-•.. IMF.VROtri, '01.:4i,..4ttlik-)6041C62 d;•r••-If' ,'I Fil Rfi;,:ttrarr 1 .. . — — - — Ct •, tr P ?''..) ;1:11 (:',;;,'C,t":'f'•I V.!!!"'..:A ..... __. ....... .. ..., . ... . _._ .. ,....-..—_. _-. __.......„.._ __ . ._ ....... ..... I.... . t , :,.; .,.! ... . .. ,,.. . f., r'' '' 1::.. r `':r,.2 ‘ '-: -! 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I-4Cit ':EV' .0112 — — — \5 4,. t 4ki c 8 CEEJ11ACVIE Oh rivElirli.,), PA'21);.7‘ ri"ACE i Commonwealth of Massa of chusetts achusens Board of Building Regulations Lrcen ulations and sure + Cons 1 r Standards CS 101143 '`` tsof s JOS43 ti4 PAX ON DADA "6tpires:06;16/2024 SPENCER MIT I �b i THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washingtcr - Suite 710 Boston, tviassachusetts 118 Home ImproverRent Contra istration " Type: Corporation ....._ •.: ton- 172960 ENERGY PROTECTORS INC. 4= = Expiration: 08/19/2024 54 PAXTON RD. . SPENCER,MA 01562 .1: �,, Update Address and Return Card. THE COMMONWEALTH H OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to. TYPE:Corporation Of f!ce of Consumer Affairs and Business Regulation Re9410.40l? titgp 1D00 Washington Street •Sudo 710 i729eo C8119f2O24 Boston.MA 02118 ENERGY PROTECTORS, 111 JOSHUA DADA j ; t 64 PAXTON RO. \ fix= t ;;4t s+' SPENCER,MA 01562 valid without signature l mass c Weatherization Barrier Incentives R ; tm on your Energy SSpeciahst`s reco[nmendiat i ons,your home can b n(' €, rr':m pnocirans-eHr„iibie insulation e-,s n„'.; eor€;ntn Before moving forward, please toll.ow ail Use nstri"rc ti ' De In+r✓ in rc''"ediate your weathbnzation b rr;ert CUSTOMER INSTRUCTIONS tt;e is .. .,tr t,r r. _ _._ witt;ira 6 days of your Hoorne Energy t : ,,Pre-Wx Barrier incentive,c,r`o CL.EARes;,it, 41 Brigham Street,Unit 10,Marlborough,MA 01752 prewxoffer clearesult.eorri ,3 ...a . ;dedu 'te.' fie - �_'r.f no` a}yr'lmit r.3rrnuht f the weatt srizaticr;work A rebate check F , S. '• • , , sr,xrr that may be a.nd to rernediate eligibl weathenzaaon MassSave.comfeniisaving/residential-rebatesiheat'doan-program CUSTOMER INFORMATION JI ANN1�TROX ,LLMUNSON r 4718065 Customer Name. lf?r;f 1. or ';..�: (1 Center Ct .. Northampton, MA -zip, 01060 41 771 1i)8 Emual Itro>ellmunsun egmarl.norra Customer8Hornecwner Signature _ Date: A I WCRI „' .t t`$2 c. the contrast;y w li evaluate the following crew where eligible Mass Save ha.ee been rriaue. Attic.Wall ;r Attic Slope e Exterior Wal! Basement ; Other. 4, Other: F i, $- =z.. i s --shed there is no active 1€nob and'arse wir.ng in the areas seiecte'below_ ' " ",3„ -C�.a Slope Exterioor Wall (•"`^)' -, ... , � � .;,� ti p:_ � a� Basement t, j Other: __.. ,...� ��Other: City: State: ZIP: :'..IA,001028 Contractor Signature: Date: ---.1 av,a - al systems iistc Ci above and have corrected any barriers as to-u r r ;ono; ,. }r:_x - ,ins and Condit;ons outlined con the back of this form. MECHANICAL SYSTEM BARRIERS ; « *".,�,y. High Carbon Monoxide. ....ratractar,s to ,,,..�v.arua • ;e:ra o ecl anical system(s)and reduce the carbon monoxide level, is asc;rE'£,$ '"*° ... :2 flue gas,to below atJi,,r , s r ;.: Draft Failure; .._ , try€. ..< w t; correct the draft ,n tt'r a ler*rice .Y'(.) Refer to rabic on reverse for acceptable draft ranges. tiyhC 7+<FStir�g COkJ Heating System irC Wator r' ato . _.. . .,ems.�.<.. -«-..- .»...L...�._,..,.<�..,,.- ....:..._..... ,._. —t,..ve......- ... -. Other . Spillage; ;to correct the spillage flae gases in the selected rnechan-cal systero(s) Must not spill after 60 seconds of operation Jos,rc1•E4.)r A`ar72La. ...W..�_... -...--�..>..._ r'.-t..,• t _ State. ZIP. Contactor Signature: ......_ . Date, s _ Iris st f a . (' hair Conditg)ns oaa;it don the foci, of