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24D-155
BP-2024-0879 11 CARPENTER AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24D-155-001 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-2024-0879 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2024 Contractor: License: Est. Cost: 13000 ENERGIA LLC 108421 Const.Class: Exp.Date: 02/19/2025 Use Group: Owner: LLC SHUMWAY PROPERTIES Lot Size (sq.ft.) Zoning: URC Applicant: ENERGIA LLC Applicant Address Phone: Insurance: 242 SUFFOLK ST (413)322-31 1 1 A0255555005 HOLYOKE, MA 01040 ISSUED ON: D7/11/2024 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATH ERIZATION 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: 1/ Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner d --�F� C DepPR < _ City of Northarr>,ptonJU / 0 Building Depa ent 20�4 r 212 rn 0 °F INS G R0000m ?ice n'°QrN M��NC rr�spscn Northampton, MA 0106 oN,r'q otoso°ys = OIUJLY phone 413-587-1240 Fax 413-587-1272 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 9-11 CARPENTER AVE Map Lot Unit NORTHAMPTON, MA 01062 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: SAUL COLON 9-11_ CARPENTER AVE Name(Print) Current Mailing Address: SEE PERMIT AUTHO 203-536-5973 Telephone Signature 2.2 Authorized Aqent: BENJAMIN BORDEN/ENERGIA LLC 242 SUFFOLK ST HOLYOKE MA 01040 Name rint) Current Mailing Address. 413-322-3111 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 13000.00 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee # 5 4. Mechanical(HVAC) 0 5. Fire Protection 6. Total=(1 +2+3+4+5) 13000 00 Check Number 5efO � !� This Section For Official Use Only of L i/ 79 Date N' Building Permit Number: v Issued Signature: //: C— 7- e- 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/ENERGIA LLC 108421 License 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 2/16/26 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 0 No 0 Brief Description of Proposed Work Insulation NOTE: INSULATION ONLY INSULATION TO WALLS INTERIOR DRILL & FILL DENSE PACK CELLULOSE I. BENJAMIN BORDEN/ENERGIA LLC , 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 Name 7/01/24 Signature of wner/Agent Date SAUL COLON ,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-4 -t -j 7/01/24 Signature of Owner Date The Commonwealth of Massachusetts Department of Industrial Accidents _ Office of Investigations _ —=�- ` 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.❑ Manufacturing no employees. [No workers' comp. insurance required]** 11.0 Health Care 4.❑ We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp. insurance req.] 12.❑■ Other Insulation *My 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:9 CARPENTER AVE City/State/Zip: NORTHAMPTON MA 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 perjury that the information provided above is true and correct. Signature: Date: 3/28124 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.❑Board of Health 2.❑Building Department 30 City/Town Clerk 4.0Licensing Board 50 Selectmen's Office 6.['Other Contact Person: Phone#: www.mass.gov/dia THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for Individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. Iffound return to: TYPE:-11C Office of Consumer Affairs and Business Regulation Registration '1' gxpiration 1000 Washington Street -Suite 710 165169' ' 02/16/2026 Boston,MA 02118 ENERGIA LLC '' • i BENJAMIN BORDEN 242 SUFFOLK STREET 'I/b• e.... 1 `U _ tder............ HOLYOKE MA 01040 Undersecretary valid without signature i Commonwealth of Massachusetts 1 Division of Occupational Licensure Board of Building Regulations and Standards • COBS % aAvisor it CS-10&821 �; ires:02/19/2025 BENJAMIN Rtilif 242 SUFFOLKST,1 n ; HOLYOKE PO_,01044 • y `rbA,4.. L.. •,,i3 I r.,--rr:rnizsione dais ii V5;;r r%,, • C e RT i /c4TG • L /A 1- -V-1 f ..teil 5 Lt Ril\ h cE__ SEE- -BA, C K ENERLLC-01 JOCELYN ACORN CERTIFICATE OF LIABILITY INSURANCE DATE(MMDDYYYY) 7/1/2024 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 Jocelyn M Douglas NAME: Phillips Insurance Agency,Inc. PHONE I FAX 97 Center Street (A/C,No,Ext): (A/C,No): Chicopee,MA 01013 ADDRESS:locelyn@phillipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC B INSURER A:Middlesex Insurance Company 23434 INSURED INSURER B: Energia LLC INSURERC: 242 Suffolk Street INSURER D: Holyoke,MA 01040 INSURER E: 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER ,IMM/DD/YYYYI IMM/DD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR A0255555001 7/1/2024 7/1/2025 DAMAGE TO RENTED 500,000 PRFMiSES fEa occurrence) MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 3,000,000 POLICY X JECT X LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER S A COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY tEa accident) $ ANY AUTO A0255555004 7/1/2024 7/1/2025 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOSOE ONLY X AUTOS W BODILY INJURY(Per accident) $ X AUTO ONLY X AUOTOS ONNLYp PRO a�deY ntDAMAGE A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE A0255555007 7/1/2024 7/1/2025 AGGREGATE S 2,000,000 DED X RETENTIONS 0 $ A WORKERS COMPENSATION y PER X STATUTE FOTH AND EMPLOYERS'LIABILITY 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE R Y/N A0255555005 7/1/2024 7/1/2025 E.L EACH ACCIDENT $ OFFICERAIE NHjEXCLUDED? N N/A 1,000,000 (Mandatory E.L.DISEASE-EA EMPLOYEE $ If yes,descnbe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I 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 Energia LLC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 ACCORDANCE WITH THE POLICY PROVISIONS. 242 Suffolk St. Holyoke,MA 1040 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD mass save Savings through energy a i PERMIT AUTHORIZATION FORM I, Saulo Colon owner of the property located at: (Owner's Name) 9 Carpenter 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. Sacdo-Colo Owner's Signature 02-09-2024 Date FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: ��1JC�2Gj,q w L " r c LK Participating Contractor Date •••••••••!•!•!�4%!.!•!•!•!•!%•!•44-ice•,•-!•4!•!•i!•!•!•-!•!•!•!•!•!•!•�i!•!•!i!•!i!•.'!•!•!•!•!•!•!�4-!•!•-!•!-!•i!i,•!•!•!.!•!•�!•!.!•i •••e•••!•00 t• •i i t- s.:. • • .•••.. i• •1•••; :460 •••$ ••• Signature Certificate •.• +, Reference number:QZAAN-F7WUR-JZRZK-HGSTF ....... ii•• ...V.Vied •••:•: ;44: •••: •., Signer Timestamp Signature VW m Saulo Colon ,.;; frAt.L••; Email:saulocolon@gmail.com :•:•: •••••••• Sent: 01 Feb 2024 02:47:19 UTC 6'olou :i;.; 44 Viewed: 08 Feb 2024 03:54:54 UTC Sacs .. ;•:•;• Signed: 09 Feb 2024 21:22:58 UTC i •'••:: 4•4: - • :4 O Recipient Verification: IP address:73.186.139.166 :•:;• ':' ',Email verified 08 Feb 2024 03:54:54 UTC Location:Hartford,United States ••••• Am ..•• :❖i' •4i• •••••; Document completed by all parties on: ::•:• : 09 Feb 2024 21:22:58 UTC :;V •:•:•. 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