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16B-033 (2) BP-2024-0878 70 FERN ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 16B-033-001 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-2024-0878 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2024 Contractor: License: Est. Cost: 3000 ENERGIA LLC 108421 Const.Class: Exp.Date: 02/19/2025 Use Group: Owner: RAY SYLVESTER Lot Size (sq.ft.) Zoning: URB Applicant: ENERGIA LLC Applicant Address Phone: Insurance: 242 SUFFOLK ST (413)322-31 1 1 A0255555005 HOLYOKE, MA 01040 ISSUED ON: 07/11/2024 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: /3'7 Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Buildine Commissioner V DeFoRoa HA.. City of Northmpt n 0 . Building Depart '0,94 212 MainiStC�enoy',e'U/< ; .tT Room 100 TNq-'�r^`3/tv I S ULA TION , PC Northampton, MA 01060 °N.��'�o>U °NS phone 413-587-1240 Fax 413-587-1272 0111.. Y 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 70 FERN ST 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: RAY SYLVESTER 70 FERN STNORTHAMPTON, MA 01062 Name(Print) Current Mailing Address347-901-0984 SEE PEA .M c r A'Crtto Telephone Signature 2.2 Authorized Agent: BENJAMIN BORDEN/ENERGIA LLC 242 SUFFOLK ST HOLYOKE MA 01040 Name(Print) 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 3000.00 (a) Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Feeuf6 11 4. Mechanical(HVAC) (�✓� 5. Fire Protection 6. Total=(1 +2+3+4+ 5) 3000.00 Check Number 5(186- This Section For Official Use Only O7f Date Building Permit Number Issued: Signature: //i�%�-- 7-iL 00 1y 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 t{13 -322- 3c1I Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ 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 ❑ Brief Description of Proposed Work Insulation NOTE: INSULATION ONLY INSULATION TO WALLS DENSE PACK CELLULOSE 3" 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 er/Agent Date 1. RAY SYLVESTER as Owner of the subject property BENJAMIN BORDEN/ENERGIA LLC hereby authorize to act on my behalf. in all matters relative to work authorized by this building permit application. SEE AL-C fl 7/01/24 Signature of Owner Date City of Northampton ` '' �,/ Massachusetts �� G 4. ,� jet m /F DEPARTMENT OF BUILDING INSPECTIONS :J ! 212 Main Street • Municipal Building �s- _ Q,C .�� Northampton, MA 01060 S�� MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 70 FERN ST NORTHAMPTON, MA 01062 Contractor ENERGIA LLC Name: Address: 242 SUFFOLK ST City. State: HOLYOKE, MA 01040 Phone: 413-322-3111 Property Owner RAY SYLVESTER Name: Address: 70 FERN ST City, State: NORTHAMPTON, MA 01062 BENJAMIN BORDEN/ENERGIA LLC (contractor) attest and affirm that the building I intend to insulate does not have any open air (knob and tube) wiring in the spaces to be insulated and that I have provided the property owner with a copy of this affidavit. Contractor signature - Date 7/01/24 City of Northampton .0yGn r „ Massachusetts '� DEPARTMENT OF BUILDING INSPECTIONS ?, 212 Main Street •Municipal Building p,• ca Northampton, MA 01060 rS Sf,�1� Debris Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from construction work being performed at: 70 FERN ST NORTHAMPTON, MA 01062 (Please print house number and street name) Is to be disposed of at: BOSTON RD WILBRAHAM (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: USA WASTE (Company Name and Address) t 78.0.e4,_____ 7/01/24 Sign re of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. 4*k Permit Authorization mass save Form ough ehergy Site ID: 5294723 Customer: RAY SYLVESTER I Ray Sylvester , owner of the property located at: (Owner's Name,printed) 70 Fern St Northampton, MA 01062 (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. Owner's Signature: Rag S7 ai`rfer Date: 06 / 07 / 2024 •••••••••••••••••••••••••••••••••••••••••••••••••••••••♦••••••••e -- FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: EWEJ&/A LLC. 7//2 L4 Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 For Cffi_e use Crl, THE COMMONWEALTH 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.].[C Office of Consumer Affairs and Business Regulation jtegistratlon >• Txpiration 1000 Washington Street -Suite 710 165169 • 02/16/2026 Boston,MA 02118 ENERGIA LLC • BENJAMIN BORDEN • • • . :qLY✓ ;+!,� U 242 SUFFOLK STREETSourvi...:___ tiOLYOKE MA 01040Undersecretary ot valid without signature Commonwealth of Massachusetts 1 Division of Occupational Licensure Board of Building Regulations and Standards COn tt; 'il evisor a CS-108421 .`S' •_L;' - __1,> ires:02/19/2025 BENJAMIN R1 .I �- -, 242 SUFFo STT,;\R g - i HOLYOKE KO mot! i .' : , 111414 vI it. :J4q'J.+.3 C aRT I'F./CA1.-E- LiA%kL-key ..14SL4 cp\ I s iA CK ENERLLC-01 JOCELYN ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM DD YYYY) 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 cor,TACT Jocelyn M Douglas NAME: Phillips Insurance Agency,Inc. PHONE I FAX 97 Center Street (A/C,No,Ext): (A/C,No): Chicopee,MA 01013 _ADD IL S5.Jocelyn@phillipsinsurance.com INSURERS)AFFORDING COVERAGE NAIC U INSURER A:Middlesex Insurance Company 23434 INSURED INSURER B: Energia LLC INSURER C: 242 Suffolk Street INSURER D: Holyoke,MA 01040 INSURER E: INSURER F: 1 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR ,INSD WVD (MM/DD/YYYYI (MM/DDIYYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE X OCCUR A0255555001 7/1/2024 7/1/2025 DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY $ 1'000'000 GENTAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 3,000,000 POLICY X PE X LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: S acccid SINGLE LIMIT S 1,000,000 A AUTOMOBILE LIABILITY ((Ea ANY AUTO A0255555004 7/1/2024 7/1/2025 BODILY INJURY(Per person) S — OWNED SCHEDULED AUTOS ONLY X AUTOS BODILYBODILY INJURY(Per accident) S X HIREDTO ONLY X NON-OWNEDUUTS ONLY (Per acccid ntDAMAGE ) S A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 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 Xy PER STATUTE OOTH AND EMPLOYERS'LIABILITY1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE YIN A0255555005 7/1/2024 7/1/2025 E L EACH ACCIDENT S MFFICERMyEMBgEER EXCLUDED? N N I A andatory m NH) E L.DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/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 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 The Commonwealth of Massachusetts • �� Department of Industrial Accidents 1 Congress Street,Suite 100 L - ; j• 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 Name(Business/Organizational/individual):ENERGIA LLC Address: 242 SUFFOLK ST City: HOLYOKE State: MA Zip: 01040 Phone#: 413-322-3111 Are you an employer?Check the appropriate box: Type of project(required): V` 1. I am an employer with 14 employees(full and/or part time)* 7. New construction ` 2. I am a sole proprietor or partnership and have no employees working for me in any 8. Remodeling capacity. [No workers'comp.insurance required.] n9. Demolition 3. I am a homeowner doing all work myself.[No workers'comp.insurance required)t 10. Building addition n4- I am a homeowner and will be hiring contractors to conduct all work on my property. 11. Electrical repairs or additions I will ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 12. Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached 13. Roof Repairs sheet. These sub-contractors have employees and have workers'comp.insurance.± 6. We are a corporation and its officers have exercised their right of exemption per MGL. X 14. Other 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. tHomeowners 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 attach 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. l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: MIDDLESEX INSURANCE CO Policy#or Self-ins.Lic.#: A0255555005 Expiration Date: 7/01/25 Job Site Address: 70 FERN ST NORTHAMPTON MA 01040 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. xiI do hereby certify under the pains and penalties of perjury that the information provided above is true and correct,and that clicking this checkbox and typing my name in the field below will act as my signature. Name: Date: I t2 "k Phone#: 413-322-3111 Email: ivelice@energiaus.com