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44-020 BP-2024-1650 85 OLD WILSON RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 44-020-001 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-2024-1650 PERMISSION IS HEREBY GRANTED TO: INSULATION 2024 I Alts Project# Renovations Repair 111/06/2024 Contractor: License: Est. Cost: 16622 CLEAN TECH CONSTRUCTION 106247 Const.Class: Exp.Date: 01/05/2026 Use Group: Owner: BOMBARD WILKINSON RONALD F&SANDRA Lot Size(sq.ft.) Zoning: SR/WP Applicant: CLEAN TECH CONSTRUCTION Applicant Address Phone: Insurance: 40 MESSINA DR 508-663-7847 WCC340I 05A BRAINTREE, MA 02184 ISSUED ON: 12/13/2024 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. Building Inspector Underground: Sen ice: Meter: Footings: Rough: Rough: House # Foundation: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: 17.2. Fees Paid: $125.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner 9ECEIv -, rI The Commonwealth of Massachusetts 1 2 2024 i Bard of Building Regulations and Standards FOR a " Massachusetts State Building Code, 780 CMR MUNICIPALITY �/ USE � Permit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling n This� Section For Official Use Only Building Permit Number: ' ''/t/570 Date Applied: Szrezvb- ,mot// 6 ✓ J Z•/3 4 Building Official(Print Name) Si re Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 85 Old Wilson Rd 1.1 a 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: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Ronald Wilkinson Northampton,MA,01062 Name(Print) City,State,ZIP 85 Old Wilson Rd 413-584-4711 info(a»cawards.com 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 0 Specify: Insulation Brief Description of Proposed Work2: Residential weatherization and air sealing with the Mass Save Program.No structural changes. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 16622.98 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical $ ❑Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ 2. Other Fe : $ 4. Mechanical (HNAC) $ List: 5. Mechanical (Fire $ Suppression) Total All � 16622.98 Check(b- Check Amount: ‘ Cash Amount: 6. Total Project Cost: $ 0 Paid in 11 ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 106247 09/26/2026 Arianna Davidson License Number Expiration Date Name of CSL Holder List CSL Type(see below) Insulation 38 Ells Ave No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) Weymouth,MA 02190 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 508-663-7847 cleantechconstruction48@gmail.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 212828 07/31/2026 Clean Tech Construction HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 40 Messina Dr cleantechconstruction48@gmail.com No.and Street Email address Braintree,MA 02184 508-663-7847 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 . e No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,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. ,Auau ra T7aw ae.- 12/12/2024 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 half/baths 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" City of Northampton Oµt AMf,TO\ �S ... S� Massachusetts c,�`G>> t t ;S � DEPARTMENT OF BUILDING INSPECTIONS S �' 212 Main Street • Municipal Building _ Northampton, MA 01060 sdti ;•0 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: 40 Messina Dr Braintree, MA 02184 The debris will be transported by: Name of Hauler: Clean Tech Construction Signature of Applicant: Date: 12/12/2024 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations - Lafayette City Center 2Avenue de Lafayette, Boston,MA 02111-1750 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (BusinessiOrganizationllndividual): Clean Tech Construction Address: 40 Messina Drive City/State/Zip: Braintree, MA 02184 Phone#: 508-663-7847 Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with 30 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑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. ❑ Demolition workingfor me in anycapacity. employees and have workers' 9. ❑ Building addition [No workers' comp.insurance comp. insurance. t required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152,§1(4),and we have no employees. [No workers' 13.®Other Insulation comp. insurance required.] *Any applicant that checks box#l must also fill out the section below showing their workers'compensation policy information. t 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 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: National Casualty Company Policy#or Self-ins. Lic.#: WCC340105A Expiration Date: 9/7/2025 Job Site Address: 85 Old Wilson Rd City/State/Zip: Northampton,MA,01062 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). 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 S 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 S250.00 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: 4t z trs v T'a ort- Date: 12/12/2024 Phone#: 508-663-7847 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 31JCity/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Lafayette City Center,2 Avenue de Lafayette Boston, MA 02111-1750 Tel. (617)727-4900 or 1-877-MASSAFE Revised 7-2019 Fax(617)727-7749 www.mass.gov/dia Final Invoice Client Info: Grand Total: $16,622.98 Homework,, Ronald Wilkinson 85 Old Wilson Road Northampton CAP: ABCD-LVI Contractor: HomeWorks Energy Invoice Number: CAP-23027 101 Station Landing,Suite 110 Medford MA,02145 Invoice Date: 6/10/2024 Measure Category Measure Description Qty Price per Unit Total Cost MISCELLANEOUS Attic/basement blower door guided sealing with one-part foam 1.00 105.00 105.00 DOORS Weatherstrip w/Q-lon or equivalent 5.00 76.00 380.00 DOORS Fixed Sweep triple flange 5.00 27.00 135.00 MISC INSULATION Domestic water pipe wrap 60.00 4.58 274.80 BASEMENT INSULATION Sill/mudsill seal & insulate to R-19 (TMAX) 148.0 3.96 586.08 MISCELLANEOUS Labor per hour 1.00 104.00 104.00 ATTIC VENTILATION Accu vent or durable equivalent 115.00 9.78 1124.70 MISCELLANEOUS CAZ Testing 5.00 85.00 425.00 WALL Vinyl over asbestos (dense pack) cellulose or equivalent 1340.00 4.97 6659.80 MISCELLANEOUS Attic/basement blower door guided sealing with one-part foam 5.00 105.00 525.00 MISCELLANEOUS Labor per hour 1.00 104.00 104.00 DOORS 1" or 2" THERMAX or equivalent on door 1.00 91.00 91.00 MISCELLANEOUS Labor per hour 0.50 104.00 52.00 ATTIC R-49 unrestricted - settled cellulose or equivalent 1320.0 2.83 3735.60 MISCELLANEOUS Combo Smoke/CO Detector 1.00 70.00 70.00 F'nIMAHY DOOR NEI'LACEMEN I S Replace pull-down attic stairway 1.00 540.00 540.00 MISCELLANEOUS Clothes dryer vent including Exhaust Duct 1.00 152.00 152.00 ATTIC Thermodome or Magnetic pull down stairway box kit or site built less than 3°thi 1.00 364.00 364.00 MISCELLANEOUS Continuous variable speed fan w/Controls(whole house replace existing) 1.00 1 090.00 1 090.00 Program Fee CAP Permit Fee 1.00 105.00 105.00 Measure Category Measure Description Qty Price per Unit Total Cost Authorized Signature: Date Total Owed to HWE $16,622.98 I N-46 0 Crik v\11`4 d c 0` 1( PLAN VIEW J; 3 Name: Id Wi1____• Site ID: CAP 3 t Z'' Finished Sq. Ft: Orr I S g Phone: 1 Year of House:tl ci 6 Electric Acct#: '. Address: #of Floors: ( Gas Acct#: tq,Alninfoir a,n Unit a: #Occupants: ? Housing Type? (0W-1 DUCTWORK INSP ION DaceinwatrarD (9 s ( ' kr) Duct Linear Ft. Duct Square Ft. 'N I- f 4 L1 11 J ( Duct Air Sealing Hours Duct Insulation - C/ k((Q 6 d yt//r L'Ok / Duct ( Insulation R oval 3 1 IIBASEMENT INSPECTION 6 h4} d M, ( I W Existing Spec'ing Ln/Sq.Ft. v 0. Bsmt Wall AG - Crawl Ceiling Crawl Rim Joist 5 it& d A) �,� In ej Bsmt RJw/Sill, f � i01� 1 Bsmt Ri NO Sill ' CO' t� Vapor Barrier! sqft. Bsmt Door' ))) Y N Blower Door? WALLS&GARAGE Drill Location? T•A K rr/ tirn Cell.Height Existinng Spec'ins , Sq.Ft.Exterior Walllt Y 7.�T rn3 , 7, x 4 x Balloon Vlatforr 1p Exterior Wall 2 x x Balloon/Platform x x Overhang x x Bailoon�attio m Garage Wall Garage Ceiling x x cc o i- 5 Sw P.t,� 0 U5 rrs iz \,1`,t{ I f(didrw4JU) (9 krkhAAvi- ,Ji ,i V? C * i49O) Insulation Removal . 50 Soft_ Sweeps:S WX Stripping:D WORK SPEC'D BUT NOT CONTRACTED •'AD BLOCKS PR •T?(MANDATORY) Attic Basement/Crawlspace Other: K&T 1Y/1,,Moisture 1 J/N Combustion Shy Y 44 Kneewall Overhang/Garage Asbestos Y/ Mold>100 sq.ft`Irf/N• CO Detector Missing Y/14.1 (Y Ductwork Exterior Walls Vermiculite Y/ I Structl Concerns Y Other. Notes for Lead Vendor/Work Not Contracted: V 1,31q ,,,, 414 cLnnt.t 15 11 O)a YU41 at I'•^ k C / , Scanned with CamScanner �IYVI �[y{//" �dA s.a+.�ra tfupuaA Supspt3 I. Z. 28upuaA BuuSIY3 V! !41S'y i+C••r.)--• YO,1471—�—•COl AI 14—� WWW—•tT thew*Val erb—�—•CCi no in Mena)ili - N -"'Stall 9N914J4S w /` —34i llp 44)41 /' /' SII / -Z co S fuuJwtp ♦SJN J8 141,4 ttwntdoy fuuuaA T!uwep asq!if 18 WtA+w+Aedoy fuuwn l ssazly • ssa))V x. adolS 4lfJ adolS 41aJ z •Y«.e 1 bMPK Y0111i444 P.m paloolj paioolj :i 1104.4, t«a. paioobun gt..?/,5 pa,00pun 8 bS pul,oadS pupslx3 p bS pulaadS pups! q _(fresco II "».ats)x q t spulp] ZMI11V x x Q imIsw+uf I3111V q)x9x'I. pas Mit MO' x .IOA® 1•M a N#N ®•.W M/all tuv/4.9 O NDNN r �FtN.a lOQ-0 Q...,,,one,,.„ OWM 4.4 x x H'.t PA..; 1 it (in ) S d 1 (-1)-1 " f. - ry '? (2.1 410 )0Wti (V ( cSSIV a Ir ' Svk Sad AY01110NVW 13VAY111J1 --,...____ Ilk Mill . t pQi ' x 7'll 0.) IgN1NN`>rNArlJ tNW a x x IdOS � y Y Y S/Jrdl ' r. S�/ !N' ax x, ^e TT� T` IfOU1l lltt clYy t'rN A•�-- ,,,,,,,„„.„„,,,,,,., ,,,in . 4 f J J,aas w�W ''Y.. HO -�� 0 ,��Woi GN771iYDo'vJ 011Mx y''' y f4P 3 A 7 oaj c.v `~`v "Ay •.., OF CV ' / pin, Gsit nffir ` 9sAi h Insulation/Air Sealing Permit Authorization Specialist: Jane Tekin Company: HomeWorks Energy Email: Jane.Tekin@homeworksenergy.com Address: 101 Station Landing Medford, Ma 02155 Phone: 781.305.3319 Property Owner Ronald Wilkinson Address: 85 Old Wilson Rd Email: info@cawards.com Northampton Site ID: CAP-23027 Phone: (413) 584-4711 I, the owner of the property identified above hereby authorize HomeWorks Energy Inc., or their Partner to act on my behalf in obtaining any building permit that maybe required to perform insulation and/or Weatherization work on my property and all matters related to the work authorized by said permit if one is obtained. Any related permit application cost will come at no additional charge provided that the agreed Weatherization work is completed. In the event that a permit is pulled on your home for insulation and/or weatherization work, you may be required to have a final inspection of the work scheduled and performed by the building inspector in your town. If required by the town, you will be notified by Home Works Energy that an inspection is necessary with instructions on how to complete this process to close out your permit. Email: 0 Customer � li)ddA Signature: Date: 5/28/2024 Ronald Wilkinson For Condo Owners: If you have property oversight by a condo association', please have the association's authorized person(s) complete and sign the section below. Please email this document to wxpermittinp,,@homeworksenergy.com once completed. We, being the duly authorized representatives of the association Name of association or management company or management company have reveiwed the plans and specifications for improvements to the address specified above. We further acknowledge that the above listed owner has given notice that they intend to seek permits and to carry out the proposed work. Signature of representative Date Print Name 0 ther unit owners may sign when there is no association. Commonwealth of Massachusetts Construction Supervisor Specialty ® Division of Occupational Licensure Board of '-ciulatdons and Standards Restricted to: Constrt: ,.wr pr Specialty. CSSL-IC-Insulation Contractor CSSL 106247 mires: 09/26/2026 ARIANNA J4ES DAVIDSON —� 38 ELLS AV WEYMOUTH Sin 02190 "We.hLtd:1' Failure to possess a current edition of the Massachusetts � �- State Building Code is cause for revocation of this license ����pp rJ Commissioner �Ja i tin+,L1 A. For information about this license Call(617)727-3200 or visit www.mass.govidpi THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Aflateand Business Regulation 1000 wa ingtoe Street-Suite 710 Boaon,Ma sacnusetts 02118 Home Improvement Cp intro tOr Registration " t='(11 ai 21W28 CLEAN TECH CONSTRUCTION NC ;_: �� , m*ratan 07A1/2026 aoMESSNADR BRANTREE,MA 02184 —zrzt} Srr Update Address and Refire Card. I HE COMMONWEALTH Or MASSACHUSETTS O$be of Coseweer Altars 6 Bwleea.Rep station kgotobm veld hr fed,.fuel use enN betre the HOME Y NOVEMEMLCONTkACTOR expiration dale. n bout return kl: TYPEr Etaihlani Cad 0f11oe of Conaunar Anne.and l:usueas FifIc ribbon )BUM me Waned...Am Street Suer its Z12920 07011202e Bab.MA 112116 CLEAN TECH CON£TRUCTION INC. AAUNN A DAV E4 ON 4OkemevA DR .• .Qs.•..Kp J+�`/is.o BRANTREE,MA 02104 Uncle sec,etaly Not vend without signature AC R CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 9/10/2024 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 RogersGray, A Baldwin Risk Partner PHONE FAX 410 University Ave (NC.No.Ext):800-553-1801 (ac,No):877-816-2156 Westwood MA 02090 ADDDDRREss: mail@rogersgray.com INSURER(S)AFFORDING COVERAGE NAIC U License#:PC-514062 INSURER A:Gotham Insurance Company 25569 INSURED VINCTRA-01 INSURERB:Princeton Excess&Surplus Lin 10786 Clean Tech Construction, Inc. — 40 Messina Dr. INSURERC:National Casualty Company 11991 Braintree MA 02184 INSURER D: Lloyd's of London 15642 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1197534235 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 SUER POIJCY EFF POLICY EXP LIMITS LTRINSD WVD POLICY NUMBER (MM/DDIYYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y Y GL202400024500 9/7/2024 9/7/2025 EACH OCCURRENCE $1,00.0,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $300,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GE AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X J JEta III _ j LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: — $ AUTOMOBILE UABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY _-. : AUTOS _ _- HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY ;AUTOS ONLY (Per accident) $ B X UMBRELLALIAB X OCCUR Y Y 82A3FF000479700 9/7/2024 9/7/2025 EACH OCCURRENCE $3,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $3.000,000 DED RETENTION S [ $ C WORKERS COMPENSATION Y WCC340105A i 9/7/2024 917/2025 X MUTE EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 'OFFICER'MEMBEREXCLUDED? N N/A (Mandatory in NH) E.L DISEASE-FA EMPLOYEE $1,000,000 1I yes,describe under -DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $1,000,000 o Professional/Pollution Liability AXPCTRL00282-24 9/7/2024 9/7/2025 Shared Limit 1,000,000 Aggreagete 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) When Required by Written Contract the following Applies: General Liability—Additional Insured Ongoing(CG2010 12/19)and Completed Operations(CG2037 12/19),Primary and Non-Contributory Basis(CG2001 04/13),Waiver of Subrogation(GL0229 10/13) Workers Compensation—Waiver of Subrogation(WC 00 03 13 4/84) Excess/Umbrella—(Follow form over underlying General Liability)Primary and Non-Contributory Basis(CXE 03 01 10/17) 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. Clean Tech Construction, Inc. 40 Messina Dr. AUT,IiQBJZEDREPRESENTATIVE Braintree MA 02184 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD DEBRIS DISPOSAL AFFIDAVIT In accordance with the provisions of M.G.L. c. 40, s. 54, Building Permit # was issued with the condition that all debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L c. 111, s. 150A. The debris will be disposed of in: Clean Tech Construction Name of Waste Facility Not Applicable - No Debris Address of Waste Facility 111.5 Debris: As a condition of issuing a permit for the demolition, renovation, rehabilitation or other alteration of a building or structure. M.G.L.c.40 s. 54 requires that the debris resulting therefrom shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L.c. 111 s. 150 A.Signature of the permit applicant, date and number of the building permit to be issued shall be indicated on a form provided by the Building Department and attached to the office copy of the building permit retained by the Building Department. If the debris will not be disposed of as indicated, the holder of the permit shall notify the building official, in writing, as to the location where the debris will be disposed. 780 CMR-6th Edition 444.20titd, Pao IL Signature of Permit Applicant Date