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23A-247 (4) 31 MANN TER BP-2021-0968 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23A-247 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit# BP-2021-0968 Project# JS-2021-001664 Est.Cost: $3036.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: AMERICAN INSTALLATIONS LLC 175982 Lot Size(sq. ft.): 7666.56 Owner: VIZENTIN ELIZABETH Zoning: URB(100)/ Applicant: AMERICAN INSTALLATIONS LLC AT: 31 MANN TER Applicant Address: Phone: Insnrnnce: 130 COLLEGE ST #100 (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON:3/8/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:ATTIC AND BASEMENT INSULATION AND AIR SEALING THROUGHOUT 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department 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. 0 • • >2 - Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 3/8/20210:00:00 $65.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner rii a bill v z ,p Depi _ City of Northampton ,5 J ��< Mom' \ .,,5'4 'PY'� ,^'y+t . Building Department FAR :',--'4 ' 212 Main Street INSULATION „ f ', Room 100 "" Northampton, MA 01060Y A "` *' phone 413-587-1240 Fax 413-587-1272 M :ko e h QfJf_, UIW .,::,,v,s,,,„„.„:„. N AfPLIGA , N FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INSULATION PERMIT This section to be completed by office 1.1 Property Address: Map 31 Lot 2 `� Unit 31 M omn TT.✓I Zone Li is S Overlay District Flot2er\e_ e., MH O tOto Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: //'Za Vien><,v) 31 PJa nn TR P/oReniee o/o 6� Name(Print) Current Mailing Address: 1 See attached '7J3--9a 3— 8U2 Telephone Signature 2.2 Authorized Aaent American Installations 130 College Street Ste. 100, South Hadley, MA 01075 Name Print) Current Mailing Address: .J (413) 552-0200 Si n ure Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 3 D 3 /O (a) Building Permit Fee 2. Electrical / (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee v� 4. Mechanical(HVAC) 5 5- Fire Protection 6. Total=(1 +2+3+4+5) 3 03 (2 Check Number 73 g This Section For Official Use Only Building Permit Number: 6P-2O21—OyG 2 Date Issued: 7/ -.2 Signature: 3. 8.70z , Building Commissioner/Inspector of Buildings Date permits@AmericanInstallations.com @ EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: Wesley K. Couture 106178 License Number 130 College Street Ste. 100, South Hadley MA 01075 9/29/2021 Address / � � Expiration Date 4:r (413)552-0200 atur Telephone 9,Registered Home Improvement Contractor: Not Applicable 0 American Installations 175982 Company Name Registration Number 130 College Street Ste. 100, South Hadley MA 01075 6/26/2021 AddressdrZ Expiration Date Telephone (413) 552-0200 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 .V No 0 Brief Description of Proposed Work NOTE: INSULATION ONL Y Attic and basement insulation and air sealing throughout. 1, American Installations - Wesley Couture , 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. Wesley K. Couture Print Name 9fgnature of 0 r/Agent Date I, ! i e- !i/ /l Zen 11 , as Owner of the subject property hereby authorize American Installations to act on my behalf, in all matters relative to work authorized by this building permit application. See attached 1 -3l -aoa.O Signature of Owner Date City of Northampton �t�� TMM1MYrp\ SAS ...Ss Massachusetts •' ' .e !mac * ;G tY t DEPARTMENT OF BUILDING INSPECTIONS • • 212 Main Street • Municipal Building cb Northampton, MA 01060 W_IFPo AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation,repair, modernization, conversion, improvement,removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: Insulation Est.Cost 3 U 3o ----- Address of Work: 31 Mann ie, F I ra$et1C� Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): _Job under$1,000.00 Owner obtaining own permit(explain): Building not owner-occupied x Other(specify): Contractor pulling permit for homeowner OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: 3 -1_al American Installations 175982 Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton „s r Massachusetts A?? •`C .u. 4 1 t4 DEPARTMENT OF BUILDING INSPECTIONS ;'1. ti•;w 49 212 Main Street •Muncipal Building a✓ Northampton, MA 01060 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: 31 " an Te KR ace_._ (Please print house number and street name) Is to be disposed of at: K er, W Materials &Recycling, 138 Palmer Ave, West Springfield, MA 01089 (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Signature of P rmit 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. KHAM_ City of Northampton :,, Massachusetts �� .G. t 4 e: DEPARTMENT OF BUILDING INSPECTIONS ti: �> 212 Main Stra®t • Municipal Building ���• �b s Northampton, MA 01060 �dh • % MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 31 M a h h �CRgac_C'., ijogen ex / Contractor / l}LJ O Name: American Installations �7 � Address: 130 College Street Ste. 100 City, State: South Hadley MA Phone: (413)552-0200 Property Owner c�' // Name: !�/JZA/. f Zer h f Address: 31 fria h el Tele— City, State: )40 ie:en Os 1144 D/D La-c 1, Wesley K. Couture (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 __4 The Commonwealth of Massachusetts . h Department of Industrial Accidents • a gig 1 Congress Street,Suite 100 \ i 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 Please Print Legibly Name (Business/Organization/Individual): American Installations, LLC Address: 130 College Street, Suite 100 City/State/Zip: South Hadley, MA 01075 Phone#: 413-552-0200 Are you an employer?Check the appropriate box: Type of project(required): t.®t am a employer with 41 employees(full and/or part-time).* 7. ❑New construction 2.0 I airs a sole proprietor or partnership and have no employees working for me in 8. El Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.Q i am a homeowner doing all work myself.[No workers'comp.insurance required.]' 10 Q 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. Electrical repairs or additions proprietors with no employees. 12.El Plumbing repairs or additions 5.EI I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repass These sub-contractors have employees and have workers'comp.insurance.: 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.©Other Insulation 152,§I(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. 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 ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Berkshire Hathaway GUARD Insurance Policy#or Self-ins.Lic11.#: AMWC187717 Expiration Date; 09/04/2021 Job Site Address: 3 V 4/ a 1 i City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). D1 6 X 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. l do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: 9. C. Date: 3 - I ^ I Phone#: 413-552-0200 Official use only. Do not write in this urea,to be completed by city or town official. City or Town: Permit/License# 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#: r Commonwealth of Massachusetts Construction Supervisor ` Division of Professional Licensure Unrestricted -Buildings of any use group which contain Board of Building Regulations and Standards less than 35,000 cubic feet (991 cubic meters) of enclosed ConstruCtiorf Supervisor space. CS-106178 9 2C . WESLEY COUTURE • 139 PACKARDVILLE ROAD PELHAM MA 01002 I Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Corn missioner 7(�ieac — - For information about this license / Call (617) 727-3200 or visit www.mass.gov/dpl ��2t/J�/Mizt o-Cl'-4l• !J'/�AaJo arC/li!Gr 4- Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC Registration: 175982 AMERICAN INSTALLATIONS,LLC. Expiration: 06/26/2021 130 COLLEGE STREET SUITE 100 SOUTH HADLEY,MA 01075 Update Address and Return Card. SCA 1 8 20M-05/17 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 175982 06/26/2021 1000 Washington Street -Suite 710 AMERICAN INSTALLATIONS,LLC. Boston,MA 02118 WESLEY COUTURE 2 l F k 130 COLLEGE STREET SUITE 100 -9•,,.r,al&L•/ ' SOUTH HADLEY,MA 01075 Undersecretary (+ bt valid without signature AC o® CERTIFICATE OF LIABILITY INSURANCE DATE(MM DD WYY) ‘.......-/ 09/21/2020 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 Linda Eichstaedt,CRIS NAME: Webber&Grinnell PHONE (413)586-0111 FAX (413)586-6481 (A/C,No,Ext): (A/C,No): 8 North King Street E-MAIL leichstaedt©webberandgrinnell.corn ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC C Northampton MA 01060 INSURER A: Employers Mutual Casualty Company 21415 INSURED INSURER B: American Installations,LLC INSURER C: AMGUARD//BHGUARD 14702 Attn:Wes&Suzanne Couture INSURER D 130 College Street,Suite 100 INSURER E: South Hadley MA 01075 INSURER F: COVERAGES CERTIFICATE NUMBER: Master Exp 9-2021 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 UBR POLICY NUMBER POLICY EFF POLICY EXP LTR INSD WVD (MM/DD/YYYY) (MMIDD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $DAMAGE TO RENTED 1,000,000 X CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 A 5D3535219 09/04/2020 09/04/2021 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER- GENERAL AGGREGATE $ 2,000,000 JEa LOC PRODUCTS-COMP/OPAGG $ 2,000,000 X POLICY OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A - OWNED SCHEDULED 5Z35352 09/04/2020 09/04/2021 BODILY INJURY(Per accident) $ __ AUTOS ONLY /� AUTOS X HIRED �/ NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY X AUTOS ONLY (Per accident) X coll$2K X comp$2K PIP-Basic $ 8,000 X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1,000,000 A - EXCESS LIAB —^ CLAIMS-MADE 5J3535220 09/04/2020 09/04/2021 AGGREGATE $ 1,000,000 DED X RETENTION $ 10,000 $ WORKERS COMPENSATION X MUTE EMPLOYERS'LIABILITY STATUTE ER Y/N 500,000 C ANYCER/MEMBRlPARTNER/EXECUTIVE Y NIA AMWC 187717 09/04/2020 09/04/2021 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 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 THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD mass save :;tensed 8 ensured PARTNER Page 1 of 2 MA CSI M:206278 � MARegsrtranona275982 American Installations www.Americanlnstallations.com 130 College Street Suite 100,South Nader,MA 01075•Office:(413)552-0200 Fax:(413)552-0202•Email supporteAmericanlrrstallations.com Customer Name:Elizabeth Vizentin Email:Not provided Phone:413-923-2809 Premise Address: 31 Mann Terrace, Florence, MA 01062 Mailing Address:31 Mann Terrace, Florence, MA 01062 Project ID:3919151 Date:Oct.27,2019 Job Description Measure Description Location Quantity Unit Total Cost Customer Cost Air Sealing at Estimated 62.5 CFM50 Per Hour 4 hr $370.32 $0.00 Door Sweep(with AS hrs) 4 each $101.24 $0.00 Exterior Door Weather Stripping (with AS hrs) 4 each $120.28 $0.00 Cut and Finish Access Living Space 1 each $124.53 $31.13 Kneewall Slope-6" Fiberglass Batting Living Space 204 SF $434.52 $108.63 Kneewall Slope-2"Thermal Barrier Polyiso Living Space 204 SF $975.12 $243.78 Kneewall Wall -3" Fiberglass Batting Living Space 136 SF $259.76 $64.94 Kneewall Walt -2"Thermal Barrier Polyiso Living Space 136 SF $650.08 $162.52 Project Total $3,035.85 WARRANTY:American installations,LLC will provide the above stated homeowner with a 1-year workmanship warranty. American installations,LLC hereby proposes to furnish all material and labor to complete the above scope of work in accordance with the above specifications and all local and state building regulations for the Total Contract Value as stated herein. ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are TOTAL CONTRACT VALUE= 5 satisfactory and are hereby accepted.You are authorized to do work as specified.Payment Down Payment=5_ will he 1/3 down prior to start of work,and balance due upon Completion. PAID Balance Due Upon Completion- 5 Signature Date Property Owner(Print) (Sign) Date Representative:(Print) (Sign) Date 1M1S AGRRMEN,IS COMPOSE)OF 1 WS PAGE AND 1HE REVERSE SIDE CP 1FRS PAGE AND SHALL BE EON LOUSED 1,1E MINE AGREEMENT Cr'ME PM11a INVOLVED'MS AGREEMDII IS BETWEEN AMERICAN iNSTALUTONS,LAC HEREINAFTER REFERRED TO AS*COMPANY, ARCM!W STOMERIS)CAMEO MOVE,,IEREMAFI ER RDERR1O 10 AS'CHEW.AND WE BE SLMIECI TDALL APPRDPRNTE LAWS,REGUTAIIONS.410 MCSHANE'S Of 711E S lA ft OF MASSAD1t5E11S OR CONNECT ICUs RESPECT MO.AS WILL AS ALL LOCAL IU RISC/CIIONS mass save °t. .;tensed&insured MACSE a.206178 \ PARTNER Page 2 of 2 MA Regrstrarron a l/5g8? AmericanEla Installations www.Amertcanlnstallations.corn 130 College Street Suite 100,South Hidey,MA 01075•Office:(413)552-0200 Fex;(413)552.0202•Emaik support4PAmericanlnstallations.com Customer Name:Elizabeth Vizentin Email:Not provided Phone:413-923-2809 Premise Address:31 Mann Terrace, Florence,MA 01062 Mailing Address:31 Mann Terrace, Florence, MA 01062 Project ID:3919151 Date:Oct.27,2019 Weatherization incentive ($1,833.01) Air sealing incentive ($591.84) Total Program Incentive -$2,424.85 Customer Total $611.00 WARRANTY:American Installations,LLC will provide the above stated homeowner with a 1-year workmanship warranty. American tnstallations,LLC hereby proposes to furnish all material and labor to complete the above scope of work in accordance with the above specifications and all local and state building regulations for the Total Contract Value as stated herein. ACCEPTANCE Or PROPOSAL: The above prices, specifications and conditions are TOTAL CONTRACT VALUE= S satisfactory and are hereby accepted.you are authorized to do work as specified.Payment Down Payment-5 200 xi 12/30/2020 will he 1/3 down prior to start of work,and balance due upon Completion. Paw Balance Due.1pon Completion.S 411 et • reth vizentin(Dec 31,2020 15:14 EST) Signature Date Property Owner(Print) (Sign} Date Representative:(Print) (Sign)___ _ Date TMK AGREEMENTi5COMPOSED Cr TINS PAGE AND THE%KASE SATE ce TINS PAGE•Ns SNAtt RE CONSIDERED THE ENTRE AGREEMENT!Pr THE PARTIES INvo.tE0'MIS AGREEMENT I5$ETWEEN AMERICANINST ALLA TONS LLC MERE IN Ar TER REFERRED TO AS tomwo•, Anon*Wsroszrl SI NAMED ABOVE_NE WRAF TER REFERRED TO AS IENr.ANo con S.Ia1ECT TO ALL APPROPRNTE t ANS,REDOLAT:ONSwrD OADINANCESCM THE STA R Of MASSAWtNFTTS OR COPAL f,LOT RESPEC TN2t5'.AS WELL A5 ALL LOCAL NRISD:CUM