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37-099 (3) BP-2023-0384 55 ICE POND DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 37-099-001 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-2023-0384 PERMISSION IS HEREBY GRANTED TO: 2023 AIR SEALING/ATTIC Project# INSULATION Contractor: License: Est. Cost: 5000 EFFICIENT BUILDINGS INC 117239 Const.Class: Exp.Date: 03/15/2026 Use Group: Owner: P PARADIS JOHN A&DENISE Lot Size (sq.ft.) Zoning: SR Applicant: EFFICIENT BUILDINGS INC Applicant Address Phone: Insurance: 973 REED RD (508)279-1110 6H48605 DARTMOUTH, MA 02747 ISSUED ON: 04/03/2023 TO PERFORM THE FOLLOWING WORK: AIR SEALING/ATTIC INSULATION 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 . ),9 cikat, Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner fulc.r 2009 1 The Commonwealth of Massachusetts w • gin Board of Building Regulations and Standards FOR Massachusetts State BuildingCode, 780 CMR MUNICIPALI Y .. USE o B . ng Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 _ One-or Two-Family Dwelling 6 This Section For Official Use Only Building Permit Niunber:twig-2O2. —03s 11- Date Applied: /LL-ui , j<o,5 //7---Z 3 31-Z023 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 56 I QS CI_ DQ. 37—ecri D o i 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 5fL J.91 acres 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 Zone: Outside Flood Zone? Municipal 1p On site disposal system 0 Check if yes SECTION 2: PROPERTY IIPVNERSHIP1 2.1 nerl of Record:„ In arCiS ° he tm ma (�iGu z Name rint) ity,State,ZIP 5 1 cfi lfck Di— igi 562 G55a- ElhCivrt-btii/d!faS agny4 r'vi . No.and Street Telephone Email Addresss/ SECTION 3:DESCRIPTION OF PROPOSED WORD (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. ❑ Number of Units Other pecify:lfSu,kt OO Brief Description of Proposed Work': or sec, i r15. I 4-( (ns Ujai-ton . SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 5c c O 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All lees: $ Check NN/l 1 b Check Amountll'Lo h c oCash Amount:____1 6. Total Project Cost: 5060 0 Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) \_ C I123 31Is) V.. License umber Expiration Date Name of CSL Holder LI Q� „ .^ List CSL Type(see below) No.and Street ((�J Type Description -�p�,/ '!,, L�- ( ,!' U Unrestricted(Buildings up to 35,000 cu.ft-) tl ar,.4.t14-�,rl gu Gum-7 —_ R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering - WS Window and Siding SF Solid Fuel Burning Appliances 57)6 21c 11)0 (1 L_enfbui/d/ ('�'Ci ctY I Insulation Telephone Emai�addr D Demolition 5.2 Registered Home Improvement Contractor(HIC) 5I �IIInCRe ation Number EptDDate HIC Company Name tircieR trin Name No.and Street 973 lased Rd Email address North Dartmouth,MA 02747 City/Town,State,ZIP Telephone 1 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 UTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize j d hr) ' &_4&G'.�A 2 to act on my behalf,in all matters relative to work authorized by this building permit application. l- / fc -cL jDhn TI Gar tt e i( #col1.3 Print Owner s Name(Electronic Signature) Date SECTION 71): OWNER' OR AUTHORIZED AGENT DECLARATION By entering e below,I hereby attest under the pains and penalties of perjury that all of the information contain this app cation is true and acc to to the be f my knowledge and understanding. 3) 1co113 Print 0 er's or horized Agent's Nam lectronic Signature) to NO 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contr ctor (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 fo d 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" �t City of Northampton Massachusetts 4 lr DEPARTMENT OF BUILDING INSPECTIONSort y �_ 212 Main Street • Municipal Building bk Northampton, MA 01060 \ Property Address: 35 '\Le. Rona I� Contractor Name: Address: Efficient Buildings Ina 973 Reed Rd City, State: North Dartmouth,MA 02747 Phone: Property Owner Name: ‘ (h \ RCul i S Address: 55 1C1_ Ton D 2- City, State: � [�1-�{ tz� )3S--i • D\b 0O I, At)Inn (contractor) attest and affirm that the building I intend to insulate does not have4ny 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 11LO\22j ACO DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/14/2022 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 (A/C,No.Ext):800-553-1801 (A/c,No):877-816-2156 Westwood MA 02090 ADDRESS: mail@rogersgray.com INSURER(S)AFFORDING COVERAGE NAIC# License#:PC-514062 INSURER A:Employers Mutual Casualty Co 21415 INSURED EFFIBUI-02 INSURER B:Tokio Marine Specialty Insuran 23850 Efficient Buildings Inc. 973 Reed Road INSURERC: North Dartmouth MA 02747 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:917872189 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 EFF POLICY EXP LIMITSLTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y Y 6D48605 8/30/2022 8/30/2023 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $500,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X JECT LOC PRODUCTS-COMP/OP AGO $2,000,000 OTHER: A AUTOMOBILE LIABILITY Y Y 6Z48605 8/30/2022 8/30/2023 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED )( NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) A )( UMBRELLA LIAB X OCCUR Y 6J48605 8/30/2022 8/30/2023 EACH OCCURRENCE $4,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED X RETENTION$1f,nnn $ A WORKERS COMPENSATION Y 6H48605 8/30/2022 8/30/2023 X PER OTH-. AND 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-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 B Pollution Liability PPK2477709 10/12/2022 10/12/2023 Occurrence $1,000,000 Aggregate $2,000,000 Retention $10,000 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(CG 7174.3 1013)and Completed Operation(CG 7174.3 1013) Primary and Non-Contributory Basis(CG 7174.3 1013),Waiver of Subrogation(CG 75 55 0219) Auto Liability-Additional Insured(CA 7450 1117),Waiver of Subrogation(CA 74 50 1117) Workers Compensation-Waiver of Subrogation(WC000313 0484) Excess/Umbrella-Additional Insured follows underlying General Liability&Auto Liability(CU 00 01 04 13) Pollution-Additional Insured(PIC-EVCP-001 0722), Primary and Non-Contributory Basis(PIC-EVCP-001 0722),Waiver of Subrogation(PIC-EVCP-001 0722) Eversource is included as cited above. 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. Eversource 247 Station Drive AU ED REPRESENTATIVE Westwood MA 02090 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD WEATHERIZATION CONTRACT EVERSURCE CUSTOMER PHONE DATE CLIENT* WORN ORDER John Paradis (781) 552-9558 02/09/2023 530712 61602 SERVICE STREET BILLING STREET PROPOSED BY. 55 Ice Pond Drive 55 Ice Pond Dr Jeff Ledoux SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Program Northampton, MA 01062 Northampton, MA 01062 EGMA-HES Page 2 DESCRIPTION QTY COST INCENTIVE TOTAL VENTILATION CHUTES 54 $223.02 $167.27 $55.75 Provide labor and materials to install ventilation chutes in the rafter bays to maintain air flow from the soffit ventilation. INSULATED BATH EXHAUST HOSE 2 $56.00 $42.00 $14.00 Provide labor and materials to install an insulated 4"exhaust hose to existing bathroom fan(s). rs PREPARE YOUR HOME Homeowner is responsible for the removal of any items stored in the 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. RECESSED LIGHTS-FSC 1 $200.00 $200.00 The recessed lights in the areas weatherization work is proposed will be reviewed by a licensed electrician to determine if they are IC-rated (Insulation Contact Rated). Total: $4,380.76 Program Incentive: $3,600.37 Client Total: $780.39 1.DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the above work at the Client's Address in a professional manner and in accordance with the terms of this Contract: 11 PAYMENT Client agrees to pay the Contractor for the Work,the Client Share of the Contract Cost is payable to the Independent Installation Contractor lilt)upon satisfactory completion' of the Work.Client understands that they will not be required to pay the Program Incentive Share of the Contract cost.Changes to the individual line items and/or previous r ttiMeraiwease or decrease the size of the Program Incentive Share. ` DocuSigned by: 1)41, 9, ,)b un, Para is \R15E8ROP ka9AF1... `.Cliel t4$IIy LOSEEDD4A5... Jeffery Ledoux 2/12/2023 1 7:37 AM PST Printed Name Date of Acceptance WEATHERIZATION CONTRACT EVERS,...URCE CUSTOMER PRONE. DATE CLIENT P WORK ORDER John Paradise.__ (781) 552-9558' 02/09/2023.._ 530712'.: 61602: SERVICE STREET BILLING STREET PROPOSED BY: 55 Ice Pond Drive 55 Ice Pond Dr e Jeff Ledoux SERVICE CITY.STATE.ZIP BILLING CITY.STATE,ZIP Program Northampton, MA 01062 ri Northampton, MA 01062 = EGMA-HES._ Page - 1 DESCRIPTION- QTY COST INCENTIVE TOTAL INCENTIVE 75% For eligible weatherization measures,Eversource is offering an incentive of 75%for insulation measures and 100%for the air sealing measures, both with no limit. You are eligible to apply for the 0%Heat Loan to finance your co-pay, applications must be submitted before the weatherization work begins.'. HOME AIR SEALING 10- S943.30 $943.30 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.) EXTERIOR DOOR WEATHER STRIPPING 2 $63.62 S63.62 Provide labor and materials to install Q-Ion weatherstripping to _. door(s)to restrict air leakage.:: DOORSWEEP. 2 $52.22. S52.22 Provide labor and materials to install a doorsweep to restrict air _. leakage.__ ATTIC DAMMING 104 S254.80 $191.10 S63.70 Provide labor and materials to install an approved damming material in the attic:: ATTIC FLOOR OPEN BLOW CELLULOSE 3" 1,049 $1.521.05 S1,140.79 $380.26 Provide labor and materials to install a 3"layer of R-11 Class I Cellulose to an open attic space.. KNEEWALL-2"RIGID BOARD 96 S461.76 $346.32 $115.44 Provide labor and materials to install rigid board at R-10 or greater with the required fire rating to a kneewall area. HATCH:THERMAL BARRIER POLYISO 2 INCH (ATTIC) 2 $94.74 S71.06. S23.68 Provide labor and materials to insulate the back of an attic hatch with 2"rigid insulation board at R-10.:_ DOOR: THERMAL BARRIER POLYISO 2"(ATTIC):_ 1 $90.61. $67.96 S22.65 Provide labor and materials to insulate the back of a door with 2"rigid insulation board. BASEMENT SILLS-6" FIBERGLASS 156 S419.64 $314.73 $104.91 Provide labor and materials to install R-19 unfaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. The Commonwealth of Massachusetts 1 1, Department of Industrial Accidents Sit:e►= 1 Congress Street,Suite 100 =iTel__ Boston,MA 02114-2017 -Nowt 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): Efficient Buildings, INC Address: 973 Reed Road City/State/Zip: N. Dartmouth, MA 02747 Phone#: (508)279-1110 Are you an employer?Check the appropriate box: Type of project(required): LEI I am a employer with 15 employees(full and/or part-time).* 7 ❑ New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8 El Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 11 0 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 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs yzir additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ]3.❑ROOF repairs These sub-contractors have employees and have workers'comp.insurance.t 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 Other Insulation 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that cheeks box#1 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 andjob site information. Insurance Company Name: Employers Mutual Casualty Company Policy#or Self-ins.Lic.#:6H48605 Expiration Date:08/30/2023 Job Site Address:55 Ice Pond Dr City/State/Zip: Northampton, MA 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 crirninal 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 tc $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. I do hereby ce • nder the pains an penalties of pe 'ury that the information provided above is true and correct. Signature: //he" " -- Date: L3/14.0 I I-3 Phone#: (5 9-1110 Official use only. Do not write in this area,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#: THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration VI ;' Type: Supplement Card EFFICIENT BUILDINGS INC edistration: 206585 973 REED RD � M � E'piration: 09/27/2024 DARTMOUTH, MA 02747 k. f 7t.`� ...", j. ,170 t 1,: � AW,.. Update Address and Return Card. 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:Supplement Card Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street Suite 710 206585 09/27/2024 Boston,MA 02118 EFFICIENT BUILDINGS INC ''t JOHN LAVERTY :74 / 973 REED RD -. �� �e ,� / pp DARTMOUTH,MA 02747 Ga ��"� i 4r � � `�� •' Undersecretary Not valid without signat Commonwealth of Massachusetts �. Division of Occupational Licensure Board of Building Regqulations and Standards c�7-I 7: COI1St liA S vVlSCr _ J CS-117239 rIcpires:03/15/2026 .OHN LAVEk-TY 110 FRANCS AVE SHREWSBURY MA 0 4 .t)I.tvcT10�0` • Commissioner dial fi &n THE COMMONWEALTH OF MASSACHUSET T S Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 -tame In-i proverment Contractor Registration • SO Type: Out of State Corporation EFFICIENT BUILDINGS INC 1 Regtstrauon: 206585 973 REED RD Expiration: 09/27/2024 DARTMOUTH,MA 02747 Update Address and Return Card. m� THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEME T CONTRACTOR expiration date. If found return to: TYPE Out of State Corporation Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 206585- . 09/27/2024 Boston,MA 02118 EFFICIENT BUILDINGS INC ----Docueicinea by JIM REARDON �A,yyLs ! `4tolA, 973 REED RD ----a szczzsss Fnso... DARTMOUTH MA 02747 /.�✓' lj° _ Undersecretary Not valid without signature uocuJign tnveiope iu:t-A1-1-U4u143VU -4ttfu-tii1A-tW241:3U/1:SF`J mass save PERMIT AUTHORIZATION FORM 1, John Paradis owner of the property located at: (Owner's Name) 55 Ice Pond Drive 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. rDocuSigned by: par diS llvOfigtE Bgffri`'�ture 2/12/2023 17:37 AM PST Date FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: �7 C' Buimlljj //IC . 6/API L6 Participating Contractor Date City of Northampton ��µi SS .�. Sp Massachusetts C_ '...ee rye y delt\ DEPARTMENT OF BUILDING INSPECTIONS D{ , DC t , ' 212 Main Street • Municipal Building yJti f.., , •..... , Northampton, MA 01060 ♦1 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: _ (113 2_QQ_d_ The debris will be transported by: Name of Hauler: pl,Lb)k(' , S er V\C,QS Signature of Applicant: Date: 6i i p h2-3