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29-087 (8) BP-2024-0094 418 RYAN RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 29-087-001 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-2024-0094 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2024 Contractor: License: Est. Cost: 8393 BRUIN REMODELING GROUP LLC 118068 Const.Class: Exp.Date: 11/12/2026 Use Group: Owner: LEPORE, TIMOTHY J.& KATE Lot Size (sq.ft.) Zoning: WSP Applicant: BRUIN REMODELING GROUP LLC Applicant Address Phone: Insurance: 208 POND ST (508)881-8200 7PJUB-6R391059UB ASHLAND, MA 01721 ISSUED ON: 01/30/2024 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATH ERI ZATION 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: /ir • >2 311 • , � Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner ' Q 2024 The Commonwealth of Massachusetts JA� 3 Board of Building Regulations and Standards FOR The State Building Code, 780 CMR MUNICIPALITY , /,. USE PE TIONS , pEPT. t ui d P4 e pplication To Construct,Repair, Renovate Or Demolish a Revised Mar 2011 NORTHAMP """`-- One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: ►2 'a2 4 l Date Applied: Z=Viti_.) /72,z f12 1- -26Z4/ Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 ronertviAddr i d 1.1 1.2 Assessors Map&Parcel Numbers `aa 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 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' rp�� 2 Ow�r1 of Record: Ot7� 00.6 ce O IJ 61 0 t.& L. Namel(Print City,State,ZIP f- V)( Iwv . f L6 -53=7-L1159 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction ❑ Existing Building Owner-Occupied 0 Repairs(s) 0 Alteration(s)t'❑ Addition J❑ Demolition 0 Accessory Bldg. 0 Number of Units Other xSpecify: Va'��Ct-�Q�it)Cx.i1. GO Brief Deescription •of Proposed Work2: •V 5 a.. t(/1c d0..17V1 I.Y\ _t- � )�,h1GW O 1 6SC� ,l-+1 Ci l SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1 393 , I I I. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ❑ Standard City/Town Application Fee 0 Total Project Cost3 (Item 6)x multiplier x 3. Plumbing $ ( 2. Other Fees: $ 4. Mechanical (HVAC) $ D List: 5. Mechanical (Fire $ Suppression Total All Fees: $ n ICheck No. _" heck Amount: Cash Amount: 6. Total Project Cost: $ t `13 , I 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Su ervisor License(CSL) CS.—I ( I 6L T ' )- 0 `/ jstocuiv, ��))(/( (�(,''1 License Number Expiration Date 7, oS Holder l f 1 List CSL Type(see below) V� Ti ,i[ I `rui,l Type Description No. d Street bleo / / �/ /�I U Unrestricted(Buildings up to 35,000 Cu.ft.) /� �J V R Restricted 1&2 Family Dwelling City own,State,ZIP M Masonry RC Roofing Covering WS Window and Siding 6n �El ` 10 _ ((: Cr 0J ,,,A'`oCovpne SF Solid Fuel Burning Appliances ► ► ` ( i} vZiJ I/ I Insulation Telephone Email address D Demolition 5 Registered H e ImprovFmFnt Contractor(HIC) T b 13 1 �1)-1.7 t((/) Yi V I ()chill HIC egistration Number E iration Date HIC Co p Name r HIC Registrant Na _,� rt, a,cl5 r Ottecc (1h W . hei— yaS!etJ d ( Q� O Email addrss Ciy/Towne 4.4 te, r of l of 1;ipho07� ne 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 AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize Uv i it / ItAA ( 6(/1 to act on my behalf,in all matters relative to work authorized by this building permit application. irJ2ri CV e. I 1 6 )4 Print Owners Name(Electronic Signature) Da 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 understan ' g. UJ1 iL �1 �v lY Print Owner's or Authorized Agent's Name(Electronic Signature) Da e 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 r•°' Massachusetts �? c * ;G DEPARTMENT OF BUILDING INSPECTIONS e 212 Main Street • Municipal Building yJyY� Northampton, MA 01060 b �',�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: /1 Qb 11 5 The debris will be transported by: Name of Hauler: ' (`' C(l1 .S Signature of Applicant: itit41 Date: The Commonwealth of Massachusetts ` I, Department of Industrial Accidents 1�_=a1 1 Congress Street, Suite 100 ,,_:N_ Boston, MA 02114-2017 ,J�4 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leaiblv Name (Business/Organization/Individual):Bruin Remodeling Group LLC Address:208 Pond St. City/State/Zip:Ashland, MA 01721 Phone#:508-881-8200 Are you an employer?Check the appropriate box: Type of project(required): I.®I am a employer with 10 employees(full and/or part-time).* 7. ew construction 2.01 am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]f 10 ❑ Building addition 4.❑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. 12.0 Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0Roof repairs 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.DOther 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. 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:AMGuard Policy#or Self-ins. Lic.#:79Jqui)UB-6R391059 UB Expiration Date:04/29/2024 Job Site Address: 41 ►�f i City/State/Zip: 6��ti1p t AJ0- Attach a copy of the workers' ensation 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. I do hereby c ify un et the pains a penalties of perjury that the information provided abov is true and correct. Signature: �� Date: 0 1ti Phone#:508-881-8200 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&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 205013'- 04/10/2024 Boston,MA 02118 BRUIN REMODELING GROUP,LLC WILLIAM DORION 7 208 POND S 01721 CL"�/a%/# • C�J,L�ieetz,” Y"ZZn-A ASHLAND,MA 01721 Undersecretary Not valid without signature Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Regulations and Standards • ConstZ uon fS rvisor CS-118068 � epires: 11/12/2026 WILLIAM FRANCIS DORION 77 HOLLY LW i r � HOLLISTON MA 01746 >1• \` # 4r�IJ,�'3:� Commissioner �'....41 BRUINRE-01 JTIERNEY ACORO` CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY) `-� 4/11 11/2/2023 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 NAME: Jewell Insurance Agency,Inc. PHONEFAX 1101 Worcester Rd (A/C,No,Eat):(508)879-1310 (A/C,No):(508)872-2764 Framingham,MA 01701 ADDAIL RESS:jtierney@newenglandins.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Norfolk& Dedham Group 23965 INSURED INSURER B:AMGuard 42390 Bruin Remodeling Group, LLC INSURER C: 208 Pond Street INSURER D: Ashland,MA 01721 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRINSR WVD, IMM/DD/YYYY1 )MM/DD/YYYY), A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PO12212513 4/29/2023 4/29/2024 DAMAGE TO RENTED 50,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ ANY AUTO 92282328A 5/4/2023 5/4/2024 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY X AUTOS BODILY INJURY(Per accident) $ X HIRED X NON-OWNED er PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY ( 1 $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE U2207879A 4/29/2023 4/29/2024 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ B WORKERS COMPENSATION PER E AND EMPLOYERS'LIABILITY STATUTE ERH ANY PROPRIETORIPARTNERIEXECUTIVE YIN 7PJUB-6R391059 UB 4/29/2023 4/29/2024 E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 it 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 Cityof Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN p ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main Street Northampton,MA 01060 AUTHORIZED REPRESENTATIVE I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD WEATHERIZATION CONTRACT EVERSURCE CUSTOMER PHONE DATE CUENTM WORK ORDER Kate Leporel (413)539-4159: 01/10/2024 557605 - 11802: SERVICE STREET BILLING STREET PROPOSED BY: 418 Ryan Road 48 Willow Street. Cole Payne❑ SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Program Florence, MA 01062 Florence, MA 01062 U EGMA-HES❑ Page I 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 8' $852.72. $852.72 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.)._ ATTIC DAMMING 30'' $83.40 $62.55 $20.85 Provide labor and materials to install an approved damming material in the attic ATTIC FLAT- 12"OPEN R-42 CELLULOSE 858 $2,196.48 $1,647.36 $549.12. Provide labor and materials to install a 12"layer of R-42 Class I Cellulose to open attic space. RECESSED LIGHT COVERS. 6: $341.34 $341.34 Install recessed light covers over existing recessed light fixtures. Up to6atno cost. . PULL-DOWN STAIR-THERMADOME: 1 $313.63. $313.63. Provide labor and materials to install an easily moved,insulating cover for the attic access folding stair. The cover has integral weather stripping to restrict air leakage. WALLS-VINYL SIDED 4 1,042_ $3,178.10 $2,383.58L $794.52E Install blown in Class I Cellulose to vinyl-sided exterior walls. Homeowner has received a copy of the EPA's Renovate Right Lead-. Safe information guide explaining the potential risk of the lead hazard exposure from the weatherization work to be performed.Your signature is your acknowledgement of receipt and agreement to proceed.. BASEMENT CEILING-6"FIBERGLASS.. 450.._ $1,197.00_ $897.75_ $299.25E Provide labor and materials to install R-19 faced fiberglass batt 0 K.L. (initials) insulation to the basement ceiling. This will be installed with the L paper backing up against the floor above.The un-papered fiberglass 0 side will be facing the basement, and these exposed fiberglass fibers L will be the visible side when standing in the basement. Your initials are your agreement and understanding of this measure Document Ref:3JHPG-RDTSY-ZHTWN-TJXFB Page 1 of 3 WEATHERIZATION CONTRACT EVERSeURCE CUSTOMER PHONE DATE CLIENT# WORK ORDER Kate Lepore (413)539-4159 01/10/2024 557605 11802 SERVICE STREET BILLING STREET PROPOSED BY: 418 Ryan Road 48 Willow Street Cole Payne SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Program Florence, MA 01062 Florence, MA 01062 EGMA-HES Page 2 DESCRIPTION QTY COST INCENTIVE TOTAL INSULATED BATH EXHAUST HOSE 4 INCH 1 $32.23 $24.17 $8.06 Provide labor and materials to install an insulated 4"exhaust hose to existing bathroom fan(s). TURBINE ROOF VENT 1 $198.21 $148.66 $49.55 Provide labor and materials to install a roof mounted turbine vent. Total: $8,393.11 Program Incentive: $6,671.76 Client Total: $1,721.35 I.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: II.PAYMENT Client agrees to pay the Contractor for the Work,the Client Share of the Contract Cost is payable to the Independent Installation Contractor(IIC)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 incentives may increase or decrease the size of the Program Incentive Share. Col Patfae kale Lepore RISE Representative Client Signature Cole Payne o1-10-2024 Printed Name Date of Acceptance Document Ref:3JHPG-RDTSY-ZHTWN-TJXFB Page 2 of 3 '_i4; ,;-'•:i♦'P •;,.•:r•...1 i�i•':OPP2 Ply ♦ i•:.'S:;:; :'•'4::;: ••"i::a•.+•.+:w:Ol 4►4+' i0O4.OPT•1���i•:Pt.'.•:•• ..j•.4'.ti•5 .• .,.'r. ape "��..: aµ,-:""..t;�. ,„�. i•:; Signature Certificate =- -�- . f� �- p; S5 ... •O.•. 'cr .,.•• _ "^; °saw: ... , • . Reference number:3JHPG-RDTSY-ZHTWN-TJXFB ,'. *.•: r 4••+, Signer Timestamp Signature +TM` .. ; ::,:; Cole Payne - :•: Email:cpayne@riseengineering.com ::•: '.••i Sent: 10 Jan 2024 18:15:19 UTC V / ?L V e :i•.' V. .:44: Signed: 10 Jan 2024 18:15:19 UTC /// Ame ,•••;• IP address:71.192.28.32 ;•�•; •i•i•' Location:Florence,United States 'i i' :•:• Kate Lepore ;4�; Email:khlepore@gmail.com ve ;;�; „,.�� Sent: 10 Jan 2024 18:15:19 UTC Kale Lepore ��•.. Viewed: 10 Jan 2024 18:17:19 UTC I �•�; '44: Signed: 10 Jan 2024 18:19:08 UTC %: ••••••• Recipient Verification: IP address:138.110.18.85 '•*.•.; '::�• :' Email verified 10 Jan 2024 18:17:19 UTC Location:South Hadley,United States .•i•: 1tt ,.ww „ ,j■fas ` . .,Mu1♦ ...i.. •f "10 Jan 2024 18:19:08 UTC 4efbarV r r` 4. • .�� '� � ' - ".imoo♦ F ✓• -K .#r -?:0^ .,� Page 1 of 1 .. , W • FP. . d - <b. •• ,iiit,L 00444R lr � „. 116 .14 +.i■? *M �"! � ue � M► 'r � •V.. �.,vogib 4 , *..i _ r144. s . 2' •:f • / . 401, --,,,,,„* PA itiez3s*, ;♦•4-PV lam. •:. .., ,}401 . . y1 %r011. , •.•: 4•.: !, •j ^+• . y d:1•"gyp° 1„ ,tti .' . ". `ram •.:. 11-14 .•••. •/ "a^ ••• . .01 ♦./" ' ".• i► Yar, :fir"► t" •.., X.: r� i".• r ♦„ ti- - �,. ma y,+ - .., .":< ,.A '�`A Ai. _iih : . 1%0 Raft. �i i'. .44 :ii ..- ,rts' .,a.■, .. .m,,, ,.4 w'" ,. 'lei' 4' ..',' dlFr - �•w..,� . "w,a." ""w - '•i:' AV .•.❖, su,416 .1k.A . 7■,.,,.0.r' 1M. ,•,� ;;�� T - "yr. "-},, ..:,.sk ..'.4111 b � �•:•. r ,, •.•••: NV Signed with PandaDoc �.: ••• • ;!4;• 0PandaDoc is a document workflow and certified eSignature :���: ��;� solution trusted by 50,000+companies worldwide. I !o- `...• ❑ moo-:,,-~ •••••, iJ :A, �^+/R7 i ."r 4. 1" a..'T '.'•'1'•'�. �' ,a0=r"'s ,ram,••,. -„*, •.•01.' ••••• •di i '44. •..• . g...4�•i4•i';';•.i i.K.k..►in.i.'•ii�i.••••••••4�••;'►•.'iii i ii•.%.•�•• i'i..•��❖.••••,i+••;;••••;;%%Z;•i i•,•;•�;�i.:;i iii:%•;•;•i':ii•10i i i i i•••i'"►••❖;$i,i i•••i•: lOtek mass save Savings through energy efficiency PERMIT AUTHORIZATION FORM 1, Kate Lepore owner of the property located at: (Owner's Name) 418 Ryan Road Florence (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. K Lepore Owner's Signature 01-10-2024 Date FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: , t1,1( 1,1 6)// icir Participating Contractor �J ate p g Document Ref:3JHPG-RDTSY-ZHTWN-TJXFB Page 1 of 1 .IOri•''-'4iri�r4iri ir�Mi•,i•X♦t•�r•♦'•*r;•iri•i•�PP;�•r 1 •,�•iri,ri•'PP1•r• ii i i'i i i'r.-•'::::. -.-:: -- - ♦ ♦ ♦• ♦♦♦••♦ ♦•0i••♦ ♦r r•Oi ♦•r r•Oriiiriii•i«sii•i aiiiriiii i•s�♦iiii iii•ii•iiiiii•%i❖i•.' '•••1�!..�! !�.!.:!ilk..�!.:..* :!.:!.�•.O!��•!.�1 � !.!.! ..:.!r!.Q ti,�!t_.b:�!.•,. >i. 4 • !e.! .!♦•. •iV •:.� b •., �?) pp. ^' ? r.... �fL.�'.- .err/... ••., :i; Signature Certificate > = - - � } :••. "° ' ;" .: ; �•�•;: Reference number:3JHPG-RDTSY-ZHTWN-TJXFB, 1 -,• .,+ ++", ..0. ..,-. 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