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24C-035 BP-2024-0332 38 NORTH ELM ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24C-035-001 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-2024-0332 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2024 Contractor: License: Est. Cost: 3800 ENERGY PROTECTORS INC 101143 Const.Class: Exp.Date: 06/16/2024 Use Group: Owner: A. RAO,MARIA Lot Size (sq.ft.) Zoning: URB Applicant: ENERGY PROTECTORS INC Applicant Address Phone: Insurance: 64 PAXTON RD (774)253-0277 6562UB0G29826021 Spencer,MA 01562 ISSUED ON: 03/27/2024 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: 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: fi/Z Fees Paid: S65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner le 0—gRP---fricfrapro,i r .-- ...1- -er-rporm---3-7.4-4*- / ,_W 4 -- . 7-., "BUILT I'1OO The Commonwealth of Massachusetts b "7 4 I? ''-•. , i ! Board of Building Regulations and Standards FOR-,(.9 Massachusetts State Building Code,780 CMR S , MUNICIPALITY Building Permit Application To Construct,Repair,Renovate 041ernolish a ROised liar 2011 ) One-or Two-Family Dwelling • .1.1/1.::-. . , ,.: This Section For Official Use Only Building Permit Number: 1 /9- 6)54' 3.7- Date Alied: de:-.'tili--1 4,, /AZ' _ . 326-Zail Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers ' Z MX 1-1'‘ 17-1 1m C t- )- 1.1a 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: Zone: Outside Flood Zone? . . Public 0 Private 0 Check if yes0 Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Recordh tv\ Y t k IN Li 4) k) Of '1/4--Inc,on 0 huei ./+4 It' 01 Ub a 1 Name(Print) City,Sttek7.Ip..... .,. 3 N 0 i i'-'rl Elm st -2- Lt13 - totx) - 4 s ) No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(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. 0 Number of Units Other 13,Srpecify: t...)et.*.v,-ert-Ls,ty Crk Brief Description of Proposed Work': Pt .t. S t c...k , k n i%.,k c., N-c, A-4"Q— .:,-. .--t- t c-. VD a ,Lk t=k co-t-t.. 0,Nctit kk-c. A-1,e_ -eKk--e r %Lir SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only (Labor and Materials) 1.Building $ --1 b C:0 I. Building Permit Fee: $ Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ 0 Total Project Cost'(Item 6)x multiplier x 3.Plumbing S 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) $ Total All Fees:h,..) # Check Nolot 0 'Check Amount: (...6 Cash Amount: 6.Total Project Cost: S Vi..7 0 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) cs.101143 arena Joshua Dada License Number Expiration Date Name of CSL Holder List CSL Type(see below)u 64 Paxton Rd No.and Street Type Description spencer MA 01562 i Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 774-2534277 jdada79@hotmeil.COm 1 Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 172960 a/19n4 Energy Protectors Inc HIC Registration Number Expiration Date HIC Company Name or H1C Registrant Name 64 Paxton Rd jdada790hotmail.com No.and Street Email address spencer,MA 01562 774-253-0277 City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.1) 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 ril 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 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. 601 G.(,, t. "11 )-1J 1y 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 Let 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" The Commonwealth of Massachusetts Department of Industrial Accidents •1011/01_? 1-- Office of Investigations SFAII= Lafayette City Center E* 2 Avenue de Lafayette, Boston, MA 02111-1750 ,•: www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Energy Protectors Inc Address:64 Paxton Rd City/State/Zip:Spencer,MA 01562 Phone #:774-253-0277 Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 11 4. ❑ 1 am a general contractor and 1 6. New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' q Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I 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 weatheriiation employees. [No workers' 13.1f Other 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: National Liability& Fire Insurance Company Policy#or Self-ins. Lic. #:V9WC421284 Expiration Date:9/1/24 Job Site Address: fUOr `AA 2 City/State/Zip:W J' VV"`'�'"'‘") `M C l 06 cI 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$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. 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: c'°-`1 " L A- Date: '3I Phone#: 774-253-0277 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): 11:1Board of Health 20 Building Department 3❑City/Town Clerk 4.1:Electrical Inspector 5E:Plumbing Inspector 6.0Other Contact Person: Phone#: City of Northampton aysi J ' 5 Massachusetts �� '< ti ,, 1 E t 4 DEPARTMENT OF BUILDING INSPECTIONS s jy .r' r 212 Main Street • Municipal Building ' :�.. Northampton, MA 01060 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: r4ci t cl�ia5 n, v Location of Facility: 6 �{ (J X1v 4 c( sPt Cc , vh vtY6� The debris will be transported by: Name of Hauler: '`31 r91 VC. Signature of Applicant: "-AA b24/1"Lk Date: f City of Northampton Massachusetts 0., '" rr sA4 C. w "a` } jet DEPARTMENT OF' BUILDING INSPECTIONS .. 4. ,. ' d 212 Main Street • Municipal Building )ems 0�� �, N 1 �,^ ._� Northampton, MA 01060 a Property Address: L (A/,,xr"r,. efen Contractor Name: R er4c, Prd " Address: � •-t Pe_40 asa City, State: k✓,eer �t�o-- Phone: 77LtfI-Z3- 0.3-7"7 Property Owner i1 ( � Name: Par-10,.. cD Address: j< N e(,,,.- 5Z City, State: /)L,�.0.-, M 4 I, r't j Qrolreio,1 (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 signatu Date �glae_.1 A` OREP CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 8/23/2023 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: Nina Arroyo Coonan Insurance Agency, Inc. PHONE FAX 267 Main Street _1A/cj o.Exu:508-987-7122 (A/c,No):508-987-7152 Oxford MA 01540 ADDRESS: nina@coonaninsurance.com INSURER(S)AFFORDING COVERAGE NAIC S - License#,1782985 INSURER A:AIX Specialty Insurance Co INSURED ENERPRO-01 INSURER a:Safety Insurance Company Energy Protectors, Inc. 64 Paxton Road INSURER C:National Liability&Fire Insurance Company -_ Spencer MA 01562 INSURER D:Philadelphia Ins Companies i_ INSURER E:Century Insurance Company INSURER F: COVERAGES CERTIFICATE NUMBER:309612825 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. INERT TYPE OF INSURANCE tADDI BURR POLICY EFF ; D/YYYYI LIMITSCY EXP LTR INS() MD POLICY NUMBER (MM/DD/YYYY) (MM Y LIN-H714840.02 8/31/2023 1 A X CO 8/31/2024 I EACH OCCURRENCE $1,000,000 CLAIMS MADE X l OCCUR ' j DAMAGE TO RENTED- _. COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $50,000 • MED EXP(Any one person) S 5,000 1 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY PE0 I LOC PRODUCTS•COMP/OP AGG $2,000,000 OTHER' I • $ B AUTOMOBILE LIABILITY Y 6236519 12/23/2022 ' 12/23/2023 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED f,SCHEDULED j BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY ,AUTOS ONLY 1(Per accident) E X UMBRELLALIAB X OCCUR Y I CCP1166257 8/31/2023 8/31/2024 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I X RETENTIONS to fpn $ C WORKERS COMPENSATION V9WC421284 9/1/2023 9/1/2024 IX PER ! 1OTH- AND EMPLOYERS'UABILITY STATUTE ER, ANYPROPRIETOR/PARTNERIEXECUTIVE YN N/A EE.L.EACH ACCIDENT $500,000 N I OFFICER/MEMBEREXCLUDED? -- _-- "-- --- (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under _..----------._.. I DESCRIPTION OF OPERATIONS below I ; E.L.DISEASE-POLICY LIMIT $500,000 D Pollution Liability Y PPK2510236 1/6/2023 1/6/2024 Aggregate Limit 500,000 Occurence 500,000 I DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Tiffany Circle Townhouses&Phoenix Company,Inc are named as additional insureds and coverage is primary and non-contributory.The additional insured applies to ongoing and completed operations. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Tiffany Circle Townhouses ACCORDANCE WITH THE POLICY PROVISIONS. c/o Phoenix Company Inc 650 Lincoln Street AUTHORIZED REPRESENTATNE Worcester MA 01605 / :L I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD I I 1 i I 1 I I THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 BoshxyAWassachusetts 02118 Home impo L:. :j Contractor Registration r € T Corporation ' ENERGY PROTECTORS INC. �i .......� i72� 64 PAXTON RD. '1* r .... Ex{iiiatron 08/1912024 SPENCER:MA 01562 s �;a s,... 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 dale. If found return to: TYPE:Cuprua`ion Office of Consumer Affairs and Business Regulation Reg1011 tiQn 1000 Washington Street -Suite 710 172Bb1) t i i4 Boston,MA 02118 ENERGY PROTECTORS PC. s £ , . JOSHUA DADA r"#) ^ i fi4 PAXTON RD. +1 �cl- SPENCER.MA 01562 t' «'9 `;`"• `�Lwrc' { I undersecretary l4bt valid without signature 1 Commonwealth of Massachusetts at Division of Occupational Licensure Board of Building RRe9utations and Standards ConsnlgwlSvisor y� y CS-101143 * _ ,pares:06/16/2024 JOSHUA S D*DA 41 p 64 PAXTON RD _ SPENCER MA 0� )f WEATHERIZATION CONTRACT EVERS=URCE CUSTOMER PHONE DATE CLIENT# WORK ORDER Maria Rao (413) 695-9355 02/28/2024 518926 61605 SERVICE STREET BILLING STREET PROPOSED BY: 38 North Elm Street 2 38 North Elm Street 2 Jeff Ledoux SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Program Northampton, MA 01060 Northampton, MA 01060 EGMA-HES Page 1 DESCRIPTION QTY COST INCENTIVE TOTAL INCENTIVE: WHOLE BUILDING Eversource, as a Sponsor of the Mass Save program, offers a Whole Building 100%insulation incentive per unit for eligible insulation and air sealing measures. This incentive is for a non-owner occupied single-family or, all units in a 2-4 building where all eligible major insulation measures in all units are being completed at the same time. KNOB&TUBE WIRING(Northhampton) We have identified that your home might have Knob&Tube wiring ArliMPZEZEIN present.The following contract is not valid unless accompanied by the Weatherization Barrier Incentive form, signed by your licensed electrician.Work will not proceed with this work until we receive a copy of the form. HOME AIR SEALING 4 $426.36 $426.36 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.) TRANSITIONS 12 $89.76 $89.76 Provide labor and materials to air seal the transitions of your home against wasteful, excess air leakage. WEATHERSTRIP DOOR 1 $36.32 $36.32 Provide labor and materials to install Q-lon weatherstripping to door(s)to restrict air leakage. ATTIC DAMMING 74 $205.72 $205.72 Provide labor and materials to install an approved damming material in the attic ATTIC FLAT- 13"OPEN R-45 CELLULOSE 250 $665.00 $665.00 Provide labor and materials to install a 13" layer of R-45 Class I Cellulose to open attic space. SLOPE-6"DENSE R-19 CELLULOSE 152 $463.60 $463.60 Provide labor and materials to install a 6" layer of R-19 Class I Cellulose to sloped ceiling area. KNEEWALL-2"RIGID BOARD 36 $196.20 $196.20 Provide labor and materials to install rigid board at R-10 or greater with the required fire rating to a kneewall area. WEATHERIZATION CONTRACT EVERS=URCE CUSTOMER PHONE DATE CLIENT WORK ORDER Maria Rao (413) 695-9355 02/28/2024 518926 61605 SERVICE STREET BILLING STREET PROPOSED BY: 38 North Elm Street 2 38 North Elm Street 2 Jeff Ledoux SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Program Northampton, MA 01060 Northampton, MA 01060 EGMA-HES Page 2 DESCRIPTION QTY COST INCENTIVE TOTAL KNEEWALL-3" FIBERGLASS R13 36 $80.28 $80.28 Provide labor and materials to install 3.5" R-13 faced fiberglass bait insulation to the kneewalls. KNEEWALL FLOOR -8" DENSE R-25 CELLULOSE 36 $114.48 $114.48 Provide labor and materials to install an 8" layer of dense packed R- 25 Class I Cellulose to a kneewall floor. KNEEWALL FLOOR -7" OPEN R-26 CELLULOSE 36 $73.44 $73.44 Provide labor and materials to install a 7" layer of R-26 Class I Cellulose to an open kneewall floor HATCH- INSULATE RIGID BOARD 2 $107.92 $107.92 Provide labor and materials to insulate the back of an attic hatch with 2" rigid insulation board at R-10. WALLS-WOOD SHINGLE SIDED 4" 320 $896.00 $896.00 Furnish and install blown in Class I Cellulose to Wood shingle exterior walls. The butt of the upper course of your wood siding is cut to drill holes into the wall sheathing behind. The holes are then plugged and the wood siding is reinstalled using exterior grade nails. Touch-up painting, if needed, will be the customer's responsibility. 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. VENTILATION CHUTES 52 $243.36 $243.36 Provide labor and materials to install ventilation chutes in the rafter bays to maintain air flow from the soffit ventilation. WEATHERIZATION CONTRACT EVERSeURCE CUSTOMER PHONE DATE CLIENT WORK ORDER Maria Rao (413) 695-9355 02/28/2024 518926 61605 SERVICE STREET BILLING STREET PROPOSED BY: 38 North Elm Street 2 38 North Elm Street 2 Jeff Ledoux SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Program Northampton, MA 01060 Northampton, MA 01060 EGMA-HES Page 3 DESCRIPTION QTY COST INCENTIVE TOTAL VENT BATH FAN TO ROOF OR OTHER 1 $166.53 $166.53 Install an insulated exhaust hose to a flapper vent to exhaust existing bathroom fan(s). Fan will be vented through the roof or an acceptable alternative if contractor cannot vent through the roof. Total: $3,764.97 Program Incentive: $3,764.97 Client Total: $0.00 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. Jelfrty Ledetg 97Laitict, caw, RISE Representative Client Signature 02-28-2024 Printed Name Date of Acceptance 40‘k mass save Savings through energy efficiency PERMIT AUTHORIZATION FORM 1, Maria Rao owner of the property located at: (Owner's Name) 38 North Elm Street 1st and 2nd fir 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. Owner's Signature 02-28-2024 • Date FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: CAIAN � �'t 3/ ) / L `( Participating Contractor Date