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22B-012 (8) BP-2024-0939 61 MEADOW ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 22B-012-001 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-2024-0939 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2024 Contractor: License: Est. Cost: 3184 BRUIN REMODELING GROUP LLC 118068 Const.Class: Exp.Date: 11/12/2026 Use Group: Owner: A RYAN WILLIAM MICHAEL&JUDITH Lot Size (sq.ft.) Zoning: URA/URB/WP Applicant: BRUIN REMODELING GROUP LLC Applicant Address Phone: Insurance: 208 POND ST (508)881-8200 6S62UB-6R36105-9-24 ASHLAND, MA 01721 ISSUED ON: 07/30/2024 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. "..7Signature: /Ir Fees Paid: $75.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Buitdina Commissioner QED /1330I Luc The Commonwealth of Massachusett 2 3 Oeg Board of Building Regulations and Sta rdsr' Pr of OR M Massachusetts State Building Code, 780 CMR—Iv°r?rHAL o!Nr, IPA ITY ok,44 Ecriory SE Building Permit Application To Construct,Repair,Renovate Or Demolis a ' ised M 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: g]D"-e�. - (3 4- f Date Applied: Ae l jZ75 //& i- - Zy Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Pf operAty�Address:l �� 1.2 Assessors Map&Parcel Numbers /� _ i-- 1 1.1 a Is this an accepted street?yes x 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' 2.1 wn r'of ord• J u Kyc�► r(o oefi ma oar Z Name(Print) City,State,ZIP (Qf f adaO 64- PI I go)(,6---r 33 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 Ipr Specify: VW cortiit.- t/24-t-hCV Brief,Description of Proposed Work2: le.(" U Qom(,(,(,(( (/ii ` 7 L.,I -r-1 9 t a SC i1n 1066e IN) de.I 1,1, SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 3 14'� O 1 1. Building Permit Fee:$ Indicate how fee is determined: D 6 ❑Standard City/Town Application Fee 2.Electrical $ 0 Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ 4 2. Other Fees: $ 4. Mechanical (HVAC) $ 0 List: 5. Mechanical (Fire Suppression) $ C Total All Fees:40' Check No. \6 Check Amount: Cash Amount: 6.Total Project Cost: $ 3 I q. UI 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) (13 — (I(O(�D(% I I I v{ f' ( ( I (CLA/1 DO V( C V) License Number Expir tion ante� N Name of CSL Hggqlder q n 7 (I c l List CSL Type(see below) V( No.avid Street a C(��\ 46' Type Description I J'q (1 {,� /Q 0 !7 c( U Unrestricted(Buildings up to 35,000 Cu.ft.) J l( /vl fT 1 ( { R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding 'IX X (()tW1id2kCtSF Sod Fuel Burning Appliances V(� `('�1.FI(L)C' I Insulation Telephone Email address D Demolition Registered :me Improvement Cont ctor(HIC) -0)'3 16iN O ( � HIC Registration umber 4/42-__ a Date HIC Compa ame HI egistrante ` d off- ,v,cibuu 4(16� . y f No. l 1 e ^ f/� 7)4 5,�)/� ,) Email address 1 ��-�'►Gf/ /"l� 1 a Cif � ��2a 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 No .0 SECTION 7a:OWNER A THORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT • I,as Owner of the subject property,hereby authorize .I) I I ( (C�V- `I/6l, 1 v 0 to act on my behalf,in all matters relative to work authorized by this building permit application. J(kc{LIPrint wner's Ne(Electronic Sr! ign�re) DSte 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. �, Ut) 1 ( I (Cc (M/1 17cvtOV1 -7/17� / ° `t 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 thc 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 .' •' Massachusetts �d�S' k ._ �t , �G i �";y{ DEPARTMENT OF BUILDING INSPECTIONS yi �� S 212 Main Street • Municipal Building i . Zs; 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: Location of Facility: ill 0 C..WO 11 S The debris will be transported by: Name of Hauler: 6l 0 i Fes. kJ L"i S Signature of Applicant: 6164 d ,..,__ , I )Date: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ==�1_ Lafayette City Center �� 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):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 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑ w construction 2.El 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' j 9. El Building addition [No workers' comp. insurance comp. insurance. 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 1 LEI 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' 13.0 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 arc 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. #:6S62UB-6R39105-9-24 Expiration Date:4/29/2025 ! f VJ Job Site Address: IQ( ��w6 , � { City/State/Zip: Iôtt'we�„ 00 2_ / 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 abov is true an correct. Signature: 11,/,0. Ql.(/t^. JI Date: 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(check one): 11:1Board of Health 21:1 Building Department 3ElCity/Town Clerk 4.0 Electrical Inspector 51:i'lumbing Inspector 6.0Other Contact Person: Phone#: THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affair and Business Regulation 1000 Washing tre t- Suite 710 Boston-Massachusetts=02118 Home Im sovemen - rac or=Registration ,. „zi .. 6: ,/ `V; Type: Supplement Card -v! isttiiation: 205013 BRUIN REMODELING GROUP,LLC "'i 208 POND ST E Cation: 04/10/2026 =�� ASHLAND,MA 01721 L., J A ._......• J�i ti��.!,.., ., _ 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 date. If found return to: TYP.E_Supbtotneht_Card Office of Consumer Affairs and Business Regulation RegistratiaR-+ '-FXfiiratlor 1000 Washington Street •Suite 710 205R13" = ;04L10/2,028 Boston,MA 02118 BRUIN REMODELING4.401 it LC�= t -H_ __ 1_1 WILLIAMOOR(ON 11- iif =?!f`+r Ic,, 208 POND ST •, - : . ' J�. 41—/,eecez-r.,\ 2 ,C2,--,,,, ASHLAND,MA 01721 _- ;;•` r• Undersecretary Not valid without signature Commonwealth of Massachusetts At Division of Occupational Licensure Board of Building Regulations and Standards Constx ?tlonis $ervisor _ •1 CS-118068 empires: 11/12/2026 WILLIAM FRANCIS DORION 77 HOLLY LN% — ,1 HOLLISTON MA 01746 ti =.. Commissioner 1...i �'.•...,.,.._- 1 __---..1111 BRUINRE-01 JTIERNEY ACORO DATE(MM/DDIYYYY) ki..----- CERTIFICATE OF LIABILITY INSURANCE 4/22/2024 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(les)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 i CONTACT NAME. Jewell Insurance Agency,Inc. PHONE FAX 1101 Worcester Rd (A/C,.�,�q�No,Eat):(508)879-1310 (ac,No):(508)872-2764 Framingham,MA 01701 F�DRE58:jtierney Dcnewenglandins.com INSURER(S)AFFORDING COVERAGE NAIC C INSURER A:Norfolk&Dedham Group 23965 _, INSURED INSURER B:Ace American Insurance Company 22667 Bruin Remodeling Group, LLC INSURERC: 208 Pond Street INSURER 0: 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 WTH 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 POUCY NUMBER POUCY EFF POUCY EXP UMITS LTR ,INSD,WYDlMM/DD/YYYYI IMM/DD/YYYYl A X COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR P012212513 4/29/2024 4/29/2025 DAMAGE TD RENTED 50,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEL AGGREGATE LIMITAPPLIES PER. GENERAL AGGREGATE $ 2,000,000 X POLICY 12ef LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER' $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ ANY AUTO 92282328A 5/4/2024 5/4/2025 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOSE� ONLY X AUTO{SyyN ID INJURY(Per acodenij $ x AURTOS ONLY x AIOJTNOS ONLY PROPERTY (Per dnt $ $ A X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS UAB ~-CLAIMS-MADE U2207879A 4/29/2024 4/29/2025 AGGREGATE $ 1,000,000 DED X RETENTIONS 10,000 $ B WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER 6S62UB-6R39105-9-24 4/29/2024 4/29/2025 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEM.ER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 II yes.describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Rernarks Schedule,may be attached If more apace Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN tY P ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main Street Northampton,MA 01060 AUUUT�`H'0ORIZZED REPRESENTATIVE U ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD WEATHERIZATION CONTRACT EVERSeURCE CUSTOMER PHONE GATE CLIENT• WORK OROQ Judy Ryan (413)265-0033-1 07/09/2024 422153 - 118127 SERVICE STREET BAILING STREET PROPOSED BY: 61 Meadow Street Fl 1 61 Meadow Street Cole Payne SERVICE CITY,STATE.ZIP Bt..UP O CITY.STATE,ZIP Program Florence, MA 01062 Northampton, MA 01062 i EGMA-HES PageO 10 DESCRIPTION QTY❑ COST. INCENTIVE TOTALD INCENTIVE 75%:. For eligible weatherization measures, Eversource is offering an incentive of 75%for insulation measures and 100%for the air sealing iJ measures, both with no limit. You are eligible to apply for the 0%Heat 'J Loan to finance your co-pay, applications must be submitted before .7 the weatherization work begins. KNOB&TUBE WIRING SIGN-OFF-FSC The wiring in the areas weatherization work is proposed will be reviewed by a licensed electrician to determine if there is any existing live knob&tube wiring. ATTIC DAMMING 15' $41.70 531.28 $10.42 Provide labor and materials to install an approved damming material in the attic ATTIC FLAT-8"OPEN R-30 CELLULOSE 455 $978.25 $733.69 S244.56 Provide labor and materials to install an 8"layer of R-30 Class I Cellulose to open attic space. BASEMENT CEILING-6"FIBERGLASS 447 $1,189.02 S891.77 $297.25. Provide labor and materials to install R-19 faced fiberglass batt 1- J.Q. (Initials) insulation to the basement ceiling. This will be installed with the • paper backing up against the floor above.The un-papered fiberglass J side will be facing the basement, and these exposed fiberglass fibers will be the visible side when standing in the basement. Your initials are your agreement and understanding of this measure Document Rot:KEDWW-F44TA-8F3SR-WK6GP Page 1 of 3 WEATHERIZATION CONTRACT EVERSURCE u ;cw a :� .f aft5ca ,. rr m4 N r F t�S ° . .f .. ..- .n*.. -� -., .., :I :..0 .. ; '.�• �' �_ ,ems L ,��:L�.�. -...,'-"..� :�:. ' CUSTOMER PHONE DATE CLIENT• WORK ORDER Judy Ryan (413)265-0033 07/09/2024 422153 11812 SERVICE STREET BILLING STREET PROPOSED BY 61 Meadow Street Fl 1 61 Meadow Street Cole Payne SERVICE CRY,STATE,ZIP BILLING CITY,STATE,ZIP Program Florence, MA 01062 Northampton, MA 01062 EGMA-HES Page 2 DESCRIPTION QTY COST INCENTIVE TOTAL CRAWLSPACE CEILING-6"FIBERGLASS 352 $975.04 $731.28 $243.76 Provide labor and materials to install R-19 faced fiberglass batt J.R. (initials) insulation to the open crawlspace ceiling.This will be installed with the paper backing up against the floor above.The un-papered fiberglass side will be facing the basement, and these exposed fiberglass fibers will be the visible side when standing in the basement. Your initials are your agreement and understanding of this measure Total: $3,184.01 Program Incentive: $2,388.02 Client Total: $795.99 1.DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the above work at the Client's Address in a professional manner and in accordance with the terms of this Contract: II.PAYMENT Client agrees to pay the Contractor for the Work,the Client Share of the Contract Cost is payable to the Independent Installation Contractor(IIC)upon satisfactory completion of the Work.Client understands that they will not be required to pay the Program Incentive Share of the Contract cost.Changes to the individual line items and/or previous incentives may increase or decrease the size of the Program incentive Share. Code Pace Judy R you RISE Representative Client Signature Cole Payne 07-10-2024 Printed Name Date of Acceptance Document Ref:KEDWW-F44TA-8F3SR-WK6GP Page 2 of 3 ;i.41i••.••.4y•.iR••'e$ ♦•:iliiiii• i....•.•.•• yi.:z.••••..•.••• ;'i ii iiii 0i iiiii'. Signature Certificate `4: AN .••: Reference number:KEDWW-F44TA-8F3SR-WK6GP :❖: :••••' ;•••• ••. •• :.• :�, Signer Timeatamp Signature . .. — -- • OA' Cole Payne I :;} •: Email:cpaync@riseengineering.com ►•i•: •;•�.; Sent, 09 Jul 2024 18:15:08 UTC Co-le j ayv,�/ 4 . Signed 09 Jul 2024 18:15:08 UTC Pii: %•; IP address:73.17.139.199 •:•�6; •••• • Location:Florence,United States �••••;, v:: Judy Ryan :: : ..•p: Email:judyryanhta@hotmail.com • �••,� Sent: 09 Jul 2024 18:15:08 UTC n ••••� „.�; Viewed: 09 Jul 2024 18:16:27 UTC ��/� K�Qu :�%i} .'.' Signed: 10 Jul 2024 18:57:14 UTC ���JJJ�I���///fff t\ ••%�•�• 411,6, I •.•• •iib ...... •;•; Recipient Verification: ____. ._ y; %i 'Email verified 09 Jul 2024 18:16:27 UTC IP address:174.192.16.141 %%: Vet •;%% Document completed by all parties on. :•:•" :••y.•% 10 Jul 2024 18:57:14 UTC 4: .•i i • • ::.%.. Page 1 of 1 we .•••: ••i•;• 411.4, Via .•.••• •••••' �•••. ••••••• 441. •.:. .•••. p•:; Signed with PandaDoc CI ;: mo.•:••. PandaDoc is a document workflow and certified eSignature r• .+' et :••.••• ;::: 0: solution trusted by 50,000+companies worldwide. 1 CI Tp— �•••. ••ii4 ;%�ii�:•:•i ii��ii:;lii� ♦••♦ •••...:i�:::.;i:.•:ii'iiii'i••Y..•iti'i :i•-••iii'.'i•i•�i;••iii :i:••-..•• ,.�•••••••••••••.••••••••••••••!i••••!•!••••!•!:b!•!•!:!•!•!:•ram!:!:!4,,!.•••••40 i•:i.16 ,•••!::!•!•!•!•!:!•!:!ww•••••::!:�i!..4..•�••••••••.•.•.•.......%.i!•i!.:..�.."...., mass save tvo.a;h c n cl>'e;f c,_y PERMIT AUTHORIZATION FORM 1, Judy Ryan owner of the property located at: (Owner's Name) 61 Meadow Street 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. t71.0(9 R you Owner's Signature 07-10-2024 Date FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: etimAttitx bt,90 II Participating Contractor Date Document Ref:KEDWW-F44TA-BF3SR-WK6GP Paps 1 of 1 !•• : i i i;11:i:❖:;:;*. J�.;::❖::;:*;*•:•:•:•::;: ..i i•�i:•:•::;: i i i i�t;:;:;.;:.; 2•?.�li-:!•vee!•!•!t1.tt-!-!4!:•:!vt:tt!�t.!!•..44'.., ?� Signature Certificate ••• Reference number:KEDWW-F44TA-8F3SR-WK6GP :;: •� Signer Tlmestamp Signature :. •. ' -- - — .' .. �:11:} Judy Ryan ••.••�•i, Email:judyryanhta@hotmail.com *i. Sri• Sent: 09 Jul 2024 18:15:08 UTC 7 �] ti to •• • Viewed: 09 Jul 2024 18:16:27 UTC , /1/ K qaa .:44 � ,0 Signed: 10 Jul 2024 18:57:14 UTC �/ •/1 ,` ••�•• ❖•S Recipient Verification: ;•••••• Am *: Email verified 09 Jul 2024 18:16:27 UTC IP address:174.192.16.141 • ••: '••O :0-•' Document completed by all parties on: OS •'••••• 10 Jul 2024 18:57:14 UTC •••••,, ••A� 4,... •••i• Page 1 of 1 ;•:•; ..•. .• 6• J4••: :N.: ... ❖••, ,••: �: • ;•••;. • ..... !•..., i'•: •. ••. ..�•., :•••i 1. ••••i dOi! v••i ••• :0 ,., ♦•, ��.. wv .•••... .p•.. 0, ,.•.•. ri ,..•� :O•••; •••••• • 04 W. Signed with PandaDoc ;Q'• •..v. PandaDoc is a document workflow and certified eSignature ,.' ,:....titOi: •:•• solution trusted by 50,000+companies worldwide. ❑I 'D— �•�$ ri'i': '•••i •.. :;•: ,...ii • r••�,•.;7:i4 i:-ii i: ii i ii i is : ii0 iii i P:i ii ii i is i s•:4 ;i i i iPiii.in k:ti i iiiiii ii : :•iiiii;:;*,.,,,.. Mass Save® Facilitated Services: Electrical Pre-Weatherization CUSTOMER INFORMATION Customer Name Judy Ryan Client#or Site ID: 422153 Site Address: 61 meadow City: Florence State: MA ZIP: 01062 Phone Number: (413)265-0033 Email: judyryanhta@hotmail.com ELECTRICAL BARRIERS (To be filled out by the licensed contractor.) Roadblocks identified at home energy assessment: K&T wiring Recessed lights Knob and Tube Wiring To determine if there is any active knob and tube wiring,the contractor will evaluate the following areas where eligible Mass Save® weatherization recommendations have been made: p Attic Floor Attic Wall Attic Slope 1 Exterior Wall (►J Basement I have performed my inspection and determined there is no active knob and tube wiring in the areas selected below: si Attic Floor ( ] Attic Wall [ ; Attic Slope Exterior Wall 0 Basement Recessed Lighting IC Sign-Off The contractor will evaluate the number of recessed lights in the following areas identified by the Home Energy Specialist: Company Name: Lieber Electrical Contractor Name: david lieber License Number: 11637b Contractor Signature: Date: Sunday,July 14,2024 My signature confirms that I have performed my inspection of the electrical systems listed above and have corrected any barriers as indicated.My signature also confirms that I have read and agree to the Terms and Conditions outlined when submitting this form. a od e OUR PLANET.YOUR NOME.