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43-073 (6) BP-2024-1496 120 DUNPHY DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 43-073-001 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-2024-1496 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2024 Contractor: License: Est. Cost: 1000 HOMEWORKS ENERGY INC 106148 Const.Class: Exp.Date:07/30/2026 ,Use Group: Owner: BURNS WALL LISA M&MARY T Lot Size (sq.ft.) Zoning: WSP Applicant: HOMEWORKS ENERGY INC Applicant Address Phone: Insurance: 71 DUDLEY ROAD 781-205-4516 1847910 SUTTON, MA 01590 ISSUED ON: 11/07/2024 TO PERFORM THE FOLLOWING WORK: INSULATION/W EATH ER I ZATI ON 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: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: r/ °E Fees Paid: $75.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner 1/2Fam 7.50 - 1K Min $75 / Please mail Permit to WXPermitting@homeworksenergy.com L&/ DepFOR`7.e.yasi,�r1 City of Northampton `' '.`\ Building DepartMentl/0 w 212 M in Street , 6 ,� �o� ? NSULA TION \F 1� ; 4,' Ro 00;\ 1 kP Northampton, MA_p1(1F. . phone 413-587-1240 Fax 41 7,=r .- //' / ONL , APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY D LLING ONLY SECTION 1 -SITE INFORMATION INSULATION PERMIT 1.1 Property Address: This section to be completed by office Map Lot Unit 120 Dunphy Drive Northampton MA 01062 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Lisa Wall 120 Dunphy Drive Northampton MA 01062 Name(Print) Current Mailin Address: See Attached (413)32o s2�i1 Telephone Signature 2.2 Authorized Agent: Adam Glenn 71 Dudley Rd Sutton MA 01590 Name(Print) Current Mailing Address: caL 781-205-4516 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 1 000 (a) Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) ft -76 5. Fire Protection 6. Total=(1 +2+3+4+5) 1000 Check Number jIS 1.1.� �f ,i This Section For Official Use Only Building Permit Number: 611 'A/'�` g& _ Date Issued: Signature: C /`— i:.,_ //. 71 Building� Commissioner/Inspector of Buildings Date wxpermitting @ homeworksenergy.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder:Adam Glenn 106148 License Number 71 Dudley Rd Sutton MA 01590 07/30/2026 Addre o1 Expiration Date 781-205-4516 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable 0 HomeWorks Energy 181138 Company Name Registration Number 71 Dudley Rd Sutton MA 01590 03/02/2025 Address caci, Expiration Date Telephone 781-205-4516 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 pi No ❑ Brief Description of Proposed Work Residential weatherization/ Air sealing. No structural changes. SITE ID Adam Glenn , 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. Adam Glenn Print Name s Cdtki. 10/23/2024 Signature of Owner/Agent Date Lisa Wall , as Owner of the subject property hereby authorize HomeWorks Energy - to act on my behalf, in all matters relative to work authorized by this building permit application. See Attached 10/23/2024 Signature of Owner Date City of Northampton °aY�M,ti SAS , ' 4yC Massachusetts -.- 'e 01 ( 4 f DEPARTMENT OF BUILDING INSPECTIONS r 7 . '� 212 Main Street • Municipal Building uti `�� Northampton, MA 01060 "I 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:Weatherization Est. Cost: 1000 Address ofwork: 120 Dunphy Drive Northampton MA 01062 Date of Permit Application: 10/23/2024 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 Other(specify): 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: 10/23/2024 Adam Glenn 181138 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 dog. 4 Massachusetts 4 fir,• DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street "Municipal Building _ 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: 120 Dunphy Drive Northampton MA 01062 (Please print house number and street name) Is to be disposed of at: McNamara Waste Services LLC, 24 E Longmeadow Rd, Hampden,MA 01036 (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) 10/23/2024 Signature of Permit 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. City of Northampton Massachusetts 'l * DEPARTMENT OF BUILDING INSPECTIONS •� 1 • ' 212 Main Street • Municipal Building Northampton, MA 01060 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 120 Dunphy Drive Northampton MA 01062 Contractor Name: HomeWorks Energy Address: 71 Dudley Road City, State: Sutton MA 1590 Phone: 781-205-4516 Property Owner Lisa Wall Name: Address: 120 Dunphy Drive Northampton MA 01062 City, State: Adam Glenn (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 Ca/4°k gaV Date 10/23/2024 HOMEENE-03 LLARIVIERE A CCU?O CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDlYYYY) 1/8/2024 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(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 Lisa Lariviere Foster Sullivan Insurance Group PHONE FAX 163 Main Street (NC,No,Ext):(978)686-2266 301 (A/C,No): North Andover, MA 01845 glass,certificates@fostersulllvangroup.com INSURER(S)AFFORDING COVERAGE NAIC K INSURER A:Kinsale Insurance Company 38920 INSURED INSURER B:The Commerce Insurance Company 34754 Homeworks Energy,Inc INSURER C:Everspan Indemnity Insurance Company 16882 101 Station Landing Suite 110 INSURER D:New Hampshire Employers Insurance Compan 13083 Medford,MA 02155 INSURER E:StarStone Specialty Insurance Company 44776 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 POUCY EXP LIMITSLTR 1NSD WVD I M,IIDDIYYYYI IMM/DD/YYYYI A X COMMERCIAL GENERAL UABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 0100275489 1/1/2024 1/1/2025 DMGSOa EocNwTEnDencel 300,000 S MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ja LOC PRODUCTS-COMP/OP AGG $ 2,000,000 ,OTHER: $ B AUTOMOBILE UABILITY (EaacccideD SINGLE LIMIT _$ 1,000,000 ANY AUTO L15948 1/1/2024 1/1/2025 BODILY INJURY(Per person) $ OWNED X SCHEDULED AUTOSO ONLY AUTOS yy BODILY INJURY(Per accident) $ X AUTOS ONLY X AUTOS ONLY {POerr accidentpAMAGE $ C UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 X EXCESS LIAO CLAIMS-MADE BR1EII-000045-00 1/1/2024 1/1/2025 AGGREGATE $ 1,000,000 DED X RETENTION$ 0 $ D AND EMPLOYERS ERS'LIA4TION BILITY X PER STATUTE ERH ECC-600-4001157-2024A 1/1/2024 1/1/2025 1,000,000 ANY PROPRIETOR/PARTNEWEXECUTIVE Y/ E.L.EACH ACCIDENT S MFFICER/MEMBER EXCLUDED? N/A andatory In NH) E.L.DISEASE-EA EMPLOYEE,$ 1'000'000 If yes.describe under 1,000,000 _DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ E Pollution U82192240AEM 1/1/2024 1/1/2025 $25k Deductible 1,000,000 A Umbrella-GL Only 0100275711-0 1/1/2024 1/1/2025 Per Occurrence 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence Only CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Homeworks EnergyInc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 101 Station Landing Ste 110 Medford,MA 02155 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts r Department of Industrial Accidents �. Office of Investigations '1 -��1— wp Lafayette City Center _pt�= 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): Homeworks Energy Address: 71 Dudley Rd City/State/Zip: Sutton MA 01590 Phone #: 781-205-4516 Are you an employer? Check the appropriate box: Type of project(required): 1.❑■ I am a employer with 500+ 4. 0 I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' P h' 9. ❑ 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.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no Weatherization employees. [No workers' 13.® Other comp. insurance required.] *Any applicant that checks box fi 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: New Hampshire Employers Insurance Company Policy#or Self-ins. Lic. #:ECC-600-4001157-2024A Expiration Date: 1/1/2025 Job Site Address: 120 Dunphy Drive Northampton MA 01062 City/State/Zip: 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 and r the �pains and pew es of perjury that the information provided above is true and correct. Signature: �"?'J `� Date: 10/23/2024 Phone#: 781-205-4516 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): 10Board of Health 20 Building Department 3EICity/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone#: Commonwealth of Massachusetts Construction Supervisor Specialty 'V° Division of Occupational Licensure Board of Building Regulations and Standards Restricted to: ConstructiqS�t pletr Specialty CSSL-IC-Insulation Contractor CSSL-106148 �'acpires: 07/30/2026 ADAM GLENN 19 CHARGE POUND RD t* A 5 WAREHAM MA 02571 2 0 — r t �O~ � i 4` �Ul.lt t1:1 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Commissioner e K/ s._ Contact OPSI:(617)727-3200 or visit www.mass.gov/dpl/opsi ____S.,,L, THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston. Massachusetts 02118 Home Improvement Con tractor Re istration n allnrallill --.- ; r. -, Type Corporation ___.ma. HOME WORKS ENERGY, INC i =� egistration: 181138 101 STATION LANDING STE -110 '° ==PI _ E piration: 03/02/2025 ariiiii MEDFORD, MA 02155 �, ti1!tit<s MOW e7 Mali : OW g •ieJ1 M s%15 N., 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:Corporation Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street •Suite 710 181138 03/02/2025 Boston.MA 02118 HOME WORKS ENERGY. INC /��" ^.� ADAM GLENN / _0a.-e) c,.7.et,‘..._ 101 STATION LANDING STE 110 ,,., i Llfr.k V MEDFORD.MA 02155 Undersecretary Not valid without signature HomeWorks 4 save ' Energy, Inc PARTNER Customer Name:Lisa Wall Email:Imwall2911@gmail.com Address:120 Dunphy Dr,Northampton,MA,01062 Site ID:12909 Job Description Measure Description Quantity Unit Total Cost Customer Cost Rim Joist-2"Thermal Barrier Polyiso 104 LF 5574.08 $143 52 Door Sweep(with AS hrs) 2 Each S59.32 $0.00 Air Sealing at Estimated 62.5 CFM50 Per Hour 1 HRS $106.59 $0.00 Exterior Door Weather Stripping(with AS hrs) 1 Each $36.32 $0.00 Project Total $776.31 Weatherization Incentive ($430.56) Air Sealing Incentive ($202.23) Total Program Incentive -$632.79 Customer Total $143.52 • OP!- • tra Price d Payment Schedule Home Works Energy c.agr. -• o per orm t • •. Lest ibed work,furnishing the material and labor specified for the listed total price. Payment of the Blanc:of the ustorrer contribution is expected upon completion of the work. 2 Customer Signature: CE) Date: Customer Phone: 41332 Specialist Signature: Aim/N Date: 10/17/2024 LIMITED TIME OFFER: The prices and incentives in this contract are subject to change in accordance with the sponsoring utility MassSave Program offers. Prnnncalc ran he cent to HFAfa1hnmewnrkcenerav rnm • Market Rate PLAN VIEW am snr.m. t 1st "r i"� ` is. 1 _fit , Notes: Tbbl _ offx IAA"{ '{ 0 if,. -� i. r t fJ., ,r. EXISTING i+t. i 4 Ft. SPEC r ��(I)'I k BGWall AG Wall Ceiling , I>> Baseicmwi EXISTING Ht. Ln/Sq Pt. 3FC SG Wall AG Wall �, Sill Ceiling �' Vapor Barrier Bsmt Door Bulkhead Door Dryer Vt Hose "erc . . . . (... - (/ __. .... . _____ .. _ _ li Sweeps v WALLS&GARAGE Blower Door? Y/IV Wall Framing x__x ____ Balloonitzi/platform &S Present?M,,,a,. strips Orie SIDING EXISTING SPEC ING #FI Cell H Width Sq.Ft. K&T �J - Windows Doors Asbestos � i Wall 1 imi •Vermiculite VVallz Moisture Wall a 7Sccu old>100sq,ft1"Y`all A ructl ConcernGar. 4Vali ombustionSGar. Ceilin; O Detect_ Overhang - -� X X __�_ Other: I ,r..71 I ATrIC CAP(Woo tAAA as BAABItogn11. OSI>!USIC.C. Ftt 4AA4AN kxIS�INR t.,• ..• ,.,IP"Ck"l" . i,ir Ai n.*r.no. A, KW Slope x x .1 '!txx xii".'n;; ..,z,-,,.r„e1 •i liable x x -4 a-......+ fill••.«,.„.O. . fWFloor x x '�lti'WAIL x x i•�—a�r.3-��r 11 I A 1 •.try,•nv',Mwog7 OL..]2':tx.SkIne x r , �"'�- DLit t N�Wx I�PEGIIUI'l —�i i i - in it 1�--_nf1 , ,I--��--''I}}1..y1 •rA•1...�i all....,, :a,thng\\`ntilAtion? ...A...r+.....�.-•�.- �.Y� r�A\ • \..• I 1. 1 - A 1 1A_w,r AA HOurt irantl on Enlel Beet_ .._.__ 7 H - e---1/ 4 z _____�_._ n e ., v. ... . .__ ___. _ . ._ ._.. _ . _ . _ . .. _. ... . ._. .. .. . _ . _ .. . . ._ . . . _ _ . . . . ._ . ... . ... . ..... . .. ...._ . .. ... _. _.. . ._ . ..... _.. .... . _. _ . _. . .._ . ._. . _. ... . . . _ ... . _ . . . ... ._ ._. ... . . ._ _ ..... ... __ ... _ . _ .... __ . .._ ._. ... . .. . _ . _. . _ .. _ _ .• . ... . .. _.. ..... __. .. . .__ _ . ._. .... ....... _._ ... . .. . .... ..... _. ___ . _ . ._ ___ ..... .. .__ __. .. .. .. .. _.. _. . . .. ._... ..... ..... ___._... _ ___ __. ___ _. . _ _______ _.. .. . ._. ... _. , _ _.. ... . . .. . . . . ._. __ . . . . . . . x x ATTIC 1 Blind Spec? r., x x ATTIC 2 Blind Spec? C) EXISTING SPEC'ING Length Width SQ.FT. a EXISTING \._ SPEC'ING Length Width SQ.FT. Unfloored 1' nfloored Floored r Floored Cath Slope ath Slope o Walls ills II i= Z.: - w• Damming: Exist-in: boring: Buildup?0 Damming: -Existing Flooring: Buildup?0 z,R60:.3-oR.6/7/B': N- Flooring. Budd up?❑ / . • New flooring Buildup? CI Temp Ac: New PDS? D Access: Temp 1= Access: Ac: New PDS? 0 __.0- --` ##RL IC: NON IC: RL Boxes: RL Covers: Sheathing: t#RL IC: NON IC: RL Boxes: RL Covers: Sheathing: ` #BFs: Vent BF: BF Hose: WHF Box?: D •BFS: Vent BF: BF Hose: WHF Box?: G Venting: Venting: Props: Prop Ext: Venting: Venting: Props: Prop Ext. Insulation/Air Sealing Permit Authorization Specialist: Michael Hathaway Company: HomeWorks Energy Email: HEA@homeworksenergy.com Address: 101 Station Landing Cell: 781.305.3319 Medford, Ma 02155 Phone: 781.305.3319 MA CSSL- 106148 MA HIC- 181138 Customer: Lisa Wall Address: 120 Dunphy Dr Email: Imwall2911@gmail.com Northampton, MA,01062 Site ID: 12909 Phone: 4133206271 I, the owner of the property identified above hereby authorize HomeWorks Energy Inc., or their Partner to act on my behalf in obtaining any building permit that maybe required to perform insulation and/or Weatherization work on my property and all matters related to the work authorized by said permit if one is obtained. Any related permit application cost will come at no additional charge provided that the agreed Weatherization work is completed. In the event that a permit is pulled on your home for insulation and/or weatherization work, you may be required to have a final inspection of the work scheduled and performed by the building inspector in your town. If required by the town, you will be notified by Home Works Energy that an inspection is necessary with instructions on how to complete this process to close out your permit. Email: Im wal12911 @gmail.corn Customer �'��i Si natur- Dat- 17/2024 Lis `t r l .- t , For Condo Owners: If you have property oversight by a condo associationt, please have the association's authorized person(s)complete and sign the section below. Please email this document to wxpermitting@homeworksenergy.com once completed. We, being the duly authorized representatives of the association Name of association or management companyt or management company have reveiwed the plans and specifications for improvements to the address specified above We further acknowledge that the above listed owner has given notice that they intend to seek permits and to carry out the proposed work. Signature of representative Date Print Name t Other unit owners may sign when there is no association.