24A-139 (2) City of Northampton
f Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal BuildingIss ,
Northampton, MA 01060 tyY
Property Address: 44 Roe Avenue
Contractor
Name: Tom Rossmassler- Energia LLC
Address: 242 Suffolk St.
City, State: Holyoke , MA
Phone: 413-322-3111
Property Owner
Name: Corinne Hoag
Address: 44 Roe Ave.
City, State: Northampton, MA 01060
1, Tom Rossmassler (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
Date
9/21/18