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22B-026 (6) 21 CORTICELLI ST BP-2020-0944 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:22B-026 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit# BP-2020-0944 Proiect# JS-2020-001606 Est.Cost:$3900.00 Fee: $60.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SEAN BRADSHAW 108517 Lot Size(sg.ft.): 9016.92 Owner: SLABICH LINDSAY Zoning: 100)/ Applicant: SEAN BRADSHAW AT. 21 CORTICELLI ST Applicant Address: Phone: Insurance: PO BOX 944 (413) 301-8010 WC CHICOPEEMA01021 ISSUED ON:2/21/2020 0:00:00 TO PERFORM THE FOLLOWING WORK:INSULATION 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department 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. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 2/21/2020 0:00:00 $60.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner T,Lufa,6v2t-� Department use only City of Northampton —" '1 strtus of, Permit: y. >� Building Department Cwrb Cut/Driveway Permit A 212 Main Street r F-9 2 0 'opr Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060-_ Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Lot 0.;L0 Unit Flo r-f-inc, , ©1 C)(0 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: L' ►� S Sib i r �--� `a-\ C��--�c��`t �r Name(Print) Current Mailing Address: /o 4iz --aala aco Pg,oma� t_f112 Telephone - Signature re N ' 2.2 Authorized Agent: ��-�.�-, fit•-z.-�s��.� tom– o �� q4� ►�� �� � Name(Print) Current Mailing Address: L/i3 -z I ?, -asp Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building y.G (a) Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) leo 5. Fire Protection 6. Total = (1 +2 +3+4+5) Cj a Check Number Q, `y� This Section For Official Use Only Building Permit Number: boo- Off/ –q Issued: ed: Signature: lu a� ao Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors (] Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding [0] Other[V Brief Description of Proposed Work: t-NS' �k C'� ©✓) Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition Wdkistinq housing, complete the following: a. Use of building :One Family Two Family Other b. Number of rooms in each family unit: ` Number of Bathrooms Z c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS 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. Signature of Owner Date 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. Print Name Signature of Owner/Agen Date SECTION 8 -CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: �� ll Not Applicable ❑ Name of License Holder: � \� r�.cdC` C-S License Number " ©j l Z t 12 c� Address Expiration Date Signatur Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ cz,A-S S—e4 1(:�q1-A Szo Company Name U Registration Number Address Expiration Date Telephone SECTION 10-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...... ❑ City of Northampton Massachusetts "' ��• DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 ......... 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: Est. Cost: ti O m o Address of Work: 0 Date of Permit Application: �� I 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: `a 1 L"L� I-o4 oan " Date 70ritractor 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 r Massachusetts ' DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building yv`•., D� Northampton, MA 01060 ssd `�0 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: (Please print house number and street name) Is to be disposed of at: (Please print name and location off ility) �` Y^7 -r—A �"I—, Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Signature of Permit Applicant or Owne e 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. SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-108517 12/10/2020 Sean Bradshaw License Number Expiration Date Name of CSL Holder U List CSI,Type(see below) P.0 Box 944 o.and Street ------ - --- — _ – - --- Type Description Chicopee, MA 01021 U Unrestricted(Buildings tip to 35,000 cu. ft. R Restricted 1&2 Family Dwelling ity/Town,State,71P M Mason ry RC Roofing Covering — WS Window and Siding SF olid Fuel Burning Appliances 413-301-8010 Sean@bradshawenterprisesllc.com I Insulation fele hone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 1944SG 02/07/2021 Bradshaw Enterprises LLC __ HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name P.0 Box 944 Shari@bradshaWenterpriSeS11C.com No.and Street Email address Chicopee,MA 01021 413-301-8010 it /Town,State,ZIP Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. 4 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide his affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes ..........0 No........... .I- 'ECI'ION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT R CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize o 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: OWNEW 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 best of in ledge and understanding. Ll 8 Print thorized Agent's Name ature) 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 U.W have access to the arbitration program or uaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.niass.&gv/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 ypc of heating system Number of decks/porches ype of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" BRADENT-01 NICOLE ACORO DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 5/6/2019 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 ,RgjACT Nicole Waslick Phillips Insurance Agency,Inc. Mm 97 Center Street (A/C,No Ext):(413)594-5984 AIC,No:(413)592-8499 Chicopee,MA 01013 JnD li :nicole@phillipsinsurance.com INSURERS AFFORDING COVERAGE NAIC A INSURERA:State Auto Insurance Cos 11017 INSURED INSURER B:Liberty Mutual Insurance Co Bradshaw Enterprises,LLC INSURERC: PO Box 944 INSURER D: Chicopee,MA 01021 INSURERE: 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 LTRA X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE [X]OCCUR X PBP2856439 4/25/2019 4/25/2020 DAMMGETo RENToocED 100'000 MED EXP(Any oneperson) 10,000 PERSONAL 8 ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 POLICY 1 JjECT LOC PRODUCTS-COMPIOPAGG 2,000,000 OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea aocident)X ANY AUTO BAP2476397 4/30/2019 4/30/2020 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY BOODILY INJURY Per accident $ ATOS ONLY AUTOO1 ONLY PPe�aca�nt AMAGE $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE PBP2856439 4/25/2019 4/25/2020 AGGREGATE $ 2,000,000 DED I X I RETENTION$ O B WORKERS COMPENSATION X PER rET OTH- AND EMPLOYERS'LIABILITY YIN TE ER 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE NIA C5-31 S-621612-019 4/25/2019 4/25/2020 E.L.EACH ACCIDENT UFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CLEAResult,Eversource and National Grid are Included as Additional Insureds in regards to General Liability on a primary and non-contibutory basis when required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CLEAResult ACCORDANCE WITH THE POLICY PROVISIONS. ATTN:Contractor Services Dept. 50 Washington St.,Suite 3000 Westborough,MA 01581 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 Department of Industrial Accidents I Congress Street,Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers'Cornpensation Insurance Affidavit: Builders/Conti-actors/Electricians/Plumbers. 'i'O BE FiLED WiTH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Bradshaw Enterprises LLC Address: PO Box 944 Cit /State/Zi Chicopee Ma 01021 Phone#: 413-301-8010 Y P�----- ----------__-___------ Are you an emplgver°Check the yppropriate box: Type of project(required): 1.0 1 am a employer with 7 employees(full and/or pert-tune)." T 0 New construction 2.0 lain a sole pmprietor or partnership and have no employees working ferment 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 3❑I am a homeowner doing all work myself INo workers'comp.insurance required J t 9. El Demolition 100 Building addition 4.I 1 an,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 arc sole 1 I.Q Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.0 I am a general contractorand I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance: 6.0 we are a co 14.®Other Insulation corporation and its officers have exercised their right of exemption per MCL c. 152,f 1(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(heir workers'compensation policy information. t Homeowners who subunit this affidavit indicating they are doing all work and then hire outside contactors must submit a new affidavit indicating such. %Contractors that check this hox must annched an additional sheet showing the name of the sub-contractors and srate whether or not those entities have employees. if the sub-cuntrnctors have employees,they must provide their workers'comp policy number g 3 I ant an eutployer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Phillips Insurance Agency, INC Policy#or Self-ins.Lic.#: PBP28SG439 Expiration Date: 4/25/2020 _- Job Site Address: _ 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 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. t I do hereby certify under the pains and penaltr it jury that the information provided above is true and correct. 1 -� ?q Signature: Date: c r Phone#: Official use only. Do not write in this area,to be completer:by city or town official. City or Town: Permit/License# r Issuing Authority(circle one): ,i 1. Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC BRADSHAW ENTERPRISES, LLC Registration: 194456 246 CONNECTICUT AVE Expiration: 02/07/2021 SPRINGFIELD, MA 01104 SCA t O 2M-06117 Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 194456 02,07/2021 1000 Washington Street-Suite 710 BRADSHAW ENTERPRISES,LLC Boston,MA 02118 SEAN M.BRADSHAW 34 FRONT STREET T SPRINGFIELD,MA 01151 `Undersecretary t Val Ithout ignature Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards ConstrVCtlbl1 lSupervisor CS-108517 G "Alp iresc: 12JI012020 SEAN MATTHEW BAIL` r, BRADSHAW 246 CONNECTICUT AVEIiE �0 SPRINGFIELD MSA 101104 "N.\ " Commissioner i - Federal ID#05.0405626 IZISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 CT Contractor Registration Nc6�2/0�1�20 m RISE 60 Shawut Road,Canton,MA 02021 ENGINEERING' CONTRACT YYZ 339-502-6335 X-7109 FAX 339-502.6345 Page 1 PROGRAM THE;CONTRACT IS ENTERED INTO BETWEEN RISE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORN AS DESCRIBED BELOW CUSTOMER P11UNt O TE CI.R.NI/ WORK ORDER Lindsay Slabich (413)218-2896 12/12/2019 493016 23802 SERVICE STREET BILLING STREET 21 Corticelli Street 21 Corticelli Street SEHVICh CITY,STAT ,ZIP BILLING CITY,STATE.ZIP Florence, MA 01062 Florence, MA 01062 DESCRIPTION QTY COST INCENTIVE TOTAL ASBESTOS HAZARD A blower door diagnostic test will not be conducted at your home,due to the possible presense of asbestos. KNOB&TUBE WIRING(Fitchburg,Northhampton) We have identified that your home might have Knob&Tube wiring initials) present. The following contract is not valid unless accompanied by the Pre-Weatherization Barrier Incentive form, signed by your licensed electrician.Work will not proceed with this work until we receive a copy of the form. ATTIC DAMMING-R-38 FIBERGLASS 158 $323.90 $242.93 $8097 Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass batts for damming purposes. ATTIC FLAT- 14"OPEN R-49 CELLULOSE 919 $1,654.20 $1,240.65 5413.55 Provide labor and materials to install a 14"layer of R-49 Class I Cellulose to open attic space. ATTIC HATCH: SEAL&INSULATE 1 $60.00 $45.00 $15.00 Provide labor and materials to insulate the back of an attic hatch with 2"rigid insulation board.Weatherstrip the perimeter. VENTILATION CHUTES 97 $242.50 $181.88 $60.62 Provide labor and materials to install ventilation chutes in the rafter bays to maintain air flow. VENT BATH FAN THRU ROOF 4 INCH 1 $118.75 $89.06 $29.69 Provide labor and materials to install an insulated exhaust hose with roof mounted flapper vent to exhaust existing bathroom fan(s). HOME AIR SEALING 12 $1,020.00 51,020.00 Provide labor and materials to seal areas of your home against wasteful, excess 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.) A reduction in cubic feet per minute(cfm)of air infiltration will occur,but the actual number of cfm is not guaranteed. At the completion of the weatherization work, and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the sub-contractor. Federal ID a 05-0405626 RISE Engineerino, RI Contractor Registration No 8186 MA Contractor Registration No 120979 �2/0�1�20 RISE 60 ShawmCT Contractor Registration No6 ut Road,Canton,MA 02021 CONTRACT � YYZ ENGINEERING' 339-502-6335 X-7109 FAX 339-502-6345 Pago 2 PROGRAM THISCONTRACT ISENTEREDINTO DETV/EE.N RISE CMA-HES ENGINEERING AND THE CUSTO KIER FOR WORK AS DESCRI13ED BELOW CSIOML PHONE DATE CLIENI 0 WORK ORULR Lindsay Slabich (413)218-2896 12/12/2019 493016 23802 'LHVICE SIIILET BILLING STREET 21 Corticelli Street 21 Corticelli Street so VICE CITY.SIAIE,21P BILLING CI Y,STATI_1IP Florence, MAO 1062 Florence, MA 01062 DESCRIPTION QTY COST INCENTIVE TOTAL CRAWLSPACE 10MIL GROUND COVER 112 $108.64 $81.48 $27.16 Provide labor and materials to install 10 ml polyethylene over open ground in designated crawlspace/earthen basement areas. CRAWLSPACE WALL R10 RIGID BOARD 108 $437.40 $328.05 $109.35 Provide labor and materials to install R-10 rigid Thermax insulation to the crawlspace perimeter wall up to the sill and against the band joist. I-INCENTIVE: 75% For eligible measures, Columbia Gas of Massachusetts is offering an incentive of 75%for insulation measures and 100%for the air sealing measures, both with no limit. Total: $3,965.39 Program Incentive: $3,229.05 Customer Total: $736.34 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Seven Hundred Thirty-Six &34/100 Dollars $736.34 UPON RECEIPT OF YOUR RIS NGINEE ING INVOICE.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF 1%WILL HE CHARGFD MONTHLY ON ANY UNPAID DALANCE AFTER 30 AYS.SEE EVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,THEDULING,AND CONTRACTOR REGISTRATION. \4 �� Q7UML9 STUTTATURt NOTE:THIS CONTRACT MAY DE WITHORAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE 30 DAYS ACCEPTANCE OF CONI RACY-THEAHOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED,YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE RISE ENGINEERING' OWNER AUTHORIZATION FORM I, Lindsay Slabich (Owner's Name) owner of the property located at: 21 Corticelli Street (Property Address) Florence, MA 01062 (Property Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. This form is only valid with a signed contract. XOwr' Signature i /j//Z-// Date RISE Engineering, a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 1 Canton, MA 02021 1339-502-6335 www.RISEengineering.com