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37-130 (10) BP-2022-0196 696 FLORENCE RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 37-130-001 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-2022-0196 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION Contractor: License: Est. Cost: 3217 THE ENERGY MONSTER 102765 Const.Class: Exp.Date:07/22/2022 Use Group: Owner: GIDDINGS, LESLEY-ANN Lot Size (sq.ft.) Zoning: SR Applicant: THE ENERGY MOIWISTER Applicant Address Phone: Insurance: 311 MAIN ST (508)796-5525 6S60UB5R71347322 WORCESTER, MA 01608 ISSUED ON:03/01/2022 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATH 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: Gas: Final: Final: Rough Frame: Rough: Fire Department Driveway Final: Fireplace/Chimney: Final: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: ii1,, • r Fees Paid: $65.00 212 Main Street,Phone(413) 587-1240,Fax:(413)587-11272 Office of the Building Commissioner - i E ' I The Commonwealth of Massachusejtts "-�`--- 1 Board of Building Regulations and Standards ; FOR �`� Massachusetts State Building Code, 780 C1M - 1 ML..�NICIPALITY ��2I ( USE Building Permit Application To Construct,Repair, Renovate Or Demolish a Re`ised Mar 2011 One-or Two-Family Dwelling' 7eim n,v�H:jsi— c r�rTn,< This Section For Official Use On1 "Mr'°N'MA 010E30 Buildin .Permit Number: 8 P. ay 0 I'!6/ Date Applied: l� /� V o,s ,// -2 3 1-ZOZZ Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 696 Flortr te.. Ai, P7o.-4..o cc- 3 7-/3 0 . o0 t 1.1 a Is this an accepted street?yes .o 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 r 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 SewageDisposal System: Public 111°- Private❑ Zone: _ Outside Flood Z9ae? Municipal C1T/On site disposal system 0 Check if yes SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: LeJ/� rr6,dq'ir s Flo hu_ Alit ao6z • Name(Print) J City,State,ZIP 6 96 /4749"Z.0 e-e — / -d 9/7•8"Z S•/7tZ No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building Owner-Occupied Ell Repairs(s) 0 Alteration(s) '<Addition ❑ Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: /is Svie4//Or), WesifJ§.e.e.-zet#..oh, 0,., c.c.sr A ii y SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 3 Z. / 7 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) $ Total All Fees• 7 7 Check No. 4161 Check Amount: V Cash Amount: 6.Total Project Cost: $ 3, 2/ 7 ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CSL 'VOL,65 7/ZZ./ZZ. Jot A Lee. License Number Expiration Date Name of CSL Holder List CSL Type(see below) 3/, A; c No.and Street Type Description nA� U Unrestricted(Buildings up to 35,000 Cu.ft.) ✓o kr e4 SP`c/- , /`"`' a l6 G t () Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding / SF Solid Fuel Burning Appliances SOF'796 'SSZS dffi:el J��e#tye.oie fyI1foov I Insulation Telephone Email address •tor++ D Demolition 5.2 Registered Home Improvement Contractor(HIC) ! 79+6 9/y/2$ E/t.e.r A�0#1 k ' HIC Registration Number Expiration Date HIC Company e or HIC Registrant Name r1 of . St 40:nc//'e.Mre.1er:5v .11✓r4i- No.and Street Email address . (apes, 10✓040•44.6fzr Joe•796 •S52S City/Town,State,ZIf 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 IV No 0 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 o/O•lol;n•__ •/L�� to act on my behalf,in all matters relative to work authorized by this building permit application. LeJ/e, I,,., ,>s Z / zz /zc 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. ,00,.,z:n,c 5p' �' Z /zz /ZZ 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 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" City of Northampton µYHAMp1 j'.` •s �q.,,. Massachusetts a�S . sc�<< ,4,tl f DEPARTMENT OF BUILDING INSPECTIONS y, • y.' 212 Main Street • Municipal Building vy CD Northampton, MA 01060 sfd .,. ��0 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: /oa La•,•7aif•i,_ Ste, /1/0r44e.(,4 r The debris will be transported by: Name of Hauler: Ei►4--rfl, I"<' _ Signature of Applicant: Date: 2/ZZ /ZZ ''&-_'`' t The Commonwealth of Massachusetts t Department of Industrial Accidents .--' I Congress Street,Suite 100 Boston,MA 02114-2017 :., wwiitmas.gorlilia Workers'Compensation Insurance Affidavit:BuiklersI('ontractors/Electriciansirluwhers. TO BE FILED SS ITII THE PER71II'1-11tit;AlritiORITI'. Applicant Information Please Print l.e.hibh Name(Busin (.k nvatiowlndividual): tee 7,, Ale-,,/Ae..--- Address: 3// /4 4 0'.' <.S4., -✓o.- 1 kr /1I A 0/6 0 8 City/State/Zip:_ Mont.- S o - 79 6 •5 5 t5 Art)put1nl ire Cheek the appropriate bo►_ SD Type of project(required): 1 1 am a employer with employ ecs thin or pan-tone i.• 7. 0 New construction 2.0 1 am a.sole proprietor rat partnership and hate no employ Les wurkurg for mac in g. 0 Remodeling aw capacity. No workers"comp.insurance minima i 9. f Demolition 30 i am a hoinooks area doing all stork myself t o%strikers'comp.insurance reuluired._I ll 0❑ Building addition 4.El i am a tunrco5mea and ss ill he hiring contracture to conduct alt whack un my propcity. 1 w ill attain:that all contractors either has c rturkrr1."etrmperrs:e1rtae mcsuran a or are sale 11.0 Electrical repairs or additiO is pruprietonwith no employees. 12.p Plumbing repairs or additions 501 am a general contractor and I base hired the sub-contractors listed un chic attached sheet. 13 Roof pairs These sub-contractors tease nnplo}'ees and have workers'comp.ursarancc. 14.2 to.Q We are a corporation and its officers have vitalised their right of et un 4arn per 111Ce1L v. Cher /n./v/�f rw"7 152,y It 41.and we Irate nu eanplusecs.(No wurkam'comp.insuante required.' *Am)applie-att that rtaocks last t31 must also till out the section below sheaving their workers'compensation policy information. t Homosiw roars who submit this attrdavit indicating they are doing all work and then hire outside ctwrtrectaxs must srdtnut a new of tides it medicating such let ntrackors that cheek this box must attached an additional sheet shushing the name of the souls-ecatdracturs.and state w fed hcr or nut those entities hays employees. Il the suh-tontractars have employees,they must prutide 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 infra-nrntiott. histuc in a Company Name:/�a,/4 n4m/ei //A d-t Pw. .Viee..I /.7 J v/ir rr ti ed, _ Poihry#or Self-ins.Lie.#: 6 f 6 0 l gS117 /3y 73ZZ Expiration Dale: / //3 /Z 3 Job Site Address: 6 9'6 Flo h ne_ / -S F/ore n e-- City State Lip: /Ui9 0/06 Z Attach a copy of the workers'compensation policy declaration page(shovi ing 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 andorir one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance C'ow'erage verification. I do hereby certify under the and penalties olperiurr that the information provided oho t r'is true and correct. signature: 1)a:c:: Z /ZZ /ZZ. atone#: 5 D&'• 79 6 • 55 Z$ official use only. Do not write in this urea,to he completed fy city or bison official I it or Town: PermiVl.icense it Issuing Authorit (circle one): 1. Board of Health 2.Building Department 3.C'il I Tot n Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other t °marl Person: Phone*: ____..........40 ACCEENE-01 DKENNEY ,d►CORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YVYY) kii.....----- 2/22/2022 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: Smith Brothers Insurance,LLC PHONE FAX (A/C,No,E:t):(508)987-0333 (A/c,No):(860)652-3236 oF, itss:generalmailbox@smithbrothersusa.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:EMC Property&Casualty Company __.25186 INSURED INSURER B: Energy Monster MA Inc INSURER C: - 311 Main Street 2nd floor INSURER D: Worcester,MA 01608 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 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 LTR INSD WVD (MM/DDIYYYY) (MM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE '$ 1,000,000 CLAIMS-MADE X,OCCUR 6D05384 6/1/2021 6/1/2022 Ma S lEa oau ante) $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL.8,ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 1 GENERAL AGGREGATE $ - 2,000,000 POLICY X lia LOC PRODUCTS-COMP/OP AGG $ 2,000,000 I OTHER: I $ A AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT 1,000,000 _(Ea accident) _$ X ANY AUTO 6Z05384 6/1/2021 6/1/2022 BODILY INJURY(Per person) $ -OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ I AUTOS ONLY AUUTOS ONLYY (Peer acden DAMAGE _� 5,000 $ A X UMBRELLA LIAB X I OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB 1 CLAIMS-MADE 6J05384 6/1/2021 6/1/2022 AGGREGATE ___$_ DED !. X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN .STATUTE ER -- ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A - - - - (Mandatory In NH) -E.L.DISEASE-EA EMPLOYEE $_ - 1 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I 1 1 I DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Florence THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Mon Street ACCORDANCE WITH THE POLICY PROVISIONS. 21Northampton,MA 01060 AUTHORIZED,�REPRESENTATIVE UT ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYVV) `,../ 02/22/2022 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 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: Donna Kenney SMITH BROTHERS INSURANCE LLC C.N,Ext): 860)652-3235 ( No): ADDRESS: dkenney@smithbrothersusa.com 68 NATIONAL DRIVE INSURER(S)AFFORDING COVERAGE NAIC# GLASTONBURY CT 06033 INSURERA: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER B: ENERGY MONSTER MA INC INSURERC: INSURER D: C O ENERGY MONSTER 311 MAIN STREET 2ND FLOOR INSURER E: _ WORCESTER MA 01608 INSURERF: COVERAGES CERTIFICATE NUMBER: 747069 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 EFF POLICY EXP W MI LIMITS LTR INSD VD POLICY NUMBER (MM/DD/YYYY) (MDD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL S ADV INJURY $ GEM.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ — ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE _ AUTOS . .(Per accident) $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION Ni PERTUTE OTH- ER AND EMPLOYERS'LIABILITY EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED?ECUiIVE Y� WA N/A 6S60UB5R71347322 01/13/2022 01/13/2023 E.L. (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Florence ACCORDANCE WITH THE POLICY PROVISIONS. 210 Main Street AUTHORIZED REPRESENTATIVE Northhampton MA 01060 Daniel M.Cr y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Encr 'Monster .v_ _minster Home Performance Contractor 125 Blackstone River Rd,Worcester,MA CONTRACT - AUDIT 608-796.6526 FAX 608-720-3933 Page 1 PROGRAM CMA-HPC cwTONEA RHoNE DATE G LWNTI weAK oabED Lesley-ann Giddings (917)825-1782 01/27/2022 338006 00001 SEMV10E IT1YEET DILLTNo sTNEET 64b605E6rr. 696 Florence Road 696 Florence Road Energy Monster stk\ACE arr.tTATE,Zii' BIILINo crlY,sTATE,zo6 Florence, MA 01062 Florence, MA 01062 DESCRIPTION QTY COST INCENTIVE TOTAL INCENTIVE 75% For eligible weatherization measures,Eversource is offering an incentive of 75%for insulation measures and 100%for the air sealing measures, both with no limit.You are eligible to apply for the 0%Heat Loan to finance your co-pay,applications must be submitted before the weatherization work begins. ATTIC FLAT-7"OPEN R-26 CELLULOSE 1,288 $1,777.44 $1,333.08 $444.36 Provide labor and materials to install a 7"layer of R-26 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. HOME AIR SEALING 12 $1,020.00 $1,020.00 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 indude air leakage to attics, basements,attached garages and other unheated areas(windows are not generally addressed.) WEATHERSTRIP AND ADD DOOR SWEEP 3 $240.00 $240.00 Provide labor and materials to install Q-Ion weatherstripping and a doorsweep to door(s)to restrict air leakage. Energy Monster aster Home Performance Contractor ,mib 126 Blackstone River Rd,Worcester,MA CONTRACT - AUDIT 508-796-5525 FAX 608-720-3933 Page 2 PROGRAM CMA-HPC COS-rain IKioNE DATE cLENT7 wogs oADEN Lesley-ann Giddings (917)825-1782 01/27/2022 338006 00001 i ItOcE STREET BIFLIND STREET PROP-OsE1561. 696 Florence Road 696 Florence Road Energy Monster S2R15LE cmTY,STATE,ZIP EILUNO cm.STAT€,ZIP Florence, MA 01062 Florence, MA 01062 DESCRIPTION QTY COST INCENTIVE TOTAL INSULATED BATH EXHAUST HOSE 4 INCH 2 $120.00 $90.00 $30.00 Provide labor and materials to install an insulated 4"exhaust hose to existing bathroom fan(s). Total: $3,217.44 Program Incentive: $2,728.08 Customer Total: $489.36 WE AGREE HEREBY TO FURNISH SERVICES.COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF "'Four Hundred Eighty-Nine&36/100 Dollars $489.36 t _ �� YL►1 ��tC Lt Lit' COMPANY REPRESENTATIVE USTOMER! L SaN TUR NOTE fle5 CONTRACT MAY BE wrTNORANM BY US IE NOT EXECUTED wR SN DATE OF ACCEPTANCE I LC 2:2-- SION DATE DAYS energvm nster This Agreement Is made by and among: ENERGY MONSTER(Company) 311 Main Street CUSTOMER(STATED ON PAGE 1.) and 2nd Floor Worcester, MA 01608 I. DESCRIPTION OF WORK TO BE PERFORMED The Company will perform the following work on the address above In a professional manner and In accordance with the terms of the Contract,Including the attached recommendations/work order/quote. II. PAYMENT Customer agrees to pay the Company for the Work as follows: The customer TOTAL less Incentives as listed on Previous Page(s),upon completion of the Work,due In full,payable by check, cash,or major credit card. III.LIMITED TIME OFFER The terms, prices,and incentive offered In this contract are valid until December 31'°of 2021. IV. COMMENCEMENT AND COMPLETION The COMPANY will not begin the work or order the materials before the signing of this Contract.Subject to the availability of subcontractors,/materials and to delays attributable to the weather,the work will begin upon verbal agreement between the COMPANY and the CUSTOMER barring delay caused by circumstances beyond the COMPANY's control.The COMPANY reserves the right to advise the CUSTOMER of changes In the projected start and completion dates,based upon availability of materials and licensed contractors. Upon completion of the work,the COMPANY will leave the Premises In a neat and orderly condition but shall not be responsible to correct conditions outside the scope of its work. V. PERMITS The COMPANY agrees to be In compliance with any necessary permits for this project depending upon the judgment of local inspectors and certifies that the COMPANY will obtain any and all necessary work-related permits. VI. MODIFICATION This contract cannot be changed except by a writing signed by the COMPANY and the CUSTOMER. VILCUSTOMER'S DUTY CUSTOMER must prepare the Premises for the work.Objects which obstruct areas of work must be moved before the work is to commence or CUSTOMER may be charged and agrees to pay the cost,time and labor incurring in moving such objects. VIII. NOTICE 1.All contractors and subcontractors must be registered by the director and any inquires about the contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration,One Ashbumham Place, Boston, Massachusetts 02108,617-727-8598. 2. The registration number of the COMPANY Is CSSL-188796. 3.The COMPANY Warrants as follows: A. Materials and workmanship will meet or exceed the specifications in the COMPANY'S materials and installation standards. B. The work and the matenals furnished by the COMPANY will conform to the requirements of this Contract.If there be a defect In workmanship or materials,or any damage caused by its subcontractors or employees that Is discovered within one year after completion of the work(including cleanup),the COMPANY will,at Its own expense,at its option,remedy, repair,correct, replace or cause to be remedied,repaired,corrected or replaced of such defect or damage. 4.The CUSTOMER has the following rights under Chapter 142A. A. At the time of signing this Contract,the CUSTOMER shall be furnished with a copy of It. No work shall begin prior to signing the Contract. B. Any party may bring an action to enforce any provisions of M.G.L.c. 142A. or to seek damages or the CUSTOMER may request that dispute be decided under the terms of a private arbitration program approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations. Customer Signature Date 7/2 7 /27 / tteigy Monster Date 1Iv(C'ACC . . m nster HEA"Work Order" Planview Diagram Air Sealing Time: I Z Vapor Barrier: Area: Z 00t.) Therma-Dome: Volume: /G O V Whole House Fan: BAS: /y 3-1 Exterior Door Weather Stripping: 0.7: /00 • Doo ceps. 220V N Existing Attic Conditions: CTrus 6">Loose Insulation Cross Batt / Modular (.{ I1.01 a 1-C - c, c k7o 'Ch 164 c 4. Li f tl c I ZC `,hl{i1'll it ., ti mass save m nster warm PERMIT AUTHORIZATION FORM I, LQS(�4,-rrnn S ,OWNER OF THE PROPERTY LOCATED AT: 1Q9(Q Il oVV.cv r 12-060i vl,c.� w ( ram 01 O i z (PROPERTY STREET ADDRESS) (CITY/TOWN) HEREBY AUTHORIZE r h e r 74'f of `�0-"- (PARTICIPATING CONTRACTOR) AN AUTHORIZED PARTICIPATING CONTRACTOR FOR THE MASS SAVE HOME ENERGY SERVICES PROGRAM UNDER THE DIRECTION OF ENERGY MONSTER,TO ACT ON MY BEHALF TO OBTAIN A BUILDING PERMIT AND TO PERFORM INSULATION AND/OR WEATHERIZATION WORK ON MY PROPERTY. J� nrl (`7rrCci I • Z7-• ZOZZ OWNER'S SIGNATURE DATE Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards ConstructionSdperVispr Specialty CSSL-102765 Ejc./pires. 0712212022 JOSH LEET 311 MAIN STREET =� WORCESTERJOW 01608 ()1S'ti�l:t0' Commissioner (1 OMc•01 Cansump Angry f b.nnsas Re uIaRon HOME IMPROVEM ENT CONTRACTOR Rs04ohition valid for Nrdhddral uses a** TYPE a ..44, , Wars in.sapirslb mum n dos.Ifo found mo sa: alfaLadiRr„ WM= Office of CMMIMisr Affairs and Ikastnesa Rsww, ISOM 09'.r$? 2 1000 ShIShinafte Smut.SaiN 110 I1€ENE RC;`/MONSTER MA !NC flogsfon.MA 0211t JOSNUA 0.LE E T 12S BLACKSTONE RNER RD ^-1�Fr+ ++1 WORCESTER I A C m r UrdErsecroaryf 77 ----IdvAt*3utsigitaturs