The URL can be used to link to this page

36-249 (5) BP-2022-0586 38 MAPLE RIDGE RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 36-249-001 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-2022-0586 PERMISSIONIS HEREBY GRANTED TO: Project# INSULATION Contractor: License: GOLD STAR INSULATION & Est. Cost: 3584 CONSTRUCTION LLC 065992 Const.Class: Exp. Date:03/16/2023 Use Group: Owner: SURECK HOROWITZ AMY B& SHANA M Lot Size (sq.ft.) Zoning: WSP Applicant: GOLD STAR INSULATION &CONSTRUCTION LLC Applicant Address Phone: Insurance: 1 CONGER RD (774)329-4664 65620B5N23815620 WORCESTER, MA 01602 ISSUED ON:05/25/2022 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATH ERIZATI 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: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: • 11-4t', I2 II Fees Paid: $65.00 212 Main Street, Phone(413)587-1240,Fa x:(413)587-1272 Office of the Building Commissioner ' ' ' ------.:-, ;;.:; . MAY 24 pepO 1 P TR b : Amp, INSE JONr� periN A o rog0oS , t tt. .,,77.`..,,..,.. IItitlilttt ' t'.tltitt \Ill ilt tit-1i i ( ii E,_l'' f'M ,y h;t, r fp i f° iw-- � ._.._ , MVP ' t'enti• , 6 p. eEui,..) i Ko,, ��Z 5-29-20z2 1,,,,L,,,:,,, 4 t ti.o.A�uttit,,r / __ SF( *TI(i\ I SItI 1v1(11011111)s 1 Proper() A tires I ' ‘,,,,,,,i, U i, 11.11t.s. ratio Amu ; 1 .-'t 1,,,, . (. 1;.tz.ku36 ) i',,,.. ..24 9 1 L.i, l.t, tft tt4 1 d,tt r,,4r, n4, .. ____. , 1 1.3 /oiling Information: M _ 1.4 Prupertl Dimensions: 1 /Itilt14 141,tn.i t4.cah,cd l ,i; I.r V i.:irxt tii 1 u•., ,r1tf i 1.3 Building Setbacks(ft) __w._� _ _ 1 _ i,— I I rtvit' id ski 1.ud, t(ca=1.,rd _ I I l'It4ur.d Prot'ided ��R..tarrd Prrntded 1 t(equircd 1 r..e dcd 1 — 1 1.6 Water Supply:t\l GI c.40 i 14) 11.7 Flood Zone information: j 1.8 Sewage Disposal S”tem: Pohl,.0 Pi-Am-0 f Lk'°`' — tlut,uk l'"":" 1 \Auueipol❑ (Sparc tIhrt,tt.ti-. to 0 I . t (ile II}e,❑ I f SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of He-col-AL .• Shone tl tit,State./it' 4u .,f:-1"root 4.113 'tI5 COS I-Mad.lddre>, SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) Not( f a tntctit l 0 I v,un_'Itutl(1iug 0 Ouuty-(kt.upiQJ 0 j Repairs(s) 0 Alterations) 0 E Addition 0 Iktrh,II(;In ❑ 1 .1 etessor% itIdo ❑ Number r rl I'nits __ Other 0 Spcit` 6.\J 4\t on __,_ I Iiricl1k-s riptitlit id I'r,rpt»CJ Wrhrk`./IIts,__Qx.j bj toi.J GL uS ._1/o � ,_ t SECTION 4:ESTIMATED CONSTRUCTION COSTS I hcttt 6)x multiplier I,tin,I d Cn,t, Official Use Only (I abor and M ikriah) I. Building5, I. Building Pcni it Fee:S _IndicateF how fee is determined: ❑standard ('its town Applicaikit e'c -.Ilrctrical S 0 I oral I'nticct(,1st'((tentx_�� .2.. .I'lumhirts S 2. Oihtr I cc,: S_ Y 4. Nir.hanic.tl (I IVA(1 S I isi: 5. \lecli.uural II ire - Suppression I S (otal All I'tt $ 06_ n.Total Project Cost: S ?'� Chcek No.lO.'Check Amos* Cash Amount: i, ,;-� _3t Li 0 Purl in lull 0 Outstanding( dance l)ue: i City of Northampton .. . Massachusetts DEPARTMENT or surtart7a rzesrrt"riciits 21? Main Sheet; • Munterp,r. 6uiiding NorthAmpton, MA 01060 t i 11ON DEBRIS AFFIDAVIT (I OR \I I I)i \JUi I I R)\ \\t) R'.\i.) I[0\ I'h0Jtt(IS) In accordance of the provisions of MGL c 40, $54, a condition of Building Permit Number $ is that all debris resulting from this work shall be disposed of in a property licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: 1 Yt-(Q e4 (A...)0( • The debris will be transported by: Name of Hauler: CI-) flu C:ie (1),/ Signature of Applicant: fC Date: OR i 1 ),P ..l,u)►,.1iiild jinni.,Jill pa1r1111+t 11,,y CrIII„Ari,kt 1 1avIik 1..,1ua<I h'h'I.. 1 1 �__ tt1dl)__• pl,01:11.11 ut,,i,t,,iu(l,u,.tlu,tl\i , 1 ca(pi,td �;Yair 1„.04))1+lN 111)0. ,1;wir:)t1 µ,i.(1 __._ —_.r.__--_.__-- slpt'y I(''l 10 JlyuatN N111110.1111N flu.1.yum±,; --___--_-.___..._—_,._ ,+au.,Ji','y toa.iytm+N _____.-•_— .,l i ii l 1,,a.,yum luuo Illo,I ,lyruyrll I II h'.I I',1 u'a i ni,,,ta!) (g,r,I!Jtt.,Clop•s,klilt tU iunrtl pay,0Ii I'II'II aitimiI) + — ----'p�uutyd I ii 1+,)rail a,k,p p,inl ! .t yaust p hill' yns(egg N L O ,ti,;'".l ill a NiAN it panto xi ttrt xumir i iu,nrxlnu tot ilankito)mit ii 1 I nlru+.H0{u1 t"?u, , -:i in'\I w t\ it punt 1t1 ur)ul1 ±tuI .NI I mil tin Iknlrultgu!Ittru(k11n1 asap() ‘.,i-1 , I'i IN.riptn1 puns Aitn'Jrnit Jut utyiioid Iaunrauyn'.toil of,,.»:ur rill;IV II!n'11111T1ua,l i )Ii I+aui,ra(,+ )nimu.l uadtty aural)atli u!p .i.tls! .tJ into x1►lranrvl pv i•ii1 Jtm 111•' !g u(tn Jam"'111'Jo•,IJust 11"a.,(I'!g up ui u(LL11d Mu!p11114 I',u!rrytt ugtt alunO uV • IS310N 1pr I)J1n u•t(',,(u o-,.1 i).,,ur\.+I.i\ l„nx,yrn, in.i I."()u,ud -C f16)[San 7 +r ._101c) Iq vet u!piinsiapun par aip.,l,n+wy<+u TO l,ay,Ip of.trm:uar par 1+1J1,1 inuiW)Itddr silo ui p tL1 luua 11nlru+Jtti++!;lip in Ili')rgl,(mind)to smi rtixl pin'',flirt.'mit alptm+suiir;C41.011 i'nuh ti)null 1411$tt!11110+41 N1)1.I.VIIVtX3(1.LN3`)V(137.I11OHIIiV IIO iNINMO NIL N( I.W'3S p• (vltirur!%uuwal.vt I),umti 1. .a(11+u1,1 i (� n,,Iu''t1JJr uuu,J u,pimnq 51111 Cy pliuu(pnr lam 011s!trtu vlprlu Ill'u!'lirgly int Itn Or of I �Z� " "a. 5 I l p g liutupnr iya.uni quldwd ivikins Nil in aau►tll,r-1 1.LIN)I:id'1`vltl 11i18I10:1 5317ddV t[().LJYN3.N()1Nl),I.l1i:('.W N.213hM0 WAWA lI I ! Id hi(L)311().L NOIIVZIIIOHISIV Ii3NM():gL NOI.tJ:IS '-- —� 'Humid lutpltny.g►In xitirn„1 all to Irtulp alit to tin+aa Ili:n usrp!lir slip 1pt 1„ad t,I,unlit,I mini,lgddr styi III," p1Iirtuttn%pity parlldukni 1y I,nm utrp!yir 1kimst ul ntull',R'd!(h 1„1yluyl l tlott,i 6 t,.i `I• i 'i'Iti1IIk\ill Iit I )1u.VIP.1'.0Itv, 'idlV0.),SI13y010Nk.111/40l1 )I" t! .,, I ot s 1 1 f)9g1)E• ,x i)I ` - I. ,'7 ) , .r t ,,a s. t11 111'1,,. , ,,, ,ui:atlt.,i try, � , , )111 1?�,:nIl =lilt, 1c v 1i,- II i VI %t,1t t,; rat,'rs eto0,0 C II II)JOlur_+Inn)latu1 will rut 3utnli1 ti,i,,-,' I :s ` t i 10,1)1,tit I;l '\+.)?1,\ :I try)Vi 1 .. \-)k `• ,Ili i.s , . 1 1 ,.. ♦ (...„1 u,, �� ,.1 1 t li \ \ 1 1• l )t l { I t\ , + 1 ' n , t bs,o ,(ilts, lt„ I I, )1 , ,ti i 10%1{1Itins, nn►tt t I I 11 11 1111 ) i)I I�\() ) � \OM I ) IN. i (lit p://WWW.maSS. V This is an official application of the Commonwealth of Massachusetts g�)'Office of Consumer Affairs&Business Regulation (httD_//www.mass.gov/ocabra rHome Imp ovement 9 Ccntlactcr grog-an~ n,aa.,.!.......... ..,.. . . ../. h I.....,......,.,.. b.a.. ...a /L ....-.... ........ . .a . , a n Mass. (http://mass.gov) My Registrations • Your company Registrations and/or Applications with their statuses are displayed in the list below. • To manage or view any Registration, click on the appropriate Task button. • To register a new company as a Home Improvement Contractor, click the Start New Application button. Start New Application (/HIC/Register/CheckList?contractorld=0&applicationld=0) Contractor HIC Registration Effective Expiration Application Application Create Name Number Status Date Date Type Status Date Gold Star Insulation & 200228 Active 12/04/202012/03/2022 Initial Registration 12/04/20� Construction Application Issued LLC Initial Registration Glen Powell 191554 Expired 04/27/2018 04/26/2020 04/27/201 Application Issued © 2021 Commonwealth of Massachusetts https://hic.oca.state.ma.us/HIC/Register/RegList 2/6/21, 11:22 AM Page 1 of 1 �,��,,e''"?.a �r, ,, ram ., + ^�'i*ri s r• ..„ . .' ', '. "' a ,` ',,,,,q -) ,z. ^� Rix „!,,, ''� g h,ro°:M'`" �`��F.. 3..... h, ✓ h' .,1.y, „ �,.y vimzi.zi ,4,�'. ',,w.rr4'nw`� . �s st ''�. .',,,y;: 3i *..•,,°i ,,, Y S+a:,. ,:-''y➢ "yi't _;t{,. A£. � k�'k2sf'L' iQ. L 'r� .ads.ykA'1{., y y+'h'''*.s "Ttl$ i 3 .�4{ At Cornrnoriwealth of �, FPM ir. a ,�achus � ` 'VOA,' r :• [ . Division� ..t...„.7. .;4°-- - 3 ' Regulations and standrds ''* - . ; `"�,,,?^ast a f'§"' �-t�t ,r$r `',�.*�� t'� "� �r�, J 2 ". i,, „i.T.V.y;:, # ,:�y Sri,ya , -* �j :3 R`�,r., r I � ,&G; "«t�d�`34 fi 'd `�`' *�.e.y �w 3 �,;y`r,. z:. .w. .7 t'k= s�z� of '`5,,,7t t,,, su 1'`�{ .y''{"r'•c'.� . _it,� l G' W s a 3, :+'�. t �'44*,z, ''? yy�, `. z, r. :fir,-per*a (.4. m a. :y y-.:.: y� ram!'. +.'`"t,:. at ,i.Y y, 's.. +,.'s t.,...• •„, �'!t F.,,..., ''F h-,3. * $ .:'P'-b:_ 4 M� Y .. lily,.S T4 • .0v ^' Ft W 'i'h.,} �.... �,'YS;. i � `."{Y { • :;y3;: "- , .(t G lh'. �M1�.K.. F,4 6-rlJ ,A f)ll -+¢+hC!. k y_'� •�'�1. ^� f �� k fD.Pi.lS4t.0§'i',e,.m-.k..il.V'.i-..I_,-'I=.:i,w-t,+,-'S eo t,-.k..ba.-.,d.r.,eI,..-.V.4,O V:,5',T1.,..=.N:,.1.,tif=-'-',-A-,rI,aL--i.,'AI,.,,. J7. ♦tom l i '} �°" sTa '#qt'` -s;;a#r^ ":Y 4 .._�.-.3.x, Ai {"' git s tom, �,A F`.Y y y"`r--44,k'"j y�y-si�sq^fa �• y.Stly�.:L '. ^J i ,rl 8 •4a+' t' g 4'''':r .w.y ,1•7'�,g ...k 4 _ tc C .s a ., artz_ - r 4 x ' b" bf'a:w+' ` v.>X!'it. 'S S 5 ,y *�.a'i'kkG r'" i� .c< Y'.✓. :r ..,'' aFr@ i r „+ s i'. ..s' `w F:.' t#"`,:.:s �.s.K r . r5 . � nib' 'z t �. a'` t -t 1 ,.- ti„,� -0.r` -.. ��r,',V:-ss y'''.�'` r8 b,,i4" j.-.V..' ". ., s A'r.i'W. _,4. .. ,, '""•"i f; .w .r _F 1.,r, . s..�2"-t. `fi F x'. Y,'3i ' rci 4. d 4 3 i"'. .,+'w;yC''txs� .'. .y F - 4'� r i f k t 1:�`E, a;# �t: ` ,`t"'' a ,Tqt�-"'� 'a` � .� $'7?:.✓r °�4.a ..t''1''vi x'q' l g,r^',-'"� 1 n t�, r. a� :c 5"a# t rr ':.zt..� ;' a` ._4 'd! . s r o> .::- . N4 {'•aF *y r'Y r, .- , `4 r# ..:•r ,,r, ` '-y Ili ' ' .' �.„,--..„s3,,, ;.-..,-,,.-:::-,:.,• -,.,;.,. .:::,,-..,-_,..,,.:_.-,.:2•-i--.,-.•_ - .•.-.;,, —.- .,_- ..•._ w%,...,:.: .,....;:.,......,. .:_y. .: . . ... • .,, _.,:,,,..,.....,:„...,.,: • s'r - ''ttii �'-ez}L:t '�s� �` a i Y °` f +s a ,t u • M 1 4 sue' >, �°..`3,4 ,�H,� `�`' �r 3 � Yy a_ Ei'- e iy rzs`r�-s r ' . 7 v, ,9g r ra Py�":'. � '4i'� 'Y��sM'}'+r��'�r t3�S�,uy 4 �^S. '". � I ;,�, 1 Y r' .. �' j` L a 6 • S 'i F ; •4� yy " ! s 'r '' gs, vS:e Ft; .t ., f ' l t - fie a' '4' t* ., •-1s� a.t r n t ,t.X Sr'r. .,; p a y; ., �; h 7 3 b z ,. .i '' � ;5'�_ >.a r $?.rt3. '� ' `q -; v,a`' se s '? 3' t_ <4. v h 6s.. '^ a' y r.:: _ d;3 ay.'d a 'S-'tt7 '4 s,y; `,:I �' _ �-' d a ; 1... _ .r - 't. c': -3..r a rz . ��."�� *34;`tom' � <� `. �,Gd i* z _ - �f`r �q , '' � y:. fr r`s� ^� r r"i� . r,+}C �.�, F �i+ �� r' 'sv-J'y.,r�.i�<�^.yyii�, -''�Y-!4 < '.,t.„.:r ,. ztz :y. `r § _,_4• 's w: x , 't " { ,r.. r' x A_ n. f.; a Ya 4-r,,,r, ' to ,m,. .:__„,Y4 . .Y•};& r`,-,:k 't'r /. .� '' v tf o-i w s'# f :� r j a s y 3 .n ,.. r•t t r, l#"'e p . e��. '3X.'i ',..x.�"'Y. 1' �`r•;aq `: F �d `v _ ..i_ti v��s�rta.�qrt �. ,a - � t ,4 f`- y' a# s 'fC .\ :T 'n1`,'R' £ �� .; 7 ' �,�rx 3l` .c., s x.t .. # .s• ,, Z. . ' , .,z•. ...,, w"y x �� ,,.. ��,��{,, �. 'C �`•�' ? t�,xrv�.'`'S� �.:"z t�`! _�'.� ea �e �4 r ,, _ '4 r ``'�_ ';_ z.�.;Y 's�gt�,�at „R'�.�;., �; +ror et�'' '�'s+.' `�^� ��`�`'^"a�i"3�'�� 'Yt'lt' �� .�*f�7t it. F��e��Y.4 '� �s'h 'i Y z.� .:s-.€��'� z a' ��"` ��__k qq �j` xd '{' 4`a'x ';'.'�k�'�� r 1 .',,,':' r 4 s . ..a: 5"r, �.'{t.'^'t €,2 4 f4� i 'tt.Z "s'. f X '^€ `"k.' x r,,:i ay ` . h�'a� yk ^"j',•„�` d k.a C,. }..@. ,�y t�,, gg�� 3', u. f rr - 'J�.'�>�' s i+ 24�.K' 3. %..a i�•.r rin rYR n i �; . y. . )) 'it'''r .- i. < .,Y 4'F .. ty.. r } 3 a: �v 3 'r r, � i�'``�Yp, .t 6 1 �. alZ-: s ,; 'd,�"7 ''-'i 'F ,Y 'k § s# ,4 `ar. �"}" ' 0.'. '.5' t r . ,, { s` v as i.r,'-' � `� :. a (y '�'w .. 'i`-?i K i-'" ':;p' w:♦ 'p^ s4',. - ; �'.:y _--y+` `Y t " ,�-..3;• r �' '�.a x k '' SFa�, �'��'� �� `,�� t _'.R,.,4 x�, �`�` � � �' � ' -. _ r a � �-� � ,rya ��. s s- 5 �_5 �, ,,g�.„,,y�-'� 'i -.Y. w ?• it 5- € 3 .�" V.-' a�a;� ',-- a., -, ,.r`"�},k+' .•�" • 'hs 'ti r z .4!!@,L,�., 4K �azh s t .# �, � `,F' *ity f w ` �.? _y'4 � r:''4'�i ke,.r� y y.'.. v • Y R*t 4' u= m0 ", $,`}�.4 rri 6'}*'Y � tr .ic *•;..,r 4•C1 "- .ors' 1 ",..Si';,.rat 'f' } ,�i. Ij >% ,, ih- y. '�} �':',�,.n fi+ �# .P �� r'�7 � ^'w%'' _ _ y-"�^'�at?�V. � 'i•^Y ��4� `c, a r� g 'S -f' rA a'*a.. „- ,` $ w z."'r3.c. ,-, s-. .E a a ,,,o Y ,t� .%, t '� -1 ,',''"•dr4 -.'S7. ri # '?ram.- �ti 4 , r ' xa. � �r 3 �, `0 � sa, +z9:.i - ..4,Y'X P.ra., s a r,'r: . `� ': '� �yu "F. ,s a .t' '... . L x ,'- t,.,a r x•,° E '. „;4 ,,, ,d`, .„ - ,,,,..s `r � * Z w''. 'Ft.-'' v`^ . .r r• v' rr y. , k aP-04.-y."' '',. d T=Y :.k 4. v `i'?i,"`r:A�di- ,, it" t'u^?;r` x4.4 �: :. ,e' �( r "4• ,1. '1 k;,, .? g" ` $a xcoa t r ' fr � � �. rr b} 4 x � } a s 3rYy y 7. e" i K3 ,jr , ! rg-4#' ,x f-, �•{� fy. - g t ^v: y533a � i _ 5.„ r'.`r. « 1 -,�": '��, ' �� w", w-�",� � s 'i � i�;,:�.9.5, �-:�,xq.. �e`�,„,� e a*+ tl;. '' � �t °iP`"•'x t '��`:A� >t Y:t"�a � 4� t �;-`y X'' .e: '�'. _ ssr.,�+� '$aF'i*�� V k.� .� 3� ,z�� aar 3z . i L ^ft',f , .. _Z. 3 4r.'r4'�3 .t 4 I..iy4„'#f ^ 4'Y4Ys`4,•r rate,{ ;twit trr, -' 4r* k.. . $y-l'': .1,1,+',44- ,- iz!A,. 34- .. z 6 i x+ 4�^'^`.� 4.a`+Y�r ;. "� r ,�,FLa "` , a -rjS" ,Y} tt . �` t�N x , s _ .. to ^ c€ '+�''s,'�'x.�F'� 'z' ,w a'i ' ¢ r v r°"°,,.y .' `�`C xx -.-, a t� .`fir+'"^5 ,, ' m v'k `.,. r �'€t h n, . • �*�'R.,ray, ,+`� ,M� � -�. �r w` �, a d ar � "'1 sa riz J !3?t '�+ �.'a * �� +e tw^n ill X a + ' q� .^..� r R- o "C z m � e . .ht y y " r ^' g` i ar 7 v` cr The Commonwealth of Massachusetts ' —.Ali.(1 Department of Industrial Accidents I Congress Street,Suite 100 "_ Boston,MA021142017 www.mass.gov/dia woOr 'Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/PIumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information %/ Please Print Legibly Name (Business/Organization/Individual):� Ld _Zjfitµ�Kfr,.,�M ( �,,�liste..4tu..i I.h. C... Address: I Ca4 - 1 g 1) City/State/Zip: („A., ,e eriGW 0(6 6 rj, Phone#: /477111---311 4 46,Ap Are you an employer?Check the appropriate box: Type of project(required): 1.2 I am a employer with 8 employees(full and/or part-time).* 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance require] 9. El Demolition 10 ❑Building addition 4.0 I am 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 are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp. insurance. , s 14. ther a44 CJOr/i 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§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 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: titn101 Mi4 tucks • Policy#or Self-ins.Lic.#: ‘5& Zo Q 5n 2.51166 Expiration Date: / ! • 1 1 - ta Job Site Address: 3I Af I tl e_ ), �� City/State/Zip: rt�'r' L,h',' (It,.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. I do hereby certifyvunndeer the pains and penalties of perjury that the information provided above is true and correct. Signature: `�e;�e` Date: 6 5/ b /c)Phone#: Ik' SVt l ,(oit ( Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Ora u.Si vi i nookilsrr 10 041011440(.40(. f A O 031 d?AA , A Ii{i(114 ' e 4 A RISE t N(ttNt I h'iN( OWNER AUTHORIZATION FORM Amy Horowitz ____ , (Owner s Name) owner of the property located at 38 Maple Ridge Road . (Property Address) Florence, MA 01062 , (Property Address) hereby authorize Subcontractor(to be filled in by office) 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 The permit will be secured by the subcontractor,at no additional cost. It is the homeowner's responsibility to close out this permit by contacting their municipality at the completion of this work. r—wcuspma e► av,y tkoretrn CAVne*A'Sl hatthe 4/26/2022 I 8:22 PM EDT Date RISE Engineering,a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335 www.RlSEengineering.com DrIntS91 Im5410pp ID D5O13460C TAU}-40,33 C-CA 9 radar&ID I OS 040%21 RISE Engineering RIContractnr Ragla:abort No t11e6 MA Contractor Reg atratton Ne 120979 CT Contra:tOt Ragloratlon No 610110 RISEL 60 Shawmut Road Canton,MA 02021 CONTRACT - WZ 339-502.8335 X-7100 FAX 339-502.6345 Page 3 PROGRAM 'me CONT#AC T O ENTEEIED WS BE Trott NRHR ENSTNEERtwp.ASS RIf CITATOMER FOS*ORA AS CMA-HES OeKIRMIRD*Et Ow '1,srnterN PHONE DATE dartea *VWFXDEIM Amy Horowitz (413)585-0608 03/30/2022 451964 64105 38 Maple Ridge Road 38 Maple Ridge Road Jon Patton ST Trt rrTv MYRTE IA EIt1N.Clry n,Ali zw "^ Florence, MA 01062 Florence, MA 01062 DESCRIPTION QTY COST INCENTIVE TOTAL STORAGE -BASEMENT Homeowner is responsible for the removal of the stored items f r blocking the installation of weathenzation work in the basement Removal must occur pnor to the scheduled work start. Total: $3,584.35 Program Incentive: $2,899.52 Customer Total: $684.83 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS FOR THE SUM OF "'Six Hundred Eighty-Four& 83/100 Dollars $684.83 UPON RECEIPT OF YOUR RISE ENUINEERING INVOICE CUSTOMER AGREE:TU OCTET AMOUNT Dilt IN I ULT.PMITRE.5I UI 1'.WILL Tit CHANGED MON I HCY ON ANT UNPAID BAT ANCE AFTER IO DAYS SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTFFS RIGHTS OF RECISION SCHEDULING AND CONTRACTOR REGISTRATION �--DocuS:uncd Oy ( I)Octl LIJnr ( d Ny MT T2EPKE517rTA'11�'L ills"---ct ST SOAR S{13Ti hMt. C 77 0 ROTE THIS CONTRACT MAY BEWIHDRAWNBYUSA MOT EXECIITED WTTHN DATE OF ACCEPTANCE 4/2"/L022 I 8:22 PM LEI SIGN DAIL 30 DAYS ACCEPTANCE OF CONTRACT THE AUUVE PRICES SPECIFICATIONS AND CONDITIONS ARE SATTSFACIORE TO US AND ARE HEREBY ACCEPTED YOU ARE AUTHORIZED TO DO THE WORK RS SPICE AD PAYMF NT Witt DC MADE AS OUTLINED ABOVE