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32A-188 (3) BP-2022-1377 29 POMEROY TERR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 32A-188-001 CITY OF NORTHAMPTON Permit: Ails Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2022-1377 PERMISSION IS HEREBY GRANT:D TO: Project# INSULATION Contractor: License: Est. Cost: 1431 BRUIN REMODELING GROUP LLC 053402 Const.Class: Exp.Date: 03/28/2023 Use Group: Owner: KALLET KROLL JOHN H&LISA Lot Size (sq.ft.) Zoning: URC Applicant: .BRUIN REMODELING GROUP LLC Applicant Address kh ne• Insurance: 208 POND ST (508)881-8200 7PJUB-6R391059UB ASHLAND, MA 01721 ISSUED ON: 10/26/2022 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHERIZATION 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 VIO i ATION OF ANY OF ITS RULES AND REGULATIONS. Signature: att. if Ti 1 !` ( j Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner , t.. / A, '1-�V ILT The Commonwealth of ssacWs /`j _ Board of Building Regulatis an Stan �� • FOR Massachusetts State Buildmg�Cdde,. 80 CMR.,. U�E L[TY n.,o� .� Building Permit Application To Construct,Repa'ir., 'np to Or l lolis a 'evised Mar 2011 One-or Two-FamilyDwellin` ..4111 This Section For Official Use On ''goFer, Building Permit Number: AP•• A 1 -• I 37 7 Date Applied: °so��S Eu110&O*),5 )/� I6-24.-ZOZz Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Addre s• 1.2 Assessors Map&Parcel Numbers a_ok -yvMQcu i, -v-c(Cc-ct aA is/ 1.1 a Is this an accepted street?yes no 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 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private❑ Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Name(Print) City,State,ZIP aA ?oct-\Qr. , tr._ffr t,4. (4V - 3ts- tA.37 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition ❑ Demolition 0 Accessory Bldg. 0 Number of Units Other lir_,Specify:W 4V,A1 --1 iv\ Brief Description of Proposed Work2: (;c S e.k.V;r\,1 ( ; c1 t} 0 0 ter, n v.1F..-1 t u n k rl hc-��.�,t.scx SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) ` 1. Building Permit Fee: $ Indicate how fee is determined: 1.Building $ 1�L��1 0 Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ / Suppression) �j n . u Total All Feed/� Check No� Check Amou Cash Amount: 6.Total Project Cost: $ 1`1,) 3 \ 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS--'0 53 yG 3 /a /�3 V L M 2 5 a-G S s;r,; License Number Expiration Date Name of CSL Holder ill List CSL Type(see below) .(\ le 0(4 No.and Street Type Description Unrestricted(Buildings up to 35,000 cu.ft.) M 0 d e..r"%-av i (\t1 P c0 C J R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding �/ SF Solid Fuel Burning Appliances () -- ( — b a'0 0 I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) \ G /' 0 /3.k1 Q(\p,n RQ c- U e) tI. L'r u v‘> HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Ndnie 0`3 '?uc\� St. GFf � � ru:.r,Cor ru� No.and treet Email address RS�, N\ U. ‘ S`o -st\ -1a.°' City/Town,State,'`ZIP 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 No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize ) C Pft C S c .C IS►� to 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: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. 300-) L nass; Lc) / 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 SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD it 11) / SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE City of Northampton o0.T 4AMJ To ��✓ " ` Massachusetts ��'�Ss DEPARTMENT OF BUILDING INSPECTIONS P'. 1 ° • p 212 Main Street • Municipal Building va.. f'► \` Northampton, MA 01060 �bW aP0 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: v Q.A9 c t The debris will be transported by: Name of Hauler: V a PA, Signature of Applicant: Date: l U /34. The Commonwealth of Massachusetts _ / Department of Industrial Accidents =d I Congress Street,Suite 100 _ M= Boston,MA 02114-2017 r F www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual):Bruin Remodeling Group LLC Address:208 Pond St. City/State/Zip:Ashland, MA 01721 Phone #:508-881-8200 Are you an employer?Check the appropriate box: Type of project(required): 1.®I am a employer with 10 _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. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required]t 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.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.1:1 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0Roof repairs These sub-contractors have employees and have workers'comp.insurance.: ` l.El We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other w Q h�`L _ �( ► 't 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 indica'ng such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entiti 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:AMGUard Policy#or Self-ins.Lic.#:7PJUB-6R30848-4-22 Expiration Date:4/29/2023 Job Site Address: , t k G NC,( o vk '- . ((INA.,4 City/State/Zip: (4 c-. (t,�f v10(C3 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure 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 t $250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DiA for nsurance coverage verification. I do hereby certify under the pains and penalties of perjure'that the information provided above is true and correct. Signature: / l erp _ Date: V U/ \C\b- Phone#:508-881-8200 Official use only. Do not write in this area,to he 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#: �--.40 BRUINRE-01 SHEALEY ACORO" DATE(MMIDD/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE 1011412022 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 ME CT Sandy Healey Jewell Insurance Agency,Inc. 508 872-2764 1101 Worcester Rd (A//CC,No,Ext):(508)879-1310 208 FA,Not( ) Framingham,MA 01701 no REss;shealey©jewellinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Norfolk&Dedham Group 23965 INSURED INSURER B:AMGuard 42390 Bruin Remodeling Group,LLC INSURERC: 208 Pond Street INSURER D: Ashland,MA 01721 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD INVD POLICY NUMBER (MM/D MM/DD/YYYY) UNITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAMS-MADE X OCCUR P012212513 4/29/2022 4/29/2023 PREMISES{ERaENT Dnae) $ 50,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 _GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY Fla LOC PRODUCTS-COMP/OP AGO $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY (Ea aBI dentD S)INGLE LIMIT $ 1,000,000 _ ANY AUTO 92282328A 5/4/2022 5/4/2023 BODILY INJURY(Per person) $ X AUTOS ONLY AUUTNOSSyUyLNED BODILY INJURY(Per accident) $ X AUTOS ONLY X oats aTYtDAMAGE 4 $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE U2207879A 4/29I2022 4/29/2023 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ B WORKERS COMPENSATION X STATE FOR AND EMPLOYERS'LIABILITY 7PJUB-6R391059 UB 4/29/2022 4/29/2023 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE YN N 1 A E.L.EACH ACCIDENT $ RFFICER/MEMBER EXCLUDED? 500,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOY_E $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main Street Northampton,MA 01060 AUTHORIZED REPRESENTATIVE I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts L Division of Professional-Licensure Board of Building Regulations and Standards ConstruCtion'Supervisor CS-053402 expires:03/28/2023 if JAMES E ROSSINI f 9 AZALEA DR MEDWAY MA_02053 % Commissioner dad /i. bF7„aL't •2-6 fi`(6st,ZaneumerilrAi y E siness,tfepwl6Oon HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 205013 04/10/2024 1000 Washington Street -Suite 710 BRUIN REMODELING GROUP,LLC Boston,MA 02118 � l JAMES ROSSINI 208 POND ST ASHLAND,MA 01721 Undersecretary Not valid without signature r,, City of Northampton N 146 f '' Massachusetts ,> DEPARTMENT OF BUILDING INSPECTIONS ft x. _.-�. � 2I2 Main Street • Municipal Building �� ,, w .:Ica Northampton, MA 01060 m/�. ' . Property Address: 4 1 rtr\e‘ eN),17-cccc,s....„ Contractor (--, Name: 1J ( `.t\., r\ -- I iv-N. rib \•"\.' t3 r av\. / -)(A Pil-.o (1-(15 c);n i Address: U i i), "Di- City, State: PS V\l,-.r.., , (,-t r-r- 6 k.) z\ Phone: S °I — i'C \ - a 4 Property Owner. Name: A'";r.t \``�C u l\• -T Address: \ r1-\ ( v' ... 7 v.-L < City, State: N) <, Orht-.(v.\c)A-4 r1 (U1. I, tr., ', �� in v 5 �,', (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..1_ 1`, '' Date r t ' DocuSign Envelope ID:80CA45E8-0FB5-4AB7-8E1F-3E1C9A4DA068 Federal ID#05-0405629 RISE Engineering`_. RI Contractor Registration No 8166 MA Contractor Registration No 120 79.. CT Contractor Registration No 620' 10 RISE60 Shawmut Unit#3,Canton,MA 02021 CONTRACT Y11 Z ❑ ENGINEERING 339-502-6335 FAX 339-502-6345 Page 1 . PROG RAM THIS CONTRACT IS ENTERED INTO BETWEEN F iE u ENGINEEREIGANDTHE CUSTOMER FORWORI AS CMA-HES DESCRIBED BELOW CUSTOMER PHONE DATE CUENT I WORK ORDER John Kroll . (413)215-1037-: 01/21/2022: 336049 61902 SERVICE STREET SLUNG STREET PROPOSED BY: 29 Pomeroy Terrace 29 Pomeroy Terrace Jeff Ledoux SERVICE CITY.STATE.ZIP BILUNG CITY.STATE.ZIP Northampton, MA 01060_ Northampton, MA 01060- 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°/0 Heat Loan to finance your co-pay, applications must be submitted before the weatherization work begins. �r > KNOB&TUBE WIRING(Northhampton):. We have identified that your home might have Knob&Tube wiring ` _(initials) present.The following contract is not valid unless accompanied by `i - the Weatherization Barrier Incentive form, signed by your licensed electrician.Work will not proceed with this work until we receive a copy _ of the form. HOME AIR SEALING 2 $170.00. $170.00 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.) DOORSWEEP 1. $25.00 $25.0C Provide labor and materials to install a doorsweep to restrict air _ leakage.. BASEMENT SILLS RIGID BOARD INSULATION . 168. $665.28 $498.9E $166.32. Provide labor and materials to install rigid board insulation to the perimeter of the basement ceiling at the house sill. INSULATE BULKHEAD DOOR 1 $110.00 $82.5( $27.50 Provide labor and materials to insulate the back of the door to the basement's bulkhead with rigid board at R-10 or greater with the required fire rating and seal the door's edge with weatherstripping to restrict air leakage. CRAWLSPACE 10MIL GROUND COVER. 475 $460.75 $345.5( $115.19 Provide labor and materials to install 10 ml polyethylene over open ground in designated crawlspace/earthen basement areas.. ASBESTOS PRECAUTION A blower door diagnostic test will not be conducted at your home, as a precaution for the presense of steam heating(past or present)that was most likely insulated with asbestos. DocuSign Envelope ID:80CA45E8-0FB5-4AB7-8E1F-3E1C9A4DA068 Federal ID#05-0405629 RISE Engineering RI Contractor Registration No 818E MA Contractor Registration No 12t 179 CT Contractor Registration No 620 20 RISE60 Shawmut Unit#3,Canton,MA 02021 CONTRACT /1 Z ENGINEERING 1 339-502-6335 FAX 339-502-6345 Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN I SE ENGINEERING AND THE CUSTOMER FOR WORI AS CMA-HES DESCRIBED BELOW CUSTOMER PHONE DATE CLIENT# WORK ORDER John Kroll (413)215-1037 01/21/2022 336049 61902 SERVICE STREET BILLING STREET PROPOSED BY: 29 Pomeroy Terrace 29 Pomeroy Terrace Jeff Ledoux SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Northampton, MA 01060 Northampton, MA 01060 DESCRIPTION QTY COST INCENTIVE TOTAL PREPARE YOUR HOME (-D, Homeowner is responsible for the removal of any items stored in the �k _(initials) areas where the weatherization measures will be installed. The workers will need the space cleared to safely bring their tools and materials into these work areas. If you have any questions or specific concerns, please bring them to the attention of your subcontractor when they call to schedule your work. Total: 0,431.03 Program Incentive: 1,122.02 Customer Total: $309.01 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Three Hundred Nine & 01/100 Dollars $309.01 UPON RECEIPT OF YOUR RISE ENGINEERING INVOICE,CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF 1°4 WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. DocuSigned by: DocuSigned by: Jr t h 4 J.. krill •-stW.64tLt lil&1W1__. w696r +A706ki.. 1/23/2022 11:20 1M EST NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE SIGN DATE 30 DAYS. ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDn1C 'S ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO HE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE DocuSign Envelope ID:80CA45E8-0FB5-4AB7-8E1F-3E1C9A4DA068 s RISE ENGINEERING OWNER AUTHORIZATION FORM I, John Kroll (Owner's Name) owner of the property located at: 29 Pomeroy Terrace (Property Address) Northampton, MA 01060 (Property Address) � F hereby authorize I:3lv,(', i ,,Jzk,; 1r(c, Subcontractor(to be fil ed 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. DocuSigned byKma O NITegt@h5` re 1/23/2022 111:20 AM EST Date RISE Engineering, a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335 www.RlSEengineering.com