38B-275 (2) BI-2022-1655
15 REVELL AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38B-275-001 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-2022-1655 PERMISSION IS HEREBY GRANTED TO:
Project# INSULATION 2022 Contractor: License:
Est. Cost: 1600 EFFICIENT BUILDINGS INC 117239
Const.Class: Exp.Date: 03/15/2026
Use Group: Owner: BROWN KAREN D
Lot Size (sq.ft.)
Zoning: URB Applicant: EFFICIENT BUILDINGS INC
Applicant Address Phone: Insurance:
973 REED RD (508)279-1110 6H48605
DARTMOUTH, MA 02747
ISSUED ON: 02/02/2023
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 VIWLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
I o • if• ,2 •
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
4' • -1oAvIr
rj - a-zz 4., ,gu,,r 1 q i5
The Commonwealth of Massachusetts 0 FC
Board of Building Regulations and Standards 2� FOR
/ Massachusetts State Building Code, 780 Cl�>,\ D�? I LITY
USE
Building Permit Application To Construct,Repair, Renovate'Or ., ish a �evised Mar 2f 11
One-or Two-Family Dwelling ,caFc,-
This Section For Official Use Only
Building ermitNu
mber: .11- (�/,1�- s Date plied:
Building
5 / 2 -Z-Z0Z3
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Prop Arty Address: 1.2 Assessors Map& Parcel Numbers
)5- \eA)�\\ Awe /3 .276—
l.la 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 0 Zone: Outside Flood Zone? Municipal❑ On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
< c c (3t0..1 n Mr11, b'fl �M a 010(o m
Name(Print) City,State,
J .r Reel-Ell ftv Z 4.41-311-'n93 K 4)@,K ►-6aVn rep0/15,."5---
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building) Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify:
Brief Description of Proposed Work':
Irv' s_e_c_\\-
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ I p,O7 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ 1 0 Standard City/Town Application Fee
0 Total Project Cost (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fee,✓''"
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ I lD�, 0 Paid in Full 0 Outstanding Balance Due: _
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 15_ 'I 7Z3 9 3 J I Sl2c2 L
'1n Lpt 1 f..Qrj'l License Number Expiration Date
Name of CSL Holder List CSL Type(see below)
\ nd rOy- (2,6 7 S A"wR-
No and Street
Type Description
�
. I �
�'1'Nice-Nice bw'�- /L�� 0�' j U Unrestricted(Buildings up to 35,000 Cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M , Masonry
RC Roofing Covering
WS _ Window and Siding
SF Solid Fuel Burning Appliances
5 4-2 'i-1 ti 0 e L,enil'6,:0cU•ti,S JL5 i,t.c,w I Insulation
Telephone Email address D Demolition
5.2 gistered Home Improvement Contractor(HIC) 5-35. Q/67/Z°Z1
� G:t ,k r�t;(vti��s �C_ HIC Registration Number Expiration!'` to
om any N e or HIC Re stra6it Nance Q a
No.and Street C{, Email address
Zarly,o -. t/mot4 c).2-'-'tt"7- 5(e"Z39- ill
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 .......... 51p No...........❑
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�Vr l/\ 1—c- v"eT'i'y-
to act on my behalf,in all matters relative to work authorized by this building permit application.
Ili_d5------ I 2_) I ci/eR02.Z...
nt Owner's ame(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
con .fined in this app • ation is true and accurate to the best of my knowledge and understanding.
e /
it ICtIZ6Z1-
,'' int Owner's uthoriz 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 Massachusetts tA?°
-"liff DEPARTMENT OF BUILDING INSPECTIONS y{•
212 Main Street • Municipal Building
Northampton, MA 01060
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: 9-1---3
The debris will be transported by:
Name of Hauler: ) —Di sposck
Signature of Applicant: Date: ) 0/Z02Z
ACORO® DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 10/14/2022
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
RogersGray,A Baldwin Risk Partner PHONE FAX
410 University Ave INC.No.Eat):800-553-1801 (A/c,No):877-816-2156
E-MWestwood MA 02090 ADDRESS: mail@rogersgray.com
INSURER(S)AFFORDING COVERAGE NAIC#
License#:PC-514062 INSURER A: Employers Mutual Casualty Co 21415
INSURED EFFIBUI-02 INSURER B:Tokio Marine Specialty Insuran 23850
Efficient Buildings Inc.
973 Reed Road INSURER C:
North Dartmouth MA 02747 INSURERD:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:298022623 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 LIMITS
LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY)
A X COMMERCIAL GENERAL LIABILITY Y Y 6D48605 8/30/2022 8/30/2023 EACH OCCURRENCE $1,000,000
DAMAGE TO RENTED
CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $500,000
MED EXP(Any one person) $10,000
PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
POLICY X 787LOC PRODUCTS-COMP/OP AGG $2,000,000
OTHER: $
A AUTOMOBILE LIABILITY Y Y 6Z48605 8/30/2022 8/30/2023 COMBINED SINGLE LIMIT $1,000,000
(Ea accident)
ANY AUTO BODILY INJURY(Per person) $
OWNED x SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
X HIRED X NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY _ AUTOS ONLY (Per accident)
A X UMBRELLA LIAB X OCCUR Y 6J48605 8/30/2022 8/30/2023 EACH OCCURRENCE $4,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000
DED X RETENTION$1n,nnn $
A WORKERS COMPENSATION Y 6H48605 8/30/2022 8/30/2023 X PER OTH-
AND EMPLOYERS'LIABILITY STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1,000,000
OFFICER/MEMBEREXCLUDED? N N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYE $1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
B Pollution Liability PPK2477709 10/12/2022 10/122023 Occurrence $1,000,000
Aggregate $2,000,000
Retention $10,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
When Required by Written Contract,the Following Applies
General Liability-Additional Insured Ongoing(CG 7174.3 1013)and Completed Operation(CG 7174.3 1013) Primary and Non-Contributory Basis(CG 7174.3
1013),Waiver of Subrogation(CG 75 55 0219)
Auto Liability-Additional Insured(CA 7450 1117),Waiver of Subrogation(CA 74 50 1117)
Workers Compensation-Waiver of Subrogation(WC000313 0484)
Excess/Umbrella-Additional Insured follows underlying General Liability&Auto Liability(CU 00 01 04 13)
Pollution-Additional Insured(PIC-EVCP-001 0722),Primary and Non-Contributory Basis(PIC-EVCP-001 0722),Waiver of Subrogation(PIC-EVCP-001 0722)
National Grid and all divisions are are included as cited above
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
National Grid
40 Sylvan Road AU EDREPRESENTATIVE
Waltham MA 02451
1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
Commonwealth of Massachusetts
Division of Occupational Licensure
Board of Building Re ulations and Standards
I T:
ons Slipw-visor
CS-117239 . ; , cpires:03/15/2026
JOHN LAVEi rY
110 FRANCl3,AVE '
SHREWSBURY MA41/01P-
T
•
,j..T,l' `aJ33
4
•
Commissionert1).
THE COMMONWEALTH OF MA:SSACH-IUSETTS
Office of Consumer Affairs and Business Regulation
1000 WashingteA4treet- Sulte 710
Boston, Massachusetts-02118
Home lmorovernent Contractor Registration
•
Type: Out of State Corporation
' + ._Registration: 206585
EFFICIENT BUILDINGS INC a ` Expiration: 09/27/2024
973 REED RO
DARTMOUTH,MA 02747 -
•
Update Address and Return Card.
T E COMMONWEALTH OF MASSACHUSETTS
S
Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the
HOME IMPROVEMENT CONTP.AC'TOR expiration date. If found return to:
TYPE'Out of Stare Corporation Office of Consumer affairs and Business Regulation
Registration - Exglraticn 1000 Washington Street -Suite 790
20ES85 : -09127/2024 Boston,MA 02118
EFFICIENT BUILDING 'INC
r—OocuSianed by.
a-
Jiro REARDON 3 �avHt.S �c+ar IL A
973 REED RD i92c226691F49o...
CG.1�k
DARTMOUTH.MA 02747
Undersecretary Not valid without signature
The Commonwealth of Massachusetts
_"`v, _ 1. Department of Industrial Accidents
=ie1= 1 Congress Street,Suite 100
_ N_— Boston,MA 02114-2017
��4 www mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print LefLibly
Name (Business/Organization/Individual): Efficient Buildings, INC
Address:973 Reed Road
City/State/Zip:N. Dartmouth, MA 02747 Phone #:(508)279-1110
Are you an employer?Check the appropriate box:
Type of project(requir d):
1.0 I am a employer with 15 employees(full and/or part-time).* 7. ❑ 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 required.]f
9. ❑ Demolition
10❑ Building addition
4.❑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 WO.❑ Electrical repairs r additions
proprietors with no employees. 12.❑Plumbing repairs or additions
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs
These sub-contractors have employees and have workers'comp.insurance.:
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c.
14.0 Other Insulation
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 indicat 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 entitie 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:Employers Mutual Casualty Company
Policy#or Self-ins.Lic.#:6H48605 Expiration Date:09/01/2023
Job Site Address: 15 Revell Ave City/State/Zip:Northampton,Ma 1060
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expira ion date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$ ,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 i surance
coverage verification.
I do hereby ce under the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date: 6:2/J 9/72oZ 2--
Phone . 8)279-1110
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#:
DEBRIS FORM
in accordance with the provisions of MGL c.40,s.54,a condition of Building Permit Number
is that the debris resulting from this work shall be disposed of in a properly licensed
solid waste disposal facility as defined by MGLc.111,s.150A.
This Debris will be disposed of in:
73 f O0r)- /9-?/7 C6474/7
(LOCATION OF FACILITY)
„,,,,(4 AV,
Signature of Permit Applicant •
/a//
•
Date
IF DUMPSTER IS USED IN EXCESS OF SIX(6)CUBIC YARDS A PERMIT FROM THE
FIRE DEPARTMENT IS REQUIRED
FOR COMMERCIAL,INDUSTRIAL,INSTITUTIONAL AND MULTI-FAMILY RESIDENTIAL OVER 20 UNITS DEMO,
RENOVATIONS OR ALTERATIONS OF THE EXISTING BUILDING:
CIRCLE ONE
"HAVE YOU SUBMITTED THE AQO6 NOTIFICATION TO THE MASSACHUSETTS DEP? YES NO
1
i 1
City of Northampton
Massachusetts c°
DEPARTMENT OF BUILDING INSPECTIONS
',0f 212 Main Street s Municipal Building v r Ada
Northampton, MA 01060 *ON
Property Address: Qt 'Qi` &—Q
Contractor
Name:
Efficient Buildings Inc
Address. s73Reed ad
NBRRi UartnOum,MA U2747
City, State: _
Phone: ST) 1161 ( ( ( 0
Property Owner
Name:
Address: to) CLQ �L fi,d
City, State: pOKVIlVIANIpitkr\
I, Jh (contractor) attest and affirm that the budding I intend to
insulate does not have anoopen 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
Docusign Envelope ID:4E6FE3E1-F880-4C21-86C9-03CF89D0A6C8
WEATHERIZATION CONTRACT EVERS : URCE
CUSTOMER PHONE. DATE CUENT WORK ORDER
Karen Brown_ (413) 387-9943 12/12/2022_ 523847__ 61902..
SERVICE STREET SLUNG STREET PROPOSED BY.
15 Revell Avenue 15 Revell Ave[ Jeff Ledoux
SERVICE CITY.STATE.ZIP BILLING CITY.STATE.ZIP Program
Northampton, MA 01060::. Northampton, MA 01060 _ EGMA-HES:_= Page- 1. •
DESCRIPTION QTY COST INCENTIVE TOTAL
INCENTIVE 75%:_
For eligible weatherization measures, Eversource is offering an _
incentive of 75°/0 for insulation measures and 100°/0 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...
KNOB&TUBE WIRING SIGN-OFF 1 S250.00 S250.00
We have identified the existence of Knob&Tube wiring in your home.
A licensed electrician will conduct an evaluation of your home to .
identify whether the knob&tube wiring is inactive. Insulation cannot
be Installed in areas where knob& tube wiring is active._
PERFORM AIR SEALING AT ESTIMATED 62.5 CFM50 PER HO__ 2 : S188.66.: $188.66._
Seal areas of your home against wasteful,excessive 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.):
EXTERIOR DOOR WEATHER STRIPPING_ 3.- $95.43. $95.43..
Provide labor and materials to install Q-Ion weatherstripping to
door(s)to restrict air leakage.:
BASEMENT SILLS-RIGID BOARD INSULATION_: 115_ S560.05 $420.04 $140.01
Provide labor and materials to install rigid board insulation to the
perimeter of the basement ceiling at the house sill.
6 MIL POLY VAPOR BARRIER:_ 1351: $137.70_. $137.70._
Provide labor and materials to install 10 ml polyethylene over open
ground in designated crawlspace/earthen basement areas.
INSTALL 2"THERMAL BARRIER POLYISO ON OPEN WALL. 84__ S407.40 $305.55. $101.85
Provide labor and materials to install 2"rigid insulation board to the
open wall.:_
DocuSign Envelope ID:4E6FE3E1-F880-4C21-86C9-03CF89D0A6C8
WEATHERIZATION CONTRACT EVERSURCE
PiQigiWMA• nf. a,._ .t.;' � . 7,. max, xd.
CUSTOMER PHONE DATE CLIENT# WORK ORDER
Karen Brown (413) 387-9943 12/12/2022 523847 61902
SERVICE STREET BILLING STREET PROPOSED BY: '
15 Revell Avenue 15 Revell Ave Jeff Ledoux
SERVICE CITY.STATE.ZIP BILLING CITY.STATE,ZIP Program
Northampton, MA 01060 Northampton, MA 01060 EGMA-HES Page 2
DESCRIPTION QTY COST INCENTIVE TOTAL
PREPARE YOUR HOME —us
Homeowner is responsible for the removal of any items stored in the I '6-t (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: $1,639.24
Program Incentive: $1,397.38
Client Total: I $241.86
I.DESCRIPTION OF WORK TO BE PERFORMED
Contractor will perform or cause to be performed the above work at the Client's Address in a professional manner and in accordance with the terms of this Contract
II.PAYMENT
Client agrees to pay the Contractor for the Work,the Client Share of the Contract Cost is payable to the Independent Installation Contractor I IICI upon satisfactiry completion
of the Work.Client understands that they will not be required to pay the Program Incentive Share of the Contract cost.Changes to the individual line items ancc/or previous
etitjme rai�rease or decrease the size of the Program Incentive Share.
iAffull �'i°u� �vu�t, breww
@6cP@�9flS9@ DocuSigned by:
Ld,1... r irI®dBNG844BO...
Jeffery Ledoux 12/13/2022 1 7:53 AM EST
Printed Name Date of Acceptance
mass save
Savings through energy efficiency
PERMIT AUTHORIZATION FORM
1, Karen Brown owner of the property located at:
(Owner's Name)
15 Revell Avenue Northampton
(Property Street Address) (City)
hereby authorize the Mass Save® Home Energy Services Program assigned Participating
Contractor to act on my behalf and obtain a building permit to perform insulation and/or
weatherization work on my property.
This form is only valid with a signed contract. The permit will be secured by the
subcontractor, at no additional cost.
,--DocuSigned by:
I _ c.in, t2rawin,
\IIVW$ r kgf rvture
12/13/2022 I 7:53 AM EST
Date
FOR OFFICE USE ONLY
I1
We have assigned the following Mass Save Home Energy Services Participating Contractor
to the above referenced project:
Efficient Buildings
Participating Contractor Date