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16C-019 (5) BP-2023-0270 410 SPRING ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 16C-019-001 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-2023-0270 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 9500 EFFICIENT BUILDINGS INC 117239 Const.Class: Exp.Date: 03/15/2026 Use Group: Owner: WALSH GOLOSSI JOSEPH M&NICO—E C Lot Size (sq.ft.) Zoning: URA/WSP Applicant: EFFICIENT BUILDINGS INC Applicant Address Phone: Insurance: 973 REED RD (508)279-1110 6H48605 DARTMOUTH, MA 02747 ISSUED ON: 03/07/2023 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 VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: it• , . �I . Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner t 11Y1iL: 3 —7 of --� '`� " ui`T I830 2lq� r�. The Commonwealth of Massachusetts 6' 7OR 4 Board of Building Regulations and Statr4s <20 ,•'MUNICIPALITY Massachusetts State Building Code, 780 USE Building Permit Application To Construct,Repair,Renovate O'^3 olish at r Re"vised Mar 2011 One-or Two-Family Dwelling ,a ,,, `.,,� This Section For Official Use Only Building Permit Number: 6%'"3.2 ,e3/0 Date Applied: Ilv„0 (/ss `/� -7-Zvz.3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Propert�v'^_Address: 1.2 Assessors Map&Parcel Numbers 1 o JN�� S TnuJf" 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❑ Private El Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: 5GQ 6-0 ols; Flcr- nc , Ma o\C of Name(Print) City,State,ZIP 9 0 ,fir:Ak 5-Trekk- 551-(oSS-k 311- 3-0 olds)7 arna:+..c* No.and Street Telephone Emttil 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 Work2: \r �c.Ay.t f,t filti C, f^S Lt kd' SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials) Official Use Only 1.Building $ 9S-00 t 00 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: j�� Check No.11 Check Amount: u Cash Amount: 6. Total Project Cost: Sq O.t 0 Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-- I'1-z3 l 3 S rr t r License Number) Expiratio Date Name of CSL HolderY List CSL Type(see below) \ \ c F1 cc ftv- .._ No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) k r'e,W s bLif rt Ma a i sys R Restricted l&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding C7, I SF Solid Fuel Burning Appliances ✓vy-21 -11I O E c t,„ -/),4 14L,u,i_eyThA L.c..ion I Insulation Telephone Email address D Demolition 5.2 gistered Home Improvement Contractor(HIC) aocasks— 9.12 -1 Z4 ,L.ce,,i- L3i-,:/AA elVI- t 4-f1C- HIC Registration Number Expiration Date IC Company Name or HIC Registrant Name 0(4-3 �?i.e J R oc cA C w,kbk:ld), s qiip14.1_,(4.,01 No.and Streett —10,dr►+ �/t C VZiy} DY S -ZN-II to Email ads 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........... ❑ SECTION 7a:OWNE AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize CI-yl to act on my behalf,in all matters relative to work authorized by this building permit application. a'10/2o z3 Print Owner's ame(Electronic Signature) Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION By ent- ••_ y name below,I hereby attest under the pains and penalties of perjury that all of the information ,000 co . • m>,i application ue and accurate to the best of my knowledge and understanding. ;��,!��I .2//0)207 3 d' int Owner's .'W 'orized AgMTP". ame(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" A!^tsPRD 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 (A/C.No.Ext):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 INSURER D: 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 UABILITY 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'LAGGREGATE LIMIT APPLIESPER: GENERAL AGGREGATE $2,000,000 POLICY X mg, LOC 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)I $ OWNED x SCHEDULED BODILY INJURY(Per acciden0 $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ A X UMBRELLA LIAB X OCCUR 6J48605 8/30/2022 8/30/2023 EACH OCCURRENCE $4,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED X RETENTION$trinnn $ A WORKERS COMPENSATION Y 6H48605 8/30/2022 8/30/2023 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE N N/A E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYES $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 10/12/2023 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 Waltham MA 02451 AU ED REPRESENTATIVE AA's() €6 ©1988-2015 ACORD CORPORATION, All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD WEATHERIZATION CONTRACT EVERS. URCE CUSTOMER PHONE DATE CLIENTS WORK ORDER Joe Golossi__: (551)655-8317-. 01/04/2021. 430197!_ 61910._ SERVICE STREET BILLING STREET PROPOSED BY 410 Spring Street • 410 Spring Street i Jeff Ledoux SERVICE CITY,STATE.OP. BILLING CITY.STATE.ZIP Prog rain Florence, MA 01062_ Florence, MA 010621 EGMA-HES Page 1 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. 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.._ MOISTURE BARRIER:_ 1 US We have identified a moisture issue in your home that needs to be JG (initials) addressed.Homeowner received a copy of the EPA's Moisture Guide and is responsible for correcting this moisture concern, prior to the installation of any weatherization work. By initialing you are agreeing to not hold RISE Engineering,or its Participating Contractors, _ responsible for any future mold and/or mildew in your home. PERFORM AIR SEALING AT ESTIMATED 62.5 CFM50 PER HO._ 12_, $1.131.96. $1.131.96_ 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 S95.43 Provide labor and materials to install Q-lon weatherstripping to door(s)to restrict air leakage.' DOORSWEEP 3 $78.33 S78.33 Provide labor and materials to install a doorsweep to restrict air_- leakage.. FSK COVERING_ 100 $96.00. S96.00 Provide labor and materials to install a FSK Paper air barrier.._ HATCH:THERMAL BARRIER POLYISO 2 INCH(ATTIC) 1 S47.37 S35.53 S11.84 Provide labor and materials to insulate the back of an attic hatch with 2"rigid insulation board at R-10. DOOR:THERMAL BARRIER POLYISO 2"(ATTIC) 1 $90.61 S67.96 S22.65 Provide labor and materials to insulate the back of the attic door with _ 2"rigid insulation board. uocusign tnvelope IL):2b9b3CIA-F7FB-4C5E-92DC-D063E6ECDD01 WEATHERIZATION CONTRACT EVERS URCE CUSTOMER PHONE DATE CLIENT* WORK ORDER Joe Golossi (551) 655-8317 01/04/2023 430197 61910 SERVICE STREET BILLING STREET PROPOSED Br 410 Spring Street 410 Spring Street Jeff Ledoux SERVICE CITY.STATE.ZIP BILLING CITY.STATE,ZIP Program Florence, MA 01062 Florence. MA 01062 EGMA-HES Page 2 DESCRIPTION QTY COST INCENTIVE TOTAL INSULATE VINYL SIDED WALL WITH 4"DENSE PACK CELLU 2,488 $6,667.84 $5,000.881 $1,666.96 Furnish and install blown in Class I Cellulose to vinyl-sided exterior walls. Homeowner has received a copy of the EPA's Renovate Right Lead-Safe information guide explaining the potential risk of the lead hazard exposure from the weatherization work to be performed. Your signature is your acknowledgement of receipt and agreement to proceed. 6 MIL POLY VAPOR BARRIER 900 $918.00 $918.00 Provide labor and materials to install 10 ml polyethylene over open ground in designated crawlspace/earthen basement areas. VENT BATH FAN TO ROOF OR OTHER 1 $146.78 $110.09 $36.69 Install an insulated exhaust hose to a flapper vent to exhaust existing bathroom fan(s). Fan will be vented through the roof or an acceptable alternative if contractor cannot vent through the roof. PREPARE YOUR HOME DS Homeowner is responsible for the removal of any items stored in the Ja (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: $9,522.32 Program Incentive: $7,784.18 Client Total: $1,738.14 I.DESCRIPTION OF WORK TO BE PERFORMED Contractor wit 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 Contr-ct: 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(IIC)upon satisfac•ry Completion of the Work.Client understands that they will not be required to pay the Program Incentive Share of the Cor;ract cost.Changes to the individual line items an.for previous inceBlidR§I Kaliblvease or decrease the size of the Program Incentive Share. r (--DocuSiig'ned by: t. LIOtoISI. 2t5L�k@f.F S&f4F1-.. "Ctier 5 LgAD74A3... Jeffery Ledoux 1/5/2023 I 12:12 PM EST Printed Name Date of Acceptance Commonwealth of Massachusetts rws Division of Occupational Licensure Board of Building R eAulatIons and Standards L'..or.stazAter:StLI-iw-visor CS-117239 :}cpires:03/15/2020 JOHN LAVE 110 FRANOISiANIE SHREWSBUO MA 0-i84.F.,, .45 -stab Commissioner cyttee,„ THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusatt02118 Home imoroverrient Contractor Registration :; • Type Out of State Corpora on • : ..-RegIstration: 206555 EFFICIENT BUILDINGS INC : • • - Expiration: 09/27/2024 973 REED RD _. • . _ • . , DARTMOUTH,MA 02747 . . .4 • _ . • • • • • Update Address and Return Ca d. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Ragistrotion valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE Out of State Gorporation Office of Consumer Affairs and Business Regulation Registration Eioiration 1000 Washington Street -Suite 790 20E586- 09/2712024 Boston,MA 02118 EFFICIENT BUILDINGS INC „--DocuSirmed by JIM REARDON . ,G11/0t-c rUiritt&- ,--.4192C226691F490.973 REED RD gif iv(4 ' DARTMOUTH.MA C2747 _ Undersecretary Not valid without signature ". The Commonwealth of Massachusetts Department of Industrial Accidents 14=��3.111 r� 1 Congress Street,Suite 100 "'�t Boston, MA 02114-2017 T err z. `. y ss'ww ntass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/EkctriciansIPluinhers. f0 BE FILED SN I I'll TILE PERMITTING AI TIIORI1'1. Applicant Information I Please Print tiibis Name IHusincss Organtzationlndti iduall: 1-- - ' -1.J- — ,J(h,.)d t(,,C/.„ ,.,,/,(.., Address: 9 - —3 /2sbz_,,L R o 5.cA -�_ City/StatefZip:N. '1:),cithi-c i7-i.,/444 0 4.7-k� Phone FF: 5D�'— ? 7-9 Ill� .%rr..um an ernplm t r.'t heck the uppnrpriule hot: Type of project(required): I I ant a entpioyer with. I J employees Ifull and or par t-sir:el• �. New construction:. I am a sok proprietor or partne-nhip and hate no en;+luyets winking fur ere in 1. D Remodeling any capacity.(Nu workers'.amp.insurance required./ 9. ❑Demolition 3E3 I am a homeowner cluing all wort;myself.(Nu workers'curry insurance required)• 4.0 I am a homeowner and w ill b...hiring cuts/tractors to conduct all work on my property. I will 10 El Building addition ensure that all contractors eider lute workers'eurnpensaUun rnsuranct ur are yule I 1 L Electrical repairs Or additions ;nrpneton w tilt no employees. 120 Plumbing repairs Or addition, 50 I am a general contractor and I have hired the sub-conuacturs listed un the attached sheet. 1; These sub-contractors have employees and hters'Bump.insurance. Root repairs at r w ut 60 We are acorporation and its officers hair exercised their right of earmption per MGL c. 14.g[Other %n (4 ij'0zi_______-_ 152,>!Ila),and we hate nuetriplay'ecs.[Nu workers'cutup.insurance'Nutted.] *Any applicant that checks but u I must a60 till out OW seCirun below.iuw ing their workers'compensation putrcy information r Homeowners who submit this ailidatd indicating tiwy see doing all work and then hue outside contractors must submit a new aftidat it indicating su,-fi. lC'untraciors that cheek this tot must atta.-hcd an additional sheet showing the name of the sul..untra Curs and stair whether or not those entmrc►bale employee, If the sub.contractors hose eriplutecs,dies must prtrtidc their worker.>'comp.pair.'.number i am an employer that is providing n'orllers'compensation insurance for my employees. Below is they polity and job site information. Insurance Company Name: ,TM Pit v.r . f-A mot,.. C'GS!^C k)- C O",104i1 Policy x or Self-ins. Lice #:(0 y" — (0O5— Expiration Date: CV I pc,-?...3 Job Site Address:L//0 ,Sid^.1,15,-- S 7/'L- Cit /State'Zip:ihf-2fIC12 , /-44 OJ (Q 'Z, 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$i,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 S250.(K)a day against the violator.A copy of this statement may be forwarded to the Office of investigations of the DR for insurance coverage verification. 1 do hereby cer •under th sins and penalties of perjury that the information provided abate its true and correct. Seen Date: />I CO-0 2 1 P one#:; )S — r:.lCl— c\ 1.- . Official use only. Do not write in this area,to be completed by city or town official ('its or Town: PermiI/License it Issuing;Authority (circle one): I. Board of Health 2. Building Department 3.('its.Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone Th . ,_.tees _ ..... . • w" f City of Northampton , � Massachusetts ‘ t DEPA.RTMENT OF BUILDING INSPECTIONS y. `. ,,$- 212 Main Street * Municipal Building i'p�4 ^• Northampton, MA 01060 'J� . Property Address: f//0 Jpg.ir'x, , T Contractor Name: _ LP I. c7 - ,pL i 1 C' t7 l%G io /6e Glen � i 7y Address: £H) P e_ci., iW City; State: 6, OC/( 12 „iute Phone: 'SZ:)C- 274 1 it O Li t i* 5 J`'J65 Property Owner Name: �t' CIO J Address: t--t I(L 5) 1 n .'�.. "' City; State: fib rto u /Lt.(' I, At1'\n 1G,v Cr -' .- (contractor) attest and affirm that the building I inte d 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. II Contractor ' n ture,i r Date ,M 7 /Z:J LJUL:UJILyI I CI II e,u1Je ILJ.Z.JJ:JJI.r/1-N-rIrO-41/4,JC-VGLA-r-IJUOJCUCI,LILJUI Aft mass save Savings through energy efficiency PERMIT AUTHORIZATION FORM 1, Joe Colossi owner of the property located at: (Owner's Name) 410 Spring Street Florence (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. covu DocuSigned by: Jet Gatessi oral tieeture 1/5/2023 I 12:12 PM EST Date FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the ve referenced project: 1`fn7 - ( Gv. 1 ..TA C— . /D/2 O Z 3 i Participating Contractor Date City of Northampton tH�M % Y{o'y� SAS -;.SAC i .'' Massachusetts �wv., 3._ 'r t ,1 , � ,4%lii DEPARTMENT OF BUILDING INSPECTIONS �'• •' ', 1 v r f' 212 Main Street • Municipal Building yJ`, b €' er ': Northampton, MA 01060 'rs' -•• .‘6C 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: (4,c/A Rctii DVi i4 G _, The debris will be transported by: Name of Hauler: P .I S ,,-, k Signature of Applicant: Date: ///b/2O1