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37-083-010 BP-2023-0556 266 GROVE ST UNIT 10 COMMONWEALTH OF ASSACHUSETTS Map:Block:Lot: 37-083-010 CITY OF NORTH MPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING ERMIT Permit # BP-2023-0556 PERMISSIO IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 1700 NEWBURY INSUL TION LLC 106113 Const.Class: Exp.Date: 02/03/20 5 SLEZ MARGARETTA J. & WESLEY R. Use Group: Owner: BERT AND Lot Size (sq.ft.) Zoning: URB Applicant: NEWS Y INSULATION LLC Applicant Address Phone: Insurance: 34 MEADOW ST APT 6 (401)309-2685 84427 WOONSOCKET, RI 02895 ISSUED ON: 05/02/2023 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATH ERI 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: 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: . 51:415/ Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner i_ 1 � u .r 19c1I - tI The Commonwealth of Massachusetts ' 0 Board of Building Regulations and Standards �qr FOR Massachusetts State Building Code, 780 CAW �0 MUNICIPALITY nr:. Building Permit Application To Construct, Repair, Renovat0 s etxtolish a /Revis4d Mar 2011 One-or Two-Family Dwelling ' ' ''%ti Otis F. / This Section For Official Use Only -\5'o'ONs Buildinig Permit Number: /l,¢' 23 '6V Date Applied: I ,vito455 / 14/7.--- 2-Zoz Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 2(o CO C3-11v e, VN ar ►d 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 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: ('{ C cC arCkk-C, 3 io L CICAArN a pkOf• mA 3t b Name(Print) I City,State,ZIP eWb� 2C(9 6.(bv e yot- -2cssS -1�i � a1iC0.�n1(Thut n-C(Mn No.and Street Telephone VI mail 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 0 Demolition 0 Accessory Bldg. 0 Number of Units Other,'Specify: -I(\SQIC I -1 Brief Description of Proposed Work2: Ca 5eccl,in j 1 O pew b'o wh cep Lkwy, k- c1/44-42‘c -.nor SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I. Building $ 11 60 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: $ Check No.1 '$Check Amount Cash Amount: 6.Total Project Cost: $ rl0 0 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVI ES 5.1 Construction Supervisor License(CSL) Y�I' 2 ' 3 12 e.%\ \(�, ctu License Num Expiration Date Name of CSLlolder J 31A �,n,, \ OW V List CSL T (see below) No.and Street`�� (^ Type Description 1,l 0(3( 3004.4. � 3 v t ql_ Q.Z�c p� U nrestricted(Buildings up to 35,000 Cu.ft.) �J ..�Jl� J R estricted 1&2 Family Dwelling City/Town,State,ZIP M asonry RC oofing Covering WS indow and Siding Liol- --2S ';�(r.U.1�Q(�.' lid Fuel Burning Appliances u(Uckk(tWCtliC4.(h(Yl ( I ) ulation Telephone V Email address 11 molition 5.2 Registered1 ` Home Improvement Contractor(HIC) 'ci , -I 1�13)2 Li ,t1 ou, 1�S�.1. 1,1.k ( ` L�,,L HIC egiissttrationiNumber Expiration Date HIC Corn y N e o HIC a strant Name ntW low wit 341 Mt + V j O qDili iinsulckhoo-c pm No.and Street I Email address �Joo()�,u4- Q� oz�.S �I-�1 2(0 tty/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 t.l to act on my behalf,in all matters relative to work authorized by is buil ' permit application. o 4 S\ezQ� 41-2-coitz- Print Owner's ame(Electronic Signature) te SECTION 7b:OWNER'OR AUTHORIZED AGENT 1ECLARATION By entering my name below,I hereby attest under the pains and penalties of per ury that all of the information contained in this application is true and accurate to the best of my knowledge understanding. - `.f /2—Co 1'22-3 Print O 's or Au o ed Agent's a(Electronic Signature) 1 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 cm 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_I Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" City of Northampton r�►.� r�r1� Sy ..;"' sict Massachusetts �4,,, t f r G t. it i. f1, w ► DEPARTMENT OF BUILDING INSPECTIONS 4 \ d f S,- a-Y'' y0, its . 212 Main Street • Municipal Building • �., -- Northampton, MA 01060 .rsy ,__ Wo 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: L1M.)-\ `(1V mMeOt %(- 5 07--46C1 C! The debris will be transported by: Name of Hauler: \i),)\OW \xy%wabo Signature of Applicant: ��\� Date: j )Z(0 /7J?3 Rhode Island DRIVER LICENSE USA .�i { �gEDERAI fDENTIFICAC.)!�i I� 3 FDO O210 19$8 4cl!IC z 2870750 al, xP 02/0312025 .-,i. , 02/1112020 , .i. 1 TR1NGAL1 , , 8 34 MEADOW RD WOONSOCKE I, RI 028954961 9 CLASS 10 fl 1 \ 02103/19n 9H END M . 1 12 RESTR NONE • - . 15;EX M 18EYES BLU 16HO 6'•10" 17 MT 190 lb 19HAIR BRO ` 5 ino 8182361 C Y madpl.mylIcenseone.com/#state=eyJpZCI61mRIYmRhMTdkLTI1MWItNDVMMC1hNjU4LWESNWlfiMTE1hfDA3ZCIslm1ldf3EionsiaW60ZXJhY3Rpb2bUeXBtijoicmVkmXJIY3QifX043d&client infix=eyJlaW4i0iJkOGVkZDEiOSImYzIwLT... G Up Mass.gov Massachusetts Division of Occupational Licensure-Office of Public Safety and Inspections Guy Tringali All Existing Licenses Held Activity Submitted Construction Supervisor Renewal If you currently hold or have previously held a license with the Office of Public Safety and Inspections("OPSI"),please make sure your license is linked with your OPSI account.A properly linked record will show all licenses below. Linking your license by registration code:Your Registration Code is found on your renewal form in the right-hand corner under License Number and Expiration Date.Request your authorization code by e-mailing OPSI-info@mass.gov with"Request for Registration Code"in the subject line.Please provide your license number and a contact number at which you can be reached. A TRINGALI,GUY ••• Type License Number Status Expiration Actions Construction Supervisor CSSL-106113 Active 2/3/2025 ••• Specialty Don't see your license?Click here to search for it. Apply for a New License To apply for a new license,please click the button below. If you have already started an application,you can return to the application at any time by clicking the application link at the right,under"Activity". To check the status of a submitted application,click the link next to any submitted application at the right under"Activity". APPLY FOR A NEW LICENSE.EXAM THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration +wtd6 �_t2. . """ (r Type: LLC w == .- Registration: 193878 NEWBURY INSULATION LLC ...k Expiration: 12/03/2024 34 MEADOW RD APT 6 -- • WOONSOCKET, RI 02895 di ~. 4 T C,,j Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:LLC Office of Consumer Affairs and Business Regulation Registration &Expiration 1000 Washington Street -Suite 710 193878 12/03/2024 Boston, MA 02118 NEWBURY INSULATION LLC GUY J.TRINGALI I Ji��34 MEADOW RD APT 6 ��w"e't'a.(/fieWOONSOCKET, RI 02895 -`�'4 ,v� Undersecretary of 'd 'shout signature A COR DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 2/27/2023 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 NAHunter Insurance, Inc. PH Sandra Niederwimmer FAX 389 Old River Road, P.O. Box 1 A/c.No.Ext):401-769-9500 _aC,Not:401-769-9502 Manville RI 02838-0001 ADDRESS: infoelunterinsurance.net INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Ohio Mutual Insurance Company 25950 INSURED NEWBU-1 INSURER B:Beacon Mutual Insurance Co 24017 Newbury Insulation, LLC Guy Tringali INSURER C:Westchester surplus lines 34 Meadow Road INSURERD: Woonsocket RI 02895 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:411612866 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 POUCY E-F POLICY EXP I.TR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDD/YYYY) (MM/DDIYYYY) LIMITS A GENERAL LIABILITY Y BP 0035443 9/14/2022 9/14/2023 EACH OCCURRENCE $1.000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $50,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 —1 POLICY PECOT- LOC $ A AUTOMOBILE LIABILITY Y CPP0027300 9/142022 9/14/2023 COMBINED SINGLE LIMIT (Ea accident) $1.000.000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) A X UMBRELLA LIAB X OCCUR CX 0004015 9/14/2022 9/14/2023 EACH OCCURRENCE $1,000,000 EXCESS UAB CLAIMS-MADE AGGREGATE $1,000,000 DED RETENTION$ $ B WORKERS COMPENSATION 84427 12/52022 12/512023 X WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE I I NIA E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 C Pollution Liability G28338703 003 12/17/2022 12/17/2023 Limit 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CLEAResult is listed as additional insured under the general liability per written contract subject to terms and conditions of policy. 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. ClearResult 112 Turnpike Rd. AUTHORIZED REPRESENTATIVE Westborough MA 01581 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents ' Office of Investigations Lafayette City Center 2 Avenue de Lafayette, Boston, MA 02111-1750 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Apjlicant Information Newbury Please Print Legibly Name (Business/Organization/Individual): Newbury Insulation Address: 34 Meadow Road City/State/Zip:Woonsocket RI 02895 Phone #:401 309 2685 Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 3 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. [' Remodeling ship and have no employees These sub-contractors have 8. [' Demolition workingfor me in anycapacity. employees and have workers' P h 9. [' Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no Insulation employees. [No workers' 13.0 Other comp. insurance required.] *My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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:Beacon Mutual Policy#or Self-ins. Lic. #: 84427 Expiration Date:12/05/2024 Job Site Address:266 Grove Street City/State/Zip:Northampton MA 01060 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 04/26/2023 S\- 4\ Phone#: 401-309-2685 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(check one): 10Board of Health 20 Building Department 3fCity/Town Clerk 4.0 Electrical Inspector 5EIF'lumbing Inspector 6.0Other Contact Person: Phone#: 44.191)\ RCS PLANVIEW DIAGRAM �:wntorne+ f✓ Homo Phone ( s r - __ _�, ._ — Work Phone: t - � d — 1+"� Coll Phone: ( � - A..,rrs,ea.r rr•access by,srgs truck' r10 f vn rr yes.describe: 0'h*ow": tons Or lNsdRSMkfs 1. Yes _ M yes.descnbe. Site tD:#4WI"VE-nergy Specialist: 145 Reviewed by: A l r ceel T AWle...._)f 1' l i rf' b y'`) 1 f k 3- /M kH + ji cl'I-137o)°' 'a„„, Pereirr-' 461Yrif,er 49°c,-elt--/P 7 ... 4" • gY I \,2) rpl 7 (1) ja 7 t gI 9 0 /e , 1 Bushes Ladder 1 Neighbor Proximity 1 Pocket Doors Insert Radiators Fence(s) Existing Conditions X=Access ❑=Vents Note Inside Square R=Roof S=Soffit G=Gable RV=Ridge Vent - CS=Continuous Soffit CDE=Continuous Drip Edge T =Triangle install 0=New Access Note in Circle C=Ceiling W=Wall S=Sheathing Temp Unless Noted Otherwise Q=Vents Note in Triangle R=8"Roof S=Soffit G=Gable M=12"Mushroom For Access . Rev 1/14 • Recommended Ventilation Calculation Recommended Ventilation Calculation Air Sealing Work Hour Calculation Work Hours 4 8 10 12 14 16 (+2) Attic Sq.Footage <500 1-800 801-1100 1101-1400 1401-1700 1701-2000 2001-2300 Every 3002 Exceptional AFL Hours Primarily Floored Attics Chimney or BF=1 Hour Multiple Chimney/BF=2 Hours Prefab/Modular Hours No Chimney=4 Hours Chimney=6 Hours Exceptional KW Hours X<20 feet=1 Hour 20 ft<X<40 ft=2 Hours X>40 ft=4 Hours Rim Joist Only Hours RJ<150 ft=1 Hour RJ>150 ft=2 Hours BMT Ceding Only Hours Ceiling Area<2,000 sq ft=1 Hour Ceiling Area>2,000 sq ft=2 Hours "'NOTE:You MUST be INSULATING RJ or Basement Ceiling to specify RJ or BMT Ceiling ONLY Air Sealing Hours"" Re 0 _>6"L nsulation Cross Batt Insulation Multipliers a >6"Mi Batt&Loose Insulation. Truss Construction For(Mice Use Only a _ CLEAResult* CONTRACT CLEAResult 41 Brigham St., Customer Name:MARGARETTA SLEZAK Marlborough,MA,01752 Email:gretta.slezak@gmail.com Phone:413-478-1459 Premise Address:266 Grove St,Northampton,MA 01060 Mailing Address:266 GROVE ST,Northampton,MA 01060 Project ID:4818183 Date:April 20,2023 Job Description Contractor will perform or cause to be performed the following work on these"Premises"in a professional manner and in accordance with the terms of this Contract,including the attached recommendations/work order describing the work in detail(the"Work")which are incorporated herein by reference. Measure Description Location Quantity Unit Total Cost Customer Cost Air Sealing at Estimated 62.5 CFM50 Per Hour 6 hr $565.98 $0.00 Door Sweep(with AS hrs) 2 each $52.22 $0.00 Exterior Door Weather Stripping (with AS hrs) 2 each $63.62 $0.00 Hatch-2"Thermal Barrier Polyiso 1 each $47.37 $0.00 Propavent 27 each $111.51 $0.00 Attic Floor-9"Open Blow Cellulose 432 SF $859.68 $0.00 Total: $1,700.38 Program Incentive: -$1,700.38 Customer Total: $0.00 Payment Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows:Payment#1:MI as a Deposit payable to CLEAResult upon signing the Contract(not to exceed 1/3 of the total retail costs). Mail check&contract to CLEAResult,41 Brigham St., , Marlborough, MA,01752.Final Payment:111111 as the final payment for the Work shall be payable to the Home Performance Contractor(HPC)or Independent Installation Contractor(IIC)upon satisfactory completion of the Work.Customer understands that he/she will not be required to pay the Utility Incentive Share of the'Contract price in the amount of-. Changes to individual line items and/or previous incentives may increase or decrease the size of the Utility Incentive Share. Dispute Resolution The IIC and Customer hereby mutually agree in advance that in the event that the IIC has a dispute concerning this Contract,the IIC may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and Customer shall be required to submit to such arbitration as provided in M.G.L.c 142A. Page 1 of 4 Document Ret 8S8BD-XKXEA-VT7ZF-DCBWH Page 1 of 5 You may cancel this agreement if it has been signed by a party at a place other than an address of the seller,provided you notify the seller in writing by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. H4Ra4RETT4s1E K 04/20/2023 Customer Signature Date Indicate your selected IIC here,if applicable Initial here if you want the Program to assign a CIAGContractor pating Contractor 4/20/23 Kevin Cote CLEAResult Signature Date Name of CLEAResult Representative Page 2 of 4 Document Ref:8S8BD-XKXEA-VT7ZF-DCBWH Page 2 of 5 Al'S- Permit Authorization mass save Form Site ID: 4818183 Customer: MARGARETTA SLEZAK Ma rg a retta I, Slezak , owner of the property located at: (Owner's Name,printed) 266 Grove St Northampton, MA 01060 (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. Owner's Signature:H4R64RE TA- SLf24K Date: 04 / 20 / 2023 •lllllletimoo/osoosoosoo ose••••i/w••.•w•lf /•••••••. ---,.... - d -..-.,- :b FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 For Office Use Only