Loading...
30B-043 (5) BP-2023-1170 291 RIVERSIDE DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 30B-043-001 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-2023-1170 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 6000 SUPERIOR INSULATION 106237 Const.Class: Exp.Date: 06/15/2025 RUBEN, KRISTIN NOELLE &HILL,LAUREN Use Group: Owner: VIRGINIA Lot Size (sq.ft.) Zoning: URB Applicant: SUPERIOR INSULATION Applicant Address Phone: Insurance: 14B ENTERPRISE LANE (401)515-4524 67872 SMITHFIELD,RI 02917 ISSUED ON: 08/30/2023 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHERIZATI 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: s2 5911T Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner , Pil A (g5 . c - ` DUi�T IV) Aoc ��—',� The Commonwealth of ssac setts c2,9 ' Board of Building Regulati anS ya rds '0(93 ICIPALITY W FOR Massachusetts State Building Co ,o' q.APT N,m USE Building Permit Application To Construct, Repair, Renov r � a Revised Mar 2011 One-or Two-Family Dwelling '06p Ns This Section For Official Use Only Building Permit Number: gP-.2 3- 11 70 Date Applied: kt' - (15� g-23-24123 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION lrrpnikii.Iriar/ b6 v� 1.2 Assessors Map& Parcel Numbers yl In 1.1 a Is this an accepted street?y,^es p( no Map Number Parcel Number t�l 1.3 Zoning Information: a 1.4 Property Dimensions: n ka Zoning District Proposed i se Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) v `a 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:rAn 1.8 Sewage Disposal System: y\ a) Zone: _ Outside Flood Zo . 1 ` a., e Public❑ Private 0 V \ Check if yes❑ Municipal 0 On site disposal system 1 SECTION 2: PROPERTY OWNERSHIP' b Ow, r'of Recor Kr>J er cioPAr1 Itor�nce, M c o 1 o u2 ame(Print City,State,ZIP 2i ( 1vx,csic -k 'Dr. 202- Z2 O - d +-12 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 0 Demolition 0 Accessory Bldg. 0 Number of Units I Other VSpecify: Insulation Brief Description of Proposed Work':air r ar d /r su lC i-c cul-i -. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ ( O n 0 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ lY ❑ Standard City/Town Application Fee 0 Total Project Costa (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Total All Fees: $ Suppression) Check No.3) vj' Check Amount: (,Q 6.Total Project Cost: $ le,no 0 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 106237 06/15/25 Kyle Leduc License Number Expiration Date Name of CSL Holder I 14B Enterprise Lane List CSL Type(see below) No.and Street Type Description Smithfield,RI 02917 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 401-744-8327 Cray@superiormass.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 175445 05/12/25 Superior Insulation - I p ame HIC Registration Number Expiration Date H14cgiitery se Lair HIC Registrant Name S cray@superiormass.com lrrtt tdf efdetRI 02917 401-515-4524 Email address 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 Issu ce of the building permit. Signed Affidavit Attached? Yes 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 see attached authorization 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 co fined in thi pplication is true and accurate to the best of my knowledge and understanding. 46/11 Pri ner's o Authorized Agent's Name(Electronic Signature) ate2-3 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 << DI •' N DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building 0 Northampton, MA 01060 sN� 3,7e 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: 14B Enterprise Lane, Smithfield, RI The debris will be transported by: Name of Hauler: Superior Insulation Signature of Applicant: Date: 3 The Commonwealth of Massachusetts . ... Department of Industrial Accidents =?fit= Office of Investigations s 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Superior Insulation, LLC Address: 140 Point Judith Rd, A7 City/State/Zip: Narragansett, RI 02882 Phone #: 401-515-4524 Are you an employer? Check the appropriate box: Type of project(required): 1.© I am a employer with 12 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' 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 employees. [No workers' 13. x❑ Other Insulate 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: Beacon Mutual Policy#or Self-ins. Licit.#: 67872 Expiration Date: 8/2/24 2q,Job Site Address: l V:-.1V eft���, to VC City/State/Zip: f IroricrM 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: � l Date: 8 7/I 2-3 Phone#: 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#: SUPEINS-01 MLONGOLUCCO '4C-0 RCP CERTIFICATE OF LIABILITY INSURANCE DA7/14/2023 TE ) 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 NAME: Mansfield Insurance Agency Inc. PHONE FAX 115 High Street (laic,No,Eat):(401)596-2096 INC,No):(401)348-2060 Westerly,RI 02891 ADDRESS:info@mansfieldins.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Employers Mutual Casualty(EMC)Company 21415 INSURED INSURER B:Beacon Mutual Insurance Co. 30325 Superior Insulation LLC INSURER c:Evanston Insurance Company Michael O'Connor 140 Point Judith Road,Unit A7 INSURER D: Narragansett,RI 02882 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 TYPE OF INSURANCE ADDLISUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMM/DD/YYYY) (MM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE X OCCUR X X 6D23763 8/2/2023 8/2/2024 PREMA SES(a occurr nce) S 500,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY JECT PRO- LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER:General Aggregate $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO X X 6B23763 8/2/2023 8/2/2024 BODILY INJURY(Per person) $ OWNED SCHEDULED _ AUTOS ONLY _ AUTOS BODILY INJURY(Per accident) $ AUTOS ONLY _ AUUTOS ONLYY PROPERTY DAMAGE Per accident) $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE X x 6N23763 8/2/2023 8/2/2024 AGGREGATE $ DED X RETENTION$ 10,000 $ 5,000,000 B WORKERS COMPENSATION X I PER TE I I EERH AND EMPLOYERS'LIABILITY Y/N X 67872 8/2/2023 8/2/2024 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Pollution Liability x x CPLMOL118083 7/6/2023 7/6/2024 Per Occurrence 250,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Residential Insulation Contractor-148 Enterprise Lane,Smithfield,RI 02917 Pollution Liability Aggregate Limit$500,000 National Grid and all divisions are named as additional insured per written contract or agreement.Waiver of subrogation is provided in favor of National Grid and all divisions per written contract or agreement. Pollution Liability includes mold CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE National Grid THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 40 Sylvan Rd Waltham,MA 02451 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Regulations and Standards Construct Qyi'Stiuper Specialty :y CSSL-106237 Qc,pires:06/15/2025 KYLE L LEDC 3750 DIAM0141 HILL RD CUMBERLAN RI 02864 11, Commissioner da �,. �FrncEta Construction Supervisor Specialty Restricted to: CSSL-IC-Insulation Contractor Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-9200 or visit www.mass.gov/dpl THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affai ' hd Business Regulation 1000 Washingtq wt - Suite 710 Boston-Massachusetts 02118 Home Im•ro , -MenT•'y -,:-etor Re 'station ¢f"' f 0,6-;: Type: Supplement Card SUPERIOR INSULATION LLC. . ' `egisf ation: 175445 140 POINT JUDITH RD UNIT A7 .. �' tation. 05/12/2025 1.4104 E s NARRAGANSETT, RI 02882 ''A. Ivo_ i .." ,,.-, ,, 41. it- __.,� ' f 1r. �� f� ... ,..�.. 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; $u 1ati ent.Card Office of Consumer Affairs and Business Regulation Resist tLow. --.:Expiration 1000 Washington Street -Suite 710 17 `_05/12/2025 Boston, MA 02118 SUPERIOR INSULAT1dN1L .. {;, ., IRE-...'• ' — ----, • / )d.1/kg.i .,,,,.............., ,, KYLE LEDUC ` -. = 140 POINT JUDITH RD(INIT �, a./Le-0,4* NARRAGANSETT, RI 02882 e' % Undersecretary Not valid without signature WEATHERIZATION CONTRACT EVERS=URCE CUSTOMER PHONE DATE CLIENTS WORK ORDER Kristin Ruben (202)236-0542 08/01/2023 544456 10303 SERVICE STREET BILLING STREET PROPOSED BY: 291 Riverside Drive 297 Riverside Dr Ben Apodaca SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Program Florence, MA 01062 Florence, Ma 01062 CMA-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%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(FSC) 1 $250.00 $250.00 The wiring in the areas weatherization work is proposed will be reviewed by a licensed electrician to determine if there is any existing live knob&tube wiring. HOME AIR SEALING 8 $754.64 $754.64 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.) WEATHERSTRIP AND ADD DOOR SWEEP 2 $115.84 $115.84 Provide labor and materials to install Q-lon weatherstripping and a doorsweep to door(s)to restrict air leakage. ATTIC DAMMING 128 $309.76 $232.32 $77.44 Provide labor and materials to install an approved damming material in the attic ATTIC FLAT-9"OPEN R-33 CELLULOSE 1,020 $1,795.20 $1,346.40 $448.80 Provide labor and materials to install a 9"layer of R-33 Class Cellulose added to open attic space. BALLOON FRAMING BLOCKING 128 $183.04 $137.28 $45.76 Install blocking in the open balloon framing for the proper installation of insulation. ATTIC HATCH-INSULATE 1 $35.00 $26.25 $8.75 Provide labor and materials to insulate the back of an attic hatch with 2"rigid insulation board at R-10. ATTIC HATCH-WEATHERSTRIP 1 $25.00 $25.00 Provide labor and materials to weatherstip the perimeter of an attic hatch with Q-Ion. INSULATE BULKHEAD DOOR 1 $68.83 $51.62 $17.21 Provide labor and materials to insulate the back of the door to the basement's bulkhead with rigid board. WEATHERIZATION CONTRACT EVERS=URCE CUSTOMER PHONE DATE CLIENT N WORK ORDER Kristin Ruben (202) 236-0542 08/01/2023 544456 10303 SERVICE STREET BILLING STREET PROPOSED BY, 291 Riverside Drive 297 Riverside Dr Ben Apodaca SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Program Florence, MA 01062 Florence, Ma 01062 CMA-HES Page 2 DESCRIPTION QTY COST INCENTIVE TOTAL CRAWLSPACE-6 MIL OR GREATER GROUND COVER 77 $78.54 $78.54 Provide labor and materials to install 6 ml or greater polyethylene over open ground in designated crawlspace/earthen basement areas. CRAWLSPACE WALL-2" RIGID BOARD 35 $160.30 $120.23 $40.07 Provide labor and materials to install 2"rigid insulation board to the crawispace perimeter wall up to the sill and against the band joist. VENTILATION CHUTES 15 $52.35 $39.26 $13.09 Provide labor and materials to install ventilation chutes in the rafter bays to maintain air flow from the soffit ventilation. ROOF VENT 8 INCH 1 $99.33 $74.50 $24.83 Provide labor and materials to install an 8"diameter roof vent(s)to increase ventilation in attic areas. The vent can be supplied in (circle color)black, brown, gray or mill finish. ROOF VENT 12 INCH 3 $398.40 $298.80 $99.60 Provide labor and materials to install a 12"diameter"mushroom"roof vent(s)to increase ventilation in attic areas. The vent can be supplied in (circle color)black, brown,gray or mill finish. PERFORATED SOFFIT PANELS 30 $925.50 $694.13 $231.37 Provide labor and materials to install perforated soffit panels to increase ventilation in attic areas. BALLOON FRAMING Your home is constructed with balloon-framed exterior walls,the wall (initials) cavities are open, continuously,from the top to the bottom.To properly insulate balloon framed walls, all the walls need to be insulated at the same time, ie:the second floor cannot have their walls insulated without also insulating the first floor walls. Your signature acknowledges that all stories at your property will need to be contracted for wall insulation at the same time. CRAWLSPACE CONTINGENCY VAPOR BARRIER Although your home would benefit from weatherization work in a (initials) crawlspace area,we have to remember the safety of the workers who will need to enter this space. The insulation contractor may need to inspect this space prior to scheduling the work to verify their ability to accomplish the scope of work. If the crawispace cannot be safely accessed and the earthen areas covered with a vapor barrier, all planned weatherization measures in the other areas of the home may be put on hold until the proper WEATHERIZATION CONTRACT EVERS=URCE CUSTOMER PHONE DATE CLIENT# WORK ORDER Kristin Ruben (202) 236-0542 08/01/2023 544456 10303 SERVICE STREET BILLING STREET PROPOSED BY, 291 Riverside Drive 297 Riverside Dr Ben Apodaca SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Program Florence, MA 01062 Florence, Ma 01062 CMA-HES Page 3 DESCRIPTION QTY COST INCENTIVE TOTAL control of the crawlspace humidity is addressed. LEAD PAINT Your home was built prior to 1978 and might have lead-based paint (initials) present.You have received a copy of the EPA's Renovate Right pamphlet informing you of the potential risk of a lead hazard exposure from the renovation activity to be performed at your home. PREPARE YOUR HOME Homeowner is responsible for the removal of any items stored in the (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: $5,251.73 Program Incentive: $4,244.81 Client Total: $1,006.92 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 pa he•ontractor for the Work,the Client Share of the Contract Cost is payable to the Independent Installation Contractor(IIC)upon satisfactory completion of the Work.Cli• A.tands that they will not be required to pay the Program Incentive Share of the Contract cost.Chan to the individual line items and/or previous incentives re .r decrease the size of the Program Incentive Share. RISE Repre "' Cli t Signature 8-1-2023 Printed Name Date of Acceptance 4#04t mass save Savings through energy efficiency PERMIT AUTHORIZATION FORM I, Kristin Ruben owner of the property located at: (Owner's Name) 291 Riverside Drive 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. Own is Signatur 8-1-2023 Date FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Particip ting Contractor Dat � r >-, City of Northampton _: ,, ir'"�, ,,: 4T',, sty' s�C . Massachusetts 41 * e`` 14 .i ;t ! -- DEPARTMENT OF BUILDING INSPECTIONS , " 212 Main Street • Municipal Building ,'"a ��'�b Y Northampton, MA 01060 '� r in 0 Property Address: 2_611 K 1 v(�Y o ,. rd Contractor ` , Name: &AP ineriASti tC�..G t c)VM Address: Eintryp ri sc ix1_____- City, State: 4` ;' � 1do 1 9.--'1 Phone: UdI 15I `.1 E L4 Property Owner on Name: C y t Address: 2-�1 1(2- k. 6l ( ie_ D r, City, State: 4`ty .; / Y I, (contractor)attest and affirm that the building I intend to insulat foes not have any open air(knob and tube)wiring in the spaces to be insulated and that I have Vprovided the property owner with a copy of this affidavit. Contractor signature fif,6{.".._ 7 Date 7 iz.s ,K n �: .