23C-018 (7) BP-2023-1221
110 NONOTUCK ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23C-018-001 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-2023-1221 PERMISSION IS HEREBY GRANTED TO:
Project# INSULATION 2023 Contractor: License:
Est. Cost: 5000 HOMEWORKS ENERGY INC 106148
Const.Class: Exp.Date: 07/30/2024
Use Group: Owner: SULLIVAN MICHAEL E& MARTHA S JENKINS
Lot Size(sq.ft.)
Zoning: URB Applicant: HOMEWORKS ENERGY INC
Applicant Address Phone: Insurance:
235 ESSEX ST 781-205-4484 1847910
WHITMAN, MA 02382
ISSUED ON: 09/07/2023
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: q
. ciAr,
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
FEE: $65.00 € ���� Please email Permit to WXPermitting@homeworksenergy.com
r
,;i City of No amp on - V : FOR'� Building epa rtter�$ !`
c. ..4),
`` 212I�Aain reet ep �L;
R m .� v\- . INSULATION
; ,24,,,,,,,,,,,, Northampton 0 `�Oc
• phone 413-587-1240 Fa -1272 Op.JL., Y
ti
A
�^I-1 n`CT.
U6 APPLICATION FOR INSULATION FOR A ONE OR TWO MILY D ELLING ONLY
SECTION 1 -SITE INFORMATION INSUL TION PERMIT
This section to be completed by office
1.1 Property Address:
Map Lot Unit
110 Nonotuck Street Northampton MA 01062 Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Michael Sullivan 110 Nonotuck Street Northampton MA 01062
Name(Print) Current Mailing Address:
See Attached
Telephone
Signature
2.2 Authorized Agent:
Adam Glenn 235 Essex Street, Whitman, MA 02382
Name(Print) cr������ Current Mailing Address:
781-205-4484
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 5,000 (a)Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) Cc
5. Fire Protection
6. Total = (1 +2+ 3+4+5) 5,000 Check Number / - .)C-15.
pp�� This Section For Official Use Only
Building Permit Number: VD- )-3- 1)-)-' Date
Issued:
Signature: /7/17--- /' 7. 2bG3
Building Commissioner/Inspector of Buildings Date
wxpermitting @ homeworksenergy.com
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 4-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:Adam Glenn 106148
License Number
235 Essex Street, Whitman, MA 02382 07/30/2024
Addre o�2 Expiration Date
781-205-4484
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
HomeWorks Energy 181138
Company Name Registration Number
235 Essex Street, Whitman, MA 02382 03/02/2025
Address cid Expiration Date
1:-Jetid << Telephone 781-205-4484
SECTION 5-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
Brief Description of Proposed Work
Residential weatherization/ Air sealing. No structural changes. SITE ID 809970
I Adam Glenn , as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Adam Glenn
cd444 ,scrav_
Print Name
8/30/2023
Signature of Owner/Agent Date
Michael Sullivan , as Owner of the subject
property
hereby authorize HomeWorks Energy
to act on my behalf, in all matters relative to work authorized by this building permit application.
See Attached 8/30/2023
Signature of Owner Date
City of Northampton
atH Mj9
••'� ,°� Massachusetts ��
40
DEPARTMENT OF BUILDING INSPECTIONS 5,
212 Main Street • Municipal Building c,D
Northampton, MA 01060 3'M�y 3,)��`�
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes.Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L.Chapter 142A requires that the"reconstruction,alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing
at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note:lithe homeowner has contracted with a corporation or LLC,that entity must be registered
Type of Work:Weatherization Est. Cost:5,000
Address of Work: 110 Nonotuck Street Northampton MA 01062
Date of Permit Application: 8/30/2023
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law(explain):
_Job under$1,000.00
Owner obtaining own permit(explain):
Building not owner-occupied
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
8/30/2023 Adam Glenn 181138
Date Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
City of Northampton
Massachusetts <,
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street •Municipal Building
�*--� Northampton, MA 01060 s,i
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building
permit all debris resulting from the construction activity governed by this Building Permit shall be disposed
of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
110 Nonotuck Street Northampton MA 01062
(Please print house number and street name)
Is to be disposed of at:
McNamara Waste Services LLC, 24 E Longmeadow Rd, Hampden,MA 01036
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
,c4av 8/30/2023
Signature of Permit Applicant or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
`�y{,,, ,jrJ City of Northampton S e. s
{5.,"'''' 10
x' ,_ Massachusetts �� 1' ''e,.
CW
�I ' t DEPARTMENT OF BUILDING INSPECTIONS x f _ yJk 1
�.- 212 Main Street • Municipal Building 'sy.,... �O
.�,,. Northampton, MA 01060 �Y 3��
MANDATORY FOR HOUSES BUILT BEFORE 1945
Property Address: 110 Nonotuck Street Northampton MA 01062
Contractor
Name HomeWorks Energy
Address: 235 Essex Street
City, State: Whitman, MA 02382
Phone: 781-205-4484
Property Owner
Name: Michael Sullivan
Address: 110 Nonotuck Street Northampton MA 01062
City, State:
I Adam Glenn (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 CdliA4 S1;)°P;IV coe--
Date 8/30/2023
The Commonwealth of Massachusetts
Department of Industrial Accidents
3= Office of Investigations
Lafayette City Center
•
-JO-
2 Avenue de Lafayette, Boston,MA 02111-1750
''M www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): HomeWorks Energy
Address: 235 Essex Street
City/State/Zip:Whitman, MA 02382 Phone #: 781-205-4484
Are you an employer? Check the appropriate box: Type of project(required):
1.❑■ I am a employer with 500+ 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. El New construction
2.El 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 �' 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.:
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
officers have exercised their 11. Plumbing El I am a homeowner doing all work repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 152, §1(4),and we have no Weatherization
employees. [No workers' 13.$ Other
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.
tContractors 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: Federated Mutual Insurance Company
Policy#or Self-ins. Lic. #:#1847910 Expiration Date: 1/1/2024
Job Site Address: 110 Nonotuck Street Northampton MA 01062 City/State/Zip:
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 und r the pains
�and pees of perjury that the information provided above is true and correct.
Signature: .2;0 v • ' Date: 8/30/2023
Phone#: 781-205-4484
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):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing
Inspector 6. Other
Contact Person: Phone#:
CPRO
A CERTIFICATE OF LIABILITY INSURANCE �'12/
12/d0/2022
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 POUCIES 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 rids to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
FEDERATED MUTUAL INSURANCE COMPANY NAME: CLIENT CONTACT CENTER
E FAX
HOME OFFICE: P.O.BOX 328 (aCNNo,Est):888-333-4949 (A/C,No):507-446-4664
OWATONNA,MN 55060 E-ADDRESS:CLIENTCONTACTCENTER@FEDINS.COM
INSURER(S)AFFORDING COVERAGE NAIL t/
INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935
INSURED 419-899.0 INSURER B:
HOMEWORKS ENERGY,INC. INSURER C:
101 STATION LNDG
MEDFORD,MA 02155-5134 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:0 REVISION NUMBER:1
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 AODL SUER POLICY NUMBER POLICY EFT POLICY ELF LIMITS
LTRINSR WL'D IMM!DDIYYYYI (MM/DDIVYVY)
X COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE $1,000,000
CLAIMS-MADE X'OCCUR PREMISEST IEaR occurrence) _ $100,000
MED EXP(Any one person) EXCLUDED
A N N 1847909 01/01/2023 01/01/2024 PERSONALS ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
POLICY � I JEC I LOC PRODUCTS-COMP/OP AGO S2,000,000
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000
(Ea acddend
X ANY AUTO BODILY INJURY(Per person)
OWNED AUTOS ONLY SCHEDULED
A _ AUTOS N N 1847908 01/01/2023 01/01/2024 BODILY INJURY(Per accident)
HIRED AUTOS ONLY _-NON-OWNED PROPERTY DAMAGE
AUTOS ONLY (Per accident)
X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $1,000,000
A EXCESSLIAB CLAIMS-MADE N N 1847911 01/01/2023 01/01/2024 AGGREGATE $1,000,000
DED RETENTION
WORKERS COMPENSATION X PER STATUTE OTH-
AND EMPLOYERS'LIABILITY 1/I N ER
ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $500000
A OFFICER/MEMBER EXCLUDED? _NIA N 1847910 01/01/2023 01/01/2024 E.L.DISEASE-EA EMPLOYEE
(Mandatory In NH) S500,000
It yes,describe under
DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule.may be attached It more space is required)
THIS COPY IS NOT TO BE REPRODUCED FOR ISSUANCE OF CERTIFICATES.
CERTIFICATE HOLDER CANCELLATION
01
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
A CERTIFICATE HAS BEEN FILED WITH EACH OF YOUR CERTIFICATE ACCORDANCE WITH THE POLICY PROVISIONS.
HOLDERS.
AUTHORIZED REPRESENTATIVE //` /{J�/j. _ I
�+ / 'VW
Cv 1988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
kilt Commonwealth of Massachusetts
Division of Occupational Licensure Construction Supervisor Specialty
Board of Sodding R i�itiorks and Standards Rest
L 4C to:
9 k IT f_ CSSL4C -inautation Contractor
Cortstructit;,�upe4,r Specialty
' ,
CSSL-106148 H ires: 07/30/2024
ADAM GLEN i 5
19 CHARGE • % ,.
WAREHAM .;'"
i •;* Failure topossess a current edition at the Massachusetts
'TfItGYr P-r State Buildsng Code is cause for revocation of this license.
For information about this license
Cap{617)727-3200or visit wwv.mass.govidpi
Commissioner ' .i. .... r. .t.,..
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
rt = .�...... "u Type: Corporation
v =-- - egistration: 181138
HOME WORKS ENERGY, INC. '..t =" - Expiration: 03/02/2025
101 STATION LANDING STE 110 ` .
MEDFORD, MA 02155 - '."�
400010.116.40
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:Corporation Office of Consumer Affairs and Business Regulation
Registration Expiration 1000 Washington Street -Suite 710
181138 03/02/2025 Boston,MA 02118
HOME WORKS ENERGY,INC.
�-..1
ADAM GLENN all444'
�
101 STATION LANDING STE 110 ,;���,i, ' zG:'s1.k" v,e �''--"�j
MEDFORD, MA 02155
Undersecretary Not valid without signature
Insulation/Air Sealing Permit Authorization
Specialist: Brian Cowles Company: HomeWorks Energy
Email: brian.cowles@homeworksenergy.com Address: 101 Station Landing
Cell: 4133480244 Medford, Ma 02155
Phone: 781.305.3319
Customer: Michael Sullivan Address: 110 Nonotuck Street
Email: sullyme@comcast.net Northampton, MA,01062
Site ID: 809970 Phone: 4135865113
I, the owner of the property identified above hereby authorize HomeWorks Energy Inc., or their Partner
to act on my behalf in obtaining any building permit that maybe required to perform
insulation and/or Weatherization work on my property and all matters related to the work authorized by said permit
if one is obtained. Any related permit application cost will come at no additional charge provided that the agreed
Weatherization work is completed.
In the event that a permit is pulled on your home for insulation and/or weatherization work, you may be required to
have a final inspection of the work scheduled and performed by the building inspector in your town. If required by the
town, you will be notified by HomeWorks Energy that an inspection is necessary with instructions on how to complete
this process to close out your permit.
Email: sullyme@comcast.net
Customer
Signature: Date: 8/29/2023
Michael Sullivan
For Condo Owners:
If you have property oversight by a condo associationt, please have the association's authorized person(s)complete
and sign the section below. Please email this document to wxpermitting@homeworksenergy.com once completed.
We, being the duly authorized representatives of the association
Name of association or management companyt
or management company have reveiwed the plans and specifications for improvements to the address specified abov€
We further acknowledge that the above listed owner has given notice that they intend to seek permits and to carry
out the proposed work.
Signature of representative Date
Print Name
t Other unit owners may sign when there is no association.
HomeWorks Energy
�fl Home Performance Contractor
irr
1 101 Station Landing,Medford,MA 02155 CONTRACT - AUDIT
HomeWorks 781-305-3319
CUSTOMER PHONE DATE CLIENT# WORK ORDER
Mike Sullivan (413) 586-5113 08/29/2023 809970 12801
SERVICE STREET BILLING STREET PROPOSED BY:
110 Nonotuck Street 110 Nonotuck St HomeWorks Energy
SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP
Florence, MA 01062 Florence, MA 01062 Page 1
DESCRIPTION QTY COST INCENTIVE TOTAL
PERFORM AIR SEALING AT ESTIMATED 62.5 CFM50 PER HO 8 $852.72 $852.72
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 $108.96 $108.96
Provide labor and materials to install 0-Ion weatherstripping to
door(s)to restrict air leakage.
DOOR SWEEP 3 $88.98 $88.98
Provide labor and materials to install a doorsweep to restrict air
leakage.
DAMMING 100 $278.00 $208.50 $69.50
Provide labor and materials to install a 12" layer of R-38 unfaced
fiberglass batts for damming purposes.
ATTIC FLOOR OPEN BLOW CELLULOSE 7" 930 $1,915.80 $1,436.85 $478.95
Provide labor and materials to install a 7" layer of R-26 Class I
Cellulose to open attic space.
DOOR:THERMAL BARRIER POLYISO 2"(ATTIC) 1 $103.05 $77.29 $25.76
Provide labor and materials to insulate the back of the attic door with
2" rigid insulation board.
ATTIC STAIR COVER THERMAL BARRIER 1 $313.63 $313.63
Provide labor and materials to install an easily moved, insulating
cover for the attic access folding stair. The cover has integral weather-
stripping to restrict air leakage.
INSTALL 2"THERMAL BARRIER POLYISO ON OPEN BASEMEN 65 $360.10 $270.08 $90.02
Provide labor and materials to install rigid board insulation to the
perimeter of the basement ceiling at the house sill.
PROPAVENT 2' OR 4' 25 $117.00 $87.75 $29.25
Provide labor and materials to install ventilation chutes in the rafter
bays to maintain air flow.
HomeWorks Energy
Home Performance Contractor
;[ ! 101 Station Landing,Medford,MA 02155 CONTRACT - AUDIT
works 781-305-3319
Energy,Inc
CUSTOMER PHONE DATE CLIENT# WORK ORDER
Mike Sullivan (413) 586-5113 08/29/2023 809970 12801
SERVICE STREET BILLING STREET PROPOSED BY:
110 Nonotuck Street 110 Nonotuck St HomeWorks Energy
SERVICE CITY,STATE.ZIP BILLING CITY,STATE,ZIP
Florence, MA 01062 Florence, MA 01062 Page 2
DESCRIPTION QTY COST INCENTIVE TOTAL
REPLACE BATH FAN HOSE 1 $32.23 $24.17 $8.06
Provide labor and materials to install an insulated 4"exhaust hose to
existing bathroom fan(s).
Total: $4,170.47
Program Incentive: $3,468.93
Customer Total: $701.54
WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF
***Seven Hundred One & 54/100 Dollars $701.54
5 ) *(911 %C-- 5._
COMPANY REPRESEN THE � CUSTOMER SIGNATURE
NOTE:THIS CONTRACT MAY HE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE
SIGN DATE
30 DAYS.