The URL can be used to link to this page

24D-046 (3) BP-2024-0178 22 STODDARD ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24D-046-001 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-2024-0178 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2024 Contractor: License: Est. Cost: 5100 ENERGY PROTECTORS INC 101143 Const.Class: Exp.Date: 06/16/2024 Use Group: Owner: M. PARKER, JEFFREY Lot Size (sq.ft.) Zoning: URB Applicant: ENERGY PROTECTORS INC Applicant Address Phone: Insurance: 64 PAXTON RD (774)253-0277 6S62UB0G29826021 Spencer, MA 01562 ISSUED ON: 02/22/2024 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: .; • V • >9 • 3-11 Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Buildine Commissioner •1,1 skiee:0 ka T f f t9rty l i l l tFH---: ."-----__ r . ./1,,..;,:-._,,,,. I - ,/2 vv `.� r^Y I LT 1 %U The Commonwealth of Massachu efts / Fee 1 Board of Building Regulations and and O , . " " Massachusetts State Building Code,imp Ro, /nrnt , irh Building Permit Application To Construct, Repair, Renovate nrbOrtoli `t4,=r,a-1 / One-or Two-Family Dwelling ``.,'e f This ection For Official Use Only Building Permit Number:� � mil- .. Date Applied: `Kos ______.__ _ l�'G_ 2 ZZZ1�?Y Building Official(Print Name) Signature Date SECTION I: SITE INFORMATION 1.1 riviy,rty ress:aactrct 1.2 Assessors Map& Parcel Numbers 1.1a 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 fl) Frontage(ft) 1.5 Building Setbacks(ft) From Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c,40,154) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: Outride Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 IvErl_treodd:2.1r j OL<R.Q or �-v1 C,L vvl f \vn ..A4 il" V k O 6 0 Name(Print) City.State,LIP _sti act ctid s r. ._ __ 4or -3oc G 3 2 k 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 ❑ Demolition 0 Accessory Bldg.0 Number of Units Other Q'specifjy: A V1 cL•k k t.7/A Brief Description of Propose`r r 2: �—�� e )C K f\ D r c-11 I / f . v3 V .%) - SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I, Building $ �I D O I. Building Permit Fee:$_ indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ 0 Total Project Cost'(Item 6)x multiplier_ x _� 3. Plumbing $ 2. Other Fees: S _ 4. Mechanical (HVAC) 5 List: _ 5. Mechanical (Fire $ ----- -- — - Suppression) Total All Fees: p �ii 3 Check No, °Check Amount: Cash Amount: 6.Total Project Cost: S % 0 0 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS•101 143 6,W24 Joshuaoaas License Number Expiration Date Name of CSL Holder List CSL Type(see below)U 64 Paatcn HO No.and Street Type Description ll Unrestricted(Buildings up to 35.000 cu.II.) Spencer MA01562 R Restricted 1&2 family Dwelling City,Town,State.LIP 1 Masonry RC Roofing Covering _ WS Window and Siding SF Solid Fuel Burning Appliances 774.253-0277 reaeelpanotmai.com 1 Insulation Telephone Email address i) Demolition 5.2 Registered Home Improvement Contractor(HIC') 172060 i 0/24 En.rpy Protectors Inc HIC Registration Number expiration Date HIC Company Name or HIC Registrant Name 64 Paxton Rd ida04794i oenal.cnm No.and Street Email address Spencer MA01562 774-25).0277 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 lssu a of the building permit. Signed Affidavit Attached? Yes No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner ot'the subject property,hereby authorin 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 contained in this application is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized 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 i IiC Program can be found at www.mass.gov'oca Information on the Construction Supervisor License can be found at Nww.niass.t ovitt§ 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" The Commonwealth of Massachusetts =WIN� -- Department of Industrial Accidents _;i 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 Applicant Information Please Print Legibly Name (Business/Organization/Individual): Energy Protectors Inc Address:64 Paxton Rd City/State/Zip:Spencer,MA 01562 Phone #:774-253-0277 Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 11 4. ❑ I am a general contractor and 1 6. El New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.# 9. El Building addition 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' 13.11 Otherweatherization 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: National Liability & Fire Insurance Company Policy#or Self-ins. Lic. #:V9WC421284 Expiration Date:9/1/24 Job Site Address: - CACI C`f S City/State/Zip: J of N�twP �1 t'\A Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). U6[a 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 S 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 S250.00 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. !do hereby certify under the p (ins and penalties of perjug that the information provided above is true and correct. Signature: (J 4_ Date: a/ k � ( Phone#: 774-253-0277 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): 11:1Board of Health 20 Building Department A:City/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone#: City of Northampton SAS r . ...,..fIC Massachusetts 'e { 44j DEPARTMENT OF BUILDING INSPECTIONS a� 212 Main Street • Municipal Building A, 1 �.. .' Northampton, MA 01060 sdj••. 0 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: Energy Protectors Inc 64 Paxton Rd Spencer, MA 01562 Location of Facility: The debris will be transported by: Name of Hauler: tE A �`lc') v�iv�-ems( )f Signature of Applicant: `` J«- - Date: \ 3 f L Ac o® CERTIFICATE OF LIABILITY INSURANCE DATE IMM/DDIYYYY) �------ 8/23/2023 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 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 Coonan Insurance Agency, Inc. PHONE Nina Arroyo FAX 267 Main Street IA/C.No,E.tk 508-987-7122 WC.No):508-987-7152 Oxford MA 01540 ADDR1ESS: ninat coonaninsurance.com INSURER(S)AFFORDING COVERAGE NAIC M License#:1782985 INSURER A:AIX Specialty Insurance Co INSURED ENERPRO-01 INSURER a:Safety Insurance Company Energy Protectors, Inc. INSURER National Liability&Fire Insurance Company 64 Paxton Road P Y Spencer MA 01562 INSURER o:Philadelphia Ins Companies INSURER E:Century Insurance Company INSURER F: COVERAGES CERTIFICATE NUMBER:309612825 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. INBR libbiliUBR TYPE OF INSURANCEPOLICY YFF POUCY EXP LTR MD ls/vD POLICYNUMBER (MM/DD/YYYY) IMMIDDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY V L1N-H714840-02 8/31/2023 8/31/2024 EACH OCCURRENCE 61,000,000 j CLAIMS-MADE X OCCUR WGE TO RENTED PREMISES(Ea occurrence) 650,000 MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY $1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY 52a LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY Y 6238519 12/23/2022 12/23/2023 (EaaTdEZSINGLE Um IT $1,000,000 ANY AUTO BODILY INJURY(Per person) S OWNED X SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) S X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY _AUTOS ONLY (Per accident) S S E X UMBRELLA WAS X OCCUR Y CCP1166257 8/31/2023 8/31/2024 EACH OCCURRENCE $1,000,000 EXCESS UAB CLAIMS-MADE AGGREGATE S DED X RETENTION$1r),mn $ c WORKERS AND EMPI orERSFLCOMPIABILITY Y/N ESATION V9WC421284 9/1/2023 9/1/2024 X ST TUTS ER ANYPROPRIETORIPARTNER/EXECUTIVE N E.L.EACH ACCIDENT S 500,000 OFFICER/MEMBEREXCLUDED9 N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POUCY LIMIT S 500,000 0 Pollution Liability Y PPK2510236 1/8/2023 1/6/2024 Aggregate Limit 500,000 Occurence 500,000 i , DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Tiffany Circle Townhouses&Phoenix Company,Inc are named as additional insureds and coverage is primary and non-contributory.The additional insured applies to ongoing and completed operations. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Tiffany Circle Townhouses ACCORDANCE WITH THE POLICY PROVISIONS. c/o Phoenix Company Inc 650 Lincoln Street AUTHORIZED REPRESENTATIVE Worcester MA 01605 ._,y ,t't-. (..LLA-41,1Ir ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD THE COMMONWEALTH OF MASSACHUSETTS Office Of Consumer Affat and Business Regulation 1000 Washingtq Sire-Suite 710 Bostorjius -OO118 Home irj o •p r «i01, �(�eitlt?n s milloolwinforirokor • ., # Type: Corporation �,� RetratS{on: 172960 ENERGY PROTECTORS INC. kiea>ion: 08l19f2024 64 PAXTON RD_ : SPENCER,MA 01562 `�` ' Update Address and Return Card. THE COMMONWLkLTH OF MASSACHUSETTS Office of Consurnlr Affairs&Business Regulation Registration valid for individual use ontr before the HOME 110PROY tEnCOl4TRACTOR expiration date. tf found return to_ TYPE',Corporation Office of Consumer Affair and Business Rerauiation Rier315 a E tarttlon 1000 Wasington Street -Suite 710 1j2980 08/3 24 Boatan,MA 02118 ENERGY PROTEcr44-.—`> Pir JOSHUA DADA 64 PAXTON RD. <,Q. :'014.4 v tv SPENCER.MA O1662 Unakeetaaeleiy valid without signature 1 DPV ononwearth of (It of Massachusetts Board oCo i/ n' uaadons and Standards 1 CS-101143 it<or -Y JOSHUA S ,' I . 64 PON .II q It,- 0 ill Aires;06/16/2024 SPENCER Mg0 Corn }�i1iVa1'•)�, fmisSiartr f .:ram• c ♦ WEATHERIZATION CONTRACT EVERSSURCE CUSTOMER PHONE DATE CLIENTS WORK ORDER Jeffery Parker (408)309-9321 11/28/2023 545402 11802 SERVICE STREET BILLING STREET PROPOSED BY. 22 Stoddard Street 22 Stoddard Cole Payne 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: RENTERS For eligible measures,the Mass Save Program offers a renters incentive of 100%off insulation,air sealing,and duct sealing measures.To be eligible for the renter incentive,the unit must be rented year-round,seasonal rentals are not eligible. KNOB&TUBE WIRING(Northhampton) We have identified that your home might have Knob&Tube wiring J.P. (initials) present.The following contract is not valid unless accompanied by the Weatherization Barrier Incentive form,signed by your licensed electrician.Work will not proceed with this work until we receive a copy of the form. WEATHERSTRIP DOOR 2 $72.64 $72.64 Provide labor and materials to install 0-Ion weatherstripping to door(s)to restrict air leakage. DOOR SWEEP 2 $59.32 $59.32 Provide labor and materials to install a doorsweep to restrict air leakage. WALLS-VINYL SIDED 4" 1,620 $4,941.00 $4,941.00 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. OKAY-WINDOWS did this refresh? Document Ref:FZGHR-J9ZHK-RBSZL-8CSNH Page 1 of 3 WEATHERIZATION CONTRACT EVERSeURCE CUSTOMER PHONE DATE CLIENT# WORK ORDER Jeffery Parker (408)309-9321 11/28/2023 545402 11802 SERVICE STREET BILLING STREET PROPOSED BY: 22 Stoddard Street 22 Stoddard Cole Payne SERVICE CITY,STATE.ZIP BILLING CrTY.STATE.ZIP Program Northampton, MA 01060 Northampton, MA 01060 EGMA-HES Page 2 DESCRIPTION QTY COST INCENTIVE TOTAL ASBESTOS PRECAUTION A blower door diagnostic test will not be conducted at your home, as a precaution for the presense of steam heating (past or present)that was most likely insulated with asbestos. Total: $5,072.96 Program Incentive: $5,072.96 Client Total: $0.00 I.DESCRIPTION OF WORK TO 8E 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(IIC)upon satisfactory 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 and/or previous incentives may increase or decrease the size of the Program Incentive Share. CAP/qRe Jeflrel Parker RISE Representative Client Signature Cole Payne 11-29-2023 Printed Name Date of Acceptance Document Ref:FZGHR-J9ZHK-R88ZL-8CSNH Page 2 of 3 :•.;-:•.:• ••... ::.:+..•••-• -•••'.•r••i•.••••••••r•:••••.'••;•-.•••:•.•r•-•r r•••Jw•-•O�•••••••••••••i••••••••O.i••••••••a•,i•i••••••i i•-•••••%i .�i•.i'%i:.':': ii`. i". .•• Signature Certificate ,,, �•.,• Reference numbe• FZGHR-J9ZHK-RB8ZL-BCSNH '•••' ;::..I ....,,. AN ••': Signer Timestamp Signature '0,,;#:% . � . Cole Payne �_...._..._....... - --.--.----- :o..; •: Email:cpayne@riseengineering.com ;•�.• Copa ;.*: Sent: 29 Nov 2023 15:25:29 UTC �e u� :41.' :C•.• Signed: 29 Nov 2023 15:25:29 UTC i--- :.:.: ;,4;.; IP address:73.17.139.199 — ;�e, "d: Location:Florence,United States �.•••• ••.••, ,•.+.�1 °} Jeffrey Parker 1 Email:jeffreyparker25@gmail.com 1 ;:•:1 .10 ; Sent 29 Nov 2023 15:26: 5 UTC �� 1�a!'7�CP,r ,•.Q•, ;.�•;.; Viewed: 29 Nov 2023 15:26:15529 UTC ••�••' j%:; Signed. 29 Nov 2023 15:28:06 UTC ••�+* '••, Recipient Verification: !:•;; :••• IP address:71.58.245.209 .❖.• !.' iEmail verified 29 Nov 2023 15:26:15 UTC Location:Westmoreland.United States •;*:•:' •,:;••• D• r,lent completed by adl parties on: :•+•,+; ..• 29 Nov 2023 15:28:06 UTC ••:'• ... Page 1 of 1 •4:4: 4.4 4441, ♦• ...• .4.. •• e.' i:. i❖: .��•�' '••••• ❖: �.1. •:, '•.•: ..•.'. I•••: ♦♦ 11• V i❖: !V.. Signed with PandaDoc ,:•:•: PandaDoc is a document workflow and certified eSignature .,• r: ; .;• solution trusted by 50,000+companies worldwide. t •a- ':•: X. ::, mass save Savings through energy efficiency PERMIT AUTHORIZATION FORM 1, Jeffery Parker owner of the property located at: (Owner's Name) 22 Stoddard Street 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. Jeffrey Parker Owner's Signature 11-29-2023 Date FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Document Ref;FZGHR-J9ZHK-RBBZL-8CSNH Page 1 of 1 âve 2022-23 eatherizationIncentives ;ir trw�ndati ri . �,.r �..� tr,, ), 6a ed C.r .. .: �. �. �•c an t ;rra uric am r,rt.io:res.,Jiair rnprt yr r ret r y,t'1 as <.IL t' fill The €str a;:t on; htriew mediate ',cut +_atne .xator, CUSTOMER INSTRUCTION . a, ren'edi ttee toe wFLatt er !r,tion barner(s), a •, and a cony of the nod( ntra(;tor mvoice(S) wits"ci CO drays of'rosr Hoo e sat - Attucks.Lane.Hyannis,MA 02601 or email to MassSave,gRlSEenginecrrrag,com, 3, ' .. rrom tti ...c..,tcrrer co-oavment arncuot of toe w:atnenratrar wor .A r•_ __ - .� °:_ ', the exceeds toe css.omer s co-payment r`.•o r u,)s-a`t'eathtr:anon,mor overner r i lstanrer He �.� ,�ffery Parker 545402 and 545403 Client wr Ste IC Anr�� 22 Stoddard Street �t, Northampton rate MA D. 0106u • ,: 603-721-1261 Email jefferyparker25@gmail.cam Customer/Homeowner Signature: /` Date: ,I 36 C PB tiD TUBE WIRING there a er4 active kr-ob and tube'w 'ia.the cce tie:-..t J:`a.,v(II ..o<,l U�..r is 41 e..i r,i s-as 4'v1. '1es S-ve a,<,r ,-ecurrrrnendations nave beer)mao,? f-ttc eloor V Attic Wall V Attic Slope V i-:xter or Wall le!Baser-•ent Other_..._._... Cat+per have oerforned mv inspection anno determined there is no active knob and tube wiring in the areas selected below. Attic°ieoy •,-l^t ;c .`Wall 4!'Attic Slope terior Wall ;ri 6aser^ent r, Other: Con*rac:r r C./\4-Si C,' C "P C / /1-1.I C 7%i C..0 .s AodreSS: 'p i, %. 5/Y4(14 yf_ City: 1 /o1�t'.r-A,f. L State:/4 �j// � , ZIP: 6 6 ;,oany Name: 4 7 r C C [: f ec 4•144-, cerise Number: S.; C7 6 Contractor Signature: '% ' ".-- ( f C Date: oost,' o that ?have Ds- tc'm ed mv{rsoectior of the electrical systems i,sttea above an;.rave correctee;. ^:...arise-.. indicates H u a t:re also confirms that I have read and agree to she Terms and Conditions outlined on the back of this form MECHANICAL SYSTEM BARRIERS(To be filled out by licensed contractor.) High Carbon Monoxide:Contractor is to service and re-evaluate the selected mechanical systems)and reduce the carbon run o ide le°vet, s rrearured o tie urdllured hue oas.to below 100 r_rarts per million(Ppm)• Draft Failure:Contractor is to correct the draft in the(elected flue(s).Refer to table on reverse for acceptable draft ranges, onde� ' "" , ��rr,, . Draft Failure �'ratfn Co pt , ati r sod CO pper Existing Graft P � I Revised Graft Pa Heating System Hot Water Heater Other -spillage:Contractor is to correct'the spillage of flue gases .t i the selected mechanical system(s).Must not spill after 60 seconds of operation. Heats rg System Hot Water Heater Other tractor v,r;� Andress: Cty State Zti :n=1 r am 4-cense Number: Contractor Signature: Date;