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42-141 (6) BP-2023-0866 763 WESTHAMPTON RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 42-141-001 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-2023-0866 PERMISSION IS HEREBY GRANTED TO: Project# 2023 INSULATION Contractor: License: Est. Cost: 6511 LANTERN ENERGY 077957 Const.Class: Exp.Date: 09/23/202 Use Group: Owner: BUZZ I BLISS DAVID K&TODD H Lot Size (sq.ft.) Zoning: WSP Applicant: LANTE'N ENERGY Applicant Address Phone: Insurance: 256 OAKWOOD DR 877-8787-3006 A020527006 GLASTONBURY, CT 06033 ISSUED ON: 07/03/2023 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHERIZATION ATTIC &WALLS 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 NORfrHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: a' I II Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax (413)587-1272 Office of the Building Commiss ner F , __ 7 -Z W /// �' ' 'i ' 4i✓Fiv`�-'j - tie T z s' Iul1lJ DepF0it,,..7^ ig6ie +� p- -._ City of Northampton �: '��- '��� L Building Department C� ,� I 212 Main Street INSULA TlON r ¢` g ` 41' ! Room 100 ,' Northampton, MA 01060 :x.._.� phone 413-587-1240 Fax 413-587-1272 Qj /L Y ,---,,, 45 f *PLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INS ULA TION PERMIT This section to be completed by office 1.1 Property Address // ��// Map �7'2- Lot / Y 1 Unit 0 C3 1 7(0 3 (A)�c J7 glint ny� ,zo f d Zone 5 p Overlay District / Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: /L /4►/i a8 L.5 S 7,0 3 LOE S7H649/07at✓ xJ /i/&21 N 7 Name(Print) Current Mailing Address: ZZ/ (6Ef e{Q.4/ti Ault1 n t114 4 70w �,itz,v1 Telephone `J -' ignature) 2.2 A//uthottrized Agent: ,n� IN / `/ / 04- ,4i ;I/67D Ct el- __ G7. LAN CAS?Ea !,^�/n�" 4 06SL3 Name(Print) Current Mailing Address. (C 7 77 / - 3 7/ 7 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building / 5 / ` . - (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of `2/ Construction from (6) 3. Plumbing ,e Building Permit Fee vo 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) CO 5 i 1 -`'% Check Number 73&4142 V Q � This Section For Official Use Only Building Permit Number: /✓�!/n 23- ODO 66, Date Issued: Signature: ////.2 -1' 3,zoz3 Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable EI Name of License Holder vt/ , 11/ 441 i4/ //a7-0077 L 5 License Number 9 J E F Si, L/ti c 4 57 F.A-, ./ill-.O(S2 3 ?D ie J23 2 0 24 Address Expiration itif/i- 9Tf 77/ - 37/7 Signature Telephone 9.Registered Home Improvement Contractor: I Not Applicable ❑ L'ia7,7:fiAl /v 45 / 77 3y9 Company Name Registration Number 2 S(v ©A icwd,, ,1 lia. 57�.h/Q✓✓ti G7. D �d,3-3 / 2-///262 3 Address `J Expiration ate Telephone?71 72/-3 212 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 buil g permit. Signed Affidavit Attached Yes No 0 Brief Description of Proposed Work NOTE: INSULATION ONL Y ,9-7-71C F/adit — & ',' oio.N ,S/Opi/ CelliIatPF_, I'd D/ t 7 S 141eke c.-40/f S/of, e — (o "`,kle-ev/,Qrl-rZrrleio%iso. 1"4115 - vI Ai)/— y ` veN3/mctc Ge/1d�asc/ //'A- s'eAti•vy I. [/v / di'4 'i /mil/ //d-To , 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. wi/// ,4A4 /14, -4 .J7.0 Print Name - 6.7206 23 Signature of Owner/Agent Date r I, 4 "i '//$ , as Owner of the subject Property `' _l /(ç )hereby authorize W 1 / to act my behalf, in all matters relative to work authorized by this building rmit application. 3 e-e 10-e/tAiii i/n/...)/64,41/...'d,. Faiyvi 6 z002.3 Signa re of Owner e City of Northampton �il'Ij�,li\ x t Massachusetts C---_,---- [ ,•„, ,',f,i DEPARTMENT OF BUILDING INSPECTIONS � •W k-s 212 Main Street •Municipal Building -. Northampton, MA 01060 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: 7(03 e s-7,14/ti p--49,11 20Qd (Please print house number and street name) Is to be disposed of at: PRAT-172Q CVA r' 22 70wJfio!)-e.S7 al CfrFeA4J MA , (Please print nahe and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) _ do-- Signature of Permit Applicant or Owner D e 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. City of Northampton Massachusetts "s. DEPARTMENT OF BUILDING INSPECTIONS �ti .r 212 Main Street • Municipal Building �, ;>' Northampton, MA 01060 ',, MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 76 3 - Gtiis,s7 H. to 70N RP d Contractor / / Name: [— /qiU?,�2/l) 7:-iv 'zg j h •A. C. Address: 2 ,c--(o ®l kLG 'ad' !/ City, State: 6- S 7o4 QLi j l C7, p a-33 Phone: ‘?7I ?7/ 37/7 Property Owner Name: 4 14,4 2// S Address: 7 , 3 (,tl-S7,-/4, ,10,IJ /7 9 - J City, State: 4/0,L7Lt4 / ` .9 , v/D to Z / I, `�In v 4 j Ai i/PD (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 af./.4.„ MIK_ Date 4o 7.7Zmz� ., ,,_ , 3,.„ itti.. Permit Authorization mass save Form Site ID: 4821586 Customer: DAVID BLISS Daviid Bliss &Todd I, Buzzee ,owner of the property located at: (Owner's Name,printed) 763 Westhampton Rd Northampton, MA 01062 (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: Va B-""J Date: 06 / 18/2023 FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: ietgA)7,- /l� rV L IZ to 2 0Z02 3 Participating Contrail Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 For Office Use Only Document Ref:YSB5E-R9821-TTWDH-3OZKR Page 7 of 17 the Commonwealth of Massachusetts I '""'""" 1 k -, Department of Industrial Accidents ; !10 Office of Investigations 1,'- 1 Congress Street,Suite 100 _ '�= Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ContractOrs/Electricians/Plumbers Applicant Information Please Print Letibly Name(Business/Organization/Individual): Lantern Energy L.L.C. Address: 256 Oakwood Drive City/State/Zip:Glastonbury, CT. 06033 Phone#: 877 878-3006 Are you an employer?Check the appropriate box: contractor and I Type of project(required): 1.❑ I am a employer with 30 4. ❑ I am a general 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.: 10.❑ Electrical repairs or additions required.] 5. ID We are a corporation and its 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.❑ Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13. ✓❑ OtherWeatherization comp.insurance required.] 1 *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 1 n/ornt ation. Insurance Company Name: Sentry Insurance Company Policy#or Self-ins.Lic.#: A020527006 Expirat' n Date: 12/31/2013 Job Site Address: ?le 3 LeJ,CS? HA MA 7 0/✓ Rcl City/Sta /Zip: A-71-) 4n/el.).,/ Ai O l ob Z Attach a copy of the workers'compensation policy declaration page(showing the p llcy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the• position 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 ma be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under th pains nd nalties of perjug that the information provided above is true and correct. Signature:1 ����'L��t Date: 6/2 (‘, Z 02. :31 Phone#:978 771-3717 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#: A`ORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/30/2022 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 Sheri Ring, CIC Byrnes Agency, Inc. - Norwich PHONE FAX 6 Consumers Avenue (ANC.No.Ext): (860) 886-5498 (A/c,No):(860) 859-5075 Norwich CT 06360-7521 ADDDRESS: sking@byrnesagency.com INSURER(S)AFFORDING COVERAGE —_ NAIC# INSURER A:Sentry Insurance Company INSURED (877) 878-3006 INSURERS:Nautilus Insurance Company ,Lantern Energy, LLC S Lantern Electrical, LLC INSURER C: 256 Oakwood Dr INSURERD: Glastonbury CT 06033 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:Cert ID 28332 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 POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD!YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR Y A020527004 12/31/2022 12/31/2023 PREMISES(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 PERSONALSADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: • GENERAL AGGREGATE $ 3,000,000 POLICY X LOC PRODUCTS-COMP/OP AGG $ 3,000,000 X OTHER:Location $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X ANY AUTO Y A020527001 12/31/2022 12/31/2023 BODILYINJURY(Perperson) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ A X UMBRELLALIAB X OCCUR Y A020527007 12/31/2022 12/31/2023 EACH OCCURRENCE $ 5,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 5,000,000 DED X RETENTIONS 10,000 WORKERS COMPENSATION PPERTl1TE ER R OTH- A AND EMPLOYERS'LIABILITY YIN A020527006 12/31/202212/31/2023 X - ANYPROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? y N/A (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Errors and Omissions CPP2031310-12 02/23/2022 02/23/2023Each Occurrence S 2,000,000 A Leased/Rented Equipment A020527003 12/31/2022 12/31/2023 $ 160,000 DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CLEAResult, National Grid and NSTAR are included as additional insureds on a primary and non-contributory basis pursuant to the attached endorsements CG7125/CA7013. 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. CLEAResult Attn: Contractor Services Dept. 50 Washington St. AUTHORIZED REPRESENTATIVE Westborough MA 01581 -KJA.a ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 1 CLEAResult CONTRACT CLEAResult 41 Brigham Si., Customer Name:DAVID BLISS Marlborough,MA,01752 Email:blsbuz@comcast.net Phone:413-586-9221 Premise Address:763 Westhampton Rd,Northampton,MA 01062 Mailing Address:763 WESTHAMPTON RD,Florence,MA 01062 Project ID:4821586 Date:April 24,2023 Applicable Customer Required Actions: Notes: • Other Customer to sheetrock attic ceiling in order to move forward with proposed attic work 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 Attic Floor-6"Open Blow Cellulose 576 SF $990.72 $247.68 Kneewall Slope-6"Fiberglass Batting 100 SF $219.00 $54.75 Kneewall Slope-2"Thermal Barrier Polyiso 100 SF $485.00 $121.25 Insulation Removal 100 SF $124.00 $124.00 Walls-Vinyl-4"Dense Pack Cellulose 1472 SF $3,944.96 $986.24 Transition Air sealing 10 LF $64.90 $0.00 Total: $6,510.40 Program Incentive: -$4,976.48 Customer Total: $1,533.92 Payment Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows:Payment#1:$511.00 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:$1,022.92 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. Page 1 of 4 Document Ref:Y885E-R9821-TTWDFF30ZKR Page 1 0117 Customer understands that he/she will not be required to pay the Utility Incentive Share of the Contract price in the amount of $4,976.48.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. 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 Dar erne .1cay,i,SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. 06/18/2023 David Bliss Customer Signature Date Indicate your selected IIC here,if applicable Initial here if you want the Program to assign a Participating 6Aulit.# CContractor Kevin Cote 05/19/2023 CLEAResult Signature Date Name of CLEAResult Representative Page 2 of 4 Document Ref:YSB5E-R9921-TTWPH-30ZKR Page 2 of 17 RCS PLANVIEW DIAGRAM i Customer: /� _ C? Home Phone: (. LI� /�� — wrk PhoneCePho -__ - Any limitations for access by large truck No Yes If yes,describe: _.-- - -- --- ---- ----- Any specific directions or landmarks? NO Yes•_ If yes,describe:_ _-... .__ Site 1D:M1 i nergy Specialist: 313 _ _ _ Reviewed Ar -0 ) 1 l / )IU'IJ /- K 4i r. 60,, ); jr-i , r-74 1 1/ c_-_ // i/at, pew ,iik 1 -.°.'Zclot-liV7 /11/1N, p/V 1/` /(9011kkitewA / Wei i. 5-- 6 `l-� , .5M pi )� I /yea1vl - It',pp __ ? LO-7Y91S_ _ m___.i_e4_it _________ /0 , 4 • • 1 47- 0 6 0 ifil o 0 6 ..... , .__, e9 [KV , For Office Use Only . Gushes Lad der_ Neighbor Proximity T Pocket Doors^ Insert Radiators Fence(%) 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 i Install 0=New Access Note in Circle C=Ceiling W=Wall S=Sheathing Temp Unless Noted Otherwise A=Vents Note in Triangle R=8"Roof S=Soffit G=Gable M=12"Mushroom For Access Rs, t•is rr7'• Commonwealth of Massachusetts Division Division of Professional Licensure 3oard of Buildina Regulations and Standards •ConstrrGttbl�lS�u,./isor CS-077957 _ _ • i;pires:09 3/2022 • WILLIAM K MILIOTO ,___' 9 LEE ST ' • ' LANCASTER-NSA 01523 . '/*-1., , - -N.N :it :_ .. x Commissioner dri A'. Btr,cl .. CcSL /Letie,„-ems Licensee Details Demographic Information _ Full Name: WILLIAM K MILIOTO Owner Name: License Address Information ---------- -__—__ City: Lancaster State: MA Zipcode: 01523 Country: United States License Information License No: CS-077957 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renevval: .9/6/2022 Issue Date: 9/23/2010 Expiration Date: i 9/23/2024 License Status: Active Today's Date: 9/29/2022 Secondary License Type: Doing Business As: Status Change Reason: License Renewal Prerequisite Information No Prerequisite Information No Available Documents THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration r - Type: LLC LANTERN ENERGY LLC. Registration: 177389 Expiration: 12/01/2023 33 WISCONSIN AVE NORWICH,CT 06360ztt 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 Exolratiort 1000 Washington Street -Suite 710 177389 12/01/2023 Boston,MA 02118 LANTERN ENERGY LLC. PETER CALLAN f�^ • !� 33 WISCONSIN AVE sf - /,/ NORWICH,CT 06360 Undersecretary (-'Not valid without signature