Loading...
13-011 (12) BP-2024-0748 24 COLES MEADOW RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 13-011-001 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-2024-0748 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2024 Contractor: License: Est.Cost: 1000 HOMEWORKS ENERGY INC 106148 Const.Class: Exp.Date:07/30/2024 Use Group: Owner: BRADLEY MARILYN J&RHONDA MARIANI Lot Size (sq.ft.) Zoning. RI/SR/WP Applicant: HOMEWORKS ENERGY INC Applicant Address Mon Insurance: 71 DUDLEY ROAD 781-205-4516 1847910 SUTTON, MA 01590 ISSUED ON: 06/11/2024 TO PERFORM THE FOLLOWING WORK: INSULATION/W E ATH E R I Z ATI 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 Drisenay 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: (7P Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner FEE: $65.00 1q�� Please email Permit to WXPermitting@homeworksenergy.com t..tt�T ,,:rant City of NorthamptonDepFOR , = r Building Department ALA:t„t 212 Main StreetJtfiy 7INSU ATION Room 10000Northampton, MA 01060 4'4r Cony_ phone 413-587-1240 Fax 413-587-1272 =��TN����sAF OtIL Y r�q , Foe° APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INSULATION PERMIT 1.1 Property Address This section to be completed by office Map Lot Unit 24 Coles Meadow Road Zone Overlay District Elm St. District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Marilyn Bradley 24 Coles Meadow Road Name(Print) Current Mailing Address: See Attached 413 584-9207 Telephone Signature 2.2 Authorized Agent: Adam Glenn , 71 Dudley Rd Sutton MA 01590 Name(Print) Current Mailing Address' gk 781-205-4516 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $1 ,000 (a) Building Permit Fee 2. Electrical ,A (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4(06 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 +2+ 3+4+5) $1,000 Check Number / 361 Q This Section For Official Use Only BuildingPermit Number: gP� °7c/-7ci Date Issued. Signature: // / 6- 0- 2601 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 71 Dudley Rd Sutton MA 01590 07/30/2024 Address Expiration Date (;I ) 781-205-4516 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ HomeWorks Energy 181138 Company Name Registration Number 71 Dudley Rd Sutton MA 01590 03/02/2025 Address Expiration Date id&14 Telephone 781-205-4516 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 I r l No ... 0 Brief Description of Proposed Work Residential weatherization/ Air sealing. No structural changes. SITE ID: 5228238 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 Print Name Cd/A, A `r3:��- U ` 6/6/2024 Signature of Owner/Agent Date Marilyn Bradley 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 6/6/2024 Signature of Owner Date City of Northampton le -lirl �. r/ Massachusetts -, 9 , t. x i it DEPARTMENT OF BUILDING INSPECTIONS fAP• 212 Main Street • Mun icipal Building �,,rip-� Northampton, MA 01060 l 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 pm-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:If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work:Weatherization Est. Cost:Si ,000 Address of Work:24 Coles Meadow Road Date of Permit Application: 6/6/2024 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: 6/6/2024 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 ca a' ' Massachusetts :.:' ,l' DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building 1 Northampton, MA 01060 ....,.,114.-r-'",...) 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: 24 Coles Meadow Road (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) C(1//aA ,,,.. ;10(1-V 6/6/2024 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. ,_,ir City of Northampton Massachusetts 11 I ,' DEPARTMENT OF BUILDING INSPECTIONS ! 1,40_.� 212 Main Street • Municipal Building 9� Northampton, MA 01060 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 24 Coles Meadow Road Contractor Name: HomeWorks Energy Address: 71 Dudley Road City, State: Sutton MA 01590 Phone: 781-205-4516 Property Owner Name: Marilyn Bradley Address: 24 Coles Meadow Road City, State: Northampton, MA 01060 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 ((JIMAj ''` 1 Date 6/6/2024 HOMEENE-03 LLARMERE ACORN DATE(MMOD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 1/8/2024 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 Lisa Lariviere Foster Sullivan Insurance Group PHONE 163 Main Street (NC,No,Fart):(978)686-2266 301 FAx I(Nc,No): _ North Andover,MA 01845 Xo' ss:certificatest fostersullivangroup.com INSURER(S)AFFORDING COVERAGE _ NAIC e INSURER A:Kinsale Insurance Company 38920 INSURED INSURER B:The Commerce Insurance Company 34754 Homeworks Energy,Inc INSURER C:Everspan Indemnity Insurance Company 16882 101 Station Landing Suite 110 INSURER D:New Hampshire Employers Insurance Compan 13083 Medford,MA 02155 INSURER E:StarStone Specialty Insurance Company 44776 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. NSR TYPE OF INSURANCE ADOL SUBR POLICY NUMBER POUCY EFF POUCY EXP UNITS LIR NSD INVD IMWDD/YYYY) (MIYDD/YYYYI A X COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE ; 1,000,000 CLAIMS-MADE X OCCUR 0100275489 1/1/2024 1/1/2025 DAMAGE TO RENTED 300,000 PRFMtSFSAFa occurrence) $ MED EXP(Any one person) ; 5,000 PERSONAL&ADV INJURY ; 1,000,000 GEM_AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY JECT LOC PRODUCTS-COMP/OPAGG ; 2,000,000 OTHER ; B AUTOMOBILE UABIUTY (Ea MB ident)SINGLE LIMIT ; 1,000,000 ANY AUTO L15948 1/1/2024 1/1/2025 BODILY INJURY(Per poison) $ AUTEEO��S ONLY X AUTOAUTOS ULEO BODILY INJURY(Per accident) $ X AIURTOS ONLY X S ONLY (Per PROPERTY DAMAGE � -; 1 C UMBRELLA UAB X OCCUR EACH OCCURRENCE ; 1,000,000 X EXCESS UAB CLAIMS-MADE BRIEII-000045-00 1/1/2024 1/1/2025 AGGREGATE ; 1,000,000 DED X RETENTION; 0 ; D WORKERS COMPENSATION X I sETTzum 1 I OORTM AND EMPLOYERS'UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE Y� ECC-600-4001157-2024A 1/1/2024 1/1/2025 EL EACH ACCIDENT $ 1,000,000 (Mandatory In EHF EXCLUDED? N/A 1,000,000 E.L.DISEASE-EA EMPLOYEE $ II yes,descnoe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ E Pollution U82192240AEM 1/1/2024 1/1/2025 $25k Deductible 1,000,000 A Umbrella-GL Only 0100275711-0 1/1/2024 1/1/2025 Per Occurrence 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Evidence Only CERTIFICATE HOLDER _ CANCELLATION - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Hom©works EnergyInc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 101 Station Landing Ste 110 Medford,MA 02155 AUTHORIZED REPRESENTATIVE i I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • The Commonwealth of Massachusetts -- F i Department of Industrial Accidents ,• .fir - Office of Investigations F.-; Lafayette City Center =1- 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): Homeworks Energy Address:71 Dudley Rd City/State/Zip:Sutton MA 01590 Phone#: 781-205-4516 Are you an employer? Check the appropriate box: Type of project(required): 1.0 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. 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 working for me in any capacity. 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 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 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no Weatherization employees. [No workers' 13.E Other comp. insurance required.] *Any 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: New Hampshire Employers Insurance Company Policy#or Self-ins. Lic. #:ECC-600-4001157-2024A Expiration Date: 1/1/2025 Job Site Address: 24 Coles Meadow Road 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 and r the pains and pe iff es of perjury that the information provided above is true and correct. g Si nature: ( y `� �z'� Date: 6/6/2024 Phone#: 781-205-4516 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 3.0City/Town Clerk 4.0 Electrical Inspector 5E 'lumbing Inspector 6.0Other Contact Person: Phone#: ‘111) Commonwealth of Massachusetts Division of Occupational Licencure Rest iQcdtc Construction Supervisor Specially Board of Building Real rations and Standards CSSL4C -insulation Contactor . :its•ru; `cti� ttpCr'V* t ti{� r:IdIty .F CSSL-106148 ;, EXpires: 07/30/2024 ADAM GLEN') 19 CHARGE POUND R WAREHAM MA i %� Failure topossess a current edition of the Massachusetts State Huild rwj Code is cause for revocation of this license For information about this license ^^, m^r ^^^. Call{617)727-3200or vise w'ww mass.gov'dp THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation HOME WORKS ENERGY, INC. Registration: 13 101 STATION LANDING STE 110 Expiration: 03//022/2/2 025 MEDFORD, MA 02155 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. ADAM GLENN (At's / 1;4,,e4jL<� 101 STATION LANDING STE 110 ,,,i _- ,.r• MEDFORD,MA 02155 Undersecretary Not valid without signature Page 1 of 1 ®C HomeWorks mass save 101 Station Landing Ste 110, / Horne Works Medford,ma 02155 I If t� Energy PARTNER (781)305-3319 Customer Name:Marilyn Bradley Email:Not provided Phone:413-584-9207 Premise Address:24 Coles Meadow Rd,Northampton,MA 01060 Mailing Address:24 Coles Meadow Rd.Northampton,MA 01060 Project ID:5282186 Date:June 1,2024 Job Description Measure Description Location Quantity Unit Total Cost Customer Cost Rim Joist-6" Fiberglass Batting Other 140 SF $427.00 $106.75 Recessed Light Enclosure Other 5 each $284.45 $0.00 Project Total $711.45 Weatherization incentive ($320.25) Air sealing incentive ($284.45) Total Program Incentive -$604.70 Customer Total $106.75 Total Contractor Price and Payment Schedule HomeWorks Energy, Inc.agrees to perform the above described work,furnishing the material and labor specified for the listed total price. Payment of the balance of the customer contribution Is expected upon completion of the work. ��'�L 6/5/2024 Customersignatcre: ���G�2��' 1�2�u���� Date: _ Customer Phone: Specialist Signature: .AitGr✓v.eCIAL Date: 6/5/2024 LIMITED TIME OFFER: The prices and incentives in this cone act are subject to change in accordance with the sponsoring utility MassSave Home Services Program offers. Proposals con be sent to•InbexHHomeWorksEnergy.com `% aj ` z r3 `- I �VIEW a Nato � t Site 1O. 5 ZZ- -3 Finished Sq. Ft. /see ry Y 2 Phone- -- �" Year of House: I Gr Cj k Electric Acct A Acidtess 73 CA l r 5 IM.4U a- 'M of Floors- r Gas Acct N /v4-`.L.19 L.Qk Lfnil e. A Occupants: Housing Type' I '' DLK1W OPX INSPECTION oe,.iiimixixo7, rl • osto sf4 1 j'fOr • linear Ft. ) H� O s . Square Ft 8) CI3`v p tin" ` • . our Seeingcross -' - t v CS (- sitsratabon •.a in anon Remote) C S Z ' — *el' — ( ` _ - _ BASEMENT INSPECTION 20 p-i- __-, Exastim ueg _s r-,g thsq.Ft .1... _r LI Elms,tau AG 1 Crawl Ceding Gran Rio loon ` 113 6 `p.. a rJ i :ci But RI NO Sal I 5 (5 3� vapor sa--e.{ -- L Beret Door, . o� _er 3 GI sio a la V Blower Door? WALLS&GARAGE Drill Location? Siding 'Ott Height d Spec ring Sperg Sa.Ft. Framing Ene for Wall 1 tj'.wK! 11 5/ I 3400 �✓-'t • ' 7 x 7 x ileattooniptIrf�r Exterior Wail 2 _, l t x x BaIn oo , Overhang a ! r^ j ( - x x IGarage Wad i x SatToonika;tcrn Garage Ceding / r x x 3 _, ,, E. 10 lOk S4-C, eSe3 /44 Ctiat6i,A(. 1.3 it 1,.Jaaa-Remove PIO Sc Sweeps_ 7 WX Stnppsag 3 WORC SPECD BUT NOT CONTRACTED JW OAD BLO0 PRESENT? MANDATORY] -ACDc I Lase--a : :rarwi6Gace 'Other 1-K&T Y Moisture Y/ ! Conrbtation Sit, Y A Isserw Mi i 1-2,or 7,- r„tJCarage Asbestos Y/450 tDO sq.ft T ', 0 Detector Misses T/ Dvr±rsxt !Exterior Wads _ 1 nsicu ae Y/1R1=uuctt Ceet�'K 'I . • -. Nasal tor wed Vaider/'Nbrti Not Csseacteil Ve6s Clot 0 v • ITPAIL4-0-7)iiick $ Aept, nf, . r BW INAlt AND EW F100A Band Spec) 10 OR ► KW stove M10 Gast FND Bind ipet i ;a . . a • FskMl* EMI • 4 s4 tr . t. .. X x Sty , r x e 110Ct11 x L.... GABU K X Ct fSS_x ` TRANS x x ;-, RAM x x 1RA ATTK :. it AT rtC SLOP' x x 4 >t 41 x x EXISTING VENTING? I►titNIGVEHTNG? EXISTINGPI►fS? V/N i. ,[1ks..-y v.. ►snn• t•..,-.,L/rr*alMans 4,0Aver. to �+..�M ..Imo Maya r k M Y Fr�trti:�nEr It'nr,on�:ntr I61t'(/3- aEl ,,ILy / S 0 0 ta Y 0 all U a 0 AL3xs1?vfr1S X 5 ....xa w.. x x ....0.a r n�. WM ai cr..20...rt 1t'..M e,......... .0. ,....a.Q Aloe.. nags etNNMI-/ D.r / s'NMI Mist tr9 m Vol: x .0058 x 1D11 stintX J x ATTIC 1 Wind Sped ❑ X X ATTIC 2 Blind Spec? 0 �>a R arm ) — Existing Specing Sq ft Existing SpeeIng ft ' 'ou...i t)n(looied_ f�'i urTC Nv►i-E •,Un(toored , Multipliers Floored Floored Mixes!mailman Out Wet s6"t,-• Non. CetiSIo�Xe_ Cain Slope Air Sealing Hours Walls t / j Walls Access cress 1 t2nhnp rupavents Vent BE BF Bose Donnellvenunj o tavent► V n 111 Dammut v W e Hw tg. / / / fit , innPFh Access:�i / Sheathing Access' __s.a/to.__Ora- NANO ANO•, or.... Ft/1M. • It L Covers Existing Venting? tQti� 3/%(/ """'"01M fifthn�? NIA taw.et 'Roof rypr r'- Insulation/Air Sealing Permit Authorization Specialist: Andrew LaRoche Company: HomeWorks Energy Email: andrew.laroche@homeworksenergy.coi Address: 101 Station Landing Cell: 8608490960 Medford. Ma 02155 Phone: 7$1.305.3319 MA CSSL- 106148 MA HIC- 181138 Customer: Marilyn Bradley Address: 24 Coles Meadow Road Email: mjb376@aol.com Northampton, MA,01060 Site ID: 5228238 Phone: 4135849207 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 o 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 Home Works Energy that an inspection is necessary with instructions on how to complete this process to close out your permit. Email: mjb376@aol.com Customer Signature: L�2GUG��� Date: 5/23/2024 Marilyn Bra cy 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 above. 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.