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17A-280 (8) BP-2024-1575 389 BRIDGE RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17A-280-001 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-2024-1575 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2024 Contractor: License: Est. Cost: 3700 ENERGY PROTECTORS INC 101143 Const.Class: Exp.Date: 06/16/2026 Use Group: Owner: ASHLEY CRYAN Lot Size (sq.ft.) Zoning: URA Applicant: ENERGY PROTECTORS INC Applicant Address Phone: Insurance: 64 PAXTON RD (774)253-0277 V9WC522768 Spencer, MA 01562 ISSUED ON:11/27/2024 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: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: h "' Fees Paid: S75.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner W The Commonwealth of Massachusetts N ov2 5 a^Board of Building Regulations and Standards >OR Massachusetts State Building Code, 78 CMR _ `I�IUNI,CIPAIpITY ___ __ USE Building Permit Application To Construct,Repair,Ren a.,Or DeMoti4h-a:'c;_ .Rerised Mar 2011 One-or Two-Family Dwelling This Section„io For Official Use Only Building Permit Number: t 1 4 " rb✓/O Date Applied: 5. G� 5 .- _ 1/-27-Z y Building Official(Print Name) S. ture Date SECTION 1:SITE INFORMATION 1.1 Property Address: 0 ck 1.2 Assessors Map&Parcel Numbers 1.1 a 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 ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.t,c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: — Outside Flood Zone''Check if yes❑ Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1m 5niert of Record: ` Ci r A I o( j � 'o f m� 61 (964, Name(Print) , City,State ZIP ✓�1� `3 8Ck ( ciaelt. 04 LAVI - t t-7 6.OJ 7 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other VSpecify: �-L�'r'�11 '-1•C-4.` - Brief Description of Proposed Work': CI\ S r Ci i / i A.Sk,k t�4.41 4 tJ- .. e. r(C e,t SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I.Building $ `n 0 b 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (I-1VAC) $ List: 5.Mechanical (Fire Suppression) $ Total All Fee Check No.g4U)Check Amount: i Cash Amount: 6.Total Project Cost: $ "3-7 00 0 Paid in Full ❑Outstanding Balance Due: i SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) cs.101143 6+16/26 Jo.nua Dada License Number Expiration Date Name of CSL Holder List CSL Type(sec below)u 64 Paxton Rd No.and Street 'type Description spe^<'or.MA 01562 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted I&2 Family Dwelling City/Town.State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 774-2530277 p.da79Qnanw.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 1729e0 11r19l26 Energy Prol.cenrs Inc HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 64 Paxton Rd pada79allotnWloom No.and Street Email address Spencer.MA 01662 774.253.0277 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 Issuan a of the building permit. Signed Affidavit Attached? Yes E No 0 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 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. each OCL ckc t t i Z� 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 ggf 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" The Commonwealth of Massachusetts Department of Industrial Accidents )1, Ofce of Investigations La a ette Ci Center f y �� = 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/Organizationandividual):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.® I am a employer with 11 4. 0 1 am a general contractor and 1 employees (full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition workingfor me in anycapacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance.: required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 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.] + 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. :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. #:V9WCC522768 Expiration Date:9/1/25 Job Site Address: -1 U( k d'<. ° J City/State/Zip: IJ OActw1v wt ( '4 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). U -. 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 them!e pains and penalties[ of perjury that the information provided above is true and correct. Signature: _ C. �\ Date: ( 2(1 Phone#: 774 -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): 1 OBoard of Health 20 Building Department 31:City/Town Clerk 4.0 Electrical Inspector SElumbing Inspector 6.0Other Contact Person: Phone#: City of Northampton r` ��' ��y,...... . SAC;_ Massachusetts j,� I"'••'c�`:,•� DEPARTMENT OF BUILDING INSPECTIONS Di 14 y 212 Main Street • Municipal Building �4 +F�� � Northampton, MA 01060 ` ^�Q 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 cisposed of in: Energy Protectors Inc 64 Paxton Rd Spencer, MA 01562 Location of Facility: The debris will be transported by: P (..\.e c c,1 Pc cAt_,_tz1 TA,L Name of Hauler: Signature of Applicant: 0 G Date: 1 / a y*12-yL .4CORO. DATE(MM.00'YYYY) `� CERTIFICATE OF LIABILITY INSURANCE 8'26,2024 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 ccnfer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: Nina Grochowski oonan Insurance Agency, Inc. PHONE I FAX 267 Main Street (A.c,twEXm 508-987-7122 _Wm,Not 508-987-7152_— Oxford MA 01540 ADo_Ess nina@coonaninsurance.com INSURER(8)AFFORDING COVERAGE NAIL a Lten$e#L7_82965 N+SURER,a_ Safety Insurance Company 188 INSURED ENERPRO-01 INSURER I1: National Liability&Fire Insurance Company Energy Protectors, Inc. — 64 Paxton Road INSURER c Westchester Insurance Company Spencer MA 01562 INSURER 0:Northfield Insurance Comp.1ry INSURER E: Nautilus Insurance Co INSURER F: COVERAGES CERTIFICATE NUMBER:1411018109 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. INER ADTYPE OF INSURANCE N BYOBR POLICY NUMBER IUWVD/VYYY1 INMID POUCY EFF Y EXP ,VTR ISOS° BYO POLICY LIMITS X COMMERCIAL GENERAL UABLITY Y ' Y WS5E9024 3/31/2024 8/31/2025 EACI-OCCURRENCE '$1,000,000 DAMA ' CLAIMS-MADE X OCCUR PREMGETORENTED _ `-- VREAIISESSEa ooa+rertcal S 50,000-_------ MED EXP(Arty one person) S 5.000 PERSONAL 6 ADV INJURY S 1.000.000 OEM AGGREGATE LIMIT APPLIES PER. I GENERAL AGGREGATE S 2,000,000 X POUCY JEC L_J LOC PRODUCTS-COMP/OP AGG S1,000,000 OTHER $ ED A AUTOMOBILE UABIUTY Y Y 6236519 '2/23/2023 12/23/2024 (E t 4e,r,tSINGLE LIMIT $1,000,000 ANY AUTO I SODI..Y INJURY(Per person) S — OWNED SCHEDULED I X BODL.Y INJURY(Per accident) S AUTOS ONLY L—AUTOS y HIRED Xy NON-OWNED -PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY .(par e`er n4------...—_._ —�.--- S E I X UMBRELLA UAB X OCCUR Y Y AN1322957 ' 8/31/2024 8/31/2025 EACI-OCCURRENCE S 1,000.000 EXCESS LIAR CLAIMS-MADE AGGREGATE__ S (�`� f !DED X RETENTION$InJVV $ B WORKERS COMPENSATION V9WC522768 911/2024 9/1/2025 X PER ETH• AND EMPLOYERS' ABILITY I 1 STATUTE ER LI ANIFROPRIETORPARTNEWEXECJTIVE Y/N l EL EACH ACCIDENT $500.000 OFFICERA,I EMBER EXCLUDED? N N/A -- - -------- — - ----------- (Mandatory In NH) E.L CIS.ASE-EA EMPLOYEE S 500,000 It yw oascnpa undo — ---t—— — -- DESCRIPTION OF OPERATIONS bebw 1 EL CISEASE-POUCY IJMT S 500,000 C ',Pollution Uab.l ty Y G74364808001 1 r8/2024 I 1/8/2025 9m unlit 500,000 uccure . DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be a/ached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE !:XPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Unitil Corporation 325 West Road AUTHORI2 ED REPRESENTATIVE Portsmouth NH 03801 • ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORC name and logo are registered marks of ACORD THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration t^• --+-- �r°Type: Corporation s --• `_ lion: 172960 ENERGY PROTECTORS INC. 64 PAXTON RD. x �� EXi ation: 08/19/2026 OM SPENCER, MA 01562 tf "—�` /47 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:Cor oraton Office of Consumer Affairs and Business Regulation FLegis_trglianj8pijtJ?n 1000 Washington Street -Suite 710 172960 0&"9/2026 Boston,MA 02118 ENFRCY PRfITFCTORS JOSHUA DADA 64 PAXTON RD. C/ A/1 SPENCER,MA 01562 Undersecretary of valid without signature Commonwealth of Massachusetts Construction Supervisor Division of Occupational Licensure Unrestricted-Buildings of any use group which contain less than Board of Building Regulations and Standards 35,000 cubic feet(991 cubic meters)of enclosed space. Cons i&i dtpprvisor mot`" •9 CS-101143 ' _ •- expires:06/16/2026 cc JOSHUA S*DA .'ret ' 64 PAXTON c t PAXTON RD '. 1 r 2' SPENCER MA"::61562 1, rt. O t• r)j L\,1 1 Failure to possess a current edition of the Massachusetts State i Building Code is cause for revocation of this license. Commissioner 1 ,f Z G4.r. _ Contact OPSI:(617)727-3200 or visit www.mass.govldpllopsi 1 CONTRACT EVERSeURCE Iimmrommo nsamommummaimm CUSTOMER PHONE DATE CJENTI WORK ORDER Ashley Cryan (413)847-6027 11108/2024 581125 10103 SERVICE STREET BUNG STREET PROPOSE[BY. 389 Bridge Road 389 Bridge Road Heather Lieber SERVICE CITY,STATE.ZIP BILLING CITY.STATE ZIP Proprem Northampton, MA 01062 Northampton, MA 01062 EGMA-HES Page 1 DESCRIPTION QTY COST INCENTIVE TOTAL INCENTIVE 75% For eligible weatherization measures, Eversource is offering an incentive of 75%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 ycur co-pay,applications me st be submitted before the weatherization work begins. Apply at MassSaveHeatLoan.com HOME AIR SEALING 6 $639.54 $639.54 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 DOOR 1 $36.32 $36.32 Provide labor and materials to install Q-Ion v+eatherstripping to door(s)to restrict air leakage. ATTIC DAMMING 10 $27.8C $20.85 56.95 Provide labor and materials to install an approved damming material in the attic ATTIC FLAT-5"OPEN R-19 CELLULOSE 508 $949.96 $712.47 $237.49 Provide labor and materials to install a 5"layer of R-19 Class I Cellulose to open attic space. HATCH-INSULATE RIG D BOARD 1 $53.9E $40.47 $13.49 Provide labor and materials to insulate the back of an attic hatch with 2"rigid insulation board at R-10. DOOR-INSULATE RIGID BOARD 1 $103.05 $77.29 $25.76 Provide labor and materials to insulate the back of a door with 2"rigid insulation board. WALLS-VINYL SIDED 4' 90 $274.50 $205.88 $68.62 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. CRAWLSPACE CEILING-6"FIBERGLASS 176 $487,52 .4 Provide labor and materials to install R-19 faced fiberglass batt �t.,�� insulation to the open crawlspace ceiling.Th s will be installed with 11, the paper backing up against the floor above. The un-papered fiberglass side will be facing the basement.and these exposed CONTRACT EVERSeURCE itaminammunimmommiammiammuumismoII 11111111111111111111111111111111111111111111111111111.1.1111111111.111111111111111111111111111111111111111111111111111111111111111111 CUSTOMER PHONE DATE CLIENT t WORK ORDER Ashley Cryan (413)847-6027 11/08/2024 581125 10103 SERVICE STREET BLLNO STREET PROPOSE(BY: 389 Bridge Road 389 Bridge Road Heather Lieber SERVICE CITY.STATE.ZIP SLING CITY,STATE.ZIP Program Northampton, MA 01062 Northampton, MA 01062 EGMA-HES Page 2 DESCRIPTION QTY COST INCENTIVE TOTAL fiberglass fibers will be the visible side when standing in the basement. Your initials are your agreement and understanding of this measure CRAWLSPACE CEILING-2"RIGID BOARD INSULATION 140 $777.00 $582.75 $194.25 Provide labor and materials to install 2"rigid board to the crawlspace ceiling. CRAWLSPACE-6 MIL POLY GROUND COVER 176 $207.68 $207.68 Provide labor and materials to install 6 ml or greater polyethylene over open ground in designated crawlspace/earthen basement areas. CRAWLSPACE WALLS-3.5"FIBERGLASS BATTING 12 $26.88 .72 Provide labor and materials to install R-13 faced fiberglass batt insulation to the open crawlspace wall.This will be installed with the paper backing up against the floor above.The un-papered fiberglass side will be facing the basement,and these exposed fiberglass fibers will be the visible side when standing in the basement. Your initials are your agreement and understanding of this measure INSULATED BATH EXHAUST HOSE 4 INCH 1 $32.23 $24.17 $8.06 Provide labor and materials to install an insulated 4"exhaust hose to existing bathroom fan(s). CRAWLSPACE CONTINGENCY A crawlspace area in your home that could benefit from weatherization a work has been identified. Although your home would benefit from weatherization work in this 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 pror to scheduling the work to verify their ability to accomplish the scope of work. CUSTOM DISCLOSURE Client is responsible for securing wall panels with screws prior to the (t dais).09 insulation work. J CONTRACT EVERSir`URCE CUSTOMER PHONE DATE CLIENT I WORK ORDER Ashley Cryan (413)847-6027 11/08/2024 581125 10103 SERVICE STREET BILLING STREET PROPOSED BY: 389 Bridge Road 389 Bridge Road Header Lieber SERVICE CITY-STATE,ZIP SWAG.CITY STATE,ZIP Program Northampton, MA 01062 Northampton, MA 01062 EGMA-HES Page 3 DESCRIPTION QTY COST INCENTIVE TOTAL KNOB&TUBE WIRING-OK Because the weatherization recommendations are in readily accessible areas and your energy specialis:verified they do not contain knob and tube wiring,your weather zation can proceed without an electrician's irspection. • Total: $3,616.44 Program Incentive: $2,933.22 Client Total: $683.22 I.DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the. .ve s •rk at vie Client's Address in a professional manner and in accordance with the terms of this Contract: II.PAYMENT Client e 'o pay the C. ct • the'Work, e Cr, Share of lb Contract Cost is payable to the ndependent Installation Contractor(IIC)upon satisfactory completion of t r .Client under o .; at . ' •• •quired to pa a Program Incentive Sh the Contract cost.Changes to the individual line items and/or previous lk y e ..yincrease. • T . hesize - he Prcgrapa Inc••• aShare. i'' /� / RI-,Repr-enhhve . �` C1 t S afore Printed Name Dat f Ac pt.mu 4 mass save ! ivings through energy efficiency PERMIT AUTHORIZATION FORM 1, Ashley Cryan _ owner of the property located at: (Owner's Name) 389 Bridge Road 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 cn my property. This form is only valid with a signed contract. The permit will be secured by the subcontractor, at no additional cost. owner's ig;ature I •ate / FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participat g Contractor Date