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BP-91387
Permit No. BP-91387 BUILDING P RRI GIS#: 4350.00 Commonweal h of 1assachu etts Map: 0080 TOWN�9 ARTIV,LOUTH Lot 0007 t I,J R ,,, 46 - 400 Siocum Road;Dartitoutit 412747 , Sub-Lot: 0000 ,f -'Phon`e,(508}9101.$29„� .faxkl5 8) 10 1838 %h Category: INSULATION ,' -,' ,,�` 3y " *k } . i Project# JS-2019-001950 PERMISSION IS IHEREBYWKANTED TO: *a S y Est.Cost $2999.00 Contractor: r .jf-t nse .. j "1�' one. Fee: $75.00 CHRISTOPHE,R,SAUNDERS h IS 5 7 (40I*487 • 2? Coast.Class: 4 . 1 a :: ' Use Group: R3 , i1, u t I.vhs, .1 . Engineer � � � 1 �� ��- f� � try/tonei #�� s Lot Size(sq.ft.) 47916 w ;L ,,, l a t 1 g: SRB 7 1 w Zoning: Applicant: - Piton ## 4 Aquifer Zone: ZONE 3 a, ° _= �' - '` '' e ' SUPERIOR INSULATION LLC (404487 9922 Flood Zone: ZONE X = New Coast.: N/A OWNER: " ? pi �` `�{ , RILEY PETER M& ':-. �` Alt.Coast: N/A ` -y` Date Typed: 0208-2019 DATE ISSUED: t 1,�`' �F -,�'"� �"� , ,/� ' 4- .a a e % TO PERFORM THE FOLLOWING WORK: --d . �� Install attic floor with cellulose and weatherization . = ` - ject Location: 11 PINE ISLAND RD t. Approved/Issued By: _ DAVI BRUNETTE,LOCAL BUILDING INSPECTOR All work shall comply with 780 CMR 9TH Ed.(MGL Chap.143)and any other applicable Mass.Laws or Codes and plans on file. Schedule appropriate inspections as required. Upon completion,final inspection is required. I I hereby certify that the proposed work is authorized by the owner of record and I have been authorized by the owner to make this application as his agent and to receive this permit, I further understand of agepcies may have reason to STOP WORK if items under their jurisdiction are not met; not withstanding the issuance of this Building/Zoni ermit. Signature of Owner/Agent. ------- --- "Persons contracting with unregistered contractors do not have access to the guaranty fund(as set forth in MGL c.142A)" Inspector of Inspector of D.P.W.Inspector Building Inspector Inspector of Gas Fire Department Plumbing Wiring Water Service#: Footings: Underground: Oil: Underground: Service: Foundation: Rough: Smoke: Rough: Rough: Sewer Service#: Rough Frame: Insulation: Final: Final: Final: Cross Connection Final: Final: Board of Health E-911 Additional Comments: Planning Board Prior to issuance of Certificate of Occupancy/Completion,this card must be returned to the Building Department with all necessary inspections signed off. Department phone numbers are listed on the white"Required Inspections"document provided with the issuance of the building permit. POST CARD SO IT IS VISIBLE FROM THE STREET TOWN OF DARTMQUiH - BUILDING DEPARTMENT RECEIPT j I ` ' PHONE 54-9t0.1820 FAX: 508-910-1838 / i Name: / „,•7('A.-L Property Owner C t i Date: 1 .) t i' a Job Location:' 't' d '•/1/ - Map: ( Lot: -? Description General Ledger #'s Ref. # Amount Building&Building Misc. 01000-44105 Electrical 01000-44106 & Gas .'..c0 0, 64 , Plumbing 7 , T 000-44107 I Trench Safety ( 4600-44129 NO Other Department°Revenue 01000-42420 BETTERMENTS White-Collector's Office Yellow Coax apst mee'.Receipt,- Pink Copy-Building Department Received By - r r`j THIS IS NOT A PERMITILICENSE FOR BUILDING, ELECTRICAL, PLUMBING OR GAS RESIDENTIAL ❑ Phased Approval(R1663.3) ` $25.00 APPLICATION FEE IS NON RE-FUNDABLE &NON TRANSFERABLE f DATE RECEIVED /oQ' " H M' DARTMOUTH BUILDING DEPARTMENT 71V7sa\ K " 400 Slocum Road, P.O. Box 79399 t ' .' Dartmouth, MA 02747 `•° ,664 . .-` Phone: 508-910-1820 Fax: 508-910-1838 www.town.dartmouth.ma.us APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING THIS SECTION FOR OFFICIAL USE ONLY !�J RECEIVED BY: BUILDING PERMIT NUMBER:=//3a"7 DATE ISSUED: SIGNATURE: Oa,Q i Fi,,,, p_la , DATE: — '7�` Building Commissioner/Inspector of Buildings Zoning District: .9/pp.� g� Zone: 0 X 0 B E1AAquifer Zone:ID V �� �� Proposed Use: THE FOLLOWING AGENCIES SHOULD BE NOTIFIED: ❑Board of 0 Board of 0 Cons. 0 Demo 0 DPW 0 Elec. 0 Energy Report Appeals Health Commission Affidavit Card Sent: Cut Off Follow-up` ❑Fire 0 Gas 0 Planning 0 Sewer Card 0 Water Card 0 Zoning 0 Other Chief Cut Off Board Cut Off Cut Off *REQUIRES INSPECTOR'S REVIEW BEFORE THE ISSUANCE OF A PERMIT. DEPARTMENTAL APPROVAL Board of Health: Signature: Dat ; 1 : .�� Conservation Commission: Signature: Date: a - " hi U A _:.;.- ,i- Other: Signature: Date: kialci Signature: Date: Signature: Date: k Brief description of work being performed: 7'I.��` ('-Cl!(a..i..31v-. _ 4 }} p� SECTION 1 -SITE INFORMATION 1.1 Property Address: t 1 I v L \, 1.2 Assessors Map& Lot Number: Lot Area (sf.) Frontage Map 80 Lot 3 - Required Provided Front Yard 1.3 Historical District 0 Yes ❑ No Side Yard Rear Yard Year Built 0 Altering more than 25%per side of building 1.4 Water Supply(MGL c40 s54): 1.5 Sewage Disposal System: Has application been submitted to the Historic Commission? « ❑ Municipal 0 Private Well ❑Municipal 0 On Site Disposal System ❑Yes ❑ No Date: Revised 10/11 0 CONSTRUCTION PLANS 0 SITE PLAN ❑ ENERGY REPORT RESIDENTIAL SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2 Owner Recor • a Ic a- \IN ttQ jI \ad P } ame(print) Contact Address Phone Number 2.2 Authorized Agent: Chris Saunders140 Point Judith Rd Unit A7,Narragansett,RI 02882 401-487-9922 Name(print) Contact Address Phone Number SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor/Specialty License: CSFA License Number: 106269 Company Name/Contractor Name: Chris Saunders 140 Point Ju ith Rd Unit A7,Narragansett,RI 02882 Address: Expiration Date: 3/25/20 Signature: Telephone:401-487-9922 3.2 Homeowner Exemption-One&Two Family Only Section 110.R5.1.3.1 Exception: FOR HOMEOWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT Exception: Arty Homeowner performing work for which a Building Permit is required shall be exempt from the provisions of this section;provides that if a Homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor. For the purposes of this section only,a"Homeowner"is defined as follows: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a Homeowner. If you are applying under this section sign below: Signature: ", l 6. SECTION 4-WORKER'S COMPENSATION INSURANCE AFFIDAVIT(MGL c 152§25) Worker's Compensation Insurance Affidavit must be completed and submitted with this application. Failure tk provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached: NrYes 0 No SECTION 5-DESCRIPTION OF PROPOSED WORK(Check all applicable) ❑ Deck 0 Pool ❑ Repairs 'I Alteration 0 Chimney/Fireplace 0 Woodstove/Pellet Stove 0 New Construction* 0 Accessory Bldg. 0 Roofing/Siding ❑Other (Energy report required) (Shed/Garage) (Specify below) ❑Addition 0 Replacement window/door 0 Demolition (Energy report required) No. of windows Doors (Specify below) *If new construction, please complete the following: Single Family: No.of Bedrooms No. of Baths Two Family: No of Bedrooms Unit 1 No. of Baths Unit 1 No of Bedrooms Unit 2 No. of Baths Unit 2 ❑Furnace(hot air)-fuel gas(natural or propane),fuel oil,electricity,other(specify): ❑Boiler(heating)-fuel gas(natural or propane),fuel oil,electricity,other(specify): HVAC(combined unit)-primary fuel,natural gas,propane,electricity,other(specify): El Air conditioning-(separate unit) ❑None of the above to be provided 0 Hot Water: Gas Electric Fuel Oil Other SECTION 6-ESTIMATED CONSTRUCTION COST Item Estimated Cost($)to be completed by permit applicant 1. Building ' ii ,2r)c 0 i 2. Electrical ' 3. Plumbin. 4. Mechanical(HVAC) 5. Total=(1 +2+3+4) (.1) LOUC) SECTION 7A-OWNER AUTHORIZATION (to be completed when owner's agent or contra tor plies for building permit) (Please Print) l see attached authorization as Own of u ' property hereby authorize to act on my behalf,in all matters relative to work uthorize n permit application. Signature of Owner Date SECTIO 7B-OWNER/AUTHORIZED AGENT DECLARATION Chris Saunders 1, ,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 der he pains and penalties of perjury. �}--_, ll 2 5/ ICI Signature of Owner/Authorized Agent Date SECTION 8-OFFICE/INSPECTOR'S NOTES Less Application Fee: $25.00 Remaining Balance: $ . Total Permit Fee: $ 7s Other$Amount$ Gross Area-New Construction total sq.ft. Gross Area-Alteration total sq.ft. A Permit Issued to: SECTION 9-ADDITIONAL COMMENTS/SKETCHES 0 /9 - eXj, dw"n1-Ard�v7iz0/ w= r 7/1{e r >1/1p( IU i1{(i /f (/t %/ i. .:rr-( (IJ(// F = Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type: Supplement Card SUPERIOR INSULATION LLC. Registration: 175445 Expiration: 05i12!2019 140 POINT JUDITH RD UNIT A7 NARRAGANSETT,RI 02882 Update Address and return card. Mark reason for change. El Address, 72 Ron...! ^gmr_gorrent oat Cap n. ., .1,-'i, ,/,,.,r./•,..,(.: Office of Consumer Affairs&pusiness Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Su lernent Cacti before the expiration date. If found return to: Registration Exoiration Office of Consumer Affairs and Business Regulation 175445 \ 05/12/2019 10 Park Plaza-Suite 5170 SUPERIOR INSULATION LLG. N Roston,MA 02116 CHRIS SAUNDERS 140 POINT JUDITH RD UNIT A7 - U NARRAGANSETT.R; 02882 Undersecretary Not valid without signature I Massachusetts Department of Public Safety rConstruction Supervisor 1 8 2 Family — Board of Building Regulations and Standards Restricted to License: CSFA-106269 Construction Supervisor 1 & 2 Family ; , CHRISTOPHER SAUNDERS 1742 MAIN STREET - - WEST WARWICK RI 02893 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. (�, Expiration: DPS Licensing information visit:WWW.MASS.GOV/DPS Commissioner 03/25/2020 LiFILE COPY Permit Authorization MSS Form fooptseiftwomwto Site ID: SA-12737 Customer: PATRICIA A RILEY PATRICIA A RILEY ,owner of the property located at: (Owner's Name,printed) 11 Pine Island Rd DARTMOUTH (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. Date: 12-22-2018 a*******************************a************************************ FOR CLEAResult OFFICE USE ONLY CLEAResult has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Of�O CLEAResult•50 Washington Street,Suite 3000•Westborough,MA 01581• 1800-480-7472 0n For°ince Use C iy ) a Z�' � ° 1, �Z�7z� �Z g• C 0 ` �Ct►t= ad O�+ i o © � � � pA Awl 7 44 Tit w -. � n i ' ��' o' z �� 0. ~oo-.1ce.0 4°m 4.�C Y t 7j� co> zz j C n � v£ i �r & z C an R '.d —.,, O,Yo00 .p r 7 , Ti'a Z NNNNN b , b ►" 4 b m ©OOOO a d �t; O ►+ 000►+N -S .+O��IWA �, 2 id C 4 A — CI i }-igu bImo, RD 'IN z p 'pc, r to °' wb ����zb� Z� " �` 9 Qa °` A t7 t. w o 'C c` ro c o o n o 0 c TkAD cobh Q ca o a ,',,, 1 k44 k o a •• A ems- N W ,p aF RP r: SB r0Nl c(h p O s � . i� k(t ,6 .444 O O Ch b, S Z x -r (� -y.i.s, o0►+AO J1 " - el 1.4 U U C O ro 4.0000 N C3�? 00000 S �8 ►+ 7 •ems - �. °p{{ r O O O►+., , , _ 4 e„ �iG e A N U1 N .pwpzi �� b t`., O N0 N N 00 b CW tjF� 5 L ►+.+N Q G O � '� co ' ' £ o,O�chti a O m c `tie o wa,- ,o c o C b , C "� A a po o=OOO o N �' ,. w st ►.. b o o �s _ ;Y b7 i.+ C A NAW �1. 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C7 rr C'h o'. d C n,� A p S F I 0 oA -' aS - - - - - — .o •o o o _ .a a b < o 0 0 ,xY G 2, N 2 ..< ,..� 2 co a. ..(� '•R ti 'zb " .» O\p, P^?o a'"-' s° K'b �' o '� CO C0 O o A. 0 0 o �a n o CO` oco OOo '" m aQ44 o m w rapt o°oe co n0 � , O a� o y Z k a ao :<s to OOn E. g 0 n avao '�� G� C,. °^° - o , 0 5 a. o Z 5 it W p , F N �. O OO �Z7 yam: o 'a-i ?m y C S a • A N n.;.-.. _ R. ,. - - -P W , N b ,00 A A I.J ei C +�. Cam. Cy 00 r+0 ; O t,= Ul to NC.4 r 00 W-^ �D b Y>- O 01 On O:° ' '� do m r. z o DO A v0v� p m y i II k M Fr Yl x RI n 4 do a A s20 � r piri Z P 0 3 o mil 1 CD Qiiili Fg A ^�, c. 11-4 A .. b C 1 1# Q H N © F+ Q u • O . W a The Commonwealth of Massachusetts r _i ` 1, Department of Industrial Accidents .,�1_ 1 Congress Street, Suite 100 it_� :,- Ff Boston,MA 02114-2017 ,,ye,, www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lezibly Name (Business/Organization/Individual): Superior Insulation, LLC Address: 140 Point Judith Rd, Unit A7 City/State/Zip: NarraginsPtt, RI 028R2 Phone #: 401-487-9922 Are you an employer?Check the appropriate box: Type of project(required): 1. r I am a employer with 8 employees(full and/or part-time).* 7. 0 New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity.[No workers'comp.insurance required.] 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. 0 Demolition 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.El Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.®Other Install Insulation 152,§1(4),and we have no employees.[No workers'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. _ a The Beacon Mutuall'nsurance mp Co (- Insurance Company Name: 4 � I � 3v� Policy#or Self-ins.Lic.#: °�67887'2�(� n ,,, Expiration Date: 8/22//2019 Job Site Address:I ` f ( VLX,..�L�IC�C,Y i01 I` 4 City/State/Zip: rk L; ' Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: l — i - Date: 1 !1 I 2 S I 1 Phone#: 401-487-9922 t 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#: SUPER-1 OP ID: MM AC-ORGY DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 07/27/2018 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 401-596-2096 CONTACT NAME: Mansfield Insurance Agency Inc PHONE 401-596-2096 I FAX 401-348-2060 115 High Street (A/C,No,Ext): (A/C,No): Westerly,RI 02891-1886 E-MAILSS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Liberty Mutual Insurance 24082 INSURED Superior Insulation LLC INSURER B:Beacon Mutual Insurance Co. Michael O'Connor 140 Point Judith Road,Unit A7 INSURER C: _ Narragansett,RI 02882 INSURER D: INSURER E: 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MM/DD/YYYYI (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR BLW57941515 08l02/2018 08/02/2019 DAMAGE TO RENTED 100,000 Y Y PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 15,000 PERSONAL 8ADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- 2,000,000 POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ ANY AUTO BAW57941515 08/02/2018 08/02/2019 BODILY INJURY(Per person) $ X OWNED SCHEDULED ONLY AUTOS BODILY INJURY(Per accident) $ X HIRED X NON WNED PROPERTY DAMAGE AUTOS ONLY AUTO ONLY (Per accident) _ $ A X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE US057941515 08/02/2018 08/02/2019 AGGREGATE $ 5,000,000 DED X RETENTION$ 10000 $ B WORKERS COMPENSATION PER O AND EMPLOYERS'LIABILITY Y/N STATUTE ER H ANY PROPRIETOR/PARTNER/EXECUTIVE 67872 08/02/2018 08/02/2019 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Insulation Contractor National Grid is listed as additional insured. Waiver of Subrogation in favor of National Grid; Liability is primary and non-contributory. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN National Grid ACCORDANCE WITH THE POLICY PROVISIONS. 40 Washington Street Westborough, MA 01581 AUTHORIZED REPRESENTATIVEAT�E �f��"• ( YSE /YI la" ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Permit No. BP-91387 t Project Location: 11 PINE ISLAND RD Commonwea - ssachusetts •* ,. **s®s.soa®. TO '.° g i 0 a , 4 UTH $• , 1 1., t 1 .� :did 1 bi y.10 .e, inr,11..1.1k ,4 * Pk / 4 f9 3 1 a' Contra t. i . e: c : one . CHRIS SAU 10626' f. t' )487-9922 Architect:' Applicant. „. Phone#: SUPERIOR I ... 44ON #• 4. z3 (401)487-9922 OWNER: '**too.,egw beae* ' 1' ,' ,r3L,Firr:° RILEY PETER M& 1 �� l'i ,; ,j '��' ' , m DATE ISSUED: A-) I TO PERFORM THE FOLLOWING WORK: Install attic floor with cellulose and weatherization 1 DATE- - _TIME I - - — -- --- TYPE OF INSPECTION&REM MKS INITIAL ILL Or/9 /C ,, ,6 of.,_ i.z , �JL, _Lf L' I', L _ b v sidimaimanimibm Certificate of Insulation and Air Sealing Work Address of Residence: Name and Address of Contractor: .1 Ofyr i5)&4 A ' f C-V PIA al h Al(\ Areas Insulated WALLS ATTIC/FLOOR CEILING/SLOPES MATERIAU Added MATERIAL/ Added MATERIAL/ ADDED LOC SQ FT Bag Count R-Value LOG SQ FT Bag Count R-Value LOC SQ FT Bag Count R-VALUE 5 76 Li c Off Cellulose,loose fill: R-3.7 per inch Cellulose,Dense Pack:,R-3.2 per inch Fiber Glass Batt: R-3.0 p/inch Poly-isocyanurate, Rigid Board: R-7.0 per inch Air Sealing #Attic Access Blower Door Completed 4 Treated Results "1‹ Attic ' Pull Down Stairs Pre Test Ic 74 Basement 1 679 Hatches Post Test n Living Space nNone gl Full Size Doors No Blower Door I certify that the residence identified above was insulated as specified, and the installation was conducted in accordance with Mass Save Home Energy Services Program standards and regu1 ons. 1"---X.,...;1 i Ciontratito Crew Lead �1 . Dat ©CLEAResult-All Rights Reserved Rev.07/201 1