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49-051 -687 PARK HILL RD BP-2020-0869 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:49-051 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit# BP-2020-0869 Proiect# JS-2020-001492 Est.Cost:$3200.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: HOMEWORKS ENERGY INC103832 Lot Size(sg. ft.): 117612.00 Owner: LEIBOWITZ MARK S Zoning: Applicant: HOMEWORKS ENERGY INC AT: 687 PARK HILL RD Applicant Address: Phone: Insurance: 101 STATION LANDING (781) 205-2595 WC MEDFORDMA02155 ISSUED ON:1/31/2020 0:00:00 TO PERFORM THE FOLLOWING WORK:INSULATION AND 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department 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. Certificate of Occupancy signature: FeeTyne: Date Paid: Amount: Building 1/31/2020 0:00:00 $65.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Dep City of Northampton , l's OR Building Department 212 Main Street^� ULATION (. Room 100 'r,� Northampton, MA 01060"'-"" �0 �- phone 413-587-1240 Fax 413-58 '1 ' ,^�c ONLY APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY a4glNG NLY SECTION 1 -SITE INFORMATION INSULATIbiV PERMIT 1.1 Property Address: This section to be completed by office Map Lot OG I Unit 687 Park Hill Road, Northampton, MA 01062 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT - aoo3 2.1 Owner of Record: Mark Lebow 687 Park Hill Road, Northampton, MA 01062 Name(Print) Current Mailing Address: 413-584-6643 Telephone Signature 2.2 Authorized Agent: Gary Clement 101 Station Landing, Medford, MA 02155 Name(Print) Current Mailing Address: 781-205-2595 Signat Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 3L^^00.00 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5) Check Number A This Section For Official Use Only Date Building Permit Number:�P lJ' Issued: Signature: /ad Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of LicenseHolder:Scott Veggeberg CSSL-103832 License Number 8 Covington Street, #1 , Boston, MA 02127 10/13/2021 Address Expiration Date ��- 781-205-2595 sigrwture Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ HomeWorks Energy Inc. 181138 Companv Name Registration Number _101 Station Landing, Medford, MA 02155 03/02/2021 Address Expiration Date Telephone 781-205-2595 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....... V No...... ❑ Brief Description of Proposed Work Insulation and weatherization work (no structural changes) 1. Gary Clement 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. Gary Clement Print Name 01 /30/2020 Signatur f OwroTAgent Date , 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. Signature of Owner Date City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building P Northampton, MA 01060 sSV ............. �^J 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 pre-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:Insulation and weatheftation work(no structural changes) Est. Cost: 3200.00 Address of Work: 687 Park Hill Road, NorthamptQn, MA 01062 Date of Permit Application: 01/30/2020 1 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: 01/30/2020 Gary Clement 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 Massachusetts DEPARTMENT OF BUILDING INSPECTIONS �'• �° � 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: (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) ,ga74, 01 /30/2020 natur f Permit Applicant or Owner Date YY 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. '\ The Commonwealth of Massachusetts Department of Industrial Accidents 0 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia !'Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Ap2licant Information Please Print Leeibly Name(Business/Organizatiorvindividual): HomeWorks Energy Inc. Address: 101 Station Landing, Suite 110 City/State/Zip: Medford, MA 02155 Phone#: 781-305-3319 Are you an employer'Check the appropriate box: Type of project(required): 1.[5 1 am a employer with 500 employees(full and/or pan-time).* 7. ❑New construction 2.0 1 aer a sole proprietor or partnership and have no employees working forme in 8. ❑Remodeling any capacity.1No workers'camp.insurance required.] 9. El Demolition 3 1 am a homeowner doing all work myself!No workers'comp insurance required.l' 10[:]Building addition 4.n I am a homeowner and will be hiring contractors to conductall work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I LF1 Electrical repairs or additions proprietors with no employees, 12. Plumbing repairs or additions 5Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance. 14.[20ther Insulation 6.Q we are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.) •Any applicant that checks box p 1 insist 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 hitt: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 sad state whether or not those entities have employees. If the sub-contractors have employees,they nmrst provide their workers'comp.policy number. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and Job site information, Insurance company Name: NH Employers Insurance Company Policy#or Self-ins.Lic.#: 4001017 Expiration Date: 01/01/2021 Job Site Address:QQ7 Eat U911 EQad Cit /State/Zi : h 111 MA 01062 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 i mprisonment,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 tement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify tet polus nd p naldes of perjury t t tire Information provided above is true and correct Si nature: Date: 01/30/2020 Phone#: 781-305-3319 Official use only. Do trot w to it 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.CitytTown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: jI i t HOMEENE-01 LLARIVIERE ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) Illk � 12/19/2019 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,LLC HONE/co,Ext):(978)686-2266 301 FA -6410 No:(978)686 6410 163 Main Street North Andover,MA 01845 E-M RIL .certificates@fostersullivangroup.com INSURERS AFFORDING COVERAGE NAIC N INSURER A:Homeland Insurance Company NY 34452 INSURED INSURERS:Safety Indemnity Insurance Company 33618 Homeworks Energy Inc. INSURER C:NH Employers Insurance Company 13083 Homeworks IIC LLC 101 Station Landing Suite 110 INSURERD: Medford,MA 02155 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 EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000 CLAIMS-MADE �OCCUR 7930060650002 4/1/2019 41112020 DAMAGE TO RENTED 500,000 MED EXP(Any oneperson) $ 10'000 PERSONAL 8 ADV INJURY 1'000'000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑PES LOC PRODUCTS-COMP/OP AGG 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO 6244378 4/1/2019 4/1/2020 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY 1xx AUTOSWNEp BODILY INJURY Per accident $ X AUTOS ONLY AUOTO ONLY P�teOa�Rd�t AMAGE $ r $ A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2'000'000 2gDEDEXCESSLIAB CLAIMS-MADE 7930060660002 4/1/2019 4/1/2020 AGGREGATE 2'000'000 X I RETENTION$ 0 C WORKERS COMPENSATION X PERTUTE I OTH- AND EMPLOYERS'LIABILITY YECC-600-4001017-2020A 1/1/2020 1/1/2021 ER 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE � N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES IACORD 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 Homeworks Ener Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9Y ACCORDANCE WITH THE POLICY PROVISIONS. 101Station Landing Ste 110 Medford,MA 02155 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card 1138 HOME WORKS ENERGY,INC. Registration: 101 STATION LANDING STE 110 Expiration: 033!02/2/02/2 021 MEDFORD,MA 02155 Update Address and Return Card. SCA 1 0 20M-05/17 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card before the expiration date. If found return to: Registratlon Exn1ration office of Consumer Affairs and Business Regulation 181138 03/02/2021 1000 Washington Street-Suite 710 HOME WORKS ENERGY,INC. Boston,MA 02118 GARY CLEMENT 101 STATION LANDING STE 110 (� MEDFORD,MA 02155 Undersecretary of v id without signature Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constructi£anSpe�%Aapr Specialty CSSL-103832 pires: 10/13/2021 SCOTT VEGGEBERG 8 COVINGTON ST #1 BOSTON MA 02127 -� 1 Co'Mmi$sioner 1 Insulation/Air Sealing Permit Authorization Specialist: James Conlon Company: HomeWorks Energy Email: JamesconIon @homeworksenergy Address: 101 Station Landing HomeWorks Cell: 8608490960 Medford, Ma 02155 Phone: 781-305-3319 Customer: Mark Leibowitz Address: 687 Park Hill Rd Email: 0 Northampton, MA 01062 Site ID: 3964916 Phone: (413) 584-6643 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. Customer V _ Signature: Date: 1/22/2020 Mark Leibowitz PLAN VIEW p Name: i W�`I1 Site ID: � "( 6 q/ �y Finished Sq. Ft: 7 Phone: c 6 L r Year of House: (f9Q Electric Acct#: Address: #of Floors: Gas Acct#: �rflx»fOfr ,. 1 R°��F unit#:lac' # Occupants: 2 Housing Type? � ni7 DUCTWORK INSPECTION Ducts Insulated? Duct Linear Ft. Duct Square Ft. ti `rS Duct Air Sealing Hours � 5 90;41,5 pT '7Duct Insulation - l' � 11�\ �r-y Duct Insulation Removal BASEMENT INSPECTION AS,eExisb,ngc'inH Ln/Sq. Ft. Bsmt Wall AG Crawl CeilinCrawl Rim JoistBsmt RJ w/Sill Bsmt RJ NO Sill Vapor BarrierimBsmt Door "Y/N Blower Door? WALLS&GARAGE Drill Location? Siding Ceil.He! ht Existing Spec'ing Sq. Ft. Framing Exterior Wall 1 x x Balloon/Platform Exterior Wall 2 x x Balloon/Platform Overhang x x Garage Wall x x Ballodn/Platform Garage Ceiling x ce. , Insulation Removal Sgft. Sweeps: WX Strip in WORK SPEC'D BUT NOT CONTRACTED D BLOCKS PRESENT?(MANDATORY) Attic Basement/Crawls ace Other: K&T Y oisture Y/N .Combustion Sfty Y Kneewall 10verhan /Gary e Asbestos Y/ old>100 sq.ft Y/N CO Detector Missing << N Ductwork I Exterior Walls Vermiculite Y/'N I Structl Concerns Y/N Other: Notes for Lead Vendor/Work Not Contracted: KW WALL AND KW FLOOR Blind Spec? ] _— O R - -— KW SLOPE AND GABLE END Blind Spec? Why?, Why? % FT FRAMING EXISTING SPEC'ING FT. WALL X\ X SLOPE X X FLOOR X X\ GABLE X X ACCESS X TRANS X X TRANS X X ATTIC ATTIC \y' SLOPE X X SLOPE X x i \ EXISTING VENTING? / EXISTING VENTING? EXISTING PIPES? Y/N KW Venting ent 8F BF Hose Dammin Sh hing Access Temp Access KW Ve ng Vent BF Terrip Actass 0 P a Mil C Insulated Wall X X Recd Light O Ins.Hose BF Vent OF F5_FV1 Chlm.CH'Damming 12"Roof V t CZRV Vol: X .01)58 Air Handier AH Temp Access TO Pull Down DSL Hatch D Wall Hatch ii/ Door n/ g"Roof Vent P X X I ATTIC 1 Blind Spec? n `-X. x ATTIC 2 Blind Spec? X u a1(z s owl Existing Spec'ing Sq ft \ Existing Spec'ing q ft C13.6(3storyl) e ✓� �'� Unfloored o G' Unflooredrusste Floored Floored None Cath Sloe - - Cath Sloe Air Sea li _ Hours Walls --- Walls Access I Access 1 //0 J Venting Propavents Vent BF I BF Hose I Da I Venting WoDavents Vent 8F BF Hose Dammin m 00 'u Temp Access,' ,(v o Sheathing Access'!" R.L.Comets: . r�:S +•Sq.Ft/300 e';;?/-f ytt_(Exist.NFA Vend (N ad Sq.Ft/300= (Exist.NFA Venting)= lNeeded / Existing Venting? ! ' M.AFAvendngl Istin Venting? NFAWentng) Roof Type: PKv /� T Page 1 c a d n HOMeWlOrkS mass save Energy, Inc PARTNER 101 Station Landing Ste 110,Medford,MA 02155 (781)305-3319 ext.120 Customer Name:Mark Leibowitz Email:leib687@gmaii.com Phone:413-584-6643 Premise Address:687 Park Hill Rd,Northampton,MA 01062 Mailing Address:687 Park Hill Rd.Northampton,MA 01062 Project ID:3971849 Date:Jan.22,2020 Job Description Measure Description Locafion Quantity Unit Total Cost Customer Cost Air Sealing at Estimated 62.5 CFM50 Per Hour 8 hr $740.64 $0.00 Door Sweep (with AS hrs) 6 each $151.86 $0.00 Exterior Door Weather Stripping (with AS hrs) 6 each $180.42 $0.00 Attic Floor-8"Open Blow Cellulose 864 SF $1,520.64 $380.16 Hatch -2"Thermal Barrier Polyiso 1 each $46.28 $11.57 Damming 40 each $95.60 $23.90 Propavent 54 each $224.64 $56.16 Bath Fan - Vent to Roof 1 each $141.30 $35.32 Project Total $3,101.38 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 tota price. Payment of the balance of the customer contribution is expected upon completion of the work. Customer Signature: Date: 2 ZC�I Customer Phone: Specialist Signature: Date: _a r uMMED TIME OFFER: The{rices and Incentives In this contract are subject to change In accordance with the sponsoring utility MassSave Home Services Program offers. Proposals can be sent to:1nboxLi0HomeWorksEnergy.com Page 2 c ( 0 "'Fn C HomeWorks mass save, Energy, Inc PARTNER 101 Station Landing Ste 110,Medford,MA 02155 (781)305-3319 ext.120 Customer Name:Mark Leibowitz Email:leib687@gmail.com Phone:413-584-6643 Premise Address:687 Park Hill Rd,Northampton,MA 01062 Mailing Address:687 Park Hill Rd,Northampton,MA 01062 Project ID:3971849 Date:Jan.22,2020 Weatherization incentive ($1,521.35) Air sealing incentive ($1,072.92) Total Program Incentive -$2,594.27 Customer Total $507.11 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 tota price. Payment of the balance of the customer contribution is expected upon completion of the work. Customer Signature: 1 �� 1 ate.` ` Date: Customer Phone: Specialist Signature: Date: UMITED TIME OFFER: The prices and Incentives in this contract are subject to change in accordance with the sponsoring utility MassSave Home Services Program offers. Proposals can be sent to:inbox@HomeWorksfnergy.com