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29-115 77 FOREST GLEN DR BP-2021-1380 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29- 115 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERI D CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Weatherization BUILDING P E RVI I T Permit# BP-2021-1380 Protect# JS-2021-002301 Est.Cost: $6000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOMEWORKS ENERGY INC181138 Lot Size(sa. ft.): 13982.76 Owner: BENT CHRISTOPHER Zoning: Applicant: HOMEWORKS ENERGY INC AT: 77 FOREST GLEN DR Applicant Address: Phone: Insurance: 357 COTTAGE ST (781) 205-2595 O WC SPRINGFIELDMA01104 ISSUED ON: TO PERFORM THE FOLLOWING WORK WEATHERIZATION/AIR SEALING 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. Le • • SU . '/ • Certificate of Occupancy signat . FeeTvpe: Date Paid: Amount: Building 5/24/2021 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner • FEE: $65.00 Dep :111,1 City p of Northampton Building Department 1 , ",. A '4 212 RoMain om Street INSULATION Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 ONLY - i 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 '/1 5- Lot Unit 77 Forest Glen Drive Northampton Massachusetts 01062 Zone Overlay District Elm St. District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Christopher Bent 77 Forest Glen Drive Northampton Massachusetts 01062 ' Name(Print) Current Mailing Address: See Attached (413)374-3397 Telephone Signature 2.2 Authorized Agent: Adam Glenn 357 Cottage Street, Springfield, MA 01104 Name(Print) cdtaA cog-3e/V- Current Mailing Address: 781-205-4484 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 6000.00 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 4/5 5. Fire Protection 6. Total = (1 +2+ 3 +4+ 5) 6000.00 Check Number ( - 14- This Section For Official Use Only Building Permit Number 69 2o21- I3g0 Date Issued: Signature: / 5- Zy' ZOZ l 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 0 Name of License Holder Adam Glenn 106148 License Number 357 Cottage Street, Springfield, MA 01104 07/30/2022 Address Expiration Date c-(- 781-205-4484 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable 0 HomeWorks Energy 181138 Company Name Registration Number 357 Cottage Street, Springfield, MA 01104 03/02/2023 Address Expiration Date %(A Telephone 781-205-4484 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 No ❑ Brief Description of Proposed Work Residential weatherization/ Air sealing. No structural changes. SITE ID 297402 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 � 64405/19/2021 Signature of Owner/Agent Date Christopher Bent 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 05/19/2021 Signature of Owner Date City of Northampton 7 4 ` MassachusettsL., . r • DEPARTMENT OF BUILDING INSPECTIONS s, 212 Main Street • Municipal Building A- , oe Northampton, MA 01060 ,f`sfrh, _ 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:Weatherization Est.Cost:6000.00 Address of Work:77 Forest Glen Drive Northampton Massachusetts 01062 Date of Permit Application: 05/19/2021 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: 05/19/2021 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 r14_, s ..»...:siMassachusetts �? !t�04 DEPARTMENT OF BUILDING INSPECTIONS z 212 Main Street •Municipal Building ti v � Northampton, MA 01060 sf�`+ .j.>>� 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: 77 Forest Glen Drive Northampton Massachusetts 01062 (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) C441‘ aii 'a 05/19/2021 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. The Commonwealth of Massachusetts ct_y! tl, Department of Industrial Accidents � 1- 1 Congress Street,Suite 100 y', �i=_ Boston, M.4 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information , Please Print Legibly Name (Business/Organization/Individual): HO M E Y p,1LORKE NS E RG--1�/ Address: 357 COTTAGE STREET City/State/Zip: SPRINGFIELD, MA 01104 Phone#: 781-205-4484 Are you an employer?Check the appropriate box: Type of project(required): 11 7^[am a employer with 500 employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]' 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 11.0 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. Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14 ther WEATHERIZATION 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. r 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 ant 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: 1/1/2022 Job Site Address 77 Forest Glen Drive Northampton Massachusetts 01062 City/State/Zip: 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 do hereby certify under tl pains an, ien' ties of that the information provided above is true and correct Signature: 41 ' Date: 05/19/2021 Phone#:781-205-4484 II wxpermitting@homeworksenercly.com 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): I. Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ��1 HOMEENE-01 LLARIVIERE ,a► /R� CERTIFICATE OF LIABILITY INSURANCE DAT1/4/2021 YY) 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 N ME:NTA Foster Sullivan Insurance Group,LLC 163 Main Street jA"Ic°°,"N,Ext):(978)686-2266 301 FAX No):(978)686-6410 North Andover,MA 01845 E-MAIL SS:certificates@fostersullivangroup.com INSURER(S)AFFORDING COVERAGE NAIL# INSURER A:Markel Insurance Company 38970 INSURED INSURER B:Safety Insurance Company 39454 Homeworks Energy,Inc INSURER C:McGowan Excess&Casualty 551155 Homeworks IIC LLC 101 Station Landing Suite 100 INSURER D:NH Employers Insurance Company 13083 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 SUER W POLICY NUMBER M/POLICY EFF POLICY EXP LIMITS LTR INSD VD IMMIDD/YYYYJ (MDD/YYYY)_ A X COMMERCIAL GENERAL UABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR MKLVIPBC001429 1/1/2021 1/1/2022 DAMAGETORENTED 100,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY O LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT OTHER: $ B AUTOMOBILE LIABILITY Ea accideCOMBINEnt SINGLE LIMIT $ 1,000,000 ANY AUTO COM5915393 1/1/2021 1/1/2022 BODILY INJURY(Per person) $_ OWNED X SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ X HIRED ONLY X NON-O ONED PROPERTY DAMAGE AUTOS (Per accident) $ $ C _ UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 1,000,000 X EXCESS LIAB CLAIMS-MADE MQSX00007091-01 1/1/2021 1/1/2022 AGGREGATE $ 1,000,000 DED X RETENTION$ 0 $ D WORKERS COMPENSATION PER OTH- AND EMPLOYERS'UABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N ECC-600-4001017-2021A 1/1/2021 1/1/2022 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Pollution Liability CPLMOL105056 1/1/2021 1/1/2022 $10,000 Deductible 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 Homeworks EnergyInc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 101Station Landing Ste 100 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 K1,/, mpeer/// tfe://„&a,34.ezedteA Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Roston. Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card Registration: 181138 HOME WORKS ENERGY,INC Expiration: 03102/2023 101 STATION LANDING STE 110 MEDFORD,MA 02155 Update Address and Return Card. SCA t a 20M-aso 7 .!`h," %i!.VI/1,1,o0i1w/7/. Office of Consumer Affairs&Baslnsee RegulNfon HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Supplement Card before the expiration date. it found return to: Elasista1120 EaRkation Office of Consumer Affairs and Business Regulation 18113E 03;0212023 1000 Washington Street -Suite 710 HOME WORKS ENERGY,JNC. Boston,MA 02118 ADAM GLENN 101 STATION LANDING STE 110 •°' eC/.v.6 MEDFORD,MA 02155 Not valid without signature Undersecretary 171 Cormmenweaflh of Massachusetts Construction Supervisor Specialty Division of Professional Licensure Restrrdedto Board of Building Regulations and Standards CSSL-4C-truulatron Contractor Constructiort.SilperVisor Specialty CSSL•106148 * rigpires 07l3012022 1 ADAM GLENN r 19 CHARGE POUnID RO WAREHAM MA 02571 `,T '+ " 4 Failure to possess a current edition of the Massachusetts n ,,� State Building Code is cause for revocation of this license '+' For information about this license Commissioner Call(617)727.3200 or visit wMrw mass.govrdpi Insulation/Air Sealing Permit Authorization Specialist: Adam Morrison Company: HomeWorks Energy Email: 0 Address: 101 Station Landing HomeWorks Cell: (781) 305-3319 Medford, Ma 02155 Phone: 781-305-3319 Customer: Christopher Bent Address: 77 Forest Glen Dr Email: cbent33@gmail.com Northhampton MA 01062 Site ID: 297402 Phone: (413)374-3397 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 a permit is pulled on your home for insulation and/or weatherization work,you may be required to have a final inspection scheduled and performed on the work by the building inspector in your town. If this case relates to your job, you will be notified by HomeWorks Energy that an inspection is necessary and you will be given the proper steps on how to complete this process to close out your permit. Email cbent33@gmail.com Customer Signature: Date: 1/19/2021 Christopher Bent 8am Rise PLAN VIEW 3 Name: Christopher Bent Site ID: 297402 Finished Sq. Ft: 1200 g Phone: (413)374-3397 Year of House: 1959 Electric Acct#: F— Zi+ Address: 77 Forest Glen Dr Northhampton MA 01062 #of Floors: 2 Gas Acct#: W Unit#: # Occupants: Housing Type? Raised Ranch DUCTWORK INSPECTION Ducts Insulated?n Wood ID 1eck 16 = 16 Duct Linear Ft. 320`} Duct Square Ft. '- `t -� Duct Air Sealing Ho rs 1/3 ) —. 20 Duct Insulation ��./ _j'3p Duct Insulation Remova ;.. BASEMENT INSPECTION � u, Existing Spec'ing Ln/Sq.Ft. m Bsmt Wall AG `6 7 Fr _ `6 Crawl Ceiling (.'9$8;' Crawl Rim Joist Bsmt RJ w/Sill — .W0' Bsmt RJ NO Sill Vapor Barrier' sgft. Bsmt Door' =" Y/N Blower Door? WALLS 8t GARAGE Drill Location? Siding Ceil.Height Existing Spec'ing Sq.Ft. Framing Exterior Wall 1 Alum 1 Vinyl 8 )1/;f 6 a r is 1024 2 x 4 X 16 BalloonOPlatfor / Exterior Wall 2 ..atigairmsy4 of .+aw 2 xa x 1s Balloon0Platforrr>I Overhang x x Garage Wall x x Balloor _Platforn Garage Ceiling t' io r x a✓'; x 1 tE� 3. cp coda _Dl ta c k o 16 ti 320 r z - c - C4 g 20 R w x W /rram A` G 26 1Fr/B 26 ti, 988 .' -- Insulation Removal Sgft, WORK SPEC'D BUT NOT CONTRACTED ROAD BLOCKS PRESENT?(MANDATORY) Attic ❑ Basement/Crawlspace❑ Other: K&T Y N Moisture Y�N Combustion Sfty Y NI Kneewall ❑ Overhang/Garage ❑ Asbestos Y ON Mold>100sgFt Y❑ CO Detector Missingg ❑ Ductwork El Exterior Walls ❑ VermiculiteY❑N Structl Concerns'Y❑N Other: Notes for Lead Vendor/Work Not Contracted: cbent33@gmail.com KW WALL AND KW FLOOR Blind Spec? OR - KW SLOPE AND GABLE END Blind Spec? ■ Why? Why? _ FRAMING EXISTING L S.FT. FRAMING EXISTING SPEC'ING SQ.FT. WALL X X SLOPE X X FLOOR X X GABLE X X o ACCESS X TRANS X X RI LL RANS X X ATTIC D ATTIC SLOPE X X vrr id SLOPE X X EXISTING VENTING? % r EX:T:::ENT1:: , BF Hose Dammin: Tern.Access KW Venting cot BF Temp Access IMEMB9KNEEWALL MANDATORY Wood Deck gd r C, 1 E6 �_--_ 16 ) 14 - Cli Q20-il." II-I - C2-0-- 20 38 • • do Z 5Fv • • .:, • • all . 0 a `� ?p5 1Fr/B 26 988 Insulated Wall • Rec'd Light 0 Ins.Hose I BF I Vent BF BFV i Chim.I CHI Damming 12'Roof(lg?g�yt�112RV Air Handler I AH) Temp Access El Pull Down WI Hatch j Wall Hatch"/ Door n/ 8'Roof Vent BRVV '.✓ BAS Vol: x .0058 x/ x/ ATTIC 1 Blind Spec? u x 19(1 story) _ P L] x x ATTIC 2 Blind Spec? is.n(2 story)) Existing Spec'ing Sq ft Existing Spec'ing Sq ft v13.6(3 story)) Unfloored !t�m1 X , 9?I( Unfloored Trusses Cross Batting Floored Floored Mixed I Duct Work I I Cath Slope Cath Slope >6"Zoosa None I I Walls Walls AIR SEALING HOURS t�ir� I Access 1'V S A e J-A Access Venting Propavents Vent BF BF Hose Damming Venting Propavents Vent BF BF Hose Damming E 1 VVHF Box: iv ) L I i 1'+ ,,,.r Temp Access:__ to a Sheathing Access:_` Sq.Ft/300= - (Exist.NFA Venting)_ (NeededLovers:___ Sq.Ft/300= . (Exist.NFA Venting)_ (Needed Existing Venting? NFA Venting) Exi ling Venting? NFA Venting) Roof Type:asphalt f)(:),r 6`1'1' t'n dikV1 i *erg 1) A/0 e HomeWorks Energy EN(I 101 Station Landing,Medford, MA 02155 CONTRACT - AUDIT f I1J11 a 1s 781-305-3319 FAX 0 Energy,Inc Page 1 PROGRAM CMA-HPC CUSTOMER PHONE DATE CLIENT# WORK ORDER Christopher Bent (413)374-3397 01/19/2021 297402 00001 SERVICE STREET BILLING STREET PROPOSED BY. 77 Forest Glen Drive 77 Forest Glen Drive HomeWorks Energy SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Florence, MA 01062 Florence, MA 01062 DESCRIPTION QTY COST INCENTIVE TOTAL INCENTIVE 75% For eligible weatherization measures, Columbia Gas of Massachusetts is offering an incentive of 75%for insulation measures and 100D/D for the air sealing measures, both with no limit. You are eligible to apply for the 0% Heat Loan to finance your co-pay, applications must be submitted before the weatherization work begins. ATTIC DAMMING-R-38 FIBERGLASS 85 $174.25 $130.69 $43.56 Provide labor and materials to install a 12" layer of R-38 unfaced fiberglass batts for damming purposes. ATTIC FLAT-5"OPEN R-19 CELLULOSE 988 $1,244.88 $933.66 $311.22 Provide labor and materials to install a 5"layer of R-19 Class I Cellulose to open attic space. VENT BATH FAN THRU ROOF 4 INCH 1 $118.75 $89.06 $29.69 Provide labor and materials to install an insulated 4"exhaust hose with roof mounted flapper vent to exhaust existing bathroom fan(s). HOME AIR SEALING 10 $850.00 $850.00 Provide labor and materials to seal areas of your home against wasteful, excess 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.) DUCT SEALING 4 $320.00 $320.00 Provide labor and materials to seal heating and/or cooling ducts within designated unheated areas. This work will be include materials and labor. WALLS VINYL SIDED 1,024 $2,058.24 $1,543.68 $514.56 Furnish and 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. HomeWorks Energy r I n I 101 Station Landing,Medford, MA 02155 g CONTRACT - AUDIT uo ieVVorks 781-305-3319 FAX 0 Energy,Inc Page 2 PROGRAM C MA-H PC CUSTOMER PHONE DATE CLIENT# WORK ORDER Christopher Bent (413)374-3397 01/19/2021 297402 00001 SERVICE STREET BILLING STREET PROPOSED BY' 77 Forest Glen Drive 77 Forest Glen Drive HomeWorks Energy SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Florence, MA 01062 Florence, MA 01062 DESCRIPTION QTY COST INCENTIVE TOTAL GARAGE CEILING: 10" DENSE CELLULOSE 400 $988.00 $741.00 $247.00 Provide labor and materials to install 10" R-35 densely packed Class I Cellulose insulation to a garage ceiling located below a heated floor area, by drilling holes in the ceiling from below. Holes drilled will be plugged. Plugs will be speckled and left in a relatively smooth condition. Finish sanding and touch-up priming/painting will be the customer's responsibility. Total: $5,754.12 Program Incentive: $4,608.09 Customer Total: $1,146.03 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***One Thousand One Hundred Forty-Six & 03/100 Dollars $1,146.03 .rY Gov I1- COMPANY REPRESENTATIVE CUSTOMER SIGNATURE 1/19/21 NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE SIGN DATE DAYS.