38B-114 (2) 45 MUNROE ST BP-2021-1538
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38B- 114 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-2021-1538
Project# JS-2021-002559
Est.Cost: $3000.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: CLEAN TECH CONSTRUCTION LLC 106150
Lot Size(sq. ft.): 7318.08 Owner: PITZER FREDERICK N& MARGARET
Zoning: URB(100)/ Applicant: CLEAN TECH CONSTRUCTION LLC
AT: 45 MUNROE ST
Applicant Address: Phone: Insurance:
40 MESSINA DR (617) 271-0768 WC
BRAINTREEMA02184 ISSUED ON:6/29/2021 0:00:00
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:
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.
(R Certificate of Occupancy signatu y 'ti •
• 1
FeeType: Date Paid: Amount:
Building 6/29/2021 0:00:00 $65.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
.4 AFFIDWi -
/3)F
The Commonwealth of Massachusetts � �
Board of Building Regulations and Standards !A'
Massachusetts State Building Code, 780 CMR `/O,y A►LOY
US
Building Permit Application To Construct, Repair, Renovate di olish a 1vied M 201
One-or Two-Family Dwelling A'h0r n�,�
J 'This Section For Official Use Only ,o /Ai r1
Building Permit Number: �/ a fj ? S/ Date plied: • a o,'c?oy4 /
EdtN oSS /7/ - 2/9.=
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assepe9Map& Parcel Numbers
45 MUNROE ST N.HAMPTON MA 01060 ,Yi3 /Pi
I.I 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.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
PEG PITZER N.HAMOPTON MA 01060
Name(Print) City, State,ZIP
45 MUNROE ST 413-531-8514
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: INSULATION
Brief Description of Proposed Work2:
INSULATION WEATHERIZATION WORK FOR MASS SAVE PROGRAM
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 3000 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire
Suppression) Total All Fees: $ (i
Check No. I Check Amount: N Cash Amount:
6. Total Project Cost: $ 3000 ❑Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 106150 5/24/2022
PATRICK MCDONOUGH License Number Expiration Date
Name of CSL Holder I
105 MARSHHAWK WAY List CSL Type(see below)
No.and Street Type Description
MARSHFIELD MA U Unrestricted(Buildings up to 35,000 cu. tt.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
�Gi;UL //1-GG7.'�/ LiffW RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
6 1 47-271-0768 CLEANTECHCONSTRUCTION@GMAIL.COM 1 Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
CLEAN TECH CONSTRUCTION 196071 6/7/2021D
Company
Name or
Registrant Name
CLEANTECHCONSTRUCTION@GMAIL.COM
No.and Street Email address
BRAINTREE MA 02184 617-271-0768
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 Issuance of the building permit.
Signed Affidavit Attached? Yes 0 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.
AUTHORIZATION FORM ATTACHED
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.
PATRICK MCDONOUGH/CLEAN TECH CONSTRUCTION 6/16/2021
Print Owner's or Authorized Agent's Name(Elect'aric 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 not 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"
Federal ID#05-0405626
RISE Engineering RI Contractor Registration No 8186
MA Contractor Registration No 120979
CT
CT Contractor Registration No620120
RISE60 Shawmut Road.Canton,MA 02021 ENGINEERING CONTRACT - WZ
339-502-6335 X-7109 FAX 339-502-6345
Page 1
PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE
CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS
DESCRIBED BELOW
CUSi o'.ILN ('HONE DATE CLIENT WORN ORDER
Fred Pitzer (413)531-8514 02/11/2020 497266 23802
SERVICE STREET TILLING STREET
45 Munroe Street 45 Munroe Street
SI:HVICL CITY,STATE,ZIP lilt LING CITY,STATE,ZIP
Northampton, MA 01060 Northampton, MA 01060
DESCRIPTION QTY COST INCENTIVE TOTAL
KNOB&TUBE WIRING(Northhampton) (((
We have identified that your home might have Knob&Tube wiring ri)(initials)
present. The following contract is not valid unless accompanied by
the Pre-Weatherization Barrier Incentive form, signed by your licensed
electrician. Work will not proceed with this work until we receive a copy
of the form.
STORAGE-ATTIC /
Homeowner is responsible for the removal of the stored items (initials) I '
blocking the installation of weatherization work in the attic Removal
must occur prior to the scheduled work start.
ATTIC DAMMING-R-38 FIBERGLASS 30 $61.50 $46.13 $15.37
Provide labor and materials to install a 12"layer of R-38 unfaced
fiberglass batts for damming purposes.
ATTIC FLAT- 12"FLOORED R-38 DENSE CELLULOSE 730 $1,992.90 $1,494.68 $498.22
Provide labor and materials to install a 12"layer of R-38 Class
Cellulose to floored attic space.
ATTIC DOOR-INSULATE&WS 1 $110.00 $82.50 $27.50
Provide labor and materials to insulate the back of the attic door with
2"rigid insulation board and seal the door's edge with
weatherstripping to restrict air leakage.
INSULATED BATH EXHAUST HOSE 4 INCH 1 $60.00 $45.00 $15.00
Provide labor and materials to install an insulated 4"exhaust hose to
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.) A
reduction in cubic feet per minute(cfm)of air infiltration will occur,but
the actual number of cfm is not guaranteed.
At the completion of the weatherization work.and at no additional cost
to the homeowner,a final blower door and/or combustion safety
analysis will be conducted by the sub-contractor.
Federal ID#05-0405626
RISE Engineering RI Contractor Registration No 8186
MA Contractor Registration No 120979
CT Contractor Registration No620120
RI S E 60 Shawmut Road,Canton,MA 02021
ENGINEERING CONTRACT - WZ
339-502-6335 X-7109 FAX 339-502-6345
Page 2
PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE
CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS
DESCRIBED BELOW
E.IISIOVE.H .'KU'II_ DATE CLIENTS WORK ORDER
Fred Pitzer (413)531-8514 02/11/2020 497266 23802
SERVICE STREET KILLING STREET
45 Munroe Street 45 Munroe Street
SERVICE CITY.STATE,ZIP BILLING CITY.SIAII .:IP
Northampton, MA 01060 Northampton, MA 01060
DESCRIPTION QTY COST INCENTIVE TOTAL
I -INCENTIVE: 75%
For eligible measures, Columbia Gas of Massachusetts 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 your co-pay,applications must be submitted before
the weatherization work begins.
Total: $3,074.40
Program Incentive: $2,518.31
Customer Total: $556.09
WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF
***Five Hundred Fifty-Six &09/100 Dollars S556.09
UPON RECEIPT OF YOUR RISE E NEERING INVOICE,CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY
UNPAID BALANCE AFTER 30 DAYS. E REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES.RIGHTS OF RECISION SCHEDULING,AND CONTRACTOR REGISTRATION.
'/H1Jt HE JENI AI If S SIGNAI(IRE
NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE / //::21)
511.1 A
l
ACCEPTANCE OF CONTRACT-THE ABOVE PRICES.SPECIFICATIONS AND CONDITIONS ARE
30 DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK
AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE
RISE
ENGINEERING'
OWNER AUTHORIZATION FORM
I, Fred Pitzer
(Owner's Name)
owner of the property located at:
45 Munroe Street .
(Property Address)
Northampton, MA 01060 ,
(Property Address)
hereby authorize .
(Subcontractor)
an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building
permit and to perform work on my property. This form is only valid with a signed contract.
, , • _
ow er's Signature
,, ////()).:D
Date
RISE Engineering, a Division of Thielsch Engineering, Inc.
60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335
www.RlSEengineering.com
The Commonwealth of Massachusetts
a„ = Department of IndustrialAccidents
Eiil_ 1 Congress Street,Suite 100
�eE Boston,MA 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): CLEAN TECH CONSTRUCTION
Address: 190 FEDERAL AVE
City/State/Zip: Quincy,MA 02169 Phone i#: 617-271-0768
Are you an employer?Check the appropriate box: Type of project(required):
20.0I am aemployerwith 6 employees(full and(or part-time i* 7. 0 New construction
2.01 am a sole proprietor or partnership and have no employees working for me in g. 0 Remodeling
any capacity.[No workers'comp.insurance required.]
31:II am a homeowner doing all work myself.[No workers'camp.insurance required.]t 9. ❑Demolition
10 0 Building addition
4.01 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 cr are sole 11.0 Electrical repairs or additions
proprietors with no employees. 12.0 Plumbing repairs or additions
5.01 am a general contractor and I have hired the sub-contractors listed on the attached sheet.
These sub-contractors have employees and have workers'comp.insurance? 13.❑Roof repairs
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c.
14®Other INSULATION
152,§1(4),and we have no employees.[No workers'camp.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 mist pro,ale they 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: TRAVELERS 1
9/18/2021
Policy#or Self-ins.Lic.#: 6HUB4N60130820 Expiration Date:
Job Site Address: 45 MUNROE ST City/State/Zip: N.HAMPTON 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 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 the pains and penalties ofperjury that the information provided above is true and correct.
Signature! GL�j2i� 91LdLl Date_ 6/16/2021
Phone#: 617-512-1509 U
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#:
ACC)Ra CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
5/13/2021
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 CON FACT
NAME:
Tobman,Molignano&Weiner Ins Agency A/c,"NE,Ext): 617-471-1123 FAX
No): 617-773-2474
21 McGrath Highway,Suite 303E-MAIL
Quincy,MA 02169 ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A: Norfolk&Dedham Mutual
INSURED INSURER B: Traveler's Indemnity Co of America
Clean Tech Construction LLC INSURER C:
190 Federal Ave INSURER D:
Quincy,MA 02169
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.
ILTR TYPE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP
INSD WVD, POLICY NUMBER (MM/DD/YYYY) (MMIDDIYYYY) LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAf10 RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 100,000
MED EXP(Any one person) $ 500,000
A PO12011894 09/18/20 09/18/21 PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY PRO-
JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
(Ea accident)
ANY AUTO BODILY INJURY(Per person) $
A OWNED X SCHEDULED 91972894A 09/16/20 09/16/21 BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS 1,000,000
X H X NON-OWNED PROPERTY DAMAGE
AUTOSIRED ONLY AUTOS ONLY (Per accident)
$
X UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ 1,000,000
A EXCESS LIAB CLAIMS-MADE U20003464A 09/18/20 09/18/21 AGGREGATE $ 1,000,000
DED RETENTION$ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE 1 A 6HU64N60130820 E.L.EACH ACCIDENT $ 500,000
B OFFICER/MEMBER EXCLUDED? 9/18/20 9/18/21
(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)
CERTIFICATE HOLDER CANCELLATION
N.HAMPTON BUILDING DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED R ENTATIVE
01 -2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
DEBRIS DISPOSAL AFFIDAVIT
In accordance with the provisions of M.G.L. c. 40, s. 54, Building Permit
was issued with the condition that all debris resulting
from this work shall be disposed of in a properly licensed solid waste
disposal facility as defined by M.G.L c. 111, s. 150A.
The debris will be disposed of in:
TROUPE WASTE DUMPSTER
Name of Waste Facility
40 MESSINA DR BRAINTREE MA 02184
Address of Waste Facility
111.5 Debris: As a condition of issuing a permit for the demolition, renovation,
rehabilitation or other alteration of a building or structure, M.G.L.c.40 s. 54 requires
that the debris resulting therefrom shall be disposed of in a properly licensed solid waste
disposal facility as defined by M.G.L.c. 111 s. 150 A.Signature of the permit applicant,
date and number of the building permit to be issued shall be indicated on a form provided
by the Building Department and attached to the office copy of the building permit
retained by the Building Department.If the debris will not be disposed of as indicated,
the holder of the permit shall notify the building official, in writing,as to the location
where the debris will be disposed.
780 CMR—6th Edition
PATRICK MCDONOUGH
Signature of Permit Applica
6/16/2021
Date
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Construction SUpenftivior Specialty
CSSL-106150 • Wires: 05/24/2022
I
PATRICK E MCDONOUGH
105 MARSHHAWK WAY
MARSHFIELD MA 02050 S�!�
Commissioner C
„74 0/ e7,4,,,,,a,eice,diaz
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
; ..__.._ .._.._, Type: LLC
lye C.
CLEAN TECH CONSTRUCTION ..,..... 1111= w Registration: 196071
" : Expiration: 06/27/2021
190 FEDERAL AVE zak = ‘
QUINCY, MA 02169
ery
Update Address and Return Card.
0 20M-05/17
Office of Consumer Affairs &Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE: LLC before the expiration date. If found return to:
Registration Expiration Office of Consumer Affairs and Business Regulation
196071 06/27/2021 1000 Washington Street - Suite 710
CLEAN TECH CONSTRUCTION Boston, MA 02118
W ILLIAM DAVIDSON ;' 1,./”"
190 FEDERAL AVE ,arc.
QUINCY, MA 02169 Undersecretary Not valid without signature
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: Supplement Card
CLEAN TECH CONSTRUCTION LLC Registration: 6/2 71
Expiration:
190 FEDERAL AVE 0 06/27/2021
QUINCY, MA 02169
Update Address and Return Card.
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:
Registration Expiration Office of Consumer Affairs and Business Regulation
196071 06/27/2021 1000 Washington Street -Suite 710
CLEAN TECH CONSTRUCTION LLC Boston,MA 02118
PATRICK E.MCDONOUGH i' B/t&Z7•W
190 FEDERAL AVE ,n.�r GG i"a,G�i�c (/
QUINCY,MA 02169 Undersecretary Not valid without signature
Construction Supervisor Specialty
Restricted to:
CSSL-IC - Insulation Contractor
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
For information about this license
Call (617) 727-3200 or visit www.mass.gov/dpl
s save -
#C.<dk
avittgs through energy efficiency
Based on your Energy Specialist's recommendations,your home can benefit from program-eligible insulation and/or air sealing
improvements.Before moving forward,please follow all the Instructions below to remediate your weatherization barriers.
CUSTOMER INSTRUCTIONS
1. Hire a qualified,licensed contractor to evaluate and/or remediate the weatherization barrier(s).
2.Submit signed and completed copies of this form and a copy of the paid contractor invoice(s)within 60 days of your Home Energy
Assessment to:c,LSE ter" ;rw,crirg: 6C,S,1.7 n''4ut Pci, Unit 2. ,r-,wn, •, u a
Or email to ColumbiaGasMMAinfv* RISEeng,neerirg.cOrn.
3.The weatherization incentive will be deducted from the customer co-payment amount of the weatherization work.A rebate check
will be issued in the event the amount exceeds the customer's co-payment amount.
4.Complete the recommended weatherization improvements.
ISTOMER INFORMATION
Customer Name: Fred Pitzer Client#or Site ID: 497266
Site Address: 45 Munroe Street City: Northampton State: MA ZIP: 01060
Phone Number: 413-531-8514 _ Email:p }itzer@smith.edu /
Customer/Homeowner Signature '�r�t�- 'i }`. �..��_ Date: ,/ -/ " "".
To determine if there is any active knob and tube wiring,the contractor will evaluate the following areas where eligible Mass Save'
weatherization recommendations have been made:
0 Attic Floor 0 Attic Wall 0 Attic Slope 0 Exterior Wall D Basement 0 Other: 0 Other:
7/1 have performed Ty inspection and determined there is no active knob and tube wiring in the areas selected below.
[ LA'A C 'Attic Floor ttic Wall ttic Slope Ci7'Exterior Wail t.Qflasement 0 Other: 0 Other:
no rirY,C7;:.a !tx':.>:.cv:sr.°,-..'Gte°LL.'xestit::
❑ I have read and agree to the Terms and Conditions on the back of this form.
Contractor Name: ,47ceitz-t / l
Address: S'/ ,7e //0 S� City: cJ r' State:fCrf#7 ZIP: '2/ 5''G
Company Name: /< 7...-t f h1 6 Ej/ifA.License Number: ,f//' �+
Contractor Signature: --^� -� G / Date:Gl ..02/ .0
sal
High Carbon Monoxide:Contractor is to service and re-evaluate the selected mechanical system(s)and reduce the carbon monoxide level,
as measured in the undiluted flue gas,to below 100 parts per million(ppm).
Draft Failure:Contractor is to correct the draft in the selected fiue(s).Refer to table on reverse for acceptable draft ranges.
Existing CO porn Revised CO ppm Extstirig Draft Pa: pev,sed Draft Pa:
Heating System
Hot Water Heater
Other:
Spillage:Contractor is to correct the spillage of flue gases in the selected mechanical system(s).Must not spill after 60 seconds of operation.
❑ Heating System 0 Hot Water Heater 0 Other:
❑ I have performed my inspection and have corrected the Items noted In the areas selected above.
❑ I have read and agree to the Terms and Conditions on the back of this form.
Contractor Name:
Address: City: State: ZIP:
Company Name: License Number:
Contractor Signature: Date:
(page 1 of 2)