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13-099 (11) BP-2021-233 5 96 COLES MEADOW RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 13-099-001 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-2021-2335 PERMISSIONIS HEREBY GRANTED TO: Project# INSULATION Contractor: License: Est. Cost: 7000 HOMEWORKS ENERGY INC 106148 Const.Class: Exp.Date:07/30/2022 Use Group: Owner: CHAFFEE RUFUS J&JOAN L Lot Size (sq.ft.) Zoning: RI/RR/SR/WP Applicant: HOMEWORKS ENERGY INC Applicant Address Phone: Insurance: 59 TOSCA DR 7812054484 ECC-600-4001017-2021A STOUGHTON, MA 02072 ISSUED ON:12/27/2021 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATH ERIZATI ON 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. Signature: O3391 • 1 • Fees Paid: $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner FEE: $65.00. i r City of Northampton ( -!E���r ; Dep � r4 `.�" Building Departmer ,'fG 7 y1F L. 212 Main Street 2 497 - INSULATION i Room 1 Q ;r- ; ` � ' ` • Northampton, M •A^46 8dn,ti,� —'�` phone 413-587-1240 Fax 413E( QIJI.. Y ____„, ,- 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 Lot d 9 Unit 96 Coles Meadow Road Northampton Massachusetts 01060 Zone Overlay District Elm St. District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Rufus Chaffee 96 Coles Meadow Road Northampton Massachusetts 01060 Name(Print) Current Mailing Address: See Attached (413)587-3197 Telephone Signature 2.2 Authorized Agent: Adam Glenn 59 Tosca Drive Stoughton, MA 02072 Name(Print) • Current Mailing Address caL <- 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 7000.00 (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 = (1 +2 + 3+4+5) 7000.00 Check Number 37.) Y. This Section For Official Use Only BuildingPermit Number: �jV—d . 47 3 3 S Date Issued: Signature: U .7 % 1 a/p ya i 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 ❑ Name of License Holder.Adam Glenn 106148 License Number 59 Tosca Drive Stoughton, MA 02072 07/30/2022 Addre V Expiration Date 781-205-4484 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ HomeWorks Energy 181138 Company Name Registration Number 59 Tosca Drive Stoughton, MA 02072 03/02/2023 Address Expiration Date Ati c.11 ) � 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 No ❑ Brief Description of Proposed Work Residential weatherization/ Air sealing. No structural changes. SITE ID 4377096 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 caL )(el.() c___(:)e._ 12/20/2021 Signature of Owner/Agent Date Rufus Chaffee , 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 12/20/2021 Signature of Owner Date City of Northampton a MA --, o •• Massachusetts '4 } DEPARTMENT OF BUILDING INSPECTIONS y cs 212 Main Street • Municipal Building J`., Northampton, MA 01060 'rsNiy. -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:Weatherization Est.Cost:7000.00 Address of Work:96 Coles Meadow Road Northampton Massachusetts 01060 Date of Permit Application: 12/20/2021 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law(explain): _Job under$I,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: 12/20/2021 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 ~ Massachusetts • ��.if' _ sq.`` , DEPARTMENT OF BUILDING INSPECTIONS ti fi, • 212 Main Street •Municipal Building vim. �D `- Northampton, MA 01060 -sNh .)°- 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: 96 Coles Meadow Road Northampton Massachusetts 01060 (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) ,,,..i;rete) 12/20/2021 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. City of Northampton Massachusetts �4, ee ,, � :J r (,,,,___ "! f; DEPARTMENT OF BUILDING INSPECTIONS `- 212 Main Street • Municipal Building J,, \a Northampton, MA 01060 rNh' x" MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 96 Coles Meadow Road Northampton Massachusetts 01060 Contractor Name HomeWorks Energy Address: 59 Tosca Drive City, State: Stoughton, MA 02072 Phone: 781-205-4484 Name:Property Owner Rufus Chaffee Address: 96 Coles Meadow Road Northampton Massachusetts 01060 City, State: Adam Glenn (contractor) attest and affirm that the building I intend to insulate does not have any open air (knob and tube)wiring in the spaces to be insulated and that I have provided the property owner with a copy of this affidavit. Contractor signature 6Alralk ,,,,gjeez‘d- c_(,e......_ Date 12/20/2021 The Commonwealth of Massachusetts 1 = `_ 1, Department of Industrial Accidents _; l 1 Congress Street,Suite 100 °°t:f— Boston, MA 02114-2017 www.mass.gov/dia wit Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aaalicant Information Please Print Legibly Name (Business/Organization/Individual): HomeWorks Fnergy Address: 59 Tosca Drive City/State/Zip: Stoughton, MA 02072 Phone#: 781-205-4484 Are you an employer?Check the appropriate box: Type of project(required): i It am a employer with 500 employees(full and/or part-tune).* 7. ❑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.] 9. ❑Demolition 3.❑i am a homeowner doing all work myself[No workers'comp.insurance required.] 10 ❑Building addition 4.0 lam 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. These sub-contractors have employees and have workers'comp.insurance.: 13. Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14 ther WEATHERIZATION 152,41(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. Insurance Company Name: NH Employers Insurance Company Policy#or Self-ins.Lic.#:#4001017 Expiration Date: 01/01/2022 Job Site Address• 96 Coles Meadow Road Northampton Massachusetts 01060 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 the pains and per ' s of perjury that the information provided above is true and correct, Signature: '�'��"``v) Date: 12/20/2021 Phone#:781-205-4484 // wxpennitting@homeworksenergy.corn_ 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#: �.41 HOMEENE-01 LLARIVIERE AcoRO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) kom...------ 1/4/2021 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 suchpendorsement(s). PRODUCER NAME CT Lisa Lariviere Foster Sullivan Insurance Group,LLC PHONE Fax 163 Main Street (A/C,No,Ext):(978)686-2266 301 (Alc,No(978)686-6410 North Andover,MA 01845 E-MAIL ss:certificates@fostersullivangroup.com INSURER(S)AFFORDING COVERAGE NAIC a 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 POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMM/DDIYYYYI (MMIDD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR MKLVIPBC001429 1/1/2021 1/1/2022 DMGSEEO EoNccTne ncel $ 100,000 MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JE� LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ COMBINED B AUTOMOBILE LIABILITY Ea accident SINGLE LIMIT $ 1,000,000 ANY AUTO COM5915393 1/1/2021 1/1/2022 BODILY INJURY(Per person) $ OWNED X SCHEDULED AUTOSBODILY INJURY(Per accident) $ _ E� ONLY AUTOS X HIRED OS ONLY X NOTN OWNED PROPERTY rraccidentDAMAGE $ OSOIJ $ C _ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 X EXCESS UAB ^ CLAIMS-MADE MQSX00007091-01 1/1/2021 1/1/2022 AGGREGATE $ 1,000,000 DED X RETENTION$ 0 $ D WORKERS COMPENSATION STATUTEPER ERH AND EMPLOYERS'LIABILITY Y/N ECC-600-4001017-2021A 1/1/2021 1/1/2022 1,000,000 ANY ANYIPRRPRIETOR EXCLUDED?RTER/ ECUTIVE N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 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/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 • . /,///./)///7/flr.JeI Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Roston. Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card Registration: 181138 uoM"r WORKS ENERGY,INC Expiration: 03/02/2023 101 STATON LANDING STE 110 M-i.;FORD, MA 02155 Update Address and Return Curd. SCA 1 0 2Qi-o5,`t 7 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: Reaistratton EXPIf81jon Office of Consumer Affairs and Business Regulation 18113E 031022023 1000 Washington Street -Sj'te 713 HOME WORKS ENERGY,INC. Boston,MA 02118 ''ram ADAM GLENN 101 STATION LANDING STE 110 MEDFORD.MA 02155 Undersecretary Not valid without signature 117 Ccrnrrn'n.vealth of Vas sachu sett s Construction Supervisor Specialty Division of Professionai Licensure Restruledto Board of Bonding Regulations and Standards CSSLJC -'rsUlation Contractor Constructrq�t.Sttppkvuc;r Specialty CSSI.1061:8 Eitpires 07/30/2022 ADAM GLENN 19 CHARGE POUND RD WAREHAM MA 02571 •_` Failure to possess a current edition of the Massachusetts r;s - State Building Code is cause for revocation of this license Commissioner ,, For information about this license Call(617)727.3200 or visit www mass.gov+dpi Insulation/Air Sealing Permit Authorization Specialist: Bryan Ruddy Company: HomeWorks Energy Email: bryan.ruddy@homeworksenergy.com Address: 101 Station Landing Cell: 4132049308 Medford,Ma 02155 Phone: 781.305.3319 Customer: Rufus Chaffee Address: 96 Coles Meadow Rd Email: rufuschaffee@comcast.net Northampton, MA, 01060 Site ID: 4377096 Phone: 4135873197 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 of the work scheduled and performed by the building inspector in your town. If required by the town, you will be notified by HomeWorks Energy that an inspection is necessary with instructions on how to complete this process to close out your permit. Email: rufuschaffee@comcast.net Customer \r \ikla 4129 Signature: Date: 12/14/2021 Rufus Chaffee For Condo Owners: If you have property oversight by a condo associationt, please have the association's authorized person(s)complete and sign the section below. Please email this document to wxpermitting@homeworksenergy.com once completed. We, being the duly authorized representatives of the association Name of association or management companyt or management company have reveiwed the plans and specifications for improvements to the address specified above. We further acknowledge that the above listed owner has given notice that they intend to seek permits and to carry out the proposed work. Signature of representative Date Print Name t Other unit owners may sign when there is no association. Page 2 of �� C HomeWorks 404it mass save Energy, Inc PARTNER 101 Station Landing Ste 110,Medford,MA 02155 (781)305-3319 ext.120 Customer Name:Rufus Chaffee Email:Not provided Phone:413-587-3197 Premise Address:96 Coles Meadow Rd,Northampton, MA 01060 Mailing Address:96 Coles Meadow Rd, Northampton, MA 01060 Project ID:4386083 Date:Dec. 14,2021 Project Total $6,154.22 Weatherization incentive ($3,699.37) Air sealing incentive ($1,221.72) Total Program Incentive -$4,921.09 Customer Total $1,233.13 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 total price. Payment of the balance of the customer contribution is expected upon completion of the work. Customer Signature:_ Date: Customer Phone: Specialist Signature: Date: _ LIMITED 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:Thbox@HomeWorksEnergy.com Page 1 of �3 HomeWorks mass save Energy, Inc PARTNER 101 Station Landing Ste 110,Medford,MA 02155 (781)305-3319 ext. 120 Customer Name:Rufus Chaffee Email:Not provided Phone:413-587-3197 Premise Address:96 Coles Meadow Rd,Northampton, MA 01060 Mailing Address:96 Coles Meadow Rd,Northampton.MA 01060 Project ID:4386083 Date:Dec. 14.2021 Job Description Measure Description Location Quantity Unit Total Cost Customer Cost Air Sealing at Estimated 62.5 CFM50 Per Hour 12 hr $1,110.96 $0.00 Door Sweep (with AS hrs) 2 each $50.62 $0.00 Exterior Door Weather Stripping (with AS hrs) 2 each $60.14 $0.00 Door-2" Thermal Barrier Polyiso 1 each $90.44 $22.61 Hatch -2"Thermal Barrier Polyiso 1 each $46.28 $11.57 Open Wall - 2" Thermal Barrier Polyiso 363 SF $1,735.14 $433.78 Damming 36 each $86.04 $21.51 Bath Fan Hose 2 each $52.40 $13.10 Attic Floor- 10" Open Blow Cellulose 1538 SF $2,922.20 $730.56 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 total price. Payment of the balance of the customer contribution is expected upon completion of the work. F+°Niikj Customer Signature:_ Date: Customer Phone: Specialist Signature: Date: LIMITED 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:tnbox@HomeWorksEnergy.com KW WALL AND KW FLOOR Blind Spec? - O R ► KW SLOPE AND GABLE END Blind Spec? Why? Why? FRAMING EXISTING .. ', " I. S0.FT. FRAMING EXISTING SPEC'ING SQ.FT. WALL X X SLOPE X X z FLOOR X x /' GABLE X X p ACCESS x Ix X X m TRANS x X ATTIC "'• 1.1 ATTIC SLOPE x X 3,!:3 SLOPE X X vi EXISTING VENTING? SiEXISTING VENTING? EXISTING PIPES? Y m KW Venting V BF BF Hose Damming Sheathing Access Temp Acces KW Venting Vent BF Temp Access KNEEWALL MANDATORY ri wet, Ppi 04. 37 ,..ta . I ' (• co-},c' GO t`--"'" "Z 1- - __ - ___ 9 & a p v l� 0 a r J ° t11 I • o Q 3�p t ` (��". 3 f z ., ca 0 JJ i 1 .""`ter, cc Iffs It - 05 '7 r 7 f . r,ei94.,ic.04,t., i a 151. Ov-.• y,cot Insulated Wall X X Rec•d Light Ins.Hose BF Vent BF BFV Chim.ICH_Damming -- - 12 Roof Vent,12RV BAS Air Handler AN' Temp Access T Pull Down PDS Hatch H Wall Hatch "/ Door r. 8"Roof Vent 8RV `-i Vo x .0058 19(l story .Z x , K}, ATTIC 1 Blind Spec? 2 x(_ xl t ATTIC 2 Blind Spec? X r1s.a(, .ry) _ z Existing Spec'ing Sq ft Existing Spec'ing Sq ft 13e, ry) 0 _ Multipliers Unfloored ' IS' 3 K Unfloored _ — Trusses Cross Batting a Floored — Floored ► _ ,1 — Mixed Insulation Duct Work v+ >6"Loose z• Cath Slo•e — Cath Slo _e Air Seailrtg Hours tJ Walls t CI 2 f Walls Ft.1 IBM ~� < Access f ) — Access :tea' r I Venting Propavents Vent BF BF Hose Dammin: Venting ' Propavents Vent BF BF Hose Dammin: c. VHF 00 c Ten p AC rssi 'u �a a Sheathn ;rvccess __- tn '^ L.CQVel'S; ' i ,.,.i• „ , u ilk.Ft/300= (Exist.NFA Venting)_ (Needed %'. Sq.Ft/300= z -')- (Exist.NFA Venting)= (Needed • 7 Existing Venting? !t I d jC ;(r ,'l NFA Venting) Existing Venting? f�' t sjjc NFA venting( Roof Type: N ,4 r/Te PLAN VIEW - 3 Name: k 0,.4,5 (,k. `- ' - Site ID: q 7 1 J 4.-r Finished Sq. Ft: Z-t)D g Phone: ' l,'.:l?:'( Year of House: 2 0 �> Electric Acct #: Address: 1 Q C:-7I•- M Jc.l. Rd # of Floors: 2_ Gas Acct #: ,, ~\ r , Unit*: # Occupants: 'f - Housing Type? Ga►v-e p,,i' DUCTWORK INSPECTION Ducts Insulated? Duct Linear Ft. 3 I I�t _. i I= Duct S e Ft. _.__. 3 1 _______- -- Duct Air Sealin s w Duct Insulation z lkuct Insula ' emoval m W BASEMENT INSPECTION 2 Existing Spec'ing Ln/Sq. Ft. 3 W m Bsmt Wall AG Crawl Ceiling Crawl Rim Joist .— — — 1-- • Bsmt RJ w/Sill iL.r.4 4 iy Bsmt RJ NO Sill — If Vapor Barrier Bsmt Door 2_ 1/ _j Y/N Blower Door? WALLS&GARAGE Drill Location? Siding Ceil.Hei:ht Existing Spec'ing S.. Ft. Framin: Exterior Wall 1 x x Balloon/Platform Exterior Wall 2 _ - - - _, x x Balloon/Platform Overhang _ -x-,�""x_.. G c g Wall x x Balloon/Platform Garage Ceiling x x cc 0 E W CC F- G, 1 I \AJfts 0 0 it rW X W C D a.r nulatio"n"Rerziova " ',.'; -- sq ft. toNeeps: w�.�a�a .9.?QS ri.aIn•: _. WORK SPEC'D BUT NOT CONTRACTED ROAD BLOCKS PRESENT?.j ANDATORY) Attic Basement/Crawlspace Other: K&T Y/>N,lMoisture Y Combustion Sfty Y[AL Kneewall Overhang/Garage Asbestos Y[N ;Mold>100 sq.ft Y O Detector Missing Y/N. Ductwork Exterior Walls Vermiculite Y/N :Structl Concerns _,Other: Notes for Lead Vendor/Work Not Contracted: