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38B-095 (13) BP-2022-1326 20 MUNROE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38B-095-001 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-2022-1326 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION Contractor: License: DIPIETRO HOME ENERGY Est. Cost: 6000 SOLUTIONS DBA REVISE 104464 Const.Class: Exp.Date: 03/06/2024 Use Group: Owner: KNUDSEN LAFORTE JACK T&NANCY J Lot Size (sq.ft.) DIPIETRO HOME ENERGY SOLUTIONS DBA Zoning: URB Applicant: REVISE Applicant Address Phone: Insurance: 32 MIDDLESEX ST (978)203-6736 WC100142000 HAVERHILL,MA 01835 ISSUED ON: 10/17/2022 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHERIZATI 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: 3--)v Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Build inn Commissioner C-tiLt et, !YT- it / �r OK.i 50.0. CT-,omit- ID-► I / CFj Ct�. p •1�juiLT Ie�o The Commonwealth of Massachuse s °Ci 1 f/ Board of Building Regulations and St r ds Q FAR W Massachusetts State Building Code, 780 �042(22IUNtIPAL1TY yq ��o�n �' USE Building Permit Application To Construct, Repair, Renovate r 'sh a Rey sed Mar 2011 One- or Two-Family Dwelling ^'4�n T / so ioNS This Section For Official Use Only Building Permit Number: 6/ /3 1941 Date Applied: e6.11+-5&-ss `' /7. 2- 0-1720ZZ Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Nu eys �'o ill �y\ r e •� 6 ' 1.1a 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(ti) 1.5 Building Setbacks(ft) i' t Pc 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: kral\K(1 MI GI sell NU*t q vvil4A M b- DI 1%00 Name(Print) City,State,ZIP (20 MLuilic�e ;S1- J q)3ga3raE(3 A041� Ichud33Y\ � nail No. and Street Telephone Email Address C a3) SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building Eil Owner-Occupied ) Repairs(s) 0 Alteration(s) lij Additipn ❑ Demolition 0 Accessory Bldg. 0 Number of Units ( Other 0 Specify: Brief Description of Proposed Work2: . 41n/,vv Zf J ( -TA SU O��-ilNv �` (i- andttA SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 006 D >x= 1. Building Permit Fee: S Indicate how fee is determined: 2. Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost' (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees:/;$ Check No.5&t )Check AmountWO Cash Amount: 6. Total Project Cost: $ Co(�(.) 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES I 5.1 Construction Supervisor License(CSL) CS I�� �y 3 �P • d�Q,s-2 M„no40s License Number Expiration Date Name of CSL Hol r ` I ds. SP,upvI ^I4t✓�� List CSL Type(see below) (ANo.an Street \VVV i Type Description L'\. n,� ,n 0\Q� U Unrestricted(Buildings up to 35,000 cu.ft.) D� 1 IN 1� �J �f R Restricted l&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances cl'769'63 (073( 104\Nri ,obi Cal VVLje, I Insulation Telephone Ema address (Dt D Demolition 5.2 Registered Home Improvement Contractor (HIC) jig q 375 3(1 t I"� V�.YV�.s�{\M0 PALL&C_ '/' iii +''"'e- M9'( SAIU.N S HIC Registration Number Expiration Date H Company Name or HIC Registrant Name A,t'o ?e(ji s-€ 3a M� ic S ictr&mimay o gcait renif . (ern No.a dStreet 1\ �rltO 3S 9lgoX3 �3b mail address 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 . l7 No . 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT S I,as Owner of the subject property,hereby authorize i MO (.)..3 - • ►t S�t`a�amt�- td1" to act on my behalf,in all matters relative to work authorized b this building permit application. ;U/rr-(? tki MA I(-vl 1kol N.vl I 0( l l ( a Print Owner's Name(EI ctronic Signature) Date SECTION 7b:OWNER1 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. Print Owner's or Authori Agent' __ Name(Electronic 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" City of Northampton /�ti 1M SAS - r/ Y, L A Massachusetts * . i ,t N; 1• -' DEPARTMENT OF BUILDING INSPECTIONS �'• c ygr \! 44 212 Main Street • Municipal Building 9Jb �a ;-e- Northampton, MA 01060 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: 33) (n, G11,',I.P . 6 Of b)3 S The debris will be transported by: Name of Hauler: G- md,k) Signature of Applicant: Date: Pt l tI I �� Department oflndustrial Accidents -a ,.___4._. Office of Investigations i� ' 600 Washington Street •:7 ", Boston, MA 02111 '' " www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Dipietro Home Energy Solutions dba Revise Address: 32 Middlesex St City/State/Zip: Haverhill, MA 01835 Phone #: 978-203-6736 Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 30 4. ❑ i am a general contractor and i employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. [' Remodeling ship and have no employees These sub-contractors have K• ❑Demolition working for me in any capacity. employees and have workers' y ❑ Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. 0 We are a corporation and its 100 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other Weatherization comp. insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. 1.I lomeowners 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 sut contractors have employees,they must provide their workers'comp,policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: HUB International New England Policy#or Self-ins. Lie.. #: WCA00573401 Expiration Date: 04/20/21123 Job Site Address: g 1VL1.,(,h ( City'State/Zip: Af4a p4A Pt/ dNG() Attach a copy of the workers' compensation policy declaration page(showing the policy number and e).piration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of c ' '• al penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK •RDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to fill, Office of Investigations of the DIA for insurance coverage verification. I do hereby certifi under the p 'is a d penalties of perjury that the information provided abovecorrect. is true an Signature: i - ,....6:: Date: I O L l.L ( - Phone#: ?7 Y •2e 3--l.&73(, 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. Plumb! g Inspector 6. Other Contact Person: Phone#: DATE(MM/DD/YYYY) LtKTIFICATE OF LIABILITY INSURANCE 04/14/2022 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 Emily Costello NAME: Costello Insurance Group IPAH/CN o,EXtt: A (978)374-6352 FX Not: (978)521-5127 2 S.Kimball St. E-MAIL SS: ecostello@costelloinsurance.com ADDRE PO BOX 5248 INSURER(S)AFFORDING COVERAGE NAIC# Bradford MA 01835 INSURER A: Colony Argo insurance INSURED INSURER B: Commerce Insurance Co. 34754 Dipietro Home Energy Solutions,Inc. INSURER C: DBA Revise INSURER D: 32 Middlesex Street INSURER E: Bradford MA 01835 INSURER F COVERAGES CERTIFICATE NUMBER: CL2241402385 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 ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $DAMAGE TO RENTED 1,000,000 CLAIMS-MADE OCCUR PREMISES Ea occurrence) $ 50,000 MED EXP(Any one person) $ 10,000 A Y PACEP308383 04/25/2022 04/25/2023 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X ROT LOC 0000 OTHER: _ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ g OWNED SCHEDULED HS6326 05/09/2022 05/09/2023 BODILY INJURY(Per accident) $ AUTOS ONLY X AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ ^- AUTOS ONLY AUTOS ONLY (Per accident) Medical payments $ 10,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LIAB CLAIMS MADE EXC4245322 04/25/2022 04/25/2023 AGGREGATE $ 3,000,000 DED X►RETENTION$ 10,000 QQ $ WORKERS COMPENSATION PESTATUTE ERH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE ( ( N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? u (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more apace is required) certificate holder is lessor of property 65 Ryan Drive Raynham,MA. Cert holder is additional insured. CERTIFICATE HOLDER CANCELLATION 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 REPRESENTATIVE MA 02767-0159 I / ©1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD „,"A L-LIIt IL/ GATE(i#N DD-'YYYY) �..e- CERTIFICATE LIABILITY INSURANCE 4/4/2022 1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERIFICATE 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 1NSURER(S).AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)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 endorsements). PRODUCER License•1780862 I CONTACT An a Tateanu NAME y HUB International New England i PHONE FAX 300 Baliardvale Street IAiC,40,Er*... (A1C.ho). Wilmington,MA 01887 rio `Riss.anya,toteanuhubinternational.com INSURERLSZAf€ORPWG COVERAGE • NAIC II _ — INSURER A;Atlantic Charter Insurance Company 44326 •INSURED INSURER 8: , Joseph A. Dipietro Heating&Cooling,Inc.,Dipietro Home iwsuRCRc Y._.r_.__. Energy Solutions,Inc.,Revise,Inc. - —” 32 Middlesex Street Haverhill,MA 01835 I►7ISURER I _.....__._ 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 FOft 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. rieR' igpoL strait POLICY EFF I POLICY EXP T TYPE Of INSURANCE Lino owl)` POLICY NUMBER T— -- ;lj jlo.:Y.l .._., LIMITS COMMERCIAL GENERAL LIABILITY jt {!I ! EACH OCCURRENCE ;_... _.. CLAIMS-WIDE [ ._f OCCUR { j I DAEI G> FORENTED T �__.___ '4ita E%P rA e kar1.ar; i { ......__, PERSONAL RA,' ;h.NRY_ :.. ....... . GE>r'L AGGREGATE LIMIT A>P yES PER R I GENIERA.-AGGREGATE ,9i i ; ! i e • POLICY# I IEGf I I LOC r?ri( f i TS CCJRif':(F Rt S OTHER' ;▪ _ ' .__ _ COMRINFO S,N•GL F..LIMIT =AUTOM681LE LIAeurt IEa_wx,aeri) $ ANY AUTO LILY;AUURY Met Ger>iXI .1 OWNED I 1 5c EDDIED _�Aa Tos°Nor I AUTo.., Bowe a piiuRY tpar 4Oc' nll'S, HIRED ��yy r�yyro`M4E0 I PRO°FRT DAMAGE AUTOS ONLY 1 i Au O $LY . F..LPItr ANdKIen1�—, 3— , I I tm6RELLA LIAO I CCCUR I ._FW H OCGIARENC ..._ • .._....._.... EXCESS LN9 .__I 1 CLAIMS•MAADEI ! E AGGREGATE DEL' RETENTION$ I ' $ I A WORmER3 COMPENSATION 1 1 j it X P H TATI��. HR AND EMPLOYERS LIABIUfY Y/N I WCA00573401 4/2012022 4120/2023 1,000,001 ,a,vy F.RopfuE`A,pAR!NFR I-XIFOUTIV E L.EACH ACCIDENT ..I._..._ rF u11f 1 R EXCLJDE? 1,tI00A0+ ? [N N t A iirl oWNorY I0 n IiIIl '� E.L.Diser se_Ea Empi.ovE l cs derad/be under 3 1000,004 . _ 1DE S,,R.p1*ON OF OPEV1ATIt,:NS t�art+w S E.L_2Ig€ASE.POLICY LIMIT ,$ ' i III DESCRIPTION OF OPERATIONS•LOCATIONS I VEHICLES(ACORO 101,AdOilaenpl Re ner3As Schedule may be attached IT more sear,Is requaredl • • • CERTIFICATE HOLDER CANCELLATION_ 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 REPRESENTATIVE ACORO 25(2016,'03) C 1988-2015 ACORD CORPORATION. Ail rights reserved. The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID:364B86FC-2437-40AF-8BEF-2DFOEBE68D80 4011i W EAT E "' a' I ION Sass save BARRIER INCENTIVES Savings 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 remediat4 your weatherization bar iers. 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 y..ur Home Energy Assessment to:Submit signed and completed copies of this Contractor Evaluation Report and a copy of the dated -nd itemized Contractor Invoice to the Participating Home Performance Contractor that completed your Home E ergy Assessment. 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. CUSTOMER INFORMATION ,, _, Nancy Knudsen or Jack LaForte 4563985 Customer Name: Client#or Site ID: 20 Monroe st Northampton 01060 Site.µddres _,.. City: State: MA ZIP:I__ ''`'413-923-8883 nancyknudsen@gmai1 .com Phone Number r--DocuSigned by: Email: NaiA4i1 uitsuk, or ,jatk La.c'oviC. 8/25/2022 Customer/Homeowner Signature: Date: 4.,--B51EC8FE895148F... KNOB AND TUBE WIRING 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: ❑Attic Floor 0 Attic Wall 0 Attic Slope ❑Exterior Wall ®Basement rg0ther: 0 Other:________•_ X I have performed my inspection and determined there is no active knob and tube wiring in the areas selected below. 0 Attic Floor 0 Attic Wall ❑Attic Slope ❑Exterior Wall 0 Basement 0 Other: 0 Other: IIK I have read and agree to the Terms and Conditions on the back of this form. Contractor Name: Thomas Parolisi Address:10 Nicole Dr City:Sandown State:NH ZIP: 03873 Company Name: Arete Elect Qomgngrlby License Number: 21987 Contractor Signature: ' Date: 8/24/20 2 MECHANICAL SYSTEM BARRIERS .F, .,.4';ilr r.1 crut 1 y I, v::irYr7 M X • High Carbon Monoxide:Contractor is to service and re-evaluate the selected mechanical system(s)and reduce the carb.n 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 flue(s).Refer to table on reverse for acceptable draft range.. High Carbon Monoxide Draft Failure Existing Revised CO rrr: ppm: Existing Draft Pa: R-vised 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 se:onds 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: Continued on back (page 1 of 2) DocuSign Envelope ID:364B86FC-2437-40AF-8BEF-2DFOEBE68D80 VENTILATION Exhaust Fan for Fresh Air: Contractor to install exhaust fan to provide measured,continuous or intermittent whole building ventilation. The required rate of flow must be capable of providing CFM(measured at fan). Dryer Vent Evaluation:Contractor to ensure the dryer vent is exhausted to the exterior through hard metal ductwork. O I have installed an exhaust fan to the specifications noted above. O I have evaluated and/or repaired the dryer vent fan to the specifications noted above. O I have read and agree to the Terms and Conditions on this form. Contractor Name: Address: City: State: ZIP: Company Name: License Number: Contractor Signature: Date: TERMS AND CONDITIONS Eligibility Requirements:Applicant must be a residential customer of a participating Mass Save Sponsor.Customer must participate in the Mass Save Home Energy Services Program(must reside in a 1-4 family home).The qualifying barrier must be identified at the time of the Home Energy Assessment as a barrier preventing the installation of proposed weatherization improvements.Customer must complete the recommended weatherization improvements to receive the applicable incentive.Customer must submit the completed Contractor Evaluation Report including a copy of the dated and itemized invoice from the licensed contractor on company letterhead within 60 days(postmarked)of the Home Energy Assessment.If contractor invoice is not provided within 60 days,the eligible weatherization barrier incentive may be forfeited.Customer participation does not guarantee the barrier will be cleared. Contractor Responsibilities and Acknowledgement:In,performing any work in connection with the Weatherization Barrier Incentive(as set forth in detail below).the contractor shall:(i)abide by all local,state and federal guidelines,applicable laws(including,but not limited to all applicab a environmental laws),building codes,regulations(including,but not limited to EPA lead-safe and any and all other applicable environmental regulations)and licensing requirements;and(ii)stop work and immediately notify the customer in any case where existing or possible health andjor safety problems exist.The licensed contractor must fill in and sign off on the testing results in the appropriate place on this form.Contractor shall remain solely and fully responsible for their confirmations and notes that they provide on this form and with respect to the Contractor Responsibilities set forth above. Knob&Tube Wiring Evaluation(up to$250 incentive):The knob and tube wiring that has been noted cannot be determined inactive at the time of the Home Energy Assessment performed by the Mass Save Home Energy Service Program.Even if the observed wiring appears to be inac:ive.there might still be active circuits located in inaccessible areas of the home(i.e.walls,etc.).The Mass Save Home Energy Services Program requires that a licensed electrician verify the absence or inactivity of the knob and tube wiring in the areas of your home where we are proposing insulation be installed.We advise you to share this form with your electrician before hiring them to inspect your home to ensure they agree to the terms.The Home Energy Services Program will rely on the electrician's certification and will not be liable if inaccurate. Mechanical System Evaluation(up to S250 incentive):Combustion safety testing has been conducted on all the heating and hot water systems in this home.These tests are conducted with all the exhaust equipment running simultaneously,creating a"worst-case"depressurization of the building.If a problem was identified.repairs to correct the problem must be completed by a qualified HVAC contractor.The problems and corrections are as follows: 1. Carbon monoxide levels exceed 100 pprn in the undiluted flue gases.After a clean and tune,or other applicable service,the measurement(s)of undiluted flue gas of carbon monoxide are to be recorded on the front of this Contractor Evaluation Report where program rules state the maximum allowable concentration is 100 ppm. 2 During your Home Energy Assessment it was discovered that the identified mechanical system(s)was continuously spilling exhaust gases into the home. This condition is also known as back draft and should end within 60 seconds of system operation in order to be considered acceptable.The contractor must service the system(s)to correct the spillage problem in the selected flue(s),and certify by signature on the front of this form hat the spillage condition has ceased after 60 seconds of operation. 3. During your Home Energy Assessment it was discovered that the identified mechanical systems)are not creating sufficient DRAFT This condition is where exhaust gases are not moving through the chimney at a fast enough rate.The contractor must service the system(s)to correct the draft problem in the selected flue(s).New draft results must be provided on the front of this form and within acceptable draft ranges as described in Table 1. Outside Temp(`F) Minirnutn Draft Pressure(Pa) <10 -2.5 Table 1 Acceptable 10-90 (outside Ternp/40)-2.75 Draft Test Ranges >90 -0.5 Exhaust Fan Installation(up to$250 incentive):The results of the completed blower door test at the time of your Home Energy Assessment or scheduled weatherization installation with a Participating Contractor,determined that your home will need an increase in fresh air flow before undertaking any program eligible weatherization work.Mass Save provides a Weatherization incentive for the installation of an exhaust fan to provide additional fresh air to the home.Your energy specialist car help determine the necessary flow rate and provide recommendations.This incentive is only available in limited situations and not all customers will receive a blower door test at the time of the Home Energy Assessment. Brought to you by: Cape BLt�CKSTONE Light S. �ompa� C.bluunbia Gas, BERKSHIRE GAS COMPANY of Massachusetts GAS A NiSour.Company • EVERSeURCE Liberty utilities nationalgn u unto' HERE WITH YOU.HERE FOR YOU. life FOP ADDITIONAL INFORMATION, PLEASE CALL YOUR ENERGY SPECIALIST. (page 2 of 2) II REVISE the way you save Permit Authorization Form Site ID: Street Address: City: To be filled out by Subcontractor (if applicable) Contractor Name: Dipietro Home Energy Solutions DBA Revise Contractor Address: 32 Middlesex St Bradford Ma 01835 I Nancy Knudsen or Jack LaForte owner of the property listed above hereby authorize Revise Energy or my assigned subcontractor listed above to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property under the Mass Save Home Energy Services Program. DocuSigned by: Owner Signature: Nat441 6.4u.!cut v jad- (,a. o►1tc 8/19/2Date: 0225146F 0 REVISE ENERGY mass 5 South Summer St.Haverhill,MA 01835 PARTN R 1. DESCRIPTION OF WORK TO BEPERFORMED REVISE ENERGY will perform or cause to be performed the following work on the customer's address below,in a professional manner and in accordance with the terms of this Contract,including the attached recommendations/work order describing the work in detail(the Work')which are incorporated herein by reference.Pricing reflected below may be subject to adjustments in program pricing and offerings and is guaranteed for 30 days from the date the Contract is printed. Customer Name:Nancy Knudsen Email:Not provided Phone:413-923-8883 Premise Address:20 Munroe St, Northampton, MA 01060 Mailing Address:20 Munroe St,Northampton, MA 01060 Project ID:4567362 Date:Aug. 19, 2022 Job Description Measure Description Location Quantity Unit Total Cost Cost Air Sealing at Estimated 62.5 CFM50 Per Hour 6 hr $565.98 $0.00 Exterior Door Weather Stripping (with AS hrs) 3 each $95.43 $0.00 Rim Joist - 2"Thermal Barrier Polyiso 160 SF $779.20 $194.80 Vapor Barrier - 6 mil Polyethylene (with AS hrs) 175 SF $178.50 $0.00 Door- 2" Thermal Barrier Polyiso 2 each $181.22 $45.30 Crawlspace Ceiling - 6" Fiberglass Batting 252 SF $614.88 $153.72 Crawlspace Wall - 2" Thermal Barrier Polyiso 252 SF $1,214.64 $303.66 Insulation Removal 105 SF $130.20 $130.20 Hatch - 2" Thermal Barrier Polyiso 1 each $47.37 $11.84 Kneewall Wall - 3" Fiberglass Batting 33 SF $64.68 $16.17 2. PAYMENT:Customer agrees to pay REVISE ENERGY for the work as follows: Payment#1(Deposit):S -A non-refundable Deposit by credit card(Mastercard.Visa,or Discover card)or check is due at the tine the Work is scheduled.Required payment information will be collected at the tine of scheduling.Deposit is not to exceed 113 of the total contract cost. Additional Payments and Final Invoice:S -Additional payments for the Work shall be due upon completion of the Work and will be invoiced to the customer for payment by check or charged to the credit card on file within 24 hours of delivery of the Final Invoice.If this credit card charge is declined for any reason,upon notice from REVISE ENERGY you will be responsible for providing valid alternative credit card information necessary to complete payment. �DocuSigned by: DocuSigned by: Nowt.6na,td,sUn. er' ,j j. c8l/19/2022 t �� 8/19/2022 amerLO8s5146F.. Date R EVI. i'Dig206AlligAtir.Signature Date Evan Rebello Name of REv1SE ENERGY Represerlahve The Terms of this Agreement are contained on both sides of this page Revise Energy 5 South Summer St Haverhill.MA 01835..800-885-SAVE hello@ReviseEnergy.corn ReviseEnergy.com (,) REVISE ENERGY ve mass 5 South Summer St.Haverhill,MA 01835 PARTN R 1. DESCRIPTION OF WORK TO BE PERFORMED REVISE ENERGY will perform or cause to be performed the following work on the customer's address below,in a professional manner and in accordance with the terms of this Contract including the attached recommendations/work order describing the work in detail(the•Work")which are incorporated herein by reference.Pricing reflected below may be subject to adjustments in program pricing and offerings and is guaranteed for 30 days from the date the Contract is printed. Customer Name:Nancy Knudsen Email:Not provided Phone:413-923-8883 Premise Address:20 Munroe St, Northampton, MA 01060 Mailing Address:20 Munroe St,Northampton, MA 01060 Project ID:4567362 Date:Aug. 19,2022 Kneewall Wall - 2" Thermal Barrier Polyiso 33 SF $158.73 $39.68 Transition Air sealing 17 LF $110.33 $0.00 Propavent 18 each $74.34 $18.59 Attic Floor - 13" Open Blow Cellulose 528 SF $1,240.80 $310.20 Door Sweep (with AS hrs) 3 each $78.33 $0.00 Project Total $5,534.63 Weatherization incentive ($3,281.90) Air sealing incentive ($1,028.57) Total Program Incentive -$4,310.47 Customer Total $1,224.16 2. PAYMENT:Customer agrees to pay REVISE ENERGY for the work as follows: Payment 01(Deposit):$ -A non-refundable Deposit by credit card(Mastercard,Visa,or Discover card)or check is due at the time the Work is scheduled.Required payment information will be collected at the time of scheduling.Deposit is not to exceed 1/3 of the total contract cost. Additional Payments and Final Invoice:$ -Additional payments for the Work shall be due upon completion of the Work and will be invoiced to the customer for payment by check or charged to the credit card on file within 24 hours of delivery of the Final Invoice.If this credit card charge is declined for any reason.upon notice from REVISE ENERGY you will be responsible for providing valid alternative credit card information necessary to complete payment. DocuSigned by: ---DocuSigned by: �ia, , ,1114 2022 8/19/2022 SW.--er- e a , �t1oc,(�a Dale R ENSEE. { � lye Signature Date Ter FE895146F Evan Rebell() Name of REVISE ENERGY Representative The Terms of this Agreement are contained on both sides of this page Revise Energy 5 South Summer St Haverhill.MA 01835 800-885-SAVE hello@ReviseEnergy.com ReviseEnergy.corn Circle One In-Home Revise Energy Planview Diagram Customer: /�,,,,,,c 4 tivayen Advisor Name: Eva', Re Q. 1 i 0 Address: _ ,Q_1.{8 el roe S f Any limitations to access by truck? Y/d Town: A1.a r tha.N,ln f cd 0 IS?6)9 Site ID. 5( 3 q is Use the greater of the two BAS#'s when calculating for MVR #of stories , 1 1.5 ,J , 2.5 3 I BAS 1: 15 cfm X#occupants X n-factor = i 950 n factor 19_ 16 15 14.4 13.7 IBAS 2: .00583 X area X height X n-factor = 1 7 3 Mechanical Ventilation Recommended:BAS>final CFM50> (0.7 X BAS) Mechanical Ventilation Required:(0.7 X BIAS)>Final CFM50 Is this part of a multi-unit workscope? Y or N iNS Multiplier? N/A >8"Loose Insulation Cross-Batt >6"Mix Loose/x-batt Truss Workscope (J po ,So — 1 j/ s u I- ��' tts.. ,u.-t 1� 1 o v iJ -l o:S ) #.' Sc..l,�+1 l ou. 1 _ (, �4J i 'E.:K+cr t o lac c r GJelk-4(1s�; 3 U I ik,... Jost F4( Ssc - IGO �� 0k.,,i0(f` (,(1 3"FG 33 6' v&per Gt.rr(cis— W.+nil roL+ — 17s Q Kn.Qe-t ale WAil_ ayotti IA-u — 33 Qccr 2" 'Po(Yrso _ I lr-e,... Led,a,, AS 17 C r z.k.L„t s pfr Cc_ Ca,a I-1 Ct - .1" r'a(f f S O — a S - CD Pr.:./f a.,fre- Any work scoped outside of best practices/approved by? t{ A ` V�.1 IT Any �a -(lid r (3" CAC— Ca S Dos r Say -3 �tT1i, (ALoi. . 36 ra e RCASOW,Y1� /0,A;(6inc) lttna9 stb 1) 3) sill 21f 53> It)) II) 11) 17- 1 _•‘..k, 4 A io) 3 O I \ II) Area y\ q> j-2) Yr Built 3) Heat Yr Y 'S DHW Yr `ItH Ventialtion SOFT SQFT/300 17 16. S . 40%Low/High /c, Existing High Existing Low Rec Vents,# Existing Propervents ) Required Propervents . aey-i r xxat . a'Dj Soffit vent? Y N -STREET- Ridge vent? Y N Gable vent? Y N Page of— Commonwealth of Massachusetts lh Division of Occupational Licensure Board of Building Re ulations and Standards �I T' Cons lon visor CS-104464 r' - f spires:03/06/2024 JAMES G D111 OPOULO$:(:. 25 SEVEN SIgTER RD ," ~ HAVERHILL ri2jA 01830 1 "1 d. JI LF d.1.33J Commissioner A.K. B' fl(l vO i I THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washingtot :$teet- Suite 710 Boston vlassachusetts. 02118 Home lmprovem et onfractorRegistration Type: Individual JAMES G.DIMOUOULOS ite�i5ltation: 167375 25 SEVEN SISTER RD Expltation: 03/11/2024 HAVERHILL, MA 01830 Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:°iaciividual• Office of Consumer Affairs and Business Regulation Re.Qist tiOrt Ext:41'0 En 1000 Washington Street -Suite 710 167 03/111/2024 Boston,MA 02118 JAMES G.DIMOUOULOS. JAMES DIMOUOULOS 25 SEVEN SISTER RD • HAVERHILL,MA 01830 Undersecretary _— N !d without signature