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29-121 (3) BP-2023-0484 64 FOREST GLEN DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 29-121-001 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-2023-0484 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 7000 HOMEWORKS ENERGY INC 106148 Const.Class: Exp.Date: 07/30/2024 Use Group: Owner: NORTH,DANIEL &LAPALM-NORTH, TIFFANY M. Lot Size (sq.ft.) Zoning: WSP Applicant: HOMEWORKS ENERGY INC Applicant Address Phone: Insurance: 235 ESSEX ST 781-205-4484 1847910 WHITMAN, MA 02382 ISSUED ON: 04/19/2023 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: 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: el * • y2 . cg't • ; , Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax (413)587-1272 Office of the Building Commissioner FEE: $65.00 ri it- 1' `.tif►lrirl, City of Northamptoyr Dep � `' '\ Building Department 40 . k , 212 Main Street s INSULATION :,,, ,,,f,2. :- Room 100 �. ' I ,.• Northampton, MA 01060 :f '` phone 413-587-1240 Fax 413-58,y-1272" - ONLY ...,,,,,. APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INSULATION PERMIT This section to be completed by office 1.1 Property Address: Map Lot Unit 64 Forest Glen Drive Northampton MA 01062 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Tiffany Lapalm-North 64 Forest Glen Drive Northampton MA 01062 Name(Print) Current Mailing Address: See Attached (413)588-4914 Telephone Signature 2.2 Authorized Agent: Adam Glenn 235 Essex Street, Whitman, MA 02382 Name(Print) � c j Current Mailing Address: c Jac, 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 7,000 (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 *VS 6. Total = (1 +2+ 3+4 + 5) 7,000 Check Number ) 1 516 This Section For Official Use Only Building Permit Number: 5/7- o?3 '� g' Date Issued: n //77Sgi ature: 1 '9' 2OZ3 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 235 Essex Street, Whitman, MA 02382 07/30/2024 Addre Expiration Date 781-205-4484 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ HomeWorks Energy 181138 Company Name Registration Number 235 Essex Street, Whitman, MA 02382 03/02/2025 Address Expiration Date „`___ 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 D Brief Description of Proposed Work Residential weatherization/ Air sealing. No structural changes. SITE ID 802635 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 cee_ 4/11/2023 Signature of Owner/Agent Date Tiffany Lapalm-North 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 4/11/2023 Signature of Owner Date City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS - z 212 Main Street • Municipal Building Northampton, MA 01060 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:7,000 Address of Work:64 Forest Glen Drive Northampton MA 01062 Date of Permit Application: 4/11/2023 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: 1 hereby apply for a building permit as the agent of the owner: 4/11/2023 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 r,,a1.'li�,!// 0 ..,.;.... Sir,,.,. Massachusetts Q? i-_ 3 , k DEPARTMENT OF BUILDING INSPECTIONS ;• �: • ��r 212 Main Street •Municipal Building Jb.. C� —�N-•-� Northampton, MA 01060 s4.1 . N'‘`� 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: 64 Forest Glen Drive Northampton MA 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) Cdal iz;0'aV 4/11/2023 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. ti,.,,.,f City of Northampton . , , t' r: Massachusetts irk DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 64 Forest Glen Drive Northampton MA 01062 Contractor Name: HomeWorks Energy Address: 235 Essex Street City, State: Whitman, MA 02382 Phone: 781-205-4484 Property Owner Name: Tiffany Lapalm-North Address: 64 Forest Glen Drive Northampton MA 01062 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 Okk 81;10(.2(1- coe_ Date 4/11/2023 The Commonwealth of Massachusetts Department of Industrial Accidents t '-z. —_ `p. Office of Investigations . l— Ø Lafayette City Center 2 Avenue de Lafayette, Boston, MA 02111-1750 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): HomeWorks Energy Address: 235 Essex Street City/State/Zip:Whitman, MA 02382 Phone #: 781-205-4484 Are you an employer? Check the appropriate box: Type of project(required): I.❑■ I am a employer with 500+ 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ID 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 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' p h' i 9. El Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.❑ 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 Weatherization employees. [No workers' 13.1.I Other 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: Federated Mutual Insurance Company Policy#or Self-ins. Lic. #:#1847910 Expiration Date: 1/1/2024 Job Site Address: 64 Forest Glen Drive Northampton MA 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 Section 25A of MGL c. 152 can lead to the imposition of criminal 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 ORDER 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 the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the thepains )and pe�y es of perjury that the information provided above is true and correct Signature: "`""` oI ' • ' Date: 4/11/2023 Phone#: 781-205-4484 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # _ Issuing Authority(check one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: A`ORCP CERTIFICATE OF LIABILITY INSURANCE �'1` 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 NAME: CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE:P.O.BOX 328 (A/C,No,EMIR 888-333-4949 (AAiC,No):507-446-4664 _ OWATONNA,MN 55060 ADDRESS:CLIENTCONTACTCENTER(caFEDINS.COM INSURERIS)AFFORDING COVERAGE NAIC# INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 419-899-0 INSURER B: HOMEWORKS ENERGY,INC. INSURER C: 101 STATION LNDG MEDFORD,MA 02155-5134 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:0 REVISION NUMBER:1 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 F TYPE OF INSURANCE AL SUBR POLICY NUMBER POLICY EFF POLICY EXP LTRINSR WVDIMM/DDIYYYY) (MM/DDIYYYY) LIMITS X COMMERCIAL GENERALUABILITY EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED $100,000 CLNMS-MADE X OCCUR PREMISES!Ea ocanencel MED EXP(My one person) EXCLUDED A N N 1847909 01/01/2023 01/01/2024 PERSONAL&A)VINJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AOOREOATE $2,000,000 HX POIICY JE LOC PRODUCTS-COMPIOP AGO $2,000,000 OTHER. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 I X ANY AUTO BODDILY ILYINJURYaccident) (M person) AOWNED AUTOS ONLY _SCHEDULED -- AUTOS N N 1847908 01l01/2023 I 01A1/2024 eoaLr INJURY(Per accident) HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE AUTOS ONLY — (Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $1,000,000 A ^—EXCESS LIAR CLAIMS—MADE N N 1847911 01/01/2023 01/01/2024 AGGREGATE $1,000,000 ^_DED RETENTION WORKERS COMPENSATION X PER STATUTE OTH- AND EMPLOYERS'LIABILITY Y/N ER -- ANY PROPRIETORIPARTNERIEXECUTIVE - E.L EACH ACCIDENT SS500 000 A OFFICER/MEMBER EXCLUDED? NIA N 1847910 01/01/2023 01/01/2024 --- ----- (MrMelory In NH) E.L.DISEASE•EA EMPLOYEE S500 000 II yes.describe under S500'000 DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD lot,Additional Remarks Schedule,may be attated it more space is required) THIS COPY IS NOT TO BE REPRODUCED FOR ISSUANCE OF CERTIFICATES. CERTIFICATE HOLDER CANCELLATION 01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN A CERTIFICATE HAS BEEN FILED WITH EACH OF YOUR CERTIFICATE ACCORDANCE WITH THE POLICY PROVISIONS. HOLDERS. AUTHORIZED REPRESENTATIVE 4/44,01/14/j )4A,‘./ '0 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD --_ Commonwealth of Massachusetts V-) Division of Occupational Licensure Construction Supervisor SFeciatty Board of Building R fattorts and St4Uulsrds Rest: ted -, 9 CSSL4C -,nsutatt�n Contactor 4`li l Constructs tt�te r Spec:tatty CSSL-106148 „� - spires: 07/3012024 ADAM GLENN 19 CHARGE 10 . A ....4. WAREHAM NO r i )4 ::,,,' . Failure to possess a current edition of the Massachusetts M 3 State Eauitd,ng Code is cause for revocation of this license For information about this license C Commissioner ', f �c tA.,. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation ""�'01.1010. Registration: 181138 HOME WORKS ENERGY, INC. Expiration: 03/02/2025 101 STATION LANDING STE 110 «- --= MEDFORD, MA 02155 a 7 1,y 1.10 cs t'. 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: Corporation Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 181138 03/02/2025 Boston, MA 02118 HOME WORKS ENERGY,INC. ADAM GLENN (dun, r'c�3/' i', 101 STATION LANDING STE 110 '- ``i ci MEDFORD, MA 02155 ��`/ � - Undersecretary Not valid without signature Insulation/Air Sealing Permit Authorization Specialist: Michael Hathaway Company: HomeWorks Energy Email: michael.hathaway@homeworksenergy. Address: 101 Station Landing Cell: 4135882467 Medford, Ma 02155 Phone: 781.305.3319 Customer: Tiffany Lapalm-North Address: 64 Forest Glen Drive Email: tlanorth14@yahoo.com Northampton, MA, 01062 Site ID: 802635 Phone: 4135884914 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: tlanorthl4@yahoo.corn Customer 14/ Signature: � Date: 2/24/2023 Tiffany La!7,•rh `/' 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. PLAN VIEW Name: 1ccNc i r .Site ID: �(., ,Cj Finished Sq. Ft: KO cc Address: kl�S� tkS A Year of House: t r D Electric Acct#: / dress: 6"k Fo' G ,� or #of Floors: Gas Acct#: 1(-lurches OLUb3- Unit#: #Occupants: 11Housing Type? j2 Cr ti. DUCTWORK INSPECTION Ducts Insul ted7r i uct Linear Ft. 't'` k I uct Square Ft. 13c.€)-ele--c Duct Air Sealing Hours A/S Duct Insulation •uct Insulation Removal j1 ( �r�t3 � ]40 z BASEMENT INSPECTION �} v ,., Existing Spec'ing Ln/Sq. Ft. )S-Lcivc-if al Bsmt Wall AG � Crawl Ceiling _ t� t.) t � Crawl Rim Joist Bsmt RJ w/Sill I\ta..c.,_ rz-6 j 1-0 Bsmt RJ NO Sill ��,/ Vapor Barrier qft, Bsmt boor 7 EDI Blower Door? WALLS&GARAGE Drill Location? Sidini Cell.Height Existing Spec'ing I Sq.Ft. Framin _ V Exterior Wall 1 in-t I '-7sj re, F611, J-`''arc cct o �x x (C�Balloon latform Exterior Wall 2 i x x Balloon/Platform Overhang '_ — x x Garage Wall x x Balloon/Platform Garage Ceiling x x cc a � O C ' IIII1I insulator Removal Sgtt. Sweeps: I WX Strippir.g: WORK SPEC'D BUT NOT CONTRACTED D BLOCKS PRESENT? ANDATORY) Attic Basement/Crawlspace Other. K&T Y/Moisture Y/ ombustion Sfty Y/ Kneewall Overhang/Garage Asbestos Y/N 'Mold>100 sq. ft Y/ Detector Missing Y Ductwork Exterior Walls Vermiculite Y N tructl Concerns Y N Other: Notes for Lead Vendor/Work Not Contracted: KW WALL AND KW FLOOR Blind Spec? OR KW SLOPE AND GABLE END Blind Spec? J by? ,.vhy? FRAMING EXISTING SP%'''IV- SO.FT. FRAMING EXISTIN( y!. WALL X X SIopt X X _ FLOOR cc O GABLE X X l_, " ACCESS� IIIV �� 13 � TRANS X X z ATTIC . I PI a ATTIC SLOPE X X xs SLOPE x XI EXISTING VENTING?I _� i EXISTING VENTING? EXISTING PIPES? Y/N fn fn w KNEEWALL.MANOATWY k, .c./ U z ' K,7> ),(akf c cc q /, �v� uGfG 'X ,0 l/ 1 H---- -- -- ( j Lk' rl I`"(20 °� �� 5 rx g/V z..b"I 4-1.:Ii-SX-)15(1? 1, e K �ye •>`I "--..'—'-'---"...: ......A1 BAS Vol: x .0058 - 4 ia�yl M r #4, ATTIC 1 Blind Spec? x X ATTif�2 Blind Spec? 1 X :,a i ror; zO Existing Spec'ing Sq ft Existing 1 Spec'ing Sq ft �" `3 C. Unfloored 3�1f ('''COic( ({}4 Unfloorediiiinal Multipliers Floored Floored • • ��Si��•^�- Doc:,f=r• Cath Sloe Cath Slope l _ ~ '6 Leas v�re Walls Was Air Sealing Hours Access C L. ,a,. . Access *.*." 1 �, 9,,t, "f�i),,,,, ltt� I i • .s Iiarrn int!.,.. .'enntlg EI ��•�f'.i . 1 namrrtinr ' 71 7 1 0 .-,-.. i —71 Lxist€i.g 1.ff.' t ng; @e /I !�1 WEATHERIZATION CONTRACT EVERS=URCE CUSTOMER PHONE DATE CLIENTS WORKORDER Daniel North (413)270-4370 02/24/2023 802635 11501 SERVICE STREET SLUNG STREET PROPOSED BY: 64 Forest Glen Drive 64 Forest Glen Dr HomeWorks Energy SERVICE CRY,STATE,ZIP SLUNG CITY,STATE,DP Program Florence, MA 01062 Florence, MA 01062 EGMA-HPC Page 1 DESCRIPTION QTY COST INCENTIVE TOTAL PERFORM AIR SEALING AT ESTIMATED 62.5 CFM50 PER HO 10 $943.30 $943.30 Seal areas of your home against wasteful,excessive 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.) EXTERIOR DOOR WEATHER STRIPPING 2 $63.62 $63.62 Provide labor and materials to install Q-Ion weatherstripping to door(s)to restrict air leakage. DOOR SWEEP 1 $26.11 $26.11 Provide labor and materials to install a doorsweep to restrict air leakage. DAMMING 20 $49.00 $36.75 $12.25 Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass batts for damming purposes. ATTIC FLOOR OPEN BLOW CELLULOSE 14" 1,048 $2,557.12 $1,917.84 $639.28 Provide labor and materials to install a 14"layer of R-49 Class I Cellulose to open attic space. HATCH: THERMAL BARRIER POLYISO 2 INCH(ATTIC) 1 $47.37 $35.53 $11.84 Provide labor and materials to insulate the back of an attic hatch with 2"rigid insulation board at R-10. INSULATE VINYL SIDED WALL WITH 4"DENSE PACK 990 $2,653.20 $1,989.90 $663.30 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. INSTALL 6"FG BATTING IN OPEN BASEMENT CEILING 20 $47.00 $35.25 $11.75 Provide labor and materials to install R-19 faced fiberglass bad (initials) insulation to the basement ceiling.This will be installed with the paper backing up against the floor above.The un-papered fiberglass side will be facing the basement, and these exposed fiberglass fibers will be the visible side when standing in the basement. Your initials are your agreement and understanding of this measure A3tip___ 3 4, .s 1/6/23 WEATHERIZATION CONTRACT EVERS...:. URCE CUSTOMER PHONE DATE CLIENT# WORK ORDER Daniel North (413) 270-4370 02/24/2023 802635 11501 SERVICE STREET BILLING STREET PROPOSED BY: 64 Forest Glen Drive 64 Forest Glen Dr HomeWorks Energy SERVICE CITY,STATE.ZIP BILLING CITY,STATE,ZIP Program Florence, MA 01062 Florence, MA 01062 EGMA-HPC Page 2 DESCRIPTION QTY COST INCENTIVE TOTAL REPLACE BATH FAN HOSE 1 $28.00 $21.00 $7.00 Provide labor and materials to install an insulated 4"exhaust hose to existing bathroom fan(s). Total: $6,414.72 Program Incentive: $5,069.30 Client Total: $1,345.42 I.DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the above work at the Client's Address in a professional manner and in accordance with the terms of this Contract: II.PAYMENT Client agrees to pay the Contractor for the Work,the Client Share of the Contract Cost is payable to the Independent Installation Contractor(IIC)upon satisfactory completion of the Work.Client understands that they will not be required to pay the Program Incentive Share of the Contract cost.Changes to the individual line items and/or previous incentives may incr e or dec ase t size of the Program Incentive Share. R e ati© _37 b 1; 3 cii &440-- 3 - Printed Name Date of Acceptance