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23A-168 (4)
BP-2023-1708 57 PINE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23A-168-001 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-2023-1708 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: DIPIETRO HOME ENERGY Est. Cost: 3946 SOLUTIONS DBA REVISE 104464 Const.Class: Exp.Date: 03/06/2024 Use Group: Owner: WOLI., RACHEL GRACE &DONAHUE, SAMUEL Lot Size (sq.ft.) DIPIETRO HOME ENERGY SOLUTIONS DBA Zoning: URB Applicant: REVISE Applicant Address Phone: Insurance: 32 MIDDLESEX ST (978)203-6736 WC100142002 HAVERHILL,MA 01835 ISSUED ON: 12/06/2023 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATH ERI ZATI 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: Q 10 ' yQ ) • I Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner J� �C,6"../ , .);t_t 158z i , The Commonwealth of Massachu •tts f* lci Board of Building Regulations and � and.-i s O�c \ a 1 Massachusetts State Building Code,"780 1.:�+ ' I'' ,CIPA► TY ;'_e,. M D� USE Building Permit Application To Construct,Repair,Reno 4 ,l+.'.olish a'"' Re ised r 2011 One-or Two-Family Dwelling �''�"''r�;'i This S ction For Official Use Only �qo 43oi S Building Permit Number: , h 3 P./103 Date Applied: 11/30/2023 /4`cr,,,..) f , / _. 'I Z-C, ZDZ3 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 57 Pine St Northampton,MA 01062 1.1a Is this an accepted street?yes V 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 yes0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Rachel Wolk Northampton,MA 01062 Name(Print) City,State,ZIP 57 Pine St 914-844-7379 rgw241@bu.edu 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) ❑ Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2:Insulation,Weatherization,and Air Sealing SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $3946.66 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $0 0 Standard City/Town Application Fee 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $0 2. Other Fees: $ 4.Mechanical (HVAC) $0 List: 5.Mechanical (Fire 4466 Suppression) $0 Total All Fee Check No. r Check Amount: Cash Amount: 6.Total Project Cost: $3946.66 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-104464 03/06/24 James Dimopoulos License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 32 Middlesex St No.and Street Type Description Haverhill,MA 01835 U Unrestricted(Buildings up to 35,000 Cu. R Restricted I&2 Family Dwelling City/Town,State,ZIF M Masonry RC Roofing Covering —�— WS Window and Siding SF Solid Fuel Burning Appliances 351-588-0362 wx-permitting@callrevise.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC-167375 03/11/24 James Dimopoulos Dipietro Home Energy Solutions dba Revise HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 32 Middlesex St wx-permitting@callrevise.com No.and Street 351-588-0362 Email address Haverhill,MA 01835 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 la No ❑ 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. See attached authorization 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 applicati is true and accurate to the best of my knowledge and understanding. 11/30/2023 Print Owner's or Authorized Agent's 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" The Commonwealth of Massachusetts * Department of Industrial Accidents = I►= 't Office of Investigations =E 1= ' Lafayette City Center t_r �r.pr 2Avenue de Lafayette, Boston,MA 02111-1750 v www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizationandividual): 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): I.El 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. 0 Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in anycapacity. employees and have workers' P h 9. ❑Building addition [No workers' comp.insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.0 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.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no Weatherization employees. [No workers' 13.❑■ 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. tContractors 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: HUB International New England Policy#or Self-ins.Lic.#:WCI00142002 Expiration Date:04/20/2024 Job Site Address: 57 Pine St City/State/Zip:Northampton, MA 01062 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 pa• and p nalties of perjury that the information provided above is true and correct. Signature: Date: 11/30/2023 Phone#: (978) 203-6736 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): 10Board of Health 20 Building Department 3.City/Town Clerk 4.0 Electrical Inspector S,111Plumbing Inspector 6.0Other Contact Person: Phone#: DATE(MM/DD/YYYY) AC LRCP CERTIFICATE 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 PHONE Ext1: (978)374-6352 AXC,No): (978)521-5127 2 S.Kimball St. E-MAIL ecostello@costelloinsurance.com ADDRESS: PO BOX 5248 INSURERS)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 SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $DAMAGE TO RENTE 1,000,000 CLAIMS-MADE X OCCUR PREMISES Ea occur ence) $ 50,000 MED EXP(Any one person) $ 10,000 A PACEP308383 04/25/2023 04/25/2024 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY X PROT LOC 00, 00PRODUCTS-COMP/OP AGG $ 20 OTHER: pollution $ 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED v SCHEDULED HS6326 05/09/2023 05/09/2024 BODILY INJURY(Per accident) $ AUTOS ONLY /—", AUTOS X HIRED �/ 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 04/25/2023 04/25/2024 AGGREGATE $ 3,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 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 Town of Northampton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 210 Main Street THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Northampton, MA 01060 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE l ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD DIPIEHO-01 CWOODSIDE ACORO" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 4/19/2023 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 License#1780862 c2NTACT Anya Toteanu NAME: HUB International New England PHONE FAX 300 Ballardvale Street (A/C,No,Ext): I(A/C,No): Wilmington,MA 01887 ittlkss:anya.toteanu@hubinternational.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Independence Casualty Insurance Company 11984 INSURED INSURER B: Dipietro Home Energy Solutions,Inc.,Joseph A.Dipietro INSURERC: Heating&Cooling,Inc - 32 Middlesex Street INSURERD: Haverhill,MA 01835 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. NOTIMTHSTANDING 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 SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVDIMMIDD/YYYY1 IMM/DD/YYYYI COMMERCIAL GENERAL UABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY j IT LOC PRODUCTS-COMP/OP AGG $ OTHER $ AUTOMOBILE LIABILITY (EaMidentSINGLE LIMIT) ANY AUTO BODILY INJURY(Per person) $ — OWNED SCHEDULED _ AUTOSRE� ONLY AUTOS BODILYO INJURY(Per accident)_$_ AUTOS ONLY AUTOS ONLY ((Perr acedent)AMAGE UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKER AND EMPLO ERS'LIAB UTY COPENSATIONX STATUTE ERH WC100142002 4/20/2023 4/20/2024 1,000,000 ANY OFFICER/MEMBER/PARTNER/EXEXCLUDED?ECUTIVE N N I 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 $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Town of Northampton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 210 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Northampton, MA 01060 AUTHORIZED REPRESENTATIVE gf"99-1 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washingtor}Street- Suite 710 Boston,Massachusetts 02118 Home ImgrovemerifeonfractorRegistration Type: Individual iiteglb7ation: 167375 JAMES G.DIMOUOULOS Ezpitation: 03/11/2024 25 SEVEN SISTER RD HAVERHILL,MA 01830 '1 ti.'i" 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:individual. Office of Consumer Affairs and Business Regulation Rosi3rteetIon Etotrem 1000 Washington Street -Suite 710 167$75 03/11/2024 Boston,MA 02118 JAMES G.DIMOUOULOS. JAMES DIMOUOULOS 25 SEVEN SISTER RD 94,0,4A!i...",(140•4 --� hiAVERHILL.MA 01830 Undersecretary C_ -� N, 1d without signature U Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Regulations and Standards CI Cons sonS S rvisor •s CS-104464 .. spires:03/06/2024 JAMES G D1IdOPOULOS ... 25 SEVEN SISTER RD HAVERHILL MA 01830 r i 1`)I Iv i t.11� ,- Commissioner ,.!•,r� ,,; •,� 4# 4((t WEATHERIZATION mass save BARRIER INCENTIVES eased 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 banters. CUSTOMER INSTRUCTIONS 1L Hire a qualified,licensed contractor to evaluate and/or remedlate the weatherization barrier(s). 2.Submit signed and completed copies of this form and a copy of the Paid contractor invoices)within 60 days of your Home Energy Assessment to:Submit signed and completed copies of this Contractor Evaluation Report and a copy of the dated and Itemized Contractor Invoice to the Participating Home Performance Contractor that completed your Home Energy 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 r.Complete the recommended weatherization improvements. CUSTOMER INFORMATION n 1 Customer Nanne: ZaC-\r Q'' V W 4I< Client K or Slte ID: Ste Address; J 7 ?(n2 CJ city; I o c Q rC Q State MA ZIP: ©l O C9 as Mee ° Phone Number. -8 7 4 73�� Email: Caratriesseitonietninar lipoene Data: 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: 0 Attic Floor O Attic Wall ❑Attic Slope l7 Exterior Wall 0 Basement 0 Other 0 Other. To be reel out by the&ow Soeciaot Fkt I have performed my inspection and determined there Is no active knob and tube wiring in the areas selected below. . Floor 1tli V1f Attic Slope.Etderior Wall KBasernent )ther, OO her. roararo outuythe[s�med i have read and agree to the Terms and Conditions on the back of this form. Contractor Name l)(-)"-J ;'t Address: as& W Guv twunofa" \- sty: Co r' — 'f state:M A MFt0 J6 Ka Company Name: 0WQJZ. UIrno.-"i C-{rtc a- License Number. Stu t ca7-13 Contractor lignetsre �t Data ti-tch aS MECHANICAL SYSTEM BARRIERS(7 oc"co out oy licensed contractor) High Carbon Menodde:Contractor is to service end re-evaluate the selected mechanical systems)and reduce the carbon monoxide level, as measured in the undiluted flue gas,to brew 100 parts per million(ppm). Dolt Mara Contractor is to correct the draft in the sekic>ted flues).Refer to table on reverse for exeptabie draft ranges High Carbon Monoxide Draft Failure Frisring CO ppm: Revised CO ppm Existing Drift Pa: Revised Draft Pa: Nardep System Nil Water Naallar Man Wham Cerltractor is to correct the spolage of flue gases in the selected mechanical systern(s).test not spill after 60 seconds of operation. O Haatlng System 0 Hot Water Hester 0 Other. ❑1 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 lignatsaa Data: Continued on back (page 1 of 2) DocuSign Envelope ID:C1FF7B18-8E1E-4ED2-AB76-E59554FA93E2 REV the way 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 Rachel wolk 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: Ott Date: 11/5/2o23 915EE46C468F483... DocuSign Envelope ID:B14FA2BA-3700-4C9D-B266-97788775F663 Revise Energy n REVISE Home Performance Contractor ,� the way you save 5 South Summer Street,Bradford,MA 01835 CONTRACT - AUDIT 1-800-885-7283 CUSTOMER PHONE DATE CLIENT# WORK ORDER Rachel Wolk (914) 844-7379 11/05/2023 812656 76201 SERVICE STREET BILLING STREET PROPOSED BY, 57 Pine Street 73 Barrett St Revise Energy SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Florence, MA 01062 Northampton, MA 01060 Page 1 DESCRIPTION QTY COST INCENTIVE TOTAL PERFORM AIR SEALING AT ESTIMATED 62.5 CFM50 PER HO 6 $639.54 $639.54 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.) DAMMING 50 $139.00 $104.25 $34.75 Provide labor and materials to install a 12"layer of R-38 unlaced fiberglass batts for damming purposes. ATTIC FLOOR OPEN BLOW CELLULOSE 6" 560 $1,097.60 $823.20 $274.40 Provide labor and materials to install a 6"layer of R-22 Class I Cellulose to open attic space. INSULATION REMOVAL 127 $179.07 $0.00 $179.07 Batt style insulation will be removed from the attic area and properly disposed, off site. DOOR: THERMAL BARRIER POLYISO 2"(ATTIC) 1 $103.05 $77.29 $25.76 Provide labor and materials to insulate the back of the attic door with 2"rigid insulation board. ATTIC STAIR COVER THERMAL BARRIER 1 $313.63 $313.63 Provide labor and materials to install an easily moved, insulating cover for the attic access folding stair. The cover has integral weather- stripping to restrict air leakage. INSULATE RIM JOIST WITH 2"THERMAL BARRIER POLYISO 127 $701.04 $525.78 $175.26 Provide labor and materials to install rigid board insulation to the perimeter of the basement ceiling at the house sill. 6 MIL POLY VAPOR BARRIER 225 $265.50 $265.50 Provide labor and materials to install 10 ml polyethylene over open ground in designated crawlspace/earthen basement areas. VENT BATH FAN TO ROOF OR OTHER 2 $333.06 $249.80 $83.26 Install a 6"insulated exhaust hose to a flapper vent to exhaust existing bathroom fan(s). Fan will be vented through the roof or an acceptable alternative if contractor cannot vent through the roof. CDocuSigned by: e-DocuSigned by: Michael E Madden 11/5/2023 WA 11/5/2023 I l -eil F83B3283DE384C5... ' D4784CBB9E1 D490_. DocuSign Envelope ID: B14FA2BA-3700-4C9D-B266-97788775F663 Revise Energy REVISE Home Performance Contractor the way you save 5 South Summer Street,Bradford,MA 01835 CONTRACT - AUDIT 1-800-885-7283 CUSTOMER PHONE DATE CLIENT H WORK ORDER Rachel Wolk (914) 844-7379 11/05/2023 812656 76201 SERVICE STREET BILLING STREET PROPOSED BY: 57 Pine Street 73 Barrett St Revise Energy SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Florence, MA 01062 Northampton, MA 01060 Page 2 DESCRIPTION QTY COST INCENTIVE TOTAL 12"MUSHROOM VENT 1 $175.17 $131.38 $43.79 Provide labor and materials to install a 12"diameter"mushroom" roof vent(s)to increase ventilation in attic areas. The vent can be supplied in (circle color)black, brown, gray or mill finish. Total: $3,946.66 Program Incentive: $3,130.37 Customer Total: $816.29 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Eight Hundred Sixteen &29/100 Dollars $816.29 p—DocuSigned by: "—DocuSigned by: e_-! .fuha 11/5/2023 autU, D4784CB89E1D490... Michael E Madden •—F8383283DE384C5...- D4784C 11/5/2023 NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE SIGN DATE 30 DAYS. Virtual Circle One In-Home Revise Energy Planview Diagram Customer: ,N.A �� ( 1�\�} Advisor Name: IA tc Address: �`1 ('c �-'L' _"?'(- Any limitations to access by truck? Y/ Town: -20 A-- -",�f TU Site ID: • .Use the greater of the two MS Ws when calculating for M�/R #of stories 1 1.5 2 _ 2.5 3 ' f MS 1: 15 cfm X H occupants X n-factor = 61 1 n-factor 19 16 15 14.4 13.7 I MS 2: .00583 X area X height X n-factor = t t Mechanical Ventilation Recommended:BAS>final CFMSO> (0.7 X BAS) Mechanical Ventilation Required:(0 7 X BAS)>Final CFM50 Is this part of a multi-unit workscope? Y o1N A/S Multiplier? N/A >6"Loose Insulation Cross-Batt >6"M'rx Loose/x-batt Truss Workscope: tXX, 0(4..vitt_ co I h JA I-Ue i t vu6, A Cl‘ k-c,t,A J O C - 6" VG, ' Any work scoped outside of best practic approved by? it U IP � — -0 o'Fg t ' -(D C) 0,05) tz--c9 s z (0) Arcs Yr Built Heat Yr DHW Yr Ventialtion SOFT SOFT/300 40%Low/High Existing High Existing Low Rec Vents,# Existing Propervents Required Propervents