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11C-051
WAP Work Order: Job Number: 13-188 Windows Deadlights 0 $0.00 $0.00 Glass replacement per ui over 64 0 $150 $0.00 Glass replacement to 64 ui 0 $44.00 $0.00 Other 0 $0.00 $0.00 Side Press Lock 0 $950 $0.00 Storm Windows 0 $0.00 $0.00 Top Sash Lock 0 $9.50 $0.00 Weatherstrip Window/Schiegal or 0 $6.00 $0.00 equivalent Total $1,089.65 Contractor Instructions: Before Starting the Job: During the Job: 1.Please notify us 24 hours before starting or scheduling a job. 1.This residence was built before 1978.Lead safe practices are 2.Obtain required building permit. required. 2.Total for Heath&Safety and Repairs cannot exceed$2500.00. 3.Davis Bacon time sheets required for ARRA work on US Department of Labor Certified Payroll Report Form WH-347. 4.Photograph any air sealing or other work to be covered by insulation. Your Invoice Must Include: 1.Client name,client address and job number. 2.Signed and dated copy of the work order. 3.Pre and post blower door test results. 4.Attic inspection form. 5.Copy of certificate of insulation. 6.Copy of building permit. 7.Manufacture labels from replacement doors and windows. 8.Photographs of air sealing or other work covered by insulation. Blower Door Test Results Pre Post Certificate of Insulation posted? Yes No (Circle One) Attic Inspection form attached? Yes N/A (Circle One) Where Posted: Contractor: Date: WAP Auditor: Date: Page 7 WAP Work Order: Job Number: 13-188 Other 0 $0.00 $0.00 Single nailed asbestos/asphalt 0 $2.21 $0.00 (dense pack) Spray Foam Walls-CDC ONLY 0 $1.12 $0.00 Test drill 4 sides 0 $60.00 $0.00 Vinyl over asbestos(dense pack) 0 $231 $0.00 Window Weight Voids(pair) 0 $12.00 $0.00 Wood clapboard/shakes/shings or 0 $1.79 $0.00 vinyl(dense pack) Window&Door Replacements 32-36 in Steel pre-hung 0 $640.50 $0.00 replacement door w/lite 32-36 in Wood pre-hung 0 $609.00 $0.00 replacement door w/lite Basement window replacement 0 $250.00 $0.00 (awning/hopper) Basement window replacement 0 $250.00 $0.00 with a frame CDC Windows 2 0 $357.43 $0.00 Other 0 $0.00 $0.00 Prime window replacement w/low-e 0 $350.00 $0.00 to 73 ui Prime window replacement w/low-e 0 $350.00 $0.00 to 74-83 ui Prime window replacement w/low-e 0 $350.00 $0.00 to 84-93 ui Prime window replacement w/low-e 0 $350.00 $0.00 to 94-101 ui Replacement Grids(per window) 0 $42.00 $0.00 Replacement window per 12/29/10 0 $350.00 $0.00 Tech Manual revision Sliding door replacement per WAP- 0 $1,100. $0.00 IM-2011-009 00 Sliding exterior door replacement 0 $1,100. $0.00 per WAP-IM-2011-009 00 zCDC Door 0 $490.00 $0.00 zCDC Window Replacement 1 0 $312.00 $0.00 Page 6 WAP Work Order: Job Number: 13-188 Cut/finish attic-kneewall access 0 $105.00 $0.00 Interior Air Sealing&Caulking 0 $75.00 $0.00 Labor only charge 0 $60.00 $0.00 Other 0 $0.00 $0.00 Replace Clothes Dryer Transition 0 $40.00 $0.00 Duct only Seal ducts with mastic or butyl 3 $65.00 $195.00 backed tape Weatherstrip(Q-lon or equal)& 0 $33.50 $0.00 R-30 attic hatch Weatherstrip(Q-Ion or equal)attic 0 $31.50 $0.00 hatch zCDC Airsealing 0 $62.46 $0.00 Other Other 0 $0.00 $0.00 I I I Permit Building permit 1 $50.00 $50.00 Other 0 $0.00 $0.00 Permit$50 0 $50.00 $0.00 Permit$35 0 $35.00 $0.00 Wall Insulation Bay Window insulate above*below 0 $100.00 $0.00 -your option as to method and Brick/Stucco(dense pack) 0 $2.89 $0.00 Double nailed asbestos/aluminum 0 $231 $0.00 (dense pack) Drill finish patch plaster(dense 0 $1.90 $0.00 pack) Drill rough plaster patch or finish 0 $1.82 $0.00 wood plug(dense pack) Page 5 WAP Work Order: Job Number: 13-188 Health&Safety Basement window w/framing- 0 $250.00 $0.00 building code compliance(non- Clothes dryer vent including 0 $89.00 $0.00 Exhaust Duct Gutter Replacement(includes down 0 $6.50 $0.00 spouts) Knob&Tube Inspection,fuses, 0 $175.00 $0.00 wiring Other 0 $0.00 $0.00 Vent kit/bath fan 0 $89.00 $0.00 Misc Insulation 2" Foam Board on Door 0 $54.00 $0.00 Domestic water pipe wrap 0 $2.63 $0.00 Duct insulation R-5 0 $3.10 $0.00 Hydronic pipe insulation 1.25-15 0 $3.68 $0.00 in.copper pipe R-5 Hydronic pipe insulation to 1 in. 0 $3.41 $0.00 copper pipe R-5 Other 0 $0.00 $0.00 Steampipe insulation 3 in.iron pipe 0 $7.61 $0.00 R-5 Steampipe insulation to 15-2 in. 0 $635 $0.00 iron pipe R-5 Steampipe insulation up to 1.25 in. 0 $551 $0.00 iron pipe R-5 Misc Measures Attic sealing with two-part foam 0 I$75.00 I I I Basement sealing with two-part 3 $75.00 $225.00 Mid-wall bypasses in basement-use 2 part foam foam-chimney,piping&electrical,Sills. Metal cover for old garage chimney Blower door set-up with pre&post 1 $45.00 $45.00 tests Cut/close attic-kneewall access (0 $78.75 $0.00 I 1 Page 4 WAP Work Order: Job Number: 13-188 Basement overhead insulation R19 0 $1.58 $0.00 Fiberglass Basement overhead insulation R30 0 $1.82 $0.00 Fiberglass Belly repairs-foam board 0 $2.00 $0.00 Belly repairs-labor 0 $60.00 $0.00 Crawlspace overhead insulation 4 ft 0 $1.87 $0.00 high or less R-19 Crawispace overhead insulation 4 ft 0 $1.96 $0.00 high or less R-30 Garage ceiling cavity filled with 0 $2.10 $0.00 blown cellulose Other 0 $0.00 $0.00 Perimeter 2 in.foam board 0 $2.50 $0.00 Perimeter Wrap R-5 reinforced foil 0 $1.91 $0.00 or vinyl faced ductwrap Sill insulation Faced R-19 55 $1.58 $86.90 Sill two-part foam w/fiberglass batt 0 $2.20 $0.00 Doors 28-32 in interior solid core door 0 $315.00 $0.00 Automatic Sweep 0 $23.00 $0.00 Basement/outside door-door only 0 $367.50 $0.00 Basement/outside door-w/jambs 0 $435.75 $0.00 Fixed Sweep 1 $15.75 $15.75 Lockset/Schlage or equal 0 $73.00 $0.00 Other 0 $0.00 $0.00 R-5 Ductwrap or R-max on door 1 $51.00 $51.00 Repair Striker Plate(WMECO 0 $8.75 $0.00 only) Repair/Refit Door 0 $52.00 $0.00 Slide Bolt 0 $9.25 $0.00 Weatherstrip s/Q-lon or equal 2 $45.50 $91.00 Page 3 WAP Work Order: Job Number: 13-188 R-30 restricted-slopes/floored fill 0 $1.48 $0.00 w/cellulose R-30 unrestricted-settled cellulose 0 $137 $0.00 R-38 unrestricted-settled cellulose 0 $1.47 $0.00 R-49 unrestricted-settled cellulose 0 $1.61 $0.00 Reinforced poly/R-20 cellulose open 0 $1.84 $0.00 rafters Reinforced poly/R-30 cellulose open 0 $2.05 $0.00 rafters Site Built pull down stair insulation 0 $180.00 $0.00 2 in foam box Spray Foam&Mesh&Blow CDC 0 $139 $0.00 ONLY Tenmat Recessed Can Cover- 0 $30.00 $0.00 pending approval Thermodome or Magnetic pull 0 $180.00 $0.00 down stairway box Attic Ventilation 1/2 Window Gable Vent 0 $118.00 $0.00 Other 0 $0.00 $0.00 Propa Vent 0 $4.00 $0.00 Rectangular gable vent 0 $92.00 $0.00 Rectangular soffit vent 0 $27.00 $0.00 Ridge vent 0 $23.00 $0.00 Roof vent 135(1 sq ft NFV)large 0 $95.00 $0.00 Roof vent 865(.4 sq ft NFV)small 0 $80.00 $0.00 Stack Vent 0 $152.00 $0.00 Turbine Vent 0 $168.00 $0.00 Varipitch vent 0 $114.00 $0.00 Basement Insulation 6 ml poly on ground 440 $0.75 $330.00 Page 2 WAP Work Order Community Action of the Franklin,Hampshire and North Job Number: 13-188 Quabbin Regions,Inc. Work Order Date:6/4/2013 P.O.Box 1432 Ownership:Renter Greenfield,MA 01302 Phone:413-774-2310 Eastern Weatherization Auditor:Brian Legg PO Box 249 Email:blegg @communityaction.us Montague MA 01351 Cell:413-834-0632 Email:easternweatherization @yahoo.com Phone:413-376-1116 Phone:413-863-5215 Cell:413-426-8768 Martha Swartz Bay State Gas $1,089.65 89 Florence St Total $1,089.65 Apt.Apt B Leeds MA 01053 413-384-6061 Safety Issue(s):Lead Paint Possible Additional Contractor Instructions: DO NOT EXCEED$4500 Total for work Order.If more work is possible-discuss doing more work with the home-owner. Authorized Actual Measure Description Qty Price Total Qty Total Comments Attic Insulation Attic stairs-fill with cellulose 0 $135.00 $0.00 Attic/Kneewall Floor Transition 0 $2.52 $0.00 Dense Pack w/cellulose Kneewalls R-12 cellulose behind 0 $1.73 $0.00 permeable membrane Other 0 $0.00 $0.00 R-10-12 restricted-slopes/floored 0 $130 $0.00 fill w/cellulose R-10-12 unrestricted-settled 0 $1.21 $0.00 cellulose R-11 FGB in open rafters/walls/ 0 $131 $0.00 kneewalls R-18-20 restricted-slopes/floored 0 $1.42 $0.00 fill w/cellulose R-18-20 unrestricted-settled 0 $1.29 $0.00 cellulose R-19 FGB in open rafters/walls/ 0 $1.47 $0.00 kneewalls Page I WAP Work Order: Job Number: 13-189 Prime window replacement w/low-e 0 $350.00 $0.00 to 74-83 ui Prime window replacement w/low-e 0 $350.00 $0.00 to 84-93 ui Prime window replacement w/low-e 0 $350.00 $0.00 to 94-101 ui Replacement Grids(per window) 0 $42.00 $0.00 Replacement window per 12/29/10 0 $350.00 $0.00 Tech Manual revision Sliding door replacement per WAP- 0 $1,100. $0.00 IM-2011-009 00 Sliding exterior door replacement 0 $1,100. $0.00 per WAP-IM-2011-009 00 zCDC Door 0 $490.00 $0.00 zCDC Window Replacement 1 0 $312.00 $0.00 Windows Deadlights 0 $0.00 $0.00 Glass replacement per ui over 64 0 $1.50 $0.00 Glass replacement to 64 ui 0 $44.00 $0.00 Other 0 $0.00 $0.00 Side Press Lock 0 $9.50 $0.00 Storm Windows 0 $0.00 $0.00 Top Sash Lock 0 $9.50 $0.00 Weatherstrip Window/Schlegal or 0 $6.00 $0.00 equivalent Total $3,406.05 Contractor Instructions: Before Starting the Job: During the Job: 1.Please notify us 24 hours before starting or scheduling a job. 1.This residence was built before 1978.Lead safe practices are 2.Obtain required building permit. required. 2.Total for Heath&Safety and Repairs cannot exceed$2500.00. 3.Davis Bacon time sheets required for ARRA work on US Department of Labor Certified Payroll Report Form WH-347. 4.Photograph any air sealing or other work to be covered by insulation. Page 7 WAP Work Order: Job Number: 13-189 Permit$35 0 I$35.00 I$0.00 I I Wall Insulation Bay Window insulate above*below 0 $100.00 $0.00 -your option as to method and Brick/Stucco(dense pack) 0 $2.89 $0.00 Double nailed asbestos/aluminum 0 $231 $0.00 (dense pack) Drill finish patch plaster(dense 0 $1.90 $0.00 pack) Drill rough plaster patch or fmish 0 $1.82 $0.00 wood plug(dense pack) Other 0 $0.00 $0.00 Single nailed asbestos/asphalt 0 $2.21 $0.00 (dense pack) Spray Foam Walls-CDC ONLY 0 $1.12 $0.00 Test drill 4 sides 0 $60.00 $0.00 Vinyl over asbestos(dense pack) 0 $231 $0.00 Window Weight Voids(pair) 0 $12.00 $0.00 Wood clapboard/shakes/shings or 0 $1.79 $0.00 vinyl(dense pack) Window&Door Replacements 32-36 in Steel pre-hung 0 $640.50 $0.00 replacement door w/lite 32-36 in Wood pre-hung 0 $609.00 $0.00 replacement door w/lite Basement window replacement 0 $250.00 $0.00 (awning/hopper) Basement window replacement 0 $250.00 $0.00 with a frame CDC Windows 2 0 $357.43 $0.00 Other 0 $0.00 $0.00 Prime window replacement w/low-e 0 $350.00 $0.00 to 73 ui Page 6 WAP Work Order: Job Number: 13-189 Steampipe insulation up to 1.25 in. 0 $5.51 I$0.00 I I iron pipe R-5 Misc Measures Attic sealing with two-part foam 0 1$75.00 $0.00 Basement sealing with two-part 3 $75.00 $225.00 foam Blower door set-up with pre&post 0 $45.00 $0.00 tests Cuticlose attic-kneewall access 3 $78.75 $236.25 Kneewall behind Bathtub-accessing attic over 1st Floor apt-Discuss location with homeowner.Access other side of kneewall as needed.Access other side of attic "firewall" to add insulation. Cut/finish attic-kneewall access 0 $105.00 $0.00 Interior Air Sealing&Caulking 0 $75.00 $0.00 Labor only charge 0 $60.00 $0.00 Other 0 $0.00 $0.00 Replace Clothes Dryer Transition 0 $40.00 $0.00 Duct only Seal ducts with mastic or butyl 0 $65.00 $0.00 backed tape Weatherstrip(Q-lon or equal)& 0 $33.50 $0.00 R-30 attic hatch Weatherstrip(Q-lon or equal)attic 0 $31.50 $0.00 hatch zCDC Airsealing 0 $62.46 $0.00 Other Other 0 $0.00 $0.00 I I Permit Building permit 0 $1.00 $0.00 Other 0 $0.00 $0.00 Permit$50 0 $50.00 $0.00 Page 5 WAP Work Order: Job Number: 13-189 Lockset/Schlage or equal 0 $73.00 $0.00 Other 0 $0.00 $0.00 R-5 Ductwrap or R-max on door 1 $51.00 $51.00 Repair Striker Plate(WMECO 0 $8.75 $0.00 only) Repair/Refit Door 0 $52.00 $0.00 Slide Bolt 0 $9.25 $0.00 Weatherstrip s/Q-Ion or equal 2 $45.50 $91.00 Front In,Base Out Health&Safety Basement window w/framing- 0 $250.00 $0.00 building code compliance(non- Clothes dryer vent including 0 $89.00 $0.00 Exhaust Duct Gutter Replacement(includes down 0 $6.50 $0.00 spouts) Knob&Tube Inspection,fuses, 0 $175.00 $0.00 wiring Other 0 $0.00 $0.00 Vent kit/bath fan 0 $89.00 $0.00 Misc Insulation 2" Foam Board on Door 0 $54.00 $0.00 Domestic water pipe wrap 0 $2.63 $0.00 Duct insulation R-5 0 $3.10 $0.00 Hydronic pipe insulation 1.25- 15 0 $3.68 $0.00 in.copper pipe R-5 Hydronic pipe insulation to 1 in. 0 $3.41 $0.00 copper pipe R-5 Other 0 $0.00 $0.00 Steampipe insulation 3 in.iron pipe 0 $7.61 $0.00 R-5 Steampipe insulation to 1.5-2 in. 0 $6.35 $0.00 iron pipe R-5 Page 4 WAP Work Order: Job Number: 13-189 Stack Vent 0 $152.00 $0.00 Turbine Vent 0 $168.00 $0.00 Varipitch vent 0 $114.00 $0.00 Basement Insulation 6 ml poly on ground 440 $0.75 $330.00 I Basement overhead insulation R19 0 $158 $0.00 Fiberglass Basement overhead insulation R30 0 $1.82 $0.00 Fiberglass Belly repairs-foam board 0 $2.00 $0.00 Belly repairs-labor 0 $60.00 $0.00 Crawlspace overhead insulation 4 ft 0 $1.87 $0.00 high or less R-19 Crawlspace overhead insulation 4 ft 0 $1.96 $0.00 high or less R-30 Garage ceiling cavity filled with 0 $2.10 $0.00 blown cellulose Other 0 $0.00 $0.00 Perimeter 2 in.foam board 0 $250 $0.00 Perimeter Wrap R-5 reinforced foil 0 $1.91 $0.00 or vinyl faced ductwrap Sill insulation Faced R-19 55 $158 $86.90 Sill two-part foam w/fiberglass batt 0 $2.20 $0.00 Doors 28-32 in interior solid core door 0 $315.00 $0.00 Automatic Sweep 0 $23.00 $0.00 Basement/outside door-door only 0 $36750 $0.00 Basement/outside door-w/jambs 0 $435.75 $0.00 Fixed Sweep 0 $15.75 $0.00 Page 3 :ana 33uRp;g$u!puetstu0❑ UM ui Pied❑ tunour'llsgJ lunotud 3[33 3 ON 3laatp $ � >;lal'oad ploy'9 $:saaj Ily Iigos $ (uolssaaddnS an...g) PraiueqKH'S :ist-j $ (DvAII) Iea!uetlaaW'fi $ :s223 X10 'Z $ SUtgmnld'£ x iagldrllnui x(9 Mail)ilso3 lQaford Ielo.L❑ 633 uorsgddy unaodiAiI3 PauPuinS❑ $ lEaWaaig'Z paa uuatap sr aaj mom 41b-!1pUI $-:aaj find Su!PI!n8 'l $ Su'PP 'I (seijateLll Pue Vogt y SNO?sil TuPWO wan `� .. . atsoO Paleulps3 S.LSOD NOLIOf12LLSNO3 OaIVI ILLSa tP 11 OLL3S :elrom pasodold;o uopdpas3Q;aug :4130dS ❑ iatpO 1 stlua Jo aaqumN ❑•Splg itzossaaay ❑ uoptlolua j ❑ uoptppy I ❑ (0009e101ly ❑ (s)snedaj ❑ paldnaZO-aauMO ❑Suipt!ng Supstxg ❑uouarvIsaop M N (ttddg ate 11B Vqa); OM a3SOd08d 30 NOLTAI SMS3a:£NOLLOIIS auogdapi. airgeuSrS eel's -Z3 ) -*ill) .. -1/14.01.-k(i --1(vA jf___. Y .aalna3S ao;ssaippy (1a!W)au,/ A/►m?Jow IDAw :paoaag Jo 13311MO I'Z x - SaaM&%o iziadO2Id =Z MOIL aS ❑ tualsAs lusodsrp a1!s up p Iedlalunlnl ❑ ,P313010 — ❑alenud ❑*Nod P�t3 apn7np :auoZ :maisds tesodsta oBolaas 8'I :aopeauojal auoz p°OU Cl (t'S§'op'a'I'J'W):Ciddns aaisM 9'I pap!Aord pannhag P3PTncUd Pannbag pap!noid panabag PEA xgras spnA aP!S PEA 1110.1d (a)SlpaeglaS Sutpttn$ S'I (13)aSeluorw (g bs)eary io'I asi Pasodwd 10114sv j BumoZ :suotsuattga dl lado rd b•I :uopeuuoJui Stquoz £'I iagwnpl paned lagwnrl drys ou sori f,1334s paidaaae ue sup sI sI'I- saagmnN pa d 78 dei saossassd VI :ssa,ippy Ap ado rd I'I NOL1V v fOdNII aLIS.:1 NOLLzaS Mu CI sSwpling jo imoadsul pauoisslruwoo 8mppng :Paitdd°IRO :.ragalnu lnniad Suipl!ng Atop asp telar O iod uopa3S gqi, SOOZ`I S mama eCllurvl-04t1 Jo-auO krnnuvrpasrnay a gs!loutat~l.rO olunouag'necks`larutsuo3 oZ uoPPeatlddy liuttad 2uipltng 8511 uorr a iL ativa OSL`a o Su!PI to a ets sttasngoessew L LTIddIOINItIW spaepuels pue suoilelnSa)l WuTP7ing jo pieog 1103 stlasngaesseyq Jo glleaMuounuo3 aqL 'Ti WAP Work Order: Job Number: 13-189 R-11 FGB in open rafters/walls/ 0 $131 $0.00 kneewalls R-18-20 restricted-slopes/floored 0 $1.42 $0.00 fill w/cellulose R-18-20 unrestricted-settled 1370 $1.29 $1,767.30 Bring Attic Cap to an R-48 cellulose R-18-20 unrestricted-settled 120 $1.29 $154.80 Insulate little kneewall around edges of back cellulose section of house. R-19 FGB in open rafters/walls/ 0 $1.47 $0.00 kneewalls R-30 restricted-slopes/floored fill 0 $1.48 $0.00 w/cellulose R-30 unrestricted-settled cellulose 0 $137 $0.00 R-38 unrestricted-settled cellulose 0 $1.47 $0.00 R-49 unrestricted-settled cellulose 0 $1.61 $0.00 Reinforced poly/R-20 cellulose open 0 $1.84 $0.00 rafters Reinforced poly/R-30 cellulose open 0 $2.05 $0.00 rafters Site Built pull down stair insulation 0 $180.00 $0.00 2 in foam box Spray Foam&Mesh&Blow CDC 0 $139 $0.00 ONLY Tenmat Recessed Can Cover- 0 $30.00 $0.00 pending approval Thermodome or Magnetic pull 2 $180.00 $360.00 1 for Whole House Fan& 1 For Attic down stairway box Stairwell Attic Ventilation 1/2 Window Gable Vent 0 $118.00 $0.00 Other 0 $0.00 $0.00 Propa Vent 0 $4.00 $0.00 Rectangular gable vent 0 $92.00 $0.00 Rectangular soffit vent 0 $27.00 $0.00 Ridge vent 0 $23.00 $0.00 Roof vent 135(1 sq ft NFV)large 0 $95.00 $0.00 Roof vent 865(.4 sq ft NFV)small 0 $80.00 $0.00 Page 2 WAP Work Order Community Action of the Franklin,Hampshire and North Job Number: 13-189 Quabbin Regions,Inc. Work Order Date:6/4/2013 P.O.Box 1432 Ownership:Renter Greenfield,MA 01302 Phone:413-774-2310 Eastern Weatherization Auditor:Brian Legg PO Box 249 Email:blegg@communityaction.us Montague MA 01351 Cell:413-834-0632 Email:easternweatherization @yahoo.com Phone:413-376-1116 Phone:413-863-5215 Cell:413-426-8768 Jenifer McKenna Bay State Gas $3,406.05 89 Florence St $3,406.05 Apt.Apt A Leeds MA 01053 Landlord Name:Jenifer McKenna Landlord Phone: Safety Issue(s):Lead Paint Possible Additional Contractor Instructions: DO NOT EXCEED$4500 Total for work Order.If more work is possible-discuss doing more work with the home-owner. Authorized Actual Measure Description Qty Price Total Qty Total Comments Attic Insulation Attic stairs-fill with cellulose 0 $135.00 $0.00 Attic/Kneewall Floor Transition 0 $2.52 $0.00 Dense Pack w/cellulose Kneewalls R-12 cellulose behind 60 ($1.73 $103.80 Insulate knee Wall of Bathroom where permeable membrane ( accessed Other 0 $0.00 $0.00 R-10-12 restricted-slopes/floored 0 $130 $0.00 fill w/cellulose R-10-12 unrestricted-settled 0 $1.21 $0.00 cellulose Page 1 D.- - NI 45753 Eye ate 04-05, -%•• cum,— NW SEX ON 541 N SMITH PAT1110K G MONTAGUE, 01351 sl9aaJ-8..Afietic2 et411-1fAt (i,,,tr,talrni CAlper,!Nor CSSL-100236 PATRICK G SMITH 79 CENTER ST. Montague MA. 01351 04/05/2014 fe -6.'---xtrae-Adille--( "° Office o onsumer atrs mess egu awn HOME IMPROVEMENT CONTRACTOR Registration: 134741 Type: == Expiration: 1/11/2014 DBA EAttERN WEATHERIZATION PATRICK SMITH 79 CENTER ST MONTAGUE,MA 01351 Undersecretary ---"41 [DATE OF LIABILITY INSURANCE t (MMIDD/YYYlf7 Arita' orntr) n E. 3 FiCATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.R. 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 be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT,- 1,� NAME: L h C I `j"1 G I \Qr C 1 KNIGHT DIK INS AGCY INC PHONE 5(Y-6 -75-3 "�15`-3-3 FAX 5 o` -75Q- 1 ) `{ 440 MAIN ST (A/C,No,Ext): (NC,No): WORCESTER,MA 01608 ADDRESS: Q C 1 77R3D INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: ACE AMERICAN INSURANCE COMPANY SMITH,PATRICK G DBA EASTERN WEATHERIZATION INSURER B: INSURER C: INSURER D: PO BOX 249 INSURER E: MONTAGUE,MA 01351 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCES 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) UNITS GENERAL LIABILITY EACH OCCURRENCE 1$ - COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ -- CLAIMS MADE ED OCCUR. PREMISES(Ea occurrence) MED EXP(Any one person) $ PERSONAL&ADV INJURY IS GENII AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ IN POLICY ED PROJECT Ei LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE j$ IN ANY AUTO LIMIT(Ea accident) IN ALL OWNED AUTOS BODILY INJURY - SCHEDULE AUTOS (Per person) BODILY INJURY j$ IN HIRED AUTOS (Per accident) - NON-OWNED AUTOS PROPERTY DAMAGE $ - (Per accident) - UMBRELLA LIAB r OCCUR EACH OCCURRENCE $ IIEXCESS LIAB C CLAIMS-MADE ,AGGREGATE i$ DEDUCTIBLE III RETENTION $ $ A WORKER'S COMPENSATION AND x WC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-5B84761A-13 03/01/2013 03/01/2014 LIMITS ANY PROPERITOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? © N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE 1$ 500,000 I yes,describe der E.L.DISEASE-POLICY LIMIT $ 500,000 O DESCRIPTION OF OPERATIONS below _ DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. THE WORKERS COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR SMITH,PATRICK G. ACTION INC NATIONAL GRID USA AND IT SUBSIDIARIES AND KEYSPAN ENERGY DELIVERY AND ITS SUBSIDIARIES MTC G.LC.A.C.INC CERTIFICATE HOLDER CANCELLATION SPRINGFIELD COMMUNITY ACTION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL B DE -. D 721 STATE ST IN ACCORDANCE WITH THE POLICY PRO • • i! • AUTHORIZED REPRESENTATIVE SPRINGFIELD,MA 01109 ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORP•- i5ierg�1 iesenred. The Commonwealth of tVlassacltusetts Department of Industrial Accidents tr'. Y.� =: l. Office of Investigations �Witt� 7 r 1( 600 T ashinf4on Street SW:: :7 Boston, t11A 02111 ' :� o' www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly �c1.� C C.4�i Name (Business+tlrganiL:ticitvindiNicittail: (��j��i {�.1 �: �tl l7_l i t`) i 5' 'Yn t-M___ Address: d-t-i ci F+?c1 e c r ,-k S tr s '�'F�LS.i. • . . _ . •. City'/State/Zip: JY�C�l ct�e 1�`t11 ( t,'z� t Phone#: 'it?) L-3-3 1S - `i 1.5 7 7a� -9 150 Are you an employer? Check the appropriate box: l Type of project(required): 4. iJ I am a general contractor and I 1.[� I am a employer with __ 1 6. E.1 New construction employees(hill and'or parts tame-i.` have hired the sub-contractors 2.L I am a sole proprietor or partner- listed on the anached sheet. i j 7. L Remodeling These sub-contractors have f ij ship and have no employees S_ `_Demolition employees and have workers working for me in an: capacity 1 9 [_ 1 Building addition [No workers' comp. insurance __. : trttl? insurance.} required.] . : A\e are a corporation and its 10.7___j k lectrical repairs or additions 3.L _, I am a homeowner dorm;all work officers have exercised their i 1 1.' j Plumbing repairs or additions right of exemption per NIGL r� myself: [No workers' comp. 1 Roof repairs insurance required.] C. 152.§it"0).and we have no employees. [No workers 13.X Other vJeG. -ber I z(3,114)of comp. insurance required.] 1/C L.'1r✓tat iot7 "An} applicant that checks box 41 must also fill out the sect bin below showing their worker;'compensation policy information t Homeowners who submit this affidavit indicating thc are duet_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'c ntpensatton insurance for my employees. Below is the policy and job site information. / 413 ein C_ ,1 Insurance Company Name:�Cc ilmeri_C.Cx -:it ,,;_ .C.r�C —C cav',r po-'Z. _/—(-1 rT._c -` 5 r--03e-�C:j Policy or Self-ins. Lie. =: { 7 ]. { U_( Expiration Date: ..:V _Q iy^ - - Job Site Address: ,r7 r70,-,A,''C.._Q 5 T1_____-_____City/State'Zip: L ee j /YL/ o/G i.3 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 5A of N161, c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 andior one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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 c 't der t, ants an enalties of 4,f,,that the information provided above -s true nd correct. Sianaturz: ' Date: _6 „..5-. i -..- _ Phone#: Lit 3`.`1c321,�c37 6 / `// 3 . tc3" 5 15 - Official use only. Do not write in this area,to be completed by eity or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town CIerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: lit a "' SECTION 8-CONSTRUCTION SERVICES - t. 8.1 Licensed Constructio upervisor: 74-X Not Applicable ❑ AO Name of License Holder: r( &4 � License Number y A rpo /Y,� r S T / o 3 Address .!/ Expiration Da 717'./17.e/-5 7 4-( ( /1/ i 5 76 4f 5"/4- Signa ur / Telephone . �-� 4 W 3 %'PZ 6 37-76 r 9:Registered Home Improvement Contractor Not Applicable ❑ gas 7r� ei--ear ei"/2 -`m/7c>�t,-) v_ . Company Name / Registration Number Address � Expiration D to '/I ,7A- e S //c /1/4- 1 37 Telephone /te /7 SECTION 10-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 ❑ 11._ Homey Owner-Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside;on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature • .4 SECTION 5-:DESCRIPTION OF PROPOSED-WORK'(check all-applicable); New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing n Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding[O] Other[0] Brief De riptiap-pf Proposed Work: we4 A,,-/ C;-'-,,./ ltyt, ti---C-e.l/ G-/Gdc-( //vs-v/at-.e).. , IA//e ar•)4x.l%1 Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Oa. If New house and or addition to existing housing;complete the following: a. Use of building : One Family Two Family�Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each ' g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a'=OWNER AUTHORIZATION-TO BE COMPLETED WHEN . OWNERS AGENT OR CONTRACTOR APPLIES,FOR BUILDING PERMIT i, ,T,, // re 47 c --, ��f{/,/�(,A s Owner o he subject property ,,_ h 4 ereby authorize Oi / -rf (. >41 / to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date - 1, � - ( C , as Owner/Authorized Agen hereby declare that the statements and in ormation on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed und- -he pains and penalties of perjury. Print/. :m . J 3 s ,, ;Vii / S',4 /Ag nature of Ow /Agent Date Department use only 2 F''1 I ' CE/t , of Northampton Status of Permit 1 ding epartment Curb Cut/Driveway Permit - M in Street Sewer/SepticAvaiiabili INV 6 �(� Ro m 100 WatedWell Availability II i -1C1 rthamp on, MA 01060 'tom Sets of*Structural Plans , ,I b•ooFBin N - 413-587-1 40 Fax 413-587-1272 PJot/S i Plarw �.- ,,� RIfIgMPT0N 0706 y� ._ r 4 ' - '- N„ Of}meFSpeCifjL Kzs r r: APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING — SECTION 1-SITE.INFORMATION 1.1 Property Address: z F4411fr F4411 This section to be completed by office gt Fl Utz,e/r/GQ 5 r /I P-7�/ 4-14-6 Map., Lot Unit L e-tv'�$ /)14 01053 Zone Overlay District Elm St.District CB District SECTION 2`-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: -_ 14 ..._ 0 1 2.._)14,..tit."100 �7/ / c ezf-c.p �j 7 L e,Am4 /APT* Name(Print \ Current Mailing Address: c At, ,,,\-, , ),(AtAlz-u,l...--, In-4r-Pti,91 .07/`'0111-e#7 1 eieohona V Sign.ture L � .e./N1.'.e(M C ke/v.v& ,,9Mac I , coo) 2.2 thorize'pent: Q al (� I szn frA y/9 sooT I/0A S r— Name(Print) C`u�e nt Mailing Address: /1r. A. °I ?7‘; If Signatur- �, „REF Telephone =�T��i►�i■ SECTION 32-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building C/ L/?$ /- (a)Building Permit Fee / / r 2. Electrical ,/ (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection r� / ` g �� 6. Total=(1 +2+3+4+5) $ %/ Y7 5 Check Number Ai VL 14 .J / This Section For Official Use Only Date Building:Permit Number. Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2013-1174 APPLICANT/CONTACT PERSON PATRICK SMITH ADDRESS/PHONE 79 CENTER ST MONTAGUE (413)367-2228 PROPERTY LOCATION 89 FLORENCE ST MAP 11C PARCEL Q51 001 ZONE URA(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out /;d3 O 4 � Fee Paid Typeof Construction: INSULATE ATTIC&WALLS&WEATHERIZATION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 100236 3 sets of Plans/Plot Plan THE FOLL WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission _ Permit DPW Storm Water Management ,yiola y S i: : e ouing Officia Date Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. 89 FLORENCE ST BP-2013-1174 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 11C-051 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit# BP-2013-1174 Project# JS-2013-001932 Est. Cost: $4495.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PATRICK SMITH 100236 Lot Size(sq. ft.): 55756.80 Owner: MCKENNA MARY JENIFER Zoning:URA(100)/ Applicant: PATRICK SMITH AT: 89 FLORENCE ST Applicant Address: Phone: Insurance: 79 CENTER ST (413) 367-2228 WC MONTAGUEMA01351 ISSUED ON:6/11/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:INSULATE ATTIC &WALLS &WEATHERIZATION POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 6/11/2013 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner