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17A-232 (2) G61wreira Gas- ma� of Massac�usdu, ..Y.� Ar MASS SAVF' PRE-WEATHER17ATION BARRIER INCENTIVE 20TS i CONTRACTOR EVALUATION REPORT r CUSTOMER INFORMATION Requesk st' 425732 Date of Assessment: 10/17/15 Energy SpeclallSt: Noam Porimutter Customer Name: Lisa Cana Phone: 4135846519 Email: IisacanWesign @gmall.com Account#: 8917070002 Service Address: 93 Lake Street City. Nodhempton Stake_ MA Zip: 01060 Rebate Recipient(if different from the Customer): Mailing Address(if different from the Service Address); City: State: Zip: Phone; 4 KNOB&TUBE WIRING 4151 Contractor is to evaluate the selected locations below where weatherization recommendations have been made to determine if there is any active knob&tube wiring: I. E]Attic ©Attic Floor QKnee Wall Floor ❑Attic Slopes I MECHANICAL SYSTEM,141614 CARBON MONOXIDE EVALUATION ❑contractor is to evaluate the selected mechanical system(s)below and provide service,if possible,to reduce high carbon monoxide levels as measured In the undiluted flue gas to below 100 ppm: E❑Heating system ❑Hot Water System ❑Other. DRYER VENT EVALUATION ❑Contractor is to evaluate the dryer vent and provide service to properly exhaust the vent to the exterior. i KNOB 8 TUBE WIRING E Upon completion of my inspectiah I have found that there is no active knot?$tube wiring in the area(s)Checked off below: j QAttic Ils^ ❑Attic Floor Knee Wall Floor I ❑Attic Slopes CONTRACTOR INF ION i Company Name::^`pl c State: r�L& Z- ip:Address: City: � � t ' !Contractor Name: T �� License,W i[',-1/ a-7&" Federal ID#: E I'. ®rhave ad.and ree to,the ms&Conditlons of the Pre-Weatherization Barrier incentive. f Contractor Signature: Date: MECHANICAL SYSTEM,H11 6 CARBON MON&IDE EVALUATION ❑The selected mechanical system has been evaluated And serviced. Testing results of carbon monoxide in the undiluted flue gas are as follows; oWeating System _CO ppm ❑HOk water System CO ppm 00ther: __ Cd ppm DRYER VENT EVALUATION _ ! ❑The dryer vent has been exhausted to the exterior. _ I CONTRACTOR INFORMATION 1 - l ; Company Name j Address: yt TZ eAA -S City: State: Zip:,2 7,; ? Contractor Name: ✓SC License#; 7�, Federal ID#: # i ' { Leh e read nd agree the Terms&Conditions of the Pre-Weatherization Barrier Incentive. Contractor Signature: Date:. CUSTOMER INSTRUCTI N5 submit signed and completed copies of this Contractor Evaluation Report and a copy of the pair!Contractor Invoice to: Pre Weatherization Barrier Incentive,C/O RISE Engineering,60 Shawmut Rd,Unit 2,Canton,MA 02021 Customer Signature• Date: Customer(mail-in)--Mille Customer Copy—Yellow Energy Specialist—Pink Contractor--Golden Rod i/t5 www.vtctoryanergyaohr lM4om Victory Energy Solutions Home Performance Contractor I Hanford Square,New Britain,CT 06053 CONTRACT 860457.5590 FAX 860.7484955 Page T PROGRAM CMA-HPC euato+reR PNONe oath CUIENTS Nr7RRONVER Lisa CWa (413)584-0519 01/06/2016 425732 00001 SERNCa GTRIW -� MUNA STREET 93 Lake Street 93 Lake Street aaavuse CM.aTATE.ZIP 1111A.04 COY,STATE.ZIP Florence,MA 01062 Florence,MA 01062 JOB DESCRIPTION VENTILATION:Provide labor and materials to install(1)insulated exhaust hose with soffit mounted flapper vent to exhaust existing bathroom fan(s). Sl 18.75 VENTILATION:Provide labor and materials to install ventilation chutes in(24)rafter bays to maintain air flow, $48.00 BASEMENT CEILING:Provide tabor and materials to install(60)linear feet of R-19 unfaccd fiberglass insulation to the perimeter of the bascment ceiling at the house sill. $103.00 BASEMEN"DOOR:Provide labor and materials to insulate the back of the basement door leading to the bulkhead with 2 rigid board that mem the sections R-3163.4 and 316.6 requirements of building code. Sea]all edges and seams with FSif tape. j 572.22 Wall" . ti Total: $2,318.86 Program incentive: $1,780.27 Customer Total: $638,59 VW AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATION&FOR THE WIN OF ***Five Hundred Thirty-Eight&$91100 Dollars $538.59 AtrnidatTDSNNiAtnRa•YktArya SotuMerta ��..�_ CMT0"R ACCEPTANCE Not&7NM CONTAAOr AtAY66 NlrtInNEAYYIY 8Y W i!x NOF FYSCUTSO wrn/w OATS Of ACCEPTANCE 30 DAYS. r� www.vtetotyanargySOttrtlOnaeQm Victory Energy Solutions Home Performance Contractor I Hartford Square.New Britain.CT 96053 CONTRACT t160-357-SM FAX 860-748445S Page t PROGRAM CMA-HPC ClUsTomet ;NONE PATH CLIENTS won OPA t Lisa Carta (413)584-0519 01106/2016 425732 00001 SWIC4 WRW UUM STREET 93 Lake Street 93 Lake Street SEIMM MY.STATE,ZW OLUNO Cm.STATE,2W Florence,MA 01062 Florence,MA 01062 JOB DESCRIPTION BARRIER:The following contract is not valid unless accompanied by the Pre-Weatherization Barrier incentive form signed by your licensed electrician. Work will not proceed with this work until we receive a cM of the form. $0.00 HEALTH&SAFETY:Weathcrization wont cannot proceed until the unvented combustion appliance is properly vented out of your ham. $0.00 AIR SEALING:Provide labor and materials to seal areas of your tame against wasteful excess air leakage.This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks foams and other products. Primary arm for sealing include air leakage to attics basements attached garages and other unheated areas(windows are not generally addressed.)(4)working hours.A reduction in cubic feet per minute(ctm)or air infiltration will occur but the actual number of cfm is trot gttarardeed. At the completion of the weatherizzation work and at no additional cost to the homeowner a final blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. $340.00 AIR SEALING:Provide labor and materials to install Q4on weatherstripping and a doorsweep to(2)door(s)to restrict air leakage. $150.00 ATTIC FLAT:Provide labor and materials to install a 5"layer of R-Ill Class 1 Cellulose added to(220)square feet of ltoomd attic space. 5286.04 DAMMING:Provide labor and materials to install a 12 layer of R-38 un€aced fiberglass batts to(44)square fat for damming per. $90.20 ATTIC FLAT:Provide labor and materials to install a I I layer of R-38 Class 1 Cellulose added to(308)square feet of open attic spaM S465A8 KNEEWALLS:Provide labor and materials to install 2" FSK faced semirigid fiberglass board insulation to(78)square felt of kneewall ate.' $273.#81 ATTIC ACCESS:Provide tabor and materials to insulate the back of the attic door with 2 rigid Thermax board and seal the door s edge with weatherstripping to restrict air leakage. $73.91 REMOVAL: Remove(78)square foot of bau style insulation from the knccwall area. $58.40 VENTILATION:Provide labor and rrtattrials to' 2)12 diameter mushroom toot vent(s)to increase ventilation in attic Stead. The van can be supplied in(circa col black brown gray or mill finish. $238.20 The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 Boston,MA 02114-2017 J www.mass.gov/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Avylicant Information F Please Print Legibly Name (Business/Organization/Individual): Address: y ar 8 City/State/Zip:h' �� Yl� Phone#: ��'�- 3..O(o - 14 4�F� ,,,Are you an employer?Check the appropriate box: Type of project(required): I I am a employer with _employees(full and/or part-time).* 7. New construction In I am a sole proprietor or partnership and have no employees working for me in $. Remodeling any capacity.[No workers'comp. insurance required.] 3.a I am a homeowner doing ll work myself 9. ❑Demolition g y [No workers'comp. insurance required.]t 10 Building addition 4 F-11 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ p Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.P40ther 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. y 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 jab site information. ��--��°°'� Insurance Company Name:?—tom TnaAx ftw to 00.1 Policy#or Self-ins. Lic.#: Q13 (o(o l.4S Expiration Date: 1 d Job Site Address: ?J La 1C e- S+ City/State/Zip: niter +�,a,aA o+0 n M A Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi nder the pains penalties of perjury that the information provided above is true and correct. S i Date: Phone#: Y Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/Licensc# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: rr -` Not Applicable ❑ Name of License Holder: c-,,e— V-on -r i G d Q 1®iE 2 t 2 License Number 1127 IS �m C h�1 S Ave ,c Crl o�z'1 Tn+� 6 z Address Expiration Date Ti'i- 3o e Lt's i-3 Signature /��� Telephone t 9. Registered Home Improvement Contractor: Not Applicable ❑ Vlc.it-ry E+-,e►^e,.� cJe�.�-1�� ins lto112-7 Company Name Registration Number .r 5 1 Address Expirati n Date (y.,� t-ictrt�rc�5g�raar� Telephonell''30L' Y3 i — e—V4 CT CxooS7, 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....... Oa-' No...... ❑ 11. - Home 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,grovided 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 Se—e— 0,-A+0`c'1E'd con-')'r'ac+ SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House [] Addition ❑ Replacement Windows Alterations) Roofing Or Doors 171 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [M Siding[C]] Other(Or �nS��lcrho� Brief Description of Proposed Work:_ �5ee Stcr�ed Cc+,�r acf- Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes ✓No Attached Narrative Renovating unfinished basement Yes _No Plans Attached Roll -Sheet 6a.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 Lis 4 C g r +q as Owner of the subject property hereby authorize M t C.hge� &C)r, to act on my behalf, in all matters relative to work authorized by this building permit application. Csee a'(t ac.hej Co;-)Jro. l Signature of Owner Date I, M t C hcte I , 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. Mtc.hete r- 1cicat? Print Name , Signature gtQ0 ner/Agent ` " ._ Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has Spe ial Permit/Variance/Finding ever been issued for/on the site? NO F DON'T KNOW Q YES IF YES, date issued: IF YES: Was th permit recorded at the Registry of Deeds? NO F DON'T KNOW o YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO )0"' DON'T KNOW Q YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. X55 • "G5 Department use only ity of Northampton Status of Permit: B 'Iding Department Curb Cut/Driveway Permit 2 Main Street Sewer/Septic Availability s Room 100 Water/Well Availability s Northampton, MA 01060 Two Sets of Structural Plans p hone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION Thi section to be completed by office 1.1 Property Address: 7 q3 LaKe, 5+ree$ Map Lot�y Unit Ncrtv�amPivn MA C+a L2 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: L +SA C ar-rcz cl3 LcXKg Sfirce�- r MA Oio 2 Name(Print) Current Mailing Address: See :Sig r,ecl CcntrctC;+) Telephone Signature 2.2 Authorized Agent: C2--1 LiZ M�c.hael CGtonF'r►dclo 15 t.1.+LCW,is �`�z yr•►c�ter +G�y�l� Ml� Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building ts 1901 y 1 (a) Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) 1 b-7 '-f f Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2016-0881 APPLICANT/CONTACT PERSON VICTORY ENERGY SOLUTIONS LLC ADDRESS/PHONE I HARTFORD SQ SUITE 206 NEW BRITAIN06052(877)306-4483 Q PROPERTY LOCATION 93 LAKE ST MAP 17A PARCEL 232 001 ZONE URBaPU THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildinv Permit Filled out Fee Paid Typeof Construction: INSTALL ATTIC INSULATION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 108212 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOR ATION PRESENTED: pproved 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 -Demolition-D,elay re of B ing O icial 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. 93 LAKE ST BP-2016-0881 GIs 4: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-232 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-2016-0881 Project# JS-2016-001496 Est. Cost: $1907.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: VICTORY ENERGY SOLUTIONS LLC 108212 Lot Size(sq. ft.): 14069.88 Owner: CARTA LISA A&DENNIS STEINER zonine: URB(100)/ Applicant: VICTORY ENERGY SOLUTIONS LLC AT. 93 LAKE ST Applicant Address: Phone: Insurance: 1 HARTFORD SQ SUITE 206 (877)306-4483 O WC NEW BRITAINCT06052 ISSUED ON.1/11/2016 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL ATTIC INSULATION 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 1/11/2016 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner