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25C-189 (7) 36 HIGHLAND AVE BP-2021-1306 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:25C- 189 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ELECTRICAL BUILDING PERMIT Permit# BP-2021-1306 Project# JS-2020-000045 Est.Cost: $7500.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: CLEAN TECH CONSTRUCTION LLC 106150 Lot Size(sq. ft.): 6098.40 Owner: GARON ANDREA Zoning: URC(100)/ Applicant: CLEAN TECH CONSTRUCTION LLC AT: 36 HIGHLAND AVE Applicant Address: Phone: Insurance: 190 FEDERAL AVE (617) 271-0768 W(' QUINCYMA02169 ISSUED ON: 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: 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. I. +I, Q Ts'1 Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 5/10/2021 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner The Commonwealth of Massachus s '0/ Board of Building Regulations and St�.ndards�y 1 0 +FOR Massachusetts State Building Code,IOC-MR cu(9J MUNICIPALITY USE Building Permit Application To Construct, Repair, Renowi ;PIr olish a Re ised Mar 2011 One-or Two-Family Dwelling -_moo fr\ a7-1 This ection For Official Use Only Buildin 'Permit Number: (!ifl ?l'� 0(% at pplied: K E OlaQ a,5 5-1026Z Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Number 36 HIGHLAND AV / 4 l.l a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(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❑ Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: ERIK CHERIES NORTHAMPTON MA 01060 Name(Print) City.State,ZIP 36 HIGHLAND AV 203-530-3917 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition ❑ Demolition 0 Accessory Bldg. 0 Number of Units Other II Specify: INSULATION Brief Description of Proposed Work': INSULATION,WEATHERIZATION FOR MA SAVE PROGRAM SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 7500 I. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List:_ 5. Mechanical (Fire $ Suppression) Total A I I Fees: $ 6.Total Project Cost: $ 7500 Check No. II 31 Check Amoun : Cash Amount: 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) 106150 5/24/2022 PATRICK MCDONOUGH License Number Expiration Date Name of CSL-Holder 105 MARSHHAWK WAY MARSHFIELD MA 02050 List CSL Type(see below) R Ad ress I Type Description PGztu��'le PeweGff U Unrestricted(up to 35,000 Cu.Ft.) R Restricted I&2 Family Dwelling Signature M Masonry Only 617-512-1509 RC Residential Roofing Covering Telephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Registered Home Improvement Contractor(HIC) CLEAN TECH CONSTRUCTION 196071 HIC Company Name or HIC Registrant Name Registration Number 190 FEDERAL AV OUINCY MA 02169 Ad�d'�re3�s 6/27/2021 W� Z7Gz..4 h.o L 617-404-8949 Expiration Date Signature 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 No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, , 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. SIGNED AUTHORIZATION FORM ATTACHED Signature of Owner Date SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION I, PATRICK MCDONOUGH/CLEAN TECH CONSTRUCTION ,as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. PATRICK MCDONOUGH Pr' N ` aG %1/1!26WA,Z. 9,t. 5/10/2021 Signature of Owner or Authorized Qgent Date (Signed under the pains and penalties of perjury) 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 lia have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R5,respectively. 2. When substantial work is planned,provide the information below: Total floors area(Sq.Ft.) (including garage,finished basement/attics,decks or porch) Gross living area(Sq. Ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE City of Northampton ( Massachusetts 'e�. �. A. � ' } DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street lit Municipal Buildin5. g, Ps Northampton, MA 01060 1"•n .4,_/):`� CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: 40 MESSINA DR BRAINTREE MA 02184 The debris will be transported by: Name of Hauler: CLEAN TECH CONSTRUCTION Signature of Applicant k end Date: 5/10/2021 Commonwealth of Massachusetts ® Division of Professional Licensure Board of Building Regulations and Standards Construction-Supervisor Specialty CSSL-106150 Expires: 05/24/2022 PATRICK E MCDONOUGH - 105 MARSHHAWK WAY 4t` MARSHFIELD MA 02050 Commissioner C Construction Supervisor Specialty Restricted to: CSSL-1C - Insulation Contractor Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call (617) 727-3200 or visit www.mass.govldpl Z Karnmo,' i`°0- i Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration ___C= Type: LLC re f z Registration: 196071 CLEAN TECH CONSTRUCTION -' - " 190 FEDERAL AVE Expiration: 06/27/2021 QUINCY, MA 02169 + • a,, Update Address and Return Card. 20M-05/17 .%/./• Y-/'/ll/lle/II/•%Q.//l e�;�Za���/r/i Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE: LLC before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 196071 06/27/2021 1000 Washington Street - Suite 710 CLEAN TECH CONSTRUCTION Boston, MA 02118 W ILLIAM DAVIDSON //-Vf 190 FEDERAL AVE QUINCY, MA 02169 Undersecretary Not valid without signature Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card Registration: 196071 CLEAN TECH CONSTRUCTION LLC Expiration: 06/27/2021 190 FEDERAL AVE QUINCY, MA 02169 Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE: Supplement Card before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 196071 06/27/2021 1000 Washington Street -Suite 710 CLEAN TECH CONSTRUCTION LLC Boston,MA 02118 PATRICK E.MCDONOUGH f)at- t-e 190 FEDERAL AVE .ol %. QUINCY,MA 02169 Undersecretary Not valid without signa ure ACC)R CA¢ DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 5/10/2021 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: Tobman,Molignano&Weiner Ins Agency �PgH��ONNO Ecu: 617-471-1123 (a/c,No): 617-773-2474 21 McGrath Highway,Suite 303 E-MAIL ' Quincy,MA 02169 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Norfolk&Dedham Mutual INSURED INSURER B: Traveler's Indemnity Co of America Clean Tech Construction LLC INSURER C: 190 Federal Ave INSURER D Quincy,MA 02169 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. 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. IL SR TYPE OF INSURANCE ADUL SUBR POLICY EFF POLICY EXP JNSD WVD POLICY NUMBER .,(MM/DD/YYYY) (MM/OD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE n OCCUR DAMAGE a Noc rED PREMISES SESS((Ea occurrence) $ 100,000 MED EXP(Any one person) $ 500,000 A - PO12011894 09/18/20 09/18/21 PERSONAL&ADV INJURY $ 1,000,000 GENII AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY a P - ❑ JECROT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ A OWNED X (Per accident)SCHEDULED 91972894A 09/16/20 09/16/21 BODILY INJURY(P $ AUTOS ONLY _ AUTOS PROPERTY DAMAGE $ 1,000,000x AUTOS ONLY HIRED X AUTOS ONLY (Per accident) X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE U20003464A 09/18/20 09/18/21 AGGREGATE $ 1,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE I/A 6HUB4N60130820 E.L.EACH ACCIDENT $ 500.000 B OFFICER/MEMBER EXCLUDED? 9/18/20 9/18/21 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached It more space Is required) CERTIFICATE HOLDER CANCELLATION NORTHAMPTON BUILDING DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED R ENTATIVE ©1 -2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts =INA=et Department of Industrial Accidents :sit_ 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.massgov/dia 11"oi ters'Compensation Insurance Affidavit:BWlders/Contractota/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Annlicant Information Please Print Legibly Name(Business/ChganirationiIndivi dual): Clean TeciLCOnstruction Address: 190 Federal Ave City/State/Zip: Quincy,MA 02169 Phone#: 617-271-0768 Are yea as employer!Cheek the appropriate bout: Type of project(required): 1.0I am a employer with 6 _employees(full and/or part-timer" 7. p New construction Ell am a sole proprietor Of partnership and have no employees working for me in Y. ❑Remodeling any capacity.[No workers'comp.insurance required.) ) 01 am a homeowner doing all work myself.(No workers'camp.itatrae required]t ❑Demolition rw I❑1 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 El Building addition ensure that all contractors either have workers compensation insurance or era sole I I.❑Electrical repairs or additions pnolx;etors with no employees. 12.Q Plumbing repairs or additions QI am a general contractor and I have hired the sub-contractors listed on the attached sheet 13 Roof repairs These subcontractors have employees and have workers'comp.insurance., ❑ P („Owe are a corporation and its officers have exercised their right of exemption per Melt,c 14.pother insulation 152.*It 4 I.and we have no employees.[No workers'comp.insurance required.l 'Any applicant that checks box#1 must also fill out the section ielow ah owuig their workeui compensation policy information. 1 Homeowners who submit this affidavit indicating they are doing all work mid then hire outside contractors must submit a new affidavit indicating such. IContractors that check this box must attached an additional sheet showing tlw name of the sub-contractors and state whether or not these entities have employees. If the:ubcontractons have employees,they must provide them wurken' poor'number. /urn an tamp/ut•er that is providing nvrkers'Compensation insurance.for nn'entplol•ees. Below is the polio and job site information. Insurance Company Name: TRAVELERS Policy#or Self-ins.Lie.#: 6HUB4N60130820 Expiration Date: 9/18/2021 Job Site Address: 36 HIGHLAND AV Cityistate/Zip:NORTHAMPTON MA 01060 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 font of a STOP WORK ORDER and a fine of up to S250.00 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 cc tiff•under the parrs and penalties of perlurt'that the information provided above is true and correct. �G.�� /11 9itd ^ L Date; 5/10/2021 Photo#: 617-512-1509 Official use only. d)o not write in this.area.to be completed by city or torso official ('its or Town: Permit/License# -- Issuing Authority(circle one): I.Board of Health 2.Building Deportment 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing inspector I,.Other Contact Person: Phone#: DocuSign Envelope ID:4F836FFE-C93B-437A-A9A0-05F629D22051 Federal ID#05-0405629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 20120 RISE CTContractor Registration 620120 60 Shawmut Road,Canton,MA 02021 ENGINEERING` CONTRACT - WZ 339-502-6335 X-7109 FAX 339-502.6345 Page 1 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CMA-HMS EENGIN IBED BELOW THE CUSTOMER FOR WORK AS DESCCUSTOMER PHONE DATE CLIENT I WORK ORDER Erik Cheries (203)530-3917 09/30/2020 492513 23802 SERVICE STREET BILLING STREET PROPOSED BY: 36 Highland Avenue 36 Highland Avenue Jon Patton SERVICE CRY,STATE,ZIP BILLING CITY,STATE,ZIP Northampton, MA 01060 Northampton, MA 01060 DESCRIPTION CITY COST INCENTIVE TOTAL INCENTIVE 100%2020 For a limited time,Columbia Gas is offering an incentive of 100%on qualifying weatherization measures.This contract must be signed and returned within 30 days and the weatherization must be installed by March 31,2021. Eligible LED lightbulbs,programable thermostats, and hot water saving items are also incentivized at 100%.WiFi- enabled thermostat incentives vary by type of thermostat. ASBESTOS HAZARD A blower door diagnostic test will not be conducted at your home,due to the possible presense of asbestos. KNOB&TUBE WIRING(Fitchburg) r ���,,V//�� We have identified that your home might have Knob&Tube wiring J-tt (initials) I present.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 copy of the form. ATTIC FLAT-6"FLOORED R-19 DENSE CELLULOSE 720 $1,404.00 $1,404.00 Provide labor and materials to install a 6"layer of R-19 Class I Cellulose to floored attic space. FLIP/SLASH/FIX EXISTING INSULATION 720 $180.00 $0.00 $180.00 Slash the vapor barrier,flip,or re-position insulation in the attic area. ATTIC HATCH-SEAL&INSULATE 1 $60.00 $60.00 Provide labor and materials to insulate the back of an attic hatch with 2"rigid insulation board.Weatherstrip the perimeter. HOME AIR SEALING 8 $680.00 $680.00 Provide labor and materials to seal areas of your home against wasteful,excess 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.) HOME AIR SEALING 8 $680.00 $680.00 Provide labor and materials to seal areas of your home against wasteful,excess 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.) DocuSign Envelope ID:4F836FFE-C93B-437A-A9A0-05F629D22051 Federal ID#05-0405629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 1 CT Contractor Registration No 620120 RISE 60 Shawmut Road,Canton,MA 02021 CONTRACT - WZ ENGINEERING- 339-502-6335 X-7109 FAX 339-502-6345 Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CLIENT P WORK ORDER Erik Cheries (203)530-3917 09/30/2020 492513 23802 SERVICE STREET BILLING STREET PROPOSED BY: 36 Highland Avenue 36 Highland Avenue Jon Patton SERVICE CITY,STATE.ZIP BILLING CITY.STATE.ZIP Northampton, MA 01060 Northampton, MA 01060 DESCRIPTION CITY COST INCENTIVE TOTAL WALLS ASBESTOS SIDED 1,516 $4,017.40 $4,017.40 Provide labor and materials to install blown in Class I Cellulose to asbestos-sided exterior walls. Touch-up painting,if needed,will be the customers responsibility. 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 acknowedgement of receipt and agreement to proceed. Total: $7,021.40 Program Incentive: $6,841.40 Customer Total: $180.00 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***One Hundred Eighty &00/100 Dollars $180.00 UPON RECEIPT OF YOUR RISE ENGINEERING INVOICE.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF I%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES.RIGHTS OF RECISION.SCHEDULING.AND CONTRACTOR REGISTRATION. r Docu5igned by: 28E8R0A08ERMCD RISE REPRESENTATNE CUSTOMER SIGNATURE NOTE THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHM DATE OF ACCEPTANCE SIGN DATE 30 DAYS. ACCEPTANCE Of CONTRACT-THE ABOVE PRICES.SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED,YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED.PAYMENT WILL RE MADE AS OUTLINED ABOVE , DocuSign Envelope ID:4F836FFE-C93B-437A-A9A0-05F629D22051 RISES ENGINEERING OWNER AUTHORIZATION FORM 1, Erik Cheries (Owner's Name) owner of the property located at: 36 Highland Avenue (Property Address) Northampton, MA 01060 (Property Address) hereby authorize Clean Tech Construction (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. This form is only valid with a signed contract. Do^cfu5iyned by: LEauxio Owners gignafure Date RISE Engineering,a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335 www.RlSEengineering.com ION mass save 2020 weatherization barrier incentives Based on your Energy Specialist's recommendations,your home can benefit from program-eligible insulation and/or ag sealinc. improvements Before moving forward,please follow all the instructions below to remedial*your weatherization barriers CUSTOMER INSTRUCTIONS 1. Hire a qualified,licensed contractor to evaluate and/or rerriediate the weatherization barrior(s). 2.Submit signed and completed copies of this form and a tvpy of the paid contractor irivnir.e(s)within 60 days of four Home Energy Assessment to:RISE Engineering,60 Shawmut Rd,Unit 2,Canton,MA 02021 or email to ColumblaGaiMAlnfo a RISEengineering.com. 3.The weatherization incentive will be deducted from the customer co•payment amount of the weatherization work A rebate check will be issued in the event the amount exceeds the customer's co•payment amount 4.Complete the recommended weatherization improvements CUSTOMER INFORMATION Customer Name Erik Cheries Client#or Site ID: 492513 Site Address 36 Highland Avenue city: Northampton State MA ZIP. 01060 Phone Number 203-530-3917 Email: ECHERIES©UMASS.El DU Customer/Homeowner Signature: t: -ii-' Date: I D/23 1 ZO-ziD 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 mode: • Attic Floor • Attic Wall • Attic Slope • Exterior Wall • Basement Other: .. Other kI have performed rrrr;inspection and determined there is no active knob and tube wiring in the areas selected below. J Attic Floc• / •tic Wall Attic Slope X Exterior Wall ,1 Basement ' Other. • , Other: • U„...e.:,r r•Ii. i. niC.hae) .- Gartr'1 ... Address: P- •hal, -75"I _City:_,iii I'JD.. (fly State:i1 ZIP:____ s __ Company Name: 6-aft", GI(o iy,+h/ "'"'"'•(,-1., 1Mt-..._ License Number: Ijb?O 6 a'D)8'$ AF Contractor Signature: _ - � Date: I,01ZZ1�D�O My signature confirms t have performed my inspection of the electrical systems listed above and have corrected any barriers as indicated.My signature also confirms that I have read and agree to the Terms and Conditions outlined on the back of this form. MECHANICAL SYSTEM BARRIERS sto i. r,v fr --;r.,a,.;. ):: < •:.•t • High Carbon Monoxide:Contractor Is to service and re-evaluate the selected mechanical systern(s)and reduce the carbon monoxide level, as measured in the undiluted flue gas,to below 100 parts per million(ppm). Draft Failure:Contractor is to correct the draft in the selected flue(s),Refer to table on reverse for acceptable draft ranges. High Calbon,Monoxide Draft Failure Existing CO DDm: Revised CO Dena Existing Draft Pa: Revised Draft Pa: Heating System Hot Water Heater Other: Spillage:Contractor is to correct the spillage of flue gases in the selected mechanical system(s).Must not spill after 60 seconds of operation Heating System Hot Water Heater Other: Contractor Name __,_ Address_ City: State ZIP: Company Name ____ _ _ License Number. Contractor Signature: Date: My signature confirms that I have performed my inspection of the mechanical systems listed above and have corrected any barriers as indicated My signature also confirms that I have read and agree to the Terms and Conditions outlined on the back of this form