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35-070 (5)
BP-2021-2189 900RYAN RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 35-070-001 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-2021-2189 PERMISSIONIS HEREBY GRANTED TO: Project# INSULATION Contractor: License: DIPIETRO HOME ENERGY Est. Cost: 2000 SOLUTIONS DBA REVISE 104464 Const.Class: Exp.Date:03/06/2022 Use Group: Owner: POLLARD KRISTINE E Lot Size (sq.ft.) DIPIETRO HOME ENERGY SOLUTIONS DBA Zoning: WSP Applicant: REVISE Applicant Address Phone: Insurance: 32 MIDDLESEX ST (978)203-6736 WC100142000 HAVERHILL, MA 01835 ISSUED ON:11/17/2021 TO PERFORM THE FOLLOWING WORK: INSULATION/W EATH ERI ZATI ON POST THIS CARD SO IT 1S 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. Signature: , tyl4A„,_, )9 3'11 • Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner lJ Ulc: -- 1958 g(WitiNat• ,p The Commonwealth of Massachu efts U , y#, Board of Building Regulations and S nda ds NOV F IR Massachusetts State Building Code, 7'80 C ? NIVIPALITY S 202/ SE Building Permit Application To Construct,Repair,itten? p Or Demolish a evis:, Mar 2011 One-or Two-Family Dwelih Na(4 sU!Lnr This Section For Official Use Only ' ON.kiA 01 T;oNs Buildin Permit Number: 41• a! Date Applied: r� c--v.�/� i � lI-IG-aozi Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Add r�s: 1.2 Assessors Map&Parcel Numbers °i0u Ky4h I- d 35 7O- 1 1.1 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) Nihor 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 yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: LiiS4-\�ne, Po "`.xA Na ,,.a (AA Ot Name(Print) City,State,ZIP Cib0 —2N04n lA 4t3 c1191 q,0-,c 1 Xcc,c(11p® Tntiu.►I , 051A. No.and Street 1 Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building It Owner-Occupied lJ Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units ( Other 0 Specify: Brief Description of Proposed Work2: wQct\(,N2A;tirk-1 zr) i 3 fx. FNY U\c`o\ SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ a2o0C) "° 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: / /' , Check No.H51DCheck Amount: U Cash Amount: � 6. Total Project Cost: $ ,-buO 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS• 044(P if 3 `(P I aD JCUAQS mt &li,a License Number Expiration Date Name of CSL Hol r I �e �� List CSL Type(see below) �.( J LW I �/ Type Description No.an Street yP P YV I p �Vn, �11$ U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP "� lJ R Restricted t&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding _ SF Solid Fuel Burning Appliances T73& 316730' ( aVN`'WA KCIODcaftleVi3L, I Insulation Telephone Ema' address (J i\ D Demolition 5.2 Registered Home Improvement Contractor(�p(HIC) I��375 (lt I QY1f�Q S �I J POLL LLS `��Q"lCD -( p' Y �d 1'� S HIC Registration Number Expiration Date HICCompany Name or HIC Registrant Name a t'o Re l jl� 3a M� lc S alxM r v gCailtevrai • cam No.a•r)d Street '` let O ig3S 9�8�3 (123 b mail address City/Town,To 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 No . 0 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 j.)trO( ¼.d)i • .iaPo 9 to act on my behalf,in all matters relative to work authorized b this building permit application. C Knsiw . iPbIlave 1 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 application is true and accurate to the best of my knowledge and understanding. �ar��`Arv)d l>,.,lo,/ tA1Print Owner's or Authorigent' 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" City of Northampton --INAMPt� = Massachusetts w,t• ic.tt DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 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: 3,D / i A 3.4)0 fik 6 dies-- The debris will be transported by: Name of Hauler: — Mdk �a� Signature of Applicant: - — Date: The Commonwealth of Massachusetts Department of Industrial Accidents ^ �,= 1= I Congress Street, Suite 100 89 - Boston, MA 02114-2017 wwit:mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le.sibIy Name (Business organization/individual): Dipietro Home Energy Solutions Inc dba Revise Address: 32 Middlesex St City/State/Zip: Bradford, MA 01835 Phone #: 978-203-6736 Are you an employer?Check the appropriate box: Type of project(required): .E3 1 am a employer with 30+ employees!full and/or part-time).* 7. ❑ New construction �.❑lam a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity.[No workers'comp.insurance required.[ 9. ❑ Demolition 3.�1 am a homeowner doing all work myself.[No workers'comp.insurance required.] _ - _ El Building addition.— -- - - •4.0I am a homeowner and will be-hiring contractors to-conriuct all work-On my property.�ili ensure that all contractors either have workers'compensation insurance or arc sole 1 l.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbin�t g repairs or additions i.❑I am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. [j ❑ROof repairs These sub-contractor have employees and have workers'comp.insurance.% Weatherization r;.❑We arc a corporation and its officers have exercised their right of exemption per htc iL c. 14.0 Other 152.§114),and we have no employees.[No workers'comp.insurance required] *Any applicant that checks box 41 must also till out the section below showing their workers'compensation policy inlhnnation. 'Homeowners who submit this affidavit indicating they arc doing atl work and then hire outside contractors must submit a new affidavit indicating such. kContraetors 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 ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site inf formation. Insurance Company Name: HUB International New England Policy#or Self-ins. Lie.#: WC100142000 Expiration Date: 04/20/2022 Job Site Address: 900 �(Ph City/State/Zip: Vi0(-PVl CP (OctOtO1O 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 he forwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby certify under the ins d penalties of perjury that the information provided above is true and correct. Si;,**nature: . Date: l g� Phone 4: 978- 3-6736 1 Official use only. Do not write in this urea,to be completed by city or town official. City or Town: Permit/License# 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#: ACC)KL) CERTIFICATE OF LIABILITY INSURANCE 1DATE(MMIDD/YYYY) L----- 04/17/2021 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 Emily Costello NAME: Costello Insurance Group PHONE (978)374-6352 FAX (978)521-5127 A/C,No,Ext): (A/C.No): 2 S.Kimball St. ADDRESS: ecostello@costelloinsurance.com PO BOX 5248 INSURER(S)AFFORDING COVERAGE NAIL p Bradford MA 01835 INSURER A- Colony Insurance INSURED INSURER B: Commerce Insurance Co. 34754 Dipietro Home Energy Solutions,Inc. INSURER C: 32 Middlesex Street INSURER D: INSURER E: Bradford MA 01835 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2141702077 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 ADUL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDrYYYY) (MM/DD/YYYY) LIMBS X COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE $ 1,000,000 ----------DAMAGETOREN-TbD CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ 50,000 MED EXP(Any one person) $ 10,000 A PACEP308383 04/25/2021 04/25/2022 PERSONAL dADVINJURY $ 1,000,000 2 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ ,000 000 , X POLICY JET LOC PRODUCTS-COMP/OP AGG ; 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B — OWNEDTOSONLY X AUTOS SCHEDULED HS6326 05/09/2021 05/09/2022 BODILY INJURY(Per accident) $ AU X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE ; 3,000,000 A EXCESS UAB CLAIMS-MADE EXC4245322 04/25/2021 04/25/2022 AGGREGATE ; 3,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'IJABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N!A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) II yes,describe under E.L.DISEASE-EA EMPLOYEE $ 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 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 REPRESENTATIVE I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD r .... ....r...�.r --- N I V I A AC R� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 4/20/2021 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(les)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 CONTACT HUB International New England PHONE FAX 300 Ballardvale Street (A/c,No,Ext):(978) 657-5100 I (NC,No):(978)988-0038 Wilmington,MA 01887 E-MAILsS: INSURER(S)AFFORDING COVERAGE NAIC A INSURER A:Independence Casualty Insurance Company 11984 INSURED INSURER B: Dipietro Home Energy Solutions,Inc.,Joseph A.Dipietro INSURER C: Heating&Cooling,Inc 32 Middlesex Street INSURER D: Haverhill,MA 01835 INSURERE: 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. INSR TYPE OF INSURANCE ADDL SUBR POUCY NUMBER POLICY EFF POLICY EXP LTR INSD WVD (MM/DDIYYYYI (MM/DD/YYYY) UMITS — .COMMERCIAL..GENERAL-LIABIUTY.------- — — -- EACH OCCURRENCE $ CLAIMS MADE OCCUR DAMAGE PREMISES(Ea occttrr rice) $ MED EXP(Any one person) S PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY Pta LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY CEOM Na deeDISINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED INJURY(Per accident) — ,AUTOS ONLY AUTOS PROPERTY O ONLY AQOOWOND (Per cldnt)_ $ $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A A DREMPLOERS YERS'LIABILITYS X STATUTE PER ERH- ANY PROPRIETOR PARTNER/EXECUTIVE YIN WCI00142000 4/20/2021 4/20/2022 S 1,000,0( E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? N N/A 1'000 0( (Mandatory n ) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,0( DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Whom It May Concern THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ?"9----2,:r-7- ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD ✓VIV JII�II uivciu1J IV.VJaJ91VpDtr1JJ'Y 1-�L'Ol../1Y-C:JCOYGD pJDO'1 REVISE the way you save 5T $ 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: 5 South Summer St Bradford Ma 01835 I Kristine Pollard 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. r—DocuSigned by: Owner Signature: �{ A5A75857B4DA41 B Date: 11/5/zo21 %` REVISE ENERGY mass save 5 South Summer St.Haverhill,MA 01835 PARTNER 1. DESCRIPTION OF WORK TO BEPERFORMED REVISE ENERGY will perform or cause to be performed the following work on the customer's address below,in a professional manner and in accordance with the terms of this Contract,including the attached recommendations/work order describing the work in detail(the'Work')which are incorporated herein by reference.Pricing reflected below may be subject to adjustments in program pricing and offerings and is guaranteed for 30 days from the date the Contract is printed. Customer Name: Kristine Pollard Email:Not provided Phone:413-961-9051 Premise Address:900 Ryan Rd, Florence, Northampton, MA 01062 Mailing Address:900 Ryan Rd, Florence,Northampton, MA 01062 Project ID:4354196 Date:Nov.5,2021 Job Description Measure Description Location Quantity Unit Total Cost Customer Cost Air Sealing at Estimated 62.5 CFM50 Per Hour 10 hr $925.80 $0.00 Door Sweep (with AS hrs) 2 each $50.62 $0.00 Exterior Door Weather Stripping (with AS hrs) 2 each $60.14 $0.00 Hatch - 2" Thermal Barrier Polyiso 1 each $46.28 $11.57 Bath Fan - Vent to Roof 1 each $141.30 $35.32 Rim Joist- 6" Fiberglass Batting 116 SF $313.20 $78.30 Duct Insulation 40 SF $160.00 $40.00 Project Total $1,697.34 Weatherization incentive ($375.59) 2. PAYMENT:Customer agrees to pay REVISE ENERGY for the work as follows: Payment#1(Deposit):$ -A non-refundable Deposit by credit card(Mastercard,Visa,or Discover card)or check is due at the tine the Work is scheduled.Required payment information will be collected at the tine of scheduling.Deposit is not to exceed 1/3 of the total contract cost. Additional Payments and Final Invoice:S -Additional payments for the Work shall be due upon completion of the Work and will be invoiced to the customer for payment by check or charged to the credit card on file within 24 hours of delivery of the Fnal Invoice.If this credit card charge is declined for any reason.upon notice from REVISE ENERGY you will be responsible for providing valid alternative credit card information necessary to complete payment. DocuSigned by: —DocuSigned by: L 11/5/2021 f 11/5/2021 Gust r S grrattre Date R EVISE E I RRRQQ'�" : nature Dale A5A75857B4DA41B... Evan69�.. Name of REVISE ENERGY Represertative The Terms of this Agreement are contained on both sides of this page Revise Energy"5 South Summer St Haverhill.MA 01835 800-885-SAVE hello@ReviseEnergy.com..ReviseEnergy.com uocuaign Gnverope ru: U i i i l uo-tSrus-4rez-tst,N4-tsotts4triosno4 rage L or 0 REVISE ENERGY -410ek- mass save 5 South Summer St,Haverhill,MA 01835 PARTNER 1. DESCRIPTION OF WORK TO BEPERFORMED REVISE ENERGY will perform or cause to be performed the following work on the customer's address below,in a professional manner and in accordance with the terms of this Contract,including the attached recommendations/work order describing the work in detail(the"Work')which are incorporated herein by reference.Pricing reflected below may be subject to adjustments in program pricing and offerings and is guaranteed for 30 days from the date the Contract is printed Customer Name: Kristine Pollard Email: Not provided Phone:413-961-9051 Premise Address:900 Ryan Rd, Florence, Northampton, MA 01062 Mailing Address:900 Ryan Rd, Florence,Northampton, MA 01062 Project ID:4354196 Date:Nov.5, 2021 Duct insulation incentive ($120.00) Air sealing incentive ($1,036.56) Total Program Incentive -$1,532.15 Customer Total $165.19 2. PAYMENT:Customer agrees to pay REVISE ENERGY for the work as follows: Payment#1(Deposit):$ -A non-refundable Deposit by credit card(Mastercard,Visa,or Discover card)or check is due at the tme the Work is scheduled.Required payment information will be collected at the tine of scheduling Deposit is not to exceed 1/3 of the total contract cost. Additional Payments and Final Invoice:$ -Additional payments for the Work shall be due upon completion of the Work and will be invoiced to the customer for payment by check or charged to the credit card on file within 24 hours of delivery of the Final Invoice.If this credit card charge is declined for any reason.upon notice from REVISE ENERGY you will be responsible for providing valid altemative credit card information necessary to complete payment. DocuSigned by: DocuSigned by: 11/5/2021 11/5/2021 Gusto r S:;grxmtrre bate R EVI E E RGY ReVesentdve& nalure Date A5A75857B4DA41B... vBFee$ /- Name or REv1SE ENERGY Retreseriative The Terms of this Agreement are contained on both sides of this page Revise Energy-5 South Summer St Haverhill MA 01835 800-885-SAVE hello@ReviseEnergy.com-ReviseEnergy.com Revise Energy Planview Diagram Customer. (� Q�d Advisor Name: Evan Rebeilo Address: AC.0 Any limitations to access by truck? Y/6 Town: F 41.4362 Site ID: L1 4 7?c *Use the greater of the two BAS#'s when calculating for MVR #of stories 1.S 2 2.5 3 I BAS 1: 15 cfm X#occupants X n-factor = _ L Il1 n-factor • 16 _ 15 14.4 13.7 BAS 2: .00583 X area X height X n-factor = ._.— Mechanical Ventilation Recommended:BAS>final CFMS0> (0.7 X BAS) Mechanical Ventilation Required:(0.7 X BAS)>final CFM50 this part of a multi-unit workscope? Y or " ws Multiplier? NIA >8"Loose Insulation rocs-BattLoose/x-batt oricay,V i) .A,- S�Air►,�- 10 U) S ini at vs —f .1) ,,b, z Otic- wYarpo9 _ yd R1` ' jo Fig-0 b 8 c e col Any work scoped outside of best practices/approved by? t rftr, fi��hfi `Gt Li r � tors: r \ t`" 7) U 1 4-wc) +) t,)• 2) Commorweattn of Ma� ssachusells �+ Division of Professional Licensors Board of Building Regulations and Standards C onstruhl&Ili$iYpervisor CS-104464 Expires:0310612022 JAMES G DIMOPOVLASI�: 25 SEVEN SISTER RD ,j HAVERHILL MA O1030' , Commissioner 9�"G€ 0-mymI Jul .eald 0/g/74.doaci-e,cedea. Office of Consumer Affairs and Business Regulation 1006 Washington Street- Suite 710 Boston, Massachusett 02118 Home Improvement_Contractor Registration ,f Type: individual JAMES G.DIMOUOULOS - 'r' Registration: 167375 25 SEVEN SISTER RD • Expiration: 03/11/2022 HAVERHILL,MA 01830 •• Update Address and Return Card. SCA 1 a'3 20M-0006/17 �/ V/f4 Om wlu, J`R Oy�d/4Ca06Qch4se '.. Office of Consumer Affairs&8ualneas Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE•`IQdividual before the expiration date. If found return to: Registration hxuiratioq Office of Consumgr Affairs and Business Regulation 16 _._=:03/11/2022 1000 Washington Street -Suite 710 JAMES G.DIMOL*-91#4:7-=' .' Boston,MA 02118 JAMES DIMOUOULbSt 25 SEVEN SISTER AID. : - .'' 1.n lG.�cGfi�•lc' `I _ HAVERHILL,MA 01830- Undersecretary Not va out signature