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32C-313 (10) BP12022-1026 36 HENRY ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 32C-313-001 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-2022-1026 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION Contractor: License: Est. Cost: 6000 HOMEWORKS ENERGY INC 106148 Const.Class: Exp.Date:07/30/2024 Use Group: Owner: VAN ZEE VICKI L Lot Size (sq.ft.) Zoning: URC Applicant: HOMEWORKS ENERGY INC Applicant Address Phone: Insurance: 59 TOSCA DR 7812054484 ECC-600-400 1 0 1 7-202 1 STOUGHTON, MA 02072 ISSUED ON:08/22/2022 TO PERFORM THE FOLLOWING WORK: INSULATION/W E ATH ER I Z AT I ON POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House # Foundation: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: ( i � • Fees Paid: 565.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner —. FEE: $65.00 Dep�OR ,., r City of Northampton , , Building Department �( , 212 Main Street INSULA TION ..� F`� Room 100 . �� Northampton, MA 01060 ��' _ Qftjj_, "/' - phone 413-587-124Q Fax 413-587-1272 APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INSULATION PERMIT 1.1 Property Address: This section to be completed by office Map - Lot 3) Unit 36 Henry Street Northampton Massachusetts 01060 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Vicki Van Zee 36 Henry Street Northampton Massachusetts 01060 Name(Print) Current Mailing Address: See Attached 336 0644 Telephone Signature 2.2 Authorized Agent: Adam Glenn 59 Tosca Drive Stoughton, MA 02072 Name(Print) cz,..gjoeidCurrent Mailing Address: 644781-205-4484 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 6,000 (a)Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee -/ (LL; 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) 6,000 Check Number 9% ( This Section For Official Use Only /� Building Permit Number: �V ' i /04 Date Issued: ..-gSignature: //% e z z zoz 2 Building Commissioner/Inspector of Buildings Date wxpermitting @ homeworksenergy.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8,1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder:Adam Glenn 106148 License Number 59 Tosca Drive Stou hton, MA 02072 07/30/2024 Add Expiration Date 781-205-4484 Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable 0 HomeWorks Energy 181138 Company Name Registration Number 59 Tosca Drive Stoughton, MA 02072 03/02/2023 Address cdia.4 Expiration Date �� Telephone 781-205-4484 SECTION 5-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 wit 1 No 0 Brief Description of Proposed Work Residential weatherization/ Air sealing. No structural changes. SITE ID 4437956 I, Adam Glenn , 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. Adam Glenn Q Print Name �/d�/ 4 8/16/2022 Signature of Owner/Agent Date l Vicki Van Zee , as Owner of the subject property hereby authorize HomeWorks Energy to act on my behalf, in all matters relative to work authorized by this building permit application. See Attached 8/16/2022 Signature of Owner Date City of Northampton StS `f/C i t ; Massachusetts a� << G •s ;}_ DEPARTMENT OF BUILDING INSPECTIONS y n► �, 212 Main Street • Municipal Building a v� Ic � Northampton, MA 01060 i�=• %� AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation ("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction,alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pm-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered. Type of Work:Weatherization Est. Cost:6,000 Address of Work:36 Henry Street Northampton Massachusetts 01060 Date of Permit Application: 8/16/2022 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law(explain): Job under$1,000.00 Owner obtaining own permit(explain): Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: 1 hereby apply for a building permit as the agent of the owner: 8/16/2022 Adam Glenn 181138 Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton Massachusetts t G DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building Northampton, MA 01060 Debris Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from construction work being performed at: 36 Henry Street Northampton Massachusetts 01060 (Please print house number and street name) Is to be disposed of at: McNamara Waste Services LLC, 24 E Longmeadow Rd, Hampden,MA 01036 (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) caL /16/2022 Signature of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. ,,�,�, City of Northampton `4` f 4.4 ys... ' Si„, Massachusetts tK ' DEPARTMENT OF BUILDING INSPECTIONS ?• 212 Main Street • Municipal Building Sv fs.,.......,..14Ca r ` Northampton, MA 01060 V�v 3+�• MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 36 Henry Street Northampton Massachusetts 01060 Contractor Name: HomeWorks Energy Address: 59 Tosca Drive City, State: Stoughton, MA 02072 Phone: 781-205-4484 Property Owner,iCki Van Zee Name: Address: 36 Henry Street Northampton Massachusetts 01060 City, State: I Adam Glenn (contractor) attest and affirm that the building I intend to insulate does not have any open air (knob and tube)wiring in the spaces to be insulated and that I have provided the property owner with a copy of this affidavit. Contractor signature Calikk Date 8/16/2022 \ The Commonwealth of Massachusetts — � I Department of Industrial Accidents _'wlc l Congress Street,Suite 100 ='l iBoston, MA 02114-2017w ww mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): HomeWorks _pe..►"g y Address: 59 Tosca Drive City/State/Zip: Stoughton, MA 02072 Phone#: 781-205-4484 Are you an employer?Check the appropriate box: Type of project(required): am a employer with 500 employees(full and/or part-time).* 7. New construction 2. I am 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.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]: 10 Q Building addition 4.0 lam 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 1 1.❑ Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.D I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.n We are a corporation and its officers have exercised their right of exemption per MGL c. 14 ther WEATHERIZATION 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. t 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 job site information. Insurance Company Name: NH Employers Insurance Company Policy#or Self-ins.Lie. #:#4001017 Expiration Date: 01/01/2023 Job Site ArirlrPcc• 36 Henry Street Northampton Massachusetts 01060 City/State/Zip: 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 certify under the pains and pe s of perjury that the information provided above is true and correct Signature: C�"�"4 8/16/2022 — — Date: Phone#:781-205-4484 II wxpermitting a( homeworksenergy.com Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# issuing Authority(circle one): I. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ��1 HOM EENE-01 LLARIVIERE ,acoRO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDlYYYY) `-..---- 1/312022 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 FaVOCT Lisa Lariviere Foster Sullivan Insurance Group,LLC PHONE A 163 Main Street yuc,No,en(978)686-2266 301 I wFc, X *44978)686.6410 North Andover,MA 01845o"aiss:certificates@fostersullivangroup.com INSURER(S)AFFORDING COVERAGE NAIC N INSURER A:Central Mutual Insurance Company 20230 INSURED INSURER B:NH Employers Insurance Company 13083 Homeworks Energy,Inc INSURER C:Markel Insurance Company 38970 Homeworks IIC LLC 101 Station Landing Suite 100 INSURER D: Medford,MA 02155 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. INSR TYPE OF INSURANCE L SUBR POUCY NUMBER POUCYD EFF POLICY YTEXPLIMITS (y mm') QAY/DD/YYYYj A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR CLP 8698469 1/1/2022 1/1/2023 DAMAGE TO RENTED 300,000 PREMISES(Ea occurrencel $ MED EXP(Any one Person) $ 5'000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ET LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY ( EOM accident)NED E LIMIT $ 1,000,000 — ANY AUTO BAP 8698470 1/1/2022 1/1/2023 BODILY INJURY(Per person) $ OWNED X SCHEDULED _ AUTOSRREE�� ONLY AUTOS BODILY BBOODILY INJURY(Per accident) $ X AUTOS ONLY X AUTO ONLY (Peer aE nI) GE $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE CXS 8698471 1/1/2022 1/1/2023 AGGREGATE $ 1,000,000 DED X RETENTIONS 0 $ B WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y!N ECC-600-40 0 1 01 7-2 022A 1/1/2022 1/1/2023 E.L.EACH ACCIDENT $ 1,000,000 ICER/ME M R EXCLUDED? N N/A QFF(Mandatory In NH) 1,000,000 E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Pollution Liability CPLMOL109278 1/1/2022 1/1/2023 $10,000 Deductible 1,000,000 DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Evidence Only CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Homeworks EnergyInc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. 101 Station Landing Ste 100 Medford,MA 02155 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Foimnew,eoeaiee-/<Aae)Jezelkt." e .� Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card Registration: 181138 HOME WORKS ENERGY,INC. Expiration: 03/02/2023 101 STATION LANDING STE 110 M DFORD,MA 02155 Update Address and Return Card. SGA 1 0 2ota-os'17 ..74, r.Mir/I•/YrrvYr"(0P/. e•-" Office of Consumer Make&tinniness Rep111a$ion HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card before the expiration date. if found return to: glop Limitation Office of Consumer Affairs and Business Regulation 181138 03/0212023 1000 Washington Street -Suite 710 HOME WORKS ENERGY,1NC. Boston,MA 02118 ADAM GLENN ( .2 •'"` G ���" 101 STATION LANDING STE 110 „,! r.a` • ��°"` MEDFORD,MA 02155 Undersecretary Not valid without signature mat- Commonwealth of Massachusetts Division of Occupational Licensure RrstrrdedtoConstruction Supervisor Specialty Board of Building Reg iations and Standards CSSLJC 'insulation Contract« Construcre41444405tr Specialty CSSL-106148 * _. spires: 07/30/2024 ADAM GLE 19 CHARGE • • _ WAREHAM M failure topossess a current edition of the Massachusetts ©t4 ViatV3` State Building Code is cause for revocation of this&cense. ,p For information about this license Cali(6 Comr iss4:.f,:r T 1 Ti 727-3200 or vise www Mass govfdp Insulation/Air Sealing Permit Authorization Specialist: James Conlon Company: HomeWorks Energy Email: james.conlon@homeworksenergy.com Address: 101 Station Landing Cell: 8608490960 Medford, Ma 02155 Phone: 781.305.3319 Customer: Vicki Van Zee Address: 36 Henry St Email: wanzee@gmail.com Northampton, MA,01060 Site ID: 4437956 Phone: 4133360644 I, the owner of the property identified above hereby authorize HomeWorks Energy Inc., or their Partner to act on my behalf in obtaining any building permit that maybe required to perform insulation and/or Weatherization work on my property and all matters related to the work authorized by said permit if one is obtained. Any related permit application cost will come at no additional charge provided that the agreed Weatherization work is completed. In the event that a permit is pulled on your home for insulation and/or weatherization work, you may be required to have a final inspection of the work scheduled and performed by the building inspector in your town. If required by the town, you will be notified by HomeWorks Energy that an inspection is necessary with instructions on how to complete this process to close out your permit. Email: vvanzee@gmail.com Customer Signature: '" " Date: 6/15/2022 Vicki Van Zee For Condo Owners: If you have property oversight by a condo associationt, please have the association's authorized person(s) complete and sign the section below. Please email this document to wxpermitting@homeworksenergy.com once completed. We, being the duly authorized representatives of the association Name of association or management companyt or management company have reveiwed the plans and specifications for improvements to the address specified above. We further acknowledge that the above listed owner has given notice that they intend to seek permits and to carry out the proposed work. Signature of representative Date Print Name t Other unit owners may sign when there is no association. PLAN VIEW KW WALL AND KW FLOOR Blind sped,'7I - - OR ---• KW SLOPE AND GABLE ENO Bend Spec? !1 > / wnv� 3 Name: (/,c%i If ' 2eP,.,- Site ID: gg37-1 S6 Finished Sq.Ft: //{ FRAMING EXISTING 5PFc'1 SO FT FRAMING EXISTING SPEC'ING / 5Ct-FT. g Phone: -//3 i 36 0.6/fi Year of House: /RDO Electric Acct#: ALL x X SLOPE X z r 5 Address: 3 n //ra%i,I'/- #of Floors: 2 Gas Acct if: — woe x X GABLE x x _ j r./4,71.0by7 ,q,/ Unit 0: 36 #Occupants: Housing Type? /2 NP/ek x x x ATTICS x x DUCTWORK INSPECTION Ducts Insulated? TTx: SLOPE x x Duct linear Ft. SLOPE x x \ EXISTING VENTING? euct Square Ft. _ i7 EXISTING VENTIN EXISTING PIPES?Y/N fF/ cT .uct Air Sealing Hours .. Duct Insulation - r - Duct Insulation Removal I I _ yZ BASEMENT INSPECTION /' y - C 00 .1 u/l/� 30 - KNEEWALL MANDATORY Existing Spec'Ing Ln/Sq.Ft. m Bsmt Wall AG --- 15 I Crawl Ceiling - '?7,6"/1e,f "'5-2 '- ?F f-e /� Crawl Rim Joist — —i------ Bsmt RJ w/Sill -217,1( 4-1,./fig ,$ /SOd Bsmt RJ NO Sill VaQor Barrier) ------ sgft. Bsmt DoorI -._. .� /,fle f-pnf i7 ,,,,IN Blower Door? WALLS&GARAGE Drill Location?`""---_. L- '^ Siding Ceil.pht Existing Spec'ing Sq.Ft. Framing ExteriorWall1 arf/i,;.. Pie-- -- %-x rtxflfclidloon atform Zr-'-- �, .:, l /; Exterior Wall x;' x Balloo atform ����� � ! G hW Overhang / x i ! ( - Garage wall /j / x 6alloonJPlattorm 3 / / Garage Ceiling / x K / I' 2,6 �/ f o �-�J 1 .) . W 4/0 rq// .p,p .. Insulation Removal i1I9 /nI''Sgft. Sweeps: WX Stripping: WORK SPEC'D BUT NOT CONTRACTED ROAD BLOCKS PRESENT? MANDATORY) Attic Basement/Crawlspace Other: K&T Y/(((��,,�gggryryry Moisture Y/3 Combustion Sfty Y/ Kneewall Overhang/Garage Asbestos Y Mold>100 sq.ft Y CO Detector Missing Y)` .' ..wwwa x x e.e nek n w"wn.[i 3*KIK 1 a...IEWID.a*. 0 "ram u.N.a.r(w; Tom,u.,, "1_"',.enw,,'0X NMI,_ann Notch.i Doe.- p. CM Vol: x .0058 Ductwork Exterior Walls Vermiculite Y/ Structl Concerns Y fN other: ---- x�x/D ATTIC 1 Blind Spec? x x ATTIC 2 Blind spec x Notes for Lead Vendor/Work Not Contracted: V Existing Spec'ing Sq ft Existing Spec'ing Sq ft �- ,floored Unfloored <s Multipliers teng wed /pc- A"pPE ;% Floored ° r s orS �/� Mixed Insulation DIM Woh Slope / Cath Slope >h'Loose ,.e - _ 1/ Air Sealing Hours Walls ;s crrs/ Pali - Access ", / /r1 r noting Propavents:gent BF_Be Hose Damoeny,,.m Venting PrQpavents Vent BF BF Hose' Darnmong / / Temp Boa:, I /7 N - Temp Antes., Sheathing Access: - R.L Coven: 'nting? A-,J,o/ lbirs N.ao.oe-,I fxlstingV.enbng? - ttf.0.Znre, Root type_A [_ PLAN VIEW z Name: (/�e % fA Zed Site ID: /7 Finished Sq. Ft: A/ '/' 3 o Phone: Cil? ? 6 'te� Year of House: '� Electric Acct#: .- r'� # of Floors: f Gas Acct#: Address: >ll`�F's-rr/� ?1 if/ Unit#: 2- # Occupants: Housing Type? e-Ir' DUCTWORK INSPECTION Ducts Insulated? Q --- Duct Linear Ft. r--- euct Square Ft. Duct Air Sealing Hours ,.'' Duct Insulation Duct Insulation Removal �� / �6 z BASEMENT INSPECTION V/�e� W Existing Spec'ing Ln/Sq. Ft. I l a l //7/i m Bsmt Wall AG Crawl Ceiling ,'1411 c--• /ave I Crawl Rim Joist -- - BsmtRJw/Sill 4- ','- , 56 1 �5 Bsmt RJ NO Sill Vapor Barrier - sqft. Bsmt Door V4P" ✓ Pi e .44-.`17 YIN Blower Door? WALLS&GARAGE Drill Location? Siding Cell. Height Existing Spec'ing Sq. Ft. Framing Exterior Wall 1 i ,CK ;!; //71 - x U.x/':" 43alloon/Platform Exterior Wall 2 ,/ x x Balloon/Platform Overhang /� / / x Garage Wall // _ / x x BaonJPlatform Garage Ceiling x x cc 0 W ZH 0 EE x W 1/ /a 7/ mp , Insulation Removal ' Sqft. Sweeps: WX Stripping: WORK SPEC'D BUT NOT CONTRACTED jitiO BLOCKS PRESENT? MANDATORY) Attic Basement/Crawlspace Other: K&T Y , N Moisturel Y Combustion Sfty Y f Kneewall Overhang/Garage Asbestos Y ry `Mold>100 sq. ft Y , CO Detector Missing Y/'N Ductwork Exterior Walls Vermiculite Y.rig Structl Concerns Y Other: --- Notes for Lead Vendor/Work Not Contracted: KW WALL AND KW FLOOR Blind Spec? -1 OR 1.- KW SLOPE AND GABLE END Blind Spec? Why? Why? FRAMING EXISTING SPECING /, SO.FT, FRAMING EXISTING SPEC'ING SQ.FT. '-- WALL .X.X X SLOPE X X FLOOR X X 7 GABLE X X '-'"'-..,.._ as / CCESS X ' TRANS X X -... A_ 2 ,./- 11 1.- RANS X X , ATTIC *. Of , > ., / SLOPE X X . CC X X 3 SLOPE EXISTING VENTING? IL, Luz EXISTING VENTING? '/4, EXISTING PIPES? Y/N . / ii = \ BF BF Hose Damming 'Sheathing Vent BF Temp Arce, N ..,..,,_ KNEEWALL MANDATORY ,.. ..,...„ i I / I i co LA ii /./— •/ „,„----"---,.. u .,. . ,...„ < , Insulated Wall X X Roc'd Light ' Ins,Hasa ritil Vent BF iBfyi Mtn.Sal Damming -- 12 F,00f Vvr.t 1.:;,. Air Handlitr — Trant FAHI o Access 7 Pull Down lid T s1 Hatch a Wall Hatch"/ Door. ' 1' R,sf%,ent 'i P'. BAS Vol:_ x .0058 19 [X Th ATTIC 1 Blind Spec? X x ATTIC 2 Blind Spec? X(3s;((32 story) Existing Spec'ing Sq ft Existing Spec'ing Sq ft -.,. Multipliers Unfloored -_ _ Unfloored Trusses ross Bamng „ , „ Floored ,/ .., ,. - .....0 r e___ ,. Floored ..,.„ Mixed Irlsul anon Dirt Work Cath Slope ,--- Cath Slope >6"Loose .Non e Air Sealing Hours Walls Walls .., Access ---- ...- Access Venting Propavents Vent BF BF lioe Dammin to Venting Propavents Vent BF BF Hose Damming 1 ta.o WHF Box: -- ,_ '0 (IJ .'... Temp Access:---- ",,, 1 Sheathing Access: in R.L.Covers:-- Sq Ft/300 E= ist.NFA Ventin . (j . 0 (Needed • Ft Sq. , /MO (Ems:.NFA Vennng)= (Needed _ /,* Existing Venting? .7770ers-rfol, . , NFA Venting) Existing Venting? NFA Venn gl Roof Type: /. Page 1 of . HomeWorks 101 Station Landing Ste 110. f mass save Medford,Ma OusS 11!! ii Energy PARTNER (781)305-3319 Customer Name:Vicki Van Zee Email: Not provided Phone:413-336-0644 Premise Address:36 HENRY ST, NORTHAMPTON.MA 01060 Mailing Address:36 Henry St, Northampton,MA 01060 Project ID:4519939 Date:June 15,2022 Job Description Measure Description Location Quantity Unit Total Cost Customer Cost Air Sealing at Estimated 62.5 CFM50 Per Hour Other 1 hr $92.58 $0.00 Rim Joist - 6" Fiberglass Batting Other 55 SF $148.50 $0.00 Crawlspace Ceiling - 6" Fiberglass Batting Other 150 SF $393.00 $0.00 Crawlspace Ceiling - 2" Thermal Barrier Polyiso Other 150 SF $717.00 $0.00 Insulation Removal Other 150 SF $189.00 $189.00 Pipe Tenting Other 20 LF $143.40 $0.00 Attic Floor- 6" Dense Pack Cellulose Other 572 SF $1,424.28 $0.00 Door - 2"Thermal Barrier Polyiso Other 1 each $90.44 $0.00 Bath Fan Hose Other 1 each $26.20 $0.00 Sheathing Access Other 2 each $80.04 $0.00 Total Contractor Price and Payment Schedule HomeWorks Energy, Inc.agrees to perform the above described work,furnishing the material and labor specified for the listed total price. Payment of the balance of the customer contribution is expected upon completion of the work. Customer Signature:_ —_-- y� v� 2..4, —__Date: 6-29-22 Customer Phone: --- — —/ _ /_ —� 6-29-22 Specialist Signature: J/G LI,' I •. _� her:. Date: ---------- UMITED TIME OFFER: The prices end incentives in this contract are subject to change in accordance with the sponsoring utility MassSave Home Services Fr ogram offers. Proposals con be sent to:lnbox@HomeWorksEnergy.com Page 2 of: 003HomeWorksma ' NER 101 Station Landing Ste 110. Medford,MA 02155 Energy PARTNER (781)305-3319 Customer Name:Vicki Van Zee Email: Not provided Phone:413-336-0644 Premise Address:36 HENRY ST, NORTHAMPTON, MA 01060 Mailing Address:36 Henry St, Northampton,MA 01060 Project ID:4519939 Date:June 15,2022 Project Total $3,304.44 Weatherization incentive ($3,022.86) Air sealing incentive ($92.58) Total Program Incentive -$3,115.44 Customer Total $189.00 Total Contractor Price and Payment Schedule HomeWorks Energy, Inc.agrees to oerform the above described work,furnishing the material and labor specified for the listed total price. Payment of the balance of the customer contribution"s expected upon completion of the work. � -� 6-29-22 Customer Signature: —_ Date:_—__--_—__—_----- Customer Phone: -- — — — ------ Gf� u -- --- __— 6-29-22 ----- — Specialist Signature: —_--- Date: UMITED TIME OFFER: The prices and incentives in this contract are subject to change in accordance with the sponsoring utility MassSave Home Services Program offers. Proposols con be sent to:Inbox@HomeWorksEnergy.com 3 HomeWorks Energy 101 Station Landing,Medford,MA 02155 CONTRACT - WZ HomeWorks 1flC ICJ 781-305-3319 "t)u1q Page 1 PROGRAM CMA-HPC CUSTOMER PHONE DATE CLIENT II WORK ORDER Peter Alrenga (312)912-1372 06/30/2022 341744 94903 SERVICE STREET BILLING STREET PROPOSED BY: 38 Henry Street 38 Henry Street HomeWorks Energy SERVICE CITY,STATE,2W BILLING CRY,STATE,ZIP Northampton, MA 01060 Northampton, MA 01060 DESCRIPTION QTY COST INCENTIVE TOTAL INCENTIVE:WHOLE BUILDING The Mass Save program offers a Whole Building 100%Insulation Incentive per unit for eligible insulation and air sealing measures. This incentive is for a non-owner occupied single-family with the utilities in the tenants name or, all units in a 2-4 building where at least one unit has the utilities in the tenants name and all eligible measures in all units are being completed at the same time. HOME AIR SEALING 2 $170.00 $170.00 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.) ATTIC FLAT-6"FLOORED R-19 DENSE CELLULOSE 572 $1,115.40 $1,115.40 Provide labor and materials to install a 6"layer of R-19 Class I Cellulose to floored attic space. BASEMENT SILLS R19 FIBERGLASS BATT 55 $107.25 $107.25 Provide labor and materials to install R-19 unfaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. CRAWLSPACE R19 FIBERGLASS AND RIGID BOARD 150 $894.00 $894.00 Provide labor and materials to install R-19 unfaced fiberglass insulation to the crawlspace ceiling to be in contact with the subfloor and completely filling the joist cavity to be flush with the joist bottoms. Then rigid board insulation will be installed and the seams all sealed with FSK tape. REMOVE EXISTING INSULATION 150 $145.50 $0.00 $145.50 Remove batt style insulation from the crawlspace area. VENTILATION CHUTES 34 $85.00 $85.00 Provide labor and materials to install ventilation chutes in the rafter bays to maintain air flow. HomeWorks Energy CI ((( ! f 101 Station Landing,Medford,MA 02155 CONTRACT - WZ HOreWoICE" 781-305-3319 YYrUc Page 2 PROGRAM CMA-HPC CUSTOMER PHONE DATE CLIENTS WORK ORDER Peter Alrenga (312)912-1372 06/30/2022 341744 94903 SERNCE STREET BIWNG STREET PROPOSED BY: 38 Henry Street 38 Henry Street HomeWorks Energy $ERNCE CITY,STATE,ZIP BIWNO CRY,STATE,ZIP Northampton, MA 01060 Northampton, MA 01060 DESCRIPTION QTY COST INCENTIVE TOTAL INSULATED BATH EXHAUST HOSE 4 INCH 1 $60.00 $60.00 Provide labor and materials to install an insulated 4"exhaust hose to existing bathroom fan(s). Total: $2,577.15 Program Incentive: $2,431.65 Customer Total: $145.50 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***One Hundred Forty-Five&50/100 Dollars $145.50 0)dact-j 1/adt/10.4, COMPANY REPRESENTATWE CUSTOMER SIGNATURE NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE 6-30-22 SIGN DATE DAYS.