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39A-066 (3) BP-2022-1362 12 HAMPTON TERR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 39A-066-001 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-2022-1362 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION Contractor: License: Est. Cost: 3000 ENERGY PROTECTORS INC 101143 Const.Class: Exp. Date: 06/16/2024 Use Group: Owner: Z BARCLAY DAVID H & LYNN Lot Size (sq.ft.) Zoning: URB Applicant: ENERGY PROTECTORS INC Applicant Address Phone: Insurance: 64 PAXTON RD (774)253-0277 6562UB0029826021 Spencer, MA 01562 ISSUED ON: 10/20/2022 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHERIZATI 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: 4 . $ Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner rz: R EC I- _; U►LT 1917 ., The Commonwealth of Maslachu etts ';1 s Board of Building Regulations and St nd4►Jy I email ' `; ' Massachusetts State Building Cde, 7 0 on 2 2022 Arm x'th this button Building Permit Application To Construct, Re air, •Or Demolish a - One-or Two-Family elli�r aT.OF t UIt.DING INSPECTION, Nt�gTunr�m�I .'AA U I(1fi0 - This Section For Official U'se Only-- J Buildin?Permit Number: .61')0- " I Date Applied: am," &o-,.) G 10 zo'zozz- Building Official(Print Name) Signature Date i SECTION 1:SITE INFORMATION / 1.11 rroopperty� dress: C 1.2 Assgs rirlap& Parcel Numbers 1.la Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Usc Lot Area(sq ft) Frontage(tt) 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 0 Check if yes❑ Zone: —_ Outside Flood Zone? Muni 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: DG&v 1� 13 ck cj etl k)d t..\--vIcoin p kv'7 4 J.'\Ar 61 O 6 d Name(Print) City,State,ZIP 1 WI 1ptbn 1—Qf ckCC- 4,c r 3 r C.5'l,v No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addit on 0 Demolition 0 Accessory Bldg.0 Number of Units Other t pecify: t V,S V I.00 e.0\ Brief Description of Proposed Work2: A -I S sec I C..4,, . vi S,.,t 4 FL tAt.— `eI( r'lve` c-,. 4.., 115 SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building S 3 Q v) 1. Building Permit Fee:S Indicate how fee is determined: O Standard City/Town Application Fee 2. Electrical S O Total Project Cost'(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: S 4. Mechanical (HVAC) S List: 5. Mechanical (Fire S Suppression) Total All Fees:A�.j4 Check No.3g0► check Amount Cash Amount: 6.Total Project Cost: S t 0 6 0 ❑Paid in Full 0 Outstandir Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) cs-101143 6,16,24 Joshua Dada License Number Expiration Date Name of CSL Holder List CSL Type(see below)u 64 Paxton Rd No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) Spencer,MA 01562 R Restricted 1&2 Family Dwelling City/'Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 774-253-0277 jdada79@hotmall.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 172960 8/19/24 Energy Protectors Inc HIC Registration Number Expiration Date HIC Company Name or H1C Registrant Name 64 Paxton Rd jdada79@hotmaitcom No.and Street Email address Spencer,MA 01562 774.253-0277 City/Town,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 Issuanc f 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 to act on my behalf,in all matters relative to work authorized by this building permit application. 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. ()-' atA. top. 1_2-- Print Owner's or Authorized Agent's Name(Electronic Signature) Da e 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 IIIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.govidps. 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" The Commonwealth of Massachusetts � —` i_ l Department of Industrial Accidents 74#0i.- 1 Congress Stream Suite 100 Boston,MA 02114-2017 4.- ww>Karass.gov/din Workers'Compensation insurance Affidavit: aaslPlrmbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Ann9eaet Information Please Print Lea3lk Name(Busineasiors nizationnndividual):Energy Protectors Inc Address:64 Paxton Rd City/State/Zip:Spencer,MA 01582 phone#:774-253-0277 Are you as employer?Check the appropriate box: Type of Project Orel : 1.9 I am a employer Wel 1 smployess(full anchor ph).' 7. ❑New construction 2.0 lam a sole proprietor or partnership and hew no enutoyass waking fa.ms in 5. Remodeling any capacity.[No workers'comp.Insurance required.] 3.0 I am a homener doing sat wok myself.[No workers'camp.insurance require] 9. ❑Demolition ow 10 0 Building addition 4.0 I am a homeowner and wB be hhing contractors to conduct as work on my property. 1 ell ensure that all contactors either have 11.workers'compensation insurance or an sole ❑Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 lam a general coalraebr and i have hind the sub.co,Mractors kid an the Misdold shoat. 13.0 Roof repairs These sub-contractors haw employees and have workers'comp.insurance. 14.©Others 6.0 We area oorposOorr and ifs calkers have eancissd their right or anaphors par MOL a 152, S vrodurs' kimonos `Any applicant th att checks box a1 Bete out ere section below r&owtrrg waters'compensation policy iatantretion. t Honreownen who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that cheek this box must attached an additional sheet showing the tame of the fora and state whether or not those entities have wars. If the sub ultaMors have employees,they must provide waters'comp.per'number. I run an employer that is providing workers'compensation l rrowce foe Hey employees. Below b the polity anti job site information Insurance Company Name:National Liability&Fire Insurance Company Policy#or Self-ins.Lic.0:1/9WC383933 Expiration Date:9/1/23 Job Site Address: , V tAl V3 `7-)4 i e City/StatetZip: A.)of k-ht_`^vQ t't t'�`t�'; Attach a copy of the workers'compensation policy declaration page(showing the policy umber and expiration date). V I O6C/ Failure to secure coverage as required under MOL 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 coverer verification. I do hereby alder the pains sadpeisrakks of perjury that Ike information provided above Is dare and correct 311111aare: `' J1 y�-,�,� Daje: t o (t phone#:774-2 77 Official use mob,. Do not wrh1 a stir this area,to he cwnpieted by City or sawn offkial City or Towle: Penult/License# issuing Antherity(cls+de leek 1.Board of Health 2.Building Department 3.Cityfl'own Clerk 4.Electrical inspector 5.Plumbing Inspector 6.Other Contact Person: Phased: City of Northampton .gal H4F•l7 ... 0" Massachusetts ?' w w 3 (c±,r DEPARTMENT OF BUILDING INSPECTIONS *' 212 Main Street • Municipal Building 9iltr Northampton, MA 01060 4fk . 1:1cv CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, 554, 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: wt_J5 0 z —c— a S L Location of Facility: The debris will be transported by: Y Name of Hauler: v\crC) � r i,,)-c._.-k- c> S A- C Signature of Applicant: A)a Date: Lo ` ( 5 2 ACCW co 1 DATE(MM/DOIYYYY) �, CERTIFICATE OF LIABILITY INSURANCE 8/31/2022 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: Nina Arroyo Coonan Insurance Agency, Inc. PHONE FAX 267 Main Street _(A/c.No Ext):508-987-7122 (NC.No:508-987-7152 Oxford MA 01540 Aeoonss: nina@coonaninsurance.com INSURER(S)AFFORDING COVERAGE NAIL M Ligense#:1782985 INSURER A:AIX Specialty Insurance Co _ INSURED ENERPRO-Or INSURER B:Safety Insurance Company Energy Protectors, Inc. 64 Paxton Road INSURER c:Capitol Specialty Insurance Corporation Spencer MA 01562 INSURER CI: National Liability&Fire Insurance Company INSURER E: Philadelphia Ins Companies INSURER F: COVERAGES CERTIFICATE NUMBER:2132532233 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 RESPE T TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT Ti ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIM LTR INSD HVVD'. POLICY NUMBER 'IMM/DD/YYYY) (MM/DpM/YY) A X '1. COMMERCIAL GENERAL LIABILITY ' L1N-H714840-01 8/31/2022 8/31/2023 EACH OCCURRENCE $1,000,000-1 DAMAGE CLAIMS-MADE X OCCUR PREMISETO RENTED S 50,000 - MED EXP(Any one parson) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLES PER: GENERAL AGGREGATE $2,000,000 X POLICY PET I LOC PRODUCTS-COMP/OP AGO $1,000,000 OTHER: $ B AUTOMOBILE UABIUTY N : 6236519 12/23/2021 12/23/2022 EaOMaccideBINEDnt)SINGLE IJMIT $1 000,000 ( ANY AUTO BODILY INJURY(Per person) $ OWNED AUTOS ONLY X SCHEDULED BODILY INJURY(Per accident) E X HIRED y NON-OWNED ,PROPERTY DAMAGE $ AUTOS ONLY _AUTOS ONLY L(Per accidenll 8 C X UMBRELLALYIB X OCCUR V CCP1070516 8/31/2022 8/31/2023 1 EACH OCCURRENCE $1,000,000 EXCESS LU16 CLAIMS-MADE F AGGREGATE $ DEO X RETENTION$in fvtn 8 D WORKERS COMPENSATION V9WC383933 9/1/2022 9/1/2023 X WAITUTE 1 ER- ANDEMPLOYERS'LIABILITY -- --- ANYPROPRIETOR/PARTNER EXECUTIVE Y/N E.L EACH ACCIDENT $500,000 OFFICER/MEMBEREXCLUDED? ❑ N/A ------- -- -- (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 11 yes,describe under DESCRIPTION OF OPERATIONS below ,E.L.DISEASE-POLICY LIMIT $500,000 E Pollution Liability PPK2386760 1/6/2022 1/6/2023 Each Occurence 1,000,000 General Aggregate 2,000,000 Products-Completed 2.000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached It 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. Eversource 247 Station Drive Westwood MA 02090 AUTHORIZED REPRESENTATIVE <,,,% C. - ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Di Commonwealth wealth of Massachusetts chusetts IIP Board of Budding R Occupational Lscensure and Stan �,ationg and Standards lords CS 101 f,3 �~ isor ti4 pSHUT S trA . i, .Fires:06/1g/?0?4 SPENCE M4'0 I CommissiCt7Cr )Q THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration ("74.-v __' Type. Corporation � sal - ' Registration: 172960 ENERGY PROTECTORS INC. Expiration: 08/19/2024 64 PAXTON RD. , SPENCER, MA 01562 C .��1 1, ti VIP Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:Corporation Office of Consumer Affairs and Business Regulation Registration Expiration _ 1000 Washington Street -Suite 710 172960 08/19/2024 Boston,MA 02118 ENERGY PROTECTORS INC. „, JOSHUA DADA 64 PAXTON RD. (�� .4 SPENCER,MA 01562 `'i�� Undersecretary Not valid without signature UocuSlgn knvolope ID N75UU;il1W1 Of 14 411 41 11AH1I I II'i1 :'IIA(Al I;!1 I Idortit 10 if 05 1149'I'20 RISE Enginooring RI contiactoi Nottlatt.illun Nn HIM; MA Conte aclot Witt%Itatloo No 1209/9 CI CooItuil lot Roip',Irtittuo No 11 1117I1 RISE00 Shawmut!toad 03,Canton,MA CONTRACT - WZ E NGINt I kIN( 339-5024335 FAX 339-502-6345 Page 1 PROGRAM I1114 C1)N INAI I III I Willi HIND,ill I WI N"NI i'NIiINf f INN,,ANn I Ht I.tI',IOW N i�.tt Y t1NM A. CMA-HES IntcpnuuNunw comma PII(Nr pair CIaNItr IN,II,Y(ntpl11 David Barclay (413) 320-9510 03/30/2022 3410f:3 3F3`)02 DEIIVICE STRUT I)II I INC 11TNYYT PROPO(rr,N. ------ 12 Hampton Terrace 12 Hampton Terrace Daniel Dia/ i RVIC!CITY,ITATE.V -00tif0 CITY.!IMF./10 p Northampton, MA 01060 Northampton, MA 01060 DESCRIPTION QTY COST INCENTIVE TOTAL INCENTIVE 75% For eligible weatherization measures,Eversourco is offering an incentive olginill.1111111.hieasures and firaNaMatiMara measures, both with no limit.You are eligible to apply for the 0%,Heat Loan to finance your co-pay, applications must be submitted before the weatherization work begins. KNOB&TUBE WIRING(Northhampton) We have identified that your home might have Knob&Tube wiring II ak) present. The following contract is not valid unless accompanied by the Weatherization Barrier Incentive form, signed by your licensed electrician. Work will not proceed with this work until we receive a copy of the form. 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.) WEATHERSTRIP DOOR $116.00 $116.00 Provide labor and materials to install 0-Ion weatherstripping to jOO lcS door(s)to restrict air leakage. WALLS WOOD SIDED 1,170 $2,351.70 $1,763.78 $587.92 Furnish and install blown In Class I Cellulose to shingle and/or clapboard exterior walls.The butt of the upper course of your wood siding is cut to drill holes into the wall sheathing behind.The holes are then plugged and the wood siding is reinstalled using exterior grade nails. 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 weathenzetlon work to be performed. Your signature Is your acknowledgement of receipt and agreement to proceed. t BASEMENT SILLS RIGID BOARD INSULATION 82 $324.72 $243.54 $81.18 Provide labor and materials to Install rigid board Insulation to the perimeter of the basement ceiling at the house sill. LEAD PAINT Your home was built prior to 1978 and might have lead-based paint Nbialtials) present. You have received a copy of the EPA's Renovate Right UocuSlgn Envelope IL):925003A9-0714-4150-9A8U-F t35L2EiA/Ai C9 I minim m N 09 oao5r,l9 RISE Engineering nI t:01111 to,Hntllry1$alion No 111 All if i3 MA C.:nnitA(to,NngiAlrnllon No 120979 C I Cool;as lot Itnolfth/ oo No ff100�120 RISE80 Shawmut Road#3,Canton,MA CONTRACT - 1r Y Z 1NGINEERING 339-502.8335 FAX 339-502-6345 fJ A PRgo 2 PROGRAM YNpanAI r INI,ANII111itIR11AI1MfP„UW,I,MIAR CMA-HES III m NMI I,NI 1 IIW "Wean 1'.I IOW!0 WANM(mole David Barclay (413) 320-9510 03/30/2022 341063 35502 SERVICI STREIT TILLING UNFIT nROPniFR NY 12 Hampton Terrace 12 Hampton Terrace Daniel Diaz IIRVIC'CWT.STATI,ZW S0.LEIGCITY,RATE.ZW Northampton,MA 01060 Northampton, MA 01060 DESCRIPTION QTY COST INCENTIVE TOTAL pamphlet informing you of the potential risk of a lead hazard exposure from the renovation activity to be performed at your home. STORAGE-BASEMENT Homeowner is responsible for the removal of the stored Items _ (initial%) blocking the installation of weatherizatlon work In the basement. Removal must occur prior to the scheduled work start. Total: $2,962.42 Program Incentive: $2,293.32 Customer Total: $669.10 WE AGREE HEREBY TO FURNISH SERVICES•COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF `**Six Hundred Sixty-Nine&10/100 Dollars $669.10 IRON RICEIIT OP YOUR MU INOIMEIMNO INVOICI,CUSTOMIR AORUS TO RUNT AMOUNT DUE IN FULL INTERNST OP I%WILL SI CHAROED MONTHLY ON ANY UNPAID SALANCI AFTER 30 DAYS.III REVIRSI FOR IMPORTANT INFORMATION ON OUARANTEIS,RIGHTS OP RECISION,SCHEDULING.AND CONTRACTOR REGISTRATION. O VOA, � by:VA/') New A?.i 4611i91 1. CUSTOMINOONATURI NOTE:THIS CONTRACT MAY SS WITHDRAWN SY W M NOT IL ICUTSD WITHIN DAM OP ACCIPTANCI ~1 ... Z o V v/ SION DATI 30 BAYS, ACCIPTANCI OF CONTRACT•THI ASOVS PRIM,SPECIFICATIONS AND CONORIONI AR/ SATISFACTORY TO US AND ARS WRIST ACCEPTED.YOU ARE AUTHORIZED TO D0 THS WORK AS SPICNIEO.PAYMINT WILL SI WADS AS OUTLWID ASOVI DocuSign Envelope ID:925003A9-0714-415D-9A80-F B51.2BA 7AI-C9 RISE ENGINEERING OWNER AUTHORIZATION FORM David Barclay (Owner's Name) owner of the property located at: 12 Hampton Terrace (Property Address) Northampton, MA 01060 (Property Address) hereby authorize Subcontractor(to be filled in by office) 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. The permit will be secured by the subcontractor, at no additional cost. It is the homeowner's responsibility to close out this permit by contacting their municipality at the completion of this work. re,421."-- wner's Signature Date RISE Engineering, a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335 www.RISEengineering.com ` t ` i• • . . - • .►..�,_d: r.�s.:J:.....1� taa :�Y1i�:►a✓,.........,a,... s.�.... . Based on your Energy Specialist's recommendations, your home can hencrrt Non f improvements.Before moving forward.please follow all the instructions below to r m. 1;,! CUSTOMER INSTRUCTIONS 1. Hire a qualified,licensed contractor to evaluate and/or remediate the weatherization hnrnerr(s). 2.Submit signed and completed copies of this form and a copy of the paid contractor invoice(s)with' .(. ,!., 1 , • Assessment to:RISE Engineering,60 Shawmut Rd,Unit2,Canton,MA 02021 or email to Eversourcelnfo o RISEenginr r, ,,,r 3.The weatherization incentive will be deducted from the customer co-payment amount of the weritheri:° ,r;;n r;;:r. will be issued in the event the amount exceeds the customer's co-payment amount. 4.Complete the recommended weatherization improvements. 5.The Mass Save' HEAT Loan offers interest-free financing opportunities that may be used to rernr,•Ji,i'' d ,;i barriers. Learn more at masssave.com!en/saving/residential-rebates/heat-loan-program• CUSTOMER INFORMAT -' --•w- . Customer Name: David,Barclay Client rt or Site ID 341 063 Site Address: 12 Hampton Terrace City: Northampton ct.t,, MA 01060 Phone Number: 41 -320-'511 _ t r ,il davidbarclay100@hotmail.com — Customer/Homeowner Signature: ' /,P1i / Date: t KNOB AND TUBE WIRING 1.uo to Y''Go incentive) To determine if there is any active knob and tube wiring,the contractor wi evaluate the following areas where weatherization recommendations have been made: 0 Attic Floor 0 Attic Wall O Attic Slope teExterior Wall O Basement 91 Other:sill plate Other. 7► I have performed my inspection and determined there is no- tive knob and tube wiring in the areas selected below. )Attic Floor 0 Attic Wall 0)Attic Slope VExterior Wall Basement Other:sill Plate (';Other: Contractor Name: Lr rry I � IVAt Address:_ R azer / Q11 R.U, _,•,,.__ _City:_ ��4 .y __ .._. State: 21. ZIP: ea. .. ot, . . Company Name: License Number: b. 3Z2?7 Contractor Signatu Date: lO� - _ My signature confirms that I 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 MEGHANICAL SYSTEM BARRIERS fun to$250 incentive;(fo bco out by licensed contractor) High Carbon Monoxide:Contractor is to service and re-evaluate the selected mechanical system(s)and reduce the carbo a 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 Carbon Monoxide Draft Failure Existing CO ppm: Revised CO ppm: fi Existing Draft Pa: Revised Draft Pa: Heating System i i 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 0 Hot Water Heater 0 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. Larry LaFountain Electrician Invoice 40 Reservation Rd. Date Invoice# Holyoke, MA 01040 Phone# 413-540-6928 4/17/2022 479 E-mail lareaulelectricragmail.com Bill To Job Location 12 Hampton Terrace Same Northampton,MA 01060 Please make checks payable to Larry LaFountain Electrician. Terms Due Date Please mail payment to above address and retain this invoice as your copy. Net 15 5/2/2022 Service Date Description Labor Hrs. Hrly. Rate Amount 4/12/2022 Electrician 1 90.00 90.00 Inspection of electrical wiring of knob&tube 0.00 0.00 wiring and other unsefe wiring methods in structure for installation of insulation in attic& outside walls&cellar sills and ceilings. Inspection Insurance 100.00 100.00 Billing 10.00 10.00 Customer is responsable for any and all collection expenses.Past due invoices over Toth I Due $200.00 30 Days late will incur a 1.5%finance charge per month.(18%per year)A$5/**S10 **rebilling charge will be applied to every statement sent to you on invoices up to 90 days late**Please remit payment in full on or before the due date to avoid all finance and re-billing cahrges.