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18C-131 (6) BP-2022-1598 73 BLACKBERRY LANE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 18C-131-001 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-2022-1598 PERMISSION IS HEREBY GRANT D TO: Project# INSULATION 2022 Contractor: License: Est. Cost: 6000 HOMEWORKS ENERGY INC 106148 Const.Class: Exp.Date: 07/30/2024 Use Group: Owner: LINDA PATTERSON, Lot Size (sq.ft.) Zoning: URB Applicant: HOMEWORKS ENERGY INC Applicant Address Phone: Insurance: 59 TOSCA DR 781-205-4484 ECC-600-00 1 0 1 7-202 JA STOUGHTON, MA 02072 ISSUED ON: 12/09/2022 TO PERFORM THE FOLLOWING WORK: INSULATI ON/WEATH ERI ZATI 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: 16 ".9 Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner FEE: $65.00 1. LT ►qL 7 I a._�r�r,♦ City of Northampton ------ Dep�� Building Department`E C E ,, J 212 Main Street INSULATION Room 100 EC6 2C2Northampton, MA 01060°_. phone 413-587-1240 Fax 413-587-1272 tONL.. .,1 ()-null i,i,'( INSPECTIONS '.v`. `-A.'h100 APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INSULATION PERMIT This section to be completed by office 1.1 • Address: Map (, Q Cr Lot ` I Unit : .ckberry Lane Northampton MA 01060 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Linda Patterson 79 Blackberry Lane Northampton MA 01060 Name(Print) Current Mailing Address: See Attached (413)800 4340 Telephone Signature 2.2 Authorized Agent: Adam Glenn 235 Essex Street, Whitman, MA 02382 Name(Print) <- Current Mailing Address: citiw. 781-205-4484 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 1/4. Mechanical (HVAC) �n 5. Fire Protection 6. Total = (1 +2+ 3+4+5) 6,000 Check Number - 7 6,..k3 This Section For Official Use Only �� Building Permit Number: 6,- `z3-�f Date` Issued: Signature: /�J'( /Z • 9- ZoZZ 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 ❑ Name of License Holder:Adam Glenn 106148 License Number 235 Essex Street, Whitman, MA 02382 07/30/2024 Addre Expiration Date 781-205-4484 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ HomeWorks Energy 181138 Company Name Registration Number 235 Essex Street, Whitman, MA 02382 03/02/2023 Address Expiration Date 14iL4 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 RI No ❑ Brief Description of Proposed Work Residential weatherization/ Air sealing. No structural changes. SITE ID CAP-4498 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 -- Print Name 11/29/2022 Signature of Owner/Agent Date Linda Patterson , 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 11/29/2022 Signature of Owner Date City of Northampton SHAM 'r Massachusetts ? *U .�- � G fill t t I . DEPARTA�NT OF BUILDING INSPECTIONS ,yM 4,1 212 Main Street • Municipal Building -, 1D ^» ,„�.r�' Northampton, MA 01060 '�Jt-yti, A,D° 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 pre-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:79 Blackberry Lane Northampton MA 01060 Date of Permit Application: 11/29/2022 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 TILE 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: 11/29/2022 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 :►n-sir,' City of Northampton ``�tii Massachusetts ll4 DEPARTMENT OF BUILDING INSPECTIONS : off, . . , 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: 79 Blackberry Lane Northampton MA 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) is")0 11/29/2022 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. „.,,.,j w City of Northampton 4 , S Massachusetts r \.(y DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal BuildingJII .fr,;r”' Northampton, MA 01060 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 79 Blackberry Lane Northampton MA 01060 Contractor Name: HomeWorks Energy Address: 235 Essex Street City, State: Whitman, MA 02382 Phone: 781-205-4484 Property Owner Name: Linda Patterson Address: 79 Blackberry Lane Northampton MA 01060 City, State: 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 6‘4 ,,,..6)0 'ad cei_ Date 11/29/2022 The Commonwealth of Massachusetts 'e=.' i Department of Industrial Accidents Sit;i61c 1 Congress Street,Suite 100 11f- Boston, MA 02114-2017 www.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): Home\orks Fnerg"y Address: 235 Essex Street City/State/Zip: Whitman, MA 02382 Phone#: 781-205-4484 - Are you an employer?Check the appropriate box: Type of project(required): 1' t am a employer with 500 employees(full and/or part-time).* 7. 0 New construction 2.11 I am a sole proprietor or partnership and have no employees working for me in 8. El Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.Q I am a homeowner doing all work myself.(No workers'comp.insurance required.]t 10 0 Building addition 4.0 1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 1 1.0 Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.0 1 am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14 I/ 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 Address- 79 Blackberry Lane Northampton MA 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 ' of perjury that the information provided above is true and correct Signature: Date: 11/29/2022 Phone#:781-205-4484 // wxpermittingAhomeworksenergy.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): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: HOMEENE-01 LLARIVIERE ACORO CERTIFICATE OF LIABILITY INSURANCE DATE 1/3/2 DIYYYY) 1/3/2022 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 Lisa Lariviere NAME: Foster Sullivan Insurance Group,LLC PHONE FAX 163 Main Street (A/C,No,Ext):(978)686-2266 301 I(NC,N.:):(978)686-6410 North Andover,MA 01845 E-MAIL certificates@fostersullivangroup.com INSURER(S)AFFORDING COVERAGE NAIC# 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 ADDL SUBR POLICY NUMBER POUCY EFF POLICY EXP LIMITS LTRINSD WVD (MM/DD/YYYY) (MM/DD/YYYYl A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR CLP 8698469 1/1/2022 1/1/2023 DAMAGEES TO(Ea RENTEDoccurrence $ 300,000 PREMIS ) 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 E� LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER' $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ ANY AUTO BAP 8698470 1/1/2022 1/1/2023 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY X AUTOS BODILY INJURY(Per accident) $ X HIREDS ONLY X AUUTIOS ONLYY PROPERTY accident)DAMAGE 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 RETENTION$ 0 $ B WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATUTE ER Y/N ECC-600-4001017-2022A 1/1/2022 1/1/2023 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED') (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 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 POLICY PROVISIONS. 101 Station Landing Ste 100 Medford,MA 02155 AUTHORIZED REPRESENTATIVE I - ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD f%":, ri1ffl tnii'()ir6/t/,.//g<7iiut(1;f4e/4 Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card HOME WORKS ENERGY,INC. Registration: 181 138 101 STATION LANDING STE 110 Expiration: 03/02/22/2023 MEDFORD,MA 02155 Update Address and Return Card. SCA I 0 2am-0517 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card before the expiration date. It found return to: Registratlog potation Office of Consumer Affairs and Business Regulation 181138 03/02/2023 1000 Washington Streit -Suite 710 HOME WORKS ENi;RGY,1NC. Boston,MA 02118 ADAM GLENN ( c,t ., 101 STATION LANDING STE 110 µ: MEDFORD,MA 02185 Undersecretary Not valid without signature --A Commonwealth of Massachusetts Division of Occupational Licensure ftestriaedtoConstruction Supervisor Specialty Board of Building Regufattons and Standards CSSt-tc insulation Contractor Construc:iQi 44ss. Specialty CSSL-106148 c tree:0713012024 ADAM GLEN.It ; 19 CHARGE ` WAREHAM M f-aiiure topossess a current edition of the Massachusetts t�Yd:�►a- State Building Code is cause for revocation of this license. For information about this license Commissioner , � /;, .l x.j Cali 017)7273200 or w v+visit wr,mass.gov+dpt SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Da.e Name of CSL Holder List CSL Type(see below) No.and Street -- Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted I&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 1 Insulation Telephone Email address I) Demolition _ _ 5.2 Registered Home Improvement Contractor(HIC) lIIC Registration Number EXpiration Date HIC Company Name or HIC Registrant Name No.and Street Email address 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 Issuance of the building permit. Signed Affidavit Attached? Yes 0 No 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of th bject property, , eb, authorize _ to ac n m eh , in all matte relaf e to work authorized by this building permit application. e-,-=.6' -(7,-: Aoar c ,,c,:.-/2°e'e.--- ,,e.) -/143c:2— Tint O er's Name(ii ctronic Signature) tiati 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 app cati 1__is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's 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 unregistere contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbi tion 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.go /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" Work Order Community Action Pioneer Valley Job Number: 22-1306WX P.O.Box 1432 Work Order Date: 11/4/2022 Greenfield,MA 01302 Ownership: Owner Phone: 413-774-2310 Home Works Energy Auditor:Xena Dreyfuss 101 Station Landing Email: xdreyfuss@communityaction.us Suite 110 Cell:413 834-2637 Medford MA 02145 Phone:413 376-1151 Email: nora.mccleary@homeworksenergy.com Phone: 781-305-3319 Linda Patterson DOE WAP 2022 $5,699.40 79 Blackberry Ln Total $5,699.40 Northampton Ma 01060-4532 DOE WAP 2022 Repair/Health&Safety $1,611.00 413-800-4340 lapatterson333@gmail.com Additional Contractor Instructions: Authorized Actual Measure Description Qty Price Total Qty Total Comments Attic Insulation R-18-20 unrestricted-settled 1248 $230 $2,870.40 bring to R60 cellulose or equivalent Doors 1" Or 2"THERMAX Or 1 $91.00 $91.00 door to garage equivalent on door Fixed Sweep triple flange 1 $27.00 $27.00 door to garage Weatherstrip w/Q-Ion or equivalent 1 $76.00 $76.00 door to garage Misc Measures Attic/basement blower door guided 8 $105.00 $840.00 Air sealing may be needed in hot water closet sealing with one-part foam to improve garage zonals Page 1 Work Order: Job Number: 22-1306WX Blower Door Testing with Zonal 1 $71.00 $71.00 Pressure-Pre&Post Clothes dryer vent including 1 $152.00 $152.00 Exhaust Duct Continuous variable speed fan w/ 1 $1,109. $1,109.00 controls(whole house new 00 installation living space) Recessed Light Enclosure 1 $50.00 $50.00 box in bath fan,box needs a cover(5/8 sheetrock or any material with R value 1 or less) Vent kit/bath fan 1 $153.00 $153.00 existing kitchen fan vents out roof.Talk to client about where to vent out new bath fan (soffit vs root)metal roof Weatherstrip(Q-lon or equivalent) 1 $104.00 $104.00 & R-code attic hatch side slide- 1/2 in plywood Permit Building Permit 1 $50.00 $50.00 Wall Insulation Test drill 4 sides 1 $106.00 $106.00 Total $5,699.40 Contractor Instructions: Before Starting the Job: During the Job: 1. Please notify us 24 hours before starting or scheduling a job. 1. Incorporate lead safe practices as applicable. 2.Obtain required building permit. 2.Total for Heath&Safety and Repairs cannot exceed$2500.00. 3.Photograph any air sealing or other work to be covered by insulation. Your Invoice Must Include: 1. Client name,client address and job number. 2. Signed and dated copy of the work order. 3.Pre and post blower door test results. 4.Attic inspection form. 5.Copy of certificate of insulation. 6. Copy of building permit. 7. Manufacture labels from replacement doors and windows. 8. Photographs of air sealing or other work covered by insulation. Page 2