29-433 (10) BP-2022-1622
19 ELLINGTON RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
29-433-001 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-2022-1622 PERMISSION IS HEREBY GRANTED TO:
Project# INSULATION 2022 Contractor: License:
DIPIETRO HOME ENERGY
Est. Cost: 2844 SOLUTIONS DBA REVISE 104464
Const.Class: Exp.Date: 03/06/2024
Use Group: Owner: L. MATUSZEK, MICHAEL
Lot Size (sq.ft.)
DIPIETRO HOME ENERGY SOLUTIHIS DBA
Zoning: WSP Applicant: REVISE
Applicant Address Phone: Insurance:
32 MIDDLESEX ST (978)203-6736 WC100142000
HAVERHILL,MA 01835
ISSUED ON:12/16/2022
TO PERFORM THE FOLLOWING WORK:
INSULATION/WEATHERIZATION
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter: Footings:
Rough: Rough: House# Foundation:
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 • • j1 730-17r
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
'JJv,c.1- 013
DEC 1 4 2022The Commonwealth of Massachusetts FOR
Board of Building Regulations and Standards
Massachusetts State Building Code, 780 CMR MUNICIPALITY
USE
Ni, ,h }lAicatton To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One- or Two-Family Dwelling
This Section For Official Use Only
Buildin9 Permit NuS /G Number: OA Ih1 ../e/a�- Date Applied: 12/09/2022
I cu„� 4Z) //'/� /2-It-7022
_
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
19 Ellington Rd Florence,MA 01062 29 29-433-001
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)
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 yes0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Michael Matsuzek Florence, MA 01062
Name(Print) City,State,ZIP
19 Ellington Rd 210-218-2186 mlmatsuzek@gmail.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2:Insulation,Weatherization,and Air Sealing
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $2844.22 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost (Item 6)x multiplier x_______
3.Plumbing $0 2. Other Fees: $
4.Mechanical (HVAC) $0 List:
5.Mechanical (Fire
Suppression) $0 Total All Fees: $ �j
Check No.U? Check Amount: U `� Cash Amount:
6. Total Project Cost: $2844.22 ❑Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
CS-104464 03/06/24
James Dimopoulos License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) U
32 Middlesex St
No.and Street Type Description
Haverhill,MA 01835 U Unrestricted(Buildings up to 35,000 Cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIF Masonry
RC Roofing Covering
9Z WS Window and Siding
SF Solid Fuel Burning Appliances
978-203-6736 madisonw@callrevise.com I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC-167375 03/11/24
James Dimopoulos Dipietro Home Energy Solutions dba Revise
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
32 Middlesex St madisonw@callrevise.com
No.and Street Email address
Haverhill,MA 01835 978-203-6736
City/Town,State,ZIP Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 2566))
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 the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
See attached authorization
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER1 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.
12/09/2022
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 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"
_ The t.'o;nnilton veulth of Massachusetts
Department of Industrial Accidents
11•
Of frce of Intestlh'atioiis
I A_ 600 Washington ashington Street
•
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electriciansfl'iuluhers
Applicant Information Please Print Let ihIv'
Name (Business/Organization/Individual): Dipietro Home Energy Solutions dba Revise
Address: 32 Middlesex St
City/State/Zip: Haverhill, MA 01835 Pho1C #: 978-203-6736
Are you an employer? Check the appropriate box: 'type of project(required):
1.El 1 am a employer with 30 e • ❑ 1 am a general contractor and 1
employees(full anchor parr-time).:` have hired the sub-contractors
O. ❑ New construction
2.❑ 1 am a sole proprietor or pattttcr_ listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have `{. ❑ i)enutlition
working for me in any capacity. employees and have workers'
9. ❑ Building adaition
[No workers' comp. insurance comp. insurance.:
required.' 5. c] We are a corporation and its 10.0 Electrical repairs uradditions
3. officers have exercised their 1 1. Plumbing rr pairs or additions
❑ i am a homeowner doing all Rork p'
myself. (No workers'comp. right of exemption per MGL 12.0 Roof repair
insurance required.] t c. 152, *1(4),and we have no
employees. [No workers' 13.0 Other - erizalion
comp. insurance required.]
*Any applicant that checks box:.I oust also till out the sectigu hehnt showing their uurkets'compensation policy inthmtaiinn.
t l lonteuwners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new allidavit indicating such.
t'ont-actors that check this box must attached an additional sheet showi-i_the name ur the sub-contractors and slate whether or not dwc catities have
employees. If the sub-contractors have employees.they must prm ide their workers'comp.policy number.
I am an employer that is provide:g workers'compensation insurance for nay employees. Below is the polity and job site
information.
Insurance Company Name: HUB International New England
Policy#or Self-ins. Lic. #: WCA00573401 Expiration Date: 04/20/2023
Job Site Address:19 Ellington Rd City StateeiZip:Florence, MA 01062
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MOL c. 152 can lead to the imposition of criminal penalties of a
tine up to$1,500.00 andlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine
of up to$250.00 a day against the violator. Bc advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certifi'under the pairs and penalties of perjury that the information provided above is true and correct.
-Signature: Date: 12/09/2022
Phone#: cl /; .-'G.S • j� .
Official use only. Do not rur/le in this area, to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority (circle one):
1. Board of health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Pilo in'#:
--..N DIPIEHO.01 _ CWOQO$IQE
ACURU CERTIFICATE OF LIABILITY INSURANCE C'•1TE NLCD0,,,,-:
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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 hive 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).
Nl:03,,cca License#1780862 CONTACT Anya Toteanu —
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HUB International New England P)IONE FAX
No,300 Ballardvale Street A•C.Na.ETD,
f-"AII an a.toteanu@•hubinternational.com
Wilmington. MA 01887 alaoR[ss: Y ..
INSURERtSI ArrORDi4G COVERAGE , NAICI
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Josepn A. Dipietro Heating &Cooling.Inc., Dipietro Home N§uR[gc.________
Energy Solutions,Inc.,Revise.Inc. — — —I
32 Middlesex Street INSURER o-
Haverhill.MA 01835 USURER E .
INSURER F: ___ _
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: L ���
THis is i' CERTIFY THAT THE PCLIGLS of INSURANCE L:STED BELOtiV HAVE BEEN ISSUED tO TIME INSURED NAVE/AMUV•L.I• THE POLICY PERIOD
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CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJEC.TO ALI. THE TERMS
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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_CERTIFICATE HOLDER
CANCELLATION
Town of Northampton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
212 Main St THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Northampton, MA 01060 _
AUTHORIZED REPRESENTATIVE
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ACORD 25(2016103) , 1988-2015 ACORD CORPORATION. Ali rights rosorvod.
The ACORD name and logo are registered marks of ACORD
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.4C0Rn' CERTIFICATE OF LIABILITY INSURANCE
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOL ER.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!De endorsed.
tf 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 CONTACI i uiIy Cus:rUly
NAME _
Costello Insurance GrtxlP PHONE •(979)37d-fi 352 inor..�+ -
A.0 Na r st), INC.Not
2 S.Knead St. t44a I%ss - •k a..: :.I ';.,...,,..'.m_O.cL'n
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:;K%euo Home E'• ;v Soluburs.Inc. INSURERC:
DBA Revise INSURER D.
32 Middlesex STreet INSURER E
Brautoo MA 01E35 INSURER F: _
COVERAGES CERTIFICATE NUMBER: CL2=4'sa.N5 REVISION NUMBER:
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CERTIFICATE HOLDER CANCELLATION
Town of Northampton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE OANCELLEO BEFORE
212 Main St THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS
Northampton, MA 01060
AJTMONIZEO RLPRESEN 1AI NE
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1988.2015 ACORD CORPORATION All rights reserved.
ACORD 25 12016)03j The ACORD name and loge are registered marks of ACORD
4
DocuSign Envelope ID:039CF331-FEEC-4098-AF3C-CB5AEBOE7AD4
4 )
REVI 3
the way you
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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: 32 Middlesex St Bradford Ma 01835
I Michael Matuszek
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.
1-DocuSigned by:
Owner Signature: ittiduitt alvsofL
'-883E1 DDEE8DD4C7...
Date: 8/25/2022
DocuSign Envelope ID:039CF331-FEEC-4098-AF3C-CB5AEBOE7AD4
Revise Energy
REVISE
t� the way you save 5 South Summer Street,Bradford,MA 01835 CONTRACT - 1Ir��/
Z
1-800-885-7283
Page 1
PROGRAM
CMA-HPC
CUSTOMER PHONE DATE CLIENT/ WORK ORDER
Michael Matuszek (210)218-2186 08/25/2022 516497 42103
SERVICE STREET BILLING STREET PROPOSED BY:
19 Ellington Road 19 Ellington Road Revise Energy
SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP
Florence, MA 01062 Florence, MA 01062
DESCRIPTION QTY COST INCENTIVE TOTAL
INCENTIVE 75%
For eligible weatherization measures, Eversource is offering an
incentive of 75%for insulation measures and 100%for the air sealing
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.
HOME AIR SEALING 10 $943.30 $943.30
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 AND ADD DOOR SWEEP 2 $115.84 $115.84
Provide labor and materials to install Q-ton weatherstripping and a
doorsweep to door(s)to restrict air leakage.
ATTIC DAMMING-R-38 FIBERGLASS 24 $58.08 $43.56 $14.52
Provide labor and materials to install a 12"layer of R-38 unfaced
fiberglass batts for damming purposes.
ATTIC FLAT-6"OPEN R-22 CELLULOSE 980 $1,489.60 $1,117.210 $372.40
Provide labor and materials to install a 6"layer of R-22 Class I
Cellulose to open attic space.
•
VENTILATION CHUTES 60 $209.40 $157.05 $52.35
Provide labor and materials to install ventilation chutes in the rafter
bays to maintain air flow.
DocuSign Envelope ID:039CF331-FEEC-4098-AF3C-CB5AEBOE7AD4
Revise Energy
REVISE
t� the way you 5avr
5 South Summer Street,Bradford,MA 01835 CONTRACT - YYZ
1-800-885-7283
Page 2
PROGRAM
CMA-HPC
CUSTOMER PHONE DATE CLIENT,/ WORK ORDER
Michael Matuszek (210) 218-2186 08/25/2022 516497 42103
SERVICE STREET BILLING STREET PROPOSED BY:
19 Ellington Road 19 Ellington Road Revise Energy
SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP
Florence, MA 01062 Florence, MA 01062
DESCRIPTION QTY COST INCENTIVE TOTAL
INSULATED BATH EXHAUST HOSE 4 INCH 1 $28.00 $21.00 $7.00
Provide labor and materials to install an insulated 4"exhaust hose to
existing bathroom fan(s).
Total: $2,844.22
Program Incentive: $2,397.95
Customer Total: $446.27
WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF
***Four Hundred Forty-Six&27/100 Dollars $446.27
DocuSigned by:
( DocuSigned by:
`PANY REPRESENTATIVE CUSTOMER SIGRAFf E1DDEE8DD4C7...
8/25/2022
NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE
SIGN DATE
DAYS.
J'",kte°_o 1.2-14 — J
Virtual Circle One In-Home
Revise Energy Planview Diagram
Customer:
__-___ At�uaif.1_._._._Ai e_k-_...__ Advisor Name: EvUn 12e1,41),
Address: __-_ -ia iF ilia . Any limitations to access by truck? N
Town: _.__.._� 1 �'�1_ _1U1A._._____010.6').___
Site ID: S I t2 Li i 1 •Use the greater of the two BAS#s when calculating for MVR
1 0 of stories I, 1.5 2 2.5 3 BAS 1: 15 cfm X#occupants X n-factor =
n factor 19 16 15 14.4 13.7f.._.,
( BAS 2: .00583 X area X height X n-factor = ' '3f).
Mechanical Ventilation Recommended:BAS>final CFM50> X BAS) Mechanical Ventilation Required:(0.7 X B4)>final CFMSO
Is this part of a multi-unit workscope? Y or IN li ? N/A \„.6^1_ ose Insulation Cross-Batt >6"Mix Loose/x-batt Truss
Wor+cscooe- 0 c L) — 1
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2) 00,rr 4cAs —D,
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Area
Yr Built
Heat Yr
DHW Yr
Ventialtlon SOFT
SOFT/300
40%Low/High
Existing High
Existing Low
Rec Vents,#
Existing Propervents
Required Propervents
Sotto vent? Y N .STREET-
Ridge vent? Y N Page_.._of
Gable vent? Y N 1
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washingtor..St.reet - Suite 710
Boston,Massachusetts 02118
Home Improvement-Contractor-Registration
Type. Individual
Jn;ViES G.I�IMpUC)Ul OS -ieglstration: 167375
25 SEVEN SISTER RD Cxpifation. 03/11/2021
HAVERHILL, MA 01830
Update Address and Return Cant.
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;Iruciividual Office of Consumer Affairs and t3usina515 Regulation
Registration gal ation 1000 Washington Street -Suite 710
167376 0E„3/11/2024 Boston,MA 02118
JAMES G.DIMOUOULdS
JAMES DIMOUOULOS
25 SEVEN SISTER RD /r..M:?
I IAVERHIL L.MA 01830
Undersecretary CCC Ngt-- id without signature
Commonwealth ot r.„ssachusetts
10, Diwston of Occupational Licensure
Board of Building Regulations and Standards
COn-,tno citIS op,„;sc,
CS-104.164 Expires: 03/06/2024
JAMES G DIMOPOULOS
25 SEVEN SISTER RD
HAVERHILL MA 01830 - in;
Cammissioner ,, aw1u / II%1,,t,tat_,.