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12C-123 (4) BP-2023-0094 111 RICK DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 12C-123-001 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-2023-0094 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 3000 HOMEWORKS ENERGY INC 106148 Const.Class: Exp.Date: 07/30/2024 Use Group: Owner: BOOTHROYD MICHELE A Lot Size (sq.ft.) Zoning: RI/WSP Applicant: HOMEWORKS ENERGY INC Applicant Address Phone: Insurance: 59 TOSCA DR 781-205-4484 ECC-600-4001017-2022A STOUGHTON, MA 02072 ISSUED ON: 01/26/2023 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 VI LATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Q �T i Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner FEE: $65.00 ' ►JU,L, Iy76 itirTr�r4i City of Northampton Dep �R f�� Building Department ‘„, ` ., �`� 212 Main Street ; ::t, Room 100 INSULA TION Northampton, MA 01060 { ; .4 phone 413-587-1240 Fax 413-587-1272 QfJL Y 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 Unit 111 Rick Drive Northampton MA 01062 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Michele Boothroyd 111 Rick Drive Northampton 'MA 01062 Name(Print) Current Mailing Address: See Attached (413)586-0562 Telephone Signature 2.2 Authorized Agent: Adam Glenn 235 Essex Street, Whitman, MA 02382 Name(Print) , ] Current Mailing Address: 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 3,000 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4 ceb 4. Mechanical (HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) 3,000 Check Number -76 11f7 ,� C This Section For Official Use Only /Building Permit Number: Z .3 r C� / Date Issued: Signature: l'24:-262.3 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 A i areria„ 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 ge1:4,“ leid 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 l l No ❑ Brief Description of Proposed Work Residential weatherization/ Air sealing. No structural changes. SITE ID 407174 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 1;a().- P-"� 1/20/2023 Signature of Owner/Agent Date Michele Boothroyd 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 1/20/2023 Signature of Owner Date City of Northampton ?� t SNS sir Massachusetts w� - t' �y I DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 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:3,000 Address of Work: 111 Rick Drive Northampton MA 01062 Date of Permit Application: 1/20/2023 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 TILE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: 1/20/2023 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 `'; (y 1 iff 1 A `. f• DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building J �`d6��' 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: 111 Rick Drive Northampton MA 01062 (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) ,g)0' 'tit) 1/20/2023 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 .a. Massachusetts !<Cal F. DEPARTMENT OF BUILDING INSPECTIONS ' ` 212 Main Street • Municipal Building Northampton, MA 01060 Obn..e ,1 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 111 Rick Drive Northampton MA 01062 Contractor Name: HomeWorks Energy Address: 235 Essex Street City, State: Whitman, MA 02382 Phone: 781-205-4484 N me rty Owner Michele Boothroyd Address: 111 Rick Drive Northampton MA 01062 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 signaturecaiw sis);(4,d- cte,_ Date 1/20/2023 The Commonwealth of Massachusetts Department of Industrial Accidents )i.. fr Office of Investigations (.,\;\\_.. v,i, a Lafayette City Center '` 2 Avenue de Lafayette,Boston,MA 02111-1750 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Homeworks Energy — Address: 235 Essex Street City/State/Zip:Whitman,MA 02382 Phone#: 781-205-4484 Are you an employer? Check the appropriate box: 500+ 4. I am a general contractor and I Type of project(required): 1.Q I am a employer with ❑ employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152,§1(4),and we have no 13. Weatherization employees. [No workers' 0 Other 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: Federated Mutual Insurance Company Policy#or Self-ins. Lic.#:#1847910 Expiration Date: 1/1/2024 Job Site Address:111 Rick Drive Northampton MA 01062 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be 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 certify u�the pains and pe s of perjury that the information provided above is true and correct Signature: ) Date:1/20/2023 Phone#: 781-205-4484 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(check one): 10Board of Health 20 Building Department laity/Town Clerk 4. ❑Electrical Inspector 5.13lumbing Inspector 6.0Other Contact Person: Phone#: ACCORD DATE CERTIFICATE OF LIABILITY INSURANCE 1 12/d012022 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 FEDERATED MUTUAL INSURANCE COMPANY NAME: CLIENT CONTACT CENTER HOME OFFICE:P.O.BOX 328 (A/C,NO,Eel):888-333-4949 NE FAX No):507-446-4664 OWATONNA,MN 55060 ADDRESS:CLIENTCONTACTCENTER@FEDINS.COM INSURER(S)AFFORDING COVERAGE NAIC R INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 419.899-D INSURER B: HOMEWORKS ENERGY,INC. INSURER C: 101 STATION LNDG MEDFORD,MA 02155-5134 INSURER 0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:0 REVISION NUMBER:1 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 SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD IMMIDDIYYYY) (MM/DDiYYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED $100,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) - MED EXP(Any one person) EXCLUDED A N N 1647909 01/01/2023 01/01/2024 PERSONALS ADVINJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $2,000,000 POLICY JECT ! LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 (Ea acddend X ANY AUTO BODILY INJURY(Per person) OWNED AUTOS ONLY SCHEDULED A _AUTOS N N 1847908 01/01/2023 01/01/2024 BODILY INJURY(Wr acddentl HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE AUTOS ONLY (Per accident) X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $1,000,000 A EXCESSLIAB CLAIMS-MADE N N 1847911 01/01/2023 01/01/2024 AGGREGATE $1,000,000 DED RETENTION WORKERS COMPENSATION X PER STATUTE OTH• ER AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT C$500 000 A OFFICERIMEMBER EXCLUDED? _NIA N 1847910 01/01/2023 01/01/2024 E.L.DISEASE-EA EMPLOYEE (Mandatory in NH) $59,000 II yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $JDD 000 DESCRIPTION OF OPERATIONS a LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Sdxdute,may be attached it more space is required) THIS COPY IS NOT TO BE REPRODUCED FOR ISSUANCE OF CERTIFICATES. CERTIFICATE HOLDER CANCELLATION 01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN A CERTIFICATE HAS BEEN FILED WITH EACH OF YOUR CERTIFICATE ACCORDANCE WITH THE POLICY PROVISIONS. HOLDERS. AUTHORIZED REPRESENTATIVE O 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016(03) The ACORD name and logo are registered marks of ACORD '-‘74 ei/LIKa4t4ac...el:;%biet, Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card Registration: 181138 HOME WORKS ENERGY,INC. 023 101 STATION LANDING STE 110 Expiration: 03;`02 MEDFORD,MA 02155 Update Address and Return Card. S$A 1 4 20M-08+17 Office of Consumer Affairs&Business Rogulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card before the expiration date. If found return to Registration gmlratlon Office of Corsurler Affairs and Business Regulation 181138 03102/2023 '000 Washington Street -Sdte713 HOME WORKS[.,NERGY,1NC• Boston,MA 02118 ADAM GLENN 101 STATION LANDING STE 1t0 p.or "— MEDFORD,MA 02155 Not valid without signature Undersecretary Commonwealth of Massachusetts Division of Occupational Licensure Restricted toConstrudion Supervisor Specialty Board of Building Regulations and Standards CSSL.IC •I nsuCation Contr actor Construct ggiti r�S'4-ekr Specialty CSSL-106148 �,. elttoires: 07130!2024 ADAM GLENN i 19 CHARGE POUN WAREHAM 144 ' w failure topossess a current edition of the Massachusetts otJv, ) State(kidding Code is cause for revocation of this ',cense. For information about this license I�.� ^ ^ T�'.7J/l��♦ I`f-- C 727.3200 or visit rvwn mass.gov+dpi COOIMtSSIVIRr r e Insulation/Air Sealing Permit Authorization Specialist: Daniel Macero Company: HomeWorks Energy Email: daniel.macero@homeworksenergy.com Address: 101 Station Landing Cell: 0000000000 Medford, Ma 02155 Phone: 781.305.3319 Customer: Michele Boothroyd Address: 111 Rick Drive Email: micheleboothroyd@gmail.com Northampton, MA, 01062 Site ID: 407174 Phone: 4135860562 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: micheleboothroyd@gmail.com Customer 't,ac ao/ham;; Signature: Date: 11/30/2022 Michele Boothroyd 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. KW WALL AND KW FLOOR Blind Spec? 0 OR '' KW SLOPE AND GABLE END Blind Spec? 0 hy? Why? FRAMING EXISTING SPF.C'ING SQ.FT. FRAMING EXISTING SPEC'INC, SQ.FT. ALL \ X X '°SLOPE X X FLOOR X GABLE X X as O- ACCESS X TRANS X X TRANS., z X t 1 ATTIC J ATTIC Si' X '— r SLOPE x x G VG? W a EXISTING VENTING? a EXISTING PIPES? Y7.14"4.:,;,,_ lii •,,, .�.. " :,,..., '^^...." KW*Mtn; �tem�s;. TempAccess �- xd m x ,ut a s ;�4 ai 4 %4, fib, 2 is S §"� r Gt'sa rs' µQ"d, A KNEEWALL MANDATORY a`Y%!!,/,.'‘•' , , 15",L 4 ': " vi . YFO e"..... p,,,i,..,. i„...., '74. UnAlit d O Y co J�' P-� T ( Insulated wan X X Reed Light O ins.Hose f Vent BF thim,©H Damming IT'Roof V t Ast Handler El TempAccess El PullDownn Hatch WO Hatch '/ Door r/ 8"Root Vent I 0 of: . 058 x x ATTIC 1 Blind Spec? El, X X ATTIC 2 Blind Spec? X s9 a sto P 15• soir, Existing Sp c'in Sq ft . .B to story, c l Existing Spec'ing Unfloored F6 IV.' -" , 9‘OrUnfl ed Multipliers NFloored \ _ Floored musses ros Batting v, Mixed insulation Duct Work Cath Slope Cath Slop '>6"Loose „•a Walls '' Walls Air Sealing riours Access '� ....— — Access /` Ventin, — E Propavents Vent E;[ RI How Damming outing a ravens Vent fir (;f Hose Dantmin(t ns 6.1 'v .►— / i� :VHF[lax: ��y a v 1enip Access: Sheathing Access:� tri SSa it/iGi- • (Euz: t.FA Yenimel• VieeCeC Sa.it/300= _ ft L,Cover'.: J. f:xist,halt Van (Needed Existing Venting? /r yl/r( WA Venting) Existing Venting? NFAVenting) Roof r},P L, tt� %�f7 ' PLAN VIEW z Name: /i ((1P ,gv's n'r"c; Site ID: 1 b1(1 "k Finished Sq. Ft: G 6 cal, Phone: Year of House: /9 7 o Electric Acct#: v Address:l// /Zrc% 1)4/' #of Floors: / Gas Acct#: J�6' 'y`'V7��— Unit#: #Occupants: Housing Type? DUCTWORK INSPECTION Ducts Insulated?0 Duct Linear Ft. /� � , rX i ♦f 4...- 1/6 Duct Square Ft. f . Duct Air Sealing Hours i ,.,....... le Duct Insulation F Duct Insulation Removal z r m a BASEMENT INSPECTION _, Existing Spec'ing Ln/Sq. Ft. v m Bsmt Wall AG " Crawl Ceiling Crawl Rim Joist _,�, . Bsmt RJw/Sill 4 Bsmt RJ NO Sill » ice .. Vaiapir Barrier -; sgft. Bsmt Door . ", YIower Door? WALLS&GARAGE Drill Location? Sidingf C ' ght_ 4�tirJ Spec'ing Sq. Ft. Framing Exterior Wall 1 ' ' ,! x x Ball on/Platform Exterior Wall 2 -.._... .:3117 x x BaQ on/Platform Overhang .1,,„ ' ,Ti..4A4 x x Garage Wall "`,(ice ,; x x Balloon/Platform Garage Ceiling ... X X cc 0 a: cc I i C\ , W w x fi Si Z D tn WORK SPEC'D BUT NOT CONTRACTED AD BLOCKS PRESENT ..{MANDATORY) Attic Basement/Crawlspace Other: K&T Y I N oisture Y/ .;Combustion Sfty Y Kneewall Overhang/Garage Asbestos Y/'. `Mold>1O0 sq. ft Y/,': ,CO Detector Missing Y Ductwork Exterior Walls Vermiculite Y/ Structl Concerns Y/( „Other: Notes for Lead Vendor/Work Not Contracted: HomeWorks Energy iflccrp 1 i 1. 101 Station Landing,Medford MA 02155 CONTRACT - AUDIT HomeWorks 781-305-3319 Page 1 PROGRAM CMA-HPC CUSTOMER PHONE DATE CLIENTS WORK ORDER Michele Boothroyd (413) 586-0562 11/30/2022 407174 00004 SERVICE STREET BILLING STREET PROPOSED BY: 111 Rick Drive 111 Rick Drive HomeWorks Energy SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Florence, MA 01062 Florence, MA 01062 DESCRIPTION OTY COST INCENTIVE TOTAL WEATHERSTRIP AND ADD DOOR SWEEP 2 $115.84 $115.84 Provide labor and materials to install Q-Ion weatherstripping and a doorsweep to door(s)to restrict air leakage. ATTIC FLAT-R-30 UNFACED FIBERGLASS 960 $2,102.40 $1,576.80 $525.60 Provide labor and materials to install a 9" layer of R-30 unfaced fiberglass batts to attic space. 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: $2,246.24 Program Incentive: $1,713.64 Customer Total: $532.60 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Five Hundred Thirty-Two & 60/100 Dollars $532.60 COMPANY REPRESENTATIVE CUSTOMER SIGNATURE 12/12/2022 NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE SIGN DATE DAYS.