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17C-061 (9)
BP-2023-0143 181 CHESTNUT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17C-061-001 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-2023-0143 PERMISSION IS HEREBY GRAN ED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 6732 5C ENERGY INC 106162 Const.Class: Exp.Date: 04/26/2023 HOLLENDER GABRIELL E&CAT INA Use Group: Owner: BESTARD ROTGER Lot Size (sq.ft.) Zoning: URA Applicant: 5C ENERGY INC Applicant Address Phone: Insurance: 3820 DIAMOND HILL RD 774-203-3704 WC928038765994 CUMBERLAND, RI 02864 ISSUED ON: 02/09/2023 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 VI LATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I )2 9V-PIT • • . Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner 4. 0E )6.r PI — +i—� k 00)„ 19d 7 • The Commonwealth of Massachusetts /' I Board of Building Regulations and Standardsv J NICIPALITY Massachusetts State Building Code, 780 CMR ?0 USE Building Permit Application To Construct, Repair, Renovate/Or Demolish a Revised Mar 21011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: 3 0' �"/443 /Date Applied: ,ems, J on / 1 Z 2-4-ZZ3 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 181 CHESTNUT STREET I7C 061-001 1.1a 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 10 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: GABRIELLE HOLLENDER FLORENCE,MA.01062 Name(Print) City,State,ZIP 181 CHESTNUT STREET 413-588-8014 GHOLLENDER@GMAIL.COM No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) j New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 cify`INSUEATION/WEATHERIZATION� Brief Description of Proposed Work: P i T SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 6,732.39 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2. Electrical $ ❑Total Project Costa (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees:g 1 tt6 6. Total Project Cost: $ Check No.4� Check Amount: Cash Amount: 6,732.39 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 106162 04/26/2023 MATTHEW RUSSELL License Number Expiration Date Name of CSL Holder R 3820 DIAMOND HILL ROAD List CSL Type(see below) No.and Street Type Description CUMBERLAND, RI 02864 U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted 1&2 Family Dwelling M Masonry RC Roofmg Covering WS Window and Siding SF Solid Fuel Burning Appliances 774-203-3704 Maryann@ 5CEnergyinc.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 195309 04/1 /2023 MATTHEW RUSSELL HIC Registration Number Exp. Lion Date HIC Company Name or HIC Registrant Name 3820 DIAMOND Hp I ROAD Ma ann@5CEner inc.co No.and Street Email address CUMBERLAND, RI 02864 774-203-3704 City/Town, State,ZIP Telephone SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.g 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 123 No ❑ 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 MATTHEW RUSSELL to act on my behalf,in all matters relative to work authorized by this building permit application. PLEASE SEE ENCLOSED AUTHORIZATION 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 con••9 n this application is true and accurate to the best of my knowledge and understanding. Alf, MATTHEW RUSSELL 1/30/23 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/tips 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" I City of Northampton oaS�M,o„ +/;,.. di,, Sys S�cc V L\ Massachusetts mow{ 1._ 'e, w 4I � gr DEPARTMENT OF BUILDING INSPECTIONS P. + r* 212 Main Street • Municipal Building yJti L4 .a' Northampton, MA 01060 �Sp ‘'‘ CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, 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: 330 VICTOR ROAD,ATTLEBORO,MA.02703 Location of Facility: The debris will be transported by: 5C ENERGY,INC. Name of Hauler: 1/30/23 Signature of Applicant: Date: mass save Weatherization barrier incentives Based on your Energy Specialist's recommendations,your home can benefit from program-eligible insulation and/or air sealing improvements,Before moving forward,please follow all the instructions below to remediate your weatherization barriers. CUSTOMER INSTRUCTIONS 1. IHlre a qualified,licensed contractor to evaluate and/or remediate the weatherization barrier(s). 2. Submit signed and completed copies of this form and a copy of the paid contractor invoice(s)within 60 days of your Home Energy Assessment to RISE Engineering 1341 Elmwood Ave,Cranston,RI 02910 or email to EversourceInfa@RISEenpi 1eering.corn. 3. The weatherization incentive will be deducted from the customer co-payment amount of the weatherization work.A rebate check will be issued in the event the amount exceeds the customer's co-payment amount. 4. Complete the recommended weatherization improvements. 6. The Mass Save*HEAT Loan offers interest-free financing opportunities that may be used to remediate eligible weatherization barriers. Learn more at rnasssave.com/en/saving/residential-rebates/heat-loan-program ' STCrMEi N.F 9RMATi'p .` . Customer Name: Gabrielle Hollender Client#or Site ID: 495148 Site Address: 181 Chestnut Street City: Florence State: ZIP: 01062 Phone Number: 413.588-Q014 mail: ghollender@9mail.com / 'I 7 A.3 . fNOSA DI WIRING Cup`to1250Incentive) • To determine if there is any active knob and tube wiring,the contractor will evaluate the following areas where eligible Mass Save' weatherization recommendations have been made: Qs Attic Floor VAttic Wall Attic Slope ie Exterior Wall 121 Basement Other:CRAWL Q Other. V NIIJ ,:: kl-er;CRAWL 0 Other: 7 { High Carbon Monoxide:Contractor is to service and re-evaluate the selected mechanical system(s)and reduce the carbon 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_ prot Failure Ex : tq CO F,:srn: ! CO n:m E,K r.0 u} .. cv...w' D of.t Pc Heating System Hot Water HeaterOther: Spillage:Contractor is to correct the spillage of flue gases in the selected mechanical system(s).Must not spill after 60 seconds of operation. Q 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. Invoice _._, k { Mike Long P.O. Box 0931 Date Invoice # 1,` .T R I L.I A N .£ -,„ Northampton,MA 4/20/2021 6228 A PRO ECECTRICAE CONTRACTOR 01 061 Bill To Gabby Hollender 181 Chestnut Street • Florence, MA 01062 Project Terms Due Date Knob and Tube Contract Due on receipt 4/20/2021 Item Quantity Description Rate Amount Electrical Labor 5.5 Electrical Labor Standard Rate -- 03-18-20 65.00 357.50 Electrical Labor 4 Electrical Labor Standard Rate -- 03-19-20 65.00 260.00 Electrical Labor 6.25 Electrical Labor Standard Rate -- 03-27-20 65.00 406.25 Electrical Labor 6 Electrical Labor Standard Rate -- 03-30-20 65.00 390.00 Electrical Labor 6 Electrical Labor Standard Rate-- 03-31-20 65.00 390.00 Electrical Labor 5 Electrical Labor Standard Rate -- 04-01-20 65.00 325.00 Electrical Labor 5 Electrical Labor Standard Rate-- 04-02-20 65.00 325.00 Electrical Labor 4.5 Electrical Labor Standard Rate-- 04-03-20 65.00 292.50 Electrical Labor 5 Electrical Labor Standard Rate --04-27-20 65.00 325.00 Electrical Labor 4 Electrical Labor Standard Rate -- 04-29-20 65.00 260.00 Electrical Labor 4.75 Electrical Labor Standard Rate -- 04-30-20 65.00 308.75 Electrical Labor 3.5 Electrical Labor Standard Rate-- 05-01-20 65.00 227.50 Electrical Labor 5.5 Electrical Labor Standard Rate-- 05-04-20 65.00 357.50 Electrical Labor 6 Electrical Labor Standard Rate-- 05-05-20 65.00 390.00 Electrical Labor 5.75 Electrical Labor Standard Rate --05-06-20 65.00 373.75 Electrical Labor 5.5 Electrical Labor Standard Rate-- 05-07-20 65.00 357.50 Electrical Labor 6.5 Electrical Labor Standard Rate -- 05-08-20 65.00 422.50 Electrical Labor 5 Electrical Labor Standard Rate-- 05-12-20 65.00 325.00 Electrical Labor 6.25 Electrical Labor Standard Rate --05-13-20 65.00 406.25 Electrical Labor 5 Electrical Labor Standard Rate -- 05-14-20 65.00 325.00 Electrical Labor 6 Electrical Labor Standard Rate -- 05-15-20 65.00 390.00 Total Thank you for your business! Payments/Credits Balance Due Phone # E-mail Web Site (413) 584-7665 MikeLongProgressiveElectric@msn.com MikeLongProgressiveElectric.com Page 1 Invoice 7e Date Invoice # Mike Long P.O. Box 0931 E t E('TILCLAN i Northampton, MA 4/20/2021 6228 A PRO ELECTRICAL CONTRACTOR 01 061 Bill To Gabby Hollender 181 Chestnut Street • Florence, MA 01062 Project Terms Due Date Knob and Tube Contract Due on receipt 4/20/2021 - Item Quantity Description Rate Amount Electrical Labor 5 Electrical Labor Standard Rate --05-18-20 65.00 325.00 Electrical Labor 3.5 Electrical Labor Standard Rate-- 05-19-20 65.00 227.50 Electrical Labor 5.5 Electrical Labor Standard Rate-- 05-20-20 65.00 357.50 Electrical Labor 4.5 Electrical Labor Standard Rate-- 05-21-20 65.00 292.50 Electrical Labor 3 Electrical Labor Standard Rate -- 05-22-20 65.00 195.00 Electrical Labor 5.5 Electrical Labor Standard Rate -- 05-26-20 65.00 357.50 Electrical Labor 3 Electrical Labor Standard Rate-- 05-27-20 65.00 195.00 Electrical Labor 4 Electrical Labor Standard Rate -- 05-28-20 65.00 260.00 Electrical Labor 4 Electrical Labor Standard Rate--05-29-20 65.00 260.00 Electrical Labor 4.5 Electrical Labor Standard Rate -- 06-01-20 65.00 292.50 Electrical Labor 5 Electrical Labor Standard Rate-- 06-02-20 65.00 325.00 Electrical Labor 2.75 Electrical Labor Standard Rate -- 06-03-20 65.00 178.75 Electrical Labor 4 Electrical Labor Standard Rate -- 06-04-20 65.00 260.00 Electrical Labor 0.75 Electrical Labor Standard Rate-- 06-05-20 65.00 48.75 Electrical Labor 2.5 Electrical Labor Standard Rate -- 06-11-20 65.00 162.50 Electrical Labor 3.25 Electrical Labor Standard Rate-- 06-22-20 65.00 211.25 Electrical Labor 3 Electrical Labor Standard Rate -- 06-23-20 65.00 195.00 Electrical Labor 4.5 Electrical Labor Standard Rate --06-28-20 65.00 292.50 Electrical Labor 3 Electrical Labor Standard Rate --06-29-20 65.00 195.00 Electrical Labor 2 Electrical Labor Standard Rate-- 06-30-20 65.00 130.00 Electrical Labor 2 Electrical Labor Standard Rate-- 07-01-20 65.00 130.00 Total Thank you for your business! Payments/Credits Balance Due Phone # E-mail Web Site (413) 584-7665 MikeLongProgressiveElectric@msn.com MikeLongProgressiveElectric.com Page 2 Invoice r' Mike Long P.O.Box 0931 Date Invoice # Il\`'' T RI c A N Northampton,MA 4/20/2021 6228 A PRO ELECTRICAL CONTRACTOR 01 061 Bill To Gabby Ilollender 181 Chestnut Street • Florence, MA 01062 Project Terms Due Date Knob and Tube Contract Due on receipt 4/20/2021 Item Quantity Description Rate Amount Electrical Labor 1.25 Electrical Labor Standard Rate -- 07-03-20 65.00 81.25 Electrical Labor 3 Electrical Labor Standard Rate -- 07-09-20 65.00 195.00 Electrical Labor I Electrical Labor Standard Rate-- 07-10-20 65.00 65.00 Electrical Labor 2.25 Electrical Labor Standard Rate-- 07-15-20 65.00 146.25 Electrical Labor 0.5 Electrical Labor Standard Rate -- 07-16-20 65.00 32.50 Electrical Labor 2 Electrical Labor Standard Rate -- 09-30-20 65.00 130.00 Electrical Labor 3 Electrical Labor Standard Rate-- 10-06-20 65.00 195.00 Electrical Labor 2.5 Electrical Labor Standard Rate -- 10-08-20 65.00 162.50 Electrical Labor 0.5 Electrical Labor Standard Rate -- 10-09-20 65.00 32.50 Electrical Labor 5 Electrical Labor Standard Rate-- 10-15-20 65.00 325.00 Electrical Labor 1.5 Electrical Labor Standard Rate-- 12-11-20 65.00 97.50 Electrical Labor 4 Electrical Labor Standard Rate-- 03-24-21 65.00 260.00 Electrical Labor 3.5 Electrical Labor Standard Rate--04-15-21 65.00 227.50 Electrical Labor 1 ElectricaI Labor Standard Rate-- 04-19-21 65.00 65.00 Parts Wire,boxes, devices, conduit, connectors, main 1,850.00 1,850.00 panel, ground rods and connectors,doorbell kit, breakers, closet lights,LED lighting, Stealth Motion light, dimmer switch, misc. Permit City of Northampton 185.00 185.00 Total $16,156.25 Thank you for your business! Payments/Credits -$15,211.25 Balance Due $945.00 Phone # E-mail Web Site (413) 584-7665 MikeLongProgressiveElectric@msn.cam MikeLongProgressiveElectric.com Page 3 RESIDENTIAL PROPERTY RECORD CARD 2023 NORTHAMPTON Situs 181 CHESTNUT ST Map ID: 17C-061-001 Class:Single Family Residence 1 Card:1 of 1 Printed: December 22,2022 CURRENT OWNER GENERAL INFORMATION HOLLENDER GABRIELL E&CATALINA Living Units 1 BESTARD ROTGER Neighborhood 5 181 CHESTNUT ST Alternate Id E y �s FLORENCE MA 01062 Vol/Pg 13504/193 ; �.:f District '" r Zoning a a , Class Residential a ig Property Notes , i _l os • Land Information Assessment Information Type Size Influence Factors Influence% Value Assessed Appraised Cost Income Primary Sf SF 27,720 141,000 Land 141,000 141,000 141,000 0 132,200 Building 226,300 226,300 216,300 0 153,400 Total 367,300 367,300 357,300 0 285,600 Manual Override Reason Base Date of Value 2023 Value Flag MARKET APPROACH Effective Date of Value 1/1/2022 Total Acres:.6364 Gross Building: Spot: Location: Entrance Information Permit Information Date ID Entry Code Source Date Issued Number Price Purpose %Complete 09/30/20 KB Info At Door Owner 07/20/21 0063 8,999 AL/RN-R Repair Existing Chimney#1 And I 11/06/99 AD Unoccupied Convert From Univers 09/21/20 0189 2,000 AD/AL/RN-R Remove Side Prch,Replace With I 10/06/99 AD Unoccupied Owner 05/17/07 1117 5,318 BLDG Remo Porch 0 tl Sales/Ownership History — Transfer Date Price Type Validity Deed Reference Deed Type Grantee 12/31/19 275,000 Land+Bldg Valid Sale 13504/193 Quit Claim HOLLENDER GABRIELLE E&CATALINA 4.#c ro mass save Savings through energy efficiency PERMIT AUTHORIZATION FORM 1, Gabrielle Hollender owner of the property located at: (Owner's Name) 181 Chestnut Street Florence (Property Street Address) (City) hereby authorize the Mass Save® Home Energy Services Program assigned Participating Contractor to act on my behalf and obtain a building permit to perform insulation and/or weatherization 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. yam, C . Own s Signature 1/16/23 Date FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: 5C ENERGY INC. 1/30/23 Participating Contractor Date WEATHERIZATION CONTRACT EVERSIURCE CUSTOMER PHONE DATE CUENTN WORK ORDER Gabrielle Hollender (413) 588-8014 01/08/2023 495148 38508 SERVICE STREET BILLING STREET PROPOSED BY: 181 Chestnut Street 181 Chestnut Street Daniel Diaz SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Program Florence, MA 01062 Florence, MA 01062 EGMA-HES Page 1 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. KNOB&TUBE WIRING(Northhampton) We have identified that your home might have Knob &Tube wiring Gil (initials) 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. II PERFORM AIR SEALING AT ESTIMATED 62.5 CFM50 PER HO 4 $377.32 $377.3 Seal areas of your home against wasteful, excessive 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.) EXTERIOR DOOR WEATHER STRIPPING 2 $63.62 $63.62 Provide labor and materials to install Q-Ion weatherstripping to door(s)to restrict air leakage. DOORSWEEP 3 $78.33 $78.33 Provide labor and materials to install a doorsweep to restrict air leakage. DAMMING 36 $88.20 $66.15 $22.05 Provide labor and materials to install an approved damming material in the attic ATTIC FLOOR OPEN BLOW CELLULOSE 10" 406 $844.48 $633.36 $211.12 Provide labor and materials to install a 10" layer of R-37 Class I Cellulose to open attic space. ATTIC FLOOR ENCLOSED CELLULOSE DENSE PACK 5" 406 $941.92 $706.44 $235.48 Provide labor and materials to install a 5" layer of R-16 Class I Cellulose to floored attic space. INSULATE VAULTED ROOF FROM INTERIOR WITH 4" DENSE 225 $544.50 $408.38 $136.12 Provide labor and materials to install blown in Class I Cellulose to vaulted walls through an interior surface drill and plug method. Plugs will be spackled and left with a rough finish. Finish sanding and touch- up priming/painting will be the customer's responsibility. Homeowner has received a copy of the EPA's Renovate Right Lead-Safe • WEATHERIZATION CONTRACT EVERS- URCE CUSTOMER PHONE DATE CLIENT N WORK ORDER Gabrielle Hollender (413) 588-8014 01/08/2023 495148 38508 SERVICE STREET BILLING STREET PROPOSED BY: 181 Chestnut Street 181 Chestnut Street Daniel Diaz SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Program Florence, MA 01062 Florence, MA 01062 EGMA-HES Page 2 DESCRIPTION QTY COST INCENTIVE TOTAL information guide explaining the potential risk of the lead hazard exposure from the weatherization work to be performed. Your signature is your acknowedgement of receipt and agreement to proceed. HATCH:THERMAL BARRIER POLYISO 2 INCH (ATTIC) 1 $47.37 $35.53 $11.84 Provide labor and materials to insulate the back of an attic hatch with 2" rigid insulation board at R-10. SHEATHING ACCESS 2 $81.60 $61.20 $20.40 Provide labor and materials to make an access opening from one attic area to another by cutting a passage through sheathing. This access will be left open as it is between two common unheated non firewalled attic areas. INSULATE CLAPBOARD SIDED WALL WITH 4" DENSE PACK C 294 $761.46 $571.10 $190.36 Provide labor and materials to install blown in Class I Cellulose to clapboard sided exterior walls. Touch-up painting, if needed,will be the customer's 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 weatherization work to be performed. Your signature is your acknowedgement of receipt and agreement to proceed. WALLS-ASBESTOS SIDED 4" 480 $1,641.60 $1,231.20 $410.40 Provide labor and materials to install blown in Class I Cellulose to asphalt-sided exterior walls. Touch-up painting, if needed,will be the customer's 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 weatherization work to be performed. Your signature is your acknowedgement of receipt and agreement to proceed. BASEMENT SILLS-RIGID BOARD INSULATION 21 $102.27 $76.70 $25.57 Provide labor and materials to install rigid board insulation to the perimeter of the basement ceiling at the house sill. INSULATE RIM JOIST WITH 6.25" FIBERGLASS BATTING 48 $129.12 $96.84 $32.28 Provide labor and materials to install R-19 unfaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. 6 MIL POLY VAPOR BARRIER 70 $71.40 $71.40 Provide labor and materials to install 10 ml polyethylene over open ground in designated crawlspace/earthen basement areas. WEATHERIZATION CONTRACT EVERS'eURCE CUSTOMER PHONE DATE CUENT N WORK ORDER Gabrielle Hollender (413) 588-8014 01/08/2023 495148 38508 SERVICE STREET BILLING STREET PROPOSED BY: 181 Chestnut Street 181 Chestnut Street Daniel Diaz SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Program Florence, MA 01062 Florence, MA 01062 EGMA-HES Page 3 DESCRIPTION QTY COST INCENTIVE TOTAL INSTALL 2"THERMAL BARRIER POLYISO ON OPEN WALL 192 $931.20 $698.40 $232.80 Provide labor and materials to install 2"rigid insulation board to the open wall. REPLACE BATH FAN HOSE 1 $28.00 $21.00 $7.00 Provide labor and materials to install an insulated 4"exhaust hose to existing bathroom fan(s). ASBESTOS PRECAUTION A blower door diagnostic test will not be conducted at your home, as a precaution for the presense of steam heating(past or present)that was most likely insulated with asbestos. LEAD PAINT Your home was built prior to 1978 and might have lead-based paint UGH (initials) present. You have received a copy of the EPA's Renovate Right pamphlet informing you of the potential risk of a lead hazard exposure from the renovation activity to be performed at your home. Total: $6,732.39 Program Incentive: $5,196.97 Client Total: $1,535.42 I.DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the above work at the Client's Address in a professional manner and in accordance with the terms of this Contract II.PAYMENT Client agrees to pay the Contractor for the Work,the Client Share of the Contract Cost is payable to the Independent Installation Contractor(IIC)upon satisfactory completion of the Work.Client understands that they will not be required to pay the Program Incentive Share of the Contract cost.Changes to the individual line items d nd/or previous incentives may in�creaa�see/or decrease the size of the Program Incentive Share. Pia� RISE Representative C len Signature Daniel Diaz 1/16/23 Printed Name Date of Acceptance The Commonwealth of Massachusetts ► Y` 1. Department of Industrial Accidents = � 1 Congress Street,Suite 100 , 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):5C Energy, Inc Address:330 Victor Rd. Bldg A City/State/Zip:Attleboro, MA 02703 Phone #: 774-203-3704 Are you an employer?Check the appropriate box: Type of project(required): 113 I am a employer with 25 employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling viy capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself[No workers'comp.insurance required.] 9. ❑Demolition 10❑Building addition 4.❑I 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 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.El 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.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. 13 Other Insulation 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *My 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. lithe 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: ARGONAUT INSURANCE COMPANY Policy#or Self-ins.Lic.#: WC928038765994 Expiration Date:12/27/2023 X 181 CHESTNUT STREET FLORENCE,MA. 1062 Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expira ion date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fme 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 fme of up $250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for urance coverage verification. I do hereby certi u er the p ins and penalties of perjury that the information provided above is true and correct. Signature: Date: 1/30/23 Phone: 774-203-3704 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#: ACc RD® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 12/28/2022 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 Rosa lynn Davila NAME: Loiselle Insurance Agency PHONE (401)723-8510 FAX (401)728-1820 (A/C,No,Ext): (NC,Nog 279 Dexter Street E-MAIL rosal nn loiselleinsurance.com ADDRESS: y P.O.Box 1148 INSURER(S)AFFORDING COVERAGE NAIC if Pawtucket RI 02862-1148 INSURER A: Employers Mutual Casualty Co 21415 INSURED INSURER B: EMC Prop&Cas Ins Co 25186 5C ENERGY,INC. INSURER C: Argonaut Insurance Co ARGO 330 VICTOR RD-BUILDING A INSURER D: RISCO RISCO INSURER E: ATTLEBORO MA 02703-6294 INSURER F: COVERAGES CERTIFICATE NUMBER: Master:2022 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.LIM ITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADULSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 RENTED CLAIMS-MADE X OCCUR PREMISESDAMAGE TO(Ea occurrence) $ 500,000 — MED EXP(Any one person) $ 10,000 A 5D98024 12/27/2022 12/27/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY n PEQ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ 20,000 B OWNED �/ SCHEDULED 5Z98024 12/27/2022 12/27/2023 BODILY INJURY(Per accident) $ 40,000 AUTOS ONLY _ AUTOS X HIRED ON �/ NON-OWNED LY AUTOS ONLY PROPERTY DAMAGE (Per accident) $ 5,000 AUT _ Uninsured motorist B> $ 1,000,000 X UMBRELLA LIAB — OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LIAB • CLAIMS MADE 5J98024 12/27/2022 12/27/2023 AGGREGATE $ 3,000,000 DED X RETENTION $ 10,000 $ WORKERS COMPENSATION PER OTH-. AND EMPLOYERS'LIABILITY STATUTE ER Y/N 1 C ANY PROPRIETOR/PARTNER/EXECUTIVE Y N/A WC928938765994 12/27/2022 12/27/2023 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 $ D Contractors Pollution Liability CPLMOL107038 06/16/2021 06/16/2023 Aggregate $250,000 Eeach Occurrence $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If 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. AUTHORIZED REPRESENTATIVE I N L" 1114° ii,44. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NO DEBRIS INSULATION ONLY DEBRIS DISPOSAL AFFIDAVIT In accordance with the provisions of M.G.L. c. 40, s. 54, Building Permit # n/a was issued with the condition that all debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L c. 111, s. 150A. The debris will be disposed of in: 5C Energy, Inc. Name of Waste Facility 330 Victor Road, Attleboro, MA 02703 Address of Waste Facility 111.5 Debris: As a condition of issuing a permit for the demolition, renovation, rehabilitation or other alteration of a building or structure, M.G.L. c. 40 s. 54 requires that the debris resulting therefrom shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L.c. 111 s. 150 A.Signature of the permit applicant, date and number of the building permit to be issued shall be indicated on a form provided by the Building Department and attached to the office copy of the building permit retained by the Building Department. If the debris will not be disposed of as indicated, the holder of the permit shall notify the building official, in writing, as to the location where the debris will be disposed. 780 CMR—6th Edition 61461— Signature of Permit Applicant I/30/23 Date 117 Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards ConstructionSupervisor Specialty CSSL-106162 Expires : 04/26/2023 MATTHEW J RUSSELL ,, 3820 DIAMOND HILL RD "' CUMBERLAND RI 02864 I le at !1 zs Nee 4 Commissioner ,,, 4.k..4fru--4---_ Construction Supervisor Specialty Restricted to: CSSL-IC - Ins'. ation Contractor Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call (617) 727-3200 or visit www.mass.gov/dpl 1 11 . / -P/1//i/ v/f/e/Y1-/'/ ./ .J fi/7-.)-3c-/-/ 4/ Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 0211 a,- Home Improvement Contractor Regis ----- 's- - - -- ' - -- -- - -- - ' ----- -"---- ..,, - _ Type: individual Registration: 195309 , MATTHEW RUSSELL -- Expiration: 04/18;2023 ------- • - ._. - -,-,,--„_ 3820 DIAMOND HILL RD , CUMBERLAND, RI 02864 . .„. Update Address and Return Card. SC ' 0 20M-05-1' .gee, Kre,,,66-irv././Yiezi& VI /(e../...-......7.2.44,-,17-; Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use on ly TYPE: indwduai before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation /95309 0418,2023 1000 Washington Street -Suite 710 Boston,MA 021 MATTHEW RUSSELL- ...0 -I-THEW RUSSELL 3820 DIAMOND HILL RD ii,S,xiii- . ' ' - -- Not valid without signature CUMBERLAND. RI 02864 Undersecretary THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington,Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration V £ _sp �. nR - _ k Type: Corporation Registration: 194390 5C ENERGY, INC. Expiration: 01/30/2025 330 VICTOR ROAD i' ` ATTL EBORO, MA 02703 • • rr 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 Reglstratign Expiration 1000 Washington Street -Suite 710 194390 01/30/2025 ,MA 02118 5C ENERGY,INC. WALTER R.COLWELL /f/r1""-- 18 GREYSTONE ROAD ��,,,.�✓C�. /i,G(.w4". _ MARBLEHEAD,MA 01945 Undersecretary Not valid without signature