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23A-270 (4) BP-2023-0286 45 MIDDLE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23A-270-001 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-2023-0286 PERMISSION IS HEREBY GRANTED TO: Project# insulation 2023 Contractor: License: Est.Cost: 7000 CLEAN TECH CONSTRUCTION 106229 Const.Class: Exp.Date: 01/05/2026 Use Group: Owner: M WALLACE JENNIFER Lot Size (sq.ft.) Zoning: URB Applicant: CLEAN TECH CONSTRUCTION Apulicant Address Phone: Insurance: 40 MESSINA DR 508-576-1026 6hub4n60130822 BRAINTREE, MA 02184 ISSUED ON: 03/09/2023 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 VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I 511.7 • 11' • >2 . Fees Paid: S65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner mot, ("/ (2 lfl 7 'f 03kt Pi (Zi ace9" Igab A'; Department use only City of Northampton "�-�.___ = 7? FOR Building Department BAR 212 Main Street - 8 2023 r.. � A Room 100 INSULA TIO N Northampton, MA 01060 -� _.r.-+ phone 413-587-1240 Fax 413-587-127 OIVL_ 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 45 Middle St Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Jennifer Wallace 45 Middle St Name(Print) Current Mailing Address: See Attached 917 817-7719 Telephone Signature 2.2 Authorized Agent: Elvis Verdezoto 40 Messina Drive Braintree, MA 02184 Name(Print) Current Mailing Address: 1/a ��at 508-576-1026 Signature Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $7,000.00 (a)Building Permit Fee • 2. Electrical (b)Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 49 4. Mechanical (HVAC) (J 5. Fire Protection 6. Total = (1 +2+ 3+4 + 5) $7,000.00 Check Number i 77 0 This Section For Official Use Only Building Permit Number: 1'2"'6)---5 — 2 w Date Issued: Signature: /! /i 1-20Z3 Building Commissioner/Inspector of Buildings Date CLEANTECHCONSTRUCTION1211 @ GMAIL.COM EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Ar SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder:Elvis Verdezoto 106229 License Number 40 Messina Drive Braintree, MA 02184 01/05/2026 Address Expiration Date / ��at 508-576-1026 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable El Clean Tech Construction 196071 Company Name Registration Number 40 Messina Drive Braintree, MA 02184 06/27/2023 Address Expiration Date t/A- JoZ Telephone 508-576-1026 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 171 1 No ❑ Brief Description of Proposed Work Residential weatherization/ Air sealing. No structural changes. Elvis Verdezoto 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. Elvis Verdezoto Print Name Aga IS)7,1r49 Signature of Owner/Agent Jennifer Wallace as Owner of the subject property hereby authorize Clean Tech Construction to act on my behalf, in all matters relative to work authorized by this building permit application. See Attached ��C���ns ar Signature of Owner City of Northampton Q[HAMp)o� ,s..... S, �. �'' :, Massachusetts ,4t.• .- ee / ti� io N; `� �` j DEPARTMENT OF BUILDING INSPECTIONS 6v ' ,- r " 212 Main Street • Municipal Building y.. t Northampton, MA 01060 j.friii•. `.. 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:$7,000.00 Address of Work:45 Middle St 111111111111111 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 THE 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: Elvis Verdezoto 196071 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 YH�M - k5.....`L...,,S� � •.' �,. Massachusetts ���' �. '''•!t,. , DEPARTMENT OF BUILDING INSPECTIONS y (� 1 212 Main Street •Municipal Building '- ca Northampton, MA 01060 J'3''qv TO' 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: 45 Middle St (Please print house number and street name) Is to be disposed of at: Not Applicable (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Signature of Permit Aplicant or Owner D e 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 • Massachusetts 4'. \ DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 fit' ?'?% MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 45 Middle St Contractor Name: Clean Tech Construction Address: 40 Messina Drive City, State: Braintree, MA 02184 Phone: 508-576-1026 Property Owner Jennifer Wallace Name: Address: 45 Middle St City, state: Northampton, MA 01060 Elvis Verdezoto (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 /aAcier' Date A 2 el The Commonwealth of Massachusetts Department of Industrial Accidents _3.1 I Ir Office of Investigations = 61=c 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): Clean Tech Construction Address: 40 Messina Drive City/State/Zip:Braintree,MA 02184 Phone #:508-576-1026 Are you an employer? Check the appropriate box: Type of project(required): 1.❑■ I am a employer with 16 4. ❑ I am a general contractor and I 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 workingfor me in anycapacity. 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 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no Insulation employees. [No workers' 13. Other comp. insurance required.] *Any applicant that checks box#I 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: Traveler's Indemnity Co of America Policy#or Self-ins. Lic. #:6HUB4N60130820 Expiration Date: 9/18/2023 Job Site Address: 45 Middle St City/State/Zip:Northampton, MA 01060 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 under the pains and penalties of perjury that the information provided above is true and correct. Signature: ,. /g7/ Phone#: 508-576-1026 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): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Rnstcxl, Massachusetts 02118 Home Improvement Contractor Registration 1» ..._._ „ :ir, � Twit Si �i' m Card _._........== 1...__.._ . s r?l 196071 CLEAN TECH CONSTRUCTION LLC _ 0627'2323 19O FEi3ttMALAVE == Z. : -- -.• QUINCY. MA 02168 vilk _ A= — .me. e. • =IMMO Mg. fop IMMM•10111•11• I-. Nrp4r. A. 44! UP Update Address and Return Card. THE COMMONWEALTH Of MASSACHUSETTS QS1Ce of ConsuntarAttalsa&Bigness Requtmion Registration veld br tlfQyidJt4use only before the HOME IMPROVEMENT CONTRACTOR expiration nat►_ It found serum to: TYPE.Suooe:n&u Card Offits d Consumer Affairs and Business Regulation Registration Eliolrl i n 1000 Washington Sttteet -Suite 710 171 06.?7 '1113 Boston,MA 02111 CLEAN TECH CONSTRUCTION Li.0 ELVIS VEROE�OTQ __�Gvtic4- •42,LeZ O� 190 FE DaVAL AVE .r OUINCY,MA 02169 Undersecretary Not valid without signature Commonwealth of Massachusetts Construction Supervisor Specialty Division of Occupational Licensure Board of Building Regulations and Standards ill Restricted to: Constructu�upertokgr Specialty CSSL-IC-Insulation Contractor s 1 CSSL-106229 F spires 01/05/2026 ELVIS 0 VERpEZOTO 16 ALSOP STREET APT 2 FALL RIVER MA 02723 6 1 ! • Failure to possess a current edition of the Massachusetts Commissioner ':c„a, f�_ 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 DATE(MMIDD/YYYY) ACOREP CERTIFICATE OF LIABILITY INSURANCE �./ 09/20/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Cathy Bentley AP INSURANCE GROUP AGENCY INC INC"No.Ext: (508)992-3130 FAX (A/C,No): ADDRess: cathy@apinsgroup.com 276 ALDEN RD INSURER(S)AFFORDING COVERAGE NAIC# FAIRHAVEN MA 02719 INSURERA: TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED INSURER B: CLEAN TECH CONSTRUCTION LLC INSURERC: INSURER D: 40 MESSINA DRIVE INSURERE: BRAINTREE MA 02184 INSURER F: COVERAGES CERTIFICATE NUMBER: 815971 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 POUCY EFF POUCYM/ EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MDD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE $ CLAIMS-MADE OCCUR PREMISESO(EaED occuErrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS N/A BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE EL.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? N/A N/A N/A 6HUB4N60130822 09/18/2022 09/18/2023 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CLEAN TECH CONSTRUCTION LLC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 40 MESSINA DRIVE AUTHORIZED REPRESENTATIVE BRAINTREE,MA 02184 n‘j Daniel M.Cro y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD DATE(MM/DD/YYYY) ACORN` CERTIFICATE OF LIABILITY INSURANCE 09r09/22 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Tobman,Molignano&Weiner Ins Agency (Arc.No Ext): 617-471-1123 F. No): 617-773-2474 21 McGrath Highway,Suite 303 E-MAIL Quincy,MA 02169 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Norfolk&Dedham Mutual INSURED INSURER B: Clean Tech Construction LLC INSURER C: 40 Messina Drive INSURER D: Braintree,MA 02184 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 ADDLEUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE T $ 1,000,000 RETED CLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) $ 300,000 M ED EXP(Any one person) $ 5,000 A P012011894 09/18/22 09/18/23 PERSONAL 8 ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JET ❑LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A - OWNED X SCHEDULED AUTOS ONLY AUTOS 91972894A 09/16/22 09/16/23 BODILY INJURY(Per accident) $ X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 A - EXCESS LIAB CLAIMS-MADE U2003464A 09/18/22 09/18/23 AGGREGATE $ 2,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEn N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 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 Clean Tech Construction LLC ACCORDANCE WITH THE POLICY PROVISIONS. 40 Messina Drive Braintree,MA 02184 AUTHORIZED R ENTATIVE I _ ©1 -2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD mass save 2022 weatherization barrier clearing Based on your Energy Specialist's recommendations,your home can benefit from program-eligible insulation and/or air sealing improvements,Before moving forward,please see the steps below to romedlate your woatherization barrlar(s), CUSTOMER INSTRUCTIONS 1. A qualified,licensed contractor will be assigned to evaluate your weatherization barriers)at no cost to you and will call to schedule, 2.The contractor will complete and submit a copy of this form,If the contractor Is unable to clear the barrier,the contractor will provide you a quote for additional services and/or parts, It Is recommended to get multiple quotes for work needed beyond the evaluation visit, You are not required to use the assigned contractor for remediet/on CUSTOMER INFORMATION(To be completed by Energy Specialist) Owner Name: JENNIFERWALLIcE _ project 1p(a): 4714024 _ Owner Occupied:El Number of Units: Phone Number; Emepl Iw653@nyu.edu eAddresss:45 MIDDLE ST P - _ .__... . .------ tereaervke ._ city: THAMPTQN stotete: MA ZIP:T Owner Signature:._ Jeuiufei Wi►llua Date: 01 / 17/2023 KNOB AND TUBE WIRING OR RECESSED LIGHTING EVALUATION To determine If there Is any active knob and tube(KW)wiring,a MA licensed electrician will evaluate the following areas where eligible Mass Save°weatherization recommendations have been made: Energy Specialist Evaluation:K&T evaluation Is needed In the following areas Crawlspace Exterior Wall O Live O Live 0 Live OLive 0 Live 0 Live O Live hive V Not Live *Not Live 0 Not Live ONot Live 0 Not Live ONot Live ONot Live Not Live Notes: BACK STICK FRAME SECTION OF THE HOMt If you decide to have any lighting fixtures covered or made in contact with insulating materials,a MA licensed electrician must certify that all fixtures located In the areas indicated below are insulated contact(IC)rated, Energy Specialist Evaluation:IC rated recessed light verification is needed In the following areas Open Attic Enclosed Floor Cavity Enclosed interior Slope All Roomed Lights O Qty. ,_ _ O Qty, __ O Qty._ . O Qty. -_ O IC Rated 0 IC Rated O IC Rated 0 IC Rated Q Not IC Rated 0 Not IC Rated 0 Not IC Rated 0 Not IC Rated Cif I have read and agree to the Terms and Conditions on the back of this form, Contractor Name. Saw/ / LYJ y� Address: kd _.____. -_--_i~ity:Z04 .r4Sre J-., _ State:,. . ZIP:,.(3 Company Name: SEA/ ILEi' .k-.4c L .License Number: - _ Contractor Signature; V ,y,,- 0 — Date:c � Zo 2_3 Permit Authorization mass save Form Site ID: 4714778 Customer: IENNIFER WALLACE Jennifer Wallace I, , owner of the property located at: (Owner's Name,printed) 45 Middle St Northampton, MA 01062 (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. Owner's Signature: Jeuutier Wallace Date: 02 /20/2023 •••••••••••••••••••••••+ •••••••••••••••••••••••a••••••0 .$ < FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Clean Tech Construction 02/20/2023 Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 For Office Use Only Document Ref:36EPZ-ZYOFB-MDE3B-UBRN5 Page 8 of 19 RCS PLANVIEW DIAGRAM Customer nlet ' or I lithtfrt/N i L Home Phone. ( )- Address. ,Yc /1 /� Glib $r _ Work Phone: ( )- - Town 0 /Jg/.Z.A6vpCJN/T Cell Phone. ( )- - Any bmdellions I .access by Wage lnxt' No_ Yos II Yes.describe Any sPecda d,recdons or Iandole,ks' No �` Yea II yet dolcnbe Site ID: 7/grinergy Specialist: 4/4'x fir/ Reviewed by: �A* feed//I' (/) 0 14/A/if 3171 75-tl? 3 r'lc" 6 6,„,„..,is-p,4-t-c_ ee,/,1-1 (5_2e.) (I7d 'g� 6. HATCH 2' POLY(1) /0b✓54-!/s W #ii L.? P7 &0-0) i 9/OW S- G/,,�4U41Z-1) J '',D p(07iJ � zZ ,..„.....------------17:' GIP ,.._.____c,) 3v ,,........„______65, ly .t---- _ 6 ►..../..7:7<A4CX--- k liv Bushes Ladder Neighbor Proximity Pocket Doors Insert Radiators Fence(s) Existing Conditions X=Access ❑=Vents Note Inside Square Ro Roof S=Soffit G=Gable RV=Ridge Vent CS=Continuous Soffit CDE=Continuous Drip Edge T=Triangle Install 0=New Access Note in Circle C=Ceiling W=Wall S=Sheathing Temp Unless Noted Otherwise A o Vents Note In Triangle R=8'Roof S=Soffit G=Gable M=12'Mushroom For Access • Pay 1/1A AREA - SUPPORTING MATH TOTAL t Jit-t�S s>'�heJ fit'x — e 19 .,t)a k, ( ram') t _O itce. 1 frioe-d4 C 16, -,2 0 `i) y 7. - .09-(4 wt sod Z 2- ' - - J- -1)-t-R (0 7') Vie g - 1'(-4-t.' i &r,,,c zSg_16) { (6 tc 14 ) — S76 _ Recommended Ventilation Calculation Recommended Ventilation Calculation AIR SEALING WORK HOURS Air Sealing Work Hour / Calculation Work Hours 4 6 8 10 12 14 16 (+2) Attic Sq.Footage <500 501-800 801-1100 1101-1400 1401-1700 1701-2000 2001-2300 Every 300' Exceptional AFL Hours Primarily Floored Attics Chimney or BF=1 Hour Multiple Chimney/BF=2 Hours Prefab/Modular Hours No Chimney=4 Hours Chimney=6 Hours Exceptional KW Hours X<20 feet=1 Hour I 20 It<X<40 ft=2 Hours X>40 It=4 Hours Rim Joist Only Hours I<LS[]ft =LHou RJ>150 ft=2 Hours BMT Ceding Only Hours Ceiling Area<2,000 sq ft=I Hour Ceiling Area>2,000 sq ft=2 Hours '"NOTE:You MUST L .T'Kri LLor asement Ceiling to specify RJ or BMT Ceiling ONLY Air Sealing Hours'" >6'Loose Insulation Cross Batt Insulation ER 0 Multipliers >6"Mix Batt&Loose insulation Truss Construction ob For Office Use Only CLEAResult' CONTRACT CLEAResult 41 Brigham St., Customer Name:JENNIFER WALLACE Marlborough,MA,01752 Email:Not provided Phone:917-817-7719 Premise Address:45 Middle St,Northampton,MA 01062 Mailing Address:45 Middle St,Northampton,MA 01062 Project ID:4714778 Date:Jan.17,2023 Job Description Contractor will perform or cause to be performed the following work on these"Premises"in a professional manner and in accordance with the terms of this Contract,including the attached recommendations/work order describing the work in detail(the"Work")which are incorporated herein by reference. Measure Description Location Quantity Unit Total Cost Customer Cost Air Sealing at Estimated 62.5 CFM50 Per Hour 1 hr $94.33 $0.00 Crawlspace Ceiling-6"Fiberglass Batting 576 SF $1,405.44 $351.36 Crawlspace Ceiling-2"Thermal Barrier Polyiso 576 SF $2,816.64 $704.16 Walls-Interior-3"Dense Pack Cellulose 176 SF $425.92 $106.48 Walls-Aluminum-3"Dense Pack Cellulose 400 SF $1,196.00 $299.00 Walls-3rd FL Clapboard-3"Dense Pack Cellulose 176 SF $454.08 $113.52 Hatch-2"Thermal Barrier Polyiso 1 each $47.37 $11.84 Total: $6,439.78 Program Incentive: -$4,853.42 Customer Total: $1,586.36 Payment Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows: Payment#1:-as a Deposit payable to CLEAResult upon signing the Contract(not to exceed 1/3 of the total retail costs). Mail check&contract to CLEAResult,41 Brigham St., ,Marlborough, MA,01752.Final Payment:-as the final payment for the Work shall be payable to the Home Performance Contractor(HPC)or Independent Installation Contractor(IIC)upon satisfactory completion of the Work. Customer understands that he/she will not be required to pay the Utility Incentive Share of the Contract price in the amount of .Changes to individual line items and/or previous incentives may increase or decrease the size of the Utility Incentive Share. Dispute Resolution The IIC and Customer hereby mutually agree in advance that in the event that the IIC has a dispute concerning this Contract,the IIC may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and Customer shall be required to submit to such arbitration as provided in M.G.L.c 142A. Page 1 of 4 Document Ref 38EPZ-ZYOFB-MDE3B-UBRN5 Page 1 of 19 You may cancel this agreement if it has been signed by a party at a place other than an address of the seller, provided you notify the seller in writing by ordinary mail posted,by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Juwgru-Wa(/iicc 02 /20 /2023 Cleam Tecj Construction Customer Signature Date Indicate your selected IIC here, if applicable Initial here if you want the Program to assign a Participating 6.3iXitik, 2/20/2023 K e v i n Cote Contractor CLEAResult Signature Date Name of CLEAResult Representative Page 2 of 4 Document Ref:36EPZ-ZYOFB-MDE3B-UBRN5 Pape 2 of 19