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39A-052 BP-2023-0428 86 LYMAN RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 39A-052-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING P RMIT � Permit# BP-2023-0428 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est.Cost: 19351 BRYAN HOBBS CS-083982 Const.Class: Exp.Date: 05/02/2024 Use Group: Owner: L ARNOLD KENNETH D&WENDY Lot Size (sq.ft.) Zoning: SC/URB Applicant: BRYAN HOBBS REMODELING LLC Applicant Address Phone: Insurance: PO BOX 1535 (413)775-9006 WC9057270 GREENFIELD, MA 01301 ISSUED ON: 04/12/2023 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 VIO .ATION OF ANY OF ITS RULES AND REGULATIONS. Signature: • 'r . . T"I . Fees Paid: $135.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner APR 1 'i 2023 The Commonwealth of Massachusetts W Office of Public Safety and Inspections ,. .,,_(j,.ni,n r.,,,ri,,(,, Massachusetts State Building Code(780 CIvIR) °'.., ,- Building Permit Application for any Building other than a One-or Two-Family Dwelling Q (This Section For Official Use Only) Building Permit Number: 13• "/O Date Applied: Building Official: SECTION 1:LOCATION No.and Street City/Town Zip Code Name of Building(if applicable) Assessors Map# Block#and/or Lot # SECTION 2:PROPOSED WORK Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below Existing Building 0 Repair 0 Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use CIChange of Occupancy 0 Other ?Specify: Pd_Vn.0,11•t 1c1N Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No 71 Is an Independent Structural Engineering Peer Review required? Yes 0 No 15L Brief Description of Proposed Work:`l V K1 AS--—CIA"' S41LP, CI,L.,d- Se cJ 1 Lk n•,i 1 V o x_/ Q).n'u 2" nn ,,,,IS CGC(LJ c c O Weal dcu,r k.. 2" Pol�,iso c. Cx 2" es 1so k.inte1'6_.)014 3" 1 1 acc .& I(ntvr 40, 5 " 'I I ' 'n biol� ' ))y1lwe 14)c o<y, Slfe1419 acr,st, Lf" deO5L rk (JiJ uW_ o.fhL ('loan, Vrn} bit, f -,. (4 lit t/rn!-, IDf'y zhkur,r, uenf, Z_ �, ►sr, n.ic har.ci►, SECTION 3:COMPLETE THIS SECI'fDN IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 0 E: Educational 0 F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 Hal 0 H-5 0 I: Institutional I-1 0 I-2❑ I-3❑ I-4❑ M: Mercantile 0 R: Residential R-10 R-2 0 R-3 0 R-4 0 S: Storage S-1❑ S-2 0 U: Utility 0 Special Use 0 and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA El IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV VA 0 VB 0 SECTION 7:SITE INFORMATION(refer to 780 CMR 1)5.3 for details on each item) Trench Permit: Debris Removal: Water Supply: Flood Zone Information: Sewage Disposal: Licensed Dis osal Site 0 Public 0 Check if outside Flood Zone 0 Indicate municipal 0 A trench will not be p Private 0 or indentify Zone: _ or on site system 0 required 0 or trench or specify: permit is enclosed 0 Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable 0 Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No 0 Yes 0 No 0 SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Does the building contain an Sprinkler System?: Special Stipulations: Design Occupant Load per Floor and Assembly space: • SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner W MCII1 Amid Ctman iQ k ✓J4'1 pkri. M A 010 o Name(Print) No.and treet City/Town Zip Property Owner Contact Information: o - - (113- ‘ EU W WCi rrwld 12 3 e co c.1-,At/— Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Name Street Address City/Town State Zip to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1) If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here D. Otherwise provide construction control forms(see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals) Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Brt Of 1 3v►ian n- x -tll , CA Compiny Name a-1 Nibs CS - O SC1 a HI(' l9UOLI r Name f Person Responsible for Construction License No. and Type if Applicable 1D elos, 1S3c &ea- IQI.6 MA GI3oa Street Address City/Town State Zip Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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. Is a signed Affidavit submitted with this application? YesP No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1.Building $ I 1 I ,0 Building Permit Fee=Total Construction •.st x , nsert here 2.Electrical $ appropriate municipal facto , =' . . 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimun{fee=$ (c.,tac icipal6ty) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ 19i 35) . (contact municipality)and write check number here 9,q6F--- SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT 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. L o• l GA-. 1-1. (1.) i,,' r cL-..- 4)C -71r loc.Co yi7143 ease rmt and sign name �r! Title Tele hone No. Date 1 S �PW elt,'ti MA- 01.30 a- 0,,,.(2.,Cur- Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: `!Li 11- Z"geZ Name Date mass save Savings through energy efficiency PERMIT AUTHORIZATION FORM I, LAkndu Avri,< d owner of the property located at: (Owner'k Name) SZc Lt ( Q IU(wA 1.OtmpJ I, )1R- (Propeity 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. 14)&44 4rte* Owner's Signature 02-23-2023 Date FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: SA,p, 1'1A K_e►notifivI},, LLc 4 I 1 `2 5 Participating Contractor Date Document Ref:HIA65-7D8NK-3Q9U5-SNH9S Page 4 of 32 • offko of conommer Affairs and Milan Ridtatleft loco womngtoo eked.eat Tic Baste%itialoachtastte 011ie Hama Improvement Contractor RigM= ago= inn MAN 17=,, Agates 11161/11= P.M BMW MODS — teknoessidislaretlieL swum Aleseausens. Dim tents:it ouraweletMalfazsgrodes 1146-g1P: j--.1; 0 , iaverige MNAHROUSEMOININAkt Mt Mr ..!stett.:te, - fIndrserising - • - - - Commonwealth of iViassachusetts Division nt Occupational Licensure Board of Building Rev ions and Standards Cgnatvateet (WSW es..or6.6ga ;01..pima:05/02/2024 SWAN 6 littpPr PI)BOX ISM GREIMPlEILINfi 6135P f • Jfax,t1:. Corntail.G2 tertv P big";•`G • L.•-•• . ,47,1 an. gaL, • e;'.\ The Commonwealth of Massachusetts Department of Industrial Accidents ( .-r .. 74 ; Office of Investigations I=l Lafayette City Center nj 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): Bryan Hobbs Remodeling, LLC Address:576 Leyden Rd Po Box 1535 City/State/Zip:Greenfield, Ma 01302 Phone#:413-775-9006 Are you an employer? Check the appropriate box: Type of project(required): I.0 I am a employer with 7 4. 0 I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6 0 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' [No workers' comp. insurance comp, insurance.t 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.0 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 Weatherization employees. [No workers' 13.11 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. tContractors 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: Selective Insurance Company Policy#or Self ins. Lic.#:WC9057270 Expiration Date:10/20/2023 Job Site Address �moi--, _Cc 9 City/State/Zip:J.)(),4}'IGM(o PA" 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_c rtify under the pains and penalties of perjury that the information provided above is true and correct. Signature: On, Date: y S 2 3 Phone#: 413-775-9006 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 31:City/Town Clerk 4.0 Electrical Inspector 5ralumbing Inspector 61:Other Contact Person: Phone t • ® A RD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 06/24/2022 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 Adina Edgett,CISR Webber&Grinnell PHONE (413)586-0111 FAX (A/C,No): 413 586-6481 8 North King Street E-MAIL SS: aedgett@webberandgrinnell.com ADDRE INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A: Selective Ins Co of S Carolina 19259 INSURED INSURER B: Selective Ins Co of America 12572 Bryan Hobbs Remodeling,LLC INSURER C: Selective Ins Co of Southeast 39926 PO Box 1535 INSURER D: Evanston/XS Brokers INSURER E: Greenfield MA 01302-1535 INSURER F: COVERAGES CERTIFICATE NUMBER: LIAB EXP 8/2023 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 ADUL dUtMR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDY�— POLICY TP ( ) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 500,000 CLAIMS-MADE X OCCUR PREMISES lEa occurrence) $ MED EXP(Any one person) $ 15,000 A S2289042 08/04/2022 08/04/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO 2,000,000 JECT LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED X SCHEDULED A9105300 08/04/2022 08/04/2023 BODILY INJURY(Per accident) $ AUTOS ONLY X AUTOS X HIRED s/ NON-OWNED PROPERTY DAMAGE $ - AUTOS ONLY _ AUTOS ONLY (Per accident) Underinsured motorist BI $ 20,000 X UMBRELLA LIAB __ OCCUR EACHOCCURRE_N_CE $ 2,000,000 EXCESS LIAB CLAIMS-MADE S2289042 08/04/2022 08/04/2023 AGGREGATE $ 2,000,000 DED RETENTION$ $ WORKERS COMPENSATION - X STATUTE EERH AND EMPLOYERS'LIABILITY YIN 1,000,000 C ANY PROPRIETOR/PARTNER/EXECUTIVE Y NIA WC9057270 10/20/2022 10/20/2023 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 $ Per Occurance $250,000 Pollution Liability D TBD 01/19/2023 01/19/2024 Aggregate $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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD City of Northampton Massachusetts c�w? x_ '<< * c DEPARTMENT OF BUILDING INSPECTIONS . -� 'ry 212 Main Street • Municipal Building J. :C� �` Northampton, MA 01060 �Sbh•• ��`� 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: Location of Facility: a3k-1 ig yl, � j( Pl Ml� The debris will be transported by: Name of Hauler: Amvi, Signature of Applicant: v /p\a,\/3. Date: (4 Z#5 I I Eased 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.Hire a qualified, licensed contractor to evaluate and/or rerediate 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: or email to ^� t-� ^•^ 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. Customer Name: Wendy Arnold Client#or Site ID: 51 3443 Site Address: 88 Lyman Road City: Northampton State: MA ZIP: 01060 Phone Number: 413-522-8034 Email: Warnold123@comcast.net Customer/Homeowner Signature: \p.4 Date: 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: Attic Floor 0 Attic Wall Attic Slope ,J Exterior Wall C✓ Basement O Other: Other: I�I have performed my inspection and determined there is no active knob and tube wiring in the areas selected below. Attic Floor n Attic Wall Attic Slope Exterior Wall / Basement Other: • Other: c . Contractor � Name: `5� e'S A%mod 16- Address: 2s lea-j4" 6-1/.4 v.•)��.>`. / /Ic Q, city: :((;Ci ti t ✓'�� 4' /4 fl : Of o Company Name: CtLd T. / /I t0 , E�ee/r.c.%sln License Number: 5 S'.55 ll/'�1 / 3 Contractor Signature: '-�� '" z- �•9' Date: 2 Z /t My signature confirms that I have performed my inspection of the electrical 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. #igl-Carbon-Meaexide•:Contractor is to service and rc evaluate the;elected-mechanical system(s)and-r • , as measured in thc undiluted flue gas,to below 100 parts per million(ppm). Draft Failure:Contractor is to correct the drat in thc selected fluc(s).Refer to table on reverse-fee eptablc draft ranges. Eidz •"'Cn flevised-CO pert Cxicting Draft Pa Revised-Dra€t-Pe Neaal flg 6y terw _ .--- I----- ----__ - Otkef --— — Spillage:Contractor is to correct the spills . 'ie✓sn•9-Systeni AtMer: Contractor t4amc: .^.ddres: Ei#}-- State: ZIP: Company Name: —Lice ee-- bcr: 4`_-en acteFSignatttre: Date: i !y 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• mass save 2022-23 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.Hire 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 Enntnc,orinn,765 Art;icfre 1 anr,!4y.:-.11ili::,MA m601 or email to rnnm. 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. 1 Customer Name: Wendy Arnold Client#or Site ID: 513441 site Address: 88 Lyman Road city: Northampton State: MA ZIP: 01060 Phone Number: 413-522-8034 Email: Warnold123@comcast.net Customer/Homeowner Signature: Date: c`4?4-2 KNOB AND TUBE WIRING . 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: 0 Attic Floor )Attic Wall C'Attic Slope Exterior Wall V Basement •Other: i )Other: ✓I have performed my inspection and determined there is no active knob and tube wiring in the areas selected below. (_)Attic Floor (3 Attic Wall ( j Attic Slope Exterior Wall ✓Basement ' 'Other: 1 Other: Contractor Name: -�c_C ,4(1 o r I Address: / City: State: ZIP: Company Name: Zi GD 1 T- Afi'W�/� t �t�'�����K�License Number: 5D SS a Contractor Signature: . Date: Z/1.1 My signature confir I have performed my inspection of the electrical 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. f r Reels- d C-O-ppm Existing Draft fh Rcviaed- Pe-Pa I1eatiIng_Systom Het-Water-Heater — -- -- — -- Other i Contractor Namc: Addrea: City: Statc: ZIP: Company Narwc: l fc _c Nur bcr: 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. mass save 2022-23 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.Hire 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:RISB^ i i FA n+o-,,,r ,,r. i" .,;.4- MA n9Rn1 or email to:JiE^ -c„„-, ,Ic9nnninnnrinn••nn,, 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. Customer Name: Wendy Arnold Client#or Site ID: 529546 Site Address: 88 Lyman Road City: Northampton State: MA ZIP: 01060 Phone Number: 413-522-8034 Email: Warnold123@com_c1ast.net Customer/Homeowner Signature: �l -'� Date: , ►,�Z- Z3 KNOB AND TUBE WIRING 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: 0 Attic Floor ( I Attic Wall ` ;Attic Slope Exterior Wall V. Basement (-;)Other: :)Other: I have performed my inspection and determined there is no active knob and tube wiring in the areas selected below. G Attic Floor I_ Attic Wall Attic Slope /;Exterior Wall Basement (_j Other: ;Other: Contractor Name: rJ ct c_o S A-r.i,l -1 L I I Address: gs a cI- �l.'!•'1 eGL R W d. City: t I/ f 6 Q'j 4 •'1 State: A( ZIP. v(D Company Name: , T A,'i1e C// _ ed-ric.. .11 License Number: ses s 68 Contractor Signature: , - �� "4" Date: Z/Z /I Z 3 My signature confirms'£have performed my inspection of the electrical systems listed above and have corrected any barriers as indicated.My signa rt1Te also confirms that I have read and agree to the Terms and Conditions outlined on the back of this form. :ina CO pprt} , Revised CO ppm Exiting-Bra€1-Pa Met--- Wa Other __tins Cy_,._._ Lot Water Other: Contractor Name: .hddreac: C,°ty: State: ZIP: Ccmpany Name: Weense-Nuffiber Contactor Slgnaturoi Dote: 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. Ak(rt- mass save 2022-23 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.Hire 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,765 Attucks Lane,Hyannis,MA 02601 or email to MassSaveJRlSEengineerina.com. 3.Tha 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. Customer Name: Wendy Arnold Client#or Site ID: 513440 Site Address: 88 Lyman Road City: Northampton State: MA ZIP: 01060 Phone Number: 413-522-8034 Email: Warnold123@comcast.net Customer/Homeowner Signature: •� Date: 124 2-3 KNOB AND TUBE WIRING '- " 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: )Attic Floor (_)Attic Wall �, i Attic Slope ;._, Exterior Wall V'Basement L.)Other: I ;Other: 10 I have performed my inspection and determined there is no active knob and tube wiring in the areas selected below. Attic Floor C)Attic Wall ; ;Attic Slope i ;Exterior Wall 16 Basement (_ Other: . (_)Other: Contractor Name: 3aco6 Am, id Address: 5 -1_ t �v7.1ati n-d_ City: W;l/lamcLvei State: M'4 ZIP: O/DY6 Company Name: &- .cp))b Arn-a G+, ec/o�4%acrl License Number: 5 ce55 b Q Contractor Signature: / dO, Date: /Z.-3 3 My signature conf at I have performed my inspection of the electrical 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. MECHANICAL SYSTEM,BARRIERS, >t HIi«u path) H - sl Co ttY� tr i _11111.11.1 s! High Carbon Monoxide:Contractor is to service and re-evaluate the selected mechanical system(s)and reduce the carbon bonoxide 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 M Draft Failure Existing CO ppm Re-,:sed CO pprn Existing Draft Pa Revised Draft Pa Heating System xxx 2000+ ,30 eigk5 er Hot Water Heater ;� -- `, � � �w (hKC e Other —�-- i Spillage:Contractor is to correct the spillage of flue gases in the selected mechanical system(s).Must not spill after 60 seconds of operation. Heating System Hot Water Heater , Other: Contractor Name: Address: City: State: ZIP: . mpany Name: ) / License Number: 3� le( I�Q 6 .. Contractor Signature: !G Wl //`-'' �' Date: 3 I?.j23 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. mass save 022-23 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 Hire 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:ZISE Engine. 1,765 Attucks Lane,Hyannis,MA 0260''. or email to. : 'SEengineerinp.com. 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. Customer Name: Wendy Arnold Client#or Site ID: 513442 Site Address: 88 Lyman Road City: Northampton State: MA ZIP: 01060 Phone Number: 413-522-8034 Email: Warnold123@comcast.net Customer/Homeowner Signature: Date: c jt L�27 NOB AND TUBE a.RING 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: e Attic Floor ' -`Attic Wall Attic Slope Exterior Wall Basement Other: • Other: el I have performed my inspection and determined there is no active knob and tube wiring in the areas selected below. ✓Attic Floor Attic Wall Attic Slope Exterior Wall Basement Other: :Other: Contractor Name: ��2 Gr,;/� ,�1 �G • OO / I / / Address: O 5 t 1- �v?.n ek F-d, t W i �l FQI+'t Sb 1J�� Sla MA Zi; 01046 Company Name: JQ -01 T /fr /e+ Pee�'1,`CI a�License Number: J S&55 6 a Contractor Signature: Date: 2/z-3/Z 3 1v signature confirmt et I have performed my inspection of the electrical 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. High-Carbon 4oneAtio:Contractor is to scrvi , es-+eeocurcd in the undiluted flue-gas-•t f+oR ), Graft Failure:Contractor is to COritie draft in-the-selcctcd-flue'c. .�4 telslcon rcvcr,c-fer acceptable-craft-ranges: • Lne...:rlg CO ppm; Re,Ase-C-013pn c:EjT'NT•g D.-aft-Pe Heating-System 1.. . Other Spiilag... • ge of€I_= Iezing System Hot Water Heater Other: Contractor Name: --- --------- ddres: — City: State: ZIP: Company Name: -- Licence Number: �ntractor-Sig ature: -- -------- 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. *itt mass save 2022-23 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.Hire 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,765 Attucks Lane,Hyannis,MA 02601 or email to MassSave@RISEengineering.com. 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. CUSTOMER INFORMATION Customer Name: Wendy Arnold Client#or Site ID: 513445 • Site Address: 88 Lyman Road City: Northampton State: MA ZIP: 01060 Phone Number: 413-522-8034 Email: WarnoId123@comcast.net Customer/Homeowner Signature: Date: KNOB AND TUBE WIRING 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: Attic Floor Attic Wall Attic Slope ; 1 Exterior Wall (_,'Basement `_-'Other: , )Other: 16 I have performed my inspection and determined there is no active knob and tube wiring in the areas selected below. le Attic Floor ()Attic Wall iJ Attic Slope 1,_.;Exterior Wall 1 Basement , Other: l, Other: Contractor Name: cx Co b /Ar&to/CI Address: 5 q ms-r- t7 C3'U City: ►A& \I cvrrr,htJ r State:/l- ZIP. 0 10 q to Company Name: i A.C.o6 T Arm EIedi"? al^ License Numb -�c ss(o r, Contractor Signature: � tab C Date: 2123(2)^ My signature confirms tha ave performed my inspection of the electrical 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. High -r y- - • -tom+-ser-si -4e - ' '^^ ^'aaa ^prime,'syst m(s)-id r 'I'' th m^n^xi^I I v • List-Iflg-6A-pryrn • Revised-CO pp}t Cxi.ting Draft RI Revved-Draft-Pa Heat Othef 1 oo�f Water Other. 'eating System �, «, 'rierntci• v[T7C1- Contractor Narnc: Addresc: City: State: ZIP: Company Name: Leec N+ ber: Contractor Signature,- Datoi 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. *4(I(C- mass save 2022-23 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.Hire 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,765 Attucks Lane,Hyannis,MA 02601 or email to MassSave©RlSEengineering.com. 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. , „r . •-., • Customer Name: Wendy Arnold Client#or Site ID: 529548 Site Address: 88 Lyman Road City: Northampton State: MA ZIP: 01060 Phone Number: 413-522-8034 Email: Warnold123@comcast.net Customer/Homeowner Signature: Date: SA? ' t 2,3 KNOB AND TUBE WIRING ,, ;...- 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: e Attic Floor (_)Attic Wall . Attic Slope Exterior Wall Basement Other: (—)Other: el have performed my inspection and determined there is no active knob and tube wiring in the areas selected below. e Attic Floor Attic Wall LI Attic Slope Exterior Wall )Basement Other: Other: Contractor Name: �etGDo 4lii O�d Address: v5 T G'L$I 6-0;v1 EK City: i///‘[r.,fbi//'Q State: ..4A ZIP'. 01494 Company Name: 'et C o rR o/6 Pee ee tr.; '^^ License Number: ) s 05 6 a Contractor Signature: 1;7 Date: 212,3/Z3 My signature confirms% at'I have performed my inspection of the electrical 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. &AtRRExii.' High Carbon Monoxide:Contractor is to service and re-evaluate the selected mechanical system(s)and reduce the carborY 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. .r 11111 Existing CO ppm Revised CO ppm Existing Draft Pa Revised Draft Pa Heating System x N xx 2000+ 0 l4(&( 5 '�1:*' _. Hot Water Heater it,Skct`e d live Other Spillage:Contractor is to correct the spillage of flue gases in the selected mechanical system(s).Must not spill after 60 seconds of operation. Heating System Hot Water Heater Other: Contractor Name: Address: City: State: ZIP: Company Name: License Number:. ` 1'35 G lec lU 8 (10 Contractor Signature: %>� � Date: 2 �?'?_ Iz3 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.