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38B-076 (4) BP-2023-0048 205 SOUTH ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38B-076-001 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-2023-0048 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 8000 HOMEWORKS ENERGY INC 106148 Const.Class: Exp.Date: 07/30/2024 Use Group: Owner: BROEKMAN ANTON M &JOAN M PERREAULT Lot Size (sq.ft.) Zoning: URB Applicant: HOMEWORKS ENERGY INC Applicant Address Phone: Insurance: 235 ESSEX ST 781-205-4484 1847910 WHITMAN, MA 02382 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 VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: -. i 1 • 0 Fees Paid: S100.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner Fee:$1 00.00 I9UG' The Commonwealth of Massachusetts c Office of Public Safety and Inspections Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling jo (This Section For Official Use Only) 0 Building Permit Number:43 4,2 Date Applied: Building Official: SECTION 1:LOCATION 205 South Street Northampton Ma01060 No.and Street City 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❑ Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other ID Specify:Weatterizabon Are building plans and/or construction documents being supplied as part of this permit application? Yes Ej No 0 Is an Independent Structural Engineering Peer Review required? Yes 0 No El Brief Description of Proposed Work Residential weathenzation/air sealing.No structural changes.(Site ID:4354360) SECTION 3:COMPLETE THIS SECTION 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) 0 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❑ 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 H-4 0 H-5 0 I: Institutional I-10 I-2❑ I-3 0 I-4❑ M: Mercantile 0 R: Residential R-111 R-2u R-3 PI R-4 S: Storage S-1❑ S-2 0 U: Utility 0 Special Use 0 and please describe below: Special Use Description: SECTION&CONSTRUCTION TYPE(Check as applicable) IA IBO HAD IIBD IllAD IIIBD IVD VA D V: � SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public 0 Check if outside Flood Zone 0 Indicate municipal 0 A trench will not be Licensed Disposal Site 0 Private 0 or indentify Zone: or on site system 0 req •r sed nch NA-or Lithey: permit is enclosed 0 to no Debris Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable Is Structure within airport approach area? Is their review con+t eted? or Consent to Build enclosed 0 Yes❑ or No n Yes❑ No f--' SECTION&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: c City of Northampton °•• ° ., Massachusetts ��. . Sic, 'c` s+ F. * C ( L' W .Y ��. DEPARTMENT OF BUILDING INSPECTIONS t; j ,, H'"�S �' 212 Main Street • Municipal Building yvti Cb' --..M Northampton, MA 01060 ..5.1`W .1<)‘-� PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR COMMERCIAL & MULTI-FAMILY NEW CONSTRUCTION/ADDITIONS/ALTERATIONS 1. Building Permit Application signed by legal owner and filled out by owner or authorized agent. 2. One set of plans and specifications of proposed work (Digital & Hard copy). 3. Site Plan with location of proposed structure(s) and setbacks. 4. Construction Debris Affidavit filled out and signed by applicant. 5. Worker's Compensation Insurance Affidavit filled out and signed by applicant. 6. Contractors must supply a copy of CSL and proof of Liability Insurance. 7. Energy Conservation Compliance Certificate (if applicable). 8. Note any Conservation and/or Special Permit requirements (if applicable). 9. Driveway Permit (if applicable). 10. Proof of Water and Sewer entry fees paid (if applicable). 11. Trench Permit (if applicable). 12. Initial Construction Control Documents filled out and signed by the Registered Design Professional in responsible charge. 13. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Joan Perreault 205 South Street Northampton Ma01060 Name(Print) No.and Street City/Town Zip Property Owner Contact Information (617) 642-4330 - - jmperreault@gmail.com Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Adam Glenn 235 Essex St, Whitman, Ma 02382 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 0. 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) Adam Glenn 781-205-4484 wxpem,itting©homeworksenergy.com CSS L-106148 Name(Registrant) Telephone No. e-mail address Registration Number 235 Essex St, Whitman, Ma 02382 07/30/2024 Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor HomeWorks Energy Company Name Adam Glenn HIC - 181138 Name of Person Responsible for Construction License No. and Type if Applicable 235 Essex St, Whitman, Ma 02382 Street Address City/Town State Zip 781-205-4484 - - wxpermitting@homeworksenergy.com 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? Yes. No D SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs:(Labor Item and Materials) Total Construction Cost(from Item 6)=$ $���� 1.Building $ 8,000 Building Permit Fee=Total Construction Cost x 7(Insert here 2.Electrical $ appropriate municipal factor)=$ 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$100 (contact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ 8,000 (contact municipality)and write check number here 15. 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 m owledge and understanding. Adam Glenn V 781-205-4484 1/6/2023 Please print and sign name Title Telephone No. Date 235 Essex St, Whitman, Ma 02382 wxpermiriing@homeworksenergy.com Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: LI'I J 20 Z3 Name Date CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE City of Northampton y •''� Massachusetts `Jt DEPARTMENT OF BUILDING INSPECTIONS �4 fY 212 Main Street • Municipal Building yJ` is Northampton, MA 01060 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: 24 E Longmeadow Rd, Hampden, MA 01036 The debris will be transported by: Name of Hauler: HomeWorks Energy Signature � < `21/6/2023 Si g e of Applicant: Date: The Commonwealth of Massachusetts ►r`*` =�=0i Department of Industrial Accidents 1111— I Congress Street,Suite 100 r- i:11- `` Boston, :MA 02114-2017 ,.--_ 0 www mass.gov/dia `- 11 Queers'('ompessation insurance Affidavit: BuiWen CoetractorsinectriciansfPlumbers. TO BE FILED t%IIII THE PER%ll mist;At'TM/Rat. Aoalieatnt Information Please Print Lettibly Name tabs ;r ,oration It�lte dianh: HomeWorks Energy Addres, 235 Essex St Whitman 781-205-4484 City/State/Zip Phvnc :Y Are ISO rm employer:'t too,k Ilse appropriate bete: Ts pe of project(required):. 1gan a employer with 500+ employees Mil and or pint-timel-• 7. Q Newconstruction 2 am a wile propnettx or partnership and have raw ernployc+es+s°Uriting for me m 11. 0 Remodeling any,opacity [No workers'cutup.insurance anyone-.j 9. ❑ Ihtttohtion 3.0 t am a ttutuottssnct doing all work myself.[ho*odour,'comp.minnow,.reoturcai.j` 10 0 Building addition 4.0 I ant a homcww nrei and will be hiong coralactors to conduct all work on my property I vail ensure that Alt...trsira:tots,either have workers'compensation insurance or are sole 11 a Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or addition, S I am a general contractor and I has e hued the subcontractors listed on the Miaebcd sheet 1 3.,Roof repairs These subconin,etors Erase employees and have*utters'currrp.insurance.: I•151 the/Weatherization b.©Vi i.are a corporation and ita offeccrs ha,ere sercrsed their right of mtem won per M(WL c. tt'_.411it,and we have no employees.(Nu wwaters'comp.insurance rewired.) •Any applicant that chocks boot sl must also fill out the section below,showing their*others'compensation pokey inionnatiun. f Hutneow tiers who submit this afl'idusrt utdacating they are dating all work and then hue u Its lc contractors must submit a new atIrdav it rndtcating such. ;Contractors that check this box must attached an ad.tttionnal sheet showing the name of the sub-contractors and state whether or not those entitles harve ennpb..ce, It ths'sub omneaeto tss tus e rrrrplu)cc's,t.hcv must provide their wurker.'sesrnt, p.ncsty ntnnt+eer .tee 1 am on employer that is providing► orAers'compensation insurance for my employees. Below is the polio.and job site information. Insurance Company Name Federated Mutual Insurance Company Policy#or Self ins.Lie. :. 1847910 Expiration Date 01/01/2024 ,lob Site Address: 205 South Street Northampton Ma01060 City/State/Zip: - Attach a copy of the workers'compensation policy declaration page(showing the policy number and expii.ttiout date). Failure to secure coverage as requiraed under SAGE c. 152. to 25A is a criminal violation punishable by a fine up to S 1,5(i0.00 and'or one-year imprisonment.as well as eivii penalties in the form of a STOP WORK ORDER and a tine of up to S250.00 a day against the violator. A copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby cent r under the pains a penalties of perjury that the information provided above is true and correct. Signature: Date 1/6/2023 pi,,,ne#; 781-205-4484 Official use only. Do net write in this area,to be completed by city or town official City or Town: Permit/License k ___________ Issuing.Xuthurits [circle one): I. Board of Health 2. Building Department 3.('O''1min Clerk 4. FIrctrical Inspector 5. Plumbing Inspector b.Other ( intact Person: Phone#: • Initial Construction Control Document ri To be submitted with the building permit application by a F Re istered Design Professional w! // t,. , 4 g� g -.,`\ 4 for work per the ninth edition of the '`'=•_. ¢ Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Date: Property Address: Project: Check(x)one or both as applicable: New construction Existing Construction Project description: I MA Registration Number: Expiration date: ,am a registered design professional,and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerningl: Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge, information, and belief such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my designee)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2_ Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3_ Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments,in a form acceptable to the building official. Upon completion of the work,I shall submit to the building official a 'Final Construction Control Document'. Enter in the space to the right a"wet" or electronic signature and seal: Phone number: Email: IBuilding Official Use Only 1 1 Building Official Name: Permit No.: Date: Note L Indicate with an'x'project design plans,computations and specifications that you prepared or directly supervised.If'other'is chosen,provide a description. Version Ol Ol 2018 Appendix 1 Construction Documents are required for structures that must comply with 780 CMR 107.The checklist below is a compilation of the documents that may be required.The applicant shall fill out the checklist and provide the contact information of the registered professionals responsible for the documents. This appendix is to be submitted with the building permit application. Checklist for Construction Documents* Mark"x"where applicable No. Item Submitted Incomplete Not Required 1 Architectural 2 Foundation 3 Structural 4 Fire Suppression 5 Fire Alarm(may require repeaters) 6 HVAC 7 Electrical 8 Plumbing(include local connections) 9 Gas(Natural,Propane,Medical or other) 10 Surveyed Site Plan(Utilities,Wetland,etc.) 11 Specifications 12 Structural Peer Review 13 Structural Tests&Inspections Program 14 Fire Protection Narrative Report 15 Existing Building Survey/Investigation 16 Energy Conservation Report 17 Architectural Access Review(521 CMR) 18 Workers Compensation Insurance 19 Hazardous Material Mitigation Documentation 20 Other(Specify) 21 Other(Specify) 22 Other(Specify) *Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the authority having jurisdiction. Registered Professional Contact Information Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Please follow this link for construction control forms to be used by Registered Design Professionals. ♦ IS '4corro CERTIFICATE OF LIABILITY INSURANCE �'1 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 POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT FEDERATED MUTUAL INSURANCE COMPANY NAME: CLIENT CONTACT CENTER X HOME OFFICE:P.O.BOX 328 iaC.No.Elnl:888-333-4949 (NE A/CC,NO):507-446-4664 OWATONNA,MN 55060 E-ADMDRESS:CUENTCONTACTCENTEROIFEDINS.COM INSURER(8)AFFORDING COVERAGE NAIC# INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 419-899-0 INSURER B: HOMEWORKS ENERGY,INC. INSURER C: 101 STATION LNDG MEDFORD,MA 02155-5134 INSURER 0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:0 REVISION NUMBER:1 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POUCY EFF POLICY EXP LIMITS LTR INSR VIVO IMMIODIYYYYI IMMIODiriril X COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED $100,000 I PREMISES[Ea occurrence) MED EXP(My one person) EXCLUDED A N N 1847909 01/01/2023 01/01i2024 PERSONAL&ADVINJURY $1,000,000 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE +D�+DDD X POLICY JECT �LOC PRO! PRODUCTS-COMP/OP AGO $2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT IEa acddenll $1+DOD+ODD X ANY AUTO BODILY INJURY(Per person) —A OWNED AUTOS ONLY AUTOSUIED N N 1847908 01/01/2023 01/01/2024 BODILY INJURY(Per accident) HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE AUTOS ONLY (Per accident) X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $1,000,000 A —+EXCESS LIAR CLAIMS-MADE N N 1847911 01/01/2023 01/01/2024 AGGREGATE $1,000,000 DED 1RETENTION WORKERS COMPENSATION OTH- AND EMPLOYERS'LIABILITY Y/N X PER STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT S500,000 A OFFICERIMEMBER EXCLUDED? ' !NIA N 1847910 01/01/2023 01/01/2024 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under E.L DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101.Additional Remarks Schedule,may be atlached it more space is required) THIS COPY IS NOT TO BE REPRODUCED FOR ISSUANCE OF CERTIFICATES. CERTIFICATE HOLDER CANCELLATION 01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN A CERTIFICATE HAS BEEN FILED WITH EACH OF YOUR CERTIFICATE ACCORDANCE WITH THE POLICY PROVISIONS. HOLDERS. AUTHORIZED REPRESENTATIVE 1144-414,/ 6 )4A,.., O 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2018/03) The ACORD name and logo are registered marks of ACORD Y4'... Keyii/i4one.ife,,,,,i, .0././162,4„vie/be(4,‘,//,' Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card Registration: 181138 HOME WORKS ENERGY,INC. Expiration: 03/02/2023 101 STATION LANDING STE 110 MEDFORD,MA 02155 update Address and Return Card. SG# 1 0 20M-05417 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Sucolemc;tt Card before the expiration date. If found return to: Reeistration giggiggibm Office of Consumer Affairs and Business Regulation 181138 03/02/2023 1000 Washington Street -Suite 710 HOME WORKS ENERGY,INC. Boston,MA 02116 ADAM GLENN ' C i c '^' 101 STATION LANDING STE 110 r.'' .: : .a/'v+ ` Not valid without signature MEDFOHD,MA 02155 Undersecretary g Commonwealth of Massachusetts � Construction Supervisor Specialty ;1 Division of Occupational Llcensure Restridedto Board of Building �RReq�Iattons and Standards CSSLa C C �insulation ortr actor ConstructsQilr5UpCr�,rt r Spi=ci ft P CSSL-108148 _ M „,.: E,%pires:07/30/2024 ADAM GLE 1S CHARGE ' • , WAREHAM M, i 4- ?y Failure topossess a current edition of the Massachusetts nCYdila State Building Code is cause for revocation of this license. For information about this license Commissioner ,,, A Caft(617)727.3200 or visit www mass.gov'dpi . . mass save 2020 weatherization barrier incentives Based on your El'•ergs See-7•elist's recommendations,your home can benefit from program-eligible insulation and/or air sealing fmPtOverhentS Sttfocre moving forward please follow ail the instructions below to remediate your weatherization barriers. CUSTOMER INSTRUCTIONS 1. 'Hire a qualified,tice.nsed contractor to evaluate and/or remediate the weatherization barrier(s). Submit signed and completed copies of this form and a copy of the paid contractor invoice(s)within 60 days of eour Home Energy Assessment to:The Participating Home Performance Contractor that completed your Home Energy Assessreierit 3.The weathereatiori 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.Compete the reccimmencied weatherization improvements, CUSTOMER INFORMA71(,)N .cuseconer Nam, Joan PatTeault 4354360 Client 4or Site ID: 202 South St Site AddressCity: Northampton state. MA ztp... 01060 Phone.1..krnt,),," Erna : -- Custdette, Hernectwnkte Ssgrttitstre'.. dadi,Pe44,24.4etet , Date: . .. ,.. . , kNOS AND TUBE ViIIRtNG to dotermine if there is any active knob and tube wiring,the contractor will evaluate the following areas where eligible Mess Save weatherize-ekes recorrehenciations have been made Attic far e Attic Wall (?).Attic Slope 0 Exterior Wall ()Basement 0 Other: 0 Other: have perforen'teid my inspection and determined there is no active knob and tube wiring in the areas selected below. (:::, Attic Picot 0 Attic Wail ,,'„")Attic Slope ()Exterior Wall 0 Basement (,)Other: 0 Other: z41t. , V6 , _11_11:11 1.%,SC t*:€',,,,‘„, __ Illti 4 / t4/14:Lit 1231CCity: Vet ci fk L State: Cr ZIP: 06413........._12rff 1 icense Nurnne`i ..„,. :-.. sig.ture, . .. . . My signature donne-ilea yee, , i ,e,,,,,, .e ie.-T,•,:c „;pection of the electrical systems listed D., 21/3.123d abceie and have corrected any earners as iridireted.My signature also confirms that I have read and agree to the 7ern- and Conditions outlined on the back of this form. reeeemeaelCAL.Seie-fetii BARRIERS i . i i -I „i....„ !,. , , ,i •••,i i.., . 11'4 Hig.%carbon Monoxide:Contractor is to service and re-evaluate the selected mechanical system(s)and reduce the carotin monoxide level, as measured ir the undiluted floe gas,to below 100 parts per million(ppm), in" Diet Rave'Contractor is to correct the draft in the selected flue(s).Refer to table on reverse for acceptable draft ranges. High Carbon Morso4ine Draft Failure .,,,,e,••• i.e.....-- , .•• ,,,. .., x....,••ii.,-iii„-,eeiiiie xi is--: ,ei...7e.ei:ieiiei xisiewiroegigeoisp,xeee.„-e: ei'eeoeifteiss:‘,.1,,...,,i,••.,„..rya. .,. trj‘i,rii,g',:iti',2!"•:::lifit0 blamt ' ' !':''''""11,set: . ',`,.i‘teleitirigeiielt.a.t&see° i., iro4i •:i •ei, e i' - ..,:—...1 il t 1-LithatiWatterflreoleifi att!fir: kc '" " Contractor is to correct the spillage of flue gases•ii the selected mechanical sySteM(S),Must not spill after 60 seconds of operation, ' (-1 HeattngSystian 0 Hot Water Heater C:i Or.i,..-r ii,,,, ! rdeitract or t4airne: 1 rile. --------- State ZIP'-' i; Addre.ss:_ _ ----- ___ -..... __ Date: i„iestraititor-ae• insse ,,,,.... ..,,, - : . --• : i -i . i • -ie i.•,, .,1 :,.. ••; s listed above and have corrected any barriers as ::'420iiiot n . i i i - .: ; -, • , ; i .i agi. - ei. Terrris arw ',Conditions cutlined on the back of this form, Insulation/Air Sealing Permit Authorization Specialist: Abel Silva Company: HomeWorks Energy Email: abel.silva@homeworksenergy.com Address: 101 Station Landing Cell: 4138246686 Medford,Ma 02155 Phone: 781.305.3319 Customer: Joan Perreault Address: 205 South St Email: imperreault@gmail.com Northampton, MA,01060 Site ID: 4354360 Phone: 6176424330 I, the owner of the property identified above hereby authorize HomeWorks Energy Inc., or their Partner to act on my behalf in obtaining any building permit that maybe required to perform insulation and/or Weatherization work on my property and all matters related to the work authorized by said permit if one is obtained. Any related permit application cost will come at no additional charge provided that the agreed Weatherization work is completed. In the event that a permit is pulled on your home for insulation and/or weatherization work, you may be required to have a final inspection of the work scheduled and performed by the building inspector in your town. If required by the town, you will be notified by HomeWorks Energy that an inspection is necessary with instructions on how to complete this process to close out your permit. Email: jmperreault@gmail.com Customer Signature: CAL �� Date: 11/30/2022 Joan Perreault For Condo Owners: If you have property oversight by a condo associationt, please have the association's authorized person(s)complete and sign the section below. Please email this document to wxpermitting@homeworksenergy.com once completed. We, being the duly authorized representatives of the association Name of association or management companyt or management company have reveiwed the plans and specifications for improvements to the address specified above. We further acknowledge that the above listed owner has given notice that they intend to seek permits and to carry out the proposed work. Signature of representative Date Print Name t Other unit owners may sign when there is no association. 166. A MULTI-FAMILY PLAN VIEW Name: ke ffewill\-- Site ID (Unit 1): Lk 5 ( 344► Finished Sq. Ft:VI H # Floors:2-- Z Phone: 6(76t11 4 3�0 Site ID (Unit 2): `-i 13S9 3G( Year Built:l`t' Occupants:s!:`;,' Addre s:l.— Ut'r,u+1 SSite ID (Unit 3): 13 if J 9 Z( Housing Type?M .I h; 5, NcA" ,,4 4C\ Al k Site ID (Unit 4): v ' Electric Acct# (unit 1): Electric (2): Electric (3): Electric (4): Gas Acct# (unit 1): Gas (2): Gas (3): Gas (4): BASEMENT INSPECTION Unit EXISTING SPEC'ING LN/SQ. FT. . rawl Ceiling G rawl Rim Joist I Pd/� 74- /' `i((���,*"""'— "` '— Bsmt RJ 7- co-15 fr 5 ) V IS W Bsmt RJ L --- . P / 10 L` i g apor Barrier kl� sgft. Bsmt Door ) St �.. «- Y� tyi I a 7 p GIs m , �2 Ut�- Of 13 V t) 0)3 1513 V ��5 V G ZI " A IS , � �t 7,0* .' ve) toT ' Doo I 'NC Q1.4 -rod itI Blower Door? vv00 U V WALLS&GARAGE Drill Location? Unit ]SIDING CEIL. HEIGHT'EXISTING SPEC'ING SQ. FT. Exterior Wall 1 ( 4r Ill ei eU C�(l Framing Exterior Wall 2 2_ ]+t.j( i i'b6 2x 0 x 1(, Balloon/Platform Exterior Wall 3tit,,-y 1 6( (}6.0 Ffr -ix q x I(, Balloon/Platform Exterior Wall 4 x x Overhang x x Balloon/Platform Garage Wall x x Garage Ceiling I 64115 Ci( D' 6 �) / o _____J Or‘ � 1 \ ( ----- -4.. 3� � 54 `',, *I? 04 t6015 /7 ....ic '3a i 1-0121 IK ii\,..7.r. 4 14 ., ` ar t c' !r+?.`l L. , jc WORK SPEC'D BUT NOT CONTRACTED Insulation Removal Unit: 1 2 _3 4 Attic Basement/Crawispace Other: Unit: SQ.FT. Sweeps: -5 3l- Kneewall Overhang/Garage Ductwork Exterior Walls WX Stripping: �j ROAD BLOCKS PRESENT?(MANDATORY) j Unit 1 2 3 4 Unit 1 2 3 4 f��nit 1 2 3 4 K&T Y/41Y/ Y/N Y/N Moisture Y/ Y/ Y/N Y/N CombustionSf�'.'.i'x Y/10,/N Y Y/N Asbestos Y/j Y/II Y/N Y/N Mold>100 sq.ft Y/ Y/ Y/N Y/N CO Detector Missing Y/,'�Y Y/ Y/N Vermiculite Y/$ Y/t Y/N Y/N Structl Concern Y/II Y/ Y/N Y/N_ Other(indicate unit) Notes: 4(7-oz.- I-1 336 KW WALL AND KW FLOOR Blind Spec? [1 • OR ► KW SLOPE AND GABLE END Blind Spec? . Why? Unit: Why? Unit: FRAMING EXISTING SPEC'ING SQ,FT. FRAMING EXISTING SPEC'ING SQ.FT. WALL X X SLOPE X X FLOOR X X GABLE X X /. 0 ACCESS X m TRANS X x Z ri TRANS x X rf ATTIC D ATTIC SLOPE x X 3 x x SLOPE EXISTING VENTING? p EXISTING VENTING' EXISTING PIPES?JIN m m KW Vent," Vent 8F HF Hose Damming Sheathing Access Temp Access / KW Venting Vent HF Temp Access W KNEEWALL MANDATORY IZ a �l! dV 2. .1L'1(6'(SV � kikAA- Z �C OR 20 hrA/5 , F cY- -r 150 t51 6 )g Z 4 (40/ %° Vdt1 � i-61 Sa M 15� �' 0 2 J J Acce,5 (o 21nrf -- -. -- ! ,,,.1 tA,ntrl 0 a qr.,,, t5 o° 150 Ii. .14 IA T*3hrA1 a it.tj ii i 2nn e6, � ® rJtl I G \ ' ' r �(� D pk, tL.2241'15"00c 224 I�, _,...--.-- Ago optic,�(� ii — 2°— A,foiti s►' L�c a.51A ,4. .,cCet 214 P•cc p DUCTWORK INSPECTION Ducts Insulated?- Duct Linear Ft. -, Duct Insulatio`n,..--- Duct Squ t. Duct jasuration Removal (-h rt,,:, 5 iL ,i/l Due ir Sealing Hours Unit: 2 x`fxf(, ATTIC 1 Blind Spec?' Z x? x ATTIC Blind Spec? Air Sealing Multipliers Unit: EXISTING SPEC'ING SQ. FT. Unit: EXISTING SPEC'ING SQ.FT. Hours F 1,1N iJ Trusses Unfloored -� � c' 1t�t.. t.6004 �Unfloored P�.l,�d I � 15 t7 pc, �ls' Unit �-{ t7 r Mixed Insulation vs Floored - y'4 (J� 6� 3{.nd 1,, 15710�j I3o >6"Loose Cath Slope Cath Slope Unit Walls •-► "—" — +y yet 3 Cross Batting Access _i .z J_D�/ Access �' .y ,� } WHF Box Unit: t'"'�+ t b"�� �S�ieathingAccess t� Unit: Venting Propavents Vent BF Hose Damming Venting Propavents Vent F BF Hose Damming R.L.Covers Unit: c 50 c L� Temp Access Unit: cu a a , ti /r/e-,' Roof Type:/1 f ,,� ', r. Page 1 of: HomeWorks ?` 101 Station Landing Ste 110, CM mass saveMedford,MA 02135 Energy PARTNER 101 305-3319 Customer Name:Joan Perreault Email:jmperreault@gmail.com Phone:617-642-4330 Premise Address:205 South St, 1,Northampton,MA 01060 Mailing Address:205 South St, 1,Northampton,MA 01060 Project ID:4667181 Date: Nov.30,2022 Job Description Measure Description Location Quantity Unit Total Cost Customer Cost Air Sealing at Estimated 62.5 CFM50 Per Hour 4 hr $377.32 $0.00 Propavent 25 each $103.25 $0.00 Damming 50 each $122.50 $0.00 Attic Floor- 15" Open Blow Cellulose 315 SF $796.95 $0.00 Door-2"Thermal Barrier Polyiso 1 each $90.61 $0.00 Exterior Door Weather Stripping (with AS hrs) 3 each $95.43 $0.00 Door Sweep (with AS hrs) 3 each $78.33 $0.00 Vapor Barrier- 6 mil Polyethylene (with AS hrs) 787 SF $802.74 $0.00 Rim Joist-2"Thermal Barrier Polyiso 165 SF $803.55 $0.00 Total Contractor Price and Payment Schedule HomeWorks Energy, Inc.agrees to perform the above described work,furnishing the material and labor specified for the listed total price. Payment of the balance of the customer contribution is expected upon completion of the work. Customer Signature: Date: Customer Phone: Specialist Signature: Date: LIMITED TIME OFFER: The prices and incentives in this contract are subject to change in accordance with the sponsoring utility MassSave Home Services Program offers. Proposals con be sent to:Inbox@HomeWorksEnergy.com Page 2 of tEioje . HomeWorks 101 Station Landing Ste 110, nmass save Medford.MA 02155 \ Energy PARTNER (781)305-3319 Customer Name:Joan Perreault Email:jmperreault@gmail.com Phone:617-642-4330 Premise Address:205 South St, 1,Northampton,MA 01060 Mailing Address:205 South St, 1,Northampton, MA 01060 Project ID:4667181 Date:Nov.30,2022 Project Total $3,270.68 Weatherization incentive ($1,916.86) Air sealing incentive ($1,353.82) Total Program Incentive -$3,270.68 Customer Total $0.00 Total Contractor Price and Payment Schedule HomeWorks Energy, Inc.agrees to perform the above described work,furnishing the material and labor specified for the listed total price. Payment of the balance of the customer contribution is expected upon completion of the work. cuz �2�2a.cu� 12/6/2022 Customer Signature:_ Date: Customer Phone: 12/6/2022 Specialist Signature: _ Date: LIMITED TIME OFFER The prices and incentives in this contract are subject to change in accordance with the sponsioring utility MassSave Home Services Program offers. Proposols con be sent to:inboxttHomeWorksEriergy.con Page 1 of: (� "() HomeWorks Awfi 101 Station Landing Ste 110, ®(} i 1117855 PARTNERsaveMedford,MA 02155 t I Energy (781)305-3319 Customer Name:Joan Perreault Email: Not provided Phone:617-642-4330 Premise Address:205 South St,2,Northampton,MA 01060 Mailing Address:205 South St,2,Northampton, MA 01060 Project ID:4667192 Date: Nov.30,2022 Job Description Measure Description Location Quantity Unit Total Cost Customer Cost Air Sealing at Estimated 62.5 CFM50 Per Hour 4 hr $377.32 $0.00 Exterior Door Weather Stripping (with AS hrs) 3 each $95.43 $0.00 Door Sweep (with AS hrs) 3 each $78.33 $0.00 Vapor Barrier- 6 mil Polyethylene (with AS hrs) 108 SF $110.16 $0.00 Door-2"Thermal Barrier Polyiso 1 each $90.61 $0.00 Attic Floor- 15"Open Blow Cellulose 150 SF $379.50 $0.00 Hatch - 2" Thermal Barrier Polyiso 1 each $47.37 $0.00 Damming 20 each $49.00 $0.00 Propavent 50 each $206.50 $0.00 Total Contractor Price and Payment Schedule HomeWorks Energy, Inc.agrees to perform the above described work,furnishing the material and labor specified for the listed total price. Payment of the balance of the customer contribution is expected upon completion of the work. Customer Signature: Date: Customer Phone: Specialist Signature: Date: LIMITED TIME OFFER The prices and incentives in this contract are subject to change in accordance with the sponsoring utility MassSave Home Services Program offers. Proposols con be sent to:Inbox§HomeWorksEnergy.com Page 2 of f° "3 HorneWorks 101 Station Landing Ste 110, Eanmass save Medford,M4 02155 Energy PARTNER (781)305-3319 Customer Name:Joan Perreault Email:Not provided Phone:617-642-4330 Premise Address:205 South St,2,Northampton,MA 01060 Mailing Address:205 South St,2,Northampton, MA 01060 Project ID:4667192 Date:Nov.30,2022 Project Total $1,434.22 Weatherization incentive ($772.98) Air sealing incentive ($661.24) Total Program Incentive -$1,434.22 Customer Total $0.00 Total Contractor Price and Payment Schedule HomeWorks Energy, Inc.agrees to perform the above described work,furnishing the material and labor specified for the listed total price. Payment of the balance of the customer contribution is expected upon completion of the work. f°4 22 12, i - 12/6/2022 Customer Signature:_ _____ Date:_ _ _ _ _ Customer Phone:_ C449-6/. 12/6/2022 Specialist Signature: _ Date: UMITED TIME OFFER: The prices and incentives in this contract are subject to change in accordance with the sponsoring utility MassSave Home Services Program offers. Proposals con be sent to:lnbox@HomeWorksEriergy.com HomeWorks Energy Co ((A) 101 Station Landing,Medford,MA 02155 CONTRACT - AUDIT HomeWorks 781-305-3319 Page 1 PROGRAM CMA-HPC CUSTOMER PHONE DATE CLIENT• WORK ORDER Hannah Archambault (857)642-4330 12/17/2021 336055 00001 SERVICE STREET BILLING STREET PROPOSED BY: 205 South Apt 2 Street Apt 2 205 South Apt 2 Street Apt 2 HomeWorks Energy SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Northampton, MA 01060 Northampton, MA 01060 DESCRIPTION QTY COST INCENTIVE TOTAL CRAWLSPACE HEIGHT NO VAPOR BARRIER Because the crawlspace cannot be safely accessed and the earthen (initials) areas covered with a vapor barrier,all planned weatherization measures in the other areas of the home will need to be put on hold until the proper control of the crawlspace humidity is addressed. HOME AIR SEALING 3 $255.00 $255.00 Provide labor and materials to seal areas of your home against wasteful, excess air leakage. Materials to be used to seal your home can include caulks,foams and other products. Primary areas for sealing include air leakage to attics, basements, attached garages and other unheated areas(windows are not generally addressed.) WEATHERSTRIP AND ADD DOOR SWEEP 2 $160.00 $160.00 Provide labor and materials to install Q-Ion weatherstripping and a doorsweep to door(s)to restrict air leakage. ATTIC DAMMING-R-38 FIBERGLASS 50 $102.50 $102.50 Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass batts for damming purposes. ATTIC FLAT-15"OPEN R-49 CELLULOSE 224 $416.64 $416.64 Provide labor and materials to install a 15"layer of R-49 Class I Cellulose to open attic space. ATTIC FLAT-9"OPEN R-33 CELLULOSE 70 $105.00 $105.00 Provide labor and materials to install a 9"layer of R-33 Class Cellulose added to open attic space. ATTIC FLAT-8"FLOORED R-25 DENSE CELLULOSE 600 $1,326.00 $1,326.00 Provide labor and materials to install an 8"layer of R-25 Class I Cellulose to floored attic space. ATTIC DOOR-INSULATE&WS 1 $110.00 $110.00 Provide labor and materials to insulate the back of the attic door with 2"rigid insulation board and seal the door's edge with weatherstripping to restrict air leakage. SHEATHING ACCESS 1 $35.00 $35.00 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. tsDr HomeWorks Energy Ir 101 Station Landing,Medford,MA 21 u,, d, 0 55 CONTRACT - AUDIT HomeWorks 781-305-3319 Page 2 PROGRAM CMA-HPC CUSTOMER PHONE DATE CLIENT WORK ORDER Hannah Archambault (857)642-4330 12/17/2021 336055 00001 SERVICE STREET BILLING STREET PROPOSED BY: 205 South Apt 2 Street Apt 2 205 South Apt 2 Street Apt 2 HomeWorks Energy SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Northampton, MA 01060 Northampton, MA 01060 DESCRIPTION QTY COST INCENTIVE TOTAL VENTILATION CHUTES 24 $60.00 $60.00 Provide labor and materials to install ventilation chutes in the rafter bays to maintain air flow. VENT BATH FAN THRU ROOF 4 INCH 1 $118.75 $118.75 Provide labor and materials to install an insulated 4"exhaust hose with roof mounted flapper vent to exhaust existing bathroom fan(s). Total: $2,688.89 Program Incentive: $2,688.89 Customer Total: $0.00 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***00/Dollars $0.00 /l<L CZ CaZ AA.A/ZauXt- COMPANY REPRESENTATIVE CUSTOM SIGNATURE 12/6/2022 NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE SIGN DATE DAYS.