31A-097 (13) BP-2023-0483
63 VERNON ST COMMONWEALTH OF MASSACHUSETTS
Map:B lock:Lot:
31A-097-001 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-2023-0483 PERMISSION IS HEREBY GRANTED TO:
Project# INSULATION 2023 Contractor: License:
Est. Cost: 3000 HOMEWORKS ENERGY INC 106148
Const.Class: Exp.Date: 07/30/2024
Use Group: Owner: BURNHAM SOPHY
Lot Size (sq.ft.)
Zoning: URB/WP Applicant: HOMEWORKS ENERGY INC
Applicant Address Phone: Insurance:
235 ESSEX ST 781-205-4484 1847910
WHITMAN, MA 02382
ISSUED ON: 04/19/2023
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: Q Cs-,
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax:I(413)587-1272
Office of the Building Commissioner
FEE: $65.00 ! J lW-I
8grr�,i City of Northampton Dep
r•
(:ift ' I,
~' 1'; Building Departure
. 212 Main Street '9 i INSULATION
Room �'
, Northampton, NiA60 Li
-<r... phone 413-587-1240 Fax 4'43 587-1272 ONLY
APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY
SECTION 1 -SITE INFORMATION INSULATION PERMIT
This section to be completed by office
1.1 Property Address:
Map Lot Unit
63 Vernon Street Northampton MA 01060 Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Sophy Burnham 63 Vernon Street Northampton MA 01060
Name(Print) Current Mailing Address:
See Attached (202)489-4885
Telephone
Signature
2.2 Authorized Agent:
Adam Glenn 235 Essex Street, Whitman, MA 02382
Name(Print) cr( .r. Current Mailing Address:
ciii4.4
781-205-4484
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 3,000 (a)Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
1404
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 +2+3+4+ 5) 3,000 Check Number 1 1'6')')"
This Section For Official Use Only
Building Permit Number: 6P- )3 - q 63 DateIssued:
Signature: / Li- /I- 20�3
Building Commissioner/Inspector of Buildings Date
wxpermitting @ homeworksenergy.com
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 4-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:Adam Glenn 106148
License Number
235 Essex Street, Whitman, MA 02382 07/30/2024
Addre Expiration Date
781-205-4484
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable D
HomeWorks Energy 181138
Company Name Registration Number
235 Essex Street, Whitman, MA 02382 03/02/2025
Address Expiration Date
g4a1, SiirtZld Telephone 781-205-4484
SECTION 5-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152, §25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes n No ❑
Brief Description of Proposed Work
Residential weatherization/ Air sealing. No structural changes. SITE ID 800656
Adam Glenn , as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Adam Glenn
Print Name 64/(4
,:54117() 4/11/2023
Signature of Owner/Agent Date
Sophy Burnham as Owner of the subject
property
hereby authorize HomeWorks Energy
to act on my behalf, in all matters relative to work authorized by this building permit application.
See Attached 4/11/2023
Signature of Owner Date
City of Northampton
0.'tHAM
O YT - -
S � S'
O
"" Massachusetts �`'•`
DEPARTMENT OF BUILDING INSPECTIONS .t
212 Main Street • Municipal Building ,
Northampton, MA 01060
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation ("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes. Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion,
improvement removal, demolition, or construction of an addition to any pm-existing owner-occupied building containing
at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered.
Type of Work:Weatherization Est. Cost:3,000
Address of Work:63 Vernon Street Northampton MA 01060
Date of Permit Application: 4/11/2023
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law(explain):
Job under$1,000.00
Owner obtaining own permit(explain):
Building not owner-occupied
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.C.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:
1 hereby apply for a building permit as the agent of the owner:
4/11/2023 Adam Glenn 181138
Date Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
City of Northampton
A x
Massachusetts
,'s kI DEPARTMENT OF BUILDING INSPECTIONS
-i, 212 Main Street •Municipal Building `
— s,-- Northampton, MA 01060
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building
permit all debris resulting from the construction activity governed by this Building Permit shall be disposed
of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
63 Vernon Street Northampton MA 01060
(Please print house number and street name)
Is to be disposed of at:
McNamara Waste Services LLC, 24 E Longmeadow Rd, Hampden, MA 01036
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Caltail Sij)raV 4/11/2023
Signature of Permit Applicant or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
y�.,,,,j City of Northampton
\4l _.... ,,, ?S`5 Sir
Y, ' S Massachusetts �� -e,
Y', � y:
s^*i DEPARTMENT OF BUILDING INSPECTIONS yJ
A •� 212 Main Street • Muni
cipal Building bf
Northampton, MA 01060 s`;', 4C-)NA
MANDATORY FOR HOUSES BUILT BEFORE 1945
Property Address: 63 Vernon Street Northampton MA 01060
Contractor
Name HomeWorks Energy
Address: 235 Essex Street
City, State: Whitman, MA 02382
Phone: 781-205-4484
Property Owner
Name: Sophy Burnham
Address: 63 Vernon Street Northampton MA 01060
City, State:
I Adam Glenn (contractor) attest and affirm that the building I intend to
insulate does not have any open air (knob and tube)wiring in the spaces to be insulated and that I have
provided the property owner with a copy of this affidavit.
Contractor signature Cailk(4'.
���e��)1:at
coe-—
Date 4/11/2023
The Commonwealth of Massachusetts
Department of Industrial Accidents
—ir —
n _= Office of Investigations
__er= Lafayette City Center
-= 2 Avenue de Lafayette, Boston, MA 02111-1750
'4 / www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): HomeWorks Energy
Address: 235 Essex Street
City/State/Zip:SlThitman,MA 02382 Phone #: 781-205-4484
Are you an employer? Check the appropriate box:
Type of project(required):
1.❑■ 500+ 4.I am a employer with ❑ I am a general contractor and I 6. ❑ New construction
employees (full and/or part-time).* have hired the sub-contractors
listed on the attached sheet. 7. ❑ Remodeling
2.❑ I am a sole proprietor or partner-
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers'
9. ❑ Building addition
[No workers' comp. insurance comp. insurance.:
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑ 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.❑l Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: Federated Mutual Insurance Company
Policy#or Self-ins. Lie. #:#1847910 Expiration Date: 1/1/2024
Job Site Address: 63 Vernon Street Northampton MA 01060 City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify und r the pains and pe vAl'es of perjuty that the information provided above is true and correct
Signature:
o.C4"4' `or/ Date: 4/11/2023
Phone#: 781-205-4484
Official use only. Do not write in this area, to be completed by city or town official.
City or Town: Permit/License #
Issuing Authority(check one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing
Inspector 6. Other
Contact Person: Phone#:
'4 o- 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 POLICIES BELOW.THIS
CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR
PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If
SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this
certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
FEDERATED MUTUAL INSURANCE COMPANY NAME: CLIENT CONTACT CENTER
PHONE HOME OFFICE:P.O.BOX 328 (A/C,No,EEO:888-333-4949 FAX
No):507-446-4664
OWATONNA,MN 55060 EADDRESS:CLIENTCONTACTCENTER@FEDINS.COM
INSURER(S)AFFORDING COVERAGE NAIC H
INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935
INSURED 419-899-0 INSURER B:
HOMEWORKS ENERGY,INC. INSURER C:
101 STATION LNDG INSURER D:
MEDFORD,MA 02155-5134 ,
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 ADM.SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS
LTRINSR WVD IMM!DDIYYYYI IMMIDDIYYYY)
X COMMERCIAL GENERALUABIUTY EACH OCCURRENCE $1,000,000
CLAIMS-MADE X OCCUR DAMAGE TO RENTED $100,000
PREMISES!Ea occurrence)
MED EXP(Arty one person) EXCLUDED
A N N 1847909 01/01/2023 01/01/2024 PERSONAL&ADV INJURY $1,000,000
'L AGGREGATE LIMIT APPLIES PER.4GENERAL AGGREGATE $2,000,000
X POLICY ' :ZC I LOC PRODUCTS-COMP/OP AGG $2,000,000
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
!Ea acdeenu $1,000,000
X ANY AUTO BODILY INJURY(Per person)
-
A _OWNED AUTOS ONLY _SaUTOsULED 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 CLAMS-MADE N N 1847911 01/01/2023 01/01/2024 AGGREGATE $1,000,000
_
DED ^^RETENTION
WORKERS COMPENSATION X PER STATUTE OTH-
AND EMPLOYERS'LIABILITY YIN ER
ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT S500,000
A OFFICERIMEMBEREXCLUDED? _NIA N 1847910 01/01/2023 01/01/2024
(Mandatory In NH) E.L DISEASE-EA EMPLOYEE 5500,000
II yes,describe under
DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached It more space is required)
THIS COPY IS NOT TO BE REPRODUCED FOR ISSUANCE OF CERTIFICATES.
CERTIFICATE HOLDER CANCELLATION
01
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES 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 POUCY PROVISIONS.
HOLDERS.
AUTHORIZED REPRESENTATIVE
Csl 1988-2015 ACORD CORPORATION.Al rigfmts reserved.
ACORD 25(2016f03) The ACORD name and logo are registered marks of ACORD
Commonwealth of Massachusetts
Division of Occupational Licertsure Construction Supervisor Specialty
Resb�dedtc
Board of Building Regulations and Standards CSSL'IC ,nsuIatiwn Contactor
Constructs (rIl r Specialty
.y
•
CSSL-106148 '1c+ .. spires: 07/30/2024
ADAM GL . k
19 CHARGE�r' `
WAREHAM Nt
NS Y7 e Failure topossess a current edition of the Massachusetts
o>tYt �J � State Building Code is cause for revocation of this license
For information about this license
Call{617) 727-3200 or visit w'ww rnass.govidpt
Commissioner cliaepi F. sattidta.,
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
110
Type: Corporation
____ ' Registration: 181138
HOME WORKS ENERGY, INC. nit
= Expiration: 03/02/2025
101 STATION LANDING STE 110 ••w—=
MEDFORD, MA 02155AMIMOINMIN
====
J1Af
5 IMP
Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the
HOME IMPROVEMENT CONTRACTOR expiration date. If found return to:
TYPE: Corporation Office of Consumer Affairs and Business Regulation
Registration Expiration 1000 Washington Street -Suite 710
181138 03/02/2025 Boston,MA 02118
HOME WORKS ENERGY,INC.
l „
ADAM GLENN 7/ Cd11/(1‘ .5);I f 4j ek---
101 STATION LANDING STE 110 Cn,a(&..'/dGl�i�Gc"
MEDFORD. MA 02155 - p,/
Undersecretary Not valid without signature
Insulation/Air Sealing Permit Authorization
Specialist: Adam Morrison Company: HomeWorks Energy
Email: adam.morrison@homeworksenergy.cc Address: 101 Station Landing
Cell: 7813053319 Medford. Ma 02155
Phone: 781.305.3319
Customer: Sophy burnham Address: 63 Vernon Street
Email: sophyburnham@gmail.com Northampton, MA,01060
Site ID: 800656 Phone: 2024894885
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: sophyburnham@gmail.com
Customer
Signature: c/0u� �GG2.Ml&f'' Date: 2/1/2023
Sophy b nham
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 abov
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.
'OWNE
NTER 2pm
PLAN VIEW
3 Name: Sophy Burnham Site ID: 800656 Finished Sq. Ft: 1433
o Phone: 2024894885 Year of House: 1869 Electric Acct #: NA
WAddress: 63 Vernon Street Northampton # of Floors: 1.5 Gas Acct #: NA
I sophvburnham(agmail Unit#: # Occupants: 1 Housing Type?Victorian
DUCTWORK INSC' Ducts Insulated?n
Duct Linear Ft.
Duct Square Ft. 3 3 16
Duct Air Sealing Hours s a
Duct Insulation I ,
' : � L'3d y`C
s Is
IoDuct Insulation Remo I
______J
w 9tNT INSPF( %I
r Cr+cXLi
g, Existing Spec'ing Ln/Sq. Ft. to 1
m Bsmt Wall AG ZV '
Crawl Ceiling 1
Crawl Rim Joist J, '..1": �)4 -
Bsmt RJ w/Sill n f
Bsmt RJ NO Sill �) Q' �'I'.?\ (#4 .1tr' y z •
Vapor Barrier' , qft. Bsmt Door 0 ,r
P.d Blower Door: 9a WALLS &(ARAG€ Drill Location?
Siding `"' Cell.Height Existing Spec'ing Sq.Ft. Framing
Exterior Wall 1 x x BalloonOPlatfor
Exterior Wall 2 x x BalloonfPlatforrr[1
Overhang x x
Garage Wall x x Balloor>J'latforrr0
Garage Ceiling x x
0
a
W 5
z
cc . 3 E d
¢ ro - IS
y `\ 1 V
g 8 t
J
" 7 V
0 F 6 litii ,
•
fr1L Insulatiooval
/ ' 0
b
il
',„'ORK SPE("t- BUT NET ONTRACTED 4 r', - Bt_OCKS PRESENT?`, "NDA' -r;'
Attic ❑ Basement rawl ace fl Other: lc' K& T Y N 4oisture Y N 2 . bustion Sfty Y) NKneewall LJ Overhang/Gre ❑ Asbesto` Y ON told>1DOsgFt YD r� Detector Missingy
Ductwork 111 Exterior Walls, ., ❑ VermiculiteY0 N li• tructl ConcernsY■ /.other: t
Notes for Lead Vendor/Wor 1Vot Contracted:
r
KW WALL AND KW FLOOR Blind Spec? 0 - OR 10. KW SLOPE AND GARLF END RI nd,: Ill
hy? Why?
FRAMING EXISTING SPEC'ING SO.FT. FRAMING EXISTING .SPEC'ING SQ.FE
WALL X X SLOPE X X
FLOOR X X GABLE X x
o ACCESS x /// TRANS X X ' z
••NS x X ATTIC
v .nK £ SLOPE X X D
3 SLOPE X X EXISTING V ING?
EXISTING VENTING? ( EXISTIN IDES? YhN n
KW Vermnng Vent BF BF Hose Damning Sheathing Access Temp Access KW Venting Vent BF Temp Accra
J R
F.
KNEEWALL MANDATORY
t„.i
1 f
;: 3 16
8 8
z to
19
''. 9 \
C ,-
oa
4 j I Q
Q
2„r
16 6 ', F 6
gill 1' .
9 10
-__
19(l sto
, x (0 Arm: 7 Blind Spec? 11 x x .ATI it: 2 Blind Spec? U x(15 a(x I
z istin Spec'ing Sq ft Existing Spec'ing Sq ft 113.E rt«v)
F UnflooredP.� -6 OR 4 Unfloored 1J;TIPLIERS
vrUsses Cross ea ng�
Wa Floored Floored �+ an Mixed InQn Duct Work
Cath Slope Cath Slop �,r� > '��o None
E. Walls ( { Walls 1/ AIR SEALING HOURS
Access ;ja/(`) p(-) y x Access .e
Venting Propavents Vent BF BF H se Damm n• Venhng ropavents Ve t BF BF Hose Damming
co —Tea
Box:
_,-) �0 �j/r(j��} Temp ss:di
otri i �..( N 1
She t Access:
R. Cove
Sq.R/300= TV-NM Venting). (Needed Sq•Pt/300= (Exist.t�F41LQndng)_ (Needed j I
Existing Venting? 3 NFA Ventre _IstingVenting? NFAvenug) Roof Type: rj7
WEATHERIZATION CONTRACT EVERS=URCE
CUSTOMER PHONE DATE CLIENT! WORK ORDER
Sophy Bumham (202)489-4885 02/01/2023 800656 91501
SERVICE STREET BILLING STREET PROPOSED BY:
63 Vernon Street 63 Vernon St HomeWorks Energy
SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZP Program
Northampton, MA 01060 Northampton, MA 01060 EGMA-HPC Page 1
DESCRIPTION QTY COST INCENTIVE TOTAL
KNOB&TUBE WIRING 1 $0.00 $250.00 -$250.00
We have identified the potential existence of knob&tube wiring in your (initials)
home.The following contract is not valid unless accompanied by the
Weatherization Barrier Incentive form,signed by your licensed
electrician.Work will not proceed until we receive a copy of this form.
PERFORM AIR SEALING AT ESTIMATED 62.5 CFM50 PER HO 8 $754.64 $754.64
Seal areas of your home against wasteful, excessive air leakage.
Materials to be used to seal your home can include caulks,foams
and other products. Primary areas for sealing include air leakage to
attics, basements,attached garages and other unheated areas
(windows are not generally addressed.)
DAMMING 40 $98.00 $73.50 $24.50
Provide labor and materials to install a 12"layer of R-38 unfaced
fiberglass batts for damming purposes.
ATTIC FLOOR OPEN BLOW CELLULOSE 6" 660 $1,135.20 $851.40 $283.80
Provide labor and materials to install a 6"layer of R-22 Class I
Cellulose to open attic space.
HATCH: THERMAL BARRIER POLYISO 2 INCH (ATTIC) 2 $94.74 $71.06 $23.68
Provide labor and materials to insulate the back of an attic hatch with
2"rigid insulation board at R-10.
INSULATE RIM JOIST WITH 2"THERMAL BARRIER POLYISO 116 $564.92 $423.69 $141.23
Provide labor and materials to install rigid board insulation to the
perimeter of the basement ceiling at the house sill.
WEATHERIZATION CONTRACT EVERSIURCE
CUSTOMER PHONE DATE CLIENT C WORK ORDER
Sophy Burnham (202) 489-4885 02/01/2023 800656 91501
SERVICE STREET BILLING STREET PROPOSED BY:
63 Vernon Street 63 Vernon St HomeWorks Energy
SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Program
Northampton, MA 01060 Northampton, MA 01060 EGMA-HPC Page 2
DESCRIPTION QTY COST INCENTIVE TOTAL
6 MIL POLY VAPOR BARRIER 322 $328.44 $328.44
Provide labor and materials to install 10 ml polyethylene over open
ground in designated crawlspace/earthen basement areas.
Total: $2,975.94
Program Incentive: $2,502.73
Client Total: $473.21
I.DESCRIPTION OF WORK TO BE PERFORMED
Contractor will perform or cause to be performed the above work at the Client's Address in a professional manner and in accordance with the terms of this Contract:
II.PAYMENT
Client agrees to pay the Contractor for the Work,the Client Share of the Contract Cost is payable to the Independent Installation Contractor(IIC)upon satisfactory completion
of the Work.Client understands that they will not be required to pay the Program Incentive Share of the Contract cost.Changes to the individual line items and/or previous
incentives may increase or decrease the size of the Program Incentive Share. `
rios±4 ge.144l/L�/'1L
RISE Representative cunt rs
03/2 '/2023
Printed Name Dab of Acooptance