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32A-193 (8) BP-2023-0786 36 PHILLIPS PL COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 32A-193-001 CITY OF NORTHAl1VIPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGI TERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARA TY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-0786 PERMISSIO IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 1000 CLEAN TECH CONS RUCTION 106229 Const.Class: Exp.Date: 01/05/202 Use Group: Owner: WAEC TER MARIE Lot Size (sq.ft.) Zoning: URC Applicant: CLEAN TECH CONSTRUCTION Applicant Address Phone: Insurance: 40 MESSINA DR 508-576-1026 6hub4n60130822 BRAINTREE, MA 02184 ISSUED ON: 06/13/2023 TO PERFORM THE FOLLOWING WORK: INSULATION/W EATH ERI Z ATI 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 NOR'THAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: • , s >2 • 7-11 • Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissiiiner "r E-vnu I'! &h e (ealeY (3 lgcb Department use only City of Northampton FOR f . • Building Department 212 Main Street � Room 100 INSULATION Northampton, MA 01060 .t, phone 413-587-1240 Fax 413-587-1272 QP4L. Y APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INSULATION PERMIT 1.1 Property Address This section to be completed by office Map Lot Unit 36 Phillips Place Northampton, MA 01060 Zone Overlay District Elm St. District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Marie Waechter 36 Phillips Place Northampton, MA 01060 Name(Print) Current Mailing Address: See Attached 413-246-3707 Telephone Signature 2.2 Authorized Agent: Elvis Verdezoto 40 Messina Drive Braintree, MA 02184 Name(Print) Current Mailing Address: 508-576-1026 Signature Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 1,000.00 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) tt 5. Fire Protection 6. Total = (1 + 2+ 3+ 4 +5) 1,000.00 Check Number This Section For Official Use Only �ly9,y3—� ,19�/ I s te Building Permit Number: t/ Issued: Signature: ' J3"ZZ3 Building Commissioner/Inspector of Buildings Date CLEANTECHCONSTRUCTION 1211 @ GMAIL.COM EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder:Elvis Verdezoto 106229 License Number 40 Messina Drive Braintree, MA 02184 01/05/2026 Address Expiration Date ligAZZi1j6v 508-576-1026 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable 0 Clean Tech Construction 196071 Company Name Registration Number 40 Messina Drive Braintree, MA 02184 06/27/2025 Address Expiration Date f/24,�diga9 Telephone 508-576-1026 SECTION 5-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes I r l No ❑ Brief Description of Proposed Work Residential weatherization/ Air sealing. No structural changes. Elvis Verdezoto as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Elvis Verdezoto Print Name Signature of Owner/Agent Date Marie Waechter as Owner of the subject property hereby authorize Clean Tech Construction to act on my behalf, in all matters relative to work authorized by this building permit application. See Attached Signature of Owner Date City of Northampton aSM�M T SAS.. • ...s�6, 4' .'"'' Massachusetts �4?' 1.- •"? �s v �� DEPARTMENT OF BUILDING INSPECTIONS a`• . 'w `. 212 Main Street • Municipal Building Q. oca *d _. Northampton, MA 01060 4;1i... �^ AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes, a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L. Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work:Weatherization Est. Cost: 1,000.00 Address of Work:36 Phillips Place Northampton, MA 01060 1110111111111 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law(explain): _Job under$1,000.00 Owner obtaining own permit(explain): Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: Elvis Verdezoto 196071 Contractor Name HIC Registration No. OR: Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton -0atH M `5- s,.. �?• ", L. Massachusetts a``�S c,�c 1A6DEPARTMENT OF BUILDING INSPECTIONS �� :(4 +` 212 Main Street •Municipal Building 0 Ca f Northampton, MA 01060 .rsE•• o 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: 36 Phillips Place Northampton, MA 01060 (Please print house number and street name) Is to be disposed of at: Not Applicable (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) -fi,l.Q% v e. .3 Signature of Permit A plicant 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. City of Northampton SAS , S,i Massachusetts *mai j % DEPARTMENT OF BUILDING INSPECTIONS .. If 212 Main Street • Municipal Building Northampton, MA 01060 bK 3.. MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 36 Phillips Place Northampton, MA 01060 Contractor Clean Tech Construction Name: Address: 40 Messina Drive City, State: Braintree, MA 02184 Phone: 508-576-1026 Property Owner Marie Waechter Name: Address: 36 Phillips Place Northampton, MA 01060 City, State: Northampton, MA 01060 Elvis Verdezoto (contractor) attest and affirm that the building I intend to insulate does not have any open air (knob and tube)wiring in the spaces to be insulated and that I have provided the property owner with a copy of this affidavit. Contractor signature (r a- Date t i Commonwealth of Massachusetts Division of Occupational Licensure Construction Supervisor Specialty Board of Building Regulations and Standards Restricted to: Constructigef upertspr Specialty CSSL-IC-Insulation Contractor CSSL-106229 E xxpires.01/05/2026 ELVIS O VERpEZOTO 16 ALSOP STREET APT 2 FALL RIVER MA 02723 ` _ "A^a ` xl:v e • Failure to possess a current edition of the Massachusetts Commissioner ._, State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov'dp1 THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration r.:f ( Li 't =are_ , '. ...:.. r Type: Supplement Card v Registration: 196071 CLEAN TECH CONSTRUCTION LLCNM OA __ .-ration: 06/272025 38 ELLS SVE .---_- WEYMOUTH,MA 02190 �, = = ©) — f 7rc. .. 111111 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:Supplement Card Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 195071 0827/2025 Boston, MA 02118 CLEAN TECH CONSTRUCTION LLC r i . ELVIS VERDEZOTO ` \ �11=- --- = ' '/ 38 ELLS AVE _ .t ,,.+rlL i'aLGw4. C yQ c, WEYMOUTH.MA 02190 —ti' Undersecretary Not valid withoUT signature The Commonwealth of Massachusetts A Department of Industrial Accidents Office of Investigations P Y= Lafayette City Center 2 Avenue de Lafayette, Boston, MA 02111-1750 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Clean Tech Construction Address:40 Messina Drive City/State/Zip:Braintree, MA 02184 Phone #:508-576-1026 Are you an employer? Check the appropriate box: Type of project(required): 1. I am a employer with 30 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. El 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. El Demolition workingfor me in anycapacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑■ Other Insulation comp. insurance required.] *My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Traveler's Indemnity Co of America Policy# or Self-ins. Lic. #:6HUB4N60130820 Expiration Date:9/18/2023 Job Site Address: 36 Phillips Place 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 under the pains and penalties of perjury that the information provided above is true and correct Signature: Date: Phone#: 781-205-4516 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#: AC'CLR,O~ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 09/09/22 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: HO Tobman,Molignano&Weiner Ins Agency (/cC.No.Ex1): 617-471-1123 FAX No): 617-773-2474 21 McGrath Highway,Suite 303 E-MAIL ADDRESS: Quincy,MA 02169 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Norfolk&Dedham Mutual INSURED INSURER B: • Clean Tech Construction LLC INSURER C: _ 40 Messina Drive INSURER D Braintree,MA 02184 INSURER E: • INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLEUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE RENTE $ 1,000,000 CLAIMS-MADE X OCCUR PREMISESO(Ea occur ence) $ 300,000 MED EXP(Any one person) $ 5,000 A P012011894 09/18 09/18/23 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PET LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A OWNEDONLY X AUTOS SCHEDULED 91972894A 09/16/22 09/16/23 BODILY INJURY(Per accident) $ AUTOS XHIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAB CLAIMS-MADE U2003464A 09/18/22 09/18/23 AGGREGATE $ 2,000,000 DED RETENTION$ - $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y I N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N!A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached It 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. Clean Tech Construction LLC 40 Messina Drive Braintree,MA 02184 AUTHORIZED R ENTATIVE ©1 -2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD CLEAResult CONTRACT CLEAResult 41 Brigham St., Customer Name:MARIE WAECHTER Marlborough,MA,01752 Email:MWaechterb@aol.comm Phone:413-246-3707 Premise Address:36 Phillips PI,Northampton,MA 01060 Mailing Address:36 PHILLIPS PL APT 1,Northampton,MA 01060 Project ID:4828885 Date:May 1,2023 Applicable Customer Required Actions: Notes: • Other Homeowner is responsible for sealing the openings that connect the two crawlspaces. Homeowner is responsible for removal of fiberglass insulation from the bulkhead door. Job Description Contractor will perform or cause to be performed the following work on these"Premises"in a professional manner and in accordance with the terms of this Contract,including the attached recommendations/work order describing the work in detail(the"Work")which are incorporated herein by reference. Measure Description Location Quantity Unit Total Cost Customer Cost Air Sealing at Estimated 62.5 CFM50 Per Hour 1 hr $94.33 $0.00 Insulation Removal 32 SF $39.68 $39.68 Rim Joist-2"Thermal Barrier Polyiso 127 SF $618.49 $154.63 Door-2"Thermal Barrier Polyiso 1 each $90.61 $22.65 Exterior Door Weather Stripping(with AS hrs) 2 each $63.62 $0.00 Door Sweep(with AS hrs) 2 each $52.22 $0.00 Total: $958.95 Program Incentive: -$741.99 Customer Total: $216.96 Payment Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows:Payment#1: as a Deposit payable to CLEAResult upon signing the Contract(not to exceed 1/3 of the total retail costs). Mail check&contract to CLEAResult,41 Brigham St., ,Marlborough,MA,01752.Final Payment: as the final payment for the Work shall be payable to the Home Performance Contractor(HPC)or Independent Installation Contractor(IIC)upon satisfactory completion of the Work. Customer understands that he/she will not be required to pay the Utility Incentive Share of the Contract price in the amount of�. Changes to individual line items and/or previous incentives may increase or decrease the size of the Utility Incentive Share. Page 1 of 4 Document Ref:7U2CO-YOU9K-SLD6O-SABXC Dispute Resolution The IIC and Customer hereby mutually agree in advance that in the event that the IIC has a dispute concerning this Contract,the IIC may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and Customer shall be required to submit to such arbitration as provided in M.G.L.c 142A. You may cancel this agreement if it has been signed by a party at a place other than an address of the seller, provided you notify the seller in writing by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement.DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Marie Waedttfer 05/02/2023 Af. Customer Signature Date Indicate your selected IIC here,if applicable Initial here if you want the Program to assign a Participating II � L Contractor ,1MI/t, C6f t, 5/1/2023 Kevin Cote CLEAResult Signature Date Name of CLEAResult Representative Page 2 of 4 Document Ref:7U2CO-YOU9K-SLD6O-SABXC .4106k Permit Authorization mass save Form Sj,w,q tPwm., eneniV e'Pt,c FM'r Site ID: 4828885 Customer: MARIE WAECHTER I� Marie Waechter , owner of the property located at: (Owner's Name,printed) 36 Phillips PI Northampton, MA 01060 (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. Owner's Signature: Marie Wa2C�f�' Date: 05 / 02 / 2023 ••••••••••••••••!••••••.e••*•••••••••••••••••+•••••••••••••••••••••••• FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Clean Tech Construction 05/02/2023 Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 For Office Use Only Document Ref:7U2CO-YOU9K-SLD6O-SABXC RCS PLANVIEW DIAGRAM Customer:_WI( Q t�C� e C 1, I-Vein Home Phone: ( LI� ) G Address: e 'h\ l S ?14 L --__ __ _ Work Phone: ( )- -- Town:_AID; T C 1)f0 r\ Cell Phone: ( )- / Any limitations for access by large truck? No✓ Yes _ If yes.describe. __ ._ -- Any specific directions or landmarks? No / Yes If yes,describe.—_ Site ID: 4828796 Energy Specialist: q-- `o /)-4,-- --y?". Vr Reviewed by: F A-,c Seal C 1 rv\ -i o i 5t (loCiSe ,1(N,t- ar Ck C tr c.W a S P 4 Uz ) 1 hour L/ LVI50(ct,+t 0 tl (`e vv.ov`L 3 3 ft R f 0;51- T3? /a7 fl V Poor TB P 0a e r.S live t r5/r, Sweet .. ( LP/1 o n s ears r?TeS n c) bto u)Qr- o c,t- 5-t — Z0 crawlspace,headroom 16",not treatable /CI _ . _____ _ Scrawlspace,headroom 34",treatable 1 g l � a 3 1 - ` F (11/ basement - t0 3) 3 oOa 49;ti ` J Fur Office Use Only q S ( lit Bushes Ladder Neighbor Proximity Pocket Doors insert Radiators Fence(s) ) Existing Conditions X=Access ❑=Vents Note Inside Square R=Root S=Soffit G=Gab e 4. RV=Ridge Vent CS=Continuous Soffit CDE=Continuous Drip Edge T=Triangle install 0=New Access Note in Circle C=Ceiling W=Wall S e Sheathing Temp Unless Noted Otherwise L=Vents Note in Triangle R=8"Roof S=Soffit G.=Gable M=12"Mushroom For Access 2200-10-1/15 • ;x MI 1X 1 . •.. SUPPORTING MATH . _. , . — ------ _ __ ________ -------------— , Recommended Ventilation Calculation Recommended Ventilation Calculation .,:,11111116maiimailia__ AIR SEALING WORK HOURS Air Sealing Work Hour Calculation I Work Hours 4 6 8 10 12 1 i Attic Sq.Footage <500 501-800 801-1100 1101-1400 1401-1700 1701 2000 '00, - ';00 -- - - Exceptional AFL Hours Primarily Floored Attics Chimney or BF = I Hour Multioie Chinn es BrT — _ _........ Prefab/Modular Hours No Chimney=4 Hours Chimiws, -6' Houi s Exceptional KW Hours X<20 feet=1 Hour 20 ft< X<40 ft = 2 I \ '41.1,t -,4 1-4ou, Rim Joist Only Hours 1C7r1<16(-7771 F 40U-r:—...) f2J>150 It - 2 Hu -- BMT Ceiling Only Hours Ceiling Area<2,000 sg ft= I Hour Ceiling Area>2000, sti rt .,. 2 H0111, --— _— — "'NOTE:You MUST be INSULATING RJ or Basement Ceiling to specify RJ or BMT Ceiling ONLY Air Sealing Hours"' CI CI Multipliers >6"Loose Insulation I CrOY,Butt Insulation gaisj >6"Mix Batt&Loose Insulation Truss Construction iffi,I I "a-()illY , . . . . ., IIIIIIIIIIIIIIIIIIIIIIIIIIIMMIIMIII r r efillrilliMENIMMO-1111.11111111.1 r p MIIIIMOMINIMINIMMIMININIMMill 400ik 2019 WEATHERIZATION mass save BARRIER INCENTIVES Savings through energy efficiency 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: Pre-Wx Barrier Incentive, c/o CLEAResult, SO Washington St. Suite 3000,Westborough, MA 015B1 or email to: prewxoffer@clearesult.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: MARIE WAECHTER Client it or Site ID: 4058308 Site Address: 36 Phillips PI City: Northampton State: MA ZIP:01060 Phone Number: 413-246-3707 Email: mwaechter@wqby.orq 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 DAttic Wall °Attic Slope ❑Exterior Wall °Basement °Other: ❑Other: ave performed my inspection and determined there is no active knob and tube wiring in the areas selected below. lfl Thic Floor Bfic Wall PrAttic Slope exterior Wall J'Basement 0 Other: 0 Other: Tihave read and agree to the Terms,and Conditions o5 the back of this form. Contractor Name: g, rQD"' v.2)0" �/ ta'^i �-7 Address: r6 / l''�`�"_ sr- L/ City: S��'�N State:WV\ ZIP` k'�" f r 1' Company Name: �5�,0 Q ��'"� � License Number: 79u Contractor Signature: [ Date: ( —' MECHANICAL SYSTEM BARRIERS(To be filled out by licensed contractor.) High Carbon Monoxide:Contractor is to service and re-evaluate the selected mechanical system(s)and reduce the carbon monoxide level, as measured in the undiluted flue gas,to below 100 parts per million(ppm). Draft Failure:Contractor is to correct the draft in the selected flue(s).Refer to table on reverse for acceptable draft ranges. High Carbon Monoxide Draft Failure Existing CO ppm: Revised CO ppm: ' Existing Draft Pa: I Revised Draft Pa: Heating System Hot Water Heater • 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. 0 Heating System 0 Hot Water Heater 0 Other: ❑ I have performed my inspection and have corrected the items noted in the areas selected above. ❑ I have read and agree to the Terms and Conditions on the back of this form. Contractor Name: Address: City: State: ZIP: Company Name: License Number: Contractor Signature: Date: Page 1 of 2 Continued on back /nenn 1..f 7� To Whom It May Concern, Please give us a call at 508-576-1026 when the permit card has been issued. We will come to pick it up in-person. Alternatively, if you would like to e-mail the permit card we are happy to print it out on our end to post it on site. Thanks! Best, i e ia, vis, an. . " - - . uction cleantechconstruction1211@gmail.com . .- .- , •