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30A-023 (13)
BP-2023-0778 48 LEXINGTON AVE COMMONWEALTH OF M SSACHUSETTS Map:Block:Lot: 30A-023-001 CITY OF NORTHA PTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARA VTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-0778 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: DIPIETRO HOME E RGY Est. Cost: 325 SOLUTIONS DBA R VISE 104464 Const.Class: Exp.Date: 03/06/202 Use Group: Owner: BAUM R MESCON CORY E &BENJAMIN S Lot Size (sq.ft.) Zoning: URB Applicant: BAUM R MESCON CORY E&BENJAMIN S Applicant Address Phone: Insurance: 48 LEXINGTON AVE FLORENCE, MA 01062 ISSUED ON: 06/14/2023 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 NOR HAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: ! II Cg is Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissi ner I I�A�►T `NAB• -- ( 3 '4 ,LT 18VI The Commonwealth of Massach .etts �/1/ FOR Board of Building Regulations and .tan.. �.,. IpALITY Q Massachusetts State Building Co• ,780 U Building Permit Application To Construct,Repair, 'erg i • . '• ised ar 2011 One-or Two-Family Dwelling �1Ty Gie '� O Dn 1 T ection For Official Use Only Q4e oo'/t; Building Permit Number: Oa pe" Date Applied: 05/24/2023��'-go i 8 I J _ 6-l4 Zt33 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 48 Lexington Ave Florence,MA 01062 1.1a Is this an accepted street?yes V no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 2 Private 0 Zone: _ Outside Flood Zone? Municipal 2 On site disposal system 0 Check if yesO SECTION 2: PROPERTY OWNE1�tSHIP' 2.1 Owner'of Record: Benjamin Baumer Florence,MA 01062 Name(Print) City,State,ZIP 48 Lexington Ave 413-218-3900 ben.baumer@gmail.com _ No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) Cl Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2:Insulation,Weatherization,and Air Sealing SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $325.12 1. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $0 ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $0 2. Other Fees: $ 4.Mechanical (HVAC) $e List: 5.Mechanical (Fire Suppression) $0 Total All Fe Check r'o.1"- Check Amount: Cash Amount: 6.Total Project Cost: $3255.1 2 0 Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-104464 03/06/24 James Dimopoulos License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 32 Middlesex St No.and Street Type Description Haverhill,MA 01835 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIF" M Masonry RC Roofing Covering ��— WS Window and Siding SF Solid Fuel Burning Appliances 978-203-6736 melissat@callrevise.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC-167375 03/11/24 James Dimopoulos Dipietro Home Energy Solutions dba Revise HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 32 Middlesex St melissat@callrevise.com No.and Street Email address Haverhill,MA 01835 978-203-6736 City/Town,State,ZIP Telephone SECTION 6: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 la No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. See attached authorization Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties o f perjury that all of the information contained in this applicati n is true and accurate to the best of my knowledge and understanding. 05/24/2023 Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program), will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Numbe 7 of half/baths Type of heating system Numbe:of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" The Commonwealth of Massac usetts t Department of Industrial Acci ents 11;) T Office of Investigations • I 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): Dipietro Home Energy Solutions dba Revise Address:32 Middlesex St City/State/Zip:Haverhill, MA 01835 __ Phone#:(978) 203-6736 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 d I employees(full and/or part-time).* have hired the sub-contract rs 6. El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor in capacity. employees and have workers' me any p insurance.: 9. ❑Building addition [No workers' comp.comp.insurance required.] 5. ❑ We are a corporation and it 10.0 Electrical repairs or additions 3.❑ officers have exercised thei I am a homeowner doing all work 11.Ej Plumbing repairs or additions myself. [No workers' comp. right of exemption per MG 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have o Weatherization employees. [No workers' 13.•Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'comp nation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside co tractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-cont actors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy mber. I not an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: HUB International New England Policy#or Self-ins.Lic.#:WC100142002 Expiration Date:04/20/2024 Job Site Address: 48 Lexington Ave City/State/Zip:Florence, MA 01062 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 pa' and p nalties of perjury that the information provided above is true and correct. Signature: t.--D- _ Date: 05/24/2023 Phone#: (978)203-6736 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 3.❑City/Town Clerk 4. Electrical Inspector 5.n13lumbing Inspector 6.0Other Contact Person: Phone-0: ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04/14/2022 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 Emily Costello NAME: Costello Insurance Group (AHO E Extl: (978)374-6352 FAX Nal: (978)521-5127 2 S.Kimball St. E-MAIL ecostello@costelloinsurance.com ADDRESS: PO BOX 5248 INSURER(S)AFFORDING COVERAGE NAIC# Bradford MA 01835 INSURERA: Colony Argo Insurance INSURED INSURER B: Commerce Insurance Co. 34754 Dipietro Home Energy Solutions,Inc. INSURER C: DBA Revise INSURER D: 32 Middlesex Street INSURER E: Bradford MA 01835 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2241402385 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE $ CLAIMS-MADE X OCCUR DAMAGE TO RENTED 50,000 PREMISES(Ea occurrence) , $ MED EXP(Any one person) $ 10,000 A PACEP308383 04/25/2023 04/25/2024 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X RO LOC 0000200 OTHER' pollution $ 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED X SCHEDULED HS6326 05/09/2023 05/09/2024 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED �/ NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) Medical payments $ 10,000 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LIAB CLAIMS-MADE EXC4245322 04/25/2023 04/25/2024 AGGREGATE $ 3,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/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/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Town of Northampton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 210 Main Street THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Northampton, MA 01060 AUTHORIZED REPRESENTATIVE I t' ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD DIPIEHO-01 CWOODSIDE ,a►coRo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) `-� 4/19/2023 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 License#1780862 CONTACT An a Toteanu NAME: y HUB International New England PHONE I FAX 300 Ballardvale Street (A/C,No,Eat): (A/C,No): Wilmington,MA 01887 ADD ESS:anya.toteanu@hubInternatlonal.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Independence Casualty Insurance Company 11984 INSURED INSURER B: Dipietro Home Energy Solutions,Inc.,Joseph A.Dipietro INSURERC: Heating&Cooling,Inc 32 Middlesex Street INSURERD: Haverhill,MA 01835 INSURERE: , 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 TYPE OF INSURANCE ADDLISUBR W POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD VD, IMM/DD/YYYYI (MM/DD/YYYYI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ _ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY IT& LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY _ AUTOS BODILYOccRl INJURY(Per accident) $ AUOTOS D ONLY _ A ONUTO WNE ONL� IPer edent?AMAGE _ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY Y/N WCI00142002 4/20/2020 4/20/2024 1,000,000 ANY PROPRIETOEER/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/Min NH)EXCLUDED? N NIA 1,000,000 E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Town of Northampton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 210 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Northampton, MA 01060 AUTHO RIZED REPRESENTATIVE I �IY ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD to-it' nationalarid mass save PERF WW,..,YrN i4ERE f•Di-,rc,u MASS SAVE® PRE-WEATHERIZATION BARRIER INCENTIVE 2013 CONTRACTOR EVALUATION REPORT Cory Mescon Rebate Recipient(if different): — Site ID:500002198300 , 48 Lexington Ave Project ID:P00000203290 Florence,MA 01062-2712 Mailing Address(If different): Customer ID:C00000208363 Date of Assessment:01.09.2014 Phone: City State: Zip: Phone: Energy Specialist:al Hanley Email: _ ENERGY SPECIALIST LVALUAl ON Cr :•I-t-d by inetitv SP—i- ii-ll KNOB&TUBE WIRING Ei Contractor is to evaluate the selected locations where weatherization recommendations have been made to detemene if active knob&tube wiring exists: 0 Attic 0 Exterior Walls 0 Basement MECHANICAL SYSTEM,HIGH CARBON MONOXIDE EVALUATION 0 Attic Floor 0 Knee Wall Floor 0 Attic Slopes 0 Contractor is to evaluate the selected mechanical system(s)below and provide service,if possible,to reduce high carbon monoxide levels as measured 1 in the undiluted flue gas to below 100 ppm: 0 Heating System i 0 Hot Water System 0 Other, DRYER VENT EVALUATION , 0 Contractor Is to evaluate the dryer vent and provide service to properly exhaust the vent to the exterior, CONTRACTOR 1 VAI UAT/ONS I.Corroi,toil by Ccrit7,:.....10'; KNOB&TUBE WIRING Upon completion at my inspection I have found that there is no active knob&tube wiring in the area(s)checked off below , AAttic 1. bie Exterior Walls I ,i5„$asement , 1:23.Attic Floor 61-Knee Wall Floor Ataatic Slopes CONTRACTOR INFO ATION Company Name: , , Address. i??)1' ...... City: Statellti ,--, Contractor Name: e )1 ••• Ali/License#: 4351r iS . Federal ID#: /.. I have ea and , s&Conditions of the Pre-Weatherization Barrier Incentive. Contractor Signature:Signature: ' , Date:7:i: 2 if .2"Pir ti MECHANICAL SYSTEM,HIGH N MONOXIDE EVALUATION 0 The selected mechanical system has been evaluated and serviced.Testing results of carbon monoxide In the undiluted flue gas are as follows - - ED Heating System CO ppm CIEl Hot Water System CO ppm 0 Other CO ppm DRYER VENT EVALUATION C3 The dryer vent has been exhausted to the exterior. CONTRACTOR INFORMATION Company Name: Address: City: State: _ Zip: Contractor Name:.,.,. License#: Federal ID#. I0 I have read,and agree to,the Terms&Conditions of the Pre-Weatherization Barrier Incentive. Contractor Signature: Date: CUSTOMER INSTRUCTIONS Submit signed and completed copies of this Contractor Evaluation Report and a copy of the paid Contractor Invoice to: Pre-WX Barrier incentive,C/0 CET,320 Riverside Drive-1A,Florence,MA 01062;or email to CustomerSupportacetonline,Org Customer Signature' ,,,,,, Date: THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington-Street- Suite 710 Bostorh- Massachusetts 02118 Home lrnprovemerit nfractorRegistration Type: Individual .ectiSailon: 167375___ JAMES G.DIMOUOULOS Expitation: 03/11/2024 25 SEVEN SISTER RD HAVERHILL,MA 01830 • 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:individual- Office of Consumer Affairs and Business Regulation Rogitt.siion ExcifratiOn 1000 Washington Street -Suite 710 16737.E 03/11/2024 Boston,MA 02118 JAMES G.DIMOUOULOS. JAMES DIMOUOULOS 25 SEVEN SISTER RD A:s ..'46 !-{gvERHILL,MA 01830 Undersecretary _---' N,pt-- a(id without signature IP Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Reulations and Standards Const, torY Srvisor .I CS-104464 x; s�pires:03/06/2024 JAMES G DIMOPOULOS -. 25 SEVEN Sl TER RD HAVERHILL MA 01830ri .... l Ccmmissioner . /; klit.ni.t� a.. rg- .,:.� DocuSignf Envelope ID: F42A535B-0351-4762-B657-2050378A8AC9 - ;::::!!Yitgt!;.;;Ili;r7i:i" ;; � EVIq the way you save` _ 1 • Permit Authorization Form Site ID: Street Address: City: To be filled out by Subcontractor (if applicable) Contractor Name: Dipietro Home Energy Solutions DBA Revise Contractor Address: 32 Middlesex St Bradford Ma 01835 Benjamin Baumer owner of the property listed above hereby authorize Reiise Energy or my assigned subcontractor listed above to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property under the Mass Save Home Energy Services Program. DocuSigned by. Owner Signature: ' a uA, t5 u,, `�—B'DD22334 D B F E 223493... Date: 5/23/2023 DocuSign Envelope ID: F42A535B-0351-4762-B657-2050378A8AC9 Revise Energy REVISE Home Performance Contractor the way you save 5 South Summer Street,Bradford,MA 01835 CONTRACT - AUDIT 1-800-885-7283 CUSTOMER PHONE DATE CLIENT# WORK ORDER Ben Baumer (413)218-3900 05/23/2023 806625 76201 SERVICE STREET BILLING STREET PROPOSED BY: 48 Lexington Avenue 48 Lexington Ave Revise Energy SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Florence, MA 01062 Florence, MA 01062 Page 1 DESCRIPTION QTY COST INCENTIVE TOTAL INSULATION REMOVAL 140 $173.60 $0.00 $173.60 Batt style insulation will be removed from the attic area and properly disposed, off site. INSULATE CLAPBOARD SIDED WALL WITH 4" DENSE PACK C 59 $151.52 $113.64 $37.88 Provide labor and materials to install blown in Class I Cellulose to clapboard sided exterior walls. Touch-up painting, if needed,will be the customer's responsibility. Homeowner has received a copy of the EPA's Renovate Right Lead-Safe information guide explaining the potential risk of the lead hazard exposure from the weatherization work to be performed.Your signature is your acknowedgement of receipt and agreement to proceed. Total: $325.12 Program Incentive: $113.64 Customer Total: $211.48 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Two Hundred Eleven &48/100 Dollars $211.48 DocusIBned by: Michael E Madden r—Doc uSigned by: L C.i •"`�" itt& Lt�A�1l�t ¢U� tx 5/23/2023 D4784CBB9E1D490... —BD234DBFE223493... �umrwni nerneaen IX I Ive CUSTOMER SIGNATURE 5/23/2023 NOTE,THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE'. SIGN DATE 30 DAYS. Revise Energy PianWow OIagra ` Customer: V C Ar A'1 t c}-1 131A9v'MkV\.- Advisor N. e: a *4414.n ').1 t r .4 k -1 E)1 4 LA Address / 6- tit fi(-'Z A){:; Any limitations to access fry truck? '(I N Town: ( t6 n C }_..X Site ID: wQ t.d(d 'Use the greater of the two BAS Nis when r,,at.Q,tat,r, for M'✓R #al starir's 1 1,5 _ 2 2.5 3 I RAS 1: 15 t.frn X X occupants X rs factor = n factor 19 16 15 14.4_ 13,/ j BAS 2: ,00583 X area X height X n-factor 4 Mechanical Ventilation Recommended:[lA5,final Cr MSQ> (f1.7 X HAS) Mechanical Ventilation Required:fr)7/CL r3J,hraI CFM`j.1 --- A/5 Is this part of a multi-unit workscopn? Y or N Multiplier/ N/A >B"f_nv 3 a i e lnavtatirn Crosg•f3xtt >F,'!/Fr I.�r�N-ta?t Tr,Bs Workscope. � (9 l,,.)S . A-i w I .-) 4 4- s-0,.)4r-1. 4 Lf o id () t,3 'A 0 00 4 u rIr'"i t 0.3 t Lit. tAf kiitk` vi it-1.k- qJ 4't(- C9 A c.“( Roo A 6.'' 0 17-,C. 4 ,)9- ef t) .3-0z, f 9' ( &A&/i SI7 C (tit L 1fi- " (=3�' irlv- IK71 00 , Any work scoped outside of best practices/approved by? (a ( 3 . -.4 1 1 ,)-v (0) , ,rs 6 c,.....) co./„...._,.... ,,,,A,„-/ ,A to 0 c_.,-) tn p"--. ,* 4k:A7k(- 4'10 N (-1-0 L.,... 2 Page—of