29-367 (8) BP-2023-0813
61 AUSTIN CIR COMMONWEALTH OF M SSACHUSETTS
Map:Block:Lot:
29-367-001 CITY OF NORTHA PTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2023-0813 PERMISSIO IS HEREBY GRANTED TO:
Project# INSULATION 2023 Contractor: License:
Est. Cost: 4000 HOMEWORKS ENE'GY INC 106148
Const.Class: Exp.Date: 07/30/202
MAT (HEWS DENNIS R& SUSAN M&BENJAMIN
Use Group: Owner: C MATI HEWS &HANK R MATTHEW
Lot Size (sq.ft.)
Zoning: WSP Applicant: HOME ORKS ENERGY INC
Applicant Address Phone: Insurance:
235 ESSEX ST 781-205-4484 1847910
WHITMAN, MA 02382
ISSUED ON: 06/23/2023
TO PERFORM THE FOLLOWING WORK:
INSULATION/WEATH ERI ZATI 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:
f a O Ti
i .
, I
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissil ner
Fee: $65.00 `1
o�a� �Gy �1I r
ICM
The Commonwealth of Massachusetts °9°' �O
'',0.)• Board of Building Regulations and Standards tiyG''o
Massachusetts State Building Code, 780 CMR ,,°, 41, ICSE LIT
s
Building Permit Application To Construct,Repair,Renovate Or Demo -,,,k Re sed M. 011
One-or Two-Family Dwelling 40
s
This Section For Official Use Only
Building Permit Number:qp )-3- /3 Date Applied: •\
14-1)i0 4?-.>5 I/& 6- g.5 zoz-5
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
61 Austin Circle
1.la Is this an accepted street?yes 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 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Jennifer Carbery Florence, MA, 01'062
Name(Print) City,State,ZIP
61 Austin Circle (413)588-8720 momabug72@aol.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other Z Specify:weatherization
Brief Description of Proposed Work2:Residential weatherization/air sealing.No structural changes.Site ID 4843837
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Off cial Use Only
(Labor and Materials)
1.Building $4,000 1. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $ _
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total A( Fees•$
Check l6. Check Amount: i v— Cash Amount:
6.Total Project Cost: $4,000 ❑Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 106148 07/30/2024
Adam Glenn License Number Expiration Date
Name of CSL Holder
235 Essex Street List CSL Type(see below) l
No.and Street Type Description
Whitman, MA 02382 U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
Cd64A J .Zed RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
781-205-4484 wxpermitting@homeworksenergy.com I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 181138 03/02/2025
HomeWorks Energy
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
235 Essex Street wxpermitting@homeworksenergy.com
No.and Street Email address
Whitman,MA 02382 781-205-4484
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 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 Adam Glenn
to act on my behalf,in all matters relative to work authorized by this building permit application.
See Attached 6/15/2023
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 of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
Adam Glenn 6/15/2023
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 Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
City of Northampton
oPSN jo -
#/j� c.`,, S,r
Massachusetts ��
,=
. . . ._ , ,
i
A . :i DEPARTMENT OF BUILDING INSPECTIONS
,� 212 Main Street • Municipal Building yi ,_-,
Northampton, MA 01060 's'ph, I,)0'
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: 235 Essex Street, Whitman, MA 02382
The debris will be transported by:
HomeWorks Energy
Name of Hauler:
s;ead
Signature of Applicant: Date:
6/15/2023
The Commonwealth of Massachusetts
Department of Industrial Accidents
- Office of Investigations
_ Lafayette City Center
2Avenue 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): Homeworks Energy
Address:235 Essex Street
City/State/Zip:Whitman, MA 02382 Phone#: 781-205-4484
Are you an employer?Check the appropriate box: Type of project(required):
1.❑■ I am a employer with 500+ 4. ❑ 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
workingfor me in anycapacity. employees and have workers'
P tY 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 12.0 Roof repairs
insurance required.]t c. 152, §1(4),and we have no Weatherization
employees. [No workers' II. Other
comp. insurance required.]
*My 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. Lic. #:#1847910 Expiration Date: 1/1/2024
Job Site Address: 61 Austin Circle 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 pains and pent lies of perjury that the information provided above is true and correct.
Signature: ClPA Date: 6/15/2023
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#:
E
AC)R�� CERTIFICATE OF LIABILITY INSURANCE DAT12/302/2 2
2f.3022
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 CENTERPHONE
I TOME OFFICE: P.O.BOX 328 (A/c,No,EXI):888-333-4949 FAX
No):507448-4684
OWATONNA,MN 55060 E-ADDRESS:CLIENTCONTACTCENTEROFEDINS.COM
INSURER(S1 AFFORDING COVERAGE NAIC II
INSURER*: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 POUCIES.UNITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP UNITS
LTR INSR WVDIMMIDD/YYYYI IMMIDDIWW)
X COMMERCIAL GENERALUABIUTY EACH OCCURRENCE $1,000,000
CLAIMS-MADE n OCCUR DAMAGE TO RENTED $100,000
PREMISES IEa occurrence)
MED EXP(Any one person) EXCLUDED
A N N 1847909 01/01/2023 01/01/2024 PERSONALS ADV emu RY $1,000,000
GEN'L AGGREGATE UNIT APPLIES PER: GENERAL AGGREGATE $2,000,000
X POLICY !PRO-
JECT LOC PRODUCTS-COMP/OP AGO $2,000,000
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000
IER Kddonll
X ANY AUTO BODILY INJURY(Per person)
A OWNED AUTOS ONLY AUTOSULED N N 18479013 01/01/2023 01/01/2024 BODILY INJURY IPerecdtfwl0
-NON-OWNED PROPERTY DAMAGE
HIRED AUTOS ONLY _AUTOS ONLY (Per accident)
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $1,000,000
A EXCESS LIAB CLAIMS-MADE N N 1847911 01/01/2023 01/01/2024 AGGREGATE $1,000,000
-
DED I !RETENTION
WORKERS COMPENSATION OTH-
AND EMPLOYERS'LIABILITY Y/N X PER STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. $5 EACH ACCIDENT $500,000
A OFFICER/MEMBER EXCLUDED? _NIA N 1847910 01/01/2023 01/01/2024
(Mandatary In NH) E.L DISEASE-EA EMPLOYEE $500,000
If yes,descrlbe under
DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT0mo
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addibonel Remarks Schedule,may be attached if more space IS required)
THIS COPY IS NOT TO BE REPRODUCED FOR ISSUANCE OF CERTIFICATES.
CERTIFICATE HOLDER CANCELLATION
01
SHOULD ANY OF THE ABOVE DESCRIBE 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 POUCY PROVISIONS.
HOLDERS. AUTHORIZED REPRES RTATIVE (/` 14
10 1988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
f
Commonwealth of Massachusetts
Division of Occupational Licensure Rest idcdto:Construction Supervisor Specially
Board of Building Rt ulatruns and Standards CSSLJC •insulation Contactor
ttlrS
(:c' i 'rtic`g -,,-)tiper' yC�—) )et;ialty
CSSL-106148 E pires: 07/30/2024
r
ADAM GLENS
19 CHARGE POUND } ,
WAREHAM NrA 026 'r 1 >` i
..
r �.
Failure to possess a current edition of the Massachusetts
t•t.� • 1-' State Build ng Code is cause for revocation of this license.
r' ! . ,ll For information about this license
Call(617) 717-3200or visit www mass.govrdpl
Corr ^"-stoner
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: Corporation
HOME WORKS ENERGY, INC. Registration: 3
1138 101 STATION LANDING STE 110 Expiration: 0 03/002/22/2
025
MEDFORD, MA 02155
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.
ADAM GLENN CALA ,i6�✓
101 STATION LANDING STE 110 -, _ wftim4'
MEDFORD,MA 02155
Undersecretary Not valid without signature
Page 1 of 2
tP
Home`AI�rLs 1015tationLandingSte110,
HomeWorks 1 �GrY R mass save
Medford,MA02155
Energy PARTNER (781)305-3319
Customer Name:Jennifer Carbery
Email:Not provided
Phone:413-588-8720
Premise Address:61 Austin Cir,Northampton,MA 01062
Mailing Address:61 Austin Cir,Northampton,MA 01062
Project ID:4868797
Date:June 13,2023
Job Description '
Measure Description Location Quantity Unit Total Cost Customer Cost
Air Sealing at Estimated 62.5 CFM50 Per Hour Other 10 hr $943.30 $0.00
Door Sweep (with AS hrs) Other 2 each $52.22 $0.00
Exterior Door Weather Stripping (with AS hrs) Other 2 each $63.62 $0.00
Insulation Removal Other 5 SF $6.20 $6.20
Rim Joist- 6" Fiberglass Batting Other 12 SF $32.28 $8.07
Hatch -2"Thermal Barrier Polyiso Other 1 each $47.37 $11.84
Attic Floor- 10"Open Blow Cellulose Other 960 SF $1,996.80 $499.20
Damming Other 25 each $61.25 $15.31
Bath Fan Hose Other 1 each $28.00 $7.00
Propavent Other 40 each $165.20 $41.30
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.
6
I-3
Customer Signature: 23tr:
Customer Phone:
Specialist Signature: _- _ —_ __ z.d _—__ 6A-3/d3
TI OFFER:
The prices and inceno sin this contract are subjec range in accord ice with the sponsoring utility tv1ass5ave Home Services Program offers.
Proposals con be sent to:I ox@HomeWorksEnlergy.com
Page 2 of 2
`' HomeWorks 101 Station Landing Ste 110,
mass saveMedford,MA 02155
y Energy PARTNER (781)305-3319
Customer Name:Jennifer Carbery
Email:Not provided
Phone:413-588-8720
Premise Address:61 Austin Cir,Northampton,MA 01062
Mailing Address:61 Austin Cir,Northampton,MA 01062
Project ID:4868797
Date:June 13,2023
Project Total $3,396.24
Weatherization incentive ($1,748.18)
Air sealing incentive ($1,059.14)
Total Program Incentive -$2,807.32
Customer Total $588.92
Total Contractor Price and Payment Schedule
HomeWorks Energy, Inc.agrees to perform the above described work,furnishing the material and labor specified for the listed total
price. Payment of the balance of the customer contri ution Is xpected upon completion of the work.
Customer Signature: ___ _______ _______ _ ate:
Customer Phone:
Specialist Signature:,1,..,6(__ _ _ ____ _/ I_ _ Date:
MITE TIMID EMI ��3
The prices and incentives in$n_contrae sal e-_ o change in a ordance with the sponsoring uUIity MassSave Home Services Program offers.
Proposals con be sent to:InboxpuHomeWorksEnergy.com
PLAN VIEW
Name: .."A,11
vt.r Cc-/LtAf Site ID: ti v - 1 Finished Sq. Ft: 3 u G
Phone: t'� �5�1 a U Year of House: ( ( 0
Electric Acct #: �"
Address:, S t;,v C'f #of Floors: I CIS Acct#'
j=(,fy ,Ain 60_ unit#. #Occupants: \ Housing Type? ,c1c\
DUCTWORK INSPECTION Ducts Insulated.
Duct Linear Ft. /,
Duct Square Ft. ( "1
Duct Air Sealing Hours
Duct Insulation \I-- fS75
Duct Insulation Removal
Eo BASEMENT INSPECTION ��?(
Existing Spec'ing Ln/Sq. t.
Bsmt Wall AG lwS rX
\ tp
Crawl Ceiling LY`
Crawl Rim Joist Swr'' XSO
Bsmt RJ w/Sill 6 /Sr---
Bsmt RJ NO Sill .-----
Vapor Barrier _,.."--sgft. Bsmt Door �'
MN Blower Door? WALLS&GARAGE Drill Location?
Siding Ceil. Height Existing Spec'ing Sq.'Ft. Framin•
Exterior Wall 1 x x Ballo Platform
Exterior Wall 2 x x alloon/Platform
Overhang x
Garage Wall _ x Balloon/Platform
Garage Ceiling x x
iN.'i,,,j7_— ( I
gc___ J
circ_ Tvc) ,:i..7
insults LRemoval
Sgft.
Sweeps:
WX Stripping:a
WORK SPEC'D BUT NOT CONTRACTED AD BLOCKS PRESENTMANDATORY)
Attic 1 JBasement/Crawlspace Other: K&T Y N Moisture Y
Kneewall / /I I ombustion Sfty Y N
Overhang/Garage Asbestos Y j NN l Mold>100 sq.ft Y/N O Detector Missing Y/N
Ductwork Exterior Walls _ Vermiculite Y qV N'i Structl Concerns Y/�t Other:
Notes for Lead Vendor/Work Not Contracted:
KW WAU.AND KW FLOOR Blind Spec? ;:: +--- __ OR a KW SLOPE AND GABLE END Blind Spec?
Why? Why?
FRAMING FXISTING j SPEC'ING .FT. FRAMING EXISTING SPECING .1SQ.F
T
WAIL X X SLOPE x X
FLOOR X X GABLE X X _CC
t
X Xx X3 LOPE x xG VENTING?z EXISTING VENTING? GX 'ern„..,:e s; ,%Vent^q Vent BF Temp 4icess
L
U
KNEE WALL MANDATORY
/44 1,x.....
p ISA?S (o VS a
(ii
op tat 3 Kc( 7
0 e6(1 tk.c_tein
< • of.....eva.t.i ?c2q
cc
,,,....i,5 x(ito
Qs .f -k,, I tkl ; 6 f PUCe- 0 .A
8 Tk„" (a(K n b l
A
..
Insulated Wall • r Reed tet •^c;e 3, Vent ec BF', Chico CH Dammm` 1T Roof VRnt 12RV
A,r Handler Al-, ' Temp Access ' ry". <.. F- •:.i, - ,. /va,l Hatch ". Door.., a'Root Vent iRV `•..., BAS Vol. x .0058
xmVx d-_\ ATTIC 1 Blind Spec? x X ATTIC 2 Blind Spec? • X�1911 story) =
` 154(2 story)
o Existi �r /S�p�ec'ing Sq ft Existing Spec'i Sgft 13.6(3 story)
E, Unfloored 1R"`F i 5'. WkDTi� �() unflawed Multipliers
T foss:a ns
• Floored Floored fMlxed Insula .• Duct Work
z- Cath Slope /7 Cath Sloe ' •• e None
K Walls / Walls p Air Sealing Hours
a Access h 0 L/ __ Access /
• 1 ` �Ventlnt' Propavents F How Damming Venting Pro avents Vent BF BF How Dammin:
to l
toWI*Box:_
c: y Temp Acces •
$j �� lit b
to Sheathing ccess: _ _
so vti a �... R.L Cove
Existing Venting? Existing_Venting? NI,41ent,na, Roof Type: .
Insulation/Air Sealing Permit Authorization
Specialist: Michael Hathaway Company: HomeWorks Energy
Email: michael.hathaway@homeworksenergy. Address: 101 Station Landing
Cell: 4135882467 Medford,Ma 02155
Phone: 781.305.3319
Customer: Jennifer Carbery Address: 61 Austin Cir
Email: momabug72@aol.com Northampton, MA,01062
Site ID: 4843837 Phone: 4135888720
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: momabug72@aol.corn
Customer
Signature: Date: 6/13/2023
Jennif
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.