38B-274 (4) BP-2023-0951
11 REVELL AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38B-274-001 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-2023-0951 PERMISSION IS HEREBY GRANTED TO:
Project# INSULATION 2023 Contractor: License:
Est. Cost: 11567 CLEAN TECH CONSTRUCTION 106247
Const.Class: Exp.Date:01/05/2026
Use Group: Owner: ALLISON COOK
Lot Size (sq.ft.)
Zoning: URB Applicant: CLEAN TECH CONSTRUCTION
Applicant Address Phone: Insurance:
40 MESSINA DR 508-576-1026 6hub4n60130822
BRAINTREE, MA 02184
ISSUED ON: 07/24/2023
TO PERFORM THE FOLLOWING WORK:
INSULATION/WETH ERIZATI 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:g , l C ►
•
Fees Paid: $74.00
212 Main Street,Phone(413)587-1240,Fax (413)587-1272
Office of the Building Commiss' ner
Department use only
Mp City of Northampton FOR
Building Department
o 212 Main Street
.,. r, Room 100 INS LA Tl N
Northampton, MA 01060 O
'1 phone 413-587-1240 Fax 413-587-1272
�� ONLY
„—APPLIdATION 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
11 REVELL AVE
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
See Attached
Telephone
Signature
2.2 Authorized Agent:
�r,.v, S o 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 , 5(c)-7 5 C (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) ? /.
5. Fire Protection
6. Total=(1 +2+3+4+5) ,\\, 5(27 So Check Number 4- aQ 7 ti
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature: --21.1•2DZ3
Building Commissioner/Inspector of Buildings Date
CLEANTECHCONSTRUCTION1211 @ GMA1L.COM
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 4-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
;�G.\ 1062- Lk-7
Name of License Holder: i\r q V‘Gk... IJI�50�
License Number
40 Messina Drive Braintree, MA 02184 01/05/2026
7Expiration Date
Qi-t. J 508-576-1026
e Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
Clean Tech Construction Ac,,{� V /���n�g�� 196071
Company Name Registration Number
40 Messina Drive Braintree, MA 02184 06/27/2025
Address Expiration Date
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 1171 No ❑
Brief Description of Proposed Work
Residential weatherization/Air sealing. No structural changes.
I dt�+- — ,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.
?r;CAVlt^CC 'D(j,Jic-\5f]\n -
nnt Na
�li—« .� ___,..� .__.--' 1 `2 0 1-2-3
ature of Owner/Agent _
i, ,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 la' 3
Z C7 i,
Signature of Owner D
City of Northampton
SiC
� :
Massachusetts AL.y- fe
1
der.
} DEPARTMENT OF BUILDING INSPNCTICWS
212 fain Street • Municipal Building 9 ,
J
Northampton, If 01060 SSHW ;tea
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:
Address of Work:
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:
I ti01�-3 A r;avi vic- 196071
11111 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
,`tS. rye, sus-"" ^IC
- Zd
tif
IA
� Massachusetts ` �. �e,
DEPARTMENT OF BUILDING INSPECTIONS 1.
4-* , i!, v 212 Main Street •Municipal Building J, CbY
Northampton, MA 01060 4ly-••35��0
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:
\\ Pave\\ A,iiv-wt
(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)
4 , ,„_,..4_,J -1 1 is I3-3
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.
„ .� City of Northampton
few f Massachusetts �%' tic
DEPARTMENT OF BUILDING INSPECTIONS }\
C`jt. ' 212 Main Street • Municipal Building "�.,,' .,�q”
Northampton, M# 01060 �`��1
MANDATORY FOR HOUSES BUILT BEFORE 1945
Property Address: `\ \'19.Ne \\ Av 2v-A)e
Contractor Name: Clean Tech Construction
Address: 40 Messina Drive
City, State: Braintree, MA 02184
Phone: 508-576-1026
Property Owner
Name: A\\NSOvc Cosh
Address: \\ cAsi..vt,\\ Av-tvw-c-
City, State: Northampton, MA 01060
1, Tlc-,Cw V'C._ ()a..V\c ).,\ (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 —
-1 I z() I L 3 C.,, niew___ --')
Date
DocuSign Envelope ID:D433CB4A-1A2E-4CD1-A57D-FADF14759E9A
WEATHERIZATION CONTRACT EVERS=URCE
CUSTOMER PHONE DATE CLIENT• WORK ORDER
Allison Cook (413)896-32501 02/06/2023 480751 38505.
SERVICE STREET SLUNG STREET PROPOSED BY:
11 Revell Avenue 11 Revell Avenue Daniel Diaz
SERVICE CITY.STATE,DP BILLING CITY,STATE,BP Program
Northampton, MA 01060 Northampton, MA 01060 EGMA-HES Page 1
DESCRIPTION CITY: COST INCENTIVE TOTAL
INCENTIVE 75%
For eligible weatherization measures,Eversource is offering an
incentive of 75%for insulation measures and 100%for the air sealing
measures, both with no limit.You are eligible to apply for the 0%Heat
Loan to finance your co-pay,applications must be submitted before
the weatherization work begins.
KNOB&TUBE WIRING(Northhampton)
We have identified that your home might have Knob&Tube wiring : i,P(Inlrlals)
present.The following contract is not valid unless accompanied by
the Weatherization Barrier Incentive form,signed by your licensed
electrician.Work will not proceed with this work until we receive a copy
of the form.
PERFORM AIR SEALING AT ESTIMATED 62.5 CFM50 PER HO 4 $377.32 $377.32
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.)
EXTERIOR DOOR WEATHER STRIPPING 5 $159.05 $159.05
Provide labor and materials to install Q-Ion weatherstripping to
door(s)to restrict air leakage.
DOORSWEEP 5. $130.55 $130.55
Provide labor and materials to install a doorsweep to restrict air
leakage.
DAMMING 50. $122.50 $91.88 $30.62
Provide labor and materials to install a 12"layer of R-38 unfaced
fiberglass batts for damming purposes.
ATTIC FLOOR OPEN BLOW CELLULOSE 15" 120 $303.60 $227.70 $75.90
Provide labor and materials to install a 15"layer of R-49 Class I
Cellulose to open attic space.
INSULATION REMOVAL: 416 $515.84 $0.00 $515.84'
Batt style insulation will be removed from the attic area and properly
disposed,off site.
ATTIC SLOPE ENCLOSED CELLULOSE DENSE PACK 6" 45 $121.05 $90.79 $30.26
Provide labor and materials to install a 6"layer of R-19 Class I
Cellulose to sloped ceiling area.
DocuSign Envelope ID:D433CB4A-1A2E-4CD1-A57D-FADF14759E9A
WEATHERIZATION CONTRACT EVERS=URCE
CUSTOMER PHONE DATE CLENTS WORK ORDER
Allison Cook (413)896-3250 02/06/2023 480751 38505
SERVICE STREET BIWNO STREET PROPOSED BY:
11 Revell Avenue 11 Revell Avenue Daniel Diaz
SERVICE CRY,STATE,ZR' BIWNO CITY,STATE,Tp Program
Northampton, MA 01060 Northampton, MA 01060 EGMA-HES Page 2
DESCRIPTION QTY COST INCENTIVE TOTAL
INSTALL 2"THERMAL BARRIER POLYISO ON KNEEWALL 416 $2,000.96 $1,500.72 $500.24
Provide labor and materials to install rigid board at R-10 or greater
with the required fire rating to a kneewall area.
INSTALL 3"FIBERGLASS BATTING IN OPEN KNEEWALL 416 $815.36 $611.52 $203.84
Provide labor and materials to install 3.5"R-13 faced fiberglass batt
insulation to the kneewalls.
KNEEWALL FLOOR ENCLOSED CELLULOSE DENSE PACK 6" 416 $1,023.36 $767.52 $255.84
Provide labor and materials to install a 6"layer of dense packed R-19
Class I Cellulose to a kneewall floor.
DOOR:THERMAL BARRIER POLYISO 2"(ATTIC) 1 $90.61 $67.96 $22.65
Provide labor and materials to insulate the back of the attic door with
2"rigid insulation board.
SHEATHING ACCESS 2 $81.60 $61.20 $20.40
Provide labor and materials to make an access opening from one
attic area to another by cutting a passage through sheathing. This
access will be left open as it is between two common unheated non
firewalled attic areas.
TEMPORARY ACCESS 1 $96.36 $72.27 $24.09
Provide labor and materials to make a temporary access to an attic
area. The opening will be closed with materials similar to those
existing. Finish sanding and painting is not included.
INSULATE CLAPBOARD SIDED WALL WITH 4"DENSE PACK C 1,692 $4,382.28 $3,286.71 $1,095.57
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.
BASEMENT SILLS-RIGID BOARD INSULATION 64 $311.68 $233.76 $77.92
Provide labor and materials to install rigid board insulation to the
perimeter of the basement ceiling at the house sill.
6 MIL POLY VAPOR BARRIER 132 $134.64 $134.64
Provide labor and materials to install 10 ml polyethylene over open
ground in designated crawlspace/earthen basement areas.
INSTALL 2"THERMAL BARRIER POLYISO ON OPEN WALL 84 $407.40 $305.55 $101.85
Provide labor and materials to install 2"rigid insulation board to the
open wall.
DocuSign Envelope ID:D433CB4A-1A2E-4CD1-A57D-FADF14759E9A
WEATHERIZATION CONTRACT EVERS=URCE
CUSTOMER PHONE DATE CLERT S WORK ORDER
Allison Cook (413)896-3250 02/06/2023 480751 38505
SERVICE STREET BILLING STREET PROPOSED OY:
11 Revell Avenue 11 Revell Avenue Daniel Diaz
SERVICE CITY,STATE,ZE SIWNO CITY,STATE,ZIP Program
Northampton, MA 01060 Northampton, MA 01060 EGMA-HES Page 3
DESCRIPTION QTY COST INCENTIVE TOTAL
PROPAVENT 2'OR 4' 16 $66.08 $49.56 $16.52
Provide labor and materials to install ventilation chutes in the rafter
bays to maintain air flow.
VENT BATH FAN TO ROOF OR OTHER 1 $146.78 $110.09 $36.69
Install an insulated exhaust hose to a flapper vent to exhaust existing
bathroom fan(s). Fan will be vented through the roof or an acceptable
alternative if contractor cannot vent through the roof.
INSTALL ALUMINUM SOFFIT VENT 8 $280.48 $210.36 $70.12
Provide labor and materials to install rectangular aluminum soffit
vents to increase ventilation in attic areas.Specify color:White or Gray.
ASBESTOS HAZARD
A blower door diagnostic test will not be conducted at your home,due
to the possible presense of asbestos.
rat
INACCESSIBLE ATTIC KNEEWALL AREA
We have identified an opportunity to insulate an attic kneewall area in
your home that is not presently accessible.We are making our
recommendations based upon an educated understanding of your
home's construction,but upon gaining access to this space,your
home's work-scope might need to be modified. Your contractor and
our RISE inspector will guide these changes and discuss them with
you prior to proceeding.
STORAGE-ATTIC
Homeowner is responsible for the removal of the stored items lhdda11)
blocking the installation of weatherization work in the attic. Removal
must occur prior to the scheduled work start.
If you have any questions or specific concerns, please bring them to
the attention of your subcontractor when they call to schedule your
work.
•
STORAGE-BASEMENT
Homeowner is responsible for the removal of the stored items
blocking the installation of weatherization work in the basement.
Removal must occur prior to the scheduled work start.
DocuSign Envelope ID:D433CB4A-1A2E-4CD1-A57D-FADF14759E9A
WEATHERIZATION CONTRACT EVERS=URCE
CUSTOMER PHONE DATE CLEWS WORK ORDER
Allison Cook (413)896-3250 02/06/2023 480751 38505
SERVICE STREET BILLING STREET PROPOSED BY:
11 Revell Avenue 11 Revell Avenue Daniel Diaz
SERVICE CRY,STATE,DP BIWND CRY,STATE,ZP Program
Northampton, MA 01060 Northampton, MA 01060 EGMA-HES Page 4
DESCRIPTION QTY COST INCENTIVE TOTAL
STORAGE-CRAWLSPACE r n,
Homeowner is responsible for the removal of the stored items J (Ini )
blocking the installation of weatherization work in the crawlspace.
Removal must occur prior to the scheduled work start.
If you have any questions or specific concerns,please bring them to
the attention of your subcontractor when they call to schedule your
work.
Total: 511,567.50
Program Incentive: 68,489.15
Client Total: 63,078.35
1.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. i
U.,. :iUnc.l I,y I✓,.„•:{anon I.T
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eq61 ifiifR i n,a
Dan Diaz 2/6/2023 110:05 AM EST
Printed Name Date of Acceptance
RISE
CST - BASIC vpCT2012
CLIENT Allison Cook CLIENT# 480751 PASS FAIL❑ NO TESTS❑
TESTER Daniel Diaz DATE 12/28/2022
Fall Reason
HVAC Equipment Type Fuel Venting Type Comments
Heating system 1 iSS=Steam Boiler 0 Natural Gas Q Natural Draft Q C
Heating system 2 F _j i C
DHW IC=StOraoe Tank 0 Natural GasQ Natural ikaft
AC
Blower Door Testing Blower Door Start: Blower Door End:
70%BAS Limit: Blower Door Barrier:
PERFORM AMBIENT CO MONITORING Zero your CO meter outdoors.
Are CO detectors present in home? Yes 0 Ambient CO in any part of home>9 ppm? No E3 Any gas leaks detected?
CO CONCERN: If ambient CO is>=35 ppm,stop test,open windows,evacuate house with homeowner.
PERFORM WORST CASE DEPRESURIZATION TEST If all appliances are sealed,skip depressurization and spillage.
Set up home in'winter conditions':Turn all combustion appliances off,close and lock all exterior doors/windows.Close all CAZ doors,if any.
Close all interior doors,except to rooms with exhaust fans or returns ducts. NOTE:Excess depresurization does not necessarily fail CST.
ESTABLISH WORST CASE Establish baseline pressure. Press enter button after stabilizing to deduct baseline. Pressure(Pa)
Turn ALL exhaust equipment ON. List exhaust appliances turned ON and quantities below. Record pressure 11.1 I
#Bath Fans 2 #Kitchen Fans 0 #Dryers 1 Central Vac 0
Air handler and exhaust ON Record pressure _ I
If the air handler increases negative pressure(more negative)in the CAZ,leave it ON. Otherwise,turn the air handler OFF
OPEN door to CAZ(if applicable) Record Pressure I
Record worst case depressurization number:Most Negative -1.1. )
If there is unsealed ductwork in CAZ with natural draft appliance,select Yes No
PERFORM SPILLAGE,DRAFT,AND CO TESTS Performed with CAZ in worst case.Monitor ambient CO throughout testing
Record Outside Temp 35.0 Draft limit 1.875 Check for evidence of flame rollout,stop testing if Yes No 0
Check for flame distortion on air handler start No 0
1. Test smallest BTU appliance for spillage within 2 minutes of operation PASS 0 Test smallest BTU appliance exhaust after
Test smallest BTU appliance draft -8.3 5 minutes of operation.
Draft limit pass/fail PASS [] CO(0):4 CO:2 02:0.0
2. Test next larger BTU appliance(if any)for spillage within 2 minutes PASS 0 Test next larger BTU appliance exhaust after
of operation.Retest smallest BTU appliance for spillage PASS 0 5 minutes of operation
Test next larger BTU appliance draft (-11.4 _ CO(0): 5 CO: 1 02: 15
Draft limit pass/fail PASS ___.. El
3.Test additional larger BTU appliances(if any)in similar fashion,re-testing each preceding smaller BTU appliance for spillage N/A_ !
4. If an appliance fails for spillage,test for spillage in natural conditions(all exhaust off),alone(Pass/Fail)
If an appliance fails in natural conditions,open window or door in CAZ to simulate makeup air,test for spillage DHW WCD-only spillage
Review likely spillage causes with customer and direct to heating contractor. that passes under natural
conditions means It Is NOT
5. Test gas oven exhaust CO:27 6.Test gas dryer exhaust. CO(0):6 CO: 2 02:6.3 a barrier to WZ.
PASS: Below CO threshold AND passes spillage. FAIL: Over CO threshold OR fails spillage. PASS.
Work may not proceed until system is serviced and problem corrected.
CONCLUSIONS: Check appropriate result at top of this form.Discuss health and safety problems,concerns,recommendations,and resolutions.
Turn off running water for DHW,check DHW temp. Make sure heating system is on/operating.
Turn fuel switch on. Issue WZ Barrier,if appropriate.
NOTES:
REFERENCE TABLES
Appliance Threshold Limit CO(0)Calculator:(20,9/(20.9-02))•C0=�' Acceptable Draft Test Ranges
Central Furnace 400 ppm air free CO(0) Outside Temp(F°) Min Draft Pressure
Boiler 400 ppm air free CO(0) CO CONCERN:If ambient CO is>=35 ppm <SO° 2.5
Vented Room Heater 200 ppm air free CO(0) Stop test,open windows and evacuate house 10°-90° (Temp/40)-2.75
with homeowner.
Water Heater 200 ppm air free CO(0) >90 -0.5
Oven/Broiler 225 as measured CO High CO on a SEALED COMBUSTION ba1 eJyk
Clothes Dryer 400 ppm air free CO(0) NOT a barrier to WZ work.Furnace is a FAIL
DATA COLLECTION
Name Allison Cook Client ID 480751 Audit Date 12-28-2022
Phone 413-896-3250 Email allison.a.cook@gmail.com Address 11 Revell Ave Northampton Unit 1
Main Concerns:
HP rebates
Had HEA before u Completed WX Rec's0 Signed VHEA Disclosure Received Conf. Email U Received Photos u
OK to record/take Photos VHEA Communication Preferences Phone Video Text 0 Email
Year Built 1915 Time in Home 30 years Style conventional Square Footage Volume
Occupants 3 Bedrooms 4 Bathrooms 2 Stories Above Grade Bsmt. Included _
BAS N-Factor Building Vent Req. 0 Occ.Vent Req. 75 BAS 0 70%BAS 0
Electric Baseline kwh Peak month kwh Baseline cost Peak month cost Photo of Bill
Heating Fuel Annual usage Peak month usage Annual cost Peak month cost Photo of Bill
Bill Concerns
Number of refrigerators 1 Brand Whirlpool Model# Photo
Washers with agitators 0 Brand Model# Photo
Dryer Fuel Electric Vented outside Yes 0 Oven Fuel Natural GO Kitchen fan vented outside No, unvdJ
Space Heaters 111 Electric Baseboard il Roof Coils n Dehumidifiers 0 Well Pump El
Hot Tub n Pool n Plug-in Car OtBher
Cooling Window AC1/i Qty. 5 Central AC Mini-split None 171 Recommend Replacement
Lighting Needs LED [✓ Already Efficient Declined Customer needs RISE to Install:
Electricity Review Notes:
System Type Fuel Vent Type Year Replace Pictures
DHW =Tank v atural G PI atural Draft 2009
Heating System 1 ► =Steam Boiler Gil atural GICII atural Draft 113 1989
Heating System 2 - - I a
Auxiliary Heat - I- I-
Thermostat Qty. T-stats OK ✓ Declined Replacement El Replace w/programable Replace w/WiFi
CAZ Concerns
Virtual HEA NO 0 IIC CST+WSV NO 0 Tech CST+WSV - Auditor Followup -
K+T YESQ Moisture NO Q Vermiculite NO 0 Structural - Storage -
CST YESQ IAQ - _ Mold NO Q Drop Ceil.Tiles - Other
Barrier to Blower Door Barrier to CST
Issue PWBI n Issue IC Signoff/Attic Prep El Issue Lead Safe n
Barrier Notes
Location Existing Insulation Scope Sq.Ft. Photos
Rim Joist None 2 inch polyiso board 64
Basement.Ceiling
Crawl Ceiling
Crawl Walls None 2 inch polyiso board 84
A/S Hrs. Duct Seal Hrs. Removal Sq. Ft. Bulkhead Doors 0 Site Built Doors Dimensions
Height Vapor Barrier Sq. Ft. 132 Basement Finished Basement/Crawl Accessible From Ext:
Basement/Crawl Notes
Location Existing Insulation Scope Sq.Ft. Photos
Overhang 1
Overhang 2
Garage Ceiling
Overhang Removal Sq. Ft. Pipe Insulation Ft. Photo of test hole(s) D Open Ceiling/Wall Barrier
Overhang/Garage Notes
None
Location Existing Insulation Siding Cell. Ht. Balloon/Plat. 3`d Fl.Add Scope Sq. Ft.
Ext.Wall 1 None wood 9 balloon 4 inch dense pack cellulose 1692
Ext.Wall 2
Ext.Wall 3
Garage Wall
Photos of all 4 wall faces u Photo of test hole(s) Ei
Exterior Wall Notes
Doors Wood Metal u Fiberglass I=1 Slider ❑
Door Kits Weather Strip Only Sweep Only Doors OK n
Windows Single Pane 7 Double Pane Triple Pane❑ Clear glazing ❑ i gle Pane Qty. 8
Wood or Vinyl ill Aluminum] Alum.w/Thermal Break Tinted(Low-E,Solar Control)
Doors/Windows Concerns
Boundary Walls and Floor vIl Knee Wall Detail
Location Existing Framing Scope Sq.Ft.
KW 1 2"balsam 2x3 remove+3"fg+2"rb 416
KW Floor 1 none 2x6 add 6"dpc 561
KW 2
KW Floor 2
Boundary Slope and Gables ,
Location Existing Framing Scope Sq.Ft.
Slope 1
Gable 1
Slope 2 A
Gable 2 1-
Air Sealing Hrs. Unfloored Transition Ft. Floored Transition Ft. 30 Removal Sq. Ft. Fix/Flip/Slash Sq.Ft.
Blind Spec? n KW Hatches Temp Accesses Finished Accesses Sheathing Accesses
Existing Venting High Needed Venting High Venting Scope add 8 8x16 soffits
Low Low
Vent Chutes na Bath Fan to Roof 1 Bath Fan to Gable Hose Only Photos n
Knee Wall Notes/Calculations
111
4064it
mass save 2022-23 Weatherizati<on Barrier Incentives
Based on your Energy Specialist's recommendations.your home can benefit from)nog►•m-eligible inudator and/or air sealing
improvements.Before moving forward.poleaxe follow all the instructions below to reme• ate your erretherization barriers.
CUSTOMER INSTRUCTIONS
1.Hire a qualified.licensee contractor to evaluate and/or remeciete the weatherizatinn errionc).
2.Submit rigned and completed copies of this form and a ropy of the paid contractor- vci-e(s)within GO days of your tIome Energy
Assessment to:RISE Engineering,765 Attucks Lane,Hyannis,MA 02601 or email to •. - '• engineering.eorn.
3.Tne weather ization incentive will be deducted from the customer co-payment amo- tot the weatheriZation work.A rebate check will
(so issued in the event the amount exceeds the customer's co-ussymeint amount.
4.Complete the recommended weatheriration improvements,
CUSTOMER INFORMATION
Customer Name Allison Cook Client it or site r: 480751
Site Address. 11 Revell Avenue City. Northampto State: MA ZIP.01060
Phone Number. 413-896-3250 . ,. alllson.a.cookegmall.com
Customer/Homeowner Signature: -c.p ►S (' Date: 7[l 0 o ni
KNOB AND TUBE WIRING (((
To determine it there is any active knob and tube wiring.the contractor will evaluate the following areas where eligible Mass Save
weatherization recommendations
have been made
r Attic Floor )Attic Wall V.Attic Slope ✓Exterior Wall ✓Basement ✓Other.KWALL ,o,hc:.
I have performed my inspection and determined there is ne active knob and tube wirntq in the areas selected below.
✓,Atticfloor ✓i Attic Wall it Slope se Exterior Wall I,Basement ✓Other:KYVALL
;. 'Other.
Contractor Name. Jesse CareP
Address: 6 Nash Hiil PL city: Wiiliarnsburg State:MA -.IN:01096
Company Name: JCamp El c c. License Number 22945A
Contractor Signature: pa:7/5/23
My sIgnatt,re confirm;that I ha _ my inspection of the electrical systems listed above aril have corrected any carriers as
indicated My signature also irm t I have read and uyree to the Terms and Conditions outlined on the back of this form.
MECHANICAL SYSTEM BARRIERS tra_t .
High Carbon Monoxltio:Contractor is to setvlce and re-evaluate the selected mechanical system(s)and reduce the carbon monoxide level,
as measured in the undiluted flue gas,to below 700 parts per mrNirm(ppm).
Draft FaIlures Contractor is to correct the draft in the selected fitters).Refer to table on reverse for acceptable draft ranges.
High Carbon Monoxide Draft Failure
Existing CO ppm Revised CO prim Existing(haft Pa Revised Draft Pa
Heating System..
►let Water heater
!Ante►
SplNeye Contrat.to is to correct the spillage of flue gases in the selected mechanical cyst s).Must not spill after c30 seconds of operation.
(7)Heating System _?Hot Water Heater i :Other.
Contractor Name.
Arlriresc• City' "rate /Ill
Company Name: License Num .
Contractor Signature: _- Date:
My signature confirms that I have performed my io$arctiort of tee mechanical systems hs -above and have corrected soy barriers as
indicated.My signature also confirms that I have-ead and agree to the Tends and Condit' ns outlined on the back of this form.
DocuSign Envelope ID:D433CB4A-1A2E-4CD1-A57D-FADF14759E9A
4#iet
mass save
Savings through energy efficiency
PERMIT AUTHORIZATION FORM
I, Allison Cook owner of the property located at:
(Owner's Name)
11 Revell Avenue Northampton
(Property Street Address) (City)
hereby authorize the Mass Save® Home Energy Services Program assigned Participating
Contractor to act on my behalf and obtain a building permit to perform insulation and/or
weatherization work on my property.
This form is only valid with a signed contract. The permit will be secured by the
subcontractor, at no additional cost.
IN.cutigned by 1
Owner's"$ignature
2/6/2023 i 10:05 AM EST
Date
FOR OFFICE USE ONLY
We have assigned the following Mass Save Home Energy Services Participating Contractor
to the above referenced project:
07/19/2023
Participating Contractor Date
DEBRIS DISPOSAL AFFIDAVIT
In accordance with the provisions of M.G.L. c. 40, s. 54, Building Permit
was issued with the condition that all debris resulting
from this work shall be disposed of in a properly licensed solid waste
disposal facility as defined by M.G.L c. 111, s. 150A.
The debris will be disposed of in:
Clean Tech Construction
Name of Waste Facility
Not Applicable - No Debris
Address of Waste Facility
111.5 Debris: As a condition of issuing a permit for the demolition, renovation,
rehabilitation or other alteration of a building or structure. M.G.L.c.40 s.54 requires
that the debris resulting therefrom shall be disposed of in a properly licensed solid waste
disposal facility as defined by M.G.L.c.111 s.150 A.Signature of the permit applicant,
date and number of the building permit to be issued shall be indicated on a form provided
by the Building Department and attached to the office copy of the building permit
retained by the Building Department.If the debris will not be disposed of as indicated,
the holder of the permit shall notify the building official,in writing,as to the location
where the debris will be disposed.
780 CMR—641 Edition
Signature of Permit Applicant
I 1
Date
Commonwealth of Massachusetts
c Construction Supervisor Specially
Division of Occupational Licensure
Board of Build,. ' gulations and Standards Restricted to:
Construr' ;perbigor Specialty CSSL-IC-Insulation Contractor
s
CSSL-106247 - ires: 09/26/2026
ARIANNA JAMES DAVIDSON f
38 ELLS AVE
WEYMOUTH MA 02190 .:
1!/;t Lt,1 l ` ,`-40
3,. Failure to possess a current edition of the Massachusetts
1 ' �,/
State Building Code is cause for revocation of this license.
Commissioner
, .r K. CJCjw>ciA.x.. For information about this license
Call(617)727-3200 or visit www.mass.govldpi
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washington Street- Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
,. ito �1
4 '
^ impF Type: Supplement Card
CLEAN TECH CONSTRUCTION LLC = aUon 1612 71
38 ELLS SVE _,__ E "'.n: 06272025
A WEYMOUTH,MA 02190 ., >__rai i Iiiiiiii
II
s armo
. i: r Al
r � w
4
ilill Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs 8 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
196071 0627/2025 Boston.MA 02118
CLEAN TECH CONSTRUCTION LLC
$ )
ARIANNA DAVIDSON tW �<J 7
38 ELLS AVE ,.,. t4,,/ ,,,,,oft.;`�„!'
WEYMOUTH,MA 02190
Undersecretary Not valid without signature
The Commonwealth of Massachusetts
Department of Industrial Accidents
gi ice of Investigations
Lafayette City Center
2 Avenue de Lafayette, Boston,MA 02111-1750
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Cotractors/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#:617-271-0768
Are you an employer?Check the appropriate box: Type of project(required):
1. I am a employer with 6+ 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. ❑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. ❑Demolition
working for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers' comp. insurance comp. insurance.
t
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 11.111 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 Insulation
employees. [No workers' 13.0 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.
tContractors 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.#:6HUB4N60130822 Expiration Date:9/18/2023
Job Site Address: 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 pedury that the information provided above is true and correct.
Signature: ��tutsista Z.aostadest Date:
Phone#: 617-271-0768
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 20 Building Department 3❑City/Town Clerk 4.0 Electrical Inspector 5i0'lumbing
Inspector 6.1:1Other
Contact Person: Phone#:
A c IJ CERTIFICATE OF LIABILITY INSURANCE DATE
09 0 2
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 poiicy(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:
Tobman,Mollgnano&Weiner Ins Agency ojc,PHONE, I, 617-471-1123 FAX(pm,No): 617-773-2474
21 McGrath Highway,Suite 303 E-MAIL
Quincy,MA 02169 ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC I
INSURER A: Norfolk&Dedham Mutual
INSURED INSURER B:
Clean Tech Construction LLC INSURER C:
40 Messina Drive
Braintree,MA 02184 INSURER :
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.
NEW
TYPE OF INSURANCE INSD SWIND POLICY NUMBER POLICY EFTYT POLICY VY LIMITS
(MaMIDD/YYW) (MMIDD/YYYY)
X COMMERCIAL GENERAL wait.rrr EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
CLAIMS-MADE n OCCUR PREMISES(Ea occurrence) S 300,000
MED EXP(Any one person) $ 5,000
A _ P012011894 09/18/22 09/18/23 PERSONAL a ADv INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
!(I POLICY n, Lam{ LOC PRODUCTS-COMP/OP AGO $ 2,000,000
I OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $(Ea accident) 1,000,000
ANY AUTO BODILY INJURY(Per person) $
A -
AUTOS ONLY X AUTOES LED
91972894A 09/16/22 09/16/23 BODILY INJURY(Per accident) $
X HIRED X NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY _ AUTOS ONLY (Per accident)
$
X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 2,000,000
A EXCESS UMB CLAIMS-MADE U2003464A 09/18/22 09/18/23 AGGREGATE $ 2,000,000
DED RETENTIONS $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT f
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $
Byes,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 If more space Is required)
The City of Boston Is an additional Insured per written contract
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
City of Boston ACCORDANCE WITH THE POLICY PROVISIONS.
1 City Hall Square
Boston,MA 02201 AUTHORIZED ATIVE
01 -2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
AW CERTIFICATE OF LIABILITY INSURANCE DATE(MM'DO/YYTY)
`.� 10/26/2022
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 pollcy(les)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 Gary Hebsch
TOBMAN MOLIGNANO&WEINER INSURANCE AGENCY INC ramp:).Extb (817)471-1123 FAX
,No1: _
EJAAIL
ADDRESS: gtleeschetrnwins.com
21 MCGRATH HIGHWAY SUITE 303 INSURERS)AFFORDING COVERAGE HMCO
QUINCY MA 02169 mums A: TRAVELERS INDEMNITY CO OF AMERICA 25686
INSURED INSURER II:
CLEAN TECH CONSTRUCTION LLC INSUREtC:
INSURE!D:
40 MESSINA DRIVE INSURER E:
BRAINTREE MA 02184 INSURER F:
COVERAGES CERTIFICATE NUMBER: 828667 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 SUS POLICY EFF Po1JCY EXP
LTR TYPE OF INSURANCE INED MD POLICY NUMBER 111111DOIMY1 IIMAIDDITYYTI UNITS
COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE i
DAMAGE TO RENTED .— -------
CLAIMS-MADE I I OCCUR PREMISES(Ell 000tsyenoel $ —_--
— —. - MED EXP(My one person) $
N/A PERSONAL a ADV INJURY $
GENL AGGREGATE LIMIT APPLIES PER: GEMERALAGGREGATE i
POLICY E j LOC PRODUCTS-COMPA7Psofa $
OTHER i
AUTOMOBILE LIABILITY COMBINED� Mont
IDLE LINT $
ANY AUTO BODILY NJURY(Par person) $
OWN SCHED
AUTOS ONLY _AUTOSULED N/A BODILY INJURY(Per.00Jdart) i
HIRED NON-OWNED PROPERTY
AUTOS ONLY —AUTOS ONLY (Per=O Mann DAMAGE uMBRELLALaa _ OCCUR EACH OCCURRENCE $
EXCESS LIB CLAIMS-MADE N/A AODfEGATE S
DEO RETENTIONS i
WORKERS COMPENSATION x PP- °
'AND EMPLOYERS'LIABILITYSTATUTE ER
A j OOFICE ORM MBEREX DEED?? Nu N/A NIA 6HUB6R60053222 09/18/2022 09/18/2023 El.EACH Acca�ENr $ 1,000,000
I(Mandatory In NH) EL DISEASE-EAEPPLOYEE $ 1,000.000
H describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LNIT $ 1,000,000
N/A
I �
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay
claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts.
This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the
issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification
Search tool at www.mass.gov/Iwd/workers-compensationllnvestigations/.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Boston ACCORDANCE WITH THE POLICY PROVISIONS.
1 City Hall square
AUTHORED REPRESENTATIVE/
Boston MA 02201 Daniel M.Crowley,CPCU,Vice President—Residual Market—WCRIBMA
®1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD