Loading...
38C-043 (2) BP-2023-0990 14 SOUTH PARK TERR COMMONWEALTH OF SSACHUSETTS Map:Block:Lot: 38C-043-001 CITY OF NORTH MPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREG STERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUA NTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-0990 PERMISSIO IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 2200 SUPERIOR INSUL TION 106237 Const.Class: Exp.Date: 06/15/20'5 Use Group: Owner: COM:R OEN, LEANNA &BRYAN Lot Size (sq.ft.) Zoning: URB Applicant: SUPE' OR INSULATION Applicant Address Phone: Insurance: 14B ENTERPRISE LANE (401)515-4524 67872 SMITHFIELD,RI 02917 ISSUED ON: 07/27/2023 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHERZATION 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 NOIZTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: • 10 • . cg) Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,F x: (413)587-1272 Office of the Building Comm' sioner 4 RC 4u,r_1 IC/26 The Commonwealth of Massac' settswt /� Board of Building Regulations an, Sta _. OR Massachusetts State Building Co e, 70 I r S`M'ITY Building Permit Application To Construct,Repair, ' n - • Revi,ed Mar 2011 One-or Two-Family Dwelling rit,„,Ncr ,,,,p This Section For Official Use Only at;,yFryoeu�B Building 44.-.) Permit Number:��.�. — W' Date Applied:pl < kosS ��, G 7-Z7-2O1z3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 141geiriyelA�ress: 1.2 Assessors Map&Parcel Nu e s nkr4�TP _ 34�C. - I 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: in 1 n j 1.4 Property Dimensions: r ou Zoning District Proposed Us Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) fa., 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:Nil 1.8 Sewage Disposal System:n` v Checkone: _ Outside if yes❑Public 0 Private 0 nyxz Flood Zo a �/l• Municipal 0 On site disposal system‘'V❑ SECTION 2: PROPERTY OWNERSHIP' 2�.1�Owner'of Record,„. Lean t_ArN . ` Q ��a pit)n A A Pr Name(Print) C'ityy,,State,ZIP ■ 11 t " , /v` 14 Sou4-1,, anz_Trxri7.cf, 2 o -G s-I- -4-s No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WOI2K2(check all that apply) New Construction ❑ Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. ❑ Number of Units y� f Other (S'�,Specify:�/�S(,/�k Brief escri tion of Proposed Work2:!'[r r Sw W Il i /r lsu �sr ex1t o� cra tills SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 2.20 0 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: Check No�j Check Amount: O' 6. Total Project Cost: $ 22_0 0 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Constructiont Supervisor License(CSL) 10(023 S 11 p `.__ 3( AC I_ altrPri&CAJO‘ • License Number Expiration D e N e f S Holder List CSL Type(see below) and Stree Type Description ni(�� 1 PJ4c1 1 /'\�Qf I L U Unrestricted(Buildings up to 35,000 Cu.ft.) City/Town(.. State,ZIP lJ R Restricted 1&2 Family Dwelling M Masonry C ITA @ &A ptrbr rrr WS RC RoofingWindow Covering Siding Li 0 1 p414 g32j- SF I Solid Fuel Burning Appliances Insulation Telephone Email address D Demolition 2 Registered Home Improveeme t Contractor(HIC) 151414 5) I 25 � b r Di on I C Registration Number piratioi Date IC C an Name or HIC Registrant Name ILIB Entrrpn sc L %Nur Email address 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? Yeso5tNo 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES 1'OR BUILDING PERMIT I,as Owner of the subject property,hereby authorize 3�-C-. Q, to act on my behalf,in all matters relative to work authorized by this building permit application. 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 a lication is true and accurate to the best of my knowledge and understanding. Prin r s or thorized Agent's Name(Electronic Signature) at � 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 'a S•s...-- s,�l Massachusetts �.?'' << „ifrt Ste.' )4 DEPARTMENT OF BUILDING INSPECTIONS Z E ZM , r1.• i 212 Main Street • Municipal Building J,,s �CL �:.! Northampton, MA 01060 'I' 10\� 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: "{ rnl C/l The debris will be transported by: Name of Hauler: ,��(/� ,C'V, or 1 Signature of Applicant: lib 61 (Z,2' Date: The Commonwealth of Massac usetts Department of Industrial Acc' ents Office of Investigations • 600 Washington Street �; Boston,MA 02111 "- - .4 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/C ntractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Superior Insulation, LLC Address: 140 Point Judith Rd,A7 City/State/Zip: Narragansett,RI 02882 Phone #: 401-515-4524 Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with 12 4. ❑ I am a general contractor . d I employees(full and/or part-time).* have hired the sub-contrac'ors 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 hay 8. ❑ Demolition working for me in any capacity. employees and have work-1 ' [No workers' comp. insurance comp.insurance.: 9. El Building addition required.] 5. ❑ We are a corporation and i 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised the 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per M I 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.x❑ Other Insulate employees.[No workers' comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'corn. nsation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside cIntractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-co i:ctors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. /am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Beacon Mutual Policy#or Self-ins.Lic.#: 678(722, Expiration Date: 8/2/23 /� Job Site Address: 4 So.. Y 1 CC.I �'C r .- City/State/Zip: tOr v fl/V'`rt 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: /1G� /-0—. a Date: T/ 7L3 Phone#: I ` Official use only. Do not write in this area, to he completed by city or town official. City or Town: Permit/Licens # Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: �-..41) SUPEINS-01 MLONGOLUCCO A Iv CERTIFICATE OF LIABILITY INSURANCE DATE(M 7/25/202 YY) 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 NAME: Mansfield Insurance Agency Inc. PHONE FAX 115 High Street (NC,No,Ext):(401)596-2096 I(ac,No):(401)348-2060 Westerly,RI 02891 ADDRESS: info@mansfieldins.com INSURER(S)AFFORDING COVERAGE NAIL# INSURER A:Employers Mutual Casualty(EMC)Company 21415 INSURED INSURER B:Beacon Mutual Insurance Co. 30325 Superior Insulation LLC INSURER C:Evanston Insurance Company Michael O'Connor 140 Point Judith Road,Unit A7 INSURER D: Narragansett,RI 02882 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMM/DD/YYYYI IMMIDDIYYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X x 6D23763 8/2/2022 8/2/2023 PREMISES(Ea occRENTurrence) $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JERCOT- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER:General Aggregate A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO X X 6B23763 8/2/2022 8/2/2023 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTEEO��S ONLY AUTOS WN BODILY INJURY(Per accident) $ AIRTOS ONLY AUOTO ONLY (Per PROPERTY DAMAGE $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE X x 6N23763 8/2/2022 8/2/2023 AGGREGATE $ DED X RETENTION$ 10,000 5,000,000 B WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN X 67872 8/2/2022 8/2/2023 500,000 AFFICER/MEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Pollution Liability x x CPLMOL107207 7/6/2022 7/6/2023 Per Occurrence 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101 Additional Remarks Schedule,may be attached If more space Is required) Residential Insulation Contractor-14B Enterprise Lane,Smithfield,RI 02917 Pollution Liability Aggregate Limit$500,000 National Grid and all divisions are named as additional insured per written contract or agreement.Waiver of subrogation is provided in favor of National Grid and all divisions per written contract or agreement. Pollution Liability includes mold CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE National Grid THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 40 Sylvan Rd Waltham,MA 02451 AUTHORIZED REPRESENTATIVE Nekrit IC xi•k•As I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts ( Division of Occupational Licensure Board of Budding Regulations and Standards ConstructiQ ' Upet' r Specialty CSSL-106237 sc FBI U ires:06/15/2025 KYLE L LEDk�C p 3750 DIAMOND HILL RD , CUMBERLAND RI 02164 Y Commissioner daiiii P. b - ` Construction Supervisor Specialty Restricted to: CSSL-IC-Insulation Contractor Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www-mass.govldpl THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affai and Business Regulation 1000 Washingtg rgot - Suite 710 Boston,.Massachusetts 02118 Home Improvement w � -.-ctoraRegistration till --' i ' / :71,-&. Itolllmor .6, lege _ ' `, Type: Supplement Card SUPERIOR INSULATION LLC. • :: 'egistration: 175445 140 POINT JUDITH RD UNIT A7 .�. .b Expiration: 05/12/2025 NARRAGANSETT, RI 02882 kMS= 'c'....01c / 1 p rs ..._ 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: Suppierrent_Card Office of Consumer Affairs and Business Regulation 1000 Washington Street -Suite 710 Registration - Expiration g 175415! V 05/12/2025 Boston, MA 02118 SUPERIOR INSULATION .."i-7-7. --- --:---_ -- 1-'1/(A) )(ia, KYLE LEDUC ; s 140 POINT JUDITH RD`{INIT . _; � '„''.'a 4-4: NARRAGANSETT, RI 0288 � �.%` Undersecretary Not valid without signature WEATHERIZATION CONTRACT EVERS=URCE CUSTOMER PHONE DATE CLIENT WORK ORDER Leanna Oen. (205) 937-7354 05/08/2023 537954 10302 SERVICE STREET BILLING STREET PROPOSED BY'. 14 South Park Terrace 14 South Park Terrace Ben Apodaca SERVICE CITY.STATE.ZIP BILLING CITY.STATE,ZIP Program Northampton. MA 01060 Northampton, MA 01060 EGMA-HES Page 1 DESCRIPTION QTY 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 SIGN-OFF (FSC) 1 $250.00 $250.00 The wiring in the areas weatherization work is proposed will be reviewed by a licensed electrician to determine if there is any existing live knob&tube wiring. HOME AIR SEALING 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.) DUCT SEALING 4 $348.36 $348.36 Provide labor and materials to seal heating and/or cooling ducts within designated unheated areas. WEATHERSTRIP DOOR 2 $63.62... $63.62❑ Provide labor and materials to install Q-Ion weatherstripping to door(s)to restrict air leakage. BASEMENT SILLS-6" FIBERGLASS 168 $451.92 $338.94 $112.98 Provide labor and materials to install R-19 unfaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. CRAWLSPACE-6 MIL POLY GROUND COVER 700 $714.00 $714.00 Provide labor and materials to install 10 ml polyethylene over open ground in designated crawlspace/earthen basement areas. KITCHEN VENT NEEDED GAS RANGE In order to maintain healthy indoor air quality and remove excess t..o. (initials) moisture, every kitchen should have an exhaust fan vented to the outdoors to provide at least 100 cubic feet per minute (CFM)of ventilation.Your home's kitchen exhaust fan for your gas range is not currently vented to the outside and it is our strong recommendation you consider venting this, in the near future.You will need to contact a licensed contractor to install hard, metal exhaust ductwork to a roof or wall mounted flapper vent. This is being brought to your attention to identify it as a pre-existing WEATHERIZATION CONTRACT EVERS=URCE CUSTOMER PHONE DATE CLIENT WORK ORDER Leanna Oen (205)937-7354 05/08/2023 537954 10302 SERVICE STREET BILLING STREET PROPOSED BY: 14 South Park Terrace 14 South Park Terrace Ben Apodaca SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Program Northampton, MA 01060 Northampton, MA 01060 EGMA-HES Page 2 DESCRIPTION QTY COST INCENTIVE TOTAL condition to the weatherization work planned for your home.Your signature is your acknowledgement of these conditions and agreement to proceed. LEAD PAINT Your home was built prior to 1978 and might have lead-based paint Lo. (initials) present.You have received a copy of the EPA's Renovate Right pamphlet informing you of the potential risk of a lead hazard exposure from the renovation activity to be performed at your home. PREPARE YOUR HOME Homeowner is responsible for the removal of any items stored in the Lo. (initials) areas where the weatherization measures will be installed. The workers will need the space cleared to safely bring their tools and materials into these work areas. 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 La. (initials) blocking the installation of weatherization work in the basement. Removal must occur prior to the scheduled work start. STORAGE-CRAWLSPACE Homeowner is responsible for the removal of the stored items Lo. (initials) 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. WEATHERIZATION CONTRACT EVERSeURCE CUSTOMER PHONE DATE CLIENTS WORK ORDER Leanna Oen (205) 937-7354 05/08/2023 537954 10302 SERVICE STREET BILLING STREET PROPOSED BY, 14 South Park Terrace 14 South Park Terrace Ben Apodaca SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Program Northampton, MA 01060 Northampton, MA 01060 EGMA-HES Page 3 DESCRIPTION QTY COST INCENTIVE TOTAL VAPOR BARRIER NOT PRESENT There is an inaccessible crawl area beneath your home with an L.o. (initials) earthen floor that cannot be treated in the course of these contracted weatherization improvements. Leaving this area untreated could potentially lead to moisture issues (such as development of mold or mildew within the home). If mold/mildew develops or gets worse after the weatherization work is complete, I understand this is my responsibility and I will not hold RISE, the Sponsors of Mass Save, or the subcontractor responsible for any damages. Total: $2,205.22 Program Incentive: $2,092.24 Client Total: $112.98 I.DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the above work at the Client's Address in a professional manner and in accordance with the terms of this Contract: II.PAYMENT Client agrees to pay the Contractor for the Work,the Client Share of the Contract Cost is payable to the Independent Installation Contractor(IIC)upon satisfactory completion of the Work.Client understands that they will not be required to pay the Program Incentive Share of the Contract cost.Changes to the individual line items and/or previous incentivesrs mnmaay increase or decrease the ' the Program Incentive Share. ea RISE Representative 4vo %a Client Signature P 0 06-07-2023 Printed Name Date of Acceptance 41 4 mass save Savings through energy efficiency PERMIT AUTHORIZATION FORM Leanna I, owner of the property located at: (Owner's Name) 14 South Park Terrace 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. IeaKxaoehe9N+ail.cotm Owner's Signature 06-07-2023 Date FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: S,A,90orTnl 041 o Participating Contractor Dat City of Northampton r - Massachusetts *' 1{c, � � DEPARTMENT OF BUILDING INSPECTIONS y xr , .,4 m ; iii,._ 212 Main NorthamptonMu ci01060uilriing JtssN stO,��:.i Property Address: 1.--•\' ,% -V(1Qortz. 1 PX( j Contractor Name: u on Address: 1 G Ef _A i C `y 1 City, State: SVV1\.1AillP cit(A , k Phone: 40, 1 4 5211 Property Owner Le Name: CD 1 Via, Oen, Address: ( tt C K-- t e�� City, State: NOridnorvlo-tn / I, `‹. 1-c,, ( ck . c, (contractor) attest and affirm that the building I intend to insulatedoes not have any open air (knob and tube)wiring in the spaces to be insulated and that I have provide the property owner with a copy of this affidavit. Contractor signature „ b f ,,,,, , ,,,i' ////96, t 7 - / /7 Date i .4)ooikkr, mass save 2022-23 Weatherization Barrier Incentives Based on your Energy Specialist's recommendations,your home can benefit fronh 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:RISE Engineering,765 Attucks Lane,Hyannis,MA 02601 or email to MassSave@RISEengirieering.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 Name: Leanna Oen Client#or Site ID: 537954 Site Address: 14 South Park Terrace City: Northampton State: MA ZIP 01060 Phan 52t4,Ce:b r: 205-037-7354 btcomer Phone Number: Email: @9rY1alL.COm 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 were eligible Mass Save' weatherization recommendations have been made: crawlspa4e 0 Attic Floor 0 Attic Wall O Attic Slope 0 Exterior Wall e Basement le Other: Q Other: r. o2 fated out 0y the Enetc y Scecalist le I have performed my inspection and determined there is no active knob and tube wiring in the areas selected below. crawlspace O Attic Floor Q Attic Wall 0 Attic Slope i 7 Exterior Wall 46 Basement e Other: _ Q Other v or filled our oY the--'e sed Efec,,....� Contractor Name: Robert Stanton Address:79 Hines Road City:Cumberland state:RI ZIP:02864 Company Name: Robert Stanton Electrician License Number: 53217-B r—oocusignea by: 6/2 3/202 3 Contractor Signature: Date: 1�°olit,vf- ga,(AfOIA,My signature confirms that l hR BEgg d my inspection of the electrical systems listed above and have corrected any barriers as indicated.My signature also confirms a have read and agree to the Terms and Conditions outlined on the back of this form. MECHANICAL SYSTEM BARRIERS�lv l?^-';[I ,1�.,:��r I�_ � �.��I� �irr i: <._�} 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 iI Existing CO ppm Revised CO ppm Existing Draft Pa 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. Q Heating System 0 Hot Water Heater 0 Other: Contractor Name: Address: City: State: ZIP: Company Name: License Number: Contractor Signature: Date: My signature confirms that I have performed my inspection of the mechanical systems listed above and have corrected any barriers as indicated.My signature also confirms that I have read and agree to the Terms and Conditions outlined on the hack of this form.