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17D-073 (11) BP-2023-0725 30 HIGH ST COMMONWEALTH OF ASSACHUSETTS Map:Block:Lot: 17D-073-001 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-2023-0725 PERMISSIO IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: DIPIETRO HOME NERGY Est. Cost: 2848 SOLUTIONS DBA EVISE 104464 Const.Class: Exp.Date: 03/06/2024 Use Group: Owner: BYER Y REVELL, MELISSA&JACKSON Lot Size (sq.ft.) DIPIE O HOME ENERGY SOLUTIONS DBA Zoning: URB Applicant: REVISE Applicant Address Phone: Insurance: 32 MIDDLESEX ST (978)203-6736 WC100142002 HAVERHILL,MA 01835 ISSUED ON: 08/10/2023 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHERIZATION 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 NO THAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: 0 • V b ).2 Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fa (413)587-1272 Office of the Building Commissioner / N 9- +`—i i o.w it ��\\ 5 / ��/ ! 1 9 � � ,,�J'l�"JUILv- d2 The Commonwealth of Massa us, t z S 1W Board of Building Regulations and Staiki,•.s,•. �� R Massachusetts State Building Code,780 I q 'tic; CIPALITY oii �tisa USE Building Permit Application To Construct,Repair,Rene ate Or.' vised Mar 2011 One-or Two-Family Dwelling °so°',s , This Section For Official Use Oily Buildin Permit Number: II P-a 3 r 1,6— Date Applied: 8 5/30/2023 eav,,s »s /AZ 6 10 Z023 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMA ON 1.1 Property Address: 1.2 Assessors ap&Parcel Numbers 30 High St Florence,MA 01062 1.1a Is this an accepted street?yes ✓ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property I imensions: 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 la Private 0 Zone: Outside Flood Zone? Municipal 2 On site disposal system 0 Check if yesla SECTION 2: PROPERTY OWNE'SHIP' 2.1 Owner'of Record: Issa Reveli Florence,MA 01062 Name(Print) City,State,ZIP 30 High St 540-255-1647 revell.issa@gmail.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 ❑ Repairs(s) 0 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 $2848.80 1. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $0 ❑Total Project Costa (Item 6)x multiplier x 3.Plumbing $0 2. Other Fees: $ 4.Mechanical (HVAC) $0 List: 5.Mechanical (Fire Suppression) $0 Total All Fees: Check No7 ' Check Amou It: Cash Amount: 6.Total Project Cost: $2848.80 0 Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SE4tVICES 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,ZI� 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 I) 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 0 No ❑ 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 of perjury that all of the information contained in this applicati n is true and accurate to the best of my knowledge and understanding. 05/30/2023 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" The Commonwealth of Massac usetts Lb\- =9Pz.t= Department of Industrial Acci ents 1_, Office of Investigations - Lafayette City Center �— 2Avenue de Lafayette,Boston,MA 2111-1750 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 and I employees(full and/or part-time).* have hired the sub-contractors 6. El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet, 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in anycapacity. employees and have workers' p ty comp.insurance.; 9. El Building addition [No workers' comp.insurance required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGt. 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no Weatherization employees. [No workers' 13.❑■ Other comp.insurance required.] *Any applicant that checks box#I 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: HUB International New England Policy#or Self-ins. Lic.#:WCI00142002 Expiration Date:04/20/2024 Job Site Address: 30 High St 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: Date: 05/30/2023 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): 11=1Board of Health 20 Building Department 3.1=ICity/Town Clerk 40 Electrical Inspector 5.alumbing Inspector 6.0Other Contact Person: Phone#: A��0 DATE(MM/DDIYYYY) `O CERTIFICATE OF LIABILITY INSURANCE 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 (A/C, Estl: (978)374-6352 FAX No): (978)521-5127 2 S.Kimball St. E-MAIL ecostello@costelloinsurance.com ADDRESS: PO BOX 5248 INSURER(S)AFFORDING COVERAGE NAIC# Bradford MA 01835 INSURER A: Colony Argo Insurance INSURED INSURERS: 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD MD (MM/DD/YYYY) (MMIDD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE RENTE CLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) $ 50,000 MED EXP(Any one person) $ 10,000 A PACEP308383 04/25/2023 04/25/2024 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X PRO LOC PRODUCTS-COMP/OPAGG $ 2,000,000 JECT 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 X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) Medical payments $ 10,000 X 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 ,,/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached 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 Northampton, MA 01060 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ,41 (../.046 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD DIPIEHO-01 CWOODSIDE ,4CORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 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(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 License#1780862 ACT Anya Toteanu HUB International New England PHONE FAX 300 Ballardvale Street (A/C,No,Ext): I(NC,No): Wilmington,MA 01887 ADDARESS:anya.toteanu@hubinternationalcom INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Independence Casualty Insurance Company 11984 INSURED INSURER B: Dipietro Home Energy Solutions,Inc.,Joseph A. Dipietro INSURER C: Heating&Cooling,Inc 32 Middlesex Street INSURERD: Haverhill,MA 01835 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 IMMIDD/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 UMIT APPLIES PER: GENERAL AGGREGATE $ POLICY j& LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILECOMBINED SINGLE LIMIT LIABILITY (Ea accident) , —ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AAUUT�OSSyyNEp BODILYOR INJURY(Per accident) $H - AURTODS ONLY _ AUTOS ONLY (Perr acEcRideent)AMAGE UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY _ STATUTE OTH- ER WCI00142002 4/20/2023 4/20/2024 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Addklonal Remarks Schedule,may be attached Ir more space Is required) CERTIFICATE HOLDER CANCELLATI1DN 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 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD City of Northampton pj�/' '7 l'` •1 f v 1 m� r Massachusetts x `�' al, DEPARTMENT OF BUILDING INSPECTIONS �& mi f 212 Main Street • Municipal Building l § Northampton, MA 01060 ht '1'1ti Property Address: 3o High Street, Northampton,MA o1062 Contractor Name: Jon E. Dyer / Jon Dyer Electric, LLC Address: 82 Wendell Ave, Suite 100, Pittsfield, MA 012( City, State: Pittsfield, MA Phone: 781-315-7630 Email: Jondyerelectrician@gmail.com Property Owner Name: Jackson ByerCy Address: 30 3-figh Street City, State: Northampton, MA o1062 1, Jon E. Dyer *** (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. ***Any present K&T is InActive*** Contractor signature f Date June 17, 202: *ik mass save Weatherizatian barrier incentives Based on your Energy Specialist's recommendations,your home can benefit frim program-eligible insulation and/or air sealing improvements. Before moving forward,please follow all the instructions below o 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 co tractor invoice(s)within 60 days of your Home Energy Assessment to:Center for EcoTechnology,320 Riverside Drive-1A, Northam.ton,MA 01062 or email to customersupport@cetonline.org. 3.The weatherization incentive will be deducted from the customer co-payme t amount of the weatherization work.A rebate check will be issued in the event the amount exceeds the customer's co-payment . ount. 4.Complete the recommended weatherization improvements. 5.The Mass Save' HEAT Loan offers interest-free financing opportunities that ay be used to remediate eligible weatherization barriers. Learn more at masssave.com/en/saving/residential-rebates/heat-lean-program CUSTOMER INFORMATION Customer Name: Jackson Byerly Client • or Site ID: Site Address: 30 High Street Northampton City: ..state: MA ZIP. 01062 Phone Number 860-906-6824 Email: jack.byerly@gmail.com Customer/Homeowner Signature: Jackson By era' _ Date: 6.1 5.2023 _ , ., KNOB AND TUBE WIRING tub to$250 ineantive) To determine if there is any active knob and tube wiring,the contractor will evaluate the following areas where eligible Mass Save' weatherization recommendations have been made: o Attic Floor 0 Attic Wall El Attic Slope 0 Exterior Wall Q Basement ❑Other: Ei Other: 0 I have performed my inspection and determined there is no active knob and tL be wiring in the areas selected below. Q Attic Floor Q Attic Wall Q Attic Slope Q Exterior Wall Q Basement El Other: Other: , Contractor Name: Jon E. Dyer email: jondyerelectrician@gmail.com 82 Wendell Ave, Suite 100 Pittsfield MA : 01201 Address: ay: State: ZIP. Jon Dyer Electric, C 37785E'&22995A Company Name: 1)14/\ License Number: Contractor Signature: Date: 6/15/23 My signature confirms that I have performed my inspection of the electrical systems listed above and have corrected any barriers as indicated.My signature also confirms that I have read and agree to the Terms and onditions outlined on the back of this form. MECHANICAL SYSTEM BARRIERS(up to$250 incentive)(To he fill:a out by licensed c.7ntrac ) 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 tabl: on reverse for acceptable draft ranges. High Carbon Monoxide Draft Failure QE g CO ppm Revised CO pc t 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. Heating System Hot Water Heater 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 back of this form. VENTILATION rue to T2 incentivr,) Exhaust Fan for Fresh Air:Contractor to install exhaust fan to provide measured,continuous or intermittent whole building ventilation. The required rate of flow must be capable of providing CFM(measured at fan). Dryer Vent Evaluation:Contractor to ensure the dryer vent is exhausted to the exterior through hard metal ductwork. 0 I have installed an exhaust fan to the specifications noted above. 0 I have evaluated and/or repaired the dryer vent fan to the specifications noted above. Contractor Name: • Address: City: State: ZIP: Company Name: —__.____.._...._........._.._--.. License Number: ---. • Contractor Signature: Date: My signature confirms that I have performed my inspection of the ventilation systems listed above and have corrected any barriers as indicated.My signature also confirms that I have read and agree to the Terms a d Conditions outlined below. TERMS AND CONDITIONS Eligibility Requirements:Applicant must be a residential customer of a participating Mass Save Sponsor.Customer must participate in the Mass Save Home Energy Services Program(must reside in a 1-4 unit family Mechanical stem Evaluation(up to$250 incentive):Combustion safety home).The qualifying barrier must be identified at the time of the Home testing has been conducted on all the heating and hot water systems in this Energy Assessment as a barrier preventing the installation of proposed home.These tests are conducted with all the exhaust equipment running weatherization improvements.Customer must complete the recommended simultaneous y,creating a"worst-case"depressurization of the building.If a weatherization improvements to receive the applicable incentive.Customer problem was identified,repairs to correct the problem must be completed by must submit the completed Contractor Evaluation Report including a a qualified H AC contractor.The problems and corrections are as follows: copy of the dated and itemized invoice from the licensed contractor on 1. Carbon onoxide levels exceed 100 ppm in the undiluted flue gases. company letterhead within 60 days(postmarked)of the Home Energy After a c-an and tune,or other applicable service,the measurement(s) Assessment.If contractor invoice is not provided within 60 days,the eligible weatherization barrier incentive may be forfeited.Customer of undilu ed flue gas of carbon monoxide are to be recorded on the participation does not guarantee the barrier will be cleared.In submitting front oft is Contractor Evaluation Report where program rules state the this application,the Customer agrees to all Terms and Conditions, maximu allowable concentration is 100 ppm. Contractor Responsibilities and Acknowledgement:In performing any 2, During y'ur Home Energy Assessment it was discovered that the work in connection with the Weatherization Barrier Incentive(as set forth identifies mechanical system(s)was continuously spilling exhaust gases into the ome.This condition is also known as back draft and should in detail below),the contractor shall:(i)abide by all local.state and federal end with n 60 seconds of system operation in order to be considered guidelines,applicable laws(including,but not limited to all applicable acceptable.The contractor must service the system(s)to correct the environmental laws),building codes,regulations(including,but not spillage•roblem in the selected flue(s),and certify by signature on limited to EPA lead-safe and any and all other applicable environmental the front of this form that the spillage condition has ceased after 60 regulations)and licensing requirements;and(ii)stop work and immediately seconds.f operation. notify the customer in any case where existing or possible health and/ or safety problems exist.The licensed contractor must fill in and sign off 3. During y'•ur Home Energy Assessment it was discovered that the on the testing results in the appropriate place on this form.Contractor identifies mechanical system(s)are not creating sufficient DRAFT.This shall remain solely and fully responsible for their confirmations and conditio is where exhaust gases are not moving through the chimney notes that they provide on this form and with respect to the Contractor at a fast -nough rate.The contractor must service the system(s)to Responsibilities set forth above. correct t e draft problem in the selected flue(s).New draft results must be provi h ed on the front of this form and within acceptable draft ranges Knob&Tube Wiring Evaluation(up to$250 incentive):The knob and tube as descri•ed in Table 1. wiring that has been noted cannot be determined inactive at the time of Table 1-Acc.ptable Draft Test Ranges the Home Energy Assessment performed by the Mass Save Home Energy Service Program.Even if the observed wiring appears to be inactive,there Outside Temp(°F) Minimum Draft Pressure(Pa) might still be active circuits located in inaccessible areas of the home(i.e, walls,etc.).The Mass Save Home Energy Services Program requires that a <10 -2.5 licensed electrician verify the absence or inactivity of the knob and tube 10-90 (outside Temp/40)-2.75 wiring in the areas of your home where we are proposing insulation be — • • installed.We advise you to share this form with your electrician before ,90 -0,5 hiring them to inspect your home to ensure they agree to the terms.The Home Energy Services Program will rely on the electrician's certification Exhaust Fan Installation(up to$250 Incentive):The results of the and will not be liable if inaccurate, completed b ower door test at the time of your Home Energy Assessment Application Form:This application must be filled out completely,truthfully or schedule weatherization installation with a Participating Contractor, and accurately.The customer must date and submit the completed determined hat your home will need an increase in fresh air flow before application along with all required documentation for specific rebates.By undertaking ny program eligible weatherization work.Mass Save provides submitting the rebate application,the customer agrees to abide by these a Weatheriz tion incentive for the installation of an exhaust fan to provide Terms and Conditions. additional fr sh air to the home.Your energy specialist can help determine the necessar flow rate and provide recommendations.This incentive is only Liability:Due to the liability involved with signing this type of form,we available in l' ited situations and not all customers will receive a blower suggest you show or describe this form to your Massachusetts licensed door test at he time of the Home Energy Assessment. electrician prior to hiring him/her to inspect your home,to be sure he/ she is willing to sign it.CLEAResult and the Mass Save Home Energy Dryer Vent Evaluation(up to$250 incentive):Contractor to ensure the Services Program will rely on the licensed electrician's determination and dryer vent is exhausted to the exterior through hard metal ductwork. certification and will not be liable if it is inaccurate. WE ARE MASS SAVE': GAS" "" EVERSSURCE Liberty nationalgrid UllitiI FOR ADDITIONAL INFORMATION. PLEASE CALL oo-4 o-7 72_ THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washingtor}Street- Suite 710 Boston,Massachusetts 02118 Home Improvement eontractorRegistration Type: Individual 414Vration: 167375 JAMES G.DIMOUOULOS Expiration: 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 beforo the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:Individual Office of Consumer Affairs and Business Regulation Rogi0t tton Exeiratlgn 1000 Washington Street -Suite 710 16775 03/11/2024 Boston,MA 02118 JAMES G.DIMOUOULOS, JAMES DIMOUOULOS `r 25 SEVEN SISTER RD ;' ^"` IIAVERHILL,MA 01830 Undersecretary C_.- NO Mild without signature DocuSign Envelope ID:61B6980E-8627-4795-A060-B20FA52C0FA8 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 Jackson Byerly (860) 906-6824 05/24/2023 806563 76201 SERVICE STREET BILLING STREET PROPOSED BY, 30 High Street 30 High St Revise Energy SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Florence, MA 01062 Florence, MA 01062 Page 1 DESCRIPTION QTY COST INCENTIVE TOTAL 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 4 $127.24 $127.24 Provide labor and materials to install Q-Ion weatherstripping to door(s)to restrict air leakage. DOOR SWEEP 4 $104.44 $104.44 Provide labor and materials to install a doorsweep to restrict air leakage. DAMMING 96 $235.20 $176.40 $58.80 Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass batts for damming purposes. ATTIC FLOOR OPEN BLOW CELLULOSE 12" 482 $1,089.32 $816.99 $272.33 Provide labor and materials to install a 12"layer of R-42 Class I Cellulose to open attic space. INSTALL 9"FIBERGLASS BATTING IN OPEN ATTIC FLOOR 30 $74.70 $56.03 $18.67 Provide labor and materials to install a 9"layer of R-30 unfaced fiberglass batts to attic space. INSULATION REMOVAL 55 $68.20 $0.00 $68.20 Batt style insulation will be removed from the attic area and properly disposed, off site. INSTALL 2"THERMAL BARRIER POLYISO ON OPEN KNEEWAL 33 $160.05 $120.04 $40.01 Provide labor and materials to install rigid board at R-10 or greater with the required fire rating to the sloped rafter area behind a kneewall. 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. INSTALL 2"THERMAL BARRIER POLYISO ON OPEN BASEMEN 26 $127.14 $95.36 $31.78 Provide labor and materials to install rigid board insulation to the perimeter of the basement ceiling at the house sill. DocuSign Envelope ID:61 B6980E-8627-4795-A060-B2OFA52COFA8 Revise Energy r � 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 Jackson Byerly (860) 906-6824 05/24/2023 806563 76201 SERVICE STREET BILLING STREET PROPOSED BY: 30 High Street 30 High St Revise Energy SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Florence, MA 01062 Florence, MA 01062 Page 2 DESCRIPTION QTY COST INCENTIVE TOTAL PROPAVENT 2'OR 4' 60 $247.80 $185.85 $61.95 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 a 6"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. Total: $2,848.80 Program Incentive: $2,237.72 Customer Total: $611.08 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Six Hundred Eleven &08/100 Dollars $611.08 DocuSigned by: ritdsotA.,DocuSigned by: 4C4B1E2D6AB8497 AD98E839CF13344E.. COMPANY REPRESENTATIVE CUSTOMER SIGNATURE 5/24/2023 NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE SIGN DATE 30 DAYS. DocuSign Envelope ID:6166980E-8627-4795-A060-B20FA52C0FA8 . REVISE „T . the way ��a_ save 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 I Jackson Byerly owner of the property listed above hereby authorize Revise 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: ituksoit, bi tytti AD08E830CFD344E... Date: 5/24/2023 Mini Circlo Ono In Ho i+ Revise Energy Planview Diagram Customer: , gs.�sohIg �tr_1V Advisor Name: _r,,-,_ /1�7y L Address: '10 i-(t) t Any limitations to access by truck? Y/ Town: av e''�Cl__MA. .thO Site ID: i()_a 0 I *Use the greater of the two BAS It's when calculating for MVR H of stories ( 1 ` 1.5 2 2.5 3 BAS 1: 15 cfm X tl occupants X n-factor = 6 "7 5 n-factor 1 19 l 16 15 , 14.4 13.7 BAS 2: .00583 X area X height X n-factor = // 5R Mechanical Ventilation Recommended:BAS>final CFM50> (0.7 X BAS) Mechanical Ventilation Required:(0.7 X BAS)>final CFMSO Is this part of a multi-unit workscope?Y o 6 A/S Multiplier? is >6"Loose Insulation Cross-Batt >6"Mix Loose/x-batt Truss Wl)orkscope: b) /hSuI -fiDY1 re Ov,. -AlL( f'o„ " 2) oo,, f,, -9 7) nirtzifi a'' Du I" —7)3 i-2) ems -Poo,1„,�,r _ .,0 3) 04-A- A 3 —q t i) Q,� �- k_ Pa 1 C ) A41C- (bY allo& — y g 2 9) p.iy i,, J44- 2t 30 1 o) PY coven — 60 Any work scoped outside of best practices/approved by? f ‘ t11 ' 11) iS .,, id a` %) ;) r Area Yr Built Heat Yr DHW Yr Ventialtion SOFT SOFT/300 40%Low/High Existing High Existing Low Rec Vents, g Existing Propervents Required Propervents Soffit vent, Y N Ridge vent'' Y N -STREET- :gni�....am, v kJ PaaP of