31D-243 (3) BP-2023-1593
2 WEST ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
31D-243-001 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-2023-1593 PERMISSION IS HEREBY GRANTED TO:
Project# INSULATION 2023 Contractor: License:
• Est. Cost: 2000 HOMEWORKS ENERGY INC 106148
Const.Class: Exp.Date: 07/30/2024
Use Group: Owner: ALICIA SAXE JOEL&
Lot Size (sq.ft.)
Zoning: CB Applicant: HOMEWORKS ENERGY INC
Applicant Address hon • Insurance:
235 ESSEX ST 781-2054484 1847910
WHITMAN, MA 02382
ISSUED ON: 12/20/2023
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 NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
I if y9 9-,
Fees Paid: $100.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
kreED—In7r—FirFiDnviT
RECEIVEL) Fee:$100.00
�UiLT /84/0
j „ * NOV - 9 2023 The Commonwealth of Massachusetts
Office of Public Safety and Inspections
- ti Massachusetts State Building Code(780 CMR)
'Pernhit Application for any Building other than a One-or Two-Family Dwelling
�lO�TH,A44nTOP. ' i
(This Section For Official Use Only)
Building Permit Number.a?3- /593 Date Applied: Building Official:
SECTION 1:LOCATION
2 West Street Northampton MA 01060
No.and Street City/Town Zip Code Name of Building(if applicable)
Assessors Map# Block#and/or Lot #
SECTION 2:PROPOSED WORK
Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below
Existing Building 0 Repair 0 Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy 0 Other QSpecify:Weatherization
Are building plans and/or construction documents being supplied as part of this permit application? Yes ✓Q No ❑
Is an Independent Structural Engineering Peer Review required? Yes 0 No Q✓
Brief Description of Proposed Work Residential weathenzation/air sealing.No structural changes.(Site ID:803706)
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 0 E: Educational 0
F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0
I: Institutional I-1 0 I-2❑ I-3 0 I-4❑ M: Mercantile 0 R: Residential R-1$ I R-211 R-3❑ R-4 0
S: Storage S-1 0 S-2 0 U: Utility 0 Special Use 0 and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA CI IBCl IIA CI IIB CI IIIA CI IIIB CI IV CI VA CI VB[]
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item)
Water Supply: Flood Zone Information Sewage Disposal: Trench Permit Debris Removal:
Public 0 Check if outside Flood Zone 0 Indicate municipal 0
A trench will not be Licensed Disposal Site 0
requiredVr trench or specify:
Private 0 or indentify Zone: or on site system 0 permit is enclosed 0 NA-Little to no Debris
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable Is Structure within airport approach area? Is their review corn leted?
or Consent to Build enclosed 0 Yes 0 or Non Yes 0 No le
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction
Does the building contain an Sprinkler System?: Special Stipulations:
Design Occupant Load per Floor and Assembly space:
City of Northampton
,,:i-, , t Massachusetts ?,' . _ .;,
� r,
:, ` DEPARTMENT OF BUILDING INSPECTIONS
i i; ;.' 212 Main Street • Municipal Building yJ�� 'e�
Northampton, MA 01060 `'••-. .)%.
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR COMMERCIAL &
MULTI-FAMILY NEW CONSTRUCTION/ADDITIONS/ALTERATIONS
1. Building Permit Application signed by legal owner and filled out by owner or authorized agent.
2. One set of plans and specifications of proposed work (Digital & Hard copy).
3. Site Plan with location of proposed structure(s) and setbacks.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CSL and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (if applicable).
8. Note any Conservation and/or Special Permit requirements (if applicable).
9. Driveway Permit (if applicable).
10. Proof of Water and Sewer entry fees paid (if applicable).
11. Trench Permit (if applicable).
12. Initial Construction Control Documents filled out and signed by the Registered Design
Professional in responsible charge.
13. Please provide the appropriate fee in the form of a check made payable to: The City of
Northampton
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
Joel Saxe 2 West Street Northampton MA 01060
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
305.481-7884 - jsaxe@umass.edu
Title Telephone No. (business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes:
Adam Glenn 235 Essex St, Whitman, Ma 02382
Name Street Address City/Town State Zip
to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1)
If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here O.
Otherwise provide construction control forms(see section 107 in the code)as required.
10.1 Registered Professional Responsible for Construction Control (the professional coordinating document submittals)
Adam Glenn 781-205-4484 wxpenn,tt,ng@homeworksenergY.mm CSSL-106148
Name Registrant) Telephone No. e-mail address Registration Number
235 Essex St, Whitman, Ma 02382 07/30/2024
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
HomeWorks Energy
Company Name ,/
Adam Glenn HIC - 181138
Name of Person Responsible for Construction License No. and Type if Applicable
235 Essex St, Whitman, Ma 02382
Street Address City/Town State Zip
781-205-4484 - - wxpermitting@homeworksenergy.com
Telephone No.(business) Telephone No.(cell) e-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152.§25C(6))
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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.
Is a signed Affidavit submitted with this application? Yesn No CI
SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE
Estimated Costs:(Labor
Item and Materials) Total Construction Cost(from Item 6)_$ 2,000
1.Building $ 2,000 Building Permit Fee=Total Construction Cost x 7 (Insert here
2.Electrical $ appropriate munici al factor)_$ .
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum f =$1�� contact municipality)
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost $ 2,000 (contact municipality)and write check number here / 4 .5--. 0
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this
application is true and accurate to the best of m knowledge and understanding.
Adam Glenn 6 `J Contractor/Authorized Agent 7817205-4484 11m2023
Please print and sign name Title Telephone No. Date
235 Essex St, Whitman, Ma 02382 wxpermitting@homeworksenergy.com
Street Address City/Town State Zip Email Address
Municipal Inspector to fill out this section upon application approval: ,/i� C7 I Z,'ZOZ3
Name Date
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
Massachusetts .45\ 'Fk<<
y DEPARTMENT OF BUILDING INSPECTIONS
1,7
i 0 1 212 Main Street • Municipal Building O 1.
A. �a.
Northampton, MA 01060 'Ps f \1''
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: 24 E Longmeadow Rd, Hampden, MA 01036
The debris will be transported by:
Name of Hauler: HomeWorks Energy
11/7/2023
Signature of Applicant: Date:
_� The Commonwealth of Massachusetts
l• ='=' ai Department of Industrial Accidents
i4 .,..
'.- 1 Congress Street,Suite 100
1:i. Boston, MA 02114-2017
www.mass.gov/dia
-_ 11 in kers'Compensation Insurance Aflidas it: Buildersi('ontractors/ElectriciansrPlumbers.
10 HI. 1.11.1.I)111111 111E Pp-R\11 111s(:.A1 111OR111.
Applicant Information Please Print Leaibts
Name 913u,ir. ,,rlr_in nation Ind'stdua.. HomeWorks Energy
Address: 235 Essex St
City.Stag Zi Whitman phone#:781-205-4484
t p'
Are.ou all rmptwert('leek the appeaprWeboa: Ts pe of project(required):
I am a employes with 500+ employees(full inane part-timel.• 7. D Ni:n cunstrucllun
2 1 am a sole proprietor or ptuntnerdsrp and have no employees working fun me in 8. O Remodeling
any capacity.[Nu workers'curnp.msutancx required.)
30 lam a hums:twiner q n doing all work myself.(No workers'comp.insurance n unrcd I"
9. ❑Demolition
l00 Building addition
4.n I ant a hotorowtu^n and will be hums vasnaradurs to conduct all work on my proven) I w ill
t►.—�+ensure that all contra-tors either base winters'cxxtnprnsation tnsuran•s ut ars:sole 1 I a Electrical repairs or additions
proprietors with no emplovccs.
12.0 Plumbing repairs or additions
50 1 am a general contractor and I base hired the sub-contractors lasted on the attached sleet.
These sub-coaatn:seturs hale employees and hise winters'conep.uuuran ce. 13.`Rox)f repairs
I• Ma ei Weatherization
6.Q We area corporation and its officers have exercised their right of exemption per KfliL c. ——
15?.,0141,and we hale no eetnpk sers.[No workers'crimp.insurance required I
*.Any applicant that cheeks hoer.1 must also till out the section below show an their nutters'compensation polity informative"
'ikmnuwnen is hi!submit taus altupasit rndaeatmne the)ate doing all work and then hue outside c ntraetors must submit a new atftdas it Inttcaartig such
:l"ontracton that check this boa must attached an additional sheet show tng the name tat the tut'-ctrrttrac tars and state is tether or not those entitles teas c
employees. It the sub-contractors haw emote)re,.thy e must pros M.:their ssorkcrs'ao-rnp puhzs number
/am an employer that i.providing►►orAer.s'compensation insurance for my employees. Below is the policy and job site
information.
Insurrtn a Company Na„,,, Federated Mutual Insurance Company
—
Policy#or Self-ins.Lie. a:184.7910 Expiration Date: 01/01/2024
Job Site Address: 2 West Street Northampton MA 01060 cityfstatezip: ___ _ __
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a tine up to S1,50001
and+ur one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.00 a
day against the violator_A copy of this statement Ilia} be forwarded to the Office of Investigations of the DIA for insurance
coverage yerttication.
I do hereby certif'under the pains and penalties of perjury.that the information prodded uhut•e is true and turret 1.
,,1 11/7/2023
Phun. 781-205-4484
Official use only. Do nut write in this area.to be completed by city or town official.
( inn or Town: Permitll.icense a
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3.CttyfTow.Clerk 4.Electrical Inspector 5. l'luoiloor. Inspector
l h.Other
i
( intact Person: Phone#:
Initial Construction Control Document
�!?� To be with the buildingpermitapplication by a
�1 submitted
`� ^y Registered Design Professional
for work per the ninth edition of the
40.
''• VA Massachusetts State Building Code, 780 C41R, Section 107
Project Title: Date:
Property Address:
Project: Check (x) one or both as applicable- New construction Existing Construction
Project description:
I MA Registration Number: Expiration date: am a registered design professional. and I have
prepared or directly supervised the preparation of all design plans.computations and specifications concerning::
Architectural Structural Mechanical
Fire Protection Electrical Other:
for the above named project and that to the best of my knowledge, information, and belief such plans,
computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (78O
CMR). and accepted engineering practices for the proposed project. I understand and agree that I (or my
designee) shall perform the necessary professional services and be present on the construction site on a regular
and periodic basis to:
1. Review, for conformance to this code and the design concept shop drawings, samples and other
submittals by the contractor in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable.
3_ Be present at intervals appropriate to the stage of construction to become generally familiar with the
progress and quality of the work and to determine if the work is being performed in a manner consistent
with the approved construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official.I shall submit field/progress reports(see item 3.)together with pertinent
comments, in a form acceptable to the building official_
Upon completion of the work, I shall submit to the building official a 'Final Construction Control Document'.
Enter in the space to the right a "wet" or
electronic signature and seal:
Phone number: Email:
Building Official Use Only
Building Official Name: Permit No.: Date:
Note 1. Indicate with an'x'project design plans.computations and specifications that you prepared or duectly supervised- If'other'is
chosen.prof:de a description
Version 01 O1 2018
Appendix 1
Construction Documents are required for structures that must comply with 780 CMR 107.The
checklist below is a compilation of the documents that may be required. The applicant shall fill out
the checklist and provide the contact information of the registered professionals responsible for the
documents. This appendix is to be submitted with the building permit application.
Checklist for Construction Documents*
Mark"x"where applicable
No. Item Submitted Incomplete Not Required
1 Architectural
2 Foundation
3 Structural
4 Fire Suppression -
5 Fire Alarm(may require repeaters)
6 HVAC
7 Electrical
8 Plumbing(include local connections) _
9 Gas(Natural,Propane,Medical or other)
10 Surveyed Site Plan(Utilities,Wetland,etc.)
11 Specifications
12 Structural Peer Review
13 Structural Tests&Inspections Program
14 Fire Protection Narrative Report
15 Existing Building Survey/Investigation
16 Energy Conservation Report
17 Architectural Access Review(521 CMR)
18 Workers Compensation Insurance
19 Hazardous Material Mitigation Documentation
20 Other(Specify)
21 Other(Specify)
22 Other(Specify)
*Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified
must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the
authority having jurisdiction.
Registered Professional Contact Information
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
Please follow this link for construction control forms to be used by Registered Design Professionals.
'4`oRo� CERTIFICATE OF LIABILITY INSURANCE DATEIM 121,10/20220/2022 Y)
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 POUCIES BELOW. THIS
CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR
PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If
SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this
certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
FEDERATED MUTUAL INSURANCE COMPANY NAME: CLIENT CONTACT CENTER
PHONE HOME OFFICE:P.O.BOX 328 (A/C,No,EEI):888-333-4949 FAX
No):507-446-4664
OWATONNA,MN 55060 E-MAIL
ADDRESS:CLIENTCONTACTCENTER rIFEDINS.COM
INSURER(S) U NG COVERCGE SIAIC
INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935
INSURED 419-899-0 INSURER B:
HOMEWORKS ENERGY,INC. INSURER C:
101 STATION LNDG INSURER D
MEDFORD,MA 02155-5134
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:0 REVISION NUMBER:1
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS
AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
LTRINSR WVDIMM!DDIYYYY) , IMMIDDIYYYY)
X COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE $1,000,000
CLAIMS-MADE IT:OCCUR DAMAGE TO RENTED $100,000
PREMISES IEa ocaorengj_
MED EXP(Any one person) EXCLUDED
A N N 1847909 01/01/2023 01/01/2024 PERSONALS ADVINJURY $1,000,000
GEN'L AGGR G E UNIT APPLIES PER: GENERAL AGGREGATE $2,000,000
1POl1CYJECT LOC PRODUCTS-COMPIOP AGO $2,000,000
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE UNIT
IEa accident) ;1,000,000
X ANY AUTO
BODILY INJURY(M persenl
A OWNED AUTOS ONLY —�OOSSULED N N 1847908 01/01/2023 01/01/2024 BODILY INJURY(Per accident)
HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE
AUTOS ONLY
— (Per accident)
X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $1,000,000
A EXCESSLIAB CLAIMS-MADE N N 1847911 01/01/2023 01/01/2024 AGGREGATE $1,000,000
DED RETENTION
WORKERS COMPENSATION X PER STATUTE] I OTH-
AND EMPLOYERS'LIABILITY l ER
ANY PROPRIETOR/PAR TNERIE XECUTIVE E.L.EACH ACCIDENT S500000
A OFFICERIMEMBEREXCLUDED? _NIA N 1847910 01/01/2023 01/01/2024
(Mandatory in NH) E.L DISEASE-EA EMPLOYEE 5500,000
II yes,desalbe under
DESCRIPTION OF OPERATIONS below E.L DISEASE•POLICY LIMIT 5500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached i1 more space is required)
THIS COPY IS NOT TO BE REPRODUCED FOR ISSUANCE OF CERTIFICATES.
CERTIFICATE HOLDER CANCELLATION
01
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
A CERTIFICATE HAS BEEN FILED WITH EACH OF YOUR CERTIFICATE ACCORDANCE WITH THE POUCY PROVISIONS.
HOLDERS. AUTHORIZED REPRESENTATIVE
6 Kew
1988-2015 ACORD CORPORATION-AM rights reserved.
ACORD25(2016/03) The ACORD name and logo are registered marks of ACORD
Commonwealth of Massachusetts
Division of Occupational Lieensure Construction Supervisor Specially
1111 Rest iQed is
L3uard of Building nst R lattun . and Standards CSSL-C - nsulation Contactor
t"1!
Loructir�uper' r Specialty
CSSL-106148 _ Eitpires: 07/30/2024
ADAM GLEN I i '
19 CHARGE 00 t -
WAREHAM Pit ` :�
}a
" Failure to possess a current ednion of the Massachusetts
1‘1,, , State Build rwj Code is cause for revor ation of this license
For information about this license
,,t Calll617) 727-3200 or visit www rnass_gov-dpi
Commtss:crecrTHE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration Type: Corporation
HOME WORKS ENERGY, INC. Registration: 181138
101 STATION LANDING STE 110 Expiration: 03/02/2025
444440,MEDFORD, MA 02155
*MUM 044
4.141104.01.
1 s,1*
Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the
HOME IMPROVEMENT CONTRACTOR expiration date. If found return to:
TYPE: Corporation Office of Consumer Affairs and Business Regulation
Registration Expiration 1000 Washington Street -Suite 710
181138 .. . 03/02/2025 Boston, MA 02118
HOME WORKS ENERGY, INC.'ADAM GLENN
dw 5);17,a d-
101 STATION LANDING STE 11�;��� r�*+�'`A'CL. zG�at�< r 0:71A--_
MEDFORD, MA 02155 �""
Undersecretary Not valid without signature
Insulation/Air Sealing Permit Authorization
Specialist: Jasmin Vazquez Company: HomeWorks Energy
Email: jasmin.vazquez@homeworksenergy.cor Address: 101 Station Landing
Cell: 4138967666 Medford,Ma 02155
Phone: 781.305.3319
Customer: Joel Saxe Address: 2 West Street
Email: jsaxe@umass.edu Northampton, MA, 01060
Site ID: 803706 Phone: 3054817884
I, the owner of the property identified above hereby authorize HomeWorks Energy Inc., or their Partner
to act on my behalf in obtaining any building permit that maybe required to perform
insulation and/or Weatherization work on my property and all matters related to the work authorized by said permit if
one is obtained. Any related permit application cost will come at no additional charge provided that the agreed
Weatherization work is completed.
In the event that a permit is pulled on your home for insulation and/or weatherization work, you may be required to
have a final inspection of the work scheduled and performed by the building inspector in your town. If required by the
town, you will be notified by HomeWorks Energy that an inspection is necessary with instructions on how to complete
this process to close out your permit.
Email: jsaxe@umass.edu
Customeryoet(-4,e_
Signature: Date: 3/22/2023
Joel Saxe
For Condo Owners:
If you have property oversight by a condo associationt, please have the association's authorized person(s) complete
and sign the section below. Please email this document to wxpermitting@homeworksenergy.com once completed.
We, being the duly authorized representatives of the association
Name of association or management companyt
or management company have reveiwed the plans and specifications for improvements to the address specified above.
We further acknowledge that the above listed owner has given notice that they intend to seek permits and to carry out
the proposed work.
Signature of representative Date
Print Name
t Other unit owners may sign when there is no association.
smINk , l: UmQSS.ef1u. MULTI-FAMILY PLAN VIEW ! �+-� u1�
UC11�: 2�ryc� -C.K.ctn c . • 22.
Name: -3()e_.1 'ram. A\tU&Te ID (Unit 1): 0 (p Finished Sq FT N` Cppc
Phone: 52_94 i •any Site ID (Unit 2): Year Built:1 4(0 c _
g Address: 2. W9/11- S} Site ID (Unit 3): Housing Type?_ _ .1 5
W �p( O,IM *t' r �JL��S� Site ID (Unit 4):
Electric Acct# (unit 1 : Electric (2): tri Electric (4):
Gas Acct# (unit 1): Gas (2): Gas (4):
BASEMENT INSPECTION Unit EXISTING SPEC'INC LN/SQ. FT. 4) 14I S 12.3 x r f 250ig
ravel Ceiling --I 1---'2.4--1
ravel Rim Joist - ' _ (j1 F-C R3 X 3 1_ ..._ ____. !`
amt RJ ri .- }>50
C.) 1 l''' m
z Bsmt RJ '` rr m
g apor Barrier r` .. .: Bsmt Doer44' ' 'p. `� i !27 z
cii Qrba?TOY! 1 ! ycl,i4 i:
11,vcu
LN Blower Door? WALLS&GARAGE Drill Location? 1 ' —�
Unit SIDING CFIL. HEIGHT EXISTING SPEC'ING SQ. FT.
Exterior Wall 1 '�tn 1 -t• 1 CtilqFraming TM
Exterior Wall 2 yl� 1 t 1 Cl.'1� O '&// x x :alloo k latform
Exterior Wall 3 t x x ::::::;::
Garage Wall - .t . x x
Garage Ceiling
0 1--244 —• i .. _
k- 1•--, i I l -i 54 x 4- ZZ 10
-►..
h -30---....11
x l 4 24 L11 si �n tox 1)4 lc M 3�L1
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is
i,1011 1 Cr) Vil SVir SY II \°—
I Ft
RK SP 'D BUTi •T CONTR ED Ins atio Re val Unit I .�
Attic Ba ment/ dG+lspace r, Other: ,.•'` Uni . SQ. T, Sweeps:
Kneew Qverhang arage p
Ductwork Exterior Walls WX Stripping:
ROAD BLOCKS PRESENT?(MANDATORY)
Unit 1 2 3 4 2 3 4 Unit 1 2 3V)PI
4
K&T N Y/N Y/NY/N_ Unit_1,
oisture Y Y/N Y/NY/N CombustionSft Y 41Y/N V/N /N
Asbestos Y Y NY NY Nold>J.00s .ftY Y NY NY N CO Detector Missing Y N /Fl,Y/N /N
VermiculiteY Y NY NY tr,ictl Concern Y NY NY NY N Other indicate unit
Notes: Mt S 1E I.� 01 t ..
4cfivcltcn The 1 Cit.l� 4 L-cA -t tr1Qrk\ i� �u e���.
he _ f ca .L....CW
U►�lit l t.N�'5 Unit y Sk(V.4�.. )
tto oec- IL 1. ti W ~Z. Q, i (\ , ; N1J�Sc �) V_.xt4S
nvv1, I1 i1 11 Iij ,o�i t t a .
.KW WALL AND XLV FLOOR Blind Spec? 4- — OR -- ---► ! 1 ..
_KW SLOPE AND GABLE END Blind Spec? 4
Unit: Why?
Unit
EiNlr- + SO FRAMING EXISTING SPEr_'I^F_ SQ.FT.
X 7 SLOPE tLX(Q KILO . 1 Jul
FLOOR X X M_ `GABL€_ {.�
O ACCESS X TRANS X ( X m
M
TRANS _. ,_.�2i is.i _ ATTIC • „ a k ,,x � ^) D
ATTIC SLOPE x X {w(� L
3 SLOPE ti X i 3 EXISTING VENTING? p
'-,1EXISTING•VE---- EXISTING PIPES, Y/N ^�
•" ,., kKhp e . 4.
0 1
2
,--,..,, n:
-,-1,.. KNEEWALLMANDATARY !
wtr - i
t t 1:
, 11
� t
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Y j
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r
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'f I,,k1 t wit r _ ; , t A tcx.)r
h\ X -)tx ',',, roll x• Ili �)?)Vol rift UCTWORK INSPECTION Ducts insulated?
V� �J t1�RS� I?h � j 0) '`�'� °R 2' D t ' n iiiDu In Ila n�\ p D c a D tI ul o e o lI) 3 1�i1� 1f'n X ID u rSloi
ni
x x ATTIC 1 Blind Spec? X ATTIC 2 Blind::pec? _ Air SealingMultipliers
Unit: EXISTING S'' ," r SQ. FT. Una • EXISTING SPFt.'•N'- SQ. FT. Hours
Unflooredu. .,,,,.,..vm...w.�. .,��..r.+.r Trusses
Unfiloa d Isial
• it Mixed Insulation
o Flooredw ' J, � Floored
y Cath Slope Cath Slope Unit >s Loose
ai Walls I Wails Goss flatting
Z �•�
G Access I {in Access .._ WHE.I}ox
,1 r-nr.' .n 01101V,ffsissasiamsaSheathing ACCESS
a V4 1'I Prrm ,t, '.,,in, Ii' 3F I,o<., Damming Venting Prog eats - rarnmm R.I..Covers
r
Y NV `' ') 1 ,' Temp Access .., n t.
u IN
7'
C.A. 3 . i 1, Roof Type ,("� r
n�. HomeWorks Energy
py� ((( Home Performance Contractor
101 Station Landing,Medford,MA 02155 I 1
. CONTRACT - WZ
781-305-3319
HomeWorks
y,Inc
CUSTOMER PHONE DATE CLIENT# WORK ORDER
Joel Saxe (305) 481-7884 09/22/2023 803706 10805
SERVICE STREET BIWNG STREET PROPOSED BY
2 West Street 2 2 West St HomeWorks Energy
SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP
Northampton, MA 01060 Northampton,MA 01060 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.
PERFORM AIR SEALING AT ESTIMATED 62.5 CFM50 PER HO 1 $106.59 $106.59
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 $145.28 $145.28
Provide labor and materials to install Q-Ion weatherstripping to
door(s)to restrict air leakage.
DOOR SWEEP 4 $118.64 $118.64
Provide labor and materials to install a doorsweep to restrict air
leakage.
INSTALL 6"CELLULOSE IN ENCLOSED ATTIC FLOOR 22 $50.82 $38.12 $12.70
Provide labor and materials to install a 6"layer of R-21 Class I
Cellulose to floored attic space.
INSTALL 8"CELLULOSE IN ENCLOSED ATTIC FLOOR 324 $813.24 $609.93 $203.31
Provide labor and materials to install an 8"layer of R-28 Class I
Cellulose to floored attic space.
ENCLOSED KNEEWALL CELLULOSE 4"DENSE PACK 10 $28.90 $21.68 $7.22
Provide labor and materials to install blown-in Class I Cellulose to a
kneewall by a method of drilling holes through the surface.The holes
are plugged and any final sanding priming, painting and/or wall
papering is the responsibility of the home owner.
Cgno
HomeWorks Energy
Home Performance Contractor
101 Station Landing,Medford,MA 02155
CONTRACT - WZ
781-305-3319
HomeWorks
CUSTOMER PHONE DATE CIJENTN WORK ORDER
Joel Saxe (305) 481-7884 09/22/2023 803706 10805
SERVICE STREET BILLING STREET PROPOSED BY:
2 West Street 2 2 West St HomeWorks Energy
SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP
Northampton, MA 01060 Northampton, MA 01060 Page 2
DESCRIPTION QTY COST INCENTIVE TOTAL
DOOR:THERMAL BARRIER POLYISO 2" (ATTIC) 1 $103.05 $77.29 $25.76
Provide labor and materials to insulate the back of the attic door with
2" rigid insulation board.
Total: $1,366.52
Program Incentive: $1,117.53
Customer Total: $248.99
WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF
***Two Hundred Forty-Eight &99/100 Dollars $248.99
14animait „.717_, -- -
COMPANY REPRESENTATIVE CUSTOMER SIGNATURE
09/22/2023
NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE
SIGN DATE
30 DAYS.
mass save 2020 weatherization barrier incentives
used on your Energy Specialist's recommendations,your home can benefit from program-eligible insulation.and/or air seelmq
improvements.elefore moving forward,please follow all the instructions oelow to remediate your weatherization barriers,
CUSTOMER INSTRUCTIONS
t Hire a ciaatiried,licensoci contractor to evaluate and/or nemediate the weatherizotion norner(a),
2.Subm.t signed and completed copies of this form and a copy of the paid contractor invoice(s)within 60 days of your Home I.-,nergy
Assessment to:The Participating Home Performance Contractor that completed your Home Energy Assessment,
3.The weetherization incentive will be deducted from the customer co-payment amount of the weetherlzation 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,
CUSTC.iriER INFORMATItat4
rl:inform.-hramoi Joel Saxe Client ff or Site ID: 803706
Silo Address: 2 West Street City, Northampton st&x., MA zip• 01060
Custerner/Horrieotilter Signature; Cato.:
KHOO-AND vvibir,lt,
To treterinine it there is any active knob and tube wAng,the contractor will evaluate the following areas where eligible Mass Save
weatherization recommenciatons have been made:
Attic Floor jilt!Attic Wall C..)Attic Slope rp Exterior Wall Basement Otheit Other
X I have performed my alspection and determined there,s no active knob and tube wiring in the areas selected below.
Floor )(Attic Wall Xi Atte Slope flExterior Wall Basement Q Other_ ether
contraittt%
Add'' Q, '1) . Aplycitt,e- - ra..C.D..
)4, Sut-Va_47404.41 . 3e7
Contractor Signetei Date, rCl/11
My sgrisare con!, ti a I i.rare perromie ;. Ii ' 5.51 r na.re rra„%:ag ary i)arr,ei:,;
indicated.My signature also confirms that I h o and agree tetthe Terms and Conditions outlined on the back of this form.
41,604MICAL,SYSTENtAPRiERS 1,4tv..44,:c::i::t-,et.",g,;.„.'
High Carbon Monoxide:Contractor is to service end - , ti mechanical system(s)and reduce the carbon monoxide level
nyc in the undiluted flue gas,to delow100 parts our P
Draft Failure:Contractor is Sc correct the draft.n the selected flues, ,etcr to table on reverse for acceptable draft ranges.
high Carbon Monoxide Draft Failure
Heating System
Hot Water Heater
Other:
Spillage:Contractor is to correct the spillage of flue gasses (,• system(s) Must not spill after 60 seconds of operation,
Heating System TiHer Water Heater TiDthei.
Cr:tetrad:Or Name ,
City: State r
Narrio Ne,r-ber:
Contractor Signature; _ „ Date:
signature confirms that i heve performed my inspection of the rierrian cal stersts listed eibove and have t.orrecteu any demurs th
indicated.My signature also confirms Mat I have read and agree to the Ter tins and Conditions outlined on the back of this form,
%awn trirr.
Exhaust Fan for Fresh Alm Contractor to install exhaust fan to provide measured, Ontinvoris or intermittent whole building vent&steno.
The tegad tate of-fioie,rntiSt be Capable of movieng_ _CPM Ottesagreel at fan),
Dryer Vent Evaluation:Contractor to ensure the dryer vent iS oxhauston to rho si6torigr through hard Metal duCtwark.
have AOC an ternauSt tan to the Spetifitations noted abOvei
have'• iatia0 Andlor repaired the dryer want fair to the artesileierions noted above,
C'..entrosSlor Name. ,
Address._ tit y State, ZIP
Tr mines, i;isris- license Number.
• ''s "'"eI, ,,c",
that ' ) Cc . " t t ,,,,ntiletIon systems listed abovn ri
as inalCated.My signature also confirms the', , 7ve read ,rgroe 10 the Terrns and Condit outlined beioye
TERMS AND CONDITIONS
eligibility Requirements:Applicant must be a residential customer of Mechanic&System Evigusition<up to S210 Inteativo Corr:sett;pis itareiV
a ow tis'igiatxi.o t,,Msc.Save Sponsor.Customer mu i tr htit: sorilluct.0 ett the htsviting sill not water sy:tissns this
Mess Save Horne Energy Services Program(must reide in 1.4 fornilY 'some These tests are congested with all the tschaust egoigiriont
herhe),The tofialitVint border rooSr hit identified of the rime of the Horne simultaneously creating a tworst-corice doprerstirizatori of me bialeirod,If a
Energy Assessment as a harrier oresieriting;he Iriateael,on of p,onWed eitsiblern was identified,repairs to to,teCt the vrcblem must be tom Dieted bY
welt:twton Improvements:Customer must ciarriOeto tire re,rinniaitired O./alined i-tyikc.contractor The register...in and it oi reetons are at follows:
1 "4"1° v°`'ner°t°' oro the co aabkCarbon monoxide levels exceed 100 nom in the undiluted flue case's
must submit the completed Contractor Evaluation Regoi, sling 14 After a dean and esme Or other evellcable service.the measurements's':
ropy of the titttett and itemized invoice from rile licenser, • tc.on of undiluted flue cos of carbon rhorowede foe to Os recorded on VW
cratnerrony letteihned within GO days ittnostmarrestis or thc y front of the Contractor Evaluation Report where program rules elate Inc
Assessment n ,'tor Invoice is not provided within - • h mireimum allowile concerto titan is IVO rpm.
sicgioto won- barrier incentive,TIn.! to forfeited •
,• as:guarantee the banner ftbe • r,,t,r5o your Warne Energy Asserriunerit it was discovered that tio,
Custortser agret!.s to MI 74srris and moor-ionic a/grater/WV Was continuously spilling ex:boost',44',t;:.
ttq- is.-inditiOn it alto knotkh eis beck craft and should
Connector RosponsibUltios and Acknowledgement hi as operator atorder to be considered
wirra'n confection witty the Waotheriitarlon Sorrier Inirenfie 6(ri r•C s tO thigit M;tt‘t,Ckt the sottrro.)to correct as
n Venal betshis) the contractor shale(0 abide by sal local.stale ad fs ArOttiqt,otutkehb..11 the selected ftusi-s-•?,and certify by sioneture on
oostatines,aputicatite laws dneluding:but not lasted tn at avolitebie the fi rant of tHs form that ttst spillaryer coedit ityp mss tereied aftes$0
environmental taws) building codes,rectulations drishigine,bet net seconds of coarse ion.
lmft to EPA lead-sore And any and all ether applisobie anvirermarttel 3,biging yaw Horne Energy Assessrherie was discovered that ifs
iegulatirtriCi<>inn ticv rising rt.qt&..,,re,A3,.etid star,wins and (1,0,,,,,,bntAy
istehtified rafeihrine;a1 syMeitits)ere trf=ntoisi •,t+fti,:100t.DPAPT,
hetItY Zhe cuti)thei in any t.,0%0 eiheia toostihs;or possible health,;gel/ sentlition Is whom exhaust gases afehot movirio through the thimrery
tit
or Safety problems twist.The licensed crantratter inset f'S in end seri oft
at a fast enough rats.The sontrectrar,11:4V,service the System:es.)to
on the tatting is'suitt sr the as 'late place on this form Contractor
correct the draft problem in the selected hods).New diets'gneiss'nest
grail remain arid fully testagriziOe ref their corifernatioris rang he groveled dr)the front Of this'sem and within acceptable draft ranges
notes tiler , on tins form tthC t,h,Oet:t tt.t tricr Codirector
A%described 6 table I.
oespoosi : t„ii iistiesti
ts,st
Kettab&Tub*Wiring Evaluate:oh(up to sal,Instentivs):The Knee end tube
wring that has beer noted cannot be oeiernened inactive at the liner sifrat Draft
the Horne Energy Assessment performed by the Mass Save Homo Energy eig -45
tarsus.Phegtate Even If the observed wiring apporers to tier inactive,there
might spit oie active circuits located in 'accessible areas of the home 0,c, 'DOM (outslde TeM0/40)-275
oe0 -Ott
licensed electririan verify the OttliOttlCe or inactivity of the Snob Clint ts.he •
wring in the trews of your home where we are oroposesst insulation be
:ristiseeci.We advise you to share this form wtth your etectriCien before Fatlangt Fen Installation top Ire S2SO Intentivim The results cril the
• hiring them re inspect yogi latiite to ensure they agree to the terms.-Tao completed blower door rest ei ther ef you,Home triers Assessment
Home Energy 5orvices Program will rely on the olettrican's certification or r-ri hatheriZatinn voth 5 Oroticidiging contractor,
and Al rest Da liable if mess orate, ow, •, •your horn-h II iiiitif riii ,in fresh air berore
o . psof-.4rsin eil4tile Ws°Y, 'so k mass say"yirrerisisis
' for the itist,r, isioiaust it to tooy.de
ado, • aiecialiSt can help determine
Sits.ns,pesp, , ,datiOnt.,This inCentive is Only
avaiiattleIn ', s, , •- tart will rec,eisie a biome
Ore",test ai • ' Horne Energy AssPoorent,
.
WE ARE MASS SAVE*:
firEtteSHIPE MACKSTONT
GAS
GAs COMPANY Cohn-nbia (ias
EVERSURCE Liberty utties nationalgrid
L,'uiljl
imp
FOR ADDITIONAL INFORMATION,PLEASE CALL 800-480-7472.