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12C-081 (8) BP-2024-0005 36 MARY JANE LN COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 12C-081-001 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-2024-0005 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2024 Contractor: License: Est. Cost: 3926 HOMEWORKS ENERGY INC 106148 Const.Class: Exp.Date:07/30/2024 Use Group: Owner: E TUMAL VINCENT J&JANE Lot Size (sq.ft.) Zoning: RI/WSP Applicant: HOMEWORKS ENERGY INC Applicant Address Phone:, Insurance: • 235 ESSEX ST 781-2054484 1847910 WHITMAN, MA 02382 ISSUED ON: 01/03/2024 TO PERFORM THE FOLLOWING WORK: INSULATION 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: • • .5.2 . 97- , I Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner FEE: $65.00 1t_1' jolt l L. Please email Permit to WXPermitting@homeworksenergy.com DepFOR tl :T.*„i City of Northampton G Building Department /V 212 Mairl Street Roori 100 3 INSULATION Northampton, MA01060 2024 OFIL. Y phone 413-587-124Q �BYyt -1272 to APPLICATION FOR INSULATION FOR A ONE OR TWO FA`AIIL\DWELLING ONLY SECTION 1 -SITE INFORMATION INSULATION PERMIT 1.1 Property Address: This section to be completed by office Map Lot 12C-081'OO1unit 36 Mary Jane Lane Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Vincent Tumal 36 Mary Jane Lane Name(Print) Current Mailing Address: See Attached Telephone Signature 2.2 Authorized Agent: Adam Glenn 235 Essex Street, Whitman, MA 02382 Name(Print) %2} Current Mailing Address: C 781-205-4484 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $ 3,926.64 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee4;. 4. Mechanical(HVAC) 5. Fire Protection 6. Total = (1 +2+3+4+5) $ 3,926.64 Check Number /,3(,/y� This Section For Official Use Only 4a),"1 "-"6 Date Building Permit Number: Issued: Signature: f7__(/1! 1 3-202 y Building Commissioner/Inspector of Buildings Date wxpermitting @ homeworksenergy.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder:Adam Glenn 106148 License Number 235 Essex Street, Whitman, MA 02382 07/30/2024 Addre Expiration Date 781-205-4484 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ HomeWorks Energy 181138 Company Name Registration Number 235 Essex Street, Whitman, MA 02382 03/02/2025 Address Expiration Date g r,(n coe _ Telephone 781-205-4484 SECTION 5-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes n No ❑ Brief Description of Proposed Work Residential weatherization/ Air sealing. No structural changes. SITE ID 814675 l Adam Glenn , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Adam Glenn _ Print Name 12.26.23 Signature of Owner/Agent Date l Vincent Tumal , as Owner of the subject property hereby authorize HomeWorks Energy to act on my behalf, in all matters relative to work authorized by this building permit application. See Attached 12.26.23 Signature of Owner Date City of Northampton SNS Massachusetts „� �._ 'e } DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building 0! Qs� --�' Northampton, MA 01060 f� •.• `�0 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes.Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization,conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC, that entity must he registered Type of Work:Weatherization Est.Cost:$ 3,926.64 Address of Work:36 Mary Jane Lane Date of Permit Application: 12.26.23 I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): Job under$1,000.00 _Owner obtaining own permit(explain): Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: 12.26.23 Adam Glenn 181138 Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton trj Massachusetts i 1$,\ .Lit: DEPARTMENT OF BUILDING INSPECTIONS A �► 212 Main Street •Municipal Building '--� Northampton, MA 01060 Debris Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from construction work being performed at: 36 Mary Jane Lane (Please print house number and street name) Is to be disposed of at: McNamara Waste Services LLC, 24 E Longmeadow Rd, Hampden, MA 01036 (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) CalW ) �/J o,��v+� 12.26.23 Signature of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. City of Northampton r ; � �- Massachusetts lOr r 4 DEPARTMENT OF BUILDING INSPECTIONSC i- // .► . 1 212 Main Street • Municipal Building f r Northampton, MA 01060 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 36 Mary Jane Lane Contractor Name: HomeWorks Energy Address: 235 Essex Street City, State: Whitman, MA 02382 Phone: 781-205-4484 Property Owner Name: Vincent Tumal Address: 36 Mary Jane Lane City, State: Adam Glenn (contractor) attest and affirm that the building I intend to insulate does not have any open air (knob and tube) wiring in the spaces to be insulated and that I have provided the property owner with a copy of this affidavit. Contractor signature 64A Date 12.26.23 The Commonwealth of Massachusetts Department of Industrial Accidents ='.`'—I —At--,� Office of Investigations =��= ' Lafayette City Center = __ :/ 2Avenue de Lafayette, Boston,MA 02111-1750 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): HomeWorks Energy Address:235 Essex Street City/State/Zip: Whitman, MA 02382 Phone#: 781-205-4484 Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 500+ 4. 0 I am a general contractor and 1 6 ❑New construction employees (full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. ElRemodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have g. ❑ Demolition workingfor me in anycapacity. employees and have workers' P h' $ 9. ❑ Building addition [No workers' comp. insurance comp. insurance. 10.0 Electrical repairs or additions required.] 5. El We are a corporation and its 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no Weatherization employees. [No workers' l 3.11 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Federated Mutual Insurance Company Policy#or Self-ins. Lic. #:#1847910 Expiration Date: 1/1/2024 Job Site Address: 36 Mary Jane Lane 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 undd^r the pains and pees ofperjury that the information provided above is true and correct. ,��1 Signature: �'el" �� Date: 12.26.23 Phone#: 781-205-4484 _ Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (check one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: , .i ne commonweaun of wlassacnuseaas Department of Industrial Accidents 9 Office of Investigations Lafayette City Center t 2 Avenue de Lafayette, Boston, MA 02111-1750 '=^� � www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Homeworks Energy Address: 235 Essex Street City/State/Zip:Whitman, MA 02382 Phone #: 508-644-8197 Are you an employer? Check the appropriate box: Type of project (required): 1. ■❑ I am a employer with 500+ 4. ❑ I am a general contractor and I 6. New construction employees (full and/or part-time).* have hired the sub-contractors 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 9. ❑ Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no Weatherization employees. [No workers' 13.111 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :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: New Hampshire Employers Insurance Company Policy#or Self-ins. Lic. #: ECC-600-4001157-2024A Expiration Date: 1/1/2025 Job Site Address: 36 Mary Jane Lane City/State/Zip:Northampton, MA 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 pekes of perjury that the information provided above is true and correct. Signature: C Date: 1.3.23 Phone#: 781-205-4516 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): 10Board of Health 20 Building Department 3❑City/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.❑Other Contact Person: Phone#: HOMEENE-03 LLARIVIERE AC J Rt CERTIFICATE OF LIABILITY INSURANCE DATE D/YYYY) �-f' � 1 1/2/2/2/2024 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 Lisa Lariviere NAME: Foster Sullivan Insurance Group PHONE FAX 163 Main Street (ac,No,E=t): (978) 686-2266 301 (A/C,No): North Andover, MA 01845 WA certificates@fostersullivangroup.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Kinsale Insurance Company 38920 INSURED INSURER B:The Commerce Insurance Company 34754 Homeworks Energy,Inc INSURER c:Everspan Indemnity Insurance Company 16882 101 Station Landing Suite 110 INSURER D:New Hampshire Employers Insurance Compan 13083 Medford,MA 02155 INSURER E:StarStone Specialty Insurance Company 44776 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 (MM/DDIYYYYI (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 0100275489 1/1/2024 1/1/2025 DAMMISEAGETOEaRENoccuTEDrrence) $ 300,000 PRES( MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2'000'000 POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ ANY AUTO TBD 1/1/2024 1/1/2025 BODILY INJURY(Per person) $ OWNED X SCHEDULED AUTOS ONLY _ AUTOS BODILY INJURY(Per accident) $ X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ C UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 X EXCESS LIAB CLAIMS-MADE BR1EII-000045-00 1/1/2024 1/1/2025 AGGREGATE $ 1,000,000 DED X RETENTION$ 0 $ D WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N ECC-600-40 0 1 1 5 7-2024A 1/1/2024 1/1/2025 1,000,000 'ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER end Rory in BE EXCLUDED? N/A 1,000,000 E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ E Pollution U82192240AEM 1/1/2024 1/1/2025 $25k Deductible 1,000,000 A Umbrella-GL Only 0100275711-0 1/1/2024 1/1/2025 Per Occurrence 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence Only CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Homeworks EnergyInc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 101 Station Landing Ste 110 Medford,MA 02155 AUTHORIZED� REPRESENTATIVE - ` ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD HomeWorks Energy EVERS-URCE Home Performance Contractor 101 Station Landing,Medford,MA 02155 CONTRACT - AUDIT 781-305-3319 CUSTOMER PHONE DATE CLIENT* WORK ORDER Vincent Tumal (413)586-0811 12/22/2023 814675 60001 SERVICE STREET &LLINO STREET PROPOSED BY: 36 Mary Jane Lane 36 Mary Jane Ln HomeWorks Energy SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Florence, MA 01062 Florence,MA 01062 Page 1 DESCRIPTION QTY COST INCENTIVE TOTAL EXTERIOR DOOR WEATHER STRIPPING(NO ASHRS) 1 $36.32 $36.32 Provide labor and materials to install Q-lon weatherstripping to door(s)to restrict air leakage. DOOR SWEEP(NO ASHRS) 1 $29.66 $29.66 Provide labor and materials to install a doorsweep to restrict air leakage. DAMMING 30 $83.40 $62.55 $20.85 Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass batts for damming purposes. ATTIC FLOOR OPEN BLOW CELLULOSE 13" 958 $2,548.28 $1,911.21 $637.07 Provide labor and materials to install a 13"layer of R-45 Class I Cellulose to open attic space. ATTIC FLOOR OPEN BLOW CELLULOSE 7" 370 $762.20 $571.65 $190.55 Provide labor and materials to install a 7"layer of R-26 Class I Cellulose to open attic space. RECESSED LIGHT ENCLOSURE NO INCENTIVE 1 $56.89 $0.00 $56.89 Install recessed light covers over existing recessed light fixtures. PROPAVENT 2'OR 4' 52 $243.36 $182.52 $60.84 Provide labor and materials to install ventilation chutes in the rafter bays to maintain air flow. 1.A„e,5k3 (2/203 HomeWorks Energy EVERScURCE Home Performance Contractor 101 Station Landing,Medford,MA 02155 CONTRACT - AUDIT 781-305-3319 CUSTOMER PHONE DATE CLIENT H WORK ORDER Vincent Tumal (413)586-0811 12/22/2023 814675 60001 SERVICE STREET BIWNG STREET PROPOSED BY. 36 Mary Jane Lane 36 Mary Jane Ln HomeWorks Energy SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Florence, MA 01062 Florence,MA 01062 Page 2 DESCRIPTION QTY COST INCENTIVE TOTAL VENT BATH FAN TO ROOF OR OTHER 1 $166.53 $124.90 $41.63 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. jg w ,6a, P/461121P7 Total: $3,926.64 Program Incentive: $2,918.81 Customer Total: $1,007.83 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***One Thousand Seven &83/100 Dollars $1,007.83 COMPANY REPRESENTATIVE CUSTOMER SIGNATURE NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE SIGN DATE 30 DAYS. Insulation/Air Sealing Permit Authorization Specialist: Michael Hathaway Company: HomeWorks Energy Email: michael.hathaway@homeworksenergy. Address: 101 Station Landing Cell: 4135882467 Medford,Ma 02155 Phone: 781.305.3319 Customer: Vincent Tumal Address: 36 Mary Jane Lane Email: gramma2mal@gmail.com Northampton, MA,01062 Site ID: 814675 Phone: 4135860811 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 Home Works Energy that an inspection is necessary with instructions on how to complete this process to close out your permit. Email: gramma2mal@gmail.com Customer Signature: Date: 12/22/2023 incept mal For Condo Owne : 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. J PLAN VIEW 3Name: V itk.C-eAr{ ri,. Site ID: { L v, j Finished Sq. Ft: l t it_ r o Phone: C,U:\cc lJ 6 S-1 f Year of House: R i, . Electric Acct#: a Address: -, 4, }.i',w y T. i;r\ #of Floors: 1 Gas Acct#:W II ( /! 1./4,r< -IL.i-p-Lti L a;4` 4' #Occupants: ' Housing Type? =` "L DUCTWORK INSPECTION Ducts insulated?C1 Duct Linear Ft. Duct Square Ft. 4uct Air Sealing Hours /A ►uct Insulation 6 L. Cif 9uct Insulation Removal7.1 j v BASEMENT INSPECTION t 40 le Existing Spec'ing h/Sq. Ft. 1`�(A �{ cr Bsmt Wall AG Crawl Ceiling Crawl Rim Joist Bsmt R1 w/Sill Bsmt RI NO Sill Vapor Barrier sqft. Bsmt Door Y/ Blower Door? WALLS &GARAGE Drill Location? Siding Ceil.Height Existing Spec'ing Sq. Ft. Framing Exterior Wall 1 x x galloon/Platform Exterior Wall 2 x x oon/Platform Overhang x Garage Wall x x Balloon/Platform ' Garage Ceiling i x x a 0 W i-- .2 x o ti im L It t El/ 1( 4,...edel.„/ i Cç / '`) ' InsunR oval ✓ S�f Sweeps: ( WX Stripping: f i WORK SPEC'D BUT NOT CONTRACTED R IAD BLOCKS PRESENT? NDATORY) Attic Basernent/Crawlspace Other: K&T Y f;N 4oisture Y/ mbustion Shy Y/ Kneewall Overhang/Garage Asbestos Y N Mold>100 sq. ft Y/N O Detector Missing Y / Ductwork Exterior Walls Vermiculite Y N Structl Concerns Y ,N Other: Notes for Lead Vendor/Work Not Contracted: KW WALL AND KW FLOOR Blind Spec? 0 'e OR ----; KW SLOPE AND GABLE END Blind Spec? 0 hy? Why? FRAMING EXISTII.4 SPEy'INC1 SQ.FT FRAMING _EXISTING SPEC'ING SQ.FT. ALL X X j SLOPE X X / o FLOOR X X �f/ GABLE X X ,j •CCESS X \ TRANS X X RAMS x X ATTIC ie r Th- .•TTIC SLOPE x X C-i? 'LOPE x x EXISTING VENTING? f ;" 'XISTING VENTING EXISTING PIPES? Y/ :r KW Venting Vent de BF Nose tDammuK Sheathing Access Temp Access W/ K venting 'Vert BF Temp AoCea f. )c p-tk--- . ..„---- .\k. 14 ociss-tif ( 1 -t- / Cr) J .:, 0 r,.40_,1/4„Li.__ -_,,, '3 6)(-7 } 0 ty....) rYis --.0 D- ),..-\,.. rc ce,k-.0-xi , 0).___ , F t& Ur r�^X l b�7 .2-jtkl /.7...--- ,..liki----- Ve-r1,1,— v—t, >s-- qS-8 91 Insulated Wa i X X Reed Light 0 Ins.Hose[lien BE N Chim.®Dammin1 12"Rod V 17RV Air Handler Term Access T❑Pull Down HetcAJ Was Hattie "/ Door;/ I. I1oW Vent BAS Vol: x .0058 • 4 19(1 story) j—X j,X ATTIC 1 Blind Spec? Cl x x ATTIC 2 Blind fSq a ❑ X(2s.4(2 posy) - ExistingS ec'i Sq ft13.613uorv1 P Existing SpeCin ft Muir 1)Lers Unfloored— Z`I F -l t 'l I (b Unfloored russet Crosse. me Floored �( � t1 a Floored _ wonetAkrlation Dint Work Cath Slope Cath Slope >a "' None /// ! Air SealingHours Wads �/ _ Walls Access p •4 Access`� Venting Prop nts Vent BF BF Hose Damming Venting opavents Wilt BF OF Hose`Damming /� /' / WHF Box: L/{ / } 5-� t, / '5 U 'c Temp Access: ina Sheathing Access: - - R.L.Covers:L Sq.Pt/300- (UHL HU Venting)- (Needed So.Et/300 - (Exist.NPA Vennngl= (Needed j Existing Venting? "`A Venting) Existing Venting? MA Venting) Roof Type: !' l