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35-138 (7) BP-2024-0013 40 WESTWOOD TERR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 35-138-001 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-2024-0013 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2024 Contractor: License: Est. Cost: 4000 HOMEWORKS ENERGY INC 106148 Const.Class: Exp.Date: 07/30/2024 Use Group: Owner: M FORRETT DONALD J&AGNES Lot Size (sq.ft.) Zoning: WSP Applicant: HOMEWORKS ENERGY INC Applicant Address Phone: Insurance: 235 ESSEX ST 781-205-4484 1847910 WHITMAN, MA 02382 ISSUED ON: 01/05/2024 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: Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner FEE: $65.00 Please' ,lmit to WXPermitting©homeworksenergy.com City of Northampton ✓44y JFOR ` Building DepartmeR, 4 , 212 Main Street tiT op ` �Q f Room 100 "-°:9rti°^,/o pysuLATioN C. Northampton, MA 01060 .' A ,^/ro _ phone 413 587 1240 Fax 413 587 1272 , ,oNs ' ONLY ___ ., •„.„. APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INSULATION PERMIT 1.1 Property Address: This section to be completed by office ■ Map Lot Unit 1.. 0 eStwoo Zone Overlay District Elm St. District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Donald Forrett 40 Westwood Terrace Name(Print) Current Mailing Address: See Attached Telephone Signature 2.2 Authorized Agent: Adam Glenn 235 Essex Street, Whitman, MA 02382 Name(Print) Current Mailing Address: / ..c )e, `a-() 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 4000 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3 Plumbing Building Permit Fee i-Iy,- 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 +2+3+4+ 5) 4000 Check Number I !, 7 This Section For Official Use Only ,. �, .. 1 1� Date Building Permit Number: / Issued: Signature: ____,Z42 J- 5 7-0 Z'•-j 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 Add TA �// Expiration Date 781-205-4484 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable 0 HomeWorks Energy 181138 Company Name Registration Number 235 Essex Street, Whitman, MA 02382 03/02/2025 Address Expiration Date JI2A , d 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 I r l No 0 Brief Description of Proposed Work Residential weatherization/ Air sealing. No structural changes. SITE ID I, 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 (Ala.n l/ ` 12/28/2023 Signature of Owner/Agent Date Donald Forrett , 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 12/28/2023 Signature of Owner Date City of Northampton Massachusetts , DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building �_ Northampton, MA 01060 jsPi\. .t.-,\\ AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered. Type of Work:Weatherization Est. Cost:4000 Address of Work:40 Westwood Terrace Date of Permit Application: 12/28/2023 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: 12/28/2023 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 r••-s y S�s, Massachusetts �2 A. --�.1 ;i DEPARTMENT OF BUILDING INSPECTIONS ? j 212 Main Street •Municipal Building rva ^D� �v Northampton, MA 01060 's1�W 3,.)‘'\'` r-• 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: 40 Westwood Terrace (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) C",44 ,,g;e:ard 12/28/2023 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. oats M - City of Northampton __ Ns Massachusetts ��+ & * c w t N •� DEPARTMENT OF BUILDING INSPECTIONS s I' 212 Main Street • Municipal Building J D/j f 3'7 `���` .=.P Northampton, MA 01060 IW ‘ MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 40 Westwood Terrace Contractor Name: HomeWorks Energy Address: 235 Essex Street City, State: Whitman, MA 02382 Phone: 781-205-4484 Property Owner Name: Donald Forrett Address: 40 Westwood Terrace City, State: Northampton MA 01062 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 ,,,.. v c u-A___ Date 12/28/2023 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Lafayette City Center 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#: 781-205-4484 Are you an employer?Check the appropriate box: Type of project(required): 1.111 I am a employer with 500+ 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ['New construction listed on the attached sheet. 7. ❑ Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance. 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.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no Weatherization employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Federated Mutual Insurance Company Policy#or Self-ins. Lic. #:#1847910 Expiration Date: 1/1/2024 Job Site Address: 40 Westwood Terrace City/State/Zip:Northampton 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 pains and pe lies of perjury that the information provided above is true and correct. Signature: Date: 12/28/2023 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#: -----'-"" HOMEENE-03 LLARIVIERE CORGP CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDYYYY) �' 1/2/2024 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,Ext): (978) 686-2266 301 I FAX (A/c,No): 163 Main Street North Andover, MA 01845 E-MAIL certificates fostersullivan rou com ADDRESS: g P• 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 W POLICY NUMBER D/POLICY EFF POLICY EXP LIMITS LTR, INSD VD (MM/DD/YYYYI (MM/DYYYY! A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 0100275489 1/1/2024 1/1/2025 DAMMISEAGE S TOEa RENTEDoccurrence $ 300,000 PRE ( ) 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 PRO- LOC 2,000,000 JECT PRODUCTS $ 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 SCHEDULED _ AUTOS ONLY X 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- ANDEMPLOYERS'LIABILITY Y/N ECC-600-4001157-2024A 1/1/2024 1/1/2025 STATUTE ER 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 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 $ 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 I I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORO CERTIFICATE OF LIABILITY INSURANCE DATE 022 12l30/L022 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 PHONE NAME: CLIENT CONTACT CENTER HOME OFFICE:P.O.BOX 328 INC,No,Roll:888-333-4949 FAX No):507-446-4664 OWATONNA,MN 55060 E-MAIL CUENTCONTACTCENT AFEDINS.COM INSURER(S)AFFO INO COVERAGE NAIC# INSURER A:FEDERATED MUT L INSURANCE COMPANY 13935 INSURED 419-899.0 INSURER It HOMEWORKS ENERGY,INC. INSURERC 101 STATION LNDG - - MEDFORD,MA 02155-5134 INSURER Cr • 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 CONTR T OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES SCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAM S. INSR TYPE OF INSURANCE ADOL SUER POLICY NUMBER POLICY FF POLICY EXP LIMITS LTRINSR,WVD, IMM/D IMMIDDIYYYYI X COMMERCIAL GENERAL� ��UABIUTY EACH OCCURRENCE $1,000,000 CLAMS-MADE J[I OCCUR DAMAGE :Ea emir-rental $1�'� �� MED EXP(Any one person) EXCLUDED A N N 1847909 1/01/2023 01/01/2024 PERSONALS ADVINJURY $1,000,000 frf M'L AGGREQME UMIT APPUES PER. OENERALADOREOATE $2,000,000 X POLICYJECT PRO- LOC PRODUCTS-COMP/OP AGO $2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 acclasnO X ANY AUTO d r BODILY INJURY(Par parson) SC A OWNED AUTOS ONLY AUMOSULED N N 1847908 01/01/2023 01/01/2024 BODILY INJURY(Par ecdMnO HIRED AUTOS ONLY NON-OWNED / PROPERTY DAMAGE AUTOS ONLY (Par accident) X UMBRELLA UAB X OCCUR EACH OCCURRENCE $1,000,000 A EXCESS UAB CLAIMS-MADE N N 1847 1 01/01/2023 01/01/2024 AGGREGATE $1,000,000 DED I !RETENTION 5ORKERS COMPENSATION X PER STATUTE OTH- ER AND EMPLOYERS'LIABILITY Y/N �sI1r� ANY PROPRIETORIPARTNERIEXECIITIVE E.L EACH ACCIDENT $J00,000 A OFP10ER/MEMBER EXCLUDED? NIA N 1847910 01/01/2023 01/01/2024 - (Mandatory In NHl E.L.DISEASE-EA EMPLOYEE $500,000 If yes.describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT ��,0Q0 DESCRIPTION Of OPERATIONS I LOCATIONS I VEHICLES(AC D 101,Additional Remarks Schedllle.may be atYched it more spate is required) THIS COPY IS NOT TO BE REPRODUCED F 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 ITN EACH OF YOUR CERTIFICATE ACCORDANCE WITH THE POUCY PROVISIONS. HOLDERS. AUTHORIZED REPRESENTATIVE CO 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Construction Supervisor Specialty Rest rct ed tc CSSL-IC • nsUkitrun Cont actor ADAM GLENN 19 CHANGE POUND RD WAREHAM MA 02571 •,`'r (allure topossess a current edition of the Massachusetts i State Etuild ng Code is cause forrevocation of this lcense- For information about this license Call iS17) 727-3200or visit www rnass.gov+dp THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation Registration: 181138 HOME WORKS ENERGY, INC. Expiration: 03/02/2025 101 STATION LANDING STE 110 MEDFORD, MA 02155 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. A N 101 S 101 STATION LANDING STE 110 MEDFORD,MA 02155 Undersecretary Not valid without signature Insulation/Air Sealing Permit Authorization Specialist: Jasmin Vasquez Company: Email: Jasmin.Vasquez@HomeworksEnergy.cc Address: 101 Station Landing Medford, Ma 02155 Phone: 781.305.3319 Property Owner Donald Forrett Address: 40 Westwood Terrace Email: sgf318@yahoo.com Northampton MA 01062 Site ID: CAP-6192 Phone: (413)588-2326 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: Customer D6`/Zet-he Pe Signature: Date: 12/19/2023 Donald Forrett For Condo Owners: If you have property oversight by a condo association , please have the association's authorized person(s)complete and sign the section below. Please email this document to once completed. We, being the duly authorized representatives of the association Name of association or management company 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 0 ther unit owners may sign when there is no association. S )c 31co eThoo.Corn 12 .`cA.23 1\34:\ PLAN VIEW Name: DDi1CGI 1 on e-l;i Site ID: n - i91 CAZ, Finished Sq. Ft: ___440111 Phone: 413. 5176 • 7 3h 1 Year of House: 55 Electric Acct#: 1 W Address: 41 -1`A od je fr #of Floors: Gas Acct#: EVR, F- `UUAIrlo N C\Q U`,t;;Plit#: #Occupants: Housing Type? fartipaLkk DUCTWORK INSPECTION Ducts Insulated?I]• Duct Linear Ft. 70 Duct Square Ft. _.. — bucl- \ , �o0�.......1Dud Air SealingHours `k hrw Duct Insulation co Duct Insulation Removal tg m BASEMENT INSPECTION C� ��r��' b Existing Spec'ing Ln/Sq, Ft. (vim D ri Bsmt Wall AG Crawl Ceiling Crawl Rim Joist �," Bsmt RJ w/Sill - `l Bsmt RI NO Sill \ �� •por Barrier] sgft. Bsmt Door' c' Blower Door? WALLS&GARAGE Drill Location?L'N! .. Siding Cell.�Heihtht Existing Spec'ing Sq.Ft. Framing _ Exterior Wall l N1,n " 0 .t_� I tip;\'•�h `_' ;.7k k ,.._..,7:- Z x )t i Balloo Platform Exterior Wall 2 '�' -- --'•- - -�-_� .- x x Balloon/Platform Overhang ram x x Garage Wall 1 I �* x x Balloon/Platform Garage Ceiling t 1 i_-.__.. _, i x x c W OJ W } 1 l L ' ! , .., Insulation Removal 0 (` ` Sgft. 2_ . `+'►: �I1f9 4, .,_ Sweeps:, WX Stripping:`, WORK SPEC'D BUT NOT CONTRACTED OAD BLOCKS PRESENTJ{,MANDATORY) Attic (Basement/Crawlspace Other: ' K&T Y(W Moisture Y t::Combustion Sfty X Kneewail Overhang/Garage Asbestos Y N Mold>100 sq. ft YCO Detector Missing /N+ Ductwork Exterior Walls Vermiculite Y([N Structl Concerns Y rN,Other: Notes for Lead Vendor/Work Not Contracted: ``t`r \ { BA �1 '�1„-0 16. KW WALL AND KW FLOOR Blind Spec? ❑ OR - KW SLOPE AND GABLE END Blind Spec? ❑ Why �� �1L 1._ a �"""" � � G SPEC'INGWALL 111111111114SCL FT. FLOOR ) \I .WA/ ■ GABLE ACCESS x =—= \ ® x x -_ ATTIC Mil ''.. ? SLOPE_,—, ATTIC SLOPE x X A MINI n S? V/N IOW It: EXISTING VENTING? EXISTING pi? Temp Acce! KNEEWAtI MANDATORY .. 0 0 E ...,. ,.:, , z. 1 1 Ei . c - ... c { Y ,. a... ) `. L G '\ \ U. ' —,,fle\0\_),L\\,(1._ kOk C,\ L21-) rn Inh11""oof y(yr�® ®Vol: x .0058 4.,wee,, X X 9tb., , ■u NA r/0© w.,rr Tv c1Ym.cc .../DO $ rbm SM N�✓1 a.wwe,, um Aaoe c a po.r �sHata E) war wrrn'/ ooa•/ S1 1911 ttC4Y ` Z.X 31 ATTIC 1 Blind Specs �' x ATTIC 2 Blind Spec? ❑ I X I13.e13gont� `191 17 m) Sq ft Existing Spec ing Sq ft ond Exi/stinf Spec'Ing Multipliers Unfloored \S ti/SaL.. 'UJnftoored r""" her d1ti°6 Floored Mixed insulation Due Wer4 Floored >6" • e "One Cath Slope Cath Slope Air Sealing Hours Watts Walls ,,,' Access Access }C.__. Venting Prevents tint OF BF Hose Down Venting g Pr t F, 1 Ddtnnsin WHF Box:r" c lamp Aecs6g +' ji ; Sheathing Recess: �'°` Roof Type: f'�,+ { sv k/3W_ •__1[eu1.qM*WAWA peseese _Sa W 300+_._-_.. __.__.._11A,t.WA Veecwd' O YeMfMi l 1 Existing Venting? NM 163,ttt11 Existing Venting?2)( g\ti ... f♦ .A HomeWorks Energy,Inc. 101 Station Landing,Suite 110 �A� Medford MA HomeWorks Single Family Home:Donald Forrett,40 Westwood Terrace,Northampton MA 01062 d2liTeelba T 2 85 Per 4.y $ 170.00 Mw Due Testing wkll Zonal PWree-Pre ILPast I 71 N $ 71.03 �wedryawmRal reldwrt DIRK 1 152 N $ 152.00 DeemRkwowrtppewnp 1 4.58 Inn $ 4.58 WwgwWIew/QlwaegdYYaIR _ 2 76 N $ 152.00 PIM1we4Rlpleawpe _ _ 2 27 N $ 54.03 Sod duds with male abgA Wood tips 1 105 hr $ 420.00 Weed dePloafWMeloololb/waabyl peer peep Widow atsepident 660 3.52 spin $ 2,323.20 TOTAL $ 3,346.78 This partnership is made possible by the Lead Vendor Integration Program through MASSCAP.