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36-280 (5) 15 WOODS RD BP-2020-0901 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36-280 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING i ER • _I1 Permit# BP-2020-0901 Proiect# JS-2020-001536 Est.Cost: $3100.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: HOMEWORKS ENERGY INC103832 Lot Size(sa.ft.): 30274.20 Owner: WEIR ROBERT E Zoning: Applicant. HOMEWORKS ENERGY INC AT. 15 WOODS RD Applicant Address: Phone: Insurance: 101 STATION LANDING (781) 205-2595 WC MEDFORDMA02155 ISSUED ON:211012020 0:00:00 TO PERFORM THE FOLLOWING WORK:INSULATION AND 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Sianature: FeeType: Date Paid: Amount: Building 2/10/2020 0:00:00 $65.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner al? City of7epa Dep Building212 t SULA TION a`:� ' t Room 10d G� - � 2020 y •r- Northampton, MA, 011S60 t°NS ONLY phone 413-587-1240 Fax 413-587- ,.� , ��r APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INS ULA TION PERMIT 1.1 Property Address2Th"s section to be completed by office Map S6 LotUnit 15 Woods Road, Northampton, MA 01062 Zone Overlay District Elm St District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 3 2.1 Owner of Record: Robert Weir 15 Woods Road, Northampton, MA 01062 Name(Print) Current Mailing Address: 4134785627 Telephone L Signature 2.2 Authorized Agent: Gary Clement 101 Station Landing, Medford, MA 02155 Name(Print) Current Mailing Address: 781-205-2595 Signat Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 3100.00 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5) Check Number ALI This Section For Official Use Only O, Date Building Permit Number: Issued: Signature: oZ� LU Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 licensed Construction Supervisor: Not Applicable ❑ Name of License Holder;Scott Veggeberg CSSL-103832 License Number 8 Covington Street, #1 , Boston, MA 02127 10/13/2021 Address Expiration Date 781-205-2595 Signature Telephone 9.Re-gistered Home Improvement Contractor: Not Applicable ❑ HomeWorks Energy Inc. 181138 Company Name Registration Number _101 Station Landing, Medford, MA 02155 03/02/2021 Address Expiration Date Telephone 781-205-2595 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....... No...... ❑ Brief Description of Proposed Work Insulation and weatherization work (no structural changes) I Gary Clement 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. Gary Clement Print Name 02/06/2020 Signatur f OwroTAgent Date ,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. Signature of Owner Date City of Northampton SSS •• SSC Massachusetts DEPARTMENT OF BUXLDING INSPECTIONS 7�. 212 Main Street • Municipal Building ti,.• c ° Northampton, MA 01060 �SViy <�� 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:Insulation and weatherization work(no structural changes) Est. Cost: 3 1 0 o_no Address of Work: 15 Woods Road Northampton MA 01062 Date of Permit Application: o 2lor)1 0 2 1 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: 02/06/2020 Gary Clement 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 `�' -�``` . • sic Massachusetts DEPARTMENT OF BUILDING INSPECTIONS ' 212 Main Street •Municipal Building Northampton, MA 01060 rst jy. �1, 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: 15 Woods Road , Northampton , MA 01062 (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) 02/06/2020 natur f 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. The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Ani licant Information Please Print Legibly Name(Business/organization/Individoal): HomeWorks Energy Inc. Address: 101 Station Landing, Suite 110 City/State/Zip: Medford, MA 02155 Phone#: 781-305-3319 Are you an employer?Check the appropriate box: Type of project(required): t.g i am a employer with 500 employees(full and/or part-time!." 7. E]New construction 2.Q t am a sole proprietor or partnership and have no employees working for me in $. E]Remodeling any capacity.INo workers'comp.insurance required.] 3.❑ 9. Demolition 1 am a homeowner doing all work myself[No workers'comp insurance required.J' ❑ 10 Building addition 4.n 1 am a homeowner and will be hiring contractors to conduct all work on my property. twill ensure that all contractors either have workers'compensation insurance or are sole 1 I.O Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.- 14.[20ther Insulation 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 152,01(4),and we have no employees.[No workers'comp.insurance required.] "Any applicant that checks box NI must also fill out the section below showing their-corkers'compensation policy information. I 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. am an employer that isproviding workers'compensation insurance for my employees. Below is the policy and fob site information. Insurance company Name: NH Employers Insurance Company Policy#or Self-ins.Lic.#: 4001017 Expiration Date: 01/01/2021 Job Site Address:rWoQds RQ@dCit /State/Zlp:a Northampton, MA 01062 _ . Failure to,secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this tement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. /do hereby certify ul ains nd p nalties of perjury t t the information provided above is true an correct Signature: Date: 02/06/2020 Phone#: 781-305-3319 Official use only. Do not w to it this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: HOMEENE-01 LLARIVIERE ACORO DATE IMM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE F12/19/2019 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 Foster Sullivan Insurance Group,LLC PHONE 978 686-2266 301 FAX 163 Main Street (A/C,No,Ext):( ) (A/C,No):(978)686-6410 North Andover,MA 01845 E-MAIL ,certificates@fostersuilivangroup.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Homeland Insurance Company NY 34452 INSURED INSURERB:Safety Indemnity Insurance Company 33618 Homeworks Energy Inc. INSURER C:NH Employers Insurance Company 13083 Homeworks IIC LLC 101 Station Landing Suite 110 INSURER D: Medford,MA 02155 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 MM/DD/YYYYIMMIDDIYYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000'000 CLAIMS-MADE FX]OCCUR 7930060650002 4/1/2019 4/1/2020 DAMAGE TO RENTED $ 500,000 PREMISES(Ea oocurrence�MED EXP(Any oneperson) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000'000 POLICY❑jE8T F—]LOC PRODUCTS-COMP/OP AGG 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO 6244378 4/1/2019 4/1/2020 BODILY INJURY Perperson) OWNED SCHEDULED AUTOS ONLY Ix AUTNOSyyNEp BODILY INJURY Per accidentX AUTOS ONLY A�TO�ONLY PFter.�Rd nl AMAGE $ P $ A UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 2'000'000 X EXCESS LIAB CLAIMS-MADE 7930060660002 4/1/2019 4/1/2020 AGGREGATE $ 2,000,000 -DEC I X I RETENTION$ 0 $ C WORKERS COMPENSATION X PERTUTE OTH- AND EMPLOYERS'LIABILITY Y/N ECC-600-4001017-2020A 1/1/2020 1/1/2021 ER 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑N N I A (Mandatory In BH) 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 I 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 Ener Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9Y ACCORDANCE WITH THE POLICY PROVISIONS. 101Station 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 Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card HOME WORKS ENERGY,INC. Registration: 181138 Expiration: 03/02/2021 101 STATION LANDING STE 110 MEDFORD,MA 02155 Update Address and Return Card. SCA 1 0 20M-05/17 .%/� `/�ii�iiiriui•sir//���.��ir��o�/iidr//� Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Suoplement Card before the expiration date. If found return to: Realstration Expiration Office of Consumer Affairs and Business Regulation 181138 03102/2021 1000 Washington Street-Suite 710 HOME WORKS ENERGY,INC. Boston,MA 02118 GARY CLEMENT \ G — 101 STATION LANDING STE 110 (� MEDFORD,MA 02155 Undersecretary of Vidid without signature I � Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constructipn-s6pe� sqr Specialty . a CSSL-103832 spires: 10/13/2021 SCOTT VEGGEBERG 8 COVINGTON ST #1 BOSTON MA 02127 Co'Mmi$sioner /L- .w Insulation/Air Sealing Permit Authorization Specialist: Adam Morrison Company: HomeWorks Energy Email: adam.morrison@homeworksener Address: 101 Station Landing HorneWorks Cell: 5133932297 Medford, Ma 02155 Phone: 781-305-3319 Customer: ROBERT WEIR Address: 15 WOODS RD. Email: weir.r@comcast.net NORTHAMPTON, MA 01062 Site ID: 3961202 Phone: (413)478-5627 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. Customer Signature: Date:Date: 1/21/2020 ROBERT WEIR PLAN VIEW r *� Name: (�� Site ID: Finished Sq. Ft: Phone: Year of House: Electric Acct#: AN res #of Floors: Gas Acct#: �tunit a: #Occupants: _ Housing Type? DUCTWORK INSPECTION Ducts Insulated?[D uct Linear Ft. uct Square Ft. lkD Duct Air Sealing Hours �n Duct Insulation Duct Insulation moval BASEMENT INSPECTION ExistingS ec'in Ln/Sq.Ft. Bsmt Wall AG 1 (� Crawl Ceilingf Crawl Rim Joist Bsmt RJ w/Sill Bsmt RJ NO Sill Vapor Barrier Bsmt Door Y N Blower Door? WALLS&GARAGE Drill Location? Siding ICeil. Height Existing S ec'ing Sq. Ft. Framing Exterior Wall 1 x x Balloon/Platform Exterior Wall 2 x x Balloon/Platform Overhang x x Garage Wall x x Ba I I oon P a orm Garage Ceiling x x E Art 1 � WORK SPEC'D BUT NOT CONTRACTED 1AAAD BLOCKS PRESENT NDATORY) Attic Basement Crawls ace I I Other: K&T Y Moisture Y N lambustion Sft KneewaII Overhan Garae Asbestos Y/ Mold>100 sq. ft Y N O Detector Missing Y/ Ductwork Exterior Walls Vermiculite Y/ Structl Concerns Y/ Other: Notes for Lead Vendor/Work Not Contracted: (� �ie KW WALL AND KW FLOOR Blind Spec? ❑ • — -- OR ----• KW SLOPE AND GABLE END Blind Spec? Why? Why? FRAMINr EXISTING SPEC'ING SO FT FRAMING EXISTING SPEC'ING .FT. WALL X 21 LOPE x x FLOOR XIO X GABLE x X ACCESS TRANS X X TRANS II ATTIC ATTIC /r h ll x l f' A;R n SLOPE x x SLOPE EXISTING VENTING? EXISTING VENTING? Q EXISTING PIPES? Y IF gVy Venan{ Veat BF Bf Rose Dam ShealhRy Auess TAm Access gW VennnB ni Bf Temp Across 3 MANDATORY t gin( F f"m S�Of3C ------------- S!o p Q � ca�s,•�td ovQc pot C. Insulated Wan X X Rer'd Light O Ins.Hose BF Vent OF BFV ChIm.QH Damming lY Roof t 12RV All Haldler AN Temp Access T J WB Down OS lurch Wall Match "/ Ooor�/ >r hoof Vent RV Vol: X .0058 1911 story) x x ATTIC 1 Blind Spec? ❑ x x ATTIC 2 Blind Spec? ❑ x(ls.a Iz story) Existing Spec'ing Sq ft Existing Spec'ing q ft 13.6(3 atony) Unfloor d cusses Cross Batting Floored Floored I" Duct�Nork >6" None Cath Slo a Cath Slope e141111 Walls Walls Access Access Venting Propavents Vent BF BF Hose Dammin ennng Pr vents V n F Hose Dammin ro m c 5 01 � a a N � Sq.Ft/30D- (Caut.NfA V.,")r_(Needed Sq F(j 300 a _Raul.NFA WnUMI•_(Needed A Vrnangl NFA VeMlns) Root Type: Existing Venting? 1 Existing Venting? Page 1 a / 0 HomeWorks mass save �n � Energy, Inc nergy, ( C PARTNER E 101 Station LandingSte 110,Medford,MA 02155 (781)305-3319 ext.120 Customer Name:Robert Weir Email:weir.r@comcast.net Phone:413-478-5627 Premise Address: 15 Woods Rd,Northampton,MA 01062 Mailing Address: 15 Woods Rd, Northampton, MA 01062 Project ID:3970701 Date:Jan.21,2020 Job Description Measure Description Location Quantity Unit Total Cost Customer Cost Air Sealing at Estimated 62.5 CFM50 Per Hour Other 8 hr $740.64 $0.00 Exterior Door Weather Stripping (with AS hrs) Other 3 each $90.21 $0.00 Bath Fan - Vent to Roof Other 1 each $141.30 $35.32 Kneewall Floor- 10" Dense Pack Cellulose Other 162 SF $518.40 $129.60 Attic Floor- 5" Open Blow Cellulose Other 760 SF $1,170.40 $292.60 Transition Air sealing Other 46 LF $314.64 $0.00 Door- 2"Thermal Barrier Polyiso Other 1 each $90.44 $22.61 Project Total $3,066.03 Weatherization incentive ($1,440.41) Total Contractor Price and Payment Schedule HomeWorks Energy, Inc. ag,ees to perform the above described work,furnishing the materia' and labor specified for the listed tota price. Payment of the balance of the customer contribution is expected upon completion of the work. Customer Signature: Date: 117-1(2-Ci Customer Phone: ' ` M c� �~ �L l_���-J Specialist Signature: Date:_ UMITEDTIME OFFER: The prices and Incentives In this contract are subject to change in accordance with the sponsoring utility MassSave Home Services Program offers. Proposals con be sent to:lnboxoa NomeWorks£nergy.corn Page 2 c p IT C HomeWorks mass save Energy, Inc PARTNER 101 Station Landing Ste 110,Medford,MA 02155 (781)305-3319 ext.120 Customer Name:Robert Weir Email:weir.r@comcast.net Phone:413-478-5627 Premise Address:15 Woods Rd,Northampton,MA 01062 Mailing Address:15 Woods Rd,Northampton,MA 01062 Project ID:3970701 Date:Jan.21,2020 Air sealing incentive ($1,145.49) Total Program Incentive -$2,585.90 Customer Total $480.13 Total Contractor Price and Payment Schedule HomeWorks Energy, Inc.agrees to perform the above described work,furnishing the material and labor specified for the listed tota price. Payment of the balance of the customer contribution is expected upon completion of the work. Customer Signature: C11�'' 1 \J� AA 02 `.� 11('� Date: L'i Customer Phone: � ^Sao II` O�tn Specialist Signature: 62=2 Date: 'IA-211,-20 UMITED TIE OFFER: The prices and Incentives in this contract are subject to change in accordance with the sponsoring utility MassSave Home Services Program offers. Proposals can be sent to:inbox@HomeWorks£nergy.com