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23A-107 (5) 137 SOUTH MAIN ST BP-2021-1433 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23A- 107 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 PERMIT Permit# BP-2021-1433 Project# JS-2021-002379 Est. Cost: $13080.00 Fee: $91.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: MATTHEW RUSSELL - 5C ENERGY 106162 Lot Size(sq.ft.): 12371.04 Owner: ROSENBLUM JEFFREY M Zoning: URB(100)/ Applicant: MATTHEW RUSSELL - 5C ENERGY AT: 137 SOUTH MAIN ST Applicant Address: Phone: Insurance: 3820 DIAMOND HILL RD (401) 651-0003 0 WC CUMBERLANDR102864 ISSUED ON:6/2/2021 0:00:00 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: 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 Signature: I ` .)2 . . if FeeType: Date Paid: Amount: Building 6/2/2021 0:00:00 $91.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner �The Commonwealth of Massach etts O Board of Building Regulations an tand ds FOR e/ Massachusetts State Building Co e, 7S) MR�/ifi • / CIPALITY _. 3 FA J USE Building Permit Application To Construct,Repair, i14 Or Dert3o<gsh a is•: Mar 2011 One- or Two-Family Dwelling ' t 0%a c c27 / D /� This Section For Official Use Only Toa�''�,�sA Building emit Number: pl'—a! /-733 Date Applied: 2'9nFors �oo'1s E'U 55 ,f,/ G- I"ZCZ) Building Official(Print Name) Signature / Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers t 7 .3., V1(�In SkYI� L 2-3 A 1o7—On\ 1.1a Is this an accepted street?yes 1. no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: JCf-F►•e�' gos -\ D urY1 F1 bY�lCQ , L 1 o(p2 Name(Print) City,State,ZIP In C.IvA-nut SL : 4t3--05-324- -3ki 5Q2-1 C gmatitCOm No.and Street Telephone *OWNER'S Email Address MUST B INCLUDED SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) ❑ Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: INSULATION Brief Description of Proposed Work': SEE CONTRACT SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $\?) L1-VCD, 1. Building Permit Fee: $ Indicate how fee is determined: I 2.Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: is,a pp Check No.37 ,Check Amount I Cash Amount: 6.Total Project Cost: $`�1 0( 08 L.-5 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 106162 04/26/2023 MATTHEW RUSSELL License Number Expiration Date Name of CSL Holder R 3820 DIAMOND HILL ROAD List CSL Type(see below) No.and Street Type Description CUMBERLAND, RI 02864 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 774-203-3704 Maryann@SCEnergyinc.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 195309 04/18/2023 MATTHEW RUSSELL I IIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 3820 DIAMOND Hu I ROAD Maryann@5CEnergyinc.com No.and Street Email address CUMBERLAND, RI 02864 774-203-3704 City/Town,State,ZIP Telephone SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes 0 No 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize MATTHEW RUSSELL to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 71): OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information con .. - n this application is true and accurate to the best of my knowledge and understanding. ' if, MATTHEW RUSSELL 5\2'11)z2,1 - Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L. c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" • DESCRIPTION OF WORK TO BE PERFORMED: USE GROUP: TYPE: t_n L)J C "1�1( Commercial: Residential: --- _ x Mined Uae: .Accessory: Maintenance: New Structure on vacant land: Change of Uric: Change of Occupancy: Addition: Alteration: Renovation: Rair: Demolition: . Type of Foundation: fl f C1 Type of of Prune:n in Wood: Manufactured; Steel: Heat 11 k Gas: Oil: Electric: Other: Style of structure: f t Q #of units: Owner Occupied: Structure#1 Dimes: Square Footage: Structure#2 Dime siou: __--- Square Footage: Structure#3 Dimensions: Square Footage: Bedrooms#: Baths#: Number of Docks:r k2 Dimensions: Square footage: Number of Porches: l j( Dimensions: Square footage: Garage: #of cars: Dimensions: Square footage: n I a Under: (}round level: Pool: Depth: Dimensions; Square footage: f\ I Heated: Above ground In ground: Shed: !11 Q Dimensions: Square footage: Detail Description: QC 1 __ Estimated Value of Project: $ % c'4'-, Official Use Only: Revised 07/2015 DocuSign Envelope ID: 18D9C590-8750-41AE-81CC-2F23110E14A1 RISE ENGINEERING" OWNER AUTHORIZATION FORM 1, Jeffrey Rosenblum (Owner's Name) owner of the property located at: 137 South Main Street (Property Address) Florence, MA 01062 (Property Address) hereby authorize Lr r(( \ 1 \v1(__ - - Subcontractor ad be'filled in by office) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. This form is only valid with a signed contract. The permit will be secured by the subcontractor, at no additional cost. It is the homeowner's responsibility to close out this permit by contacting their municipality at the completion of this work. DocuSigned by: rOSt,tnlaim Owne?'glOPi iYre 2/16/2021 1 6:16 AM PST Date RISE Engineering, a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335 www.RlSEengineering.com DocuSign Envelope ID:18D9C590-8750-41AE-81CC-2F23110E14A1 Federal ID#05-0405629 RISE Engineering RI Contractor Registration#8186 MA Contractor Registration#120979 RISE60 Shawmut,Canton,MA ENGINEERING CONTRACT - WZ (401)784-3700 FAX(401)784.3710 Page 1 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE ENGINEERING AND THE CUSTOMER FOR WORK AS CMA-HES DESCRBEDBELOW CUSTOMER PHONE DATE CLIENT I WORK ORDER Jeffrey Rosenblum (413)695-3264 02/09/2021 310451 38502 SERVICE STREET BILLING STREET PROPOSED BY: 137 South Main Street 2 Rea Daniel Diaz SERVICE CITY.STATE,zip BILLING CITY,STATE,U' Florence, MA 01062 Florence, MA 01062 DESCRIPTION QTY COST INCENTIVE TOTAL INCENTIVE: RENTERS For eligible measures, the Mass Save Program offers a renters incentive of 100%off insulation and air sealing measures.To participate in the Renter incentive,please submit a copy of the year- round rental agreement. To be eligible for the renter incentive,the utility bills must be in the tenant's name and the home must be rented on a year-round basis. KNOB&TUBE WIRING lib We have identified the potential existence of Knob&Tube wiring in ' (initials) your home.The following contract is not valid unless accompanied by the Pre-Weatherization Barrier Incentive form, signed by your licensed electrician.Work will not proceed with this work until we receive a copy of the form. ASBESTOS HAZARD A blower door diagnostic test will not be conducted at your home,due to the possible presense of asbestos. HOMESOTE CEILINGS BARRIER:Your ceilings are constructed of a lightweight cardboard composite material. These ceilings cannot support the additional weight of blown-in insulation or air sealing measures, the tiles could be dislodged due to movement of workers in the attic and cause damage to the ceiling tiles. Until you renovate these ceilings,we will only insulate with rolled out fiberglass batt insulation. This is being brought to your attention to identify it as a pre-existing condition to the weatherizatiom work planned for your home. Your signature is your acknowledgement of these conditions and agreement to proceed. INACCESSIBLE ATTIC AREA ( US We have identified an opportunity to insulate an attic area in your I J (initials) home that is not presently accessible.We are making our recommendations based upon an educated understanding of your home's construction, but upon gaining access to this space, your home's work-scope might need to be modified. Your contractor and our RISE inspector will guide these changes and discuss them with you prior to proceeding. DocuSign Envelope ID: 18D9C590-8750-41AE-81 CC-2F23110E 14A1 Federal ID#05-0405629 RISE Engineering RI Contractor Registration#8186 MA Contractor Registration#120979 RISE60 Shawmut,Canton,MA CONTRACT - WZ ENGINEERING` (401)784-3700 FAX(401)784-3710 Page 2 PROGRAM THo CONTRACT IS ENTERED INTO BETWEEN RISE ENGINEERING AND THE CUSTOMER FOR WORK AS CMA-HES DESCRIBED BELOW CUSTOMER PHONE DATE CLIENT• WORK ORDER Jeffrey Rosenblum (413)695-3264 02/09/2021 310451 38502 SERVICE STREET BILLING STREET PROPOSED BY: 137 South Main Street 2 Rea Daniel Diaz SERVICE CITY,STATE,ZIP BILLING CITY.STATE,ZIP Florence, MA 01062 Florence, MA 01062 DESCRIPTION QTY COST INCENTIVE TOTAL HOME AIR SEALING 3 $255.00 $255.00 Provide labor and materials to seal areas of your home against wasteful,excess 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.) WEATHERSTRIP AND ADD DOOR SWEEP 1 $80.00 $80.00 Provide labor and materials to install Q-lon weatherstripping and a doorsweep to door(s)to restrict air leakage. ATTIC DAMMING-R-38 FIBERGLASS 78 $159.90 $159.90 Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass batts for damming purposes. ATTIC FLAT- 12"OPEN R-42 CELLULOSE 312 $524.16 $524.16 Provide labor and materials to install a 12"layer of R-42 Class I Cellulose to open attic space. SLOPE-6"DENSE R-19 CELLULOSE 410 $799.50 $799.50 Provide labor and materials to install a 6"layer of R-19 Class I Cellulose to sloped ceiling area. VENTILATION CHUTES 41 $102.50 $102.50 Provide labor and materials to install ventilation chutes in the rafter bays to maintain air flow. VENT BATH FAN THRU ROOF 4 INCH 1 $118.75 $118.75 Provide labor and materials to install an insulated 4"exhaust hose with roof mounted flapper vent to exhaust existing bathroom fan(s). WALLS ASBESTOS SIDED 614 $1,627.10 $1,627.10 Provide labor and materials to install blown in Class I Cellulose to asbestos-sided exterior walls. Touch-up painting,if needed,will be the customer's responsibility. Homeowner has received a copy of the EPA's Renovate Right Lead-Safe information guide explaining the potential risk of the lead hazard exposure from the weatherization work to be performed.Your signature is your acknowedgement of receipt and agreement to proceed. DocuSign Envelope ID: 18D9C590-8750-41AE-81 CC-2F23110E 14A1 Federal ID#05-0405629 RISE Engineering RI Contractor Registration#8186 MA Contractor Registration#120979 RISE60 Shawmut,Canton,MA CO NTRACT CINFFRiNG - WZ (401)784-3700 FAX(401)784-3710 Page 3 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE ENGINEERING AND THE CUSTOMER FOR WORK AS CMA-HES DESCRIBED BELOW CUSTOMER PHONE DATE CLIENT I WORK ORDER Jeffrey Rosenblum (413)695-3264 02/09/2021 310451 38502 SERVICE STREET BILLING STREET PROPOSED BY. 137 South Main Street 2 Rea Daniel Diaz SERVICE CITY.STATE.ZIP BILLING CITY.STATE,ZIP Florence, MA 01062 Florence, MA 01062 DESCRIPTION QTY COST INCENTIVE TOTAL PRE-TEST WORK-SCOPE REVIEW- RISE TECHNICIAN Prior to the installation of any of the weatherization measures, your home will need to have a work-scope verification conducted by a RISE Technician,and a combustion safety test to check all the combustion appliances.This test will check the existing carbon monoxide levels in each appliance, how well the fumes exhaust out of your home, and the amount of available air-flow in your home. Total: $3,666.91 Program Incentive: $3,666.91 Customer Total: $0.00 WE AGREE HEREBY TO FURNISH SERVICES•COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF '00/ Dollars $0.00 UPON RECEIPT OF YOUR RISE ENGINEERING INVOICE,CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES.RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. l DocuSigncd by. DocuSlgncd by. 2/16/2021 I 6:16 AM PST NOTE:THIS CONTRACT MAY BE WITHDRAWN SY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE SIGN DATE 30 DAYS. ACCEPTANCE OF CONTRACT-THE ABOVE PRICES.SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE DocuSign Envelope ID: 18D9C590-8750-41AE-81CC-2F23110E14A1 RISE -, ENGINEERING- OWNER AUTHORIZATION FORM I, Jeffrey Rosenblum , (Owner's Name) owner of the property located at: 137 South Main Street (Property Address) Florence, MA 01062 (Property Address) hereby authorize ,C L \v'i , Subcontractor(to Wed in by office) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. This form is only valid with a signed contract. The permit will be secured by the subcontractor, at no additional cost. It is the homeowner's responsibility to close out this permit by contacting their municipality at the completion of this work. DocuSigncd by: �bSt,ln.lo6+ Own gSVPi re 2/16/2021 1 6:16 AM PST Date RISE Engineering, a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335 www.RISEengineering.com DocuSign Envelope ID: 18D9C590-8750-41AE-81 CC-2F23110E 14A1 Federal ID#05-0405629 RISE Engineering RI Contractor Registration#8186 MA Contractor Registration#120979 RISE 60 Shawmut,Canton,MA ENGINEERING- CONTRACT - WZ (401)784-3700 FAX(401)784-3710 Page 1 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE ENGINEERING AND THE CUSTOMER FOR WORK AS C MA-HES DESCRIBED BELOW CUSTOMER PHONE DATE CLIENT N WORK ORDER Jeffrey Rosenblum (413)695-3264 02/09/2021 310450 38502 SERVICE STREET BILLING STREET PROPOSED BY: 137 South Main Street 2 Fro Daniel Diaz SERVICE CITY.STATE,ZIP BILLING CITY,STATE,ZIP Florence, MA 01062 Florence, MA 01062 DESCRIPTION QTY COST INCENTIVE TOTAL INCENTIVE: RENTERS For eligible measures,the Mass Save Program offers a renters incentive of 100%off insulation and air sealing measures.To participate in the Renter incentive, please submit a copy of the year- round rental agreement. To be eligible for the renter incentive,the utility bills must be in the tenant's name and the home must be rented on a year-round basis. KNOB&TUBE WIRING We have identified the potential existence of Knob&Tube wiring in J (initials) your home. The following contract is not valid unless accompanied by the Pre-Weatherization Barrier Incentive form, signed by your licensed electrician.Work will not proceed with this work until we receive a copy of the form. ASBESTOS HAZARD A blower door diagnostic test will not be conducted at your home,due to the possible presense of asbestos. HOMESOTE CEILINGS BARRIER: Your ceilings are constructed of a lightweight cardboard composite material. These ceilings cannot support the additional weight of blown-in insulation or air sealing measures, the tiles could be dislodged due to movement of workers in the attic and cause damage to the ceiling tiles. Until you renovate these ceilings,we will only insulate with rolled out fiberglass batt insulation. This is being brought to your attention to identify it as a pre-existing condition to the weatherizatiom work planned for your home. Your signature is your acknowledgement of these conditions and agreement to proceed. INACCESSIBLE ATTIC AREA Us We have identified an opportunity to insulate an attic area in your J (initials) home that is not presently accessible.We are making our �-- recommendations based upon an educated understanding of your home's construction, but upon gaining access to this space, your home's work-scope might need to be modified. Your contractor and our RISE inspector will guide these changes and discuss them with you prior to proceeding. DocuSign Envelope ID: 18D9C590-8750-41AE-81CC-2F23110E14A1 Federal ID#05-0405629 RISE Engineering RI Contractor Registration#8186 MA Contractor Registration#120979 RISE60 Shawmut,Canton,MA CONTRACT - WZ ENGINEERING C (401)784-3700 FAX(401)784-3710 Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE ENGINEERING AND THE CUSTOMER FOR WORK AS CMA-HES DESCRMED BELOW CUSTOMER PHONE DATE CLENT I WORK ORDER Jeffrey Rosenblum (413)695-3264 02/09/2021 310450 38502 SERVICE STREET BILLING STREET PROPOSED BY: 137 South Main Street 2 Fro Daniel Diaz SERVICE CRY,STATE,ZIP BILLING CITY,STATE,ZIP Florence, MA 01062 Florence, MA 01062 DESCRIPTION QTY COST INCENTIVE TOTAL HOME AIR SEALING 3 $255.00 $255.00 Provide labor and materials to seal areas of your home against wasteful,excess 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.) WEATHERSTRIP AND ADD DOOR SWEEP 1 $80.00 $80.00 Provide labor and materials to install Q-Ion weatherstripping and a doorsweep to door(s)to restrict air leakage. ATTIC DAMMING-R-38 FIBERGLASS 90 $184.50 $184.50 Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass batts for damming purposes. ATTIC FLAT- 12"OPEN R-42 CELLULOSE 290 $487.20 $487.20 Provide labor and materials to install a 12"layer of R-42 Class I Cellulose to open attic space. SLOPE-6"DENSE R-19 CELLULOSE 215 $419.25 $419.25 Provide labor and materials to install a 6"layer of R-19 Class I Cellulose to sloped ceiling area. ATTIC HATCH-SEAL& INSULATE 1 $60.00 $60.00 Provide labor and materials to insulate the back of an attic hatch with 2"rigid insulation board.Weatherstrip the perimeter. VENTILATION CHUTES 29 $72.50 $72.50 Provide labor and materials to install ventilation chutes in the rafter bays to maintain air flow. INSULATED BATH EXHAUST HOSE 4 INCH 1 $60.00 $60.00 Provide labor and materials to install an insulated 4"exhaust hose to existing bathroom fan(s). WALLS ASBESTOS SIDED 391 $1,036.15 $1,036.15 Provide labor and materials to install blown in Class I Cellulose to asbestos-sided exterior walls. Touch-up painting,if needed,will be the customers responsibility. Homeowner has received a copy of the EPA's Renovate Right Lead-Safe information guide explaining the potential risk of the lead hazard exposure from the weatherization work to be performed.Your signature is your acknowedgement of receipt and agreement to proceed. DocuSign Envelope ID: 18D9C590-8750-41AE-81CC-2F23110E14A1 Federal ID#05-0405629 RISE Engineering RI Contractor Registration#8186 MA Contractor Registration#120979 RISE60 Shawmut,Canton,MA ENvINEERING CONTRACT - WZ (401)784-3700 FAX(401)784-3710 Page 3 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE ENGINEERING AND THE CUSTOMER FOR WORK AS CMA-HES DESCRIBED BELOW CUSTOMER PHONE DATE CLIENT 0 WORK ORDER Jeffrey Rosenblum (413)695-3264 02/09/2021 310450 38502 SERVICE STREET BILLING STREET PROPOSED BY: 137 South Main Street 2 Fro • Daniel Diaz SERVICE CITY,STATE,ZIP BILLING CITY.STATE.ZIP Florence, MA 01062 Florence, MA 01062 DESCRIPTION QTY COST INCENTIVE TOTAL PRE-TEST WORK-SCOPE REVIEW-RISE TECHNICIAN Prior to the installation of any of the weatherization measures, your home will need to have a work-scope verification conducted by a RISE Technician, and a combustion safety test to check all the combustion appliances.This test will check the existing carbon monoxide levels in each appliance, how well the fumes exhaust out of your home, and the amount of available air-flow in your home. Total: $2,654.60 Program Incentive: $2,654.60 Customer Total: $0.00 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***00f Dollars $0.00 UPON RECEIPT OF YOUR RISE ENGINEERING INVOICE.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES.RIGHTS OF RECISION.SCHEDULING.AND CONTRACTOR REGISTRATION. r—DocuSigned by. DocuSigned by. 2/16/2021 1 6:16 AM PST NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE SIGN DATE 30 DAYS. ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED,PAYMENT WILL BE MADE AS OUTLINED ABOVE Permit Authorization mass save Form Site ID: 4158713 Customer: JEFFREY ROSENBLUM 'j VArl , owner of the property located at: (Owner's Name,printed) 137 S Main St Northampton, MA 01062 (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. Owner's Signature: ' 3 t Date: I _ t/ \/`� 4 FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: !� 5\ 2 l\ Participatfng ontractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 r._� Rev.102015 CLEAResult CONTRACT CLEAResult 50 Washington Street, Customer Name:JEFFREY ROSENBLUM Westborough,MA,01581 Email:jmr5927@gmail.com Phone:413-695-3264 Premise Address:137 S Main St,Northampton,MA 01062 Mailing Address:137 S MAIN ST,Florence,MA 01062 Project ID:4176504 Date:Feb.23,2021 Applicable Customer Required Actions: Notes: • Other Customer agrees to have knob and tube signed off. Customer understand that the other units needs to sign up to qualify for the 100%incentive Job Description Contractor will perform or cause to be performed the following work on these"Premises"in a professional manner and in accordance with the terms of this Contract, including the attached recommendations/work order describing the work in detail (the"Work")which are incorporated herein by reference. Measure Description Location Quantity Unit Total Cost Customer Cost Walls-Asbestos-4"Dense Pack Cellulose 1496 SF $5,071.44 $0.00 Crawlspace Ceiling-9"Fiberglass Batting 192 SF $566.40 $0.00 Crawlspace Ceiling-2"Thermal Barrier Polyiso 192 SF $917.76 $0.00 Air Sealing at Estimated 62.5 CFM50 Per Hour 1 hr $92.58 $0.00 Door Sweep (with AS hrs) 2 each $50.62 $0.00 Exterior Door Weather Stripping(with AS hrs) 2 each $60.14 $0.00 Total: $6,758.94 Program Incentive: -$6,758.94 Weatherization Barrier Incentive: -$250.00 Customer Total: $-250.00 Payment Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows: Payment#1:$0.00 as a Deposit payable to CLEAResult upon signing the Contract(not to exceed 1/3 of the total retail costs). Mail check&contract to CLEAResult, 50 Washington Street, ,Westborough, MA, 01581. Final Payment:$-250.00 as the final payment for the Work shall be payable to the Home Performance Contractor(HPC)or Independent Installation Contractor(IIC)upon satisfactory completion of the Work.Customer understands that he/she will not be required to pay the Utility Incentive Share of the Contract price in the amount of$7,008.94. Changes to individual line items and/or previous incentives may increase or decrease the size of the Utility Incentive Share. Page 1 of 4 Dispute Resolution The IIC and Customer hereby mutually agree in advance that in the event that the IIC has a dispute concerning this Contract,the IIC may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and Customer shall be required to submit to such arbitration as provided in M.G.L.c 142A. You may cancel this agreement if it has been signed by a party at a place other than an address of the seller,provided you notify the seller in writing by ordinary mail posted,by telegram sent or by delivery.not later than midnight of the third business day following the signing of th4 agreement. DO NOT SIGN THIS CONTR T IF THERE ARE ANY BLANK SPACES. Customer gnature gnature bate Indicate your selected IIC here,if applicable Initial here if you I want the Program to assign a Participating Contractor /'iNrii Cott L( a '' ( )`� --� V r i r, ( Ci ? CLEAResuit Signature a Name of CLEAResult Representative Page 2 of 4 __ '\ The Commonwealth of Massachusetts � _ 1. Department of Industrial Accidents =E�i= 1 Congress Street,Suite 100 __ �- Boston,MA 02114-2017 96: WWW.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual):5C Energy, Inc Address:330 Victor Rd. Bldg A City/State/Zip:Attleboro, MA 02703 Phone #:774-203-3704 Are you an employer?Check the appropriate box: Type of project(required): 1.I✓ I am a employer with 30 employees(full and/or part-time).* 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]* 9. El Demolition 10 ❑ Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and T have hired the sub-contractors listed on the attached sheet. 13.❑ROOF repairs These sub-contractors have employees and have workers'comp.insurance.; 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑✓ Other Insulation 152,*1(4),and we have no employees.[No workers'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:Employers Mutual Casualty Co. Policy#or Self-ins.Lie.. #:5H98024 Expiration Date:12/27/2021 X Job Site Address: \J. 1 't Nl(,tn S e e.,b City/State/ZipJO\4 nmpf�Wlr C��OL Attach a copy of the workers'compensation policy declaration page(showing the policy number and eipiration date). 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 statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi 'u er the p ins and penalties of peijui i'that the information provided above is true and correct Signature: Date'.5121\2— l4 Phone: 774-203-3704 Official use only. Do not write in this area,to be completed by city or town of/icial. 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#: A I® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DOlYYW) 12/30/2020 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 Rosalynn Davila NAME: Loiselle Insurance Agency PHONE.Exq: (401)723-8510 I FA No): (401)728-1820 279 Dexter Street E-MAIL rosalynn@loiselleinsurance.com ADDRESS: P.O.Box 1148 INSURER(S)AFFORDING COVERAGE NAIC 0 Pawtucket RI 02862-1148 INSURER A: Employers Mutual Casualty Co 21415 INSURED INSURER B: Evanston Ins Co 35378 5C ENERGY,INC. INSURER C: 330 VICTOR RD-BUILDING A INSURER D: INSURER E: ATTLEBORO MA 02703-6294 INSURER F: COVERAGES CERTIFICATE NUMBER: Master 2020-2021 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 ADDL SUBR POLICY EFF POLICY EXP LTR INSD SWVD POLICY NUMBERPOLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE (MM/DD/YYYY) (MMIDDIYYYY) XI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE n OCCUR PREMISES(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 A 5D98024 12/27/2020 12/27/2021 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 1 POLICY PRO 2000,000 JECT LOC PRODUCTS-COMPIOP AGG $ , OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ 20,000 A OWNED X SCHEDULED 5Z98024 12/27/2020 12/27/2021 BODILY INJURY(Per accident) $ 40,000 AUTOS ONLY AUTOS X HI AURTOEDS ONLY X AUTO NON-OWNED Y SONL PROPERTY DAMAGE (Per accident) $ 5,000 Uninsured motorist BI $ 1,000,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAB —y CLAIMS-MADE 5J98024 12/27/2020 12/27/2021 AGGREGATE $ 2,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN 500,000 A ANY PROPRIETOR/PARTNER/EXECUTIVE NIA 5H98024 12/27/2020 12/27/2021 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Contractors Pollution Liability B CPLMOL103296 06/16/2020 06/16/2021 Aggregate $250,000 Each Occurrence $250,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 5C Energy,Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 330 Victor Road,Building A AUTHORIZED REPRESENTATIVE 1� „,/� Attleboro MA 02703-6294 ° 44, q _„_'La ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD � ,,.,�Xy City of Northampton `S Massachusetts ,�w. <<c ;,(// ".. DEPARTMENT OF BUILDING INSPECTIONS 7o s4 .000,,�s• 212 Main Street • Municipal Building bC` Northampton, MA 01060 Property Address: d-57 60U,k 'AGM (Slit�L Contractor r "� Name: 11 t.tikMALW C�ALSP `i Address: 3Qj21.) b 1 CLmOr' 0-1 k1 V40 City, State: CAA-rrbb r t a f d ) �L Q', ''"I' Phone: 114 -2b3 - 3 (104/- Property Owner , Name: ��„"1YgOSeirl��wr ' ` Address: to MS+ LY1 * Skx Q City, State: 1:1b Yen Cf r IA >k bAe(p�! Matthew Russell I, (contractor) attest and affirm that the building I intend to insulate does not have any open .' -lb and tube) wiring in the spaces to be insulated and that I have provided the property owner w. a copy of this affidavit. Contractor signature /t Date 5\2 1 l r-o2.-- � City of Northampton o.eN AM�>o\, S m.....S ���' �� Massachusetts �.,t ;: ��'% ,I( 14i c A Ii . � t DEPARTMENT OF BUILDING INSPECTIONS '. ,' r y,'. �Y �a: !�'r 212 Main Street • Municipal Building vh 'a \` �ercf-11, Northampton, MA 01060 ssy .. �1�C CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, 554, 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, 5 150A. The debris will be disposed of in: 330 Victor Road, Attleboro, MA. 02703 Location of Facility: The debris will be transported by: 5C Energy, Inc. Name of Hauler: ill" 0 Signature of Applicant: Date: 15\2-1 1 NO DEBRIS INSULATION ONLY DEBRIS DISPOSAL AFFIDAVIT In accordance with the provisions of M.G.L. c. 40, s. 54, Building Permit 4 n/a was issued with the condition that all debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L c. 111, s. 150A. The debris will be disposed of in: 5C Energy, Inc. Name of Waste Facility 330 Victor Road, Attleboro, MA 02703 Address of Waste Facility 111.5 Debris: As a condition of issuing a permit for the demolition, renovation, rehabilitation or other alteration of a building or structure, M.G.L. c. 40 s. 54 requires that the debris resulting therefrom shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L.c. 111 s. 150 A.Signature of the permit applicant, date and number of the building permit to be issued shall be indicated on a form provided by the Building Department and attached to the office copy of the building permit retained by the Building Department. If the debris will not be disposed of as indicated, the holder of the permit shall notify the building official, in writing, as to the location where the debris will be disposed. 780 CMR—6th Edition 1D 61 646B-- Signature of Permit Applicant _42:1 Date • Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction,Sii0ervisor Specialty CSSL-106162 Expires : 04/26/2023 MATTHEW J RUSSELL * 3820 DIAMOND HILL RD CUMBERLAND RI 02864 I . 1 , Nrie Commissioner Construction Supervisor Specialty Restricted to: CSSL-IC - Inst. ation Contractor Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call (617) 727-3200 or visit www.mass.gov/dpl I . 4/15/2021 Office of Consumer Affairs&Business Regulation-Mass.Gov Mass.go Office of Consumer Affairs and Business Regulation I;.,a HIC Registration Complaints Registration 195309 Registrant Matthew Russell Name Matthew russell Address 3820 Diamond Hill Rd City, State Cumberland, RI 02864 Zip Expiration 04/18/2023 Date Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search Site Policies Contact Us ©2018 Commonwealth of Massachusetts. Mass.Gov®is a registered service mark of the Commonwealth of Massachusetts. https://services.oca.state.ma.us/hic/licdetails.aspx?txtSearchLN=195309 1/1 12Z2uZ1 (Mice of Consumer Affairs&Business Regulation-Mass.Gov Mass,gw, Office of Con cz Affairs and Business Req I `� 1 (OCABR) HIC Registration Complaints Registration 194390 Registrant 5C ENERGY, INC. Name Walter Colwell Address 18 Greystone Road City, State Marblehead, MA 01945 Zip Expiration 01/30/2023 Date Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search Site Policies Contact Us ©2018 Commonwealth of Massachusetts. Mass.Gov®is a registered service mark of the Commonwealth of Massachusetts. https:llservices.oca.state.ma.us/hlc/licdetails.aspx?txtSearchLN=194390 1/1