Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
17C-096 (12)
BP-2022-0476 140 CHESTNUT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17C-096-001 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-2022-0476 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION Contractor: License: Est. Cost: 3000 HOMEWORKS ENERGY INC 106148 Const.Class: Exp.Date:07/30/2022 Use Group: Owner: T ROLL JESSICA Lot Size (sq.ft.) Zoning: URA Applicant: HOMEWORKS ENERGY INC Applicant Address Phone:. Insurance: 59 TOSCA DR 7812054484 ECC-600-400 1 0 1 7-202 1 A STOUGHTON, MA 02072 ISSUED ON:05/19/2022 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATH ER IZATI ON POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: �. • , . , I Fees Paid: $65.00 212 Main Street, Phone(413) 587-1240,Fax:(413)587-1272 Office of the Buildinc Commissioner --14.fr`r t tJ r '0Ui-T k4OO FEE: $65.00 1.n- The Commonwealth of Massachusetts`�----�—j V t' ` II W Board of Building Regulations and Standards x FOR Massachusetts State Building Code, 780 C m'ilNiCIPALI'I'Y c 2022 USE Building Permit Application To Construct,Repair,Renovate Or Demolish a R4vised Mar 2011 One-or Two-Family Dwelling,-r: r ei ni p�HC DNS.; 7�aN3 I This Section For Official Use Oii ;"P on,,M A otnTo Buildin Permit Number: (,0—.l J-' (� 7&'i Date Applied: � 1 5-1 2vzz Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 140 Chestnut Street Northampton Massachusetts 01062 1.1 a Is this an accepted street?yes 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 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Jessica Roll Northampton Massachusetts 01062 Name(Print) City,State,ZIP 140 Chestnut Street (413) 345-0688 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other ✓Specify:Weatherization Brief Description of Proposed Work2:Residential weatherization/Air sealing.No structural changes.SITE ID 4462916 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $3,000 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $,�n Check No. 63�.tcheck Amount:104 Cash Amount: 6.Total Project Cost: $3,000 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 106148 07/30/2022 Adam Glenn License Number Expiration Date Name of CSL Holder I 59 Tosca Drive List CSL Type(see below) No.and Street Type Description Stoughton, MA 02072 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 781-205-4484 wxpermitting@homeworksenergy.com Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 181138 03/02/2023 HomeWorks Energy HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 59 Tosca Drive wxpermitting@homeworksenergy.com No.and Street Stoughton,MA 02072 781-205-4484 Email address 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 [J No 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,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. Jessica Roll 4/28/2022 Print Owner's Name(Electronic Signature) Date SECTION 7b: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 contained in this application is true and accurate to the best of my knowledge and understanding. Adam Glenn 4/28/2022 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" �ypWn; Illl/ : J% • nIrNMt+" CITY OF NORTH ADAMS,MASSACHUSETTS Inspection Services 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 contracted with a corporation or LLC,that entity must be registered Type of work: Residential weatherization/Air sealing.No structural changes.SITE ID 4462916 Est. cost: 3,000 Address of work: 140 Chestnut Street Northampton Massachusetts 01062 Date of permit application: 4/28/2022 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law(explain): Job under$1,000.00 Building not owner-occupied Owner obtaining own permit(explain): pi Other(specify): Weatherization 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. Signed under the penalties of perjury: I hereby apply for a permit as the agent of the owner. 4/28/2022 HomeWorks Energy 181138 Date Contractor Name HIC Registration No. Or: Notwithstanding the above notice,I hereby apply for a permit as the owner of the above property: Date Owner Name and Signature I11111N11111117I/IF re.iter.. /�`' r: IIII,Ii1Nt,\ CITY OF NORTH ADAMS,MASSACHUSETTS Inspection Services Construction Debris Disposal Affidavit (Required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code,780 CMR section 111.5 Debris,and the provisions of MGL c 40, S54: 140 Chestnut Street Northampton Massachusetts 01062 Building Permit# is issued for with (Location) the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris will be transported by: N/A Little to no debris (Name of hauler) Debris will be disposed in: Dumpster permit required: Yes N/A Little to no debris 12 NO (Name of facility) N/A Little to no debris (Address of facility) cia44 rz..4a<-() 4/28/2022 Date Signature of permit applicant The Commonwealth of Massachusetts i .,o.;., _ 1, Department of Industrial Accidents rlrli�s 1= 1 Congress Street,Suite 100 s Boston, MA 02114-2017 www.mass.gov/dia W orkers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): HorneWorksFnergy Address: 59 Tosca Drive City/State/Zip: Stoughton, MA 02072 Phone#: 781-205-4484 Are you an employer?Check the appropriate box: Type of project(required): am a employer with 500 employees(full and/or part-time).* 7. ❑New construction 2. I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.] 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 11.111 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.01 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 ther WEATHERIZATION 6.1_1 We are a corporation and its officers have exercised their right of exemption per MGL c. 152,1/1(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. 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 subcontractors 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: NH Employers Insurance Company Policy#or Self-ins.Lic. #: #4001017 Expiration Date: 01/01/2023 Job Site Address 140 Chestnut Street City/State/Zip: Northampton Massachusetts 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 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 certify under the pains and pei • s of perjury that the information provided above is true and correct. (PACSignature: Date: 4/28/2022 Phone#:781-205-4484 // wxpermittng@homeworksenergy.com Official use only. Do not write in 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#: ��.....44 HOMEENE-01 LLARIVIERE A CORD DATE(MMIDDIYYYY) �� CERTIFICATE OF LIABILITY INSURANCE 1/3/2022 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,LLCFAX 163 Main Street (n"Ic,No,Ext):(978) 686-2266 301 (A/C,No):(978)686-6410 North Andover,MA 01845 ittAFtEss:certificates@fostersullivangroup.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Central Mutual Insurance Company 20230 INSURED INSURER B:NH Employers Insurance Company 13083 Homeworks Energy,Inc INSURER C:Markel Insurance Company 38970 Homeworks IIC LLC 101 Station Landing Suite 100 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 LTR INSD WVD (MM/DDIYYYYI (MM/DD/YYYY) 1,000,000 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE X OCCUR CLP 8698469 1/1/2022 1/1/2023 DAMAGE TO RENTED 300,000 PREMISES(Ea occurrence) $ • 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 PRO- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ ANY AUTO BAP 8698470 1/1/2022 1/1/2023 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) $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE CXS 8698471 1/1/2022 1/1/2023 AGGREGATE $ 1,000,000 DED X RETENTION$ 0 $ B WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N ECC-600-4001017-2022A 1/1/2022 1/1/2023 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N N I 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 $ C Pollution Liability CPLMOL109278 1/1/2022 1/1/2023 $10,000 Deductible 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 100 Medford,MA 02155 AUTHORIZED REPRESENTATIVE I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ,°.,,.,f City of Northampton w/- t �= Massachusetts \. x ' 0* DEPARTMENT OF BUILDING INSPECTIONS 1_.f_�; 212 Main Street • Municipal Building Northampton, MA 01060 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 140 Chestnut Street Northampton Massachusetts 01062 Contractor Name: HomeWorks Energy Address: 59 Tosca Drive City, State: Stoughton, MA 02072 Phone: 781-205-4484 Name:Property Owner Jessica Roll Address: 140 Chestnut Street Northampton Massachusetts 01062 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 CAkik ,six)01/ird- c.. ...___ Date 5/4/2022 The Commonwealth of Massachusetts Department of Industrial Accidents .ekT_ 1 Congress Street,Suite 100 151_ 1 iif Boston, MA 02114-2017 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): HorneWorks FnArgy Address: 59 Tosca Drive City/State/Zip: Stoughton, MA 02072 Phone#: 781-205-4484 Are you an employer?Check the appropriate box: Type of project(required): WI�/[am a employer with 500 employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 9. 0 Demolition 3.0 I am a homeowner doing all work myself [No workers'comp.insurance required.]e 10 0 Building addition 4.0 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 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 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-: 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14 ther WEATHERIZATION 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. :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: NH Employers Insurance Company Policy#or Self-ins.Lic.#:#4001017 Expiration Date: 01/01/2023 Job Site Address 140 Chestnut Street Northampton Massachusetts 01062 City/State/Zip: _ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation•punishable by a 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 certify under the pains and pe ' of perjury that the information provided above is true and correct. ediAtik Signature: Date: 5/4/2022 Phone#:781-205-4484 II wxpermittingAhomeworksenergy.corn. Official use only. Do not write in 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#: 974, F0,11.,?1,0-n7/990W//iygekipiexat,-.).te-/ti Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Roston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card HOME WORKS ENERGY, INC Registration: 131138 Exp,rateon: 031022023 101 STATION LANDING STE 110 MEDFORD,MA 02155 _ Update Address and Return Card. SCA ' 0 2OM-O5tt7 . 3 Pewee,. erve/1.` Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Supplement Card before the expiration date. If found return to: Rogistratioo L11211 0911 Office of Consumer Affairs end Business Regulation 181138 03J0212023 1000 Washington Street •Suite 710 HOME WORKS ENERGY,INC• Boston,MA 02118 ADAM GLENN ,/` c::; u 44~ 101 STATION LANDING STE 110 r r„r,rr4(a — MEDFORD,MA 02155 Undersecretary Not valid without signature Int CoinrnnnweaNh of Massachusetts Division of Professional Licensure Rest, acted to.Construction Supervisor Specialty Board of Budding Regulations and Standards CSSL -Insulation Contractor Constructic .Supeivi c r Specialty CSSL-106148 !pires 07/30/2022 ADAM GLENN 19 CHARGE POUND Rp f WAREHAM MA 02671 611 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Commissioner Call(617)727-3200 or visit www mass.govrdpl Insulation/Air Sealing Permit Authorization Specialist: Anthony Ingham Company: HomeWorks Energy Email: anthony.ingham@homeworksenergy.cc Address: 101 Station Landing Cell: 4132096477 Medford, Ma 02155 Phone: 781.305.3319 Customer: Jessica Roll Address: 140 Chestnut St Email: jessica.t.roll@gmail.com Florence, MA,01062 Site ID: 4462916 Phone: 4133450688 I, the owner of the property identified above hereby authorize HomeWorks Energy Inc., or their Partner to act on my behalf in obtaining any building permit that maybe required to perform insulation and/or Weatherization work on my property and all matters related to the work authorized by said permit if one is obtained. Any related permit application cost will come at no additional charge provided that the agreed Weatherization work is completed. In the event that a permit is pulled on your home for insulation and/or weatherization work, you may be required to have a final inspection of the work scheduled and performed by the building inspector in your town. If required by the town, you will be notified by HomeWorks Energy that an inspection is necessary with instructions on how to complete this process to close out your permit. Email: jessica.t.roll@gmail.com Customer Signature: ., /di/1-) Date: 4/20/2022 Jessica Roll For Condo Owners: If you have property oversight by a condo associationt, please have the association's authorized person(s)complete and sign the section below. Please email this document to wxpermitting@homeworksenergy.com once completed. We, being the duly authorized representatives of the association Name of association or management companyt or management company have reveiwed the plans and specifications for improvements to the address specified above. We further acknowledge that the above listed owner has given notice that they intend to seek permits and to carry out the proposed work. Signature of representative Date Print Name t Other unit owners may sign when there is no association. PLAN VIEW 3 Name: .3�SS1[' o. R G 1 Site ID: lig 6 a 9 I b Finished Sq. Ft: ii q(o 2 Phone: t-lt--3t-\ 5-0 6' ' Year of House: i q OQ Electric Acct#: — Address: 144 C./he 54n0-k S+ #of Floors: Gas Acct#: — F 1c,Q„ J nit,G A Unit#: # Occupants: 3 Housing Type? Conn,cq DUCTWORK INSPECTION Ducts Insulated? Ica' Duct Linear Ft. ' F 1 r � Duct Square Ft. 1;' 4 G,S Pce55, Duct Air Sealing Hours I S 4 o6 5 v c. if r Duct Insulation � p oe5 1,j(.0 -k ,' I ~ Duct Insulation Removal /lp rip W BASEMENT INSPECTION '1 g Existing Spec'ing Ln/Sq. Ft. m Bsmt Wall AG _ Q` G� PC 1 Dc r Crawl Ceiling • J `� -{o Crawl Rim Joist ,n' ,. j \ X 1 Bsmt RJ w/Sill P 4- Bsmt RJ NO Sill (100e <:l , .YC ' O6\ 0Vap4 r Barrier' . Bsmt Doo PC) �� y/N Blower Door? p � WALLS&GARAGE Drill Location? Cf e//;3/� FC�J Siding Ceil. Height Existing Spec'ing Sq. Ft. Framing Exterior Wall 1 x x Bal atform Exterior Wall 2 x x alloon/Platform Overhang -------- x Garage Wall x x Balloon/Platform Garage Ceiling x x et 0 2 o \Oa 1 flSO1o\*E8 W X W D G A) S xa- 1 u)a�on'Remov�l ±` (Fo/r7 '\ S �� Sgft. 6) ''A-(- (e N/c a Sweeps:t� ID Iw s.�l■Iltfi d WORK SPEC'D BUT NOT CONTRACTED AOAD BLOCKS PRESENT?JMANDATORY) Attic Basement/Crawlspace Otb- K&T Y V Moisture Y(()Combustion Sfty V JPI Kneewall Overhang/Garda---'' Asbestos Y/ Mold>100 sq.ft Y CO Detector Missing Y��N Ductwork is Vermiculite Y/ 4 Structl Concerns Y ( Other: �_ Notes for Lead Vendor/Work Not Contracted: _----- KW WALL AND KW FLOOR Blind Spec? ❑ f- OR KW SLOPE AND GABLE END Blind Spec? _ Why? Why? FRAMING EXISTING • ' t • .� FRAMING EXISTING SPEC'ING Q.FT. WALL X X Or SLOPE X X FLOOR X X GABLE X X o ACCESS X TRANS X X Z P u- RANS X X ATTICca D ATTIC SLOPE X X N 3 SLOPE X X EXISTING VENTING? EXISTING VENTING? EXISTING PIPES /N ^' KW Venting Vent BF Temp Access KW Venting Vent BF : Hose Dammi Sheathing Access Temp Access • a KNEEWALL MANDATORY (k e c is 064 of a SofF�fi � �u k c o< -- tan ® al3, IC) A 1 S V (:), H r S t 0 cgsB c K?L 5qI a CI) n (Rich )4 C D) D _ .,, ,0...,(v) rY\ a.1 c\ 7\ 3C) Insulated Wall X X Rec'd Light 0 Ins.Hose ii Bf Vent OF Chim.(CN Damming 12'Roof (12RV Air Handier® Temp Access(T ?Pull Down PDS) Hatch 17 Wall Hatch "/ Door c/ tr Roof vent BAS Vol: x .0058 e4L foX[b ATTIC 1 Blind Spec? X X ATTIC 2 Blind Spec? 7 x �1SA(2 story) z Existing Spec'ing Sq ft Existing Spec'ing S. ' 13.6(3 story) o Multipliers Unfloored 5F48 k °t'•O('x:%', Si� Unfloored / �— ross:a ng Floored L" ---. ` Floored xM ed Ins Iau.• % ct Work - Cath Slope Cath Slope >6"Loose - ,;,..,46 v Walls ,- Walls Air Sealing Hours Access (C','K t Access / Venting Propavents Vent BF [:y Hose Dammin: Venting • ..avents Vent BF BF Hose Dammin: no no c w w Temp Access „_ La. tom. Sheathing Access:_ So.Ft/300 a - (Exist.NFA Venting)_ (Needed •.Ft/300= _ .. ....- ' R.L.Covers.____ ... ` p Venting) (Exist,NFA Venting)= NFA venting) Roof Type: Existing Venting? h�. a i .)1)'D" Existing Venting? Page 1 of �QAkt �3 HomeWorks mass save �n � Energy, Inc PARTNER 101 Station Landing Ste 110,Medford,MA 02155 (781)305-3319 ext.120 Customer Name:Jessica Roll Email:Not provided Phone:413-345-0688 Premise Address:140 Chestnut St,Northampton,MA 01062 Mailing Address: 140 Chestnut St,Northampton, MA 01062 Project ID:4482352 Date:April 20,2022 Job Description Measure Description Location Quantity Unit Total Cost Customer Cost Air Sealing at Estimated 62.5 CFM50 Per Hour Other 6 hr $555.48 $0.00 Rim Joist- 2"Thermal Barrier Polyiso Other 30 SF $143.40 $35.85 Door- 2" Thermal Barrier Polyiso Other 1 each $90.44 $22.61 Door Sweep (with AS hrs) Other 2 each $50.62 $0.00 Exterior Door Weather Stripping (with AS hrs) Other 2 each $60.14 $0.00 Attic Floor-9" Open Blow Cellulose Other 598 SF $1,088.36 $272.10 Hatch -2"Thermal Barrier Polyiso Other 1 each $46.28 $11.57 Damming Other 30 each $71.70 $17.92 Project Total $2,106.42 Total Contractor Price and Payment Schedule HorneWorks Energy, Inc. agrees to perform the above described work,furnishing the material and labor specified for the listed total price. Payment of the balance of the customer contribution is expected upon completion of the work. Customer Signature: Date: Customer Phone: Specialist Signature: Date: A/On's( LIMITED TIME 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@HomeWorksEnergy.com Page 2 of �3 HomeWorks 4ave �n � Energy, Inc PARTNER 101 Station Landing Ste 110,Medford,MA 02155 (781)305-3319 ext.120 Customer Name:Jessica Roll Email:Not provided Phone:413-345-0688 Premise Address:140 Chestnut St, Northampton,MA 01062 Mailing Address: 140 Chestnut St,Northampton, MA 01062 Project ID:4482352 Date:April 20,2022 Weatherization incentive ($1,080.13) Air sealing incentive ($666.24) Total Program Incentive -$1,746.37 Customer Total $360.05 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 total price. Payment of the balance of the customer contribution is expected upon completion of the work. Customer Signature: c7e ytc.t, /�.oP Date: Customer Phone: Specialist Signature: ite rivet Date: UMITED 111I E 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:lnbox@HomeWorksEnergy.com