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39A-061 (5) BP-2023-0234 7 HAMPTON TERR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 39A-061-001 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-2023-0234 PERMISSION IS HEREBY GRANT D TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 2000 IIOMEWORKS ENERGY INC 106148 Const.Class: Exp.Date: 07/30/2024 BLOOMGARDEN ALAN H&KATHLEEN E Use Group: Owner: BREDIN Lot Size (sq.ft.) Zoning: URB Applicant: HOMEWORKS ENERGY INC Applicant Address Phone: Insurance: 59 TOSCA DR 781-205-4484 ECC-600-400 1 0 1 7-2022A STOUGHTON, MA 02072 ISSUED ON: 02/27/2023 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATH ERIZATI 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 VIO ATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I � 1� Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner FEE: $65.00 40 r I WO r City of Northampton _.�:e'. _'.. DepF� "49 Building Department . , 212 Room Main 0Street it. !IVS1JLIlTION 1 k_ :' Northampton, MA 01060 4 20,E phone 413-587-1240 Fax 413-587-1272 QjJj_ Y APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INSULATION PERMIT This section to be completed by office 1.1 Property Address: Map Lot Unit 7 Hampton Terrace Northampton MA 01060 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Alan Bloomgarden 7 Hampton Terrace Northampton MA 01060 Name(Print) Current Mailing Address: See Attached (413)387-8490 Telephone Signature 2.2 Authorized Agent: Adam Glenn 235 Essex Street, Whitman, MA 02382 Name(Print) Current Mailing Address: �, uti_ 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 2,000 (a)Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) # 6. 5. Fire Protection (Ji 6. Total =(1 +2+3+4+ 5) 2,000 Check Number I 1 1 24 This Section For Official Use Only 3 Building Permit Number: 6 a^,.- 41 y DateIssued: Signature: /0' // - Z - 27-)Z 3 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 Adak Expiration Date cree.A...._ 781-205-4484 Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ HomeWorks Energy 181138 Company Name Registration Number 235 Essex Street, Whitman, MA 02382 03/02/2023 Address Expiration Date 1�'' 781-205-4484 ofLLk c� � G(J �� Telephone_ _ 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 i I No ❑ Brief Description of Proposed Work Residential weatherization/ Air sealing. No structural changes. SITE ID 800500 l Adam Glenn , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Adam Glenn Print Name 64,4 ,,,, ,,c), .,;(j_ cte......_ 2/9/2023 Signature of Owner/Agent Date Alan Bloomgarden 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 2/9/2023 Signature of Owner Date City of Northampton at H • Massachusetts A. x. � si DEPARTMENT OF BUILDING INSPECTIONS jj ,z }+► t 212 Main Street • Municipal Building Northampton, MA 01060 SSIA 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 pm-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:2,000 Address of Work:7 Hampton Terrace Northampton MA 01060 Date of Permit Application: 2/9/2023 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: 2/9/2023 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 `�ti�:►:► girl. Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building Northampton, MA 01060 Cr— 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: 7 Hampton Terrace Northampton MA 01060 (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) CdO-A ,..1j0e/V. 2/9/2023 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. 1,�,,.,ir City of Northampton ��. ,� z,vS 7- s• c, 47 Y v Massachusetts 4v' << `, ji''',Vt DEPARTMENT OF BUILDING INSPECTIONS *S' �P, a "f�r 212 Main Street •• Municipal Building , 1C. -:.r,.K '"` Northampton, MA 01060 �bW•`a'�� MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 7 Hampton Terrace Northampton MA 01060 Contractor Name: HomeWorks Energy Address: 235 Essex Street City, State: Whitman, MA 02382 Phone: 781-205-4484 Property Owner Name: Alan Bloomgarden Address: 7 Hampton Terrace Northampton MA 01060 City, State: I 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 signatureC‘4 i;1#41;} coe--.. Date 2/9/2023 The Commonwealth of Massachusetts Department of Industrial Accidents tOffice of Investigations _A Lafayette City Center ‘,, if2 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.Q 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 2 ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3 officers have exercised their❑ I am a homeowner doing all work11.El Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no 13 Weatherization . employees. [No workers' o Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Federated Mutual Insurance Company Policy#or Self-ins. Lic. #:#1847910 Expiration Date: 1/1/2024 Job Site Address:7 Hampton Terrace Northampton MA 01060 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 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 tine 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 and r the pains and pe s of perjury that the information provided above is true and correct Signature: Date:2/9/2023 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): 11:1Board of Health 2❑Building Department laity/Town Clerk 4. ❑Electrical Inspector 5.Elumbing Inspector 6.0Other Contact Person: Phone#: D '4� CERTIFICATE OF LIABILITY INSURANCE �'1 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 NAME: CLIENT CONTACT CENTER PHONE X HOME OFFICE:P.O.BOX 328 (A/C,No,Ert):888-333-4949 (A/c,No):507-446-4664 OWATONNA,MN 55060 E-ADDRESS:CLIENTCONTACTCENTER(n)FEDINS.COM INSURER(S)AFFORDING COVERAGE NAIC S INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 419.899-0 INSURER B: HOMEWORKS ENERGY,INC. INSURER C: 101 STATION LNDG INSURER D: MEDFORD,MA 02155-5134 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 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 SUER POLICY NUMBER POLICY EFF POLICY EXP LTR INSR WVDIMMIDDIYYYY) UAM/DD,YYYYI LIMITS X COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED $100,000 ._ PREMISES IEa occurrence) MED EXP(Any one Person) EXCLUDED A N N 1847909 01/01/2023 01/01/2024 PERSONALS ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $2,000,000 HX IPOLICY TA: I LOC PRODUCTS-COMP/OP AUG 52,000,000 '_yI OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 lEa acdden0 X ANY AUTO BODILY INJURY(Per Person) AOWNED AUTOS ONLY SCHEDULED AUTOS N N 1847908 01/01/2023 01/01/2024 BODILY INJURY(Per accident) HIRED AUTOS ONLY —'NON-OWNED PROPERTY DAMAGE AUTOS ONLY IPer accident) X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $1,000,000 A _EXCESSl1AB CLAIMS-MADE N N 1847911 01/01/2023 01/01/2024 AGGREGATE $1,000,000 DED '_RETENTION WORKERS COMPENSATION X PER STATUTE OTH AND EMPLOYERS'LIABILITY Y/N ER ANY PROPRIETOR/PAR TNERIEXECUTIVE E.L.EACH ACCIDENT 5500030 A OFFICER/MEMBER EXCLUDED? _NIA N 1847910 01/01/2023 01/01/2024 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 5500 �0 II yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule.may be allached 11 more space is required) THIS COPY IS NOT TO BE REPRODUCED FOR ISSUANCE OF CERTIFICATES. CERTIFICATE HOLDER CANCELLATION 01 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN A CERTIFICATE HAS BEEN FILED WITH EACH OF YOUR CERTIFICATE ACCORDANCE WITH THE POLICY PROVISIONS. HOLDERS. AUTHORIZED REPRESENTATIVE 6 )(tA„.. 0 1988-2015 ACORD CORPORATION.AN rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD k9Z F0,1?"1-1/7/1-10e-e2X1./ ' //.//ei/44eZe4/r;Ae-Jef e Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Nome Improvement Contractor Registration Typo Supplement Card Registration: HOME WORKS ENERGY,INC181138 101 STATiON LANDING STE 110 Expiration: 03;'02 02/2023 2 MEDFORD,MA 02155 Update Address and Return Card. 5CA 1 4 20M-05/117 Ones of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supoiernrrht Card before the expiration date. tf found return to: Jiegistratlop gAgfration Office of Corsurrier Affairs and Business Regulation 181138 0310212023 '000 Washington Street -SJ•te 713 HOME WORKS ENERGY,1NC. Boston,MA 02118 ADAM GLENN ;IOLA i 101 STATION LANDING STE 110 '4.4 t 14""4. Not valid without signatureMEDFOHD,MA 02155 Undersecretary Commonwealth of Massachusetts Construction Supervisor Specialty Division of Occupational Licensure Reshrdedlo Board of Building Regulations and Standards CSSLJC -Insulation Contractor Constructs; u t' y Specialty CSSL-106148 ldttpires. 0713012024 ADAM GLENI) 19 CHARGE 00 WAREHAM f4 Fmlure to possess a current edition of the Massachusetts Yrj a State Building Code is cause for revocation of this license. t'rVda For information about this license Call(617)727.3200 or visit www mass.gov/dpl Commissioner daida Insulation/Air Sealing Permit Authorization Specialist: Michael Hathaway Company: HomeWorks Energy Email: michael.hathaway@homeworksenergy. Address: 101 Station Landing Cell: 4135882467 Medford,Ma 02155 Phone: 781.305.3319 Customer: Alan Bloomgarden Address: 7 Hampton Terrace Email: abloomga@gmail.com Northampton, MA,01060 Site ID: 800500 Phone: 4133878490 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: abloomga@gmail.com Customer Signature: ,A Le.fri. 946, Date: 2/1/2023 Alan Bloomgarden 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 Name: e- IS 6 'Gycl�Cr' Site ID: 0S QU Finished Sq. Ft: ( 6 Phone: $� Year of House: i Z,`l 7 Electric Acct#: Address: -7 1 r # of Floors: Gas Acct#: tluv't rt1 �# # Occupants: ' Housing Type? Oa( S—t/' DUCTWORK INSPECTION Ducts Insulated?] �GK \ I O uct linear Ft. c� ► r U�`�� ,bud Square Ft. v._Pui t� Duct Air Sealing Hours t� ��1� C�^0844 .uct It::::: ny..).) o �Dud n Removal E-cJ ,' BASEMENT INSPECTION �� , (' e.)L1 �vu�� Existing Spec'ing In/Sq. Ft. % ' /� ! €S t +� 1La5 ' 75 Bsmt Ri w/Sill Bsmt R htn I NO Sill \G.. ea "k( `b _ j Vapo Barrier /_,( sqft. Bsmt Doo)J Y ower Door? )-'(-C e-'-" WALLS&GARAGE Drill Location? Siding Cell.Height Existing Spec'ing Sq.Ft. Framin , Exterior Wall 1 -. x Balloon/Platform Ext& :: rior W x x Balloon orm Ovhang x xx x alloo / ia x x , :r i C( S ,_ t) 4L -- S'e.—. irOUlati007*, '. Sweeps: '' WX Stripping: WORK SPEC'D BUT NOT CONTRACTED _ - ROAD BLOCKS PRESEN ANDATORY) Attic Basement/Crawispace Other: K&T OiiNMoisture Yombustion Sfty Y N j Kneewall Overhang/Garage Asbestos / I Mold>100 sq. ft Y 0 Detector Missing Y N Ductwork Exterior Walls Vermiculite Y N Structl Concerns Y Other: Notes for Lead Vendor/Work Not Contracted: a KW WAIL AND KW FLOOR Blind Spec? 0 "" OR • KW SLOPE AND GABLE END Blind Spec? 0 hy? why? FRAMING EXISTING , - SCL FT. FRAMING EXISTING SPEWING SQ.FT. WALL X X SLOPE X X FLOOR X X {{E GABLE X X CCESS X I / \ TRANS X X i z eCI TRANS x x t 1 ATTIC TTIC 7.4 x x x x SLOPE EXISTING T1NG VENTING? " EXISTING VENTING? �-- o Y EXISTING PIPES? Y/N / m h,t Vti7 n. I 1 KNEEWALI MANDATORY i, f „ y‘!, k,- ‘*\.L_._ i(c)0( 2 ..... tr d ,cl Y Ks 1 cel 4 0 -Li f \v� rnwutea V.ait X X Rend 1.1rie O ins.Hine Vent BR Chan al Danrrwat ll"Roof Ale Hai Handier Temo Actin Q NH Down Hitch WO Haar "/ Roe k Door / b' ept RV BAS Vol: X .0058 x x ATTIC 1 Blind Spec? 0 x x ATTIC 2 Bli t/pec? E x(5.J t2 r.c;y — Existing Spe.(ing Sq ft Existing Spec' Sq ft "dt3"1ult Unfloored r Unfloored \/ultipliers Floored ` -:e: crv:::amng f Floored M,xed'nsylanor, :Work Cath Slope / Cath Slope f( >b`Loo:e ' O n_ Walls Walls Air Seating Hour, Access Access I Vent(ng Propa ntr. at I31 (34 tt.;s,. Itantrnrn&_, `:'antrnp Prop ants tent 61 i3i ttc„R, 1)tnt r,ic; ro W i-IF Bu)q letup Atgess. i 4E(j,, .... r.. ..r...... __........... . .i 1 ExistingV r>�.enn ;) - Root1'v)iASPi''4- l�� g? Existing Ventin�? _ t WEATHERIZATION CONTRACT EVERS...URCE 41/ CUSTOMER PHONE DATE CLIENT* WORK ORDER Alan Bloomgarden (413) 387-8490 02/01/2023 800500 11601 SERVICE STREET BILLING STREET PROPOSED BY: 7 Hampton Terrace 7 Hampton Ter HomeWorks Energy SERVICE CITY.STATE,ZIP BILLING CITY,STATE,ZIP Program Northampton, MA 01060 Northampton, MA 01060 EGMA-HPC Page 1 DESCRIPTION QTY COST INCENTIVE TOTAL PERFORM AIR SEALING AT ESTIMATED 62.5 CFM50 PER HO 2 $188.66 $188.66 Seal areas of your home against wasteful, excessive 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.) DOOR SWEEP 3 $78.33 $78.33 Provide labor and materials to install a doorsweep to restrict air leakage. DOOR: THERMAL BARRIER POLYISO 2"(ATTIC) 1 $90.61 $67.96 $22.65 Provide labor and materials to insulate the back of the attic door with 2"rigid insulation board. INSULATE RIM JOIST WITH 2"THERMAL BARRIER POLYISO 142 $691.54 $518.66 $172.88 Provide labor and materials to install rigid board insulation to the perimeter of the basement ceiling at the house sill. 6 MIL POLY VAPOR BARRIER 346 $352.92 $352.92 Provide labor and materials to install 10 ml polyethylene over open ground in designated crawlspace/earthen basement areas. Total: $1,402.06 Program Incentive: $1,206.53 Client Total: $195.53 I.DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the above work at the Client's Address in a professional manner and in accordance with the terms of this Contract: II.PAYMENT Client agrees to pay the Contractor for the Work,the Client Share of the Contract Cost is payable to the Independent Installation Contractor(IIC)upon satisfactory completion of the Work.Client understands that they will not be required to pay the Program Incentive Share of the Contract cost.Changes to the individual line items and/or previous incentives may increase or decrease the size of the Program Incentive Share. AGt/tA azi . 4 Spa RISE Representative Client Signature 2.8.2023 Printed Name Date of Acceptance