Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
32A-168-002
BP-2023-1651 50 HAWLEY ST UNIT 2 COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 32A-168-002 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-2023-1651 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: DIPIETRO HOME ENERGY Est.Cost: 327 SOLUTIONS DBA REVISE 104464 Const.Class: Exp.Date: 03/06/2024 Ilse Group: Owner: SETH WARREN, CHARLES Lot Size (sq.ft.) DIPIETRO HOME ENERGY SOLUTIONS DBA Zoning: URC Applicant: REVISE Applicant Address Phone: Insurance: 32 MIDDLESEX ST (978)203-6736 WC100142002 HAVERHILL,MA 01835 ISSUED ON: 11/27/2023 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHERIZATION POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House # Foundation: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: ( i Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner 314 'r.- The Commonwealth of Massachuse s 4./OR Board of Building Regulations and StoQishO dar 410 M[1N IPA ITY Massachusetts State Building Code,7CSE Building Permit Application To Construct,Repair, a Rev' ed M r 2011 One-or Two-Family Dwelling G rNgMbmiG Te NON This Section For Official Use Only N,Mq 0F 6770 Ns Building Permit Number: �J�'eA 3 05. Date Applied: 11/17/2023 44..) l /l//'� _ I I-27-7043 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 50 Hawley St#2 Northampton,MA 01060 1.1 a Is this an accepted street?yes V 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 yesO SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Seth Warren Northampton,MA 01060 Name(Print) City,State,ZIP 50 Hawley St#2 201-232-8802 seth.warren@me.com 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 0 Specify: Brief Description of Proposed Work2:Insulation,weatherization,and Air Sealing SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $327.69 1. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $0 ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $0 2. Other Fees: $ 4.Mechanical (HVAC) $0 List: 5.Mechanical (Fire Suppression) $0 Total All Fees: (, Check No./V9theck Amount:OF ids Amount: 6.Total Project Cost: $327.69 ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-104464 03/06/24 James Dimopoulos License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 32 Middlesex St No.and Street Type Description Haverhill,MA 01835 U Unrestricted(Buildings up to 35,000 cu.ft.) Restricted 1&2 Family Dwelling City/Town,State,ZIF `✓ M Masonry RC Roofing Covering ��— WS Window and Siding SF Solid Fuel Burning Appliances 351-588-0362 hopet@callrevise.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC-167375 03/11/24 James Dimopoulos Dipietro Home Energy Solutions dba Revise HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 32 Middlesex St hopet@callrevise.com No.and Street 351-588-0362 Email address Haverhill,MA 01835 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 ❑ 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 to act on my behalf,in all matters relative to work authorized by this building permit application. See attached authorization 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 applicati n is true and accurate to the best of my knowledge and understanding. 11/17/2023 Print Owner's or Authorized Agent's ame(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" The Commonwealth of Massachusetts Department of Industrial Accidents _; ►_' Office of Investigations Lafayette City Center _ff = 2Avenue 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): Dipietro Home Energy Solutions dba Revise Address:32 Middlesex St City/State/Zip:Haverhill, MA 01835 Phone#:351-588-0362 Are you an employer?Check the appropriate box: Type of project(required): 1.❑■ I am a employer with 30 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 workingfor me in anycapacity. employees and have workers' P tY 9. ❑Building addition [No workers' comp.insurance comp.insurance.: required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 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 Weatherization employees. [No workers' 13.0 Other comp.insurance required.] _ 'My 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: HUB International New England Policy#or Self-ins.Lic.#:WC100142002 Expiration Date:04/20/2024 Job Site Address: 50 Hawley St#2 City/State/Zip:Northampton, MA 01060 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the p ' and p nalties of perjury that the information provided above is true and correct. Signature: �o-y Date: 11/17/2023 Phone#: 351-588-0362 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): 10Board of Health 20 Building Department 31:City/Town Clerk 4.0 Electrical Inspector 5OPlumbing Inspector 6.0Other Contact Person: Phone#: A�R� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 04/14/2022 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 Emily Costello NAME: Costello Insurance Group PHONE E Ext): (978)374-6352 FAX No): (978)521-5127 2 S.Kimball St. E-MAIL ecostello@costelloinsurance.com ADDRESS: PO BOX 5248 INSURER(S)AFFORDING COVERAGE NAIC# Bradford MA 01835 INSURER A: Colony Argo Insurance INSURED INSURER B: Commerce Insurance Co. 34754 Dipietro Home Energy Solutions,Inc. INSURER C: DBA Revise INSURER D: 32 Middlesex Street INSURER E: Bradford MA 01835 INSURERF: COVERAGES CERTIFICATE NUMBER: CL2241402385 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 SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000 DAMAGE TO RENTE CLAIMS-MADE X OCCUR PREM SES(Ea occur ence) $ 50,000 MED EXP(Any one person) $ 10,000 A PACEP308383 04/25/2023 04/25/2024 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY X PRO LOC PRODUCTS-COMP/OPAGG $ 2,000,000 JECT OTHER: pollution $ 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED X SCHEDULED HS6326 05/09/2023 05/09/2024 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS XHIRED N/ NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY ov's_ AUTOS ONLY (Per accident) Medical payments $ 10,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LIAB CLAIMS-MADE EXC4245322 04/25/2023 04/25/2024 AGGREGATE $ 3,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Town of Northampton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 210 Main Street THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Northampton, MA 01060 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE urn, �ofC I 1� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD DIPIEHO-01 CWOODSIDE ,d►coRo CERTIFICATE OF LIABILITY INSURANCE DATED/YYYY) `•—/ 4/19/219/2023 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 License#1780862 rciQgii ICT Anya Toteanu HUB International New England PHONE FAX 300 Ballardvale Street (NC,No,Ext): (A/C,No): Wilmington, MA 01887 RM.;anya.toteanu©hubinternational.com INSURER(S)AFFORDING COVERAGE NAIC N INSURER A:Independence Casualty Insurance Company 11984 INSURED INSURER B: Dipietro Home Energy Solutions,Inc.,Joseph A. Dipietro INSURER C: Heating&Cooling,Inc 32 Middlesex Street INSURER D: Haverhill,MA 01835 INSURERE: 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 IMMIDD/YYYYI (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 52I f LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ — OWNED SCHEDULED AUTOSRE� ONLY AUTOS� yy�ED BODILY INJURY(Per accident) $ _ AUTOS ONLY AUTO ONLY (Per accideT DAMAGE UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY Y/N WC100142002 4/20/2023 4/20/2024 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? N N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Town of Northampton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 210 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Northampton, MA 01060 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE g (/ %��T ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington-Street- Suite 710 Bostorh Massachusetts 02118 Home Improvement eonfractorRegistration Type; Individual Ategt5t1'ation: 167375 JAMES G.DIMOUOULOS ExRitation: 03/11/2024 25 SEVEN SISTER RD HAVERHILL,MA 01830 y ti.'► Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Atfa rs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:-Individual Office of Consumer Affairs and Business Regulation f3ygiettstion EzpiratIQn 1000 Washington Street -Suite 710 167$7.6 03/11/2024 Boston,MA 02118 JAMES G.DIMOUOULOS. JAMES DIMOUOULOS 25 SEVEN SISTER RD 1,4,7.4re a •%t14r"ft I{gVERHILI,MA 01830 Undersecretary �_:-- Ngt id without signature 10 Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Regulations and Standards 't I t Co nstot4ton Silogrvisor CS-104464 x 4�pires:03/06/2024 JAMES G DIM}OPOULOS 25 SEVEN SIifTER RD HAVERHILL MA 01830 i ..-%'/i 1 1% ".1: ;.,,:e.,, Commissioner _ t Revise Energy ," REVISE Home Performance Contractor 1 the way you save 5 South Summer Street,Bradford,MA 01835 CONTRACT - AUDIT 1-800-885-7283 CUSTOMER PHONE DATE CLIENT# WORK ORDER Charles Warren (201)232-8802 11/09/2023 811766 00001 SERVICE STREET BILLING STREET PROPOSED BY: 50 Hawley Street 2 50 Hawley St Revise Energy SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Northampton, MA 01060 Northampton, MA 01060 Page 1 DESCRIPTION QTY COST INCENTIVE TOTAL PERFORM AIR SEALING AT ESTIMATED 62.5 CFM50 PER HO 1 $106.59 $106.59 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.) EXTERIOR DOOR WEATHER STRIPPING 1 $36.32 $36.32 Provide labor and materials to install Q-Ion weatherstripping to door(s)to restrict air leakage. DOOR SWEEP 1 $29.66 $29.66 Provide labor and materials to install a doorsweep to restrict air leakage. Revise Energy -) REVISE Home Performance Contractor 1.= the way you save 5 South Summer Street,Bradford,MA 01835 CONTRACT - AUDIT 1-800-885-7283 CUSTOMER PHONE DATE CLIENT# WORK ORDER Charles Warren (201) 232-8802 11/09/2023 811766 00001 SERVICE STREET BILLING STREET PROPOSED BY: 50 Hawley Street 2 50 Hawley St Revise Energy SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Northampton, MA 01060 Northampton, MA 01060 Page 2 DESCRIPTION QTY COST INCENTIVE TOTAL INSTALL 2"THERMAL BARRIER POLYISO ON OPEN BASEMEN 28 $155.12 $155.12 Provide labor and materials to install rigid board insulation to the perimeter of the basement ceiling at the house sill. Total: $327.69 Program Incentive: $327.69 Customer Total: $0.00 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***00/ Dollars $0.00 MICHAEL MONAST /Wc1.[ /o U'/e_DD75' COMPANY REPRESENTATIVE CUSTOMER SIGNATURE 11-9-2023 NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE SIGN DATE 30 DAYS. .i:..1i ri_ • !! a+!a�A. 1,1/:.M fMgil%t�1�fi+`� 11f' '/ h f 7M R!'.l�!#. 'f P'•It!t ell r f�A Q! ..!�'�! A }!r Based on your Energy Specialist's recommendations,your home can benefit from program-eligible insulation and/or air sealing improvements.Before moving forward,please follow all the instructions below to remediate your weatherization barriers. CUSTOMER INSTRUCTIONS 1. Hire a qualified,licensed contractor to evaluate and/or remediate the weatherization barrier(s). 2.Submit signed and completed copies of this form and a copy of the paid contractor invoice(s)within 60 days of your Home Energy Assessment to:R!SS nR n^cri^c,GO g;,,,,,,,y,,, „t 2 or email to 3.The weatherization incentive will be deducted from the customer co-payment amount of the weatherization work.A rebate check will be issued in the event the amount exceeds the customer's co-payment amount. 4.Complete the recommended weatherization improvements. . Customer Name: Judith Burke Client#or Site ID: 324847 site Address 50 Hawley Street, Unit 1 City: Northampton State: MA ZIP:Northam ton01060 Phone Number. 413-584-2990 Email: judith.burk@gmail.com Customer/Homeowner Signature: Date: �. •_ _ s - � To determine if there is any active knob and tube wiring,the contractor will evaluate the following areas where eligible Mass Save' weatherization recommendations have been made: Attic Floor , Attic Wall Attic Slope • Exterior Wall • Racment Other. Other i have performed my inspection and determined there is no active knob and tube wiring in the areas selected below. Attic Floor ( tic Wall (---Atticet Slope prior Wall /..-Egement ,Other: Other: Contractor Name: nn)66�—rt a1 �hJ �� Address: c2.(� �!e-a`Ver- F GCe' 12f/` City: C b . t'�'`-G l�sta/te_ lip Q 16"/ .- Company Name: .f D��`--<r ! cL - -ctC I rI?i License Number. t 6 0 Q 6 `- /J Contractor Signature: ,} .'1/►��/ Date: �a./0—/ My signature confirms that i have performed my inspection of the electrical systems listed above and have corrected any barriers as indicated.My signature also confirms that I have read and agree to the Terms and Conditions outlined on the back of this form. _,...,:r .. High Carbon Monoxide:Contractor is to service and re-evaluate the selected mechanical system(s)and reduce the carbon monoXide llevel, as measured in the undiluted flue gas,to below 100 parts per million(ppm). Draft Failure:Contractor is to correct the draft in the selected flue(s).Refer to table on reverse for acceptable draft ranges. .1111111111111 Existing CO ppm: Revised CO ppm: Existing Draft Pa: Revised Draft Pa: Heating System Hot Water Heater Other Spillage:Contractor is to correct the spillage of flue gac in the selected mechanical systems) Must not spill after 60 seconds of operation. Heating System Hot Water Heater Other. Contie for Name Address: City State: ZIP: Company Name. License Number Contractor Signature: Date: Hy signature:confirms that I have performed my inspedian of the mechanical systems listed above and have corrected arty birders as indicated.My signature also confirms that I have read and agree to the Terms and Conditions outlined on the bad(of this torte. DocuSign Envelope ID:E0F0B695-37A3-4896-AAEO-D300BEE3E3E5 mod, ' ° REvis E �b... > �,. the way you save { Permit Authorization Form Site ID: Street Address: City: To be filled out by Subcontractor (if applicable) Contractor Name: Dipietro Home Energy Solutions DBA Revise Contractor Address: 32 Middlesex St Bradford Ma 01835 I Philip Brooks owner of the property listed above hereby authorize Revise Energy or my assigned subcontractor listed above to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property under the Mass Save Home Energy Services Program. p-DocuSigned by: Owner Signature: PLutir bracts 4424873E26184C0... Date: 11/9/2023 Virtual Circle One In-Home Revise Energy Planview Diagram Customer: Address: 7%+6 l urke Yeth W.tne„fMkrt Mtrieo Advisor Name: ess: cp k il S,i;- p1.1,1 13(,dic S Any limitations to access by truc ? Y Town: 1uUf-'rh m04-or) Site l D: 4't\b9 x /St t16 l / $i. q b 811/8 b *Use the greater of the two BAS r$'s when calculating for MVR —.. of stories 1 1.5 2 2.5 3 BAS 1: 15 cfm X#occupants X n-factor = n-factor 19 16 15 14.4 13.7,) BAS 2: .00583 X area X height X n-factor = t S/ _ Mechanical Ventilation Recommended:BAS>final CFMSO> (0.7 X BAS) Mechanical Ventilation Required:(0.7 X BAS)>final CFM50 is A/S Multiplie r >6"Loose Insulation Cross-Batt >6"Mix Loose/x-batt Truss this part of a multi-unit workscop��r N Workscope:U A..l. I Gera /72>r t�C 1 M 1- 2 or‘. it t're'l ryr3 7 2 er i tfr 5 114( WQ.ere+t ra ter-et G.-u/Ati z Odor tc.+ 4 4 At-r 1 I 7 #11) 1 H'rs 2 3 say < dour' tc.k + t s KeS 000' 12 t31: 4o>e i_' „ Patty Z$ 04Mm:AY 401 d fi Pol a. 2 t ----). /o I1"0Gt S Any work scoped outside of best practices/approved by? 131: i3C it- . Li - l t- �- 0 —__t F r7' -4 f itZr3eieS" 6 il m Alk a ___--x----)c---K >c---)c—x----K------J ; 11 I 11 `✓ E-- 3 to I) 4 819,to, of ill t3/W,ir, 16,i7-,fg 11 usn►`1- / r3roukc. s 1 /3 oil Area `1 4,-, Yr Built / 14 t}CS 17ok' l DHW Yr 1 S O4.M m:1 604 Venttaltion SOFT SOFT/300 ; t 6 14{t‘0 r3 t rd 5- 40%Low/High Existing High 17 t" Pa' 1.7(64 c,,--` i4 11 Existing Low 72 d Rec Vents.# 1 i-ftM-<Ai l Existing Propervents Required Propervents 1 Soffit vent? Y N 11 ICI IV HO A ( R€dge vent? Y N -STREET- Gatie vent? Y N Page____of----