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31B-128 (2) BP-2024-1052 63 PROSPECT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31B-128-001 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-2024-1052 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2024 Contractor: License: Est.Cost: 5028 CLEAN TECH CONSTRUCTION 106247 Const.Class: Exp.Date: 01/05/2026 Use Group: Owner: R CLAYTON JAMES E JR& LINDA E Lot Size(sq.ft.) Zoning: URC Applicant: CLEAN TECH CONSTRUCTION Applicant Address Phone: Insurance: 38 ELLIS AVE 508-663-7847 6hub4n60130823 WEYMOUTH, MA 02190 ISSUED ON: 08/20/2024 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHER I ZATI 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: 72 Fees Paid: $75.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner tiffs O1_ z 00 The Commonwealth of Massachusetts wP 1) Board of Building Regulations and Standards F a Massachusetts State Building Code, 780 CMR MUNIC TY ,cw z s z Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised 011 ._ o One-or Two-Family Dwelling 0 This Section For Official Use Only W `' o cr Building Permit Number;,/ y. 'a A Date Applied: 0 z Li STZ fi / a7,ro %ii 2y Building Official(Print me) ignature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 63 Prospect Street 1.1 a Is this an accepted street?yes no r 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 ifyes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: James Clayton Northampton,MA 01060 Name(Print) City,State,ZIP 63 Prospect Street 413-387-3069 iclayton63@gmail.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) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Insulation Brief Description of Proposed Work2: Residential weatherization and air sealing with the Mass Save Program.No structural changes. SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $5028.05 1. Building Permit Fee: $ Indicate how fee is determined: 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:$ 5028.05 Check No. j 4/Check Amount: Cash Amount: 6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 106247 09/26/2026 Arianna Davidson License Number Expiration Date Name of CSL Holder List CSL Type(see below) Insulation 38 Ells Ave No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) Weymouth,MA 02190 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 508-663-7847 cleantechconstruction48(4amail.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 196071 06/27/2025 Clean Tech Construction HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 38 Ells Ave cleantechconstruction48@gmail.com No.and Street Email address Weymouth,MA 02190 508-663-7847 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 a 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 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 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. 4uaxata-T]ovcchait. 8/14/2024 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.aov/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" City of Northampton DaY HAMP�O S � � -✓ Massachusetts ��?SA DEPARTMENT OF BUILDING INSPECTIONS �' x r r fi' 212 Main Street • Municipal Building yJ � � : Northampton, MA 01060 J:PN,y `1" CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, 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, S 150A. The debris will be disposed of in: Location of Facility: 40 Messina Drive Braintree, MA 02184 The debris will be transported by: Name of Hauler: Clean Tech Construction Signature of Applicant: 42..atotez, T>aw aei Date: 8/14/2024 Commonwealth of Massachusetts Construction Supervisor Specialty IPDivision of Occupational Licensure Board of Builder,- 9Pg.ulations and Standards Restricted to: + Specialty CSSL-IC-Insulation Contractor Construct - r r Secialt CSSL-106247 Wires: 09/26/2026 ARIANNA JAMES DAVIDSON r 38 ELLS AVE WEYMOUTH MA 02190 �`.' ilk I'ti6111.0.3" Failure to possess a current edition of the Massachusetts I. State Building Code is cause for revocation of this license. ,� Commissioner `��4-t K. /&,((.rq., For information about this license "-I Call(617)727-3200 or visit www.mass.gov/dpl THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Re•istration iiii ^� Type: Supplement Card CLEAN TECH CONSTRUCTION LLC trot tion: 196071 38 ELLS SVE �` . ....1MO. �'�ation: 06/27/2025 �WEYMOUTH,MA 02190 4 _ L°,',. Immomm won, ^r-•- < .o — Art F., SP Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:Supplenient Card Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 196071 06/27/2025 Boston,MA 02118 CLEAN TECH CONSTRUCTION LLC = }qtJ ARIANNA DAVIDSON y —n== fjp !V 38 ELLS AVE id,..,...,'. ../ a.�ZfL 44.G >!ti �G"Gl /Z WEYMOUTH,MA 02190 Undersecretary Not valid without signature ACCPREP DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 09/15/2023 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 CONTACT Gary Hebsch TOBMAN PARTNERS INSURANCE AGENCY INC PHONE E#): (617)471-1123 FAX No): E-MAIL ADDRESS: 9hebschC tmwins.com 21 MCGRATH HIGHWAY SUITE 303 INSURER(S)AFFORDING COVERAGE NAICte QUINCY MA 02169 INSURERA: TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED INSURER B: CLEAN TECH CONSTRUCTION LLC INSURER C: INSURER D: _ 40 MESSINA DRIVE INSURER E: • BRAINTREE MA 02184 INSURER F: COVERAGES CERTIFICATE NUMBER: 931330 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 LTRINSD WVD (MMIDD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ r DAMAGE TO RENTED CLAIMS-MADE I OCCUR _PREMISE$_LEa occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ I POLICY I jE LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY A OF ICER/MEMBER XCLU ED?ECUTIVE N/A N/A NIA 6HUB6R60053223 09/18/2023 09/18/2024 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA A EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B, no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires, or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued (unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage- Coverage Verification Search tool at www.mass.gov/Iwdlworkers-compensationlinvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Clean Tech Construction, LLC ACCORDANCE WITH THE POLICY PROVISIONS. 40 Messina Drive AUTHORIZED REPRESENTATIVE C Braintree MA 02184 J X �S Daniel M.Crowley.CPCU.Vice President—Residual Market—WCRIBMA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD °A�()R1� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 09/19/23 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 NAME: Tobman Partners Insurance Agency Inc. PHONE o,Ext): 617.471-1123 (AA/C,No): 617-773-2474 21 Mayor Thomas J McGrath Highway E-MAIL Suite 303 ADDRESS: Quincy,MA 02169 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Nautilus Insurance Company INSURED INSURER B: Safety Insurance Co Clean Tech Construction LLC INSURER C: 40 Messina Drive INSURER D: Braintree,MA 02184 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 EFF POLICY EXP INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE l 0 RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) S 300,000 MED EXP(Any one person) $ 5,000 A NN1562513 09/18/23 09/18/24 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B - OWNED x SCHEDULED AUTOS ONLY AUTOS 5931459 09/16/23 09/16/24 BODILY INJURY(Per accident) $ X HIRED X NATO -OSNEL D PROPERTY DAMAGE AUTOS ONLY W ONY (Per acadent) • X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 A - EXCESS LIAB CLAIMS-MADE AN1293596 09/18/23 09/18/24 AGGREGATE S 2,000,000 DED RETENTION$ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S It yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 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 Clean Tech Construction,LLC ACCORDANCE WITH THE POLICY PROVISIONS. 40 Messina Drive Braintree,MA 02184 AUTHORIZED R ENTATIVE ©1 -2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations It. Lafayette City Center 10 2 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): Clean Tech Construction Address:40 Messina Drive City/State/Zip:Braintree,MA 02184 Phone#:508-663-7874 Are you an employer? Check the appropriate box: Type of project(required): 1.111 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' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.t required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.111 Roof repairs insurance required.] t c. 152,§1(4),and we have no Insulation employees. [No workers' 13.❑■ 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:Traveler's Indemnity Co of America Policy#or Self-ins. Lic. #:6HUB6R60053223 Expiration Date:9/18/2024 Job Site Address: 63 Prospect Street 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 pains and penaltiesss of perjury that the information provided above is true and correct. Signature: .'2� Z7G%fiYdBrL Date: 8/14/2024 Phone#: 508-663-7874 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): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: WEATHERIZATION CONTRACT EVERS,URCE misaummmmmmmommokL CUSTOMER PHONE DATE CLIENT I WORN ORDER James Clayton (413)387-3069 07/03/2024 517659 38505 SERVICE STREET BILLING STREET PROPOSED BY'. 63 Prospect Street 63 Prospect Street Daniel Diaz SERVICE CITY,STATE,ZIP BILUNG CITY,STATE.ZIP Program. Northampton, MA 01060 Northampton, MA 01060 EGMA-HES Page 1 DESCRIPTION QTY COST INCENTIVE TOTAL KNOB &TUBE WIRING We have identified the potential existence of knob&tube wiring in your ,/c' (initial.) home.The following contract is not valid unless accompanied by the Weatherization Barrier Incentive form,signed by your licensed electrician.Work will not proceed until we receive a copy of this form. HOME AIR SEALING 6 5639.54 S639.54 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.) WEATHERSTRIP DOOR 1 $36.32 $36.32 Provide labor and materials to install 0-Ion weatherstripping to 0 door(s)to restrict air leakage. ATTIC DAMMING 28 S77.84 $58.38 $19.46 Provide labor and materials to install an approved damming material in the attic ATTIC FLAT- 13"OPEN R-45 CELLULOSE 741 51,971.06 $1,478.30 S492.76 Provide labor and materials to install a 13"layer of R-45 Class I Cellulose to open attic space. SLOPE-6" DENSE R-19 CELLULOSEL 352.: $1,073.600 $805.20: $268.40. Provide labor and materials to install a 6"layer of R-19 Class I Cellulose to sloped ceiling area: HATCH- INSULATE RIGID BOARD 1 S53.96 $40.47 S13.49 Provide labor and materials to insulate the back of an attic hatch with 2"rigid insulation board at R-10. SHEATHING ACCESS 2: S92.48 $69.36 $23.12 Provide labor and materials to make an access opening from one Li attic area to another by cutting a passage through sheathing. This 0 access will be left open as it is between two common unheated non firewalled attic areas. VENTILATION CHUTES 135 $631.80. $473.85 $157.95 Provide labor and materials to install ventilation chutes in the rafter bays to maintain air flow from the soffit ventilation. INSULATED BATH EXHAUST HOSE 4 INCH 1 $32.23 $24.17 $8.06 Provide labor and materials to install an insulated 4"exhaust hose to existing bathroom fan(s). Document Ref:RYJVA-WS5KP-SQXNY-OIYOQ Page 1 of 4 WEATHERIZATION CONTRACT EVERS,-a URCE CUSTOMER PHONE OATS CLIENTC WORK ORDER James Clayton (413) 387-3069 07/03/2024 517659 38505 SERVICE STREET BILLING STREET PROPOSED BY, 63 Prospect Street 63 Prospect Street Daniel Diaz SERVICE CITY,STATE,ZIP BILLING CITY.STATE.ZIP Program Northampton, MA 01060 Northampton, MA 01060 EGMA-HES Page 2 DESCRIPTION QTY COST INCENTIVE TOTAL GABLE VENT 3 $419.22 $314.42 $104.80 Provide labor and materials to install an aluminum attic vent in the gable. Total: $5,028.05 Program Incentive: $3,940.01 Client Total: $1,088.04 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 ma or decrease the size of the Program Incentive Share. _ Jaw.:aye* RISE Representative Client Signature 07-03-2024 Printed Name Date of Acceptance Document Ref:RYJVA-WS5KPSQXNY-OIYQQ Page 2 of 4 404et mass save Savings through energy efficiency PERMIT AUTHORIZATION FORM 1, James Clayton owner of the property located at: (Owner's Name) 63 Prospect Street Northampton (Property Street Address) (City) hereby authorize the Mass Save® Home Energy Services Program assigned Participating Contractor to act on my behalf and obtain a building permit to perform insulation and/or weatherization 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. Jatues' Claglozc Owner's Signature 07-03-2024 Date FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: A� Pa.®' c erz 8/14/2024 Participating Contractor Date Document Ref:RYJVA-WS5KP-SQXNY-OIYQQ Page 3 of 4 ••••• ••' .•••.•, .•❖�• ..•••• Signature Certificate :ii Reference numb RYJVA-WS5KP-SQXNY-0IYQQ ..•.. ••7•4. !•❖. AN :O•: :me, �� •:•;• Signer Timestamp Signature .•. '00: Robert Given .;•;: ,��� Email rgiven@nseengineenng.com ��... •••••: R��� '.•d: ,•.� Sent: 03 Jul 2024 16:21:25 UTC ,;;•••• .;•�:� Signed: 03 Jul 2024 16.21:25 UTC - -_-- :.•;•. ••••:' IP address 108.49.236.58 ••••• •....s. Location:Reading,United States ,•••••' James Clayton •;•;•: Email:jclayton63@gmail.com .;•;•: :•�•�. I n '••4••. ••.•: Sent 03 Jul 2024 16 2125 UTC 1 Jat I . cf / �j),•4 •.•••. �.i� Viewed. 03Jul202418-44:13UTC V1uj((N (�(i(j(�+ ;�;:; • i�i;.; Signed 03 Jul 2024 18.44:52 UTC .••••' • '••:• Recipient Verification: IP address.73.159.8.61 WO :;i;: • Email vented 03 Jul 2024 18:44:13 UTC Location:Northampton,United States '.•i: :.:.i '. . 'O•'• Document completed by all parties on: .':••••. ;:: 03 Jul 2024 18:44:52 UTC ;:;:••:, •j.''• : Page 1 of 1 AN• . •..• •.•.. ••. •❖.' �•i•: :•••i • P.•••. .••. : •. .N. 4.0. . ..• •.• ••••• 4.4 AN .••••• '1•••: .••• • me. MA W.NV Signed with PandaDoc ;....•: • ;•• PandaDoc is a document workflow and certified eSignature , 'a• ,;; V. solution trusted by 50,000+companies worldwide. Er 'U ••••.' •.. i••• " •• ••••. .. :•-v- •iii•iiiiiiiiiiii•-:iiiiii••iiii•-:iiiiiiii❖i:i•-•iiii:iiiiiiiiiiiiii:i•-•iii•-:iiiiiii•+•••••••••iiiiiiiii•:•i••••i••••• Client: James Clayton RISE Address: 63 Prospect Street AN EMPLOYEE-OWNED COMPANY Northampton, MA 01060 Energy Specialist: Daniel Diaz Phone: (413)387-3069 Program: CMA-HES Client# 517659 Work Order# 38502 Work Scope DESCRIPTION Qty Notes 1 KNOB&TUBE WIRING(Northhampton) 1 2 HOME AIR SEALING 6 3 ATTIC DAMMING-R-38 FIBERGLASS 28 4 ATTIC FLAT-13"OPEN R-45 CELLULOSE 741 5 SLOPE-6"DENSE R-19 CELLULOSE 352 6 ATTIC HATCH-INSULATE 1 7 ATTIC HATCH-WEATHERSTRIP 1 8 VENTILATION CHUTES 135 9 INSULATED BATH EXHAUST HOSE 4 INCH 2 10 GABLE VENT 12 X 12 3 11 ASBESTOS HAZARD 1 12 LEAD PAINT 1 13 STORAGE-ATTIC 1 Diagram • mass save 2022-23 Weatherization Barrier Incentives._.., 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 INSTRt.CTIONS 1.Hire a qualified,licensed contractor to evaluate and/or remediate the weatherizatlon Darrier(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:RISE Engineering,766 Aftucks Lent,Hyannis,MA 02601 or email to MassSave i;RISEenginasring.com. 3.The weatherization incentive will be deducted from the customer co-payment amount of the weatherization work.A rebate check will be issuec in the event the amount exceeds the customer's co-payment amount. 4.Complete the recommended weatherization Improvements. CUSTOMER INFORMATION J Customer Name: James Clayton Client#or Site ID: 517659 Site Address: 63 Prospect Street City: Northampton State: MA Z,p 01060 Weveab Number: Phone Number:: 413 Email. 1 9 -387-3069 _ jclayton63@gmail.com , .mot �7 Custometf Horneowns signatute .Ar 0 -- Date__--6�//C7"p---- KNOB AND TUBE WIRING To determine if there is any active nob and tube wh n he contractor will evaluate the following areas where eligible Mass Save' weatherization recommendations have been made: ✓Attic Floor Attic Wall ✓Attic Slope Exterior Wall Basement Otne': �r0 bo BMW at cy ow Energy so0.a st /I have performed my inspection and determined there is no active knob and tube wiring in the areas selected below. VAttic Floor Attic Wall ✓Attic Slope Exterior Wall' Basement Other: Other:_- Contractor Name: , (Live' `-' t e f C Address: 6"7 .t -S,r7/i.'l _ ^v%, City F f t"f e t 1 4 e State:el 4 ZIP: 0< 0 O 1 Company Name: C. F' T' C ( T '<< C License Number, j ,A e- % contractor signature: �"� t " .• C•- C Date: 772./f 3-3 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 reed and agree to the Terms and Conditions outlined on the bads of this form. MECI4ANIQAL SYSTEM BARRIERS(To he fried out by licensed contractor) High Carbon Monoxide:Contractor is to service and re-evaluate the selected mechanical system(s)and reduce the carbon monoxide level, 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. High Carbon Monoxide Draft Failure Existing CO ppm Revised CO ppm Existing Draft Pe Revised Draft Pa Heating System Hot Water Heater I^` Other Spillage:Contractor Is to correct the spillage of flue gases in the selected mechanical system(s).Must not spill after 60 seconds of operation. Heating System Hot Water Heater Other Contractor Name: Address: City: State: ZIP: Company Name: —_ _-__--_License Number: Contractor Signature: Dab: My signature confirms that I have performed my inspection of the mechanical 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. VENTILATION(ao to S?50 inpan'.n,; Exhaust Fan for Fresh Alr.Contractor to Install exhaust fan to provide measured,continuous or Intermittent whole building ventilation. The required rate of flow must be capable of providing CFM(measured at fan). Kitchen Exhaust Vet Contractor to ensure kitchen exhaust fan is vented to the exterior using code approved materials. Plumbing Vent Stacks:Contractor to ensure all plumbing vent stacks are vented.to the exterior using code approved materials. Dryer Vent Evaluation:Contractor to ensure the dryer vent is exhausted to the exterior through hard metal ductwork. I have Installed an exhaust fan to the specifications noted above I have evaluated and/or repaired the dryer vent fan to the specifications noted above. aw Contractor Name: Address: City: State: ZIP: Company Name: License Number: Contractor Signature: Date: My signature confirms that I have performed my inspection of the ventilation 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 below. • TERMS AND CONDITIONS mammy 1loquinmentai Applicant must be a residentle,Customer of a participating 3. Dunne your Home Energy Assessment it was discovered that the identified Mass Save Sponsor.Cu stonier roust participate n the Mass Save Home Energy ?nectarine!system(x)are not creating sufficient DRAFT This condition is where Services Program(must reside in a 1-4 unit fern ly home).The qualifying barrier must exhaust gases are not moving through the chimney eta fest enough rats-The be ldentMec et the time or the tome Energy Assessment as a barrier preventing contractor must service the system(s)to correct the draft prob.ern in the selected the insbllation of proposed weathertzation improvements Customer must complete (us(s).New draft results must be provided on the front of this form and within the recommended weethenzatlon improvements to receive the applicable incentive acceptable draft ranges as described in Table 1. Customer must Submit the completed Contractor Evaluation Report including a copy of the dated and itemized invoice from the learned contractor on company letterhead Table 1-Acceptable Draft Test Ranges wdhln 60 days(poatrrwWd)of the Mame Energy Assessment if contractor Invoice is not provided within 60 days,the eligible weetherizatlon barrier incentive may be • Outside Temp CF) Minimum Draft t assure CPIs) i? forfoited.Customer stoer part.cipatbn does not guarantee the be.rier witl bo Cored.In ,. . 1_. ._�.._.. .. ..... ._... -.-'_ submitting this aopticat,on,the Customer agrees to al!Terms and Conditions. c10 T-"-------- - `2.5 -.�_— ____ ._.__.._i Contractor Responalbllpes and Acknowledgement:in performing any work in "K j 3t`.10-90 (Outside limp/40)•2.75 connection with the Wsetherizetion Barr er Incentive(as set forth in detail below), —>90 -0.5 the contractor dWl:(I)abide by all local,slate and federal guidelines.appllcabie laws(Including,but not limited to all apse:Cable environmental lows),building codes. regulations(including.but not limited to EPA Lead-safe end any ano ell other appticabie err ronmental regulations)and licensing requirements;end(ii)stop work and [shout!Pen IMalatlon(up to$250 neentsw):The.results of the completed blower immediately notify the customer:n any case where existing or possible health and/or door test at the time of your Mine i-.mercy AsSesament Or scheduled weatherization safety Orobams exist.The licanto°contractor must fill in and sign off on the testing installation with a vart'c.pat.ng Contractor,determined that your home will need an results in the appropriate place on this form.Contractor shell remain stxele and fitly f increase in fresh air flow before undertaking any program eligible weetherization work. responsible nor their confirmations and notes that they provide on this form and with Mass Save provides s Wielheniration incentive for the installation or an exhaust ten to respect to the Contractor Responsibilities set forth above. provide additional fresh air to the hone.Your Energy Spatia ist can bolo determine the necosiary flow rate end provide recommendations Thus incentive is only available in irri.ted situations and not a:i customers will receive a blower door test et the time of the Knob a Tube WIHng Eveluatbe(up to$210 bmroo t)the The knob and tube vrslnit biome f:nergy Assessment. an that hes be noted Cannot be determined'inactive at the time of the Moore Energy Assessment performed by the Mess Sava Nome Energy Servi a Program.Even H the Dryer vent ivaivatbn(tip to$250 incantMx Contractor to ensure the dryer vent:s observed wiring bottlers to be inactive,then right still be active circuits located in si exhausted to the exterior through hard metal ductwork redesss:bis areas Of the home(ie,walls,etc-3.The Masa Sate.home Energy Services Program reduirae that a licensed electrician verify the absence or Inactivity of the .Kltcken Exhaust Vent(up to$2f0 Incentie):It was discovered during your Home knob and tube wiring in thrones of your home where we are proposing Insulation r Energy Assessment that your kitchen's exhaust fan was not property vented in be installed.We advise you to share this form with your electrician before hiring them y accordance with State building code.Mass Save provides a Weatherizaton Incentive to to inspect your ikon to ensure they egfee to the terms.The Home Etvergy Services have a contractor ensure your kitchen exhaust fan is vented to the exterior of the home Program will rely on tea electreaterse CMtlflgNpn end wet oot be liable N:haCetirate- s using ccxd.,approved materials. App(icatlon forme The (1)rnytimasectoutoseeeh()t gUtleuYlt slid ' tslsnbtre vent sucks pp to$250 kicsteem):it was discovered during your Hans energy accurately The customer must- end h ennet a comtplobQ soolka,•tin along with Assessment that your homey plumbing vent sleck(s)are not properly vented in all required documentation for specificnbetes.ay Wb11* sg the rebate appecatiori accordance w�tn State bw!dng code.Mass Save provides a Weathonrat�om incentive the customer agrees to abide by these Wan and COndkioen to have a contractor ensure all plumbing vent stacks we vented to the exterior of the home s ang code approved materaS- Liability:Outs to the liability involved with signing this type of farm.we suggest you show or doscr-be this form to your Massachusetts licensed electrician poor to hiring R+n.!her to inspect your home-to be sure he/she-s wining to sign it.Ct_EAResult and the Mess Sate Homes Energy Services Program*if rely on the ilcensed electrician's determirotion and certification and will not be I able If It is inaccurate. Mechanical System avaltation(up to$230 Mpentfv,).Combustion safety testing has WE ARE MASS SAVE•: been cosdue ed on all eta heating and hot water systems in this home.Those tests are conductedd with all the exhaust equipment running s%nwltaneously,creating a"worst-ease- deprossurizetion of the building If a problem was iderntiied repairs to correct the problem m 1,RCE CE ust Mrec be completed by a qualified INAC cotor fire problems ano corrections are BERKSHIRE EVE RS es Wows: GAS ,il1 1. Carbon monoxide levels exceed tee ppm In the wdfutec fk,e gases.After a dew. rri4rurc�r • and tune or other applicable service,the meaaurernent(f)of undiluted flue gas of carbon monoxide ere to be recorded on the front of the Contractor Evaluation • Liberty nationaigri Report whered 0 j,prtjl program rues state the maximum ellowatre[oricentra;ion:s 100 gem 2 Dunne your Home Energy Assessment it was discovered that the identified meetsanic,:system(e)was continuously spiting exhaust gases into the home This condition:s also known as back oraft and should end within 60 seconds of system operation in Order to be Considered acceptable.The contractor must service the systems)to correct the spillage probiarri in the selected fue(s), end certify by signature on the front of this form that tee spillage Condition has ceased after 60 seconds of operation. FOR ADDITIONAL INFORMATION,PLEASE CALL 339-SO2.633S. DEBRIS DISPOSAL AFFIDAVIT In accordance with the provisions of M.G.L. c. 40, s. 54, Building Permit 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: Clean Tech Construction Name of Waste Facility Not Applicable - No Debris 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 42;a4fdZCL Signature of Permit Applicant Date