Loading...
HomeMy WebLinkAboutBuilding Permit #672-15 - 28 CABOT ROAD 2/26/2015BUILDING PERMIT 6,. TOWN OF NORTH ANDOVEW' APPLICATION FOR PLAN. EXAMI NATION�,--,'.- -7 1 Permit No#:612--I! Date�Recei.vpd'. Are a AcHU Date Issued: IMPORTANT: Applicant must complete all items onthispage O J" 4p"Ro 77 'p t 66 YQ. . no r "e if Y,,. S- iMAP -e-s yes MEW K 11D 1 ITIf n y 1A b e._ +n.6 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building 0 One family 0 Addition El Two or more family 11 Industrial AAlteration— No. of units: 0 Commercial El Repair, replacement 0 Assessory Bldg El Others: 11 Demolition El Other LFF, 'Wetlands 0- '410 � 7-11, 7� Floodplain f ---' I r . n I . DESCRIPT ON OF VVORK TO PE PERFORMED; 07 Identification - Please Type or Print Clearly OWNER: Name: Phone: Address: ARCHITECT/ENGINEER Phone: Address: Reg. FEE SCHEDULE. BULDING PERMIT'VZOO PER $1000.00 OF THE TOTAVESTIMATED, COST BASED ON $125.00 PER S. F. Total Project Cost: $ a�l FEE:$ Check No.: Recei0t'No:..`.:` NOTE: Persons contracting with unregistered contractors do.fiot-haveacces�to toe guaranty funds Location 2-8 No. 2 jz-co Date (012 1�7 Check # /00 28610 TOWN OF NORTH ANDOVER ' Certificate of Occupancy $- Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL $ Building Inspector Plans Submitted ❑ Plans Waived. El Certified Plot Plan ❑ Stamped Plans ❑ �ypF OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature, CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature , COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Con neCtion/Sig nature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street _ k E DEPAR MT ENT = Ternp Dumpste onsite y�esa �' ' }[no- s. - t (Locatedtat t12 LMirjStreet: CFre:_Depya�rta ngnatur�e%dated ...� g. Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2008 No Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 2008 idPP!-FO 3 0 H E9* t;u LLI S LL 0 CC C cu L Y \ O O LL w TO N U a N N 0 N Z Vr Z G J_ m O "O 7 O LL L D O d' C E L U - O LL 0 H Z (7 Z m J d L O �' C LL 0 u Z Q U_ W L =1bo w O OC U � N Ln m Co L1 oC O a Z y� Q L to d' C LL Z LUU °C Q W 0 W 5 LL i :3- Co O z ++ N {n N N Y O N .� O OV Q. 4.; ro- - 3iaoi = as CL L16.0 E 6: C N � J � CL >0 N O $ O O > N n E c o `° CL C p aMi - ) O C m m 0 C 1) 0) �H0�= = m CL N F' NLLJ O V m N W_ _ -0 +��+ O O .F N O N O Q. L O V = V O W i v y H UQ d 3 d N J �j N to -0 O0. "' C _O Z CIOz 0m co Z Cl) w x LLIH LLJ w/ CL O LU z Z m Cl) ■ U r z 0 W z T ti pq F - • Nv N w ft di E d Z 0 rM7 L.: CL 01— m m F- 00 --- -a 0 0 O Q Q � Q J O z CLN i Of ice of ConSLImer Affaits and. BLISineSS Regulation 10 Park Plaza - SUite 5170 Boston, Massachusetts 021 16 Home Improvement. Contractor Registration Reqistration: 165640 Type: LLC Expiration: 3115/2016 AIR - TIGHT LLC. 4/VEATHERAZATIQN JAMES EQRTIN 10 PINE KNOLL DR. BEVERLY, MA 01915 01'lice of Constj"ter Affairs & Itusincss Rc2idaaIion t Registration: aoROVEMENTCONTRACTOR I € S 165640 Type: `T•. -' Expiration: 3/1512416 LLC AIR - TIGHT LLC. WEATHERAZATION JAMES FORTIN 10 PINE KNOLL DR. BEVERLY, MA 01915 `trndcrsecrrtara Trt/ 248557 Update Address and return card. Mark reason for chane. Address Renewal Employment Lost Card License or registration valid for individul use only before the expiration cute. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, NIA 021.16 Not vai�,,ill ignature �� I•a.. `25,;1 ��* r jir1 J7 l •.irIrl, tars <I k 1 ;I, :r• CS -052576 }'v JA.NIES Ii FOR -1 -IN III '1'1:VE,,KNOIJ.DH I3cvcrls MA 01915) 10/03/2015 The Commommilth of Massachusetts Department of Industrial A cciilent.v Qff ice of hrveJvtigatiotts I Congress Street, Suite 100 Boston, MA 02114-20.17 mvlv.masv.gov1di(i Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print LeLyihly Business/Organization Name: Address.- ct,ty/slatc/zIP: 1) hone YI: Are you an employer? Check the -.1ppropri.Ate I)ox: I aill a employer \Viol employees (fitill and/ or part-tillic 2. ❑ f M11 a SOIC proprietor, or partnership and have no employees working, to nic in any capacity. fNo workers' comp. ing,11-alicc j.cqjjjj-c(jj 3, ❑ We are a corporation and its officers have exercised their right OfeXcrilptiorl per c. 152, § 1(4), an(] \vc have no employees,. tNo Nvorkei-s' comp. instirancc r-cqtiire(fj* 4. E] VVe are a non-profit organization, staffed by VOIL111(cel-S, with no employees. [No \vorkci-s' comp. i mm ra rice req.} Business Type (required): 5. 0 Retail 6. E] ltcstaLix-aritff-iai-/1: itijii-! Establishnicnt 7. E] Office and/or Sales (incl. real estate, UL110, etc.) 8. Fj Non-profit 9, El l"Mtertainment I 01n Manu.1actming H.E] licalth Care 12.n Other MIY N)P11C;R1( Mat chceks' box NI must also ('111 out the section below showing their workers' compensation policy i'fOrmation. " H- the corporalc officer-, have exemptal (11CITIselve" but tile corporation has other employces, ;I workers' compensartim policy k required and such ❑in 01'gaMiZ+160rl 1,11 OIL [(I cheek h()1, !it. um art entjd({rer that is providing worhers.* eorxzarrc rr,sUtinrl insurance for nij, emj)1qjYees. Below is the policy info rill atio 11. insurer's A (ld \A . ......... . . ....... • .. — ------- -A , k2 J, N ,,i �,, -, Polic\ 11 (l r Self -ins. 1- i a C� Attaid, a copy of (fie Nvorkers' compensation policy declaration page (showing the policy ntimber and expiration (late). FailM-C to SCCUrc coverage as rC(jUil-Cd under Section 25A of'M,,GI, c, 152 can lead to the imposition of criminal penalties ol"a fine tip to S 1,500,00 and/or one-year i 111pri soil inclit. as well as civil penalties in the form ofa STOP WORK 0RDF'R and a fine of it[) to $250,00 a day against the violator. Be advised that a copy of'this statement may tic tbrwarded to the 0111cc of Investigatiorls, ol'the DfA flor insurance coveragc verification. do hert,.,br certif p, under the pains atidpettaftiev ofperjiiry that the ill rmalimprovidedabove is id true mcorrect fio a kc: — - ---------- Phone fl: Official use only. Do not write in this area, to be completed by ci(j, or fawn official, City ,ol-Tolyll: Permit/lAceme (circle one): 1. Board of Health 2,13WIding Department 3. City/Town Clerk 4. Licensing.13oard 5, Selecitnerl's office Contact Person: phone #: I'll "..MINS,govaltil ACC)R & CERTIFICATE OF LIABILITY INSURANCE F___�DATE 13I2015vv) 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 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 TGA Cross Insurance, Inc. 401 Edgewater Place Suite 220 Wakefield MA 01880 CONTACT Jill DeHetre NAME: PHONE AIC.. (781)914 -100 0 AIC No: (781)224-5777 E-MAIL dehetre@t across.com ADDRESS:? g INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Arbella Protection 41360 INSURED Air -Tight Weatherization, LLC 9 Story Ave. Beverly MA 01 915 INSURERB:Arbella Mutual 17000 INSURERC: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:CL14111923181 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 LTR TYPE OF INSURANCE ADDL UBR POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY 'RM MEMISES Ea AGES ( RENTED 100,000 occurrence $ A CLAIMS -MADE I XI OCCUR 8500046432- 3/8/2014 /8/2015 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 $ POLICYFX PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Eaaccident 1,000,000 _ BODILY INJURY (Per person) $ A ANY AUTO ALL OWNEDX SCHEDULED AUTOS AUTOS 1020015286 3/8/2014 /8/2015 BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident X HIRED AUTOS X NON -OWNED AUTOS Ph scial Damage Perils $ X UMBRELLA LIAB X OCCUR I EACH OCCURRENCE $ 2 , 000 , 000 AGGREGATE $ $2,000,000 B EXCESS LIAB CLAIMS -MADE DED I X I RETENTION$ 10,000 $ 4600052930 3/5/2019 /5/2015 WORKERS COMPENSATIONWC STATURY - OTH- IR AND EMPLOYERS' LIABILITY YIN N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT 1 $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) L,r-K 1 11-II.A I C r1ULUCK %,AIVI.CLLA I IUIV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street Building 20, Suite 2035 AUTHORIZED REPRESENTATIVE North Andover, MA 01845 Thomas Gregory/JD2 ACORD 25 25 (2010/05) INS025 (?mnn.5i ni ©1988-2010 ACORD CORPORATION. All rights reserved. Tho Arr)pn name and Innn aro ronic►ororl marlrc of Arr1R11 CERTIFICATE OF LIABILITY INSURANCE DATF(MMIDDlVYYY) 01 /13/2015 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 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 MassPay Insurance Services, LLC 27 Garden Street, Unit 1 B Danvers, MA 01923 CONTACT ,Jacqueline Marie Melanson, CLCS NAME: PHONE Ext : (978) 774 4338 x105 ac No): (978) 774-1318 E-MAIL ) @p ackie hilrichardinsurance.com ADDRESS: INSURER(S) AFFORDING COVERAGE INSURER A: AmGUARD Insurance Company 42390 INSURED Air -Tight Weatherization, LLC 9 Story Ave Beverly, MA 01915 INSURER B: INSURER C: EACH OCCURRENCE $ INSURER D: MED EXP (Any one person) $ 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY __ CLAIMS -MADE L�J OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE ___ LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS L —_ _ COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident UMBRELLA LIAB EXCESS iCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / NM ANY PROP RIETOR/PARTNER/EXECUTIVEE.L. OFFICER/MEMBER EXCLUDED? [ (Mandatory in NH) If Yes, describe under DESCRIPTION OF OPERATIONS below N / A AIWC576437 07/01/2014 07/01/2015WC STATU- OTH- _S I ER EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1.000,000 E.L. DISEASE - POLICY LIMIT 1 $ 1,000000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) Proof of Workers Compensation Town of North Andover 1600 Osgood St Bldg 30 Suite 2035 North Andover, MA 01845 GANGtLLA I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD To Whom It May Concern, I, James Fortin, do authorize William M. Crowley to act as my agent in the process of applying for building permits and other necessary documentation pursuant to the conduct of my business by Air -Tight Weatherizaiton LLC. tl�ggnature� State of Massachusetts County On this \cA day of SE �% , 2014, before me personally appeared to me known to the person (or persons) described in and who executed the foregoing instrument, and acknowledgement that he/she/they executed the same as his/her/their free act and deed. l` g�,OBE+ RA MON AN Notary Public Notary Public COMMONWEALTH OF MASSACHUSETTS UlfMy Commission Expires Print Name: September 17, 2021 My commission expires: Conser at�on Services Group 50 Washington St. Suite 3000 Westborough, MA 01581 Robert Bryan l 28 Cabot Rd North Andover, MA 01845-3502 SitelD: S00002285059 K�\, RTIFICATE OF COMPLETION �0 / Phone (Eve): 978-688-0761 Phone (Day): / E -Mail: salbry2@yahoo.com Combustion Safety Test Completed YIN Pre Blower Door # (If applicable) Post Blower Door # (if applicable) Contract ID: 20141207_ASEAL Company: Air -Tight Weatherization Sub -contractor Work Order #: S85059P91093C271 QuantltY Installed) . Exterior Door Weather Stripping 3 Living Space Perform Air Sealing at Estimated 62.5 CFM50 Per Hour 6 Door Sweep 3 Contract ID: 20141207 WORK Sub -contractor Work Order #: S85059P91093C271 Location- Y 7 Dcrtton^`= _ r ar xr Qwantlty Installe _ml d ... ,.i.. Living Space Hatch: Thermal Barrier Polyiso 2 inch (Attic) 1 Damming 30 Living Space Insulate Rim Joist with 6.25" Fiberglass Batting 26 Living Space Attic Floor Open Blow Cellulose 7" 624 Living Space Insulate Wood Shingle Sided Wall With 4" Dense Pack Cellulos 1,216 PLEASE NOTE: The Inspection of the house is for the purpose of finding CUSTOMER AUTHORIZATION OF CERTIFIED WORK out whether the Contractor completed the work. CUSTOMER SHOULD NOT RELY ON THE INSPECTION FOR ASSURANCE THAT THE CONTRACTOR'S WORK NECESSARILY COMPLIES WITH ALL LAWS AND STANDARDS RELATED TO SAFETY. It was the Contractor's sole responsibilty to assure that the measures were installed properly and safely. In addition, this Post -Installation Inspection does not replace inspections by licensed inspectors where required by state or local law. It is the duty of the Customer to obtain such required inspections. Contractor's Signature Date I confirm that the measures listed above have been completed to my satisfaction. I have received a copy of the Certificate of Completion and hereby authorize the release of any final payments to the Contractor. I understand that this Authorization of Completed Work does not in any manner void any warranties provided to me by the Contractor. Customer's Signature Date Conservation Services Group - 50 Washington Street Suite 3000 - Westborough, MA 01581 - (508) 836-9500 C o n Lig Services Group 50 Washington St. Suite 3000 Westborough, MA 01581 CONTRACTOR WORK ORDER Printed: 1/28/2015 Work Order Id: S85059P91093C271 rroi tractoralrifoion - � rmat s Cutomer/Ste Air -Tight Weatherization Robert Bryan Email: salbry2@yahoo.com 9 Story Ave 28 Cabot Rd Phone (Eve): 978-688-0761 Total $ Phone (Day): 3 Beverly, MA 01915 North Andover, MA 01845-3502 Site ID: S00002285059 ofi 57-otal Installed' Measulre8} _ry f z w z a` , _ fr Location Description Quantity Unit $ Total $ Exterior Door Weather Stripping 3 $27.59 $82.77 Living Space Perform Air Sealing at Estimated 62.5 CFM50 6 $84.32 $505.92 Door Sweep 3 $23.18 $69.54 Living Space Hatch: Thermal Barrier Polyiso 2 inch (Attic) 1 $41.71 $41.71 Damming 30 $2.19 $65.70 Living Space Insulate Rim Joist with 6.25" Fiberglass Batting 26 $2.40 $62.40 Living Space Attic Floor Open Blow Cellulose 7" 624 $1.53 $954.72 Living Space Insulate Wood Shingle Sided Wall With 4" Den 1,216 $2.16 $2,626.56 Installed Measures Total $4,409.32 'IVorkOrder}Notes; r,Paymen>ts -. Incentive Payments Customer Share Air Sealing Incentive Weatherization Incentive Total Incentive Payments Total Customer Share Less Deposit Of Customer Share Balance (Due Contractor) $658.23 $2,000.00 $2,658.23 $1,751.09 $583.70 $1,167.39 Conservation Services Group - 50 Washington Street Suite 3000 - Westborough, MA 01581 - (508) 836-9500 Residential Air Sealing Work Order Con' SDaig Printed: 1/15/2015 Pg: 1 Services Group 50 Washington St. Suite 3000 Westborough, MA 01581 �CusfomerlS�te Robert Bryan Phone (eve): 978-688-0761 28 Cabot Rd Phone (day): North Andover, MA 01845-3502 Site ID: S00002285059 I Home Infglrr>aation: Heating Fuel: Oil Building Volume: 8,736 BAS cfm50: 813 Distribution Type: Boiler with DHW - Baseboard ,Existing Conditions ri - - _ :— �_.. —_� __k- _ __. - 4:i Existing Insulation: Fiberglass Batts Depth: 5.0 Truss Construction: __.. _ Can Blower Door Be Completed? Yes Area Notes �,- b _ Attic Basement/Crawlspace All Accessible Penetrations: Yes Exterior Penetrations: Yes Therma-Dome: No Ceiling Penetrations: No w/carpentry: No Exterior Door Weatherstrip: No WHF Box: No Vapor Barrier (Sgft): No Additional Areas of Concern... Additional Areas of Concern... Garage Living Space All Penetrations: No Plumbing: Yes Weatherstrip Door to Living Space: No Weatherstrip Exterior Doors: Yes Additional Areas of Concern... Additional Areas of Concern... Front, Side, Basement Conservation Services Group - 50 Washington Street Suite 3000 - Westborough, MA 01581 - (508) 836-9500 Con sDa 5 Services Group 50 Washington St. Suite 3000 Westborough, MA 01581 Customer/Site Details: Robert Bryan 28 Cabot Rd Residential Air Sealing Work Order Printed: 1/15/2015 Pg: 2 North Andover, MA 01845-3502 - ., , Contractar Motes Start time: Stop time: _ AS Techs: - Pre CFM 50: Post CFM 50: CFM 50 Reduction: Combustion Safety Test Completed? Yes No Pass or Fail? RCS PLANVIEW DIAGRAM Customer: d Home Phone: ( !R 76- )- G 0 Address:Ca 1, OL 0,6 Work Phon�5 ( )- - Town: fij_ rn(\�,J r Cell Phone: Any limitations for access by large truck? No V Yes If yes, describe: Any specific directions or landmarks? No Yes If yes, describe: Site ID:—a Energy Specialist: G(i L Reviewed by: • AFL Open Blow Cell 7" - (624) 2!" �0 (2. Hatch: TB Poly 2" - (1) (3.) Insulate R/J - (26) su, C < (4.) Insulate Wood Shingle Wall w/4" (5.) Damming - (30)vT DP - (1216) '',, r"i` _ 3> FFA s«Q A -- X AIL $ r- <--_� 3jS1� Y ri r 0 1 ■ ' ❑k 4. � For Office Use Only 1 e IJ Bushes Ladder Neighbor Proximity Pocket Doors Insert Radiators Fence(s) Existing Conditions X = Access ❑ = Vents Note Inside Square R= Roof S = Soffit G = Gable RV = Ridge Vent CS = Continuous Soffit ' CDE = Continuous Drip Edge T = Triangle Install O = New Access Note in Circle C = Ceiling W = Wall S = Sheathing Temp Unless Noted Otherwise = Vents Note in Triangle R = 8" Roof S = Soffit G = Gable M = 12" Mushroom For Access Rev 1/14 CONTRACT FOR Conser atlon PRODUCTS / SERV/CE WORK S V%11 e5 O Gr u �C F This service is brought to you through support from your local utility This Agreement is made by and among... 6 _ . Living Space _ and Robert Bryan Conservatioin Services Group (CSG) . 28 Cabot Rd :R CS :. NortllAndover ,`MA i0184S3502 ... ......_..._ 50 Washington Street, Suite. 3000 Site TD: 500002285059. Westborqugh, MA 01581 Project ID: P00000291093 Reg. No. 173484 Customer ID C0000029SI65 Federal ID No. 222457170 Contract ID:.20141207 ASEAL .:(Mail completed,contract to address above) I. DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the following work on these "Premises" in a professional manner and in accordance with the teams of this Contract, including the attached recommendations/work order describing the work in detail (the "Work") which are incorporated herein by reference: Description Perform Air Sealing at Estimated 62.5 CFM50 Per Hour I]oor Sweep Exterior Door Weather Stripping IP For office use only Quantity Location 6 _ . Living Space _ $505.92 - ._ ...... 3N/A $69.54 3 N/A$82.77 .... .._.. .. ........... ... ......_..._ Sub Total. $658.23 Utility Incentive Share $658.23 Customer Contribution $0.00 Printed: 12/16/2014 Page 1 of 2 II. PAYMENT Customer agrees to pay Contractor for the Work, the Customer Share of the Contract Price as follows: Payment #1: $ 0 as a Deposit payable to CSG upon signing the Contract (not to exceed 1/3 of the total retail costs). Mail clieck & contract to CSG, Attru RCS, 50 Washington St., Ste. 3000, Westborough, MA 01581. Final Payment: $ 0 as the final payment for the Work shall be payable to the Independent Installation Contractor ("IIC") upon satisfactory completion of the Work. Customer understands that he/she will not be required to pay the Utility Incentive Share of the Contract price in the amount of $ 65 23 Changes to individual line items and/or previous incentives may increase or decrease the size of the Utility Incentive Share. III. DISPUTE RESOLUTION The IIC and Cusinmer hereby mutually agree in advance that in the event that the IIC has a dispute concerning this Contract, the UC may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Afthirs and Business Regulation and Customer shall be required to submit to such arbitration as provided in MG.L c 142A. You may cancel this agreement if it has been signed by a party at a place other than an address of the seller, provided you notify the seller in writing by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agre me�nnt. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Customer Signature -z D to Indicate your selected IIC here, if applicable (ok) Initial here if you want Gre arida I2/ 15/ 14 Gree Janda the Program to assign` a gg I Participating Contractor CSG Signature Date Name ofG� Representative (Printed) TERMS AND CONDITIONS APPEAR ON TIM REVERSE. 3114 CONTRACT FOR Consel- atlon PRODUCTS / SERVICE WORK Cons0eration Services Group I. DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the following work on these "Premises" in a professional manner and in accordance with the terms of this Contract, including the attached recommendations/work order describing the work in detail (the "Work") which are incorporated herein by reference: Description This service is brought to you through support from your local utility This Agreement is made by and among Robeil Bryan and .28 Cabot Rd Conservation Services Group (CSG) North Andover, MA 01845-3502 Attri: RCS Liwng Space 50 Washington Street, Suite 3000 Site ID; $00002285059.:.Westborough, MA 01581 Project ID: P00000291093 Reg. No. 173484 - Customer ID: C00000295165 Federal ID No 222457170 contract ID: 20141207 WORD . (Mail completed contract to address above). . I. DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the following work on these "Premises" in a professional manner and in accordance with the terms of this Contract, including the attached recommendations/work order describing the work in detail (the "Work") which are incorporated herein by reference: Description Quantity Location Attic Floor Open Blow Cellulose 7' I.... . 624 Living Space _ _. .. $954.72 Hatch Thermal Barrier Polyiso 2 inch,.(Attic) 1 Liwng Space $41.71 Insulate Rim Joist with 6 25 Fiberglass Batting 26 _ Living,Space . _ ... $62.40 Insulate Wood Shingle Sided Wall With 4' Dense Pack Cellulose. , 1,216 Living, Space __ „ $2,626.56 Damming 30 _......_N/A_ ......... _.._ _ $65.70 ......._........ Sub Total: $3,751.09 Utility Incentive Share $2,000.00 Customer Contribution $1,751.09 O nFor office use only Printed: 12/1612014 Pape 2 of 2 II. PAYMENT Customer agrees to pay Contractor for the Work, the Customer Share of the Contract Price as follows: Payment #1: $ 59370 as a Deposit, payable to CSG upon signing the Contract (not to exceed 1/3 of the total retail costs), Mail check & contract to CSG, Attn: RCS, 50 Washington St., Ste. 3000, Westborough, MA 01581. Final Payment: $ 1167.39 as the final payment for the Work shall be payable to the Independent Installation Contractor ("IIC") upon satisfactory completion of the Work. Customer understands that he/she will not be required to pay the Utility Incentive Share of the Contract price in the amount of $ 2000 Changes to individual line items and/or previous incentives may increase or decrease the size of the Utility Incentive Share. III. DISPUTE RESOLUTION The IIC and Customer hereby mutually agree in advance that in the event that the IIC has a dispute concerning this Contract, the IIC may submit such dispute to a private arbitration service which has been approved by the Office of Cons neer Affaas and Business Regulation and Customer shall be required to submit to such arbitration as provided in M.G.L. c 142A. You may cancel this agreement if it has been signed by a party at a place other than an address of the seller, provided you notify the seller in writing by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES, Customer Signature Da Indicate your selected IIC here, if applicable (OR) Initial here if you want Gregg Janda 12/14/15 (iParticipating CL gg Ianda the Prograng Contractor assign a CSG Signature Date Name of CS presentative (Printed) TERMS AND CONDITIONS APPEAR ON THE REVERSE. 3/14 Customer Name: Robert Bryan Site ID: S00002285059 CSG Enclosed Cavity Insulation Fact Sheet Your Energy Specialist has determined that your home would benefit from insulation. Below is a list of the problems that might be encountered during this process. We have selected those which may pertain to your existing siding material or interior areas being treated. Please read carefully each potential issue and sign at the bottom. A copy of this signed fact sheet must be returned with a signed contract or the scheduling of the insulation work will be delayed. At the time of your Home Energy Assessment the Energy Specialist evaluated the current condition of your exterior siding and interior materials. It has been determined that the process of removing certain areas of your siding, drilling holes and blowing in the insulation could result in some damage to the siding or to the esthetics of the paint. Prior to the start of the insulation job, the contractor will demonstrate to the homeowner a sample of the siding removal and reinstallation. Wood Clapboard & Sh'ingle.Sding 1 The present condition and age of the exterior shingle or clapboard plays an important part as to how easily the siding can be removed and reinstalled. Older siding that has been exposed to the elements and has numerous layers of paint or stain has a greater risk of being split or cracked in the removal process. Under these conditions a shingle or clapboard may crack in half when trying to remove it. When this occurs the contractor will try to reinstall the shingle or clapboard so the split or cracked areas butt up tight together. When it is not possible to reinstall a cracked shingle or clapboard, because the split or cracked areas will not butt up tight together, the contractor can repair the crack with exterior wood patch or as a last option replace the damaged area with a similar type of shingle or clapboard. Note: It is the homeowner's responsibility (if needed) to touch up paint or stain on shingles or clapboards that have been removed. Additional Areas Specified at Assessment 7 Additional Areas Specified at Assessment Customer Signature. w ,Bryan Date: .tan 13, 2015 For more information please visit the interactive house web site at http://masssave.csgrp.com/masssave_content.html FcrDffice U-ze c'nl Signature: L'lexr,Bxv ., r! ,;11 Its yaii o"', Email: salbry2@yahoo.com Bryan 2285059_Enclosed Site ID 2285059 EchoSign Document History Created: January 06, 2015 By: Mass Save (esign-res@csgrp.com) Status: SIGNED Transaction ID: X14GLXES74J7C5B "Bryan 2285059_ Enclosed_Cavity_Fact_Sheet_- —Site—ID-2285059" History �- Document created by Mass Save (esign-res@csgrp.com) January 06, 2015 - 1:30 PM EST - IP address: 199.102.118.86 St Document emailed to Robert Bryan (salbry2@yahoo.com) for signature January 06, 2015 - 1:30 PM EST )- Document viewed by Robert Bryan (salbry2@yahoo.com) January 06, 2015 - 2:04 PM EST - IP address: 100.0.117.151 Document e -signed by Robert Bryan (salbry2@yahoo.com) Signature Date: January 13, 2015 - 10:17 AM EST - Time Source: server - IP address: 108.7.235.29 Cavity_Fact_S January 13, 2015 Signed document emailed to Mass Save (esign-res@csgrp.com) and Robert Bryan (salbry2@yahoo.com) January 13, 2015 - 10:17 AM EST ® Adobe EchoSign SAMPLE PRE -RENOVATION FORM This sample form may be used by renovation firms to document compliance with the Federal pre -renovation education and renovation, repair, and painting regulations. Occupant Confirmation Pa hlet Receipt I have received a copy of the lead hazard information pamphlet informing me of the potential risk of the lead hazard exposure from renovation activity to be performed in my dwelling unit. I received this pamphlet before the work began. Signature Date Renovator's Self Certification Option (for tenant -occupied dwellings only) Instructions to Renovator: If the lead hazard information pamphlet was delivered but a tenant signature was not obtainable, you may check the appropriate box below. ❑ Declined - I certify that I have made a good faith effort to deliver the lead hazard information pamphlet to the rental dwelling unit listed below at the date and time indicated and that the occupant declined to sign the confirmation of receipt. I further certify that I have left a copy of the pamphlet at the unit with the occupant. ❑ Unavailable for signature - I certify that I have made a good faith effort to deliver the lead hazard information pamphlet to the rental dwelling unit listed below and that the occupant was unavailable to sign the confirmation of receipt. I further certify that I have left a copy of the pamphlet at the unit by sliding it under the door or by (fill in how pamphlet was left). sG/Ae A-14 Gt 4 Printed Name df Person Cerjfying Delivery Attempted Delivery Date Signature of Perh n Certifying Llad Pamphlet Delivery Unit Address Note Regarding Mailing Option — As an alternative to delivery in person, you may mail the lead hazard information pamphlet to the owner and/or tenant. Pamphlet must be mailed at least seven days before renovation. Mailing must be documented by a certificate of mailing from the post office. Customer Name: Robert Bryan Site ID: S00002285059 Date: 12/2/14 Mass Save Customer Disclosure and Preparation Requirements At your Home Energy Assessment your Energy Specialist has reviewed and identified applicable cost-effective opportunities, potential health and safety concerns as well as any customer required actions to facilitate improvements in your home. Your Energy Specialist is trained to evaluate and propose appropriate site-specific improvements that will reduce energy consumption and improve comfort. The following conditions were noted at the time of the Home Energy Assessment: Combustion Safety: Initial Here Issues Detected at Assessment Combustion Appliances: Issues Detected at Assessment Pipe Disclaimer: Issues Detected at Assessment Moisture Concerns: Issues Detected at Assessment Initial Here Initial Here Customer: Weatherizatiorr Preparation Requirements ❑ Storage Removal ❑ Platform Buildup ❑ CO ;q'etector `' Floorlri Removal` Specified .Measures Agreement SMA Customers are responsible to compiete any noted required -actions In order to'be eligible for program weatherIiAtion work at their homer The participating Contractor willbe confirming fhe. completion of these required.actions prior to scheduling an Irti'tial Here installation date.._ - 1.) Customer must install Carbon Monoxide (CO) Detector Prior to work This notice does not constitute an endorsement or warranty regarding the presence or absence of other real or potential health and safety hazards that may exist at this address or premises. If you have questions regarding this information, or to schedule a follow-up inspection after the noted conditions have been corrected, please call our Customer Service at 800-480-7472. Customer Signature: �o�e.er aL Date: Jan 23, 2015 Energy Specialist: Gregg Janda-277 Phone: 508-948-8372 Email: Gregg.Janda@csgrp.com 0 Conservation Services Group • 50 Washington Street, Suite 3000 • Westborough, MA 01581 Far Gffke Uce Gn lv Robert Bryan Mass Save Customer Disclosure & Preparation Requirements EchoSign Document History January 23, 2015 Created: January 22, 2015 By: Mass Save (esign-res@csgrp.com) Status: SIGNED Transaction ID: XIZL8KJX5456F74 "Robert Bryan Mass Save Customer Disclosure & Preparation Requirements" History Document created by Mass Save (esign-res@csgrp.com) January 22, 2015 - 9:05 AM EST - IP address: 199.102.118.86 l Document emailed to Robert Bryan (salbry2@yahoo.com) for signature January 22, 2015 - 9:08 AM EST �v Document viewed by Robert Bryan (salbry2@yahoo.com) January 22, 2015 - 7:04 PM EST - IP address: 100.0.117.126 Document e -signed by Robert Bryan (salbry2@yahoo.com) Signature Date: January 23, 2015 - 1:13 PM EST - Time Source: server - IP address: 100.0.117.126 Signed document emailed to Mass Save (esign-res@csgrp.com) and Robert Bryan (salbry2@yahoo.com) January 23, 2015 - 1:13 PM EST RV Adobe EchoSign .0 't 4ebr9x $Brpr _ m q lm a mass save F'RTICIPhTING �o:aTAu�nR� PERMIT AUTHORIZATION FORM f, Robert Bryan owner of the property located at: (Owner's Name, printed) 28 Cabot Rd N. Andover (Property Street Address) (city) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to acton my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. Owners signature hy— Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Rev. 1.21.? 201.1. D ate [oil}rN1 01 1 For CfPiee U_e C,nhy mm a) E rD z 0 u Ol E flo z c i 0 V� Z 0 0ro.ED vi 04 Kv 7f�Qj CL H cu ca < co z 41 0 a, t4 0 L—] zz 0 L.Al 15 O 8 E d 04 w F >27 0 E) El u L] 0 I 0 z a-0 = 0 z 8-0 -06 11 El U -Q o E < kd < I z z L.j QZ UD ro aL>' Z u El El F1 li cc5 to > 0 4w Z 0 > _0 0 txo :Ei c c 0 0 0 < z < El 1.0m a Z v Z 0 E < < Z < z El m OL CL c m ❑ El o LJ o LJ Lj CL n F] CL o m0 0 z c 4 -0 0 00 m v c U Li EJ El 'o (D 0� 0 a) E rD z 0 u Ol E flo z c L- 0 Li LW 2 0 D —AM row 9--- 0 z 0 u c cl co 'CLV a , z ❑ 72w a ;3 Ti mo 4f Z E < < z z 15 Elnao 0 u -U El El CL z z vNi ,1 0 0 Qj - WF 't c m - El ER w 0 C u o < Q u El E—.1 6 u 'D -c �5 -.2 M co �: I CL Ilu >- El a < U bt E < . QA QW EI CL aj > c 0 11? E fl, — w z 0 x W. W 2 5 m roz 0 0 El 0 1 No 0) 'a z o z CL 0 ED CL to vi VI Cc, (U as > Fj Qj 0 w 41 0 L) C3. V=)0 3 a In z CL 0- or,ac cmv —AM row 9---