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HomeMy WebLinkAboutBuilding Permit # 2/26/2015 ---------- BUILDING PERMIT NORTH TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION�,- 0 1— Permit No#: W 2 DateReceived .Arev vs US Date Issued: IMPORTANT: plicant must complete all items on this,,-,page SIR I IMP ,NO 11 vol JWAi Ivo )NI 0 RON/," f TYPE OF IMPROVEMENT— PROPOSED USE Residential Non- Residential ❑ New Building [I One family 11 Addition [I Two or more family El Industrial ,.Alteration No. of units: El Commercial El Repair, replacement El Assessory Bldg El Others: El Demolition El Other II SCRIPT :)N OF Vl=RK TO 13E P[=DFORMED:, ' OI O 1 v "s Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: �r r y / Jrr / �„ / / i / Mpg F/I TWO �1�� 1 / ,/f /�� f, / rr �l1 l /� r ��/1// Wei A/1 0110 ON,IrUy IN 'WIN "i ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$1200 PER$1000.00 OF THE TOTAL"ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: FEE: $ Check No.: Receipt No.::� 21% 51D NOTE: Persons contracting with unregistered contractors do not have.'acces tot e guaranty fund n t wi ure:o r. ,contr cto ...df," fgep'A ,5,Jg h NORTH Town ofP �• '' 0/ O No. L�K. h ver, Mass, '`'� I 2(p 2 '5 COCKICKIW,C� s � BOARD OF HEALTH PER Food/Kitchen Septic System THIS CERTIFIES THAT ............. .....r 41I06T A. ,. T LD BUILDING INSPECTOR ........... .. ..... ..... ....................... . . ... .... ..... ..... has permission to erect . buildingson ..................... Foundation. �...... ... ................!. ..... Rough to be occupied as ��� � � �. .. .. chimney ...5...... ........................ .... .. .....'s...... . ........... . i ...... provided that the person accepting this permit shall in every respect conform to the to s of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration�nd Construction of Buildings in the Town of North Andover. et a PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI STAS Rough Service .............. ...... ......... ..................... Fina BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. 01'[ice ol'Consumer AlTairs and Business Regulation 10 Part: Plaza - Suite, S 170 Boston, NtISSaChLISCttS 021 1 G I-10111e Improvement Contractor Registratioll Registration: 165640 Type: LLC Expiration: 3115/2016 Trtt 248557 AIR - TIGHT LLC. WEATHERAZATION JAMES FORTIN 10 PINE KNOLL DR. BEVERLY, MA 01315 Update Address and return card.Nlark reason for chain„e. Address Reneuval Employment Lost Card 01ficc otConsunicr Altair.& ISusincss ItcUulatioa License or rQgistration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 165640 Typo: Office of Consumer Affairs and Business Regulation Expiration: 3115/2016 LLC 10 Nark Plaza-Suite 5I70 Roston,NIA 02116 AIR-TIGHT LLC WEATHERAZA'i ION JAMES FORTIN 10 PINE KNOLL DR BEVERLY, MA 01915 E ndu sccrc t rry Not valid without signature CS-052576 t r t :z�r t !: i-'oW'IN Iit I'INEIKNO1,1,DR NIA 01915 10l03i2o1 5 The Commonwealth of.rllassacltusetls Department fr f Industrial It c'cidelltv if, f Office o Irtve.stfgataoit.s .t=rr 1 Congress Street, Suite 100 Boston, /VL4 02114-2017 411 OV.ttt uss.90 v11fa Workers' Compensation Insurance Affidavit: General Businesses Applicant hiftwinationj�� l Please Print eRibly 13ttslllc`ss/Otk�?ittlization IYcImc1 r , -'lt)1�tSltllC IO: e �, PhollCF�: ._ lr`� �C-1 ;; (,C1°1, -( i Are you aft employer? check- tile approprmte hox. Bminess Type(e-ccquired): I. [ ant a employer with J, - employees (full illid S. r-1 Retail m p to lime) 6. E] IZetiUutr;uttlfiar/F tong, k=::St tblishment �.❑ I ml it xrle pfoprtc,tor or partnership and have no 7. ❑ Office ancl+ur Sales(,incl, rcutl estate, auto,etc,j employe-es wok kutg for file in any capacity. JNo workers' comp. insucuncc required) Non-profit ❑ \Vc al-e a corporation and its officer: ACC>R"O CERTIFICATE F LIABILITY 'NSURANCE DATE(MMIDDYYYY) �I��Hi 1/13/2015 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 CONTACT Jill DeHetre NAME: TGA Cross Insurance, Inc. PHOIC.NE0. . (781) 914-1000 A/c No: (TBl>2z4-sT7T 401 Edgewater Place ADDRESS:Jdehetre@tgacross.com Suite 220 INSURERS)AFFORDING COVERAGE NAIC 11 Wakefield MA 01880 INSURER A:Arbella Protection 41360 INSURED INSURER B;Arbella Mutual 17000 Air-Tight Weatherization, LLC INSURERC: 9 Story Ave. INSURER D: INSURER E: Beverly MA 01915 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 I ADDLTYPE OF INSURANCE INSR SUER LTR POLICY NUMBER MMIDDYYYY MMIDDYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100 000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ , A CLAIMS-MADElil 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 POLICY X PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT '.. Ea accident 1,000,000 ANY AUTO BODILY INJURY(Per person) $ A X ALL OWNED X SCHEDULED 1020015286 3/8/2014 /8/2015 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED Pe accident)RTY DAMAGE $ HIRED AUTOS X AUTOS Ph scial Damage Perils $ X I UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ $2,000,000 '.. DED X I RETENTION$ 10,000 4600052930 3/5/2019 /5/2015 $ WORKERS COMPENSATION WC STATU- OT WORKERS EMPLOYERS'LIABILITY Y I N ANY PROPRIETORIPARTNER/EXECUTIVEE] N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under '.. DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,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 Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street Building 20, Suite 2035 AUTHORIZED REPRESENTATIVE North Andover, MA 01845 it AC7 Thomas Gregory/JD2 'L : ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 r?mnnr)nt Tho Ar'nRr1 name nnrl Innn am rronicfnrcrl mnrlrc of ACnRiI CERTIFICATE F LIABILITY INSURANCED01/13//201201� YY) 01/15 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(les) 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 CONTACT Jacqueline Marie Melanson,CLCS MassPay Insurance Services,LLC — 27 Garden Street, Unit 1 B PHONE Ext): (978)774 4338 X105 ac Ne: (978)774-1318 Danvers,MA 01923 E-MAIL ADDRESS: jackie@philrichardinSLirance.com INSURERS)AFFORDING COVERAGE NAIC# INSURERA: AmGUARD Insurance Company 42390 INSURED Air-Tight Weatherization,LLC INSURER B: 9 Story Ave INSURER C: Beverly,MA 01915 INSURER D: 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 LIMITS LTR D POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED _COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence, _._._,_______ CLAIMS-MADE u OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO- LOC $ _�-� AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acddent ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ _._ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ '.. HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ '.. A WORKERS COMPENSATION AIWC576437 07/01/2014 07/01/2015 WC STATU- I OTH- '.. AND EMPLOYERS'LIABILITYY/N LIMITSTORY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFCER/MEMBER EXCLUDED? IN 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/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) '.. Proof of Workers Compensation CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St Bldg 30 ACCORDANCE WITH THE POLICY PROVISIONS. Suite 2035 North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 7 r,,l1, 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. ignature State of Massachusetts County ;,, _ M, On this day of � � , 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. NotaryPublic �^ OVERT A. MONAHAN d Notary Public COMMONWEALTH OF MASSACHUSETTS My Commission Expires Print Name: September 17, 2021 My commission expires: , p � �TUFUCATE OF COMPLETION xoWashington St.Suite 3000 Westborough,mw 015*1 Robert Bryan Phono(Evo): 978-688-0761 28 Cabot Rd Phone(Duy)� � � North Andover, MA 01045-3502 E'88oi|: uo|bry?@yohnn.00m Sito0: D00002285059 _~�~ Combustion Safety Test Completed YYN Pre Blower Door# (if applicable) Post Blower Door# (if applicable) Contract ID:2O1412D7_ASEAL Company: Air-TightVVaothehzudnn Sub-contractor Work Order#: G85059P91093C271 Exterior Door Weather Stripping � � 3 Living Space Perform Air Sealing at Estimated 82.5CFW450 Per Hour O Door Sweep 3 Contract ID: 20141207_VVORK Sub-contractor Work Order#: S85050P91093C271 IL in Living Space Hatch:Thermal Barrier Po|yiao2 inch (Attic) 1 Damming 30 Living Space Insulate Rim Joist with S.25" Fiberglass Batting 26 Living Space Attic Floor Open Blow Cellulose 7" S24 � � � Living Space Insulate Wood Shingle Sided Wall With 4/' Dense Pack CeUu|oa 1.216 � PLEASE NOTE:The Inspection mthe house mfor the purpose mfinding CUSTOMER AUTHORIZATION ofCERTIFIED WORK out whether the Contractor completed the work. | confirm that the measures listed above have been completed to my oosTomsn axouLo NOT mecy ON THE |wnpEcT|ow FOR oonwamivn. | have mooiw:o v copy of the oonmvato of Completion and *nsonAwCE THAT THE nowTnAcTon'S vvnRx NEosns*n|Lv xe=uv authorize the re|ouxv of any final payments to the Contractor. | ooMpuso WITH ALL uvwa AND aTxmoAnon RELATED To understand that this Authorization mCompleted Work does not in any SAFETY. manner void any warranties pmvmao to mo by the Contractor. It was the ovnoamo,'o vv|v moponomi|ty to assure that the m000umo were inmunou p,vpo,|y and safely. In vudxion, this rvo#nxtmnaUvn Inspection ovno not mp|000 inspections by n*:nnon iovywomm wmom required by oww or |onu| law. It is the duh of the Customer to "mvm such required inspections. Contractor's Signature Customer's Signature Date Date Conservation Services Group 50 Washington Street Suite 3000 Westborough, MA 01581 (508)836-9500 CONTRACTOR WORK ORDER `Sc:,cvices Gr-OLID 50 Washington St.Suite 3000 Printed: 1/28/2015 Westborough,MA 01581 Work Order Id: S85059P91093C271 Contractor Information . .; GustornCr( te Detaal - - Air-Tight Weatherization Robert Bryan Email: salbry2@yahoo.com 9 Story Ave 28 Cabot Rd Phone(Eve): 978-688-0761 Phone(Day): Beverly, MA 01915 North Andover, MA 01845-3502 Site ID: S00002285059 Tota(lnstalted sures- Location ures 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 T' 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 __ , WorkOrder,Notes; Payrndnts Incentive Payments Air Sealing Incentive $658.23 Weatherization Incentive $2,000.00 Total Incentive Payments $2,658.23 Customer Share Total Customer Share $1,751.09 Less Deposit Of $583.70 Customer Share Balance(Due Contractor) $1,167.39 Conservation Services Group-50 Washington Street Suite 3000-Westborough, MA 01581 -(508)836-9500 Residential Asir Sealing Work Order Printed: 1/15/2015 Pg: 1 C Services Gr®up 50 Washington St.Suite 3000 Westborough,MA 01581 Customer/Ste;D.etails Robert Bryan Phone(eve): 978-688-0761 28 Cabot Rd Phone(day): North Andover, MA 01845-3502 Site ID: S00002285059 Home Information-_ -- - — - -_- Heating Fuel: Oil Building Volume: 8,736 BAS cfm50: 813 Distribution Type: Boiler with DHW-Baseboard Existn__g;Conditions. Existing Insulation: Fiberglass Batts Depth: 5.0 Truss Construction: Can Blower Door Be Completed? Yes Area=Not es - — - - ------ -- _ -- Attic Basement/Crawlspace All Accessible Penetrations: Yes Exterior Penetrations: Yes Therma-Dome: No Ceiling Penetrations: No w/carpentry: No Exterior Door Weatherstrip: No WHF Box: No Vapor Barrier(Sgft): No Additional Areas of Concern... Additional Areas of Concern... Garage Living Space All Penetrations: No Plumbing: Yes Weatherstrip Door to Living Space: No Weatherstrip Exterior Doors: Yes Additional Areas of Concern... Additional Areas of Concern... Front,Side,Basement Conservation Services Group-50 Washington Street Suite 3000-Westborough, MA 01581 -(508)836-9500 ✓� Residential Air Sealing Work Order Printed: 1/15/2015 Pg: 2 Sei-vices Gr-c)Lt 3 50 Washington St.Suite 3000 Westborough,MA 01581 Customer/Site Details: Robert Bryan 28 Cabot Rd North Andover, MA 01845-3502 on rapt _ f ..J,obilnformatron,:.i Start time: Stop time: AS Techs: Pre CFM 50: Post CFM 50: CFM 50 Reduction: Combustion Safety Test Completed? Yes No Pass or Fail? RCS PLAPIVIEW DIAGRAM Customer: d h ✓r Home Phone: ( Address:_�)$ A C G 10� Work Phon(j ( )- - Town: /o flnf)d J Cr Cell Phone: (Any limitations for access by large truck? No Yes If yes.describe: - Any specific directions or landmarks? No V Yes If yes,describe: Site ID: ei Energy Specialist: Grp 1 - Reviewed by: AFL Open Blow Cell 7" - (624) Per kro (2. Hatch: TB Poly 2" - (1) (3.) Insulate R/J- (26) (4.) Insulate Wood Shingle Wall w/4"DP - (1216) ', J (5.)Damming- (30) �� a � 0 a � �g 8r .�•�0 3�� L� O .4 4 O Tip R] ®� For Office Use Only �S Bushes Ladder Neighbor Proximity Pocket Doors Insert Radiators Fences) 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 A=Vents Note in Triangle R=8"Roof S=Soffit G =Gable M=12"Mushroom For Access Rev 1/14 C"C"ONTRA CT FOR COC1SOr ation PRODUCTS SERVICE WORK Services Group This service is brought to you through support from your local utility This Agreement is made by and among -and. Robert Bryan 28 Cabot Rd Conservation Services Group(CSG) NorthAndover,'MA 01845-3502 Attrl:.RCS 50 Washington Street,Suite 3000 Site TD 500002285059 Westborough,MA 01581 Project ID:P00000291093 Reg.No. 173484 Customer ID:C00000295165 Federal ID No. 222457170 Contract M.20141207_ASEAL -(Mail corn eted,contract to address above) L DESCRIPTION OF WORK TO BE PERFORMED Contractor will perforin 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 Perform Air Sealing at Estimated 62.5 CFM50 Per Hour 6 Living Space _ , $505.92 _. Door Sweep 3 N/A $69.54 Exterior-Door Weather Stripping3 N/ -- $82.77__ _.. _.A. _ Sub Total: $658.23 Utility Incentive Share $658.23 Customer Contribution $0.00 Of. S. For office use only Printed:12/16/2014 Page 1 of 2 Ill. PAYMENT Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows:Payment#l:$ 0 as a Deposit payable to CSG upon signing the Contract(not to exceed 113 of the total retail costs).Mail check&contract to CSG,,Atte;RCS,50 Washington St.,Ste. 3000,Westborough,MA 01.581.Mnal Payment:$ 0 as the final payment for the Work shall be payable to the Independent Installation Contractor("1110")upon satisfacto 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$ 658.23 Changes to individual lure items and/or previous incentives may increase or decrease the size of the Utility Incentive Share. Ill, DISPUTE RESOLUTION Tine BC and Customer hereby mutually agree in advance that in the event that the IIC has a dispute concerning this Contract,the IIC may subnut such dispute to a private arbifration service which has been approved by the Office of ConsnmterAf'airs 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 agre ment. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Customer Signature J� D to Indicate your selected IIC here,if applicable (oR1 Initia]here if you want Gregg Tarda _ 1 ./ Gregg Tanda the Program to assign a CSG Signature Date Name of G Representative(Printed) Participating Contractor TERMS AND CONDITIONS APPEAR ON TIM REVERSE. 3114 Ar Ar LUMTRACT FOR PRODUCrSSERVICE WORK Conser ation / Services Group This service is brought to you through support from your local utility This Agreement is made by and among and Robert'Bryan 28 Cabot Rd Conservation Services Group(CSG) North Andover,NIA 01845-3502 Attl1:RCS 50 Washington Street,Suite 3000 Site ID;5000022$5059 Westborough,.MA 01581 Project ID:P00000291093 Reg.No. 173484 Customer ID:C00000295165 Contract ID:20141207 WORD 1'ederaJ ID No.222457170 (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,inchtding the attached recontmendatiorWworlc order describing the work in detail(the"Work")which are incorporated herein by reference: Description quantity Location Attic Floor Open Blow Cellulose 7" 624 Living Space _____ $954.72 Hatch Thermal Barrier Polyiso 2 inch(Attic) _.._ . 1 Living Space . $41.71 . Insulate Rim Joist-with 6 25"Fiberglass Batting 26 Living,Space ._ 46.2.4.011— Insulate Wood 62.40InsulateWood Shingle Sided Wail With 4"Dense Pack Cellulose 1,216 ___ 1-1 Ing, pace _ $2,626.56 Damming 30 N/A $65.70__. Sub Total: $3,751.09 Utility Incentive Share $2,000.00 Customer Contribution $1,751.09 NET For office use only Printed:12/16/2014 Page 2 of 2 II, PAYMENT Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows:Payment#1:$ 58370 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 01.581.Mnal Payment:$ ]1fl7.39 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$, •2()00 .Chtunges to individual line items and/or previous incentives may increase or decrease the size of the Utility Incentive Share. Ill.DISPUTE RESOLUTION The IIC and Customer hereby mutually agree ut advance that In the event that the ITC has a dispute concerting this Contract,the IIC may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affann and Business Regulation and Customer shall be required to submit to such arbitration as provided in NEW.c 14M. 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 DatC Indicate your selected IIC here,if applicable (OR) Initial here if you want Gregganal 12114/15 Gregg anda the icipaProgting C ntrassact a CSG Signature j Date Name of CSG7 epresentative(Printed) Participating Contractor TERMS.AND Co"ITIONS APPEAR ON THE REVERSE. 3/14 Customer Name: Robert Bryan Site ID: 500002285059 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&Shingle Siding 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. No Additional Areas Specified at Assessment No Additional Areas Specified at Assessment Customer Si nature: Bryan Date: Jan 13, 2015 g p;�p Pr. - 0 FrIF For more information please visit the interactive house web site at http://masssave.csgi-p.com/masssave_content.html FrrCffite U E e Gnh'e Signature: �ev . Email: salbry2@yahoo.com >,r. „a��,.,..,r ri ercr,��,�,%rr r.e ;�.r......, r�__�r<i,. �1�r:ntu�ra.ci�rn��m�uww.r.rauwrr�,uxas,�i�ru�re�a�utttr�urr�;�irr�u+u nr�kr�ajrar�a�ar�wa�nr:r�raunu�i�,rm�..uar;�s�emunrm,5ea�t�mura�aivaiis��,vvra,rri�+a�r�auwune�e,�r�rr.�:r�m�,.,�:�nu..,ra-n uAr✓i.�air,.:rr,,,o,,,�, ..si,, j t k 0 ll 1 � r i ID EchoSign Document History b January 13, 2015 d, _ --- Created: January 06,2015 r FI By: Mass Save(esign-res@esgrp.com) - Status: SIGNED t if Transaction ID: X14GLXES74J7C5B "Bryan 2285059-Enclosed-Cavity-Fact-Sheet--Site ID_2285059" History Document created by Mass Save (esign-rcs@csgrp.com January 06,2015-1:30 PM EST-IP address: 199.102.118.86 ; 1 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 f Signed document emailed to Mass Save (esign-res@csgrp.com) and Robert Bryan (salbrY @Yahoo.com) January 13, 2015-10:17 AM EST k f r' I' A I 4 Adobe EchoSign 111 IN f� ......::..........:.. „, r , ,,,i,r:, ,r izr lJ�,ln-.r+.rr d. Ir./3u �./ni1/�,kkL!L!.r/.U!iUls.<!^p....ta11f9lYA"lfLl.du'...".�7lgm.�pu➢.21 D4kA81P.�'�.�5,'R.W.NIS7Y1�G'ik�W�NJ,IOW,NM�GX�YTJte'YIIIYlNDfl����i211f/1d�2YP"NitJX�YdLF�',714`7F.^Y�rM^llJrP+7M1 NINi,1IM1�J0.Ri1n+iYtNIY"aVNIWI,�fre?l lv//f�r�lr LLNf�o�!/Jn/T�1.�1mm10 r,i�,z"z1'f SAMPLE PRE-RENOVATION 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 PaVphlet Receipt 12fl 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. zL Printed am of caner- ccupant A A Signature of Oy6ner-occupgAt 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). Printed Name&Person Cer 'fying Delivery Attempted Delivery Date Signature of Per on Certifying L ad 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. � � � ' ' 'Custom6rNume: Robert BSite ID: S00002285059 Data: � Mass Save Customer Disclosure and Preparation Requirements Atyour Home Energy Assessment yourEnergy8pedaUsthasevie*edendidendfiedapp|icab|ocog-effecdveoppnrtunities,potential health and safety concerns as well as any customer required actions to facilitate improvements in your home. Your Energy Specialist istrained to evaluate and propose appropriate site-specific improvements that will reduce energy consumption and improve comfort. The following � conditions were noted atthe time nfthe Home Energy Assessment: Combustion Safety: Initial Here � No Issues Detected at Assessment � Combustion Appliances: Initial nere No Issues Detected at Assessment Pipe Disclaimer: -Initial Here - Moimiune[bncerno /mtu/n°m No Issues Detected at Assessment El' Storage Removal Platform Bullclu I PCO Detector Customer Weatherization Preparation Requirements:. 'Flooring Removal E] Specified Measures Agreement(SMA) Customers are responsible to complete any noted required actions in order to'be eligible for program weatherization work at their home. The participating Contractor will be confirming the corn pletion of these,required actions prior to scheduling an Initial 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, Jan 2015 CugomerSignaturo: Date: ' Energy Specialist: GreggJanda-277 Phone: 508-948-8372 Email: Gregg.Janda@csgrp.com eym�' Conservation Services Group e 5UWashington Street,Suite 3000 e Westborough, MA 01581 ".="..U.~., „,,�� � w .�;�;�;wireswruamvuurw+annrourvaucm,�cwmw,tnrr�.�irrr�mmineraaxx�vwr msuwmneue+aui+wluarwmAurrvr�nawxwua”mw•Iwxnnw,awi�vrcamnamw�urcrvuvnml"i,rrrmnnrwrrinrunac�rr rr�mrcwaa:mrwr,r i, a _� „, ,-,., ,,,,, „i.�✓i /�Lr/rr, rY.:'ve v,n,.�P/ll�/l/fd'.!/1!lrAiPOJ/lb�8a� „rMfbG Ul.drnPlZmNnilrla'MiiG¢�NNUAIPt�nN.Avd`q�',bwr:GarG!�.mlV�u!WMumrre ldNWN�am.0 Ya IY� I Y�Iw/gyp ') 4��`�tri ; o I . v EchoSign Document History January 23, 205 tw N. Created: January 22,2015 E By: Mass Save(esign-res@csgrp.com) f .. .. j —.. ..-�.. . �- Status: SIGNED 14 �f Transaction ID: XIZL8KJX5456F74 k l "Robert Bryan Mass Save Customer Disclosure & Preparation << Requirements" History U i� i� Document created by Mass Save (esign-res@esgrp.com) F January 22,2015-9:05 AM EST-IP address: 199.102.118.86 �I f� � �f Document emailed to Robert Bryan (salbry2@yahoo.com)for signature January 22,2015-9:08 AM EST I, E> Document viewed by Robert Bryan (salbry2@yahoo.com) January 22,2015-7:04 PM EST-IP address: 100.0.117.126 �r la 6 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 a � ') Signed document emailed to Mass Save (esign-res@csgrp.com) and Robert Bryan (salbry2@yahoo.com) 1 {i January 23,2015-1:13 PM EST r h I:? a u f k �k¢ res k, ki, Ej ((, f I /Adobe EchoSign ", .. �. +...� �� wamur" rra�n�ra�ruo,rrci+o-icrerrwa�"ruNauw"ararvxnoiuwrmu�rv�mein�uermerirueur?nwaa�taraw,r�wxxr„r.wrawu,warrterrerwrrunra..,a rrmarr.,x�rr„rnr„nrirr✓r..mmi roriiaHmmnnimr,.;r, 'rlr rr„�.!� n�,r. ,.,.r „c,,,, ia- -s,.,,w...,. .r r,,.e, res. wry;n�+a,�oirr�.r�rr��eGrmmx�,rrv�oxtirrm,deo-rx�.�r�rxa�ruo,���r�+uiv”xm"vmuc�wr�urwsiax,uraor�r� ar.n �Q ,�4eor9X SgrYf� ! a PARTICI PATINE CONTRACTOR PERMIT AUTHORIZATION FORM I, Robert Bryan owner of the property located at: (Owner's Narne,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 act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. Owners Signature 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: Pa rticip ati ng Co ntractor D ate 0 I OF For Cffire U=a C,nty Rev. 11C Combustion Safety Test Form CUSTOMER NAME: SITE ID: Hot Water Heater Heating Sys- Atmospheric induced Powered Vent' Sea.ed` 777 Stainless St.' DH IJ IND TANKLES5 ELEC.. BOILER FURN. OTHER Heating: Fuel; Fuel: Hot water It/p,,00 NOT DRILL A TE57 HOLE. Other tests vilJ be completed as appropria e{Co a;vent;ermi on Were any gas leaks detected(if applicable)? YES NO Are there broken,detatched or corroded flue pipes?: YES NO Are there any unvented gas appliances(does not include ovens)?: YES N0 Was there a working carbon monoxide detector in the home?: YES NO 0 Outside TempBath: Kit: Dryer; Outside Temp: Bath: Kit; Dryer, CAZ Baseline Pressure: Air Handier: ON OFF N/A CAZ Baseline Pressure: Air Handier: ON OFF N/A CAZ Worst Case Pressure: Basement Door: OPEN CLOSED CAZ Worst Case Pressure: Basement Door: OPEN CL05ED Total Pressure Change: Other Doors: Total Pressure Change: Other Doors P�- r CO Draft Draft w/Heating Sys On CO Draft Draft w/Heating Sys On Pass Spillage Test Pass Draft Test Pass CO Test Pass Spillage Test Pass Draft Test Pass CO Test 17 Yes ❑No ❑N/A ❑Yes ❑No ❑N/A ❑Yes ❑No ❑N/A ❑Yes ❑No ❑N/A Yes []❑IVo ❑N/AD Yes D No LJ N/A CO Draft CO Draft I l I I l I Pass Spillage Test Pass DraftTest Pass CO Test Pass Spillage Test Pass Draft Test Pass CO Test Yes❑No❑NJA ❑Yes [:]No ❑N/A ❑Yes ❑No❑N/A E:11 Yes ❑No ❑N/A ❑Yes []No❑N/A E]Yes❑No E. ]N/A Ambient CO in CAZ: jAmbient CO in living Space: Ambient CO in CAZ: lArnbiei it CO is Living Spate: - a I VA "Equippe Pass Spillage Draft CO Equip Type Pass Spillage Draft CO ❑Yes ❑No❑N/A ❑Yes ❑No ❑N/A ❑Yes ❑No[:]N/A ❑Yes i❑No []N/A e CO(Measured at exhaust port); CO(Measured at exhaust pori): Ambient CO. Ambient CO: Technician Name: a Company Name: Test Dates: (,cnservation Services Group All RlEh;s Re'cr'ec ter-Z;2G11 11C Combustion Safety Test Form CUSTOMER NAME: SITE 1D: Hot Vater Heater Heating Sys_ Atmospheric educed Powered Vent' Sealed- "B"Vent" PVC Brent' Stainless St.' DHW IND TANKLESS ELEC. BOILER TURN. OTHER Heating, fuel: fuel: Hot Water, If yes,DO NOT DRILL A TEST HOLE. Other tests ual7 be.rompleted as appropriate(CD a;vent teTm6naticn.) Safety Ilnspection 'where araygas leaks detected(if appiicable)? YES NO Are there broken,detatched or corroded flue pipes?: YES NO Are there any unvented gas appliances(does not include ovens)?: YES NO Was thTEST IN ere a workingcarbon o monoxide detector in the home?: YES NO TEST OUT Combustion Appliance +. Depressurization Outside Temp: Bath: it Dryer; Outside Temo: Bath: Kit; Dyer; CAZ Baseline Pressure: Air Handier: ON OFF N/A CAZ Baseline Pressure: Air Handler: ON OFF N/A CAZ Worst Case Pressure: Basement Door; OPEN CLOSED CAZ Worst Case Pressure; Basement Door: OPEN CLOSED Total Pressure Change: 10ther Doors: Total Pressure 7—the Change: e r Doors; i4 - CO Draft Draft vv/Heating Sys On CO Draft Draft w/Heating Sys On I / Pass Spillage Test Pass Draft Test Pass CO Test Pass Spillage Test Pass Draft Test Pass CO Test ❑Yes ❑No[N/A ❑Yes ❑No []N/A ,:]Yes ❑No ❑N/A Yes I No t N/A ❑ ] ]. []Yes ❑No ❑N/A ]Yes ]No []N/A I Heating System Worst Case CO Draft CO Draft Pass Spillage Test Pass Draft Test Pass CO Test Pass Spillage Test Pass Draft Test Pass CO Test ]Yes ❑No N/A ❑Yes❑No ❑N/A ❑Yes [No N/A ❑Yes []No ❑N/A ❑Yes 0 No ❑N/A ❑Yes ]No I_]N/A Ambient CO in CAZ: Ambient CO in living Space: Ambient CO in CAZ: Ambient CO in Living Space: . - t Equip Type Pass Spillage Draft CO Equip Type Pass Spillage Draft CO ]Yes []No]NIA ❑Yes n No ]NJA ::]Yes EI No F]NIA ❑Yes 1]No ❑N/A . � s CO(Measured at exhaust port}; CO(Measured at exhaust port): Ambient C0: Ambient CD: Technician Name: _ Company Name: Test Dates: Censcr;ation Services Grouy All r.Vgh's Fu:_`c