WoNumber1 Work Order
Action,Inc. Job Number: 23-208-A
47 Washington St. Work Order Date: 5/10/2023
Gloucester,MA 01930 Ownership: Renter
Phone: 978-283-2131
Atlantic Weatherization Auditor:Bryan Vaudo
61 Rear Jefferson Ave Email:bvaudo@actioninc.org
Salem MA 01970 Cell: 978-590-1498
Email: tpalm01@comcast.net
Phone: 978-744-8143
Cell: 508-726-1036
Lisa Wallmark NGRID Gas $7,136.26
36 Derby St Total $7,136.26
Salem Ma 01970-5606
Contact Person:Barbara Wioneck
Contact Phone: 781-929-6519
Safety Issue(s):Knob&Tube Wiring/Lead Paint Possible
Authorized Actual
Measure Description Qty Price Total Qty Total Comments
Basement Insulation
6 ml poly on ground-Fire-rated 455 $2.04 $928.20 Area from washer/dryer to electric panels
poly
6 ml poly on ground-Standard 476 $1.34 $637.84 Area behind washer/dryer and addition
poly room
Sill/mudsill seal&insulate to R-19 132 $3.96 $522.72
(TMAX)
Doors
Fixed Sweep triple flange 2 $27.00 $54.00 Both side doors
Weatherstrip w/Q-Ion or equivalent 2 $76.00 $152.00 Both side doors
Health&Safety
Replace Clothes Dryer/Exhaust Fan 1 $67.00 $67.00 Dryer hose is semi rigid but in poor
Transition Duct only condition.
Misc Measures
Attic/basement blower door guided 2 $125.00 1$250.00 Basement,chimney,and other openings.
sealing with two-part foam
Date: 5/10/2023 Page 1
Work Order: Job Number: 23-208-A
Vent kit/bath fan 1 $153.00 $153.00 Vent 1st floor fan out sidewall
Permit
Building Permit 1 $125.00 $125.00
Wall Insulation
Double nailed asbestos(dense pack) 894 $4.75 $4,246.50 1st floor net walls.
cellulose or equivalent
Total $7,136.26
Contractor Instructions:
Before Starting the Job: During,the Job:
1.Please notify us 24 hours before starting or scheduling a job. 1.This residence was built before 1978.Lead safe practices are
2. Obtain required building permit. required.
2.Total for Heath&Safety and Repairs cannot exceed$2500.00.
Additional Contractor Instructions:
Attic Inspection form attached? Yes N/A (Circle One
Certificate of Insulation posted? Yes No (Circle One)
Atlantic Weatherization hereby certifies that this job was supervised and completed in compliance with all Department of Labor
Standards and Lead RRP regulations.
Contractor Signature: Date: RRP License#:
I hereby acknowlege that all work has been completed and inspected.
Customer Signature: Date:
Date: 5/10/2023 Page 2
Work Order: Job Number: 23-208-A
Energy Director: Uale: f Fiscal Officer: Date:
FOR AQE NCY UEE QNLY
Pre Post Language Other than English needed? Yes No (Circle One)
Dryer CO 0.000 If Yes,indicate language:
Stove CO 0.000 Occupany change in last 18 months? Yes No (Circle One)
H2O Tank CO 0.000 Comments:
Heating System CO 0.000 Number of windows
Ambient CO 0.000 Number of rooms
Blower Door
Date: 5/10/2023 Page 3