wONumber2 Work Order
Action,Inc. Job Number: 23-209-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
Tiffany St.Ives NGRID Gas $6,084.90
36 Derby St Total $6,084.90
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
Attic Insulation
Attic stairs-fill with cellulose or 1 $232.00 $232.00
equivalent
R-30 unrestricted-settled cellulose 300 $2.39 $717.00 Side of attic without storage.Dam around
or equivalent window and chimney.Add electrical flags
and depth rules.
Attic Ventilation
Vent extension above insulation 39 $3.60 $140.40 To keep insulation off of sheathing where we
are adding R30
Doors
1" Or 2"THERMAX Or 1 $91.00 $91.00 Attic door
equivalent on door
Fixed Sweep triple flange 1 $27.00 $27.00 Attic door
Weatherstrip w/Q-Ion or equivalent 1 $76.00 $76.00 Attic door
Misc Measures
Attic/basement blower door guided 2 $125.00 $250.00 1 1 1 Attic under existing blown cell,and other
sealing with two-part foam openings.
Date: 5/10/2023 Page 1
Work Order: Job Number: 23-209-A
Vent kit/bath fan 1 $153.00 $153.00 2nd floor fan vent through roof with semi
rigid hose and insulate in attic.
Wall Insulation
Double nailed asbestos(dense pack) 926 $4.75 $4,398.50 2nd floor net walls.
cellulose or equivalent
Total $6,084.90
Contractor Instructions:
Before Starting thp_Jvh: Dying 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 Weatherixation 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 M
I hereby acknowlege that all work has been completed and inspected.
Customer Signature: Date:
Energy Director: Date: Fiscal Officer: Date:
Date: 5/10/2023 Page 2
Work Order: Job Number: 23-209-A
POR AGENCY USE ONLY
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