42-182 133 GLENDALE RD BP-2019-0209
GIs#: COMMONWEALTH OF MASSACHUSETTS
MW-.Block:42- 182 CITY OF NORTHAMPTON
Lot:- PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:New Single Family House BUILDING PERMIT
Permit# BP-2019-0209
Project# JS-2019-000341
Est. Cost:$157933.00
Feel$624.50 PERMISSIONIS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: PIONEER VALLEY HABITAT FOR HUMANITY 046013
Lot Size(sq. 11): Owner: MINERAL HILLS REALTY LLC
Zoning: Applicant. PIONEER VALLEY HABITAT FOR HUMANITY
AT: 133 GLENDALE RD
ApplicantAddress: Phone: Insurance:
P O BOX 60642 (413) 586-5430 O WC
FLORENCEMA01062 ISSUED ON.-811712018 0.00:00
TO PERFORM THE FOLLOWING WORK:2 STORY SINGLE FAMILY HOUSE
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:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Cbimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Simnature:
FeeType: Date Paid: Amount:
Building 8/17/20[80:00:00 $624.50
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2019-0209
APPLICANT/CONTACT PERSON PIONEE R VALLEY HA [TAT FOR HUMANITY
ADDRESS/PHONE P O BOX 60642 FL RENCE (413) '6-54301)
PROPERTY LOCATION 133 GLENDALE D
MAP 42 PARCEL 182 ZONE
THIS SE ',TIONEQB=Qff10AL USE ONLY:
PERMI PLICATIf� CHECKLIST
ENC OSED ~ REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filledout
Fee Paid
TyceofConstruction, 2 STORY SINGIN F MIL OUSE
New Construction
Non Structural interior renovations
Addition to Existine
Accessory Structure
Buildine Plans Included:
Owner/Statement or License 046013
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDRI$:§
Intermediate Project: Site Plan AND/OR__Special Permit With Site Plan
Major Project Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER:§
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
_Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
/ /�/� �Y 8 17 1 R
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
Department use only
City of Northampton Status of Permit:
Building Department Cum CWDrveway Permit
212 Main Street SewedSeptic Availability
Room 100 WaterAMell Availability
Northampton, MA 01060 Tyro Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 PlotBite Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH
/AjONE
,OORR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Pmoerly Address: Jh_s section to be co/mpte�y office
133 Glendale Rd Map �7[OCl Lot /C�1( Unit
Northampton, MA 01062
Zone Overlay District
Elm SL Distdcl CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Mineral Hills Realty, LLC PO Bax 60642 Florence, MA 01062
Na a(Print) Current Mailing Address',
413-586-5430
Telephone
Signat r
2.2 Authorized Agent:
Pioneer Valley Habitat for Humanity, Inc. PO Box 60642 Florence, MA 01062
Name1ld7 � 413- Mailing Address
(( 413-586-5430
Signa a Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building
123,933 (a)Building Permit Fee
2. Electrical 9,000 (b)Estimated Total Cost of
Construction from 6
3. Plumbing 9,000 Building Permit Fee
4. Mechanical(HVAC) 16,000 �7
5. Fire Protection
6. Total=(1 +2+3+4+5) $157,933 Check Number
This Section For Official Use Only
Date
Building Permit Number'. Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
'This column to be filled in by
Building Impanmcnt
Lot Size .38 acres(16,724.69 sf) .38 acres
Frontage me back lot on common drive me back lot on common drive
Setbacks Front 20.
Side L: R: L: t5' R: t5'
Rear 20
Building Height 0 21'
Bldg,Square Footage 0 0vv 1,232 7
Open Space Footage 4b
(Lut arca minus Erg&paved 100 15,493 93
,kin
#offarking Spaces 0 2
Fill: tbtl basetl on grading
volume&I odfumn
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONTKNOW O YES 0
IF YES, date issued: 9/12/16
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DON'T KNOW O YES O
IF YES: enter Book 12486 Page 226 and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO ® DON'T KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O
IF YES,describe Size, type and location: temporary construction sign for Habitat for Humanity4' x 3'on wood frame
E. Will the construction activity disturb(clearing, grading,excavation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO O
IF VES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicablel
New House 0 Addition ❑ Replacement W(ndows Alterationfs) ❑ Roofing ❑
ar Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs CJI Decks ID SidirI Oth 11
Brief Description of Proposed
Work build 2 story single family home
Alteration of existing bedroom_Vas_No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
Ga. If New house and or addition to existing housing- complete the following'.
a. Use of building One Family x Two Family Other
b. Number of rooms in each family unit. 7 Number of Bathrooms 2
c. Is there a garage attached? no
d. Proposed Square footage of new construction. 1.232 Dimensions 14'.44'
e. Number of stories? 2
f. Method of heating? ductless mini split Fireplaces or Woodstoves none Number of each
g. Energy Conservation Compliance. Yes Masscheck Energy Compliance form attached? preliminary HERS
In Type of construction stick framed wootl
Is construction within 100 flof wetlands?_Yes V No. Is construction within 100 yr. Floodplain_Yes V No
j. Depth of basement or cellar floor below finished grade n/a-slab on grade
k. Will building conform to the Building and Zoning regulations? _V Yes_No,
I. Septic Tank V City Sewer_ Private well_ City water Supply V
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS 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.
Signature of Ower Date
`
kG-
rewpi C Yas owner/Authorized
Agent h r by declare that the a at ments and information on the fore ing application are true nd accurate,to the best of my knowledge
and belie .
SI,y ned underthap ns andalbes of peg u
eCAan � � ov�� EX r u�\JCX)\Ire-rl�pr
P in me
8 « i8
Signao erlAg D to
SECTIONS-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Ne m.gA License Nestler: Michael these 048013
License Number
PO Boz 94,36 Boggs Rd.Shutesbury,MA 01072 4/14/19
�// YfyV bfl Expiration pate
{r/M� 413$36fi717
brlgnature I Telephone
9.Registered Home bnpmvernept Obstructor. Not Applicabls;K
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.O.L.c.162,§t6C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide cols aRtlavit will result
in me denial ofthe issuance of the building permit.
Signed Affidavit Attached Yes....... 91' No...... ❑
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owas r-oetunted DweBinss ofone(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner Bets
as supervisor.CMR 790, Sixth Edition Section 1033 S1.
Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is intended m be,a one or two family dwelling attached or detached structures accessory to such use and/or fart.
structures.A Person whoconstructs more than home in a Iwo-year period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shell be
nessuasible for sit such woirkperformed under the buildhat mraft,
As acting Construction Suoervkor your presence on the job site will be required from time to time,during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability ofEmployers to
Employees for injuries not resulting in Death)ofthe Massachusetts General Laws Annotated,you may be Has for person(s)
you hire to perform work for you undo this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: 133 Glendale Rd Natlhampton, MA 01082
The debris will be transported by: HaNeat voiunw.m or Duseau Truddng
The debris will be received by: valley Recycling or Duseau Trucking
Building permit number:
Name of Permit Applicant /Pioneer Valley Habitat for Humanity, Inc
8113/18 ��/��' Execubve Director
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
USDepartment of Industrial Accidents
Office of Investigations
1 Congress Street,Suite 100
Boston,MA 02114-20177
www.mass.gov/dia
Workers' Compensation Insurance Affidavit Budders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organisation/Individual): Pioneer Valley Habitat for Hume nity, Inc
.
Address: PO Box 60642
City/State/Zip: Florence, MA 01062 Phone 4: 413586-5430
Are von an employer?Check the appropriate box:
Type of project(required):
I.[vC I am a employer with 6 4. ❑ 1 ave a general contractor and I
employees(full and/or part-time)P 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 g, ❑ Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp, insuranee.l 9. ❑ Building addition
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 I I.❑ Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL 12❑ Roofrepairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.]
'Any applicant that checks box N I must also fill out the section below showing their workers compensation policy information.
1 lomcowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such_
:Convectors that check this box must attached an addutle.1 sheet showing the name of the subcontractors and state whether or not those entities have
employees. If the sub eontracters have employees,they must provide their workers comp_policy number.
7 am an employer that is providing workers'compensation insurance for my employees. Below is life policy and job.site
information.
Insurance Company Name: Lockton Affinity, LLC
Policy#or Self-ins. Lic. #: C48747401 Expiration Date: 4/1/2019
Job Site Address: 133 Glendale Rd City/State/Zip: Northampton, MA 01062
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 ofthe DIA for insurance coverage verification.
Ido hereby cern under l e pans and penalties of perjury that the information provided above is true and correct.
Signature' s Date 8113/18
Phone#: 413-5 -5430
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License h
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written"
An employer is defined as"an individual,partnership, association, corporation or other legal entity,or any two or more
of the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer, or the
receiver ortrustee of an individual,partnership, association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every stale or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority,"
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractors) morels), address(es)and phone number(s) along with their cer ificale(s) of
insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information (if necessary) and under"Job Site Address"the applicant should write"all locations in_(city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
1 Congress Street, Suite 100
Boston,MA 02114-2017
Tel. # 617-7274900 ext 7406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 7-2013
www.mass.gov/dia
_ City of Northampton
Massachusetts
Ayd'1j a. <
D212 NaiENS' a BUILDING INSPECTIONS
212 Hain Street • Municipal Building SF
Northampton, 4A 01060 ty `eC
PECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her
construction supervisor. The state defines"Homeowner"as, " Person(s) who owns a parcel on which
he/she resides or intends to be, a one or two family dwelling, attached or detached structures
accessory to such use and/or farm structures. A person who constructs more than one home in a two-
year period shall not be considered a home owner."
The building department forthe City of Northampton wants any person(s) who seek to use the home
owner exemption, to act as their own construction supervisor, to be aware that by doing so you
become responsible for compliance with state building codes and regulations. The inspection
process requires that the building department be called to inspect work at various stages, which include
foundation/footings (before backfill) sonotube holes (before pour) a rough building inspection
(before work is concealed) insulation inspection (if required)and a final building inspection
The building department requires these inspections before the work is concealed, failure to secure
these inspections can result in failure to obtain a certificate of occupancy ung)the work can be
Inspected.
If the homeowner hires other trades to perform work(electrical, plumbing & gas) the homeowner will be
responsible to make sure that the trades hired secure their proper permits in conjunction to the building
permit issued, and that they get their required inspections. Failure of the individual trades to secure
the permits and inspections as required can DELAY the project until such time as the proper permits
and inspections are made
I, understand the above.
(Home owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit issued to me.
Date
Address of work location
Home Energy Rating Certificate Rating Date: 2018-07-12 46
Projected Report Registry ID: Unregistered ..
J P Ekotrope ID: ILVxB 1 Pv
HERS' Index Score: Annual Savings
GlendaleYour home's HERS score s a Per 've 133 . .
performance score.The leave,cahte number,
O
r.
the more energy efficient the home.To $ 2,412 suilder:
41 learn more,visit www.he,�index.com -Relative to an average U.S.1home PV Habitat for Humanity
Your Home's Estimated Energy Use: This home meets or exceeds the
Use[MBSu) Annual Cost criteria of the following:
Heating 3.9 $198 Energy Star v3
Cooling 0.4 $22 Energy Star v3,1
Hot Water 10.1 $517 2015 International Energy Conservation Code
Lights/Appliances 13.5 $689
Service Charges $0
Generation (e.g.Solar) 0.0 -$0
Total: 28.0 $1,426
Home Feature Summary: Rating Completed by:
nevi Home Type. Single(amily detached Energy Raterlanne Callan
Conditioned Floor Area: 1,222 sq.tc RESNET ID3463906
6buaH rer Nmnber of Bedrooms: 3
eo—, Rating Company:Polver House Energy Consulting
Primary Heating 5yster, Air Source Heat Pump-Hech it-39 COP 479 Well 5t Srnc 105,AmherH,MA
r. Rlmary Cooling System'. All Saint Heat PUMP-EIMrit-2535EEE
'nhxome f� Pi lmary s%atei Heating_ Water Heater•Elecnic A.9 Ene,gy Factor •
House Tightness 2ACHS0 Rating Provider.Energy Raters at MasseIrILl tte p� �
Ventilation: 50.0 CFM•24.0 Watts
Duct Leakage to 0u1,lde Untested r
At....GradGradr,Walls: R 34
w mlrx�
Ceiling: A"lrrR43
.o
Wind Type lib loe.0.270 SHGC:0.'00
�rn.,ry d t Wall=. is A
no
Lamle Cal Ian,Certified Energy Rater
DIgllally signed TRn 8 at 853 AM
at • •
Permit No. W04-19
Date Approved:
Exp.Date: 111411
CITY OF NORTHAMPTON,MA
RESIDENTIAL OR COMMERCIAL BUILDING WATER ENTRY PERMIT
A Department of Public Works Trench Permit Shall be required
prior to any construction or connection activity associated with this application.
To the City of NORTHAMPTON, MASSACHUSETTS:
The undersigned,being the OWNER of the property
(Ow=,Owners Agent)
located at 133 GLENDALE RD ,does hereby request a permit to install and
(Number and Street)
connects. 2" Water Service to the RESIDENCE at said location.
(Size) (Residence,Commercial Bldg.,etc.)
1. "Owner"shall mean the person holding title to the property served or to be served by the
water service.
2. The person or firm who will perform the proposed work is:
BRADWAY CONSTRUCTION ,of 396 WEST ST, LUDLOW,MA
(Name) (Address)
3. Plan/sketch and specifications for the proposed water service shall be attached to permit.
In Consideration of the granting of this permit,the undersigned agrees:
I. The Water Department shall make all taps to the water aurin.
2. WATER ENTRY PERMIT FEE IS$1250.00 SUBDIVISION ENTRY FEE$2,500.00
3. Additional work performed by City forces from the water main to street line shall be paid at
the prevailing labor rates and cost of material.
Water Meters 5/0" $450.00
Water Meters 3/4" $450.00
Water Meters 1" $550.00
Radio Read N/A $150.00
****Water Meters>1"will he purchased by the City and charred to the customer. ***`
4. A Radio Read Fee is charged with the purchase of a am meter.
5. The Water Superintendent shag be notified for water Hoe inspection prior to backfill of
trench.
W oy9
W.'t--tI
7,019-ov7- SEE ATTACHED UTILITY CONNECTION REQUIREMENTS
Permit No. W04-19
CITY OF NORTHAMPTON,MA
RESIDENTIAL OR COMMERCIAL BUILDING WATER ENTRY APPLICATION
DATE: 7252018 SIGNED:
PIONEER HABITAT FOR HUMANITY
(Name of Applicant)
PO BOX 60642,NORTHAMPTON,MA 01060
(Address of Applicant)
413-586-5430(MEGAN MCDONOUGH)
(Telephone No.of Applicant) II
$ 200 Entry fee paid Check No. 8875 rces YCT��,, ��w-r Fyzvt$
$ 130 Meter fee paid Check No. 8875 "vol-& a ayatla4n-�,(,.f
$ 135 Radio Read fee paid Check No. 8875 D
Application approved and per/mit issued:
DATE: zf-( SIGNEAM�torof
Department:of Works)
Fee Schedule: Fire Line Fee included in Water Entry Fee
Water Entry Permit Fee $1,250.00 Subdivision Entry fee $2,500.00
5/8"Meter Fee: $450.00
3/4"Meter Fee: $450.00
I"Meter Fee: $550.00
Radio Read Fee: - $150.00
SEE ATTACHED UTILITY CONNECTION REQUIREMENTS