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29-159 WAP Wor Order: Job Number: 12 -312 Side Press Lock 0 $9. $0.00 Storm Windows 0 $0. $0.00 Top Sash Lock 0 S9. S0.00 Weatherstrip Window /Schlegal or 0 $6. $0.00 equivalent Total $3,10438 Contractor Instructions: Before Starting the Job: During the Job: 1. Please notify us 24 hours before starting or sched ling a job. 1. Incorporate lead safe practices as applicable. 2. Obtain required building permit. 2. Total for Heath & Safety and Repairs cannot exceed $2500.00. 3. Davis Bacon time sheets required for ARRA work on US Department of Labor Certified Payroll Report Form WH -347. 4. Photograph any air sealing or other work to be covered by insulation. Your Invoice Must Include:: I. Client name, client address and job number. 2. Signed and dated copy of the work order. 3. Pre and post blower door test results. 4. Attic inspection form. 5. Copy of certificate of insulation. 6. Copy of building permit. 7. Manufacture labels from replacement doors and Nfindows. 8. Photographs of air sealing or other work covered by insulation. Additional Contractor Instructions: Blower Door Test Results Pre Post Certificate of Insulation posted? Yes No (Circle One) Attic Inspection form attached? Yes N/A (Circle One) Where Posted: Contractor: Date: WAP Auditor: Date: • Page 7 WAP Wor Order: Job Number: 12 -312 Window Weight Voids (pair) 0 $12 10 $0.00 Wood clapboard /shakes/shings or 0 $1. $0.00 vinyl (dense pack) Window &Door Replacements 32 -36 in Steel pre -hung 0 $64 .50 $0.00 replacement door w/lite 32 -36 in Wood pre -hung 0 $60 .00 $0.00 replacement door w/lite Basement window replacement 0 $25 .00 $0.00 (awning/hopper) Basement window replacement 0 $25 .00 $0.00 with a frame CDC Windows 2 0 $35 .43 $0.00 Other 0 $0.11 $0.00 Prime window replacement w/low -e 0 $351.00 $0.00 to 73 ui Prime window replacement w/low -e 0 S3 1.00 $0.00 to 74 -83 ui Prime window replacement w /low -e 0 $3 - '1.00 $0.00 to 84-93 ui Prime window replacement w/low -e 0 $3 $ .00 $0.00 to 94 -101 ui Replacement Grids (per window) 0 $4 • 00 $0.00 Replacement window per 12/29/10 0 $3 - 1.00 $0.00 Tech Manual revision Sliding door replacement per WAP- 0 Si, 00. $0.00 IM- 2011 -009 00 Sliding exterior door replacement 0 $I, 00. $0.00 per WAP -IM- 2011 -009 00 zCDC Door 0 $4' +.00 $0.00 zCDC Window Replacement 1 0 $3 ' .00 $0.00 Windows Deadlights 0 $0. 0 $0.00 Glass replacement per ui over 64 0 $1..0 $0.00 Glass replacement to 64 ui 0 $4 • .00 $0.00 Other 0 $0 10 $0.00 Page 6 WAP Work Order: Job Number: 12 -312 Replace Clothes Dryer Transition 0 $40 .00 $0.00 Duct only Seal ducts with mastic or butyl 3 $65.00 $195.00 backed tape Weatherstrip (Q -Ion or equal) & Q 53350 $0.00 R -30 attic hatch Weatherstrip (Q -lon or equal) attic 0 53150 $0.00 hatch zCDC Airsealing 0 562 46 $0.00 Other Other 0 I SO.GO 150.00 Permit Building permit 50 $1.( 0 550.00 Other 0 S0.(0 $0.00 Permit $50 0 550 00 50.00 Permit $35 0 $35 00 50.00 Wall Insulation Bay Window insulate above * below 0 5100.00 $0.00 - your option as to method and Brick/Stucco (dense pack) 0 $2.$9 $0.00 Double nailed asbestos/aluminum 0 $2.: 1 50.00 (dense pack) Drill finish patch plaster (dense 0 5110 50.00 pack) Drill rough plaster patch or finish 0 $1.112 $0.00 wood plug (dense pack) Other 0 $0.60 $0.00 Single nailed asbestos /asphalt 0 $2.:1 50.00 (dense pack) Spray Foam Walls - CDC ONLY 0 $1.12 50.00 Test drill 4 sides 0 $6(.00 50.00 Vinyl over asbestos (dense pack) 0 52.31 $0.00 Page 5 WAP Wor Order: Job Number: 12 -312 Clothes dryer vent including 0 589 10 $0.00 Exhaust Duct Gutter Replacement (includes down 0 $6. - 1 $0.00 spouts) Knob & Tube Inspection, fuses, 0 $17 .00 $0.00 wiring Other 0 $0. + 1 $0.00 Vent kit/bath fan 0 589 $0.00 Misc Insulation 2" Foam Board on Door 1 $54 +0 554.00 Kneewall access doors. Domestic water pipe wrap 0 $2.. c 50.00 Duct insulation R -5 0 $3. 1 $0.00 Hydronic pipe insulation 1.25 -1.5 0 $3. : $0.00 in. copper pipe R -5 Hydronic pipe insulation to 1 in. 0 53. 1 $0.00 copper pipe R -5 Other 0 50. 0 50.00 Steampipe insulation 3 in. iron pipe 0 $7. 1 $0.00 R -5 Steampipe insulation to 1.5 - 2 in. 0 $6. 5 $0.00 iron pipe R -5 Steampipe insulation up to 1.25 in. 0 55. 1 50.00 iron pipe R -5 Misc Measures Attic sealing with two -part foam 2 S7 00 $150.00 Access via gable end vents if possible. Photos please of partition top plate sealing. Basement sealing with two -part 2 $7 00 $150.00 foam Blower door set -up with pre & post 1 54 .00 1545.00 tests Cut/close attic - kneewall access 0 $7 .75 $0.00 Cut/finish attic - kneewall access 0 $1 5.00 50.00 Interior Air Sealing & Caulking 0 $7 .00 $0.00 Labor only charge 0 $6 .00 50.00 Other 0 $0 + 0 $0.00 Page 4 WAP Work Order: Job Number: 12 -312 Belly repairs - labor' 0 $60.00 $0.00 Crawlspace overhead insulation 4 ft 0 $1.87 $0.00 high or less R -19 Crawlspace overhead insulation 4 ft 0 $1.9( 50.00 high or less R -30 Garage ceiling cavity filled with 0 52.1( $0.00 blown cellulose Other 0 $0.0( $0.00 Perimeter 2 in. foam board 0 $2.5( $0.00 Perimeter Wrap R -5 reinforced foil 300 $1.9' $573.00 Estimated qty. Discuss w /me on site. Much of or vinyl faced ductwrap basement finished. Sill insulation Faced R -19 0 $1.51 $0.00 Sill two -part foam w /fiberglass batt 116 S2.21 $255.20 Finished portions of basement have suspended ceilings. Doors 28 -32 in interior solid core door 0 $31!.00 $0.00 Automatic Sweep 0 523.30 $0.00 Basement/outside door - door only 0 $36 -.50 50.00 Basement/outside door - w /jambs Q $43$.75 $0.00 Fixed Sweep 0 515.75 $0.00 Lockset/Schlage or equal 0 $73 00 50.00 Other 0 $0.(0 50.00 R -5 Ductwrap or R -max on door 0 551,00 $0.00 Repair/Refit Door 1 $52.00 $52.00 Kneewall access door Repair/Refit Door 1 552.00 552.00 Basement exterior. Slide Bolt 0 $9. ;5 50.00 Weatherstrip s/Q -Ion or equal 1 541.50 545.50 Kneewall access door Weatherstrip s /Q -lon or equal 1 $41.50 $45.50 Health & Safety Basement window w /framing - 0 I $250.00 $0.00 building code compliance ( non- 1 I I Page 3 • WAP Wor Order: Job Number: 12 -312 R -49 unrestricted - settled cellulose 0 $1.6 $0.00 Reinforced poly/R -20 cellulose open 0 $1.8' $0.00 rafters Reinforced poly/R -30 cellulose open 0 $2.0 $0.00 rafters Site Built pull down stair insulation 0 $181 00 $0.00 2 in foam box Spray Foam & Mesh & Blow CDC 0 $1.3 $0.00 ONLY Tenmat Recessed Can Cover - 0 $30.1 $0.00 pending approval Thermodome or Magnetic pull 0 $181 00 $0.00 down stairway box Attic Ventilation 1/2 Window Gable Vent 0 $11: 00 $0.00 Other 0 $0.1 i $0.00 Propa Vent 0 $4.11 80.00 Rectangular gable vent 0 $92'1 0 $0.00 Rectangular soffit vent 0 $27 10 $0.00 Ridge vent 0 823 10 $0.00 Roof vent 135 (1 sq ft NFV) large 0 $95 10 $0.00 Roof vent 865 (.4 sq ft NFV) small 0 880 10 $0.00 Stack Vent 0 $15.00 $0.00 Turbine Vent 0 $1 ( :.00 $0.00 Varipitch vent 0 $1 .00 $0.00 Basement Insulation 6 ml poly on ground 0 $0. 5 $0.00 Basement overhead insulation R19 0 $1..8 $0.00 Fiberglass Basement overhead insulation R30 0 $1 :2 $0.00 Fiberglass Belly repairs - foam board 0 $210 $0.00 Page 2 WAP Work Order Community Action of the Franklin, Hampshire and Job Number: 12 -312 North Quabbin Regions, Inc. Work Order Date: 10/17/2012 P.o. Box 1432 Ownership: Owner Greenfield, MA 01302 Phone: 413- 774 -2310 Eastern Weatherization Auditor: Brad Councilman 79 Center St Email: bcouncilman @communityaction.us Montague MA 01351 Cell: 413- 834 -4043 Phone: 413 - 367 -2228 Phone: 413- 376 -1149 Stephen O'Sullivan Bay State Gas $2,900.38 71 Crestview Dr DOE WAP 2012 $204.00 Florence MA 01062 Total $3,104.38 413- 887 -7293 DOE WAP 2012 Repair/Health & Safety $0.00 Aulwrized Actual Measure Description Comments Qty Pre Total Qty Total Attic Insulation Attic stairs - fill with' cellulose 0 $131-00 $0.00 AtticlKneewall Floor Transition 34 $2.5t $85.68 Dense Pack w /cellulose Kneewalls R -12 cellulose behind 150 $1.73 $259.50 Back side of building. Discuss front with me permeable membrane on site. Other 0 $0.00 $0.00 R -10-12 restricted - slopes/floored 160 $1.30 $208.00 Kneewall floors rear side. fill w /cellulose R -10 -12 restricted - slopes /floored 680 $1.30 $884.00 Slopes, if accessible. Discuss front side of fill w /cellulose building with me on site. R -10-12 unrestricted - settled 0 $1.41 $0.00 cellulose R -11 FGB in open rafters /walls/ 0 $1.:1 $0.00 kneewalls R -18 -20 restricted - slopes /floored 0 $1.42 $0.00 fill w /cellulose R -18-20 unrestricted - settled 0 $1.:9 $0.00 cellulose R -19 FGB in open rafters /walls/ 0 $1.47 $0.00 kneewalls R -30 restricted - slopes /floored fill 0 $1.18 $0.00 w /cellulose R -30 unrestricted - settled cellulose 0 $137 $0.00 R -38 unrestricted - settled cellulose 0 $1 .47 $0.00 Page 1 - - = - i I ? " 01:. ' , -: ., - ;*,',,4--'47if '.11 „..,''''' ' ,,,•-r;:t;' — , Mazsachusetts Department of Public Safety Board of Building Regulations and Standards Construction Super%isor Spccialt■ License CSSL-100236 PATRICK G SMITH 79 CENTER ST. Montague MA 01351 -: E < pratior commiss)oner 04/05/2014 -fir onsumer 6O ea Office 0 1 Bd.../7/1144,a+oelia fi ai mess egu ation ........, l y---- --- ;,- 7------ -,, :7 , HOME IMPROVEMENT CONTRACTOR 134741 Type: ■:1 Sail \I i Expiration: 1/11/2014 DBA E'AgtERN WEATHERIZATION PATRICK SMITH 79 CENTER ST MONTAGUE, MA 01351 Undersecretary ACORD CERTIFICATE OF LIABILITY INSURANCE PATE IMICOPerell 03/05/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CODERS 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: I the certacate holder is an ADDITIONAL INSURED. the pcYcyUes) must be endorsed. If SUBROGATION IS WAIVED. subject to the terms and conditions of the policy. certain policies may requite an endorsement. A stetement on this certificate does not confer rights to the certlieate holder in lieu of such endorsementfs). PRODUCER — CONTACT Webber & Grinnell Ins. Agency, Inc. Ex 413.586.0111 t F L io t : 413.586.6481 8 North King Street Northampton, MA 01060 =St 00014938 00014938 MRTUI AFFORDING COVERAGE NAIL INSURER A : Selective Ins Co of Southeast Patrick G. Smith NSURERs: Safety Insurance Co. _ '773 DBA: Eastern Weatherizat ion INSURER C WCAR -ACE _ 79 Center Street INSURER D: Montague, MA 01351 INSLmERE: INSURER F : COVERAGES CERTIFICATE NUMBER: Master Exp 02/13 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BERN ISSUED 10 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 REDU PAID CLAIMS. LTR TYPE OF NEURANCE POLICY MIAOW the xTrP7,1 Z16041 NppDDIYYYJY LIMITS GENERAL ' S1968742 03/01/2012 03!0112013 EACH occuaR€NCE $ 1,000,000 X COMdEPC AL GENERAL LiAB■L DAMAGE T ( " � ° s 100,000 PREMISES (Ea occurrence) X 1 ocCt,A i I MED EXP (Any one xenon) s 10,000 A ' PERSONAL s ADV INJURY $ 1,000,000 GENERAL AGGREGATE s 3,000,000 - GEJ AGGREGATE LIMIT APPLES PER PRODUCTS - COMP/OP AGG $ 3,000,000 X W.4. CCY ' PRQ ' LGC AUTOMOSILE LABILITY 6216637 02/14/2012 02/14/2013 COMBINED SINGLE LIMIT $ (Es accident) 1,000,000 av AU BODILY INJURY (Per oersan) $ OW AUTOS BODILY INJURY (Pe. acndert) $ B X S _HEDU.ED AUTOS PROPERTY DAMAGE X kIRE AUTOS (Per accident) $ . X Nct.- OW',EDAUTOS I $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LAB c vs -MADE AGGREGATE $ GEDJCTIBLE ( $ RETENTICNr f i y � $ AAND EMPLOYERS' LASILITY r 6S62U64495P63212 03101/2012 03/01/2013 X 1 T UNIT$ 1 ER ANY PRORRIETOFURARTNERIEXECUT�VE 7. 1 N I A EL EACH ACCIDENT $ SO0, 000 C I GFFIC EE EXCLUDED 7 plandeltoty I E.L. DISEASE - EA EMPLOYEE $ 500, 000 , Ir Oesc^Oe'n I I E L DISEASE - PCCICY LIMIT $ SOO 000 IP? r'sON• •- RATIONSDelow DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Mach ACORD 101. Add Bonet Remarks Schedule. I more specs Is required) Workers Compensation policy does not provide coverage for Patrick G. Smith. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELL,ID BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED N ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZo REPRESENTATIVE r Evi of Insurance Cynthia Henderson, CISR /CINDY ®1928 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD Information and Instr• uctions 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 a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee 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 state 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- contractor(s) name(s), address(es) and phone number(s) along with their certificate(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. Nan 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 rrrust 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 Depaitment's address, telephone.and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617 -727 -4900 ext 406 or 1- 877 - MASSAFE Revised 11 -22 -06 Fax # 617- 727 -7749 www.mass:gov /dia • • The Commonwealth of Massachusetts Department of Industrial Accidents " TAO Office oflnvestigations 600 Washington Street = :: � B MA 02111 ,r • ~M "1r s ' ° www.nzass.gov /dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name (Business / Organization /Individual): G ( 5 ��/'ry k 7 /aALi /" i k s,41,T4 Address: ' C'. , --` Me Al ex a Al ®f 5S - City /State /Zip: 4204)/1, fY2 Phone. #: /3 '577 R-? Are you an employer? Check the appropriate box: Type of project (required): 1. X I am a employer with „. 4. 0 I am a general contractor and I employees (full and/or part- time).* have hired the sub- contractors 6. El New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub- contractors have 8. 0 Demolition . working for in any capacity. employees and have workers' 9 Building addition • [No workers' comp. insurance comp. insurance.$ required.] 5. [ . We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12:0 Roof repairs insurance required.] t . c. 152, § 1(4), and we have no �-�r employees. [No workers' 13 J Other /IP1 /?-4 -T f4 )1- comp. insurance required.] Cp / /c /6 ri' //VS Set7ii y *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. • t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have . employees. If the sub - contractors have employees, they must provide their workers' comp. policy number. l am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: j (' / el/ Policy # or Self -ins. Lic. #:. S 6Q W 13VV ?5 pc 32/ 2 Expiration Date: 3/1 ,2_0 /...5 Job Site . Address: 7/ (/ 7 2 /-PLt/ /2 r City /State /Zip: /6/ - -e- - clCt 4 4 (O( . 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 of the DIA for insurance coverage verification. 1 do hereby cert under the pains and penalties o perjury that the information provided abo is true a d correct. • ( A) Si•nature: i° d A 49 446 //L Date: _ Phone #: L p 3 3 O 7 ,z,2.2- Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City /Town Clerk 4. Electrical Inspector 5. Plumbing Inspector S. Other Contact Person: Phone #: a SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: _� Not Applicable ❑ Name of License Holder : fit C �/ 4 .54i// License Number 7 c s� (/f)TC - — ®l 3 cf' 100 Q-4 Address Expiration Date Signature Telephone 9. Registered Home Improvement Contractor Not Applicable ❑ Company Name Registraf n Nuvrber 79 c .',tdTec -- , 6ti7e ,* 0/5s f // /,` Address Ex ration Date Telephone SECTION 10 WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes ; No ❑ 11. Home Owner Exemption The current exemption for "homeowners" was extended to include Owner - occupied Dwellings of one (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 acts as supervisor. CMR 780, Sixth Edition Section 108.3.5.1. 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 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 homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he /she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor 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 of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you under 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 _ _ SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) i l Roofing r7 Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [❑ Siding [D] Other Brief Descripti Work:'/ A.0-7 � 219 -/ M.11-1 C r �// L� rtit) -Q v l / 00(4,, / /9---777( alet lS Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is constructioh within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulation's? Yes No . 1. Septic Tank City Sewer Private well City water Supply SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 4/Mee OS -v // /C� , as Owner of the subject property fi hereby authorize �r( 6-' / to aac/t�oonnAmy behalf, in all matters relative to work authorized b y t is building permit applicatio . Signature ow Date I, e ��/ 4 -4 S , as Owner /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed un r• ; pains and pens of perjury. Print - 111 4=2 /./ Signature of Owner /Agen 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 iI t r s Building Department �I Lot Size , Frontage Setbacks Front 4 I ,_._.._.. . Side L. n.... = R:1 I L.`, __' R:1„.... .. I .1 .zm --i i Rear Building Height I �� Bldg. Square Footage . -__I % 1 ._. _ L„. Open Space Footage _ Lot area minus bldg & paved € . 1 ( g P _.__._.. l._ __ _ .. parking) # of Parking Spaces -` Fill: ..._..,. �__.. .. ._..,,._ _..___.__...,_ „.. �._; I (volume & Location) -. - -. - -... _.__. __ § �_ _ A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW 0 YES IF YES, date issued:: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES Q r - IF YES: enter Book Page' 1 and /or Document # ' B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Q , Date Issued: C. Do any signs exist on the property? YES Q NO Q IF YES, describe size, type and location D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO Q IF YES, describe size, type and location: 1 �..._,�.w. - I 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 Q NO 0 I F YES, then a Northampton Storm Water Management Permit from the DPW is required. i Department use only City of Nort status o f Permlt RECEIVED z�. Building Department Curb C4,;,' ut/Dnveway Pe rmi t OCT 212 Ma in Street S ewr S eptic vau li Availability s abrhty 23 Room 100 Water/We Northampton, MA 0 Two Sets s Plan . DEPT o� aw�i��n;- f hcRrhaM�ro io ne 1 587 -1240 F 1272 Plot/sde P lans ' ' 0-ter eci. � P fy APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWE SECTION 1 - SITE INFORMATION 1 Property Addres / This section to be completed by office 7��'.�? S � U� e� f)/ Map Lot Unit /7/ d f�� / �" /0 6 Zone Over District Elm St. District CB District SECTION 2 - PR OPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name (P rint ) C urrent Mai Add . ress: Te e 7 / `/ 5 Signature 2.2 Authorized Agent: - IML4) 01 �y9il‘�/�j ✓ a 5 / � �j � / L�el/•r S77(il°11 1a 614/ - - iltlipM °I ame (Print) i Curr M ailing Address: � 3 S7 S g atur Telephone SECTION 3- ESTIMATED C COSTS Item Estimated Cost (Dollars) to be Officia Use Only com pleted by p applicant 1. Building �/ ' T � Co 3 /6 / (a) Building Permit Fee /i O 2. Electrical / (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) �j1 ® ! Check Number 1, � �� T sued: his Section For Official Use On Date Bu ilding Permit N umber. Is Signature: Bu ilding Commissioner /Inspector of Buildings Date File # BP- 2013 -0490 APPLICANT /CONTACT PERSON PATRICK SMITH ADDRESS/PHONE 79 CENTER ST MONTAGUE (413) 367 -2228 PROPERTY LOCATION 71 CRESTVIEW DR MAP 29 PARCEL 459 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out p ,� Fee Paid `3 C� '� Typeof Construction: INSULATE ATTIC & WALLS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 100236 3 sets of Plans / Plot Plan THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON NF ATION PRESENTED: Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ 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 D / 6 - 7 V/ Signature of Buil ing 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. 71 CRESTVIEW DR BP- 2013 -0490 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29 - 459 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PER IIT Permit # BP- 2013 -0490 Project # JS- 2013- 000776 Est. Cost: $3104.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PATRICK SMITH 100236 Lot Size(sq. ft.): 10018.80 Owner: O'SULLIVAN STEPHEN M & AIMEE S Zoning: Applicant: PATRICK SMITH AT: 71 CRESTVIEW DR Applicant Address: Phone: Insurance: 79 CENTER ST (413) 367 -2228 WC MONTAGUEMA01351 ISSUED ON:10/25/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:INSULATE ATTIC & WALLS 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 /Chimney: 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 Signature: FeeType: Date Paid: Amount: Building 10/25/2012 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner jcm home improvement jcm home improvement Estimate p.o. box 329 Leeds, MA 01062 Date Estimate # (413)585 -8482 10/13/2012 1 1006 jcmhome @comcast.net Exp. Date 10/20/2012 Address David Nanartonis 83 Brierwood dr. Florence Ma 01062 Activity Quantity Rate Amount • REPLACE ROOF • Remove one layer of asphalt roofing totaling approx. 1200 sq. ft.5500 • Install Ice & water barrier along eves • Install 151b felt throughout • 30 yr. shingle to be installed ( color choice by homeowner) • Repair chimney flashing as necessary • Replace all metal edges and vent pipe flanges • All debris removed from premises • All labor, material and permit fee's included 1 5,500.00'! 5,500.00 • $1000 due upon signing, final payment upon completion I � ' I I I Totall $5,500.00 44 t \ t2 731/2 1 I- Accepted By 1 �' Acc pted Date: City of Northampton /(411,4',111, Massachusetts uAl DEPARTMENT OF BUILDIN INSPECTIONS *, 212 Main Street • Municipal Building ,J a� wu ✓ Northampton, MA 01060 3 �h✓ INSPECTOR 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 for the 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 until 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 The Commonwealth of Massachusetts - Department of Industrial Accidents R- Office of Investigations 600 Washington Street ,� t ,, Boston, MA 02111 `'y ,, � ., � ,.g. ti` ~'' www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders /Contractors/Electricians /Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): '-s'e / Address: tk 0 0c k 5+ City /State /Zip: ckoreY,c M4. of o Phone #: L ( 7L ..( e0. Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. n I am a general contractor and I employees (full and/or part-time).* have hired the sub contractors 6. ❑ New construction 2i am a sole proprietor or partner listed on the attached sheet. 7. n Remodeling �--� ship and have no employees These sub contractors have g. I Demolition for me in any capacity. employees and have workers' working y 9. n Building addition [No workers' comp. insurance comp. insurance.t required.] 5. n We are a corporation and its 10.n Electrical repairs or additions officers have exercised their 11. Plumbing repairs or additions 3. I am a homeowner doing all work g P myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13.n Other • comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have employees. If the sub - contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State /Zip: 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 of the DIA for insurance coverage verification. I do hereby certify under th`` ain d penalties of perjury that the information provided above is true and correct. f _ Signature: D „/-13-- Date: i2 Phone • . L/ l 3 -- 5 P� Q'i P o, Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # 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 #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: �I Not Applicable ❑ Name of License Holder : �55 r `�4j� 077 Li / 0 J License Number �1 o CDc,. k . -1 L ce aloe ,.1//// Address - 7 Exit tion ate ` ii3 ^ 51.E d Telephone 9: Regis #ered Home,improvement Contractor. ; Not Applicable ❑ J 55e M c^J a7q Company Name Registration Number LtO d / / Address /I ��,,NN,,____ ,�r��n (('��,� D Expirati n Date i�' lQ .rc< 441 Q(Q�O� Telephone S0 & 18 2 SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G,L. c. 152, § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes ❑ No ❑ 11� no r. me Owne Exempt The current exemption for "homeowners" was extended to include Owner - occupied Dwellings of one (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 acts as supervisor. CMR 780, Sixth Edition Section 108.3.5.1. 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 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 homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he /she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor 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 of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you under 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 rw SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House (1 Addition ❑ Replacement Windows Alteration(s) 1 Roofing Or Doors l] Accessory Bldg. n Demolition ❑ New Signs [O] Decks [C]. Siding [0] Other [0] Brief Descrin of Proposed Work: ■Qw%o.iz \ \el e" c.• I n Sfrt. 1 1 qnc ■1 7 d Ir , %.9: 0 4.., 14 sJ,,'y le Alteration of existing bedroom Yes No Adding new bedroom Yes r I Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a IfNe v house :and flr= addition. existing housing, complete the following: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each ' g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a OWNER AUTHORIZATION -TO BE COMPLETED WHEN - OWNERS:AGENT OR.CONTRACTOR,APPLIES FOR BUILDING PERMIT 0 , cA_v• i d /Ihrt en4c7 r-► I , as Owner of the subject property T hereby authorize TJ CSS /1o`n4C to act on my behalf, in all matters relative to work autho ed by this building permit application. /O/ 9S/ a Signature of Owner D�fe to( N `r is J C S ,"? i J drr r i , as Owner /Authorized Agent hereby declare that the statemerfts and information on the foregoi applicatiO are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. , / Z c&v !C( V / f' t c'/1 iS �C�SS r ► • • Print Name /0 aS Signature of Owner /Agent�� rate • - 0.- .. Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by 'i' oning This column to be filled in /Mir Building Department IV3 A N.5 J Lot Size __ -___ . _ , - --- Frontage Setbacks Front - - _ . --- - Side L: — R:--- L: R: Rear ; , ____ _ Building Height . = , . Bldg. Square Footage . % , .. Open Space Footage -- (Lot area minus bldg & paved parking) # of Parking Spaces Fill: = = ■ (volume & Location) _ A. Has a Special Permit/Variance/Finding e er been issued for/on the site? NO 0 DON'T KNOW YES 0 IF YES, date issued:: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES 0 IF YES: enter Book Page' : and/or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW ' YES 0 er -----4 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained , Date Issued: C. Do any signs exist on the property? YES 0 NO 0 -------- IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO er ------ IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excav ' , illing) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. '� Deportment use only y k y City of Northampton Status Building Department curb CufilDnveway,Perrntt n w 212 Main Street Seuyer /Septic Awadablllty 2 Room 100 W ater]VUelt Avallabihty ` �E� oNS orthampton, MA 01060 T vr a Sefseot Structural Plans T �,, �'" j of 6v MpS NNE . - 3,-14;41 � � r MP : ' •ne 413-587-1240 Fax 413-587-1272 Plot/Site Ptans 't " p�eNOR�N' Other Specify ! APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address This section to be completed by office 3 rsie °"`', Dr. Map Lot Unit F ( c re 1C 2 itel4 010V) Zone Overlay Dis #uct EIm St. District' CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Dvtv of A/cnc ni„S c'? 3 /2/ct/ -C Name (Print) Current Mailing s Address: r 3 — e6— c7 9S Telephone Signature 2.2 Authorized Agent: sse • --ah. 1 -10 Name (Print) Current Mailing Address: per/ t- f r 3 -- SCpS U 1 c1 Signs ure Telephone "'TION 3 - STIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant , 1. Building \c,5-17° (a)` Building" Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 1' . 3. Plumbing Building Peimit Fee? 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) �� , ( Check Numbed,. This .Section For Official Use Only Building Permit Numbers Date . � Issued: Signature: . Building Commissioner /Inspector of Buildings Date 83 BRIERWOOD DR BP- 2013 -0501 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29 - 159 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit # BP- 2013 -0501 Project # JS- 2013- 000793 Est. Cost: $5500.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JESSE MONTGOMERY 077410 Lot Size(sq. ft.): 10018.80 Owner: DURANT MARIE L Zoning: Applicant: JESSE MONTGOMERY AT: 83 BRIERWOOD DR Applicant Address: Phone: Insurance: 40 OAK ST (413) 585 -8482 FLORENCEMA01062 ISSUED ON:10/25/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF 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 /Chimney: 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 Signature: FeeType: Date Paid: Amount: Building 10/25/2012 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck— Building Commissioner