Loading...
44-110 WAP Work Order: Job Number: 13-199 Glass replacement per ui over 64 0 $1.50 $0.00 Glass replacement to 64 ui 0 $44.00 $0.00 Other 0 $0.00 $0.00 Side Press Lock 0 $9.50 $0.00 Storm Windows 0 $0.00 $0.00 Top Sash Lock 0 $9.50 $0.00 Weatherstrip Window/Schlegal or 0 $6.00 $0.00 equivalent Total $2,235.10 Contractor Instructions: Before Starting the Job: During the Job: 1.Please notify us 24 hours before starting or scheduling a job. 1.Incorporate lead safe practices as applicable. 2.Obtain required building permit. 2.Total for Heath&Safety and Repairs cannot exceed$2500.00. 3.Davis Bacon time sheets required for ARRA work on US Department of Labor Certified Payroll Report Form WH-347. 4.Photograph any air sealing or other work to be covered by insulation. Your Invoice Must Include: 1.Client name,client address and job number. 2.Signed and dated copy of the work order. 3.Pre and post blower door test results. 4.Attic inspection form. 5.Copy of certificate of insulation. 6.Copy of building permit. 7.Manufacture labels from replacement doors and windows. 8.Photographs of air sealing or other work covered by insulation. Blower Door Test Results Pre Post Certificate of Insulation posted? Yes No (Circle One) Attic Inspection form attached? Yes N/A (Circle One) Where Posted: Contractor:/ A , Alb Date •, AP Auditor: Date: / - OW, 'V Page 7 0 ZL'999$ 09.£l1$ 00'5$ JOAO 90'59$ 00'b0Z$ 00'0V$ 00'001.$ 00'1-$ 00'6$ JOAO WAP Work Order: Job Number: 13-199 Spray Foam Walls-CDC ONLY 0 $1.12 $0.00 Test drill 4 sides 0 $60.00 $0.00 Vinyl over asbestos(dense pack) 0 $2.31 $0.00 Window Weight Voids(pair) 0 $12.00 $0.00 Wood clapboard/shakes/shings or 0 $1.79 $0.00 vinyl(dense pack) Window&Door Replacements 32-36 in Steel pre-hung (0 $640.50 $0.00 replacement door w/lite 32-36 in Wood pre-hung 0 $609.00 $0.00 replacement door w/lite Basement window replacement 0 $250.00 $0.00 (awning/hopper) Basement window replacement 0 $250.00 $0.00 with a frame CDC Windows 2 0 $357.43 $0.00 Other 0 $0.00 $0.00 Prime window replacement w/low-e 0 $350.00 $0.00 to 73 ui Prime window replacement w/low-e 0 $350.00 $0.00 to 74-83 ui Prime window replacement w/low-e 0 $350.00 $0.00 to 84-93 ui Prime window replacement w/low-e 0 $350.00 $0.00 to 94-101 ui Replacement Grids(per window) 0 $42.00 $0.00 Replacement window per 12/29/10 0 $350.00 $0.00 Tech Manual revision Sliding door replacement per WAP- 0 $1,100. $0.00 IM-2011-009 00 Sliding exterior door replacement 0 $1,100. $0.00 per WAP-IM-2011-009 00 zCDC Door 0 $490.00 $0.00 zCDC Window Replacement 1 0 $312.00 $0.00 Windows Deadlights 0 I$0.00 $0.00 I I Page 6 aapun + t . 9 "itino Japun p ►; tra !9 a aid p {�!q. uacu�ed gun©wd unatuy le;fll tlietu lunptV� unpuV y duawJoplin �1AI 00'0$00.0$ WAP Work Order: Job Number: 13-199 Interior Air Sealing&Caulking 0 $75.00 $0.00 Labor only charge 0 $60.00 $0.00 Other 1 $75.00 $75.00 build foam board cover for whole house fan Replace Clothes Dryer Transition 1 $40.00 $40.00 Duct only Seal ducts with mastic or butyl 0 $65.00 $0.00 backed tape Weatherstrip(Q-lon or equal)& 1 $33.50 $33.50 R-30 attic hatch Weatherstrip(Q-lon or equal)attic 0 $31.50 $0.00 hatch zCDC Airsealing 0 $62.46 $0.00 Other Other 0 I$0.00 I$0.00 Permit Building permit 0 $1.00 $0.00 Other 0 $0.00 $0.00 Permit$50 0 $50.00 $0.00 Permit$35 0 $35.00 $0.00 Wall Insulation Bay Window insulate above*below 0 $100.00 $0.00 -your option as to method and Brick/Stucco(dense pack) 0 $2.89 $0.00 Double nailed asbestos/aluminum 0 $2.31 $0.00 (dense pack) Drill fmish patch plaster(dense 0 $1.90 $0.00 pack) Drill rough plaster patch or finish 0 $1.82 $0.00 wood plug(dense pack) Other 0 $0.00 $0.00 Single nailed asbestos/asphalt 0 $2.21 $0.00 (dense pack) Page 5 WAP Work Order: Job Number: 13-199 Health&Safety Basement window w/framing- 0 $250.00 $0.00 building code compliance(non- Clothes dryer vent including 0 $89.00 $0.00 Exhaust Duct Gutter Replacement(includes down 0 $6.50 $0.00 spouts) Knob&Tube Inspection,fuses, 0 $175.00 $0.00 wiring Other 0 $0.00 $0.00 Vent kit/bath fan 2 $89.00 $178.00 bath fan and kitchen fan Misc Insulation 2"Foam Board on Door 0 $54.00 $0.00 Domestic water pipe wrap 0 $2.63 $0.00 Duct insulation R-5 0 $3.10 $0.00 Hydronic pipe insulation 1.25-1.5 0 $3.68 $0.00 in.copper pipe R-5 Hydronic pipe insulation to 1 in. 0 $3.41 $0.00 copper pipe R-5 Other 0 $0.00 $0.00 Steampipe insulation 3 in.iron pipe 0 $7.61 $0.00 R-5 Steampipe insulation to 1.5-2 in. 0 $6.35 $0.00 iron pipe R-5 Steampipe insulation up to 1.25 in. 0 $5.51 $0.00 iron pipe R-5 Misc Measures Attic sealing with two-part foam 3 $75.00 $225.00 Basement sealing with two-part 0 $75.00 $0.00 foam Blower door set-up with pre&post 1 $45.00 $45.00 tests Cut/close attic-kneewall access 0 $78.75 $0.00 Cut/finish attic-kneewall access 0 $105.00 $0.00 Page 4 1 WAP Work Order: Job Number: 13-199 Basement overhead insulation R19 0 $1.58 $0.00 1 Fiberglass Basement overhead insulation R30 0 $1.82 $0.00 Fiberglass Belly repairs-foam board 0 $2.00 $0.00 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 $1.96 $0.00 high or less R-30 Garage ceiling cavity filled with 0 $2.10 $0.00 blown cellulose Other 0 $0.00 $0.00 • Perimeter 2 in.foam board 0 $2.50 $0.00 • Perimeter Wrap R-5 reinforced foil 0 $1.91 $0.00 or vinyl faced ductwrap • Sill insulation Faced R-19 0 $1.58 $0.00 Sill two-part foam w/fiberglass batt 0 $2.20 $0.00 Doors 28-32 in interior solid core door 0 1$315.00 $0.00 Automatic Sweep 2 $23.00 $46.00 Basement/outside door-door only 0 $367.50 $0.00 Basement/outside door-w/jambs 0 $435.75 $0.00 Fixed Sweep 0 $15.75 $0.00 Lockset/Schlage or equal 0 $73.00 $0.00 Other 0 $0.00 $0.00 R-5 Ductwrap or R max on door 0 $51.00 $0.00 Repair Striker Plate(WMECO 0 $8.75 $0.00 only) Repair/Refit Door 0 $52.00 $0.00 Slide Bolt 0 $9.25 $0.00 Weatherstrip s/Q-lon or equal 2 $45.50 $91.00 Page 3 WAP Work Order: Job Number: 13-199 R-30 restricted-slopes/floored fill 0 $1.48 $0.00 w/cellulose R-30 unrestricted-settled cellulose 0 $1.37 $0.00 R-38 unrestricted-settled cellulose 0 $1.47 $0.00 R-49 unrestricted-settled cellulose 0 $1.61 $0.00 Reinforced poly/R-20 cellulose open 0 $1.84 $0.00 rafters Reinforced poly/R-30 cellulose open 0 $2.05 $0.00 rafters Site Built pull down stair insulation 0 $180.00 $0.00 2 in foam box Spray Foam&Mesh&Blow CDC 0 $1.39 $0.00 ONLY Tenmat Recessed Can Cover- 0 $30.00 $0.00 pending approval Thermodome or Magnetic pull 0 $180.00 $0.00 down stairway box Attic Ventilation 1/2 Window Gable Vent 0 $118.00 $0.00 Other 0 $0.00 $0.00 Propa Vent 40 ($4.00 $160.00 only where soffet vents are Rectangular gable vent 0 ($92.00 $0.00 Rectangular soffit vent 0 $27.00 $0.00 Ridge vent 0 $23.00 $0.00 Roof vent 135(1 sq ft NFV)large 0 $95.00 $0.00 Roof vent 865(.4 sq ft NFV)small 0 $80.00 $0.00 Stack Vent 0 $152.00 $0.00 Turbine Vent 0 $168.00 $0.00 Varipitch vent 0 $114.00 $0.00 Basement Insulation 6 ml poly on ground 0 $0.75 1$0. 00 I I I Page 2 WAP Work Order Community Action of the Franklin,Hampshire and North Job Number: 13-199 Quabbin Regions,Inc. Work Order Date:6/20/2013 P.O.Box 1432 Ownership:Owner Greenfield,MA 01302 Phone:413-774-2310 Eastern Weatherization Auditor:Joseph Rosenburg PO Box 249 Email:josenburg@communityaction.us Montague MA 01351 Cell:413-325-3229 Email:easternweatherization @yahoo.com Phone:413-376-1135 Phone:413-863-5215 Cell:413-426-8768 Saydren Jonei NGRID Electric $2,235.10 24 Westhampton Rd Total $2,235.10 Florence MA 01062 413-210-0909 Additional Contractor Instructions: Authorized Actual Measure Description Comments Qty Price Total Qty, Total Attic Insulation Attic stairs-fill with cellulose 0 $135.00 $0.00 Attic/Kneewall Floor Transition 0 $2.52 $0.00 Dense Pack w/cellulose Kneewalls R-12 cellulose behind 0 $1.73 $0.00 permeable membrane Other 0 $0.00 $0.00 R-10-12 restricted-slopes/floored 0 $1.30 $0.00 fill w/cellulose R-10-12 unrestricted-settled 0 $1.21 $0.00 cellulose R-11 FGB in open rafters/walls/ 0 $1.31 $0.00 kneewalls R-18-20 restricted-slopes/floored 0 $1.42 $0.00 fill w/cellulose R-18-20 unrestricted-settled 1040 $1.29 $1,341.60 client will remove storage give plenty of cellulose Notice R-19 FGB in open rafters/walls/ 0 $1.47 $0.00 kneewalls Page 1 ,:r (!itj .af Nnrtftum{�turr i RttssttttlIgPliS * , c: DEPARTMENT OF BUILDING INSPECTIONS r)`_, )}[ ""4 ' 212 Main Street • Municipal Uuildin �f,l'il. ?�^fir Northampton, MA 01060 LOUISIHASBROUCK BUILDING PERMIT FEES Phone: (413)587-1240 BUILDING COMMISSIONER Effective July 21,2008 Fax: (413)587-1272 DEMOLITION $ 20.00 ACCESSORY STRUCTURE $ 35.00 PRINCIPAL BUILDING—Residential $200.00 PRINCIPAL BUILDING-Commercial *NEW CONSTRUCTION $ .50 per square foot for 15t floor .30 " " " 2nd floor .20 " " " " %floors,attic,basement,garage STRUCTURAL ALTERATIONS IN ALL USE GROUPS $6.00 per thousand dollars of estimated cost or fraction thereof, with a minimum fee of$55.00 $25.00 WOODBURNING STOVE *NEW ACCESSORY STRUCTURES one hundred twenty(120)square feet and over $ .20 per square foot with a minimum fee of$25.00 *NEW ACCESSORY STRUCTURES under one hundred twenty(120)square feet $25.00 per inspection *SWIMMING POOLS $30.00 for above ground $60.00 for in-ground *SIGNS&AWNINGS $30.00 *DECKS $50.00 REPLACEMENT WINDOWS $35.00 SIDING&ROOFING Residential $35.00 per structure Commercial $55.00 min.per structure OR$6/K of estimated cost TENTS $25.00 *ZONING REQUEST FORMS $15.00 (includes home occupation registration) REISSUE OF LOST PERMIT $25.00 CERTIFICATE OF ANNUAL INSP. $100.00 (minimum) Temporary Certificate of Occupancy $25.00 PERMITS REQUIRING ONLY 1 (1)INSPECTION WILL BE A MINIMUM OF$25.00;ALL OTHERS WILL HAVE A$50.00 MINIMUM. PERMIT FEES SHALL BE PAID TO THE ORDER OF THE City of Northampton AND SUBMITTED,WITH THE COMPLETED PERMIT APPLICATION,TO THE OFFICE OF THE BUILDING INSPECTOR. WORK STARTED WITHOUT PERMIT IS SUBJECT TO DOUBLE NORMAL FEE. !! NO CASH -CHECKS OR MONEY ORDERS ONLY !! *Filing deadline Is 12:00 pm(noon)on Wednesday. Department use only City of Northampton Status of Permit; Building Department Curb Cut/Dnveway Permit 212 Main Street Sewer/Septic Avail ability Room 100 Water=/WeIl Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site`Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: f� This section to be completed by office Tai q',/✓I 7.1491 �' Map Lot Unit r/vr c e M ( 0 02-- Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: .SaN1-e S 11r--r/✓ .2 4l weC/I plc ✓, ee/vc,ovi' /10-0/0‘ ._ Name(Print) Current Mailing Address: Telephone V/3 -- / /5 p�e�D Q Signature ( !/y� !// / 2.2 thorized A ent: 4/ /4 "(/TA � PC / rUr/1/</-S' /Ca//S n�sr a� 37( 7nt) Current Mailing Address: � 49; 61?'�� 7I F nar \ ,` 4 Telephone �I SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 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) ? 3f Check Number ( / This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date The C'ominonwealth of Massachusetts - Department of Industrial Accidents ___. Li _ Office of Investigations =. 600 If�ashington Street = = a Boston, i1•L4 02111 3 www.mass.g o v/tdia Es Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant information Please Print LeEibl r' ��T C i C.4� Name (Business;C)rganizati�on.lndividuaf l E Q5�e__� ti J�G Ll 7_Ct,7�j n / S<'r-t t t:'., Address: I-h CI .\-----c, \ \ l t 1_YL_ \•, 11 . }■r ate! 1 �l� City/'State/Zip: MO 4'41_ ><,% N`41? C�4 5� t Phone#: t? ''tr'a -.5.5, i 3 - `x 13 17—`i/5O Are You an employer? Check the appropriate box: Type of project(required): I. I Sill a entplov.r with ��__ 1 am s general contractor and I ` h, D Nev.,'construction) have hired the sub-contractors employees(Mil and or part-time f.' 2.❑ ! a _ li_;ted on the attached sheet. Remodeling am a sole proprietor or partner- j -s ship and have no C}111?l0`oes These sub-contractors have S, '-: Deni(t111}On t4orking for me in an'. capac}it. employees and have workers- q._ i3. E! Building addition (No workers" comp. insurance comp. insit}'ance. required.] tVe arc a corporation and its j 111. -1 Electrical repairs or additions officers ilat'e exercised their i I._; Plumbing repan-s or additions i 3.❑ I and a homeowner drain,all v.orl ri.;ht of exemption per it•IC,L j , t-- myself. [\o workers'comp- 1_.7 Roof repairs insurance required.]_ c. 15 , §it- ).and we have no ! I employees. [No workers' ! 13.0 other VJectthe t ect-t C`t---);i cutup. insurance required.] K 71—..,11.5 i ict.t i s t') -An, applicant that cheeks h;,::#1 must also till out the sectirm below showtns their workers'compensation policy inft.manion homeowners who submit this affidavit indicat}teg the are d:-;ug all tiro;!:and then hire outside contractors must submit a new affidavit mdicatrne•ueh :Contractors that check this box mast attached an additional sheet showing the name of the sub-contractors and state whether or not those entittes have employees. if the sub-contractors acne employees,they must provide their norkcis-comp.policy number. I am an employer that is providing workers'eulltpensatnut insurance far my employees. Below is the policy and ph site information. 413 tirt�`; Insurance Company Name: AC, A,y)er1.ccL ?--..s_c"i ,,_ate',-1 J 0vr.. (: 1,ri..__/_[l'rj\C \_ci_ (15e.c-CL J _ Policy =or Self-ins.Lie. } Expiration Date: -5 1 r20 1 `] Job Site Address ,/ l/IoS_ !! `v!` _ `_,___Cih`StateZip: f�d/{/''�f �J 9 � d6�1 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage zis required under Section 25.A of: 161. c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 anCi or one-;'ear inlprisonnient.as well as civil penalties in the form of a STOP WORK ORDER and a line of up to 5250.00 a day against the violator. Re 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 c 'ti der t, t ains an erla/lie s t f 'that the Win-motion provided rho a is true d correct. f J/ ? /Sinare i �� Date: Phone:: 9 i3 -tj i2(�"'c3 7 L- 'O / "--/i 3 5ln-- 5 Li I3 Official use only. Do not write in this area.to be completed by city or town official. 1 City or Town: l'erniit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3. City/Town Cleric 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: S SECTION 5: CONSTRUCTION SERVICES 5.1iiiTcY Construction Supervisor License CSL) /60 ". c Sm 77 License Number Exp' ation I/ ate Name of CSL Holder / l .a S6 � List CSL Type(see below)_ T/4'No.and Street Type Description i U/��r Fa /7 /lilt o/ 76"3 U Unrestricted(Buildings up to 35,000 Cu.ft.) R Restricted 1&2 Family Dwelling City/T ,State,ZIP �� M Masonry .at.A./L RC Roofing Covering - WS Window and Siding y'2/ y2z ' SF Solid Fuel Burning Appliances l (� b I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) (. c17 V/ // /_ 4 € N HIC Registration Number Expi tion Date HIC Company Name or HIC Registrant Name - No.and Street j Email address City/Town,State,ZIP Telephone SECTION 6: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 0 SECTION 7a•OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT /74 I,as Owner of the subject property,hereby authorize /C/Z S77-1 G to act on my behalf,in all matters relative to work authorized b this building permit application. -So/ie,.. 1 , .5_4,54‘e/1. Print Owner's Name(ElectcOnic Signature) D to SECTION 7b:OWNER1 OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest is er the pains and penalties of perjury that all of the information con d ained in this application is true and a c to th- ,'11. of my wledge and understanding. 47(- ((.‘\ S/1/ (A ,, Print Owner's or Authorized Agent's Name(blectro)c Signature) D e NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces _ Number of bedrooms _ Number of bathrooms Number of half/baths Type of heating system Number of decks/porches _ Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" 4 ' juN 1 1 T ,- Commonwealth of Massachusetts t:ard of Building Regulations and Standards FOR ''-. ' , pE�'o BUILDTON'N_Er•`. - usetts State Building Code, 780 CMR MUNICIPALITY ....;.- Noa USE :uilding Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Applied: Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers z , a/er-h l(77'4/ 4( for { 1.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: %ZsAr-ti caei/'ei✓ r/6r-?i.r/c ( 44fr 0 /Q‘;-- Name(Print) City,State,ZIP Y W 4raz44 E/ Y/1 2 ( 6' O fr R' _ No.and Street Telephone Email Address SECTION 3:DESCRIPTIO OF PROPOSED WORK2(check all t t apply) New Construction❑ Existing Building Owner-Occupied fr Repairs(s) ,,Alteration(s) Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other Specify Brief Description` of Proposed Work2: __ _ M/e CIZ 6� 2c'z..4-�T'/ati_ ,e- C..eilc1 o 1AS tea' 1 d Alt'//C - ,l SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official UseOpy (Labor and Materials) 1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ T I All s $ Suppression) Check No. Check AmoumTOU Cash Amount: 6.Total Project Cost: $) 3 �, ❑Paid to Full ❑Outstanding Balance Due: File#BP-2013-1239 APPLICANT/CONTACT PERSON PATRICK SMITH ADDRESS/PHONE 79 CENTER ST MONTAGUE (413)367-2228 PROPERTY LOCATION 24 WESTHAMPTON RD MAP 44 PARCEL 110 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out J/ �/ Fee Paid / l�1 Typeof Construction: WEATHERIZATION&ATTIC&WALL INSULATION 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 OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF 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 Demolition Delay r Signature of ildin icial ' 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. 24 WESTHAMPTON RD BP-2013-1239 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:44- 110 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 PERMIT Permit# BP-2013-1239 Project# JS-2013-002045 Est.Cost: $2235.00 Fee:$55.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: PATRICK SMITH 100236 Lot Size(sq. ft.): 46609.20 Owner: CONNOR PETER C&SAYDREN JONEI Zoning: Applicant: PATRICK SMITH AT: 24 WESTHAMPTON RD Applicant Address: Phone: Insurance: 79 CENTER ST (413) 367-2228 WC MONTAGUEMA01351 ISSUED ON:6/25/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:WEATHERIZATION & ATTIC & WALL INSULATION 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 6/25/2013 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner