38A-031 (2) WAP Work Order: Job Number: 13-467
Top Sash Lock 0 $9.50 $0.00
Weatherstrip Window/Schlegal or 0 $6.00 $0.00
equivalent
Total $2,032.89
Contractor Instructions:
Before Starting the Job: During the Job:
1.Please notify us 24 hours before starting or scheduling a job. 1.This residence was built before 1978.Lead safe practices are
2.Obtain required building permit. required.
2.Total for Heath&Safety and Repairs cannot exceed$2500.00.
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: Date: WAP Auditor: Date:
Page 7
WAP Work Order: Job Number: 13-467
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 $0.00 $0.00
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
Page 6
WAP Work Order: Job Number: 13-467
Other 0 $0.00 $0.00
Replace Clothes Dryer Transition 0 $40.00 $0.00
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
Other
Other 0 I$0.00 ($0.00 I I
Permit
Building permit 0 $1.00 $0.00
Other 0 $0.00 $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 finish 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)
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)
Page 5
WAP Work Order: Job Number: 13-467
Clothes dryer vent including 1 $89.00 $89.00
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 0 $89.00 $0.00
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 3 $75.00 $225.00
foam
Blower door set-up with pre&post 1 $45.00 $45.00
tests
CO alarm(DOE2013 only) 0 $19.58 $0.00
Cut/close attic-kneewall access 0 $78.75 $0.00
Cut/finish attic-kneewall access 0 $105.00 $0.00
Interior Air Sealing&Caulking 0 $60.00 $0.00
Labor only charge 0 $60.00 $0.00
Page 4
WAP Work Order: Job Number: 13-467
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 Unfaced 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 I$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
1
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-Jon or equal 2 $45.50 $91.00
Health&Safety
Basement window w/framing- 0 I$250.00 $0.00
building code compliance(non-
Page Page 3
WAP Work Order: Job Number: 13-467
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
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 0 $4.00 $0.00
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 $0.00
Basement overhead insulation R19 0 $1.58 $0.00
Fiberglass
Basement overhead insulation R30 0 $1.82 $0.00
Fiberglass
Page 2
WAP Work Order
Community Action of the Franklin,Hampshire and North Job Number: 13-467
Quabbin Regions,Inc. Work Order Date:10/31/2013
P.O.Box 1432 Ownership:Owner
Greenfield,MA 01302
Phone:413-774-2310
Eastern Weatherization Auditor:Joseph Rosenburg
PO Box 249 Email:jrosenburg@communityaction.us
Montague MA 01351 Cell:413-325-3229
Email:easternweatherization @yahoo.com Phone:413-376-1135
Phone:413-772-9950
Cell:413-426-8768
Shane Frenier Bay State Gas $2,032.89
61 Chapel St Total $2,032.89
Northampton MA 01060
413-587-9239
Safety Issue(s):Lead Paint Possible
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 991 $1.29 $1,278.39
cellulose
R-19 FGB in open rafters/walls/ 0 $1.47 $0.00
kneewalls
Page 1
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DRIVER'S LICENSE
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PATRICK 6 ��{
79 CENTER ST '
MONTAGUE.MA
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PATRICK G SMITH
79 CENTER ST.
Montague Y+ , 0135/
04/05/2014
ol
Office otjCoasamer Affairs&BuSiiiess stegufation
HOME IMPROVEMENT CONTRACTOR
Registration: 134741 Type:
Expiration: 1/11/2014 OBA
EASTERN WEATHERIZATION
PATRICK SMITH
79 CENTER ST
MONTAGUE,MA 01351
Undersecretan
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1 Are Irma 237..emplover?Check thppropria re box:
I ••—. 11 Type of-project(required):
n a emplo r ith
4. 7-• lain a eneral contraczor aid i
aye w f.L., -' .....
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I - - .inployees(full andlor part-timei." h-lve hired the ul-,-eontractors 11 '
2.0 I am a SOle proprietor .st.partner- ilr-areci inl the-aU.:acile.C1 Sili:-.:-.1. i i ,_ L___: Remodeling. .
These
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sobcontractors have : , „ ,-, ,- • •
i ship and ilnVe. 110 eilipiOVeeS t r--'! yeiTIOM301-2
I Working forme in an:. capacity. employees grid have' re-<" I :
11 1•1_ i I Buildinu addition
1 1-No la-orkers comp. hi m
surance
cop.insurance.-
i !equIr...u.! -; : we„re a --4--,,•-•-i•-,i1 and kis i 1, 10-LJ Electrical repairs or.,ddtions
officer<ivy:: x..ercise;_i their 1 I ,-
am a homeowner cloinf...,all work e ; i II., ; ituricine repairs or additions
r111 of:exemption per IvIGI. I i ,.., , ,
myself-No workers-comp_
; , ,...: 1001 repzurs
insurance required.11 c. .1.•:.7s. and we have no ;
11 13.17.. Other U..5e0.-±her 1 771.±1,-1 nl
empioyees. No workers'
comp_insurance required.; I —.- i.,-. — i • •
1 II ' /L.- f I-15C!0J 101--) :
Al*appik:mt'am checks b••:,,:,:•-•1 mast elso lit r•er.thz secthai 1•-..-ii-ow siirr.val....their e-orkerf crimp:us:aim:pc:iity ini-i,nnalian
'usgr,-.(m-aers-.rho suhinii;his:Iflidavit I ieailiie tilt:::arc d.,.--ia,....all--tati.:and litun ino:outsidit ix,nirtich:ns must submit 2 JIM ajlidaVil Ia.:hi:a:1W!ilICII
:Cmitractors:hal s:111:this F :.c,aa.tsi au:.,,,:ii,:i„.,-;a:Jai:h.-4.1%i...;11,•,:silo:vulg.:hr.;eerie Clf the::-.-ub-commr.t"ti.anti stalt--vinnher or rim-,10::;-.vi,:s h•,•:,,-,
•:ropteivees. tithe$ub-conira„::‘,1-:::LPL::criirtiny;;; ;. tc,:inns!prm-dc their worker:- rap.rir.liey ithrailtr.
I aliE air emplorer that is providing workers'comperisafion inso-rancefil:my employees-. Below is the nollev find lith sire
itifilrlizatioa. 2:-1-,..7 ir-,—,r-
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ft-Isar:Ince Company Name:Act. arn--.7,-,-.1 r c--.1 -7-..-,...,c,:_aci.1,-,.r.., __ia,:;_\,-,_,-,..i.c.)4.._-__..._.-.,;.__I i•-• ti%a',zit— U■t.._.n 5e-4----)C_
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Policv:4 or Self-ins.Lie -7•.: 1-'0.-i LI—1 te- i 11 11 C11 EXpiratiOn Dvilc: ,._5 I 1 /620 l._ -1_,_
- ,.... .:__...L.,._.,fa -,.....1 _
Job Site Address: 41_ C A/4 f, 4.T. _ CityState-"Zip:Ald/741--'1 4119- 64/06'0
Attie:la copy of the workers' compensation policy declaration page(showing the policy number and eapiralion daze).
Failure to secure cuveraue as required under Section 25:1,of lviCil.. c_ 152 can lead to the imposition of criminal pe.naiii.e.....5 of a
fine up to SI,500.00 andfor otte-ycar imprisoinnent.as well as civil penalties in the form of o STOP WORK ORDPR and.= iine
ofup TO 5250.00 a day anainst tie violator. Re advise.d that a co pY of this statement ma..i..i.e forwarded to the 011-1.1.-.e of
investiaations of the DiA for insurance cortraae‘.-eezuion.
-------7-77
I do hereby ii„,....„„)...ye.er ,fill!er till; alas:my!I:r iiiiiiieS rifpVfirifli the iiiiiIrmaii Oil provided above I /rile'_ird eorrecz.
riga,/
‘ (j—N 9,<:1_, 7:111.1/1 f-4- s=
S itznature: V ____ _Date:
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P h o n e#: il 1 0-‘ - k. 1 /I 6 .1 D.:.I..., 1 m
Off:rid LUC Indy- Do rim:Vrife fir dra OWL:,to be complete.d hr thy or touni oitithlL
11
I i
City or Town: l'erroitiLiccose mm
It
iSstdag Authority(circle one):
1
1.Board of Health I Building.Department 3.Cilyrrown Clerk 4. Electrical inspector 5.Pirimbint:Inspector ■
....- n-,}..-
kl.:A.:2z
li
:._ay..?ersoe: Phone r4:
ii
,
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable £
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
9.Registered Home ImprovemenYConfiactor 'z ..... .,.... Not Applicable £
Company Name Registration Number
Address Expiration 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.
r
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House El Addition J Replacement Windows Alteration(s) Roofing El
Or Doors D \/
Accessory Bldg. ❑ Demolition ❑ New Signs [oj Decks [l Siding [D] Other`
Brief Description of Proposed We�`7`/ Q/ J
Work: -[ n l 2 (1" t /6-N e//v/J e f iV 5 rh
�O✓'� �(/ ''
Alteration of existing bedroom Yes No Adding new bedroom Yes No C4-4J,1'�//
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
fa,If New house and aditno eidstingfi"ouslnq;„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
I, SA a/t-`'( Z 'v/ C ,as Owner of the subject
property
hereby authorize 04 77:1 C s.771
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, ( 1727 (4- c L17 / , as Owner/Authorized
Agent here. declare that the statements an in rmation on the foregoing application are true and accurate, to the best of my knowledge
and belief
Sig u r e pain pen 'ties per' ry.
int Name
//// c/7
Signature of Owner/Agent Date
Department use only
- ,_ `\� C��tq`� f Northampton Status of Permit .'
Suit iing Department Curb Cut/Driveway Permit
NOV 1(2013
21 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
I —. — Northampton, MA 01060 Two Sets of Structural Plans
Elec n I
phone 413-8p-1240 Fax 413-587-1272 Psite Plany s
Other Specif :_
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
S ECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address: / _
of/ CA 01/4-Pt g Map Lot Unit
/1/0 , 17 tt�70 701//1.4/3' O`v 6 0 Zone Overlay District
Elm St.District CB District
SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
/7 = � h �
. 5/1 /J, r� ,-, �' i �0c_g�,% �iii, d0G0
Name(Print) Current Mat }g/A res 7
7,2. 3 7
X i 1/ 1A-1-)c.1 Telephone 1 Si//ignaturd 1
2.2 Au orized Agent:
6i r (� c/ /i7 WI
_ � /7 tf S 4 5 �
Nam• Print) Current Mailing Address/ 0/ 3 76
...41/ i 474 •7 4/21 8-76 7
gnature Telephone
SECTION 3 I-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) 404, C) '3 Check Number /tV4/ �
This Section For Official Use Only TTT
Date
Building Permit Number. Issued:
Signature:
Building Commissioner/Inspector of Buildin s Date
p61 1£fI 10N + e lam iivsvietYloAr
14-41c + Pje,115
cp e a c-A.P d
File#BP-2014-0622
APPLICANT/CONTACT PERSON PATRICK SMITH
ADDRESS/PHONE P 0 BOX 249 MONTAGUE (413)426-8768()
PROPERTY LOCATION 61 CHAPEL ST
MAP 38A PARCEL 031 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out �/!/�J 5�
Fee Paid /�''`�'(P
Typeof Construction: INSTALL 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 FOL OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
pproved 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
-••olition Delay
tilert)r, /
ature of Building ficial 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.
61 CHAPEL ST BP-2014-0622
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38A-031 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-2014-0622
Project# JS-2014-001049
Est. Cost: $2033.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: PATRICK SMITH 100236
Lot Size(sq.ft.): 2439.36 Owner: FRENIER MELISSA L&SHANE L
Zoning:URB(100)/ Applicant: PATRICK SMITH
AT: 61 CHAPEL ST
Applicant Address: Phone: Insurance:
P 0 BOX 249 (413) 426-8768 () WC
MONTAGU EMA01351 ISSUED ON:11/18/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 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 11/18/2013 0:00:00 $55.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner