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15B-051 (2) BP-2021-0464 132 CHESTERFIELD RD COMMONWEALTH OF MASSACHUSETTS GIS#________ CITY OF NORTHAMPTON !�1ap:Block: 15B-O51 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Lot: Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) (are<Jnrv•New Single Family House BUILDING PERMIT Permit# BP-2021-0464 Project# J S-2021-000781 Est.Cost: $380000.00 Fee: $1499.00 PERMISSION IS HEREBY GRANTED TO: Contractor: License: Use Group: Const. Class: KEITER BUILDERS 102457 Lot Size(sq.ft.): Owner: Scott Keiter Zoning_ Applicant: KEITER BUILDERS AT: 1 32 CHESTERFIELD RD Applicant Address: Phone: Insurance: Phone:r 35 MAIN ST __ __ (413) 586-8600 () WC FLORENCEMA01062 ISSUED ON:10/30/2020 0:00:00 TO PERFORM THE FOLLOWING WORK:NEW SINGLE FAMILY HOUSE POST THIS CARD SO IT IS VISIBLE FROM THE STREET BuildingInspector Inspector of Plumbing Inspector of Wiring D.P.W. p Underground: Service: Meter: Footings: Rough: Rough: .- 1 House# Foundation:0.ie. I Z-23 Zd 70 K. Q �-��jJ "i ,- Driveway Final: t. / Final: Final: -/L. r} Rough Frame: t Li•7•Z 1 IC 2. ____ ~i� (:,;as: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: ()k. 1/0J/0)-\ p t _ _ �� Final: (j,� (,�-Z1- Z I 1<Q Final:, Smoke: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND RE,.0 TIONS. ' i r , >9 I,:. 1 • Certificate of Occupancy/ Signatu !: I 0 FeeType: Date Paid: Amount: Building 10/30/2020 0:00:00 $1499.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis l lasbrouck-Building Commissioner G ft�iC SUSS f3 S 11C ( 6 F * , The Commonwealth of Massachusetts t ' 4 CI , City of Northampton of Occup ancy Certificate anc fp y In accordance with 780 CMR, (The Ninth Edition of the Massachusetts Residential Building Code) this Certificate of Occupancy is issued to the premise or structure or part thereof as herein identified. Identify Name of Building of Space Within, Building Owner, or Permit Holder Certificate No. Issued to BP-2021-0464 Keiter Builders Identify property address including street number, name, city or town and county Located at 132 Chesterfield Road HERS Rating Florence, Hampshire, Massachusetts 48 Use Group Classification(s) Single Family Dwelling This Certificate of Occupancy is hereby issued by the undersigned to certify that the premise, structure or portion thereof as herein specified has been inspected for general fire and life safety features. This certificate shall allow for the use as herein described and in conformance with any and all conditions as identified below. It shall be posted in a conspicuous place within the space as directed by the undersigned. Failure to post the certificate,failure to comply with conditions or,tampering with the contents of the certificate is strictly prohibited. Conditions of Use Single Family Dwelling All fire protection and life safety systems must be maintained, and all means of egress must be kept clear Name of Municipal Date of Final Map/Plot: Building Official Kevin Ross Inspection 06/21/2021 Signature of Municipal Date of 15B-051 Building Official - Issuance 06/21/2021 1111110111001~1~11010 Home Energy Rating Certificate Rating Date: 2021-06-19 HIS . Registry ID: 939392862 HERS Final Report Ekotrope ID: ILKbmON2 HERS® Index Score: Annual Savings Home: 4 Your home's HERS score is a relative 132 Chesterfield Rd performance score.The lower the number, 1 1 1 Florence, MA 01053 the more energy efficient the home.To 4/,' Builder: learn more,visit www.hersindex.com *Relative to an average U.S.home Keiter Builders Inc. Your Home's Estimated Energy Use: This home meets or exceeds the Use if48tul Annual Cost criteria of the following: Heating 53.1 $1,402 2018 International Energy Conservation Code Cooling 1.0 $68 Hot Water 10.9 $285 Lights/Appliances 19.0 $1,101 Service Charges $84 Generation(e.g.Solar) 0.0 $0 Total: 84,0 $2,940 HERS Index Home Feature Summary: Rating Completed by: „4100.. ...Elmo Home Type: Single family detached Model: N/A Energy Rater: Adin Maynard RESNET ID: 9463452 Existing =40 Community: N/A fintnes 1 a ,, I .1 Conditioned Floor Area: 2,200 ft2 Rating Company: HIS&HERS Energy Efficiency 144 '7 Number of Bedrooms: 4 Mailing:12 Perkins Ave.Northampton MA 01060 Reference tri „„,,"- 4136588784 Home him Primary Heating System: Furnace•Propane.96 AFUE...— Primary Cooling System: Air Conditioner•Electric•17.25 SEER Rating Provider Energy Raters of Massachusetts so , To Primary Water Heating: Water Heater•Propane•0.97 Energy Factor 2 Woodlawn Street Amesbury MA 01913 978-270-3911 P1 House Tightness: 574 CFMSO(0.94 ACHSO)y, 1 Ventilation: 64 CFM•18 Watts 3.0 This Home Duct Leakage to Outside: Untested Forced Air 2fr Above Grade Walls: R-20 deZZ' to Ceiling: Vaulted Roof,R-49 Zeto Energy _ Home u Window Type: U-Value:0.28,SHGC:0.28 Adin Maynard,Certified Energy Rater •mi 1 F41,0t, 1111P.. itn"" Foundation Walls: R-16 Digitally signed:6/20/21 at 10:11 PM ekotrope 1 Ekotrope RATER-Version 3.2.4 26q6 The Energy Rating Disclosure for this home is available from the Approved Rating Provider. This re art does not constitute an warrant or uarantee. 2018 IECC R-406 RESNET Registered Energy Rating Index Report Property Organization Energy Rating index information Builder:Keiter Builders Inc. Company:HIS & HERS Energy Efficiency RESNET Registered Rating Address: Phone:4136588784 Rating No:939392862 132 Chesterfield Rd, Florence, MA 01053 Rater:Adin Maynard Rater ID (RTIN):9463452 Date Rated:2021-06-19 • ; , Estimated Annual Energy Consumption* ; Rated Home Calculated Energy Use Rated Home Cost($/yr) (MBtu) 1 Heating 53.1 $1,402 Cooling 1.0 $68 Water Heating 10.9 $285 Lights&Appliances 19.0 $1,101 Photovoltatcs 0.0 $0 *AZeif *Based ce,standard dwatind condttons ERI with PV:53 ERI without PV:53 Annual Estimates Electric(kWh):5,034.7 CO2 Emissions(Tons):7.9 Natural Gas(Therms):0.0 Maximum Energy Rating index:61 This Home's Energy Rating index:53 PASS This home MEETS the Energy Rating Index Score requirement of 2018 IECC R-406 for Climate Zone 5, It MEETS all of the requirements verified by Ekotrope. Mandatory requirements are summarized on the 2nd page of this report, some of which are not verified by Ekotrope. Name: Adin Maynard Signature: Organization: HIS & HERS Energy Efficiency Digitally signed: 6/20/21 at 10:11 PM Rating Provider Data arid Seal Company:Energy Raters of Massachusetts Address:2 Woodlawn Street Amesbury, MA 01913 Phone#:978-270-3911 A 1, NO. 13' Fax#: To determine if a provider is properly accredited go to:www.resnelusiprofessionaliprograrnsisearch_directoty (Confirmed and tested) Climate Zone 5 Mandatory Requirements Provision Number Topic Compliance Decision 2009 IECC Table Building thermal envelope minimum insulation levels and PASS 402.1.1 or 402.1.3 maximum fenestration U-factor and SHGC R401.3 Post a permanent certificate listing the level of efficiencies Certificate required for CO installed in the house R402.4.1.2 Envelope air leakage maximum leakage rate i PASS R402.4,1 I Table Comply with air sealing and insulation requirements in Table 1 Checklist required for CO i R402.4.1.1 R402,4.1.1 R402.4.4 Rooms containing fuel-burning appliances PASS* R402.5 Maximum fenestration U-factor and SHGC (U-Factor) PASS (SHGC) PASS R403.1.2 Heat pump controls PASS' l R406.2 Ducts outside of conditioned space to be insulated to a PASS* minimum of R-6. R403.3.2 Duct sealing on all ducts PASS' R403.3.3 Duct testing for ducts in unconditioned space PASS' I R403.3.5 Building cavities not used as ducts. PASS* R403.5.1 Heated water circulation and temperature maintenance PASS* systems comply R403.5.3 Hot water pipe insulated to R-3 PASS R403.6 Mechanical ventilation meeting the requirements of the IRC PASS' or IMC. Outdoor air and exhaust dampers installed R403.7 ACCA Manual J and S conducted for all heating and cooling ACCA forms required for systems. I permit R403.8 Systems serving multiple dwelling units to meet the PASS' i mechanical requirements of IECC commercial code R403.9 Snow melt and ice system controls installed where applicable PASS' R403.10 Pools and permanent spa energy consumption meet I PASS' 1 requirements for heaters, time clocks and covers R403.11 Portable spas meet the requirements of APSP-14, i I PASS' R404.1 1 High efficacy lights installed in 90°/0 of permanently installed PASS fixtures, 1 ,....... J L..._ i 'These items have been field-verified by the Rater, Field Inspector, Code Inspector, or Builder, ._ .,1,4.....,.v...,.. s,,r,..:0..,..:.“,,,..,..i,,,,,,;..,...,,,:.,....,.....n.4........,,,,,,,,,......,1.1,;:,..„,,,,,:,..,,,I,..,,,,;:„..Jo:. ••*,#;ii 11 .•'-'11:1..-' . .. . — ,i.*`,4 0; •;*..*'4.'s...*;4*A),* •;4'.1 4**.'* . .. ,.it#t',,'.;*4 I'',,• *;..#'0*,.*•;*.Vet,• •*44.4.....,,'*;;;.4`,* *;*V4::,,,,e.e,;*'4:**.. . ee;.4**,,,e'",4,-.6.6,..'s!,, . ,.,,.,,,%,, ....;', : f; 61. ::''.. ,-': *6°' 6* •::. •' ' .141t 64 ' , .**'' *IS '''., • : '66 ' It '• , :: 41 '' St ''* , — f* " *t —',. ,,"' , * 4 ....' '. ,,,,, .. '' W '`' " W • ' W • • 'V ' W '' . .e...• .• ' '( ' ., ,... 132 Chesterfield Rd •.„.., ... .... ..: ... 9 Florence MA 01053 .7.. N.. . ' .,•' *4`' • Builder: Keiter Builders Inc. • -- ,.. -.... ... .,•-•. -. . , .-- THIS HOME IS CERTIFIED TO MEET THE ..... 2018 INTERNATIONAL ENERGY CONSERVATION CODE .. ... .., ... ,'...- --....::. . . . .-. . . ., ...., ., .,. Building Features . .., -., ...- ' -... Ceiling Vaulted Roof, R-49 Duct Supply R-6.0, Return R-6.0 -- ... •M• ... Above Grade Walls R-20 Duct Leakage to Outside Untested Forced Air(Exempt) ... -- ,-..- Foundation Walls R-16 Total Duct Leakage Untested (Exempt) -- . i .:: ...., ..,. '-- Framed Floor N/A Heating Furnace• Propane • 96 AFUE „.4.: : • ..4:1 Slab R-0.0 Perimeter, R-0.0 Under Cooling Air Conditioner • Electric • 17.25 SEER - -.' :.•-• .,:....;,' ,,,... ,....J. ... Infiltration 574 CFM50 (0.94 ACH50) Water Heating Water Heater • Propane • 0.97 Energy Factor - •-° ' ... zt, ..... Window U-Value: 0.28, SHGC: 0.28 ..„ ...,. '..- -....'i,.... ".-:.... .-.'f As a 3rd party extension of the code jurisdiction utilizing these reports, I certify that this energy code compliance document has been created in accordance with the requirements of ...,, Chapter 4 of the adopted International Energy Conservation Code based on Climate Zone 5',It rating is Protected,I certify that the building design described herein is consistent with the ..' 'Raiding plans,specifications,and other calculations submitted with the permit application If rating is Confirmed.I certify that the address referenced above has been inspected/tested and '** that the mandatory provisions of the IECC have been Installed to meet or exceed the intent of the IECC or will be verified as such by another party, ..,.• . '*• 4:::' ) Name: Adin Maynard Signature: ... -•. ,.. "-- " . •.. Organization: HIS & HERS Energy Efficiency Digitally signed: 6/20/21 at 10:11 PM ..., .--. : .... .-- , ,•:.. -- ,.....; Ekotrope RATER-Version 3.2.4.2696 .- . 2018 IECC compliance results calculated using Ekotrope RATER's energy and code compliance algorithm. —.r. Ekotrope RATER is a RESNET Accredited HERS Rating Tool.All results are based on data entered by Ekotrope users (:::: ) Ekotrope disclaims all liability for the information shown on this report. .•,,. ....., '"••• — . " .., , ' .,. . ,— . .. • '^' ... t* ., #* , Y* ,. *t . .44 ,, **., ,, . .64 , ... .. 6*, .• , ,61. .. 7. ,•,,,,, :•;', e':*':.*' I ...4,4,0:'`FI'',:t.",..:0,,..*:x:ik .!:/.,,„..,..,,..„,,4,:f. S.1‘!:,•,.4„,.,e,,,,e::. ,..!‘ i,,,,'+.,.§,,,,,...,;.,,,,,,•ti!'ir's,0,,,,,e4;,,,,*6tr ,, :, ,,,*4.,7064,,,sit'5 ' ,...:' ' ' .1,4,k 6.': , ..e 4'e •4.*4 4,*^.e'',•*.e 4'' '',4:4 4 4,..,4,ty..4?• *'',st..*.t,'*,**.0.4.4.** *4.4.4.*,.4,,*4.4..4.4,4'* . *,°*°.yr.' IECC 2018 Label 132 Chesterfield Rd Ekorope RATER-Version: 3.2.4.2696 HERS®index Score 48 Building Envelope Specs Ceiling. R-49 Above Grade Walls: R-20 Foundation Walls: R-16 Exposed Floor: N/A Slab: R-0 Infiltration: 574 CFM50 (0.94 ACH50) Duct Insulation: N/A Duct Lkg to Outdoors: Untested Forced Air , Ll-ValUe:-0.28:SHGC: 0.28 Door: R-5 Heating: Furnace• Propane• 96 AFUE Cooling:Air Conditioner• Electric• 17.25 SEER Hot Water: Water Heater . Propane 0.97 Energy Factor Average Mechanical Ventilation: 64 CFM Signature: Air Leakage Report 011101111•1111 Property Organization Inspection Status HIS 132 Chesterfield Rd HIS & HERS Energy Effici 2021-06-19 HERS Florence, MA 01053 Adin Maynard Rater ID (RTIN): 9463452 4136588784 RESNET Registered 132 Chesterfield Rd (Confirmed) 132 Chesterfield_Keiter_Fnl Builder Keiter Builders Inc, General Information Conditioned Floor Area [ft2] 2,200 Infiltration Volume [ft3] 36,600 Number of Bedrooms ;4 Air Leakage Measured Infiltration 574 CFM50 (0.94 ACH50) ACH50 (Calculated) 0.94 ELA[sq. in.] (Calculated) 31.57 ELA per 100 s.f. Shell Area (Calculated) ,0.432 CFM50 (Calculated) 574 CFM50/s.f. Shell Area (Calculated) :0.079 Duct Leakage Leakage to Outdoors Total Leakage Test Type Total Leakage [CFM @ 25 Pa] Total Leakage[CFM25/ 100 s.f.] Total Leakage[CFM25/CFA] Mechanical Ventilation Rate [CFM] 64 CFM Hours per day 24.0 Fan Power 18 Watts Recovery Efficiency% 75.0 Runs at least once every 3 hrs? ,true Average Rate [CFM] 64.0 CFM 2010 ASHRAE 62.2 Req. Cont. Ventilation 59.5 2013 ASHRAE 62.2 Req. Cont. Ventilation '84.1 Ekotrope RATER-Version 3.2 4.2696 All results are based on data entered by Ekotrope users.Ekotrope disclaims all liability for the information shown on this report Building Specification�^ �� n��Ko��U�� *u��uo�� w`�� «- ' � ��NN� � m wm~� _ Property Organization Inspection Status H�� 132 {�hasterhe|URa HIS & HERS Energy Efhoi' 2021-06'19 HERS Florence, M/\01O53 AdinK4aynord Rater |D (RTN): 94G3462 4136588784 RESNETRegisteroU 132 Chesterfield Rd (Confirmed) 132 Chesterfield_Kei1e[_Fn| Builder Ko|ter Builders Inc. Building Information Rating Conditioned Area Utj 2.200,00 H�ERS Index 48 Conditioned Volume [ft` 30.600 00 HERS Index w/o PV 48 Thermal Boundary Area [h=] 7,30030 Number OfBedrooms 4 Housing Type Single family detached Building Shell Ceiling w/Attiu None Windows (largest) U'Vaiue: 0.28.SHQC: 0-28 Vaulted Ceiling VVindmw/VVa{| Ratio 014 R49.7^PSF, 4-24.Tmys Vault_R4R N��NL U'0,021 Infiltration 574 CFK45Q (0,84ACH50) Above Grade Walls R19.CE1.S'16� U'U.U56 Duct LkghoOutside untested Forced Air Found. Walls 25/8^ThedNnx |SO_R16� R'16 Total Duct Leakage|Untested Framed Floors None S|aba|unmmu/ated o|ab: R-0 Mechanical Systems Heating Furnace` Propane '95AFUE Cooling Air Conditioner ' Electric^ 1725SEER Water Heating Water Heater^ Propane` 0.97 Energy Factor Programmable Thermostat Yen Ventilation System 64 CFM ^ 18VYotts Lights and Appliances Percent Interior LED 10011& Clothes Dryer Fuel Electric Percent Exterior LED 100% Clothes Dryer CEF 33 Refngenator(kVVh/yn 693,0 Clothes Washer LER(kWh/yr) 60.0 Dishwasher Efficiency 200kVVh C|othes VVasherCapaoty 4,3 Ceiling Fan None RanQe/OvenFue| Propane Ekotrope RATER'Version 3.24,2696 All,esv/*are based n"data entered/°sK"vnpe users,cxotm"e*sdm.rns a//iam/ity for the information shown,"this spom RESNET HOME ENERGY HIS RATING Standard Disclosure HERS For home(s) located at: 132 Chesterfield Rd, Florence, MA Check the applicable disclosure(s): 1. The Rater or the Rater's employer is receiving a fee for providing the rating on this home. 172. In addition to the rating, the Rater or the Rater's employer has also provided the following consulting services for this home: ti A. Mechanical system design B. Moisture control or indoor air quality consulting C. Performance testing and/or commissioning other than required for the rating itself , D. Training for sales or construction personnel E. Other(specify) { 3. The Rater or the Rater's employer is: Hi A. The seller of this home or their agent I B. The mortgagor for some portion of the financed payments on this home 1C.An employee, contractor, or consultant of the electric and/or natural gas utility serving this home L4. The Rater or Rater's employer is a supplier or installer of products, which may include: Products Installed in this home by OR is in the business of HVAC systems TiRater FlEmployer nRater ' 'Employer Thermal insulation systems ::Rater riEmployer nRater Employer Air sealing of envelope or duct systems EiRater FlEmployer ' Rater Employer Energy efficient appliances Rater Employer Rater Employer Construction (budder, developer, construction contractor, etc) _Rater ]Employer E]Rater DEmployer Other(specify): - :Rater 1Employer Rater Employer 1175. This home has been verified under the provisions of Chapter 6, Section 603 "Technical Requirements for Sampling" of the Mortgage Industry National Home Energy Rating Standard as set forth by the Residential Energy Services Network (RESNET). Rater Certification#: 9463452 Name: Adin Maynard Signature: Organization: HIS & HERS Energy Efficiency Digitally signed: 6/20/21 at 10:11 PM I attest that the above information is true and correct to the best of my knowledge. As a Rater or Rating Provider I abide by the rating quality control provisions of the Mortgage Industry NationalHome Energy Rating Standard as set forth by the Residential Energy Services Network(RESNET). The national rating quality control provisions of the rating standard are contained in Chapter One 102.1.4.6 of the standard and are posted at https://standards.resnet.us The Home Energy Rating Standard Disclosure for this home is available from the rating provider. RESNET Form 03001-2 -Amended March 20, 2017 132 CHESTERFIELD RD EP-2021-0819 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Map: 15B Lot:051 ELECTRICAL PERMIT Permit: Electrical Category: WIRE FOR NEW SINGLE FAMILY HOUSE Permit# Electrical PERMISSION IS HEREBY GRANTED TO: Project# JS-2021-000781 Est.Cost: Contractor: License: Fee: $200.00 TOWER ELECTRIC Master A18067 Owner: Scott Keiter Applicant: TOWER ELECTRIC AT: 132 CHESTERFIELD RD Applicant Address Phone Insurance 578 N. Westfield St (413) 530-4343 () C-(413) 789-4111 Liability, CPA5469227 FEEDING HILLS MA01030 ISSUED ON:4/5/202I 0:00:00 TO PERFORM THE FOLLOWING WORK: WIRE FOR NEW SINGLE FAMILY HOUSE Call In Date: Date Requested Inspection Date/SignOff: Reinspect?: Trench/UG: Special Instructions x / Rough r �- x Special Instructions: nn Final: C!-/(�- SRE Called In: Signature: Fee Tvp__e:: Amount: DatePaid Electrical $200.00 4/5/2021 0:00:00 7549 212 Main Street,Phone(413)587-1244,Fax(413)587-1272-Inspector of Wires -Roger Malo MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK i*11 Northampton 03-23-2021 0 33a �'-.1tll�� CITYITOWN _ MA DATE PERMIT# PP-202�- �- 7r JOBSITE ADDRESS 132 Chesterfield Road OWNER'S NAME Jennifer Harmon POWNER ADDRESS Same TEL 413-320-9562 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL El RESIDENTIAL 111 PRINT CLEARLY NEW: El RENOVATION: El REPLACEMENT: El PLANS SUBMITTED: YES El NO❑ FIXTURES 1 FLOOR-0 BSM 1 2 3 4 5 6 7 AAibb 10 11 12 13 14 BATHTUB 1 ' IC � CROSS CONNECTION DEVICE r� ` DEDICATED SPECIAL WASTE SYSTEM f L. DEDICATED GAS/OIL/SAND SYSTEM /i *4/9DEDICATED GREASE SYSTEM , ?S /` DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM °9ry` ,!� c i DISHWASHER 1 `'?.HT't'0. DRINKING FOUNTAIN • �4,MS,O�c FOOD DISPOSER 9°'v.ONs FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY 1 2 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 1 URINAL PLUMBING & GAS INSP LC I OH WASHING MACHINE CONNECTION 1 NOR I HAMPTON WATER HEATER ALL TYPES 1 APPROVED NOT APPROVED WATER PIPING 1 OTHER First Fixture:$65 10 Additional:$100 Water Heater:$50 Total:$215.00 WMHCP Job w21-004 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES® NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ® OTHER TYPE OF INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. R e././e,"�1�/ PLUMBER'S NAME Richard Scott Cernak II LICENSE# 15672 SIGNATURE MP❑ JP❑ CORPORATION ®# 4386-PL-C PARTNERSHIP El# LLC❑# COMPANY NAME Western Mass Heating Cooling&Plumbing, Inc. ADDRESS 4 South Main Street(Suite K) CITY Haydenville STATE MA ZIP 01039 TEL 413-268-7777 FAX CELL EMAIL info@westernmassheatingcooling.com � (� $/ 9A9y IZ- !g- E CHECK #35746 $65.00 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK VA$ I ciTY NORTHAMPTON MA DATE _5/19/2021 PERMIT# GP-2-D2-/-0il-I/ JENNIFER HARMON & ` JOBSITE ADDRESS 132 CHESTERFIELD ROAD OWNER'S NAME CAROLYN SANDEL GcOWNER ADDRESS TEL 617-201-2730 FAX TYPE OR '— CCUPANCYTYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:® RENOVATION: ❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO ❑ APPLIANCES 1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 _i BOILER BOOSTER 111111111 ■ �111 �. CONVERSION BURNER COOK STOVE _1111 DIRECT VENT HEATER ®� �� 111111111111011111111111111 DRYER MI_—_— FIREPLACE WI II IIII 1111111 1.1111�� FRYOLATOR FURNACE GENERATOR II GRILLE BBQ INFRARED HEATER LABORATORY COCKS MI ■�® ME � MAKEUP AIR UNIT MI I OVEN IIIII 11111• iii�� ®� POOL HEATER _.__. �� __� ROOM/SPACE HEATER e • '�ON ROOF TOP UNIT m� r ' • l TEST �� ii . . . ,• li • . . . . •VE ME UNIT HEATER Mil ■� E1111111 UNVENTED ROOM HEATER WATER HEATER ___' MI- —�—�_� OTHER EXTERIOR LINE 1 �� r '� TO BUILDING �111 II ■�®111111111 mm Ell UN MI Ell INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ® NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ® OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and Information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all PeC' " t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ..4.4.4 16/41 PLUMBER-GASFITTER NAME ALED H. GEORGE LICENSE# 3809 SIGNATURE "' MP❑ MGF 2 JP❑ JGF❑ LPG!❑ CORPORATION ®#130C PARTNERSHIP❑# LLC❑# COMPANY NAME GEORGE PROPANE. INC, ADDRESS 3 BERKSHIRE TRAIT WFST, PC) ROX 102 CITY GOSHEN STATE MA ZIP 01030-0102 TEL (413)268-8360 FAX 413)268-0206 CELL- _ EMAIL mgeorge@georgepropane.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES 6 Z-et 7fi _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK e=_ Northampton am on 03-23-2021 •I:,�_� CITY P MA DATE PERMIT# GP-ZOZI- �3l� JOBSITE ADDRESS 132 Chesterfield Road OWNER'S NAME Jennifer Harmon GOWNER ADDRESS Same TEL 413-320-9562 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL ai PRINT CLEARLY NEW:® RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES 1 FLOORS-, BSM 1 ' 2 3 4 5 6 7 8 9 < 11 12 13 14 BOILER , (�1 ,'\� BOOSTER CONVERSION BURNER // �4, COOK STOVE 1 , ` 4 DIRECT VENT HEATER oF` c9S `� DRYER :1/0 0 �0� z. FIREPLACE 1 ti��'/� FRYOLATOR .,,�,,[:,if,' / 'YSA FURNACE 1 ^�4 �; ; GENERATOR ��'so��tis e/ GRILLE INFRARED HEATER s, F. LABORATORY COCKS ' MAKEUP AIRUNIT PLUMBING & GAS INSPECTOR POOL HEATER NO RTHAM Nl ON ROOM I SPACE HEATER APPROVED NOT APPROVED ROOF TOP UNIT TEST 1 UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 OTHER 1st fixture:$45 4 Additional:$80 Total: $125.00 wMHCP Job w21-004 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES © NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY u OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. R,'cloy,r/C2/raf .9 PLUMBER-GASFITTER NAME Richard Scott Cernak II LICENSE# 15672 SIGNATURE MP a MGF❑ JP❑ JGF❑ LPG'❑ CORPORATION ®# 4386-PL-C PARTNERSHIP❑# LLC❑# COMPANY NAME Western Mass Heating Cooling& Plumbing, Inc. ADDRESS 4 South Main Street(suite K) CITY Haydenville STATE MA ZIP 01039 TEL 413-268-7777 FAX CELL EMAIL info@westernmassheatingcooling.com (jF1I1 Jf 6 S `77>