25C-062 (10) BP-2021-2311
262 BRIDGE ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot: •
25C-062-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2021-2311 PERMISSIONIS HEREBY GRANTED TO:
Project# INSULATION Contractor: License:
Est. Cost: 7145 POTENTIAL ENERGY LLC 108817
Const.Class: •
Exp.Date:08/31/2022
Use Group: Owner: WELCH BERNARD C JR&CELIA PASTORIZA
Lot Size (sq.ft.)
Zoning: URB Applicant: POTENTIAL ENERGY LLC
Applicant Address Phone: Insurance:
1 HARTFORD SQ BOX 2E (413)798fi273() 9083282
NEW BRITAIN,CT 06052
ISSUED ON:12/28/2021
TO PERFORM THE FOLLOWING WORK:
INSULATION/WEATH ERI ZATI ON
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.
Signature: in4L yU • ''�
Fees Paid: $65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
Co _____3____. t----r-a ki4./
m n-t,��-c CEa
The Commonwealth of Massachus s FOR
., Board of Building Regulations acid St dat 07 CIPALITY
E_ Massachusetts State Building Code, 7 0 CMR 2021
�°
•
Building Permit Application orTwo-Family Construct, ir, em ri�'^ � s
u s lish a R ised Mar 2011
e-
Dwelling' Oh'.r.44 n.,
This Section For Official Use Only '...._,--- j�
/�
Building Permit Number: ° fJ d t+ 70 II Date Applied:
Building •
4 l %I; ,,,. • TP il P/ S)/ai
Official(Print Name) Signature I Da*
gn
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
262 Bridge Street 25C-062
1.1a Is this an accepted street?yes' '
no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
RA Multi-Family Residential 20037.6 sf 20 ft
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 Private CI Zone: _ Outside Flood lone? MunicipalVOn site disposal system 0
Check if ye
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Bernard Welch Jr. Northampton,MA 01060
Name(Print) City,State,ZIP
262 Bridge Street 413-320-8068 celiapastoriza@gmail.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED� WORK2(check all that apply)
New Construction 0 Existing Building Owner-Occupied 19 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units 3 Other Specify: insulation
Brief Description of Proposed Work': Walls wood sided 2976sf,attic door seal&insulate 1 ea,basement
sills 80 sf thermal berrier polyiso,Bulkhead door seal&insulate(1),home air sealing (2)hrs
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 7145.06 1. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2.Electrical $ ❑Total Project Cost' (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fsg.:4
A #0I6j
Check No.it Check Amount: lA `-Cash Amount:
6.Total Project Cost: $ 7145.06 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
CS-108817 08/23/22
Robert Calhoun License Number Expiration Date
Name of CSL Holder U
List CSL Type(see below) _
8 Upper River Road
No.and Street Type Description
South Hadley,MA 01075 U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
(413)523-3120 rob@greencollarma.com I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
192284 06/21/22
Potential Energy LLC HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
1 Hartford Square, Door 65, Suite 216 Info@potentialenergyus.com
No.and Street Email address
New Britain, CT 06025 413-798-0273
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 0 No .0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize Robert Calhoun
to act on my behalf,in all matters relative to work authorized by this building permit application.
thAitt2A- 6(24104 (2/i7/2J
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
/e66 -Cali, /2/i7/2i
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
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.) 3872 (including garage,finished basement/attics,decks or porch)
Gross living area(sq. ft.) 3872 Habitable room count 16
Number of fireplaces 1 Number of bedrooms 6
Number of bathrooms 4 Number of half/baths 0
Type of heating system oil/steam Number of decks/porches 2
Type of cooling system A/C Enclosed 1 Open 1
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
*' Name Bernard Welch Client 504375 Audit Date 7/20/2020
c
m
"- Phone 413-320-8068 Address 262 Bridge Street Northampton Unit 2
EXTERIOR WALLS:ADD 4"DP TO I I I I I
I
1ST FL WALLS(CLAP BOARD) : -1 1 miliine
)_t1 i
. _—.,.
... _— ..__-.—....._,._—
Mi i n .,�..._.._�........._— ».,,_...�.,..,......p.. 4. _,. ',..
, 1. .......
..._.....,........ ... .4. ....„...„....._ . 4 +.
ADD SITE BUILT DOOR TO t -
BULKHEAD ti" WOO S ._`P' • r—.— # .
MR
RIM JOIST:ADD 2"RB TO 1 ,.
UNFINISHED SIDE i �w.
{ 4•
,M. — —_t_
v i
.(.."".`i"... -
■
, 41
NOTES:VIRTUAL ASSESSMENT 16 i
1ST
FLt_, 1 I-4
GARAGE
Contractor H+S Early Access: NO I —
R�1 46 1
1 X i =Access ®=Temp Access 30
v v T_
A =Vent [1=Bath Fan i i I i . 1 4-1
O =Recessed Light I I=Chimney 37 —
.
R =Whole House Fan
DocuSign Envelope ID:B8976D86-9EC7-4437-A28A-0F710FDE5CD9
RISES
ENGINEERING-
OWNER AUTHORIZATION FORM
I, Bernard Welch ,
(Owner's Name)
owner of the property located at:
262 Bridge Street ,
(Property Address)
Northampton, MA 01060 ,
(Property Address)
hereby authorize ,
(Subcontractor)
an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building
permit and to perform work on my property. This form is only valid with a signed contract.
The permit will be secured by the subcontractor, at no additional cost.
It is the homeowner's responsibility to close out this permit by contacting their municipality at
the completion of this work.
DocuSigned by.
L
c,vu,�v� ( h.L
{�,g�' #ure
7/26/2020 11:58 PM EDT
Date
RISE Engineering, a Division of Thielsch Engineering, Inc.
60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335
www.RISEengineering.com
•
The Commonwealth of Massachusetts
—�, Department of Industrial Accidents
it_;"1i���,. Office of Investigations
='ret� 600 Washington Street
=itIta e =
Boston,MA 02111
=t www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/individual): • ,erANC..,k �ntZ ,LL C
Address: G,+e- klv T6Gre :
City/State/Zip: /ve= ; CT o(ceS2 Phone#: -] 13 8, --C cl `L
Are you an employer?Check the appropriate box: Type of project(required):
1.21 I am a employer with , 4. [] I am a general contractor and I
6. ❑ New construction
employees(full and/or part-time).* have hired the sub-contractors
listed on the attached sheet. 7. El Remodeling
2.❑ lam a sole proprietor or partner-
ship and have no employees These sub contractors have 8. El Demolition
workingfor me in anycapacity. employees and have workers'
P t 9. 0 Building addition
[No workers' comp. insurance comp.instuattce.
required.] 5. [] We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers'
' co right of exemption per MGL
comp. 12.0 Roof repairs
insurance required.]t c. 152, §1(4),and we have no 3.[�Other_insulation
employees. [No workers' 1
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: j sGC, ;L[i,.'1( ----
Policy#or Self-ins. Lic.#: L.1C- q Expiration Date: 8 :2'-t I
Job Site Address: 262 Bridge Street Apt F11 _Cityistate/zip: Northampton, MA 01060
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
tine 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 un the•p ' 'es of perjury that the information provided above Is true and correct
Signatures Date: 12/20/2021
Phone#: `-1 7q - � �?
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#:
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OK
Commonwealth( of Massacrrusetts
Owvisron of Professional Licensure
Board of Building R ► tilat ons and Standards
Constpuctionl 'v "
CS - 108817 E, C r 08/ '312O22
ROBERT CALHOUN
8 UPPER FIVER r20
SOUTH HAM L Y MA 0107
tl1
Commissioner it --
https://photos.google.com/u/1/searchLtra Jphoto/AF 1 QipNr_M67vkYizCEKxoDinvAmhCXbe3VxzW68RhsF 1/1
15:7cuSig't Envelope ID:B8976D86-9EC7-4437-A28A-0F710FDE5CD9
Federal ID#05-0405629
RISE Engineering RI Contractor Registration#8186
MA Contractor Registration#120979
RISE1341 Elmwood Avenue,Cranston, RI 02910
ENGINEERING" CONTRACT - VZ
401-784-3700 FAX 401-784-3710
Page 1
PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE
CMA-HES ENGINEERIN AND OW E CUSTOMER FOR WORK AS
ESCUSTOMER PHONE DATE CLIENT E WORK ORDER
Bernard Welch (413)320-8068 07/20/2020 504375 38502
SERVICE STREET BILLING STREET PROPOSED BY.
262 Bridge Street FI2 262 Bridge Street FI2 Daniel Diaz
SERVICE CITY,STATE.ZIP BILLING CRY,STATE,ZIP
Northampton, MA 01060 Northampton, MA 01060
DESCRIPTION QTY COST INCENTIVE TOTAL
ASBESTOS HAZARD
A blower door diagnostic test will not be conducted at your home,due
to the possible presense of asbestos.
u�
KNOB&TUBE WIRING
We have identified the existence of Knob&Tube wiring in your home. i (initials) I
The following contract is not valid unless accompanied by the Pre-
Weatherization Barrier Incentive form, signed by your licensed
electrician.Work will not proceed with this work until we receive a copy
of the form.
COMBUSTION SAFETY TEST ��''''11
Prior to the installation of the recommended weatherization OP(initials) I
measures,we will need to conduct a Combustion Safety Test of all
the combustion appliances present in your home. Upon receipt of this
signed proposal,RISE Engineering will reach out to schedule this
test, at no cost to you.
HOME AIR SEALING 2 $170.00 $170.00
Provide labor and materials to seal areas of your home against
wasteful,excess air leakage. Materials to be used to seal your home
can include caulks,foams and other products. Primary areas for
sealing include air leakage to attics,basements, attached garages
and other unheated areas(windows are not generally addressed.)
WALLS WOOD SIDED 1,584 $3,183.84 $3,183.84
Furnish and install blown in Class I Cellulose to shingle and/or
clapboard exterior walls. The butt of the upper course of your wood
siding is cut to drill holes into the wall sheathing behind.The holes
are then plugged and the wood siding is reinstalled using stainless
steel finish nails.Touch-up painting, if needed, will be the customer's
responsibility. Invoicing will occur upon completion of installation.
Homeowner has received a copy of the EPA's Renovate Right Lead-
Safe information guide explaining the potential risk of the lead hazard
exposure from the weatherization work to be performed. Your
signature is your acknowledgement of receipt and agreement to
proceed.
BASEMENT SILLS RIGID BOARD INSULATION 80 $316.80 $316.80
Provide labor and materials to install rigid board insulation to the
perimeter of the basement ceiling at the house sill.
BULKHEAD DOOR SITE-BUILT 1 $566.50 $566.50
Provide labor and materials to install a site-built bulkhead door at the
'ocuSigti Envelope ID:B8976086-9EC7-4437-A28A-OF710FDE5CD9
Federal ID#05-0405629
RISE Engineering RI Contractor Registration#8186
MA Contractor Registration#120979
\vi
RISE1341 Elmwood Avenue,Cranston,RI 02910
ENGINEERING CONTRACT - WZ
401-784-3700 FAX 401-784-3710
Page 2
PROGRAM THIS CONTRACT IS ENTERED NTO BETWEEN RISE
CMA-HES ENGINEERI GANDBELO E CUSTOMER FOR WORK AS
ESCUSTOMER PHONE DATE CLIENT M WORK ORDER
Bernard Welch (413)320-8068 07/20/2020 504375 38502
SERVICE STREET BILLNO STREET PROPOSED BY:
262 Bridge Street FI2 262 Bridge Street FI2 Daniel Diaz
SERVICE CRY,STATE.ZIP BILLNG CITY,STATE,ZP
Northampton, MA 01060 Northampton, MA 01060
DESCRIPTION QTY COST INCENTIVE TOTAL
base of the bulkhead in the basement. Insulate the back of the
bulkhead door with rigid insulation board and seal the door's edge
with weatherstripping to restrict air leakage.
INCENTIVE 100%2020
For a limited time, Columbia Gas is offering an incentive of 100% on
qualifying weatherization measures for customers who had a home
energy assessment in 2020. This contract must be signed and
returned within 20 days and the weatherization must be installed by
October 31,2020.The installation of your home's weatherization will
be scheduled when our in-home operations resume. Eligible LED
lightbulbs, programable thermostats,and hot water saving items are
also incentivized at 100%.WiFi-enabled thermostat incentives vary by
type of thermostat.
Total: $4,237.14
Program Incentive: $4,237.14
Customer Total: $0.00
WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF
***00/ Dollars $0.00
UPON RECEIPT OF YOUR RISE ENGINEERING INVOICE.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%RILL BE CHARGED MONTHLY ON ANY
UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION.
DocuSigned by: �DocuSigned by:
4P 210. ''lt'-
RI E REPRESENTA E C�Sn�� P
A27880A179AA491- \-12D28D9COD9943E. ^^1�C ^�
NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE ��2 U�2020 I 1:SS PM EDT
SIGN DATE
30 DAYS. ACCEPTANCE OF CONTRACT-THE ABOVE PRICES.SPECIFICATIONS AND CONDITIONS ARE
SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK
AS SPECFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE
'ocuSigri Envelope ID:B8976D86-9EC7-4437-A28A-0F710FDE5CD9
Federal ID#05-0405629
RISE Engineering RI Contractor Registration#8186
MA Contractor Registration#120979
RISE1341 Elmwood Avenue,Cranston, RI 02910 ENGINEERING CONTRACT - WZ
401-784-3700 FAX 401-784-3710
Page 1
PROGRAM THIS CONTRACT IS ENTERED MTO BETWEEN RISE
C MA-FIES DENGINEERING AND ESCRIBED BELOW THE CUSTOMER FOR WORK AS
CUSTOMER PHONE DATE CLIENT N WORK ORDER
Bernard Welch (413)320-8068 07/20/2020 504374 38502
SERVICE STREET BILLING STREET PROPOSED BY:
262 Bridge Street Fl 1 262 Bridge Street Fl 1 Daniel Diaz
SERVICE CRY,STATE,ZIP BILLNO CITY,STATE,ZP
Northampton, MA 01060 Northampton, MA 01060
DESCRIPTION QTY COST INCENTIVE TOTAL
ASBESTOS HAZARD
A blower door diagnostic test will not be conducted at your home,due
to the possible presense of asbestos.
KNOB&TUBE WIRING ��us11,,
We have identified the existence of Knob&Tube wiring in your home. fly"(initials)
The following contract is not valid unless accompanied by the Pre-
Weatherization Barrier Incentive form, signed by your licensed
electrician. Work will not proceed with this work until we receive a copy
of the form.
COMBUSTION SAFETY TEST V*
Prior to the installation of the recommended weatherization tal (initials)
measures,we will need to conduct a Combustion Safety Test of all
the combustion appliances present in your home. Upon receipt of this
signed proposal, RISE Engineering will reach out to schedule this
test, at no cost to you.
ATTIC DOOR- INSULATE&WS 1 $110.00 $110.00
Provide labor and materials to insulate the back of the attic door with
2"rigid insulation board and seal the door's edge with
weatherstripping to restrict air leakage.
WALLS WOOD SIDED 1,392 $2,797.92 $2,797.92
Furnish and install blown in Class I Cellulose to shingle and/or
clapboard exterior walls. The butt of the upper course of your wood
siding is cut to drill holes into the wall sheathing behind.The holes
are then plugged and the wood siding is reinstalled using stainless
steel finish nails.Touch-up painting, if needed,will be the customer's
responsibility. Invoicing will occur upon completion of installation.
Homeowner has received a copy of the EPA's Renovate Right Lead-
Safe information guide explaining the potential risk of the lead hazard
exposure from the weatherization work to be performed. Your
signature is your acknowledgement of receipt and agreement to
proceed.
IcuSigo Envelope ID: B8976D86-9EC7-4437-A28A-0F710FDE5CD9
Federal ID#05-0405629
RISE Engineering RI Contractor Registration#8186
MA Contractor Registration#120979
RISE1341 Elmwood Avenue,Cranston, RI 02910
ENGINEERING- CONTRACT - WZ
401-784-3700 FAX 401-784-3710
Page 2
PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE
C MA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS
DESCRIBED BELOW
CUSTOMER PHONE DATE CLIENT WORK ORDER
Bernard Welch (413)320-8068 07/20/2020 504374 38502
SERVICE STREET BILLING STREET PROPOSED BY:
262 Bridge Street Fl 1 262 Bridge Street Fl 1 Daniel Diaz
SERVICE CITY.STATE.ZIP BILLING CITY.STATE.ZIP
Northampton, MA 01060 Northampton, MA 01060
DESCRIPTION QTY COST INCENTIVE TOTAL
INCENTIVE 100%2020
For a limited time, Columbia Gas is offering an incentive of 100% on
qualifying weatherization measures for customers who had a home
energy assessment in 2020. This contract must be signed and
returned within 20 days and the weatherization must be installed by
October 31, 2020.The installation of your home's weatherization will
be scheduled when our in-home operations resume. Eligible LED
lightbulbs, programable thermostats,and hot water saving items are
also incentivized at 100%.WiFi-enabled thermostat incentives vary by
type of thermostat.
Total: $2,907.92
Program Incentive: $2,907.92
Customer Total: $0.00
WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF
***00/ Dollars $0.00
UPON RECEIPT OF YOUR RISE ENGINEERING INVOICE.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY
UNPAID BALANCE AFTER 30 DAYS SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES.RIGHTS OF RECISION_SCHEDULING.AND CONTRACTOR REGISTRATION
DocuSigncd by. ,.—f�JDocuSigncd by:
V
RISEREPR EINNTTAlIVE CU5 M I' A U 1E414
—42/F.60A1/OAAATF ` 17-)7R.!i�CCC 179::iI C -1 -7 58
NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE 7/2t=/2020 I 1: PM EDT
SIGN DATE
30 DAYS. ACCEPTANCE OF CONTRACT-THE ABOVE PRICES SPECIFICATIONS AND CONDITIONS ARE
SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK
AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE
City of Northampton
Massachusetts a�
A_ IL..2 DEPARTMENT OF BUILDING INSPECTIONS \
4 S • 212 Main Street • Municipal Building ��J DOD
Northampton, MA 01060 SbW'8r'Sx^
Property Address: Ali, '.+ ,c� Wit, M of -,c,, ,r> en ,0,0‘,-6
Contractor
Name: Q& --i.c kl EnRiit ,tic_
Address: �7, - ,,
:
City, State ,. -'tx,\8.� � cL; rs
Phone: 4i r 02'72
Property Owner
Name: cc%Ord
Address: Z j,Z .r,
City, State: njv44,c; ii„1 MA- 01
I, (contractor) attest and affirm that the building I intend to
insulate does not have any open air (knob and tube) wiring in the spaces to be insulated and that I have
provided the property owner with a copy of this affidavit.
Contractor signature -.0�
Date
v �..u .. yco,
cn
Chk_a_ c&. i-e_ecly krNi- 4r- .4A.s ,--1 z--::,
e` / The Commonwealth of Massachuse ; N
r Board of Building Regulations and Stai c i o P
j: Massachusetts State Building Code, 78( ; 'i- c., coo Q '"
*
Building Permit Application To Construct,Repair, ReiIII
N f�4 r..
o
One-or Two-Family Dwelling
This Section For Official Use 'i � t
Building Permit Number: Date Applied: H'
Building Official(Print Name) Signature CU 1: II.; r�
SECTION 1:SITE INFORMA C a N i! —r
1.1 Property Address: 1.2 Assessors '4 '�"' Y 01 ru
)(o a 3c-;di .S -. F.I_ i-2 / 25.--o10L- ' 0 m * Rif] .J
l.la Is this an accepted street?yes V no Map Number - Li) 43 rn
1.3 Zoning Information: 1.4 Propert) t Q'
Zoning District Proposed Us4 Lot Area(sq 8; it
1.5 Building Setbacks(ft) .
*
Front Yard Side Yards * •+
* 17
Required Provided Required Provide i c « cp
E * c ru
* a)
1.6 Wate,Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: s a rr
Zone: Outside Flood Z o * -+
Public I Private 0 I7 I * a
Check if yes V rn * 0 rn
SECTION 2: PROPERTY OWll J N , '-5—a on N a .•
w — * C
2.1 Ownert of Record: J NN m 3 v
3t'rr-r ) in eick `�. Ala-��4 0 °� c co a5 C':>
Name(Print) City,State, ooN Q * c m i,I O
W o q 1= * co i;I .-a
?—(.7 ' cli 5 412--J 2.0 -- I' Z U z o CO * a m ;,
No.and Street ' Telephone W t * E }„ 1
�! air o * r O
SECTION 3:DESCRIPTION OF PROPOSED W {I` Q 000 a Z o t co x+ O
0 0 ;i
New Construction 0 Existing Building Owner-Occupied -iR di Z o z c o Z m ;> _
WIE 3 0 o N
Demolition 0 Accessory Bldg. ❑ Number of Units %,-. O~ @ o .-
Brief Description of Proposed Work': 'LJci q t Je ej1 S, 1 S i O. a, t— a2 s;
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SECTION 4;ESTIMATED CONSTRI 1' }o W u
Estimated Costs: ;i. i
Item (Labor and Materials) r
1.Building $ — I;4 s•61,0. 1. Building Permit rue: a uiwcaty uvw Lcc la ucw ......
2.Electrical $ 0 Standard City/Town Application Fee
0 Total Project Cost (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire ' $
Suppression) Total All Fees:$
6.Total Project Cost: $ i l y 'a
Check No. Check Amount: Cash Amount:
7 � 0 Paid in Full 0 Outstanding Balance Due: