24D-213 (off 4iCr V'e--t s r' BP-2021-2116
65 WARNER ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23D-213-001 CITY OF NORTHAMPTON
Permit: New Build
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2021-2116 PERMISSION IS HEREBY GRANTE I TO:
Project# NEW HOUSE Contractor: License:
Est. Cost: 325000 JOHN HANDZEL 013693
Const.Class: Exp.Date:07/20/2023
Use Group: Owner: NU-WAY HOMES INC
Lot Size (sq.ft.)
Zoning: Applicant: JOHN HANDZEL
Applicant Address Phone: Insurance:
10 White Ave. 4135630085
EAST LONGMEADOW, MA 01028
ISSUED ON:10/28/2021
TO PERFORM THE FOLLO WING WORK:
NEW HOUSE
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
-i 7 .-z2
Underground: `Service: Meter: Footings:
Rough- Z9- Z 2 Rough: 3 '4 c-2'3 House # Foundation:
4444weieay Final: 'inal:oy Final: Rough Frame: t=K ��°a �z
‘-07-2Z � ` - P-y_ a-
Gas: Fire Depar im it 2P'`� Fireplace/Chimney:
Rough: Oil: Insulation: 0 it -1`,- Z2 IV R
Final:6,-Z4P—Z.. Smoke:491Z.,,,e
[ - "7- Final: O.IL. (o-zq• iz i 'Q
THIS PERMIT MAY BE RE\ OKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: i
r
''' (Pi v ,
Fees Paid: $1,175.40
212 Main Street. Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
77 ,// t"W ,trio per ? 1
•
The Commonwealth of Massachusetts
City of Northampton
Certificate of Occupancy
a n c
p 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
Nu-Way Homes Inc. BP 2021-2116
Identify property address including street number, name, city or town and county
Located at
65 Warner Street HERS Rating
Florence, Hampshire, Massachusetts 55
Use Group
Classification(s) Single Family Dwelling Unit
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 he 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 Unit
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 06/29/2022
Signature of Municipal Date of 23D-213
Building Official Issuance 06/29/2022
Home Energy Rating Certificate Rating Date: 2021-11-07
Final Report Registry ID: 331662974
Ekotrope ID: ILKP4akd
HERS® Index Score: Annual Savings Home:
55 Your home's HERS score is a relative 65 Warner St
performance score.The lower the number,
the more energy efficient the home.To Builder:
learn more,visit www.hersindex.com $ 2„25O
Relative* to an average U.S.home NNorthamton, MA 01 062_
u-Way Homes Inc
Your Home's Estimated Energy Use: This home meets or exceeds the
criteria of the following:
Use[MEltu] Annual Cost
Heating 61.3 $666 2018 International Energy Conservation Code
Cooling 0.6 $25
Hot Water 2.5 $107
Lights/Appliances 23.9 $920
Service Charges $81
Generation (e.g.Solar) 0.0 $0
Total: 88.3 $1,798
HERS Index Homo Feature Summary: Rating Completed by:
411hp, Mere 200,11V Home Type: Single family detached
Model: John Handzel Custom Energy Rater: Paul DellaTorm
RESNE I ID: 8,1/6762
Community: Northamton
Existing • Ito
Homes ,40 Conditioned Floor Area: 2,717 le Rating Company: Energy Compliance Services
, ,zo Number of Bedrooms: 4 27 Hudson Dr.Southwick MA 01077
Referenc i- i
; Ito Primary Heating System: Furnace•Propane•96 AFUE 413-427-2423
e 3,00
Home w Primary Cooling System: Air Conditioner•Electric•14 SEER
Rating Provider: Building Efficiency Resources
Primary Water Heating: Residential Water Heater•Electric•3.85 Energy Factor PO Box 1769 Brevard,NC 28712
in House Tightness: 869 CFM50(2.19 ACH50)
m 800-399-9620
60 filk Ventilation: 68 CFM•9 Watts
Duct Leakage to Outside: 24 CFM @ 25Pa(0.88/100 fti)
NI 40 Mistletoe Above Grade Walls: R-21
30 ..
Ceiling: Attic,R-49
20
Window Type: U-Vaiue:0.28,SHGC:0.34 Pad Delfa,MI le
to
Zeta Energy Foundation Walls: R-13
Home cl Paul DellaTorre,Certified Energy Rater
Framed Floor: N/A
"Mk, i„•••1.itvDigitally signed:6/27/22 at 4:45 PM
v24,1,0%,
ib ekotrope Ekotrope RATER Version:4.0.1.2938
The fnergy Rating Disclost ire for this home is available from the Approved Rating Provider.
This report does not constitute any warranty or guarantee.
Home Energy Rating Certificate Rating Date: 2021-11-07
Final Report Registry ID: 331662974
Ekotrope ID: ILKP4akd
HERS. Index Score: Annual Savings Home:
Your home's HERS score is a relative 65 Warner St
performance score.The lower the number,
5
Northamton MA 01062
the more energy efficient the home.To2 Builder.
learn more, visit www.hersindex.com 329
*Relative to an average U.S.home Nu-Way Homes Inc
Your Home's Estimated Energy Use: This home meets or exceeds the
Use[MBtu) Annual Cost criteria of the following:
Heating 54,4 S591 2018 International Energy Conservation Code
Cooling 0.6 $28
Hot Water 2.5 S 107
Lights/Appliances 23,8 S912
Service Charges $81
Generation re.g. Solar) 0.0 50
Total: 81.2 $1,719
HERS Index Home Feature Summary: Rating Completed by:
46, r..r.I Home Type: Single family detached
Model: John Handzel Custom Energy Rater: Paul DeilaTorre
Iv
rMsr,t; ,•o Community: Northamton RESNET ID: 8776762
N001es no Conditioned Floor Area: 2,717 ft2 Rating Company: Energy Compliance Services
Number of Bedrooms: 4 27 Hudson Dr.Southwick MA 01077
r, ,,p '""""" :'D Primary Heating System: Furnace•Propane•96 AFUE 413-427-1423
Hor0t' ""'100 Primary Cooling System: Air Conditioner•Electric•14 SEER
90 Rating Provider: Building Efficiency Resources
Primary Water Heating: Residential Water Heater•Electric•3,85 Energy Factor PO Box 1769 Brevard,NC 28712
ro House Tightness: 869 CFM50(2.19 ACH50) 800-399-9620
-sow Ventilation: 68 CFM••9 Watts
,u Duct Leakage to Outside: 24 CFM @ 25Pa(0.88/100 ft2)
—`a0 This Ham Above Grade Walls: R-21 .
p° Ceiling: Attic,R-49° Window Type: U-Value:0.28,SHGC:0.34 [alit
-/�
1 of fa rol v
zero Energy c Foundation Walls: R-13
Framed Floor: N/A Paul DellaTorre,Certified Energy Rater
�' � WI bogy Digitally signed:6/27/22 at 4:45 PM
0 E'kotr0
p Ekotrope RATER-Version:4.0.1.2938
The Energy Rating Disclosure for this home is available from the Approved Rating Provider.
Energy savings calculated without modifications to the energy model.(As Modeled) This report does not constitute any warranty or guarantee.
65 Warner 't Northamton MA
HERS*Index Store: Rating Date: Nov 7,2021
55 HERS Registry ID: 331662974
Annual Estimat-s: Rating Company:
Electric(kWh): 7,554.8 Energy Compliance Services
Rating Provider
Propane(Gallon ): 6094 Building Efficiency Resources
CO2(Tons): 8.7 Rating Provider Address:
Box 1769 Breva 28712
HERS Index Home Feature Summary:
Single family detached,4
--1 bedrooms,2,717 ft2
I a*
Heating:96 AFUE
Fxtsttng j 140
Hrtt#5 t 1 110 Cooling: 14 SEER
.........:LC Hot Water:3.85 Energy Factor
loci Air Leakage:
869 CFM50(2.19 ACH50)
in
Iv
Ventilation:68 CFM•9 W
_
Duct LTO:
Tho Noma 24 CFM @ 25Pa(0.88 i 100 ft2)
Above Grade Walls:R-21
II Ceiling:Attic.R-49
Home,,4,9 Enew o
Window:U:0.28•SHGC:0.34
'4111P° ""bwitt Foundation Walls:R-13
Ekotrope RATER-Version:
iir ekotrope 433.1.2938
rots report does not constrtute arty warranty ot guorentre.
IECC 201 : Performance Compliance
Property Organization Inspection Status
65 Warner St Energy Compliance Servic 2021-11-07
Northamton, MA11062 Paul DellaTorre Rater ID (RTIN): 8776762
Model: John Haniizel Custom RESNET Registered
Community: Nort amton Builder (Confirmed)
Nu-Way Homes Inc
0009_John Hand•el65 Warner
St Northampton 211107
HERS_0727_000•_John
Handzel65 War er
Annual Energy Cost
Design IECC 2018 Performance As Designed
Heating $2,364 $2264
Cooling $100 $69
Water Heating $118 $118
Mechanical Venti ation $60 $12
SubTotal - Used to determine compliance $2,643 $2,462
Lights &Applian -s wlout Ventilation S993 $993
Onsite generatio SO SO
Total $3.635 $3,455
R405.3 Sour e Energy Exception: The proposed home uses 9.06 MBtu LESS source energy than the reference home.
Requirements
O 406 3 Performance-based compliance passes by 9 4%
• R402 4'I 2 An Leakage Testing Air sealing is 2 19 ACH at 50 Pa It must not exceed 3 00 ACH at 50 Pa.
• R402 5 Area-weighted average fenestration SHGC
R402 5 Area-weighted average fenestration U-Factor
R404 1 Lighting Equipment Efficiency
• R403 6 1 Mechanical Ventilation Efficacy
• Mandatory Checklist requirementsMandatcheckedor4c=tropiiust thatmet are not
(6) IRC,f,1150" 4 3 Mechanical Ventilation Rate
• R405.2 Duct Insulation
Desig exceeds requirements for IECC 2018 Performance compliance by 9.4%.
As a 3rd party extensio of the code junsdiction utilong these reports.I certify that this energy code compliance document has been created in accordance with the requirements of
Chapter 4 of the adopte,International Energy Conservation Code based on HAMPSHIRE County If rating is Projected,I certify that the building design described herein is consistent
with the building 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 th- 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
N.me: Paul DellaTorre Signature: Pat<(OeflaMi
Organize ion: Energy Compliance Services Digitally signed: 6127/22 at 4:45 PM
Ekotrope RATER- Version 4.0.1.2938
IECC 2018 Performance compliance results calculated using Ekotrope RATER's energy and code compliance algorithm
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
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� •-. Northamton, MA 01062 ,�-
•.a" Builder: Nu-Way Homes Inc
Model: John Handzel Custom Community: Northamton ...
.µ-:'), THIS HOME IS CERTIFIED TO MEET THE ‹ ,` „
„. 2018 INTERNATIONAL ENERGY CONSERVATION CODE =.•
:� Building Features
. Ceiling Attic, R-49 Duct Supply R-8.0, Return R-8.0 .
. : 1
Above Grade Walls R-21 Duct Leakage to Outside 24 CFM @ 25Pa (0.88/ 100 ft2)
=' Foundation Walls R-13 Total Duct Leakage 129 CFM @ 25Pa (Post-Construction) '_
,; Framed Floor N/A Heating Furnace • Propane • 96 AFUE ' .
Slab R-0.0 Perimeter, R-0.0 Under Cooling Air Conditioner• Electric• 14 SEER
Infiltration 869 CFM50(219 ACH50) Water Heating Residential Water Heater• Electric• 3.85 Energy • ,•.
Factor
Window U-Value: 0.28. SHGC: 0.34
. As a 3rd party extension of the code jurlsdiction 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 HAMPSHIRE County.if rating is Proiected,I certify that the building design described herein is consistent with
•.� �` me building plans.specifications,and other calculations submitted Aith Me permit application If rating is Confirmed.I certify that the address referenced above has been inspecteditested r'. ,'
and that the mandatory provisrcms of the iECC have been instated to meet or exceed Me intent oh the IECC or will be verified as such by another party 4r° .w
.y
y7 ' -;�„;
�M.
Name: Paul DellaTorre Signature: Art( diiT.; ff •
e'-e Organization: Energy Compliance Services Digitally signed: 6t27/22 at 4:45 Pt `»'
a. Ekotrope RATER-Version 4.0.1.2938 .
2018 IECC comptance results calculated using Ekotrope RATER's energy and code compliance algorithm.
Ekotrope RATER is a RESNET Accredited HERS Rating Tool Alt results are based on data entered by Ekotrope users.
Elotrope.disclaims all liability for the information shown on this report 4 ' :•
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NECC 2018 Label
65 Warner St
Model: John Handzel Custom
Ekotrope RATER-Version:4.0.1.2938
HERS®Index Score: 55
Ceiling:,R-49
Above Grade Walls: R-21
Foundation Walls: R-13
Exposed Floor: N/A
Slab: R-0
Infiltration: 869 CFM50(2.19 ACH50)
Duct Insulation: Supply: R8, Return: R8
Duct Lkg to Outdoors: 24 CFM a@ 25Pa (0.88/ 100
ft2)
Window & i oor Specs
U-Value: 0.28, SHGC: 0.34
Door: R-6
Heating: Furnace• Propane• 96 AFUE
Cooling:Air Conditioner• Electric• 14 SEER
Hot Water: Residential Water Heater• Electric •
3.85 Energy Factor
Averaoe Mechanical Ventilation: 68 CFM
Bulkier or Design Professional
Signature:
to6wI-- , e- sl
Itxpp��// II��//yyi� II Official Use Only
Conuxoes�veaLtla o�fi'(a�a,rhaaeftt3
I" *:ii, 'i Permit No. Et'''-- 2-2-0' 3
", j .epartmenl of.ere ..�sruicee
1 '_1 Occupancy and Fee Checked />'�
" t BOARD OF FIRE PREVENTION REGULATIONS ev. 1/077
1
V (leave blank) !
MP
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL ORK
All work to he performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.Of)
(PLEASE PRINT IN INK OR TYPE ALL INFORM4TION) Date: e `s, '2 2 /
City or Town of: /Vd r-'4 c np i,1 To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) 6 3S l`Ili..ffa e - .S#ree.i-
Owner or Tenant Jt;1)r i Han n 2e./! Telephone No. AV) S s Oi t'
Owner's Address /0 i.ill)i Ave. 6.4-.54- l-�'•� rate{vt-r.:'t f in A L..'10 2 y"
Is this permit in conjunction with a building permit? Yes 1 No E (Check Appropriate Box)
Purpose of Building 4 C t:.O L.01.__`ft'r'tAC.t c:*'t Utility Authorization No. 3o,S ;,2 SY. /
Existing Service Amps / Volts Overhead ❑ Undgrd E No.of Meter
New Service 204-, Amps t 24) / 2`'tO Volts Overhead Er.
Undgrd 0 No.of Meter j
Number of Feeders and Ampacity i Z
Location and Nature of Proposed Electrical Work: 71/eA L.Ort S*t••'td{G-tic.� 0 /I r/'t!r j
t Completion of the followin fable may be waived by the Inspector of Wires.,
No.of otal
No.of Recessed Luminaires No.of Ceil Susp.(Paddle)Fans Transformers 'I
: KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
Above In- No.of Emergency-Lighting
No.of Luminaires Swimming Pool grad. � grad. ❑ Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners 'No.of Detection and
initiating Devices
No.of Ranges No.of Air Cond. Total
g Tons No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
p Totals: Detection/Alerting Devices
p al
No.of Dishwashers Space/Area Heating KW Local 0 MConnecunicition [J Other
No.of Dryers Heating Appliances KW -Tecurity Systems:*
r Y Na of Devices or Equivalent
No.of Water No.of No.of Data Wiring:
Heaters KW Signs Ballasts No.of Devices or Equivalent
a Bathtubs No.of Motors Total HP 'Telecommunications No fDevi Wiring:
No.Hydromassage Na of Devices or Equivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of!fires.
Estimated Value of EI tric l Work: (When required by municipal policy.)
Work to Start: .. ,�2 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial eqttivalent. The
undersigned certifies that such cove ge is in force,and has exhibited proof of same to the permit issuing ounce
CHECK ONE: INSURANCE [BOND 0 OTHER 0 (Specify:)
I certir,under the pains and penalties of perjury,that the information on this application is true and comp! e.
FIRM NAME: ra11cy e/ .c• -c,C1"ch.-t LLe LIC.NO.:
Licensee: ;Octd 1 S I a'' f3,/e} Signature veezi -9< LIC.NO.:' , -=J'/ 7 -13
/Ifapplicable,enter "exempt"in the license number line i Bus.Tel.No.:013)3 7 -394i 7
Address: y 3 Tck: h fi , yt,, /01/ t'17 9 0/O'S• Alt.Tel.No.:_
*Per M.G.L. c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance cove ge normally
required by law. By my signature below,J hereby waive this requirement. I am the(check one)0 owner 0 owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $ .2 C. C.
- a - a- Qo vb , `'�
S_ / 7- 2.), SOILJ,L
OirilL c 141, 26 bat L t1r Ll
L, at-(- a a- r i`Nti 1 P'\Th
- . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
_1, ,51 CITY/TOWN pr a . ft4 MA DATE 3/irj2 L PERMIT# 7P2,.0 22.- 0/0 7
JO11 SITE ADDRESS 65 LJa..LN�2 S." OWNER'S NAME J4L j ,itet
rno
PN
OWNEf#ADDRESS /v �✓ `�- A- chi Cory TEL 4l3'SZ 3' oo5f FAX
TYPE ORF- OCtOPIiNCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL®/
PRINT
CLEARLY NEW:lie RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑
IllalRES Z — FLOOR-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB /
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER /
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN
iNTERCEPTOR(INTERIOR) PLUM INC GAS INSPECTOR
LAVATORY KITCHEN SINK r NORT AMPTON
ROOF DRAIN / / APPR VED ItO i APPFOVED
ROOF
SHOWER STALL / /
SERVICE/MOP SINK
TOILET / / 2
URINAL
WASHING MACHINE CONNECTION /
WATER HEATER ALL TYPES 1
WATER PIPING / /_ j
uIfltr
INSURANCE COVERAGE:
I !-• -r!ts- L • -.' ----- -L! \' ---4- ' _-- --• _l "! Al A•.! r1
have a current li'h'+:t.!„--=-�r-r-x n+.::; "-- -- I'- ---
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY i 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
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 wiedge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance with fir^^• ,.c
PLUMBER'S NAME GN✓r/L ''S" LICENSE# 33 e(3S GN URE
MP❑ JP rie .
CORPORATION❑# PARTNERSHIP❑# ) LLC❑#
rsAUL1RtV killRf.0 Sh1..1S /4104- ffllr-iicce (9)
CITY C��u� ✓1 // �' STATE 414 ZIP a//Jt) TEL 9/? - ' ? ' Wth
__
FAX CELL EMAIL �+�ea"!^'� "AI
I'd ,'14 22
27 Z
ck4/D / -4gg
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
kr, !6
1=i= CITY G lv z" MA DATE JAZZ-- PERMIT#(-)(-ZD, Z-62 o
\ 0 6 S Gt-�''''- -- SI OWNER'S NAME T i n t✓v e JOBSIT&ADDRESS
j .
G1V OWNER;ADDRESS /ol14j A/5 g (.6 ( TEL yl3'S7. /657 FAX
TYPE titOCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL ❑ RESIDENTIAL ILIK
PRINT
CLEARLY NEW:RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES El NO❑
APPLIANCES Z FLOORS-4 BSM 1 2 3 4 5 6 7 8 9 10 11 '12 13 14
BOILER
BOOSTER
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER
DRYER
FIREPLACE /
FRYOLATOR
FURNACE /
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATER j
ROOM/SPACE HEATER
ROOF TOP UNIT
TEST
UNIT HEATER
UNVENTED ROOM HEATER I
WATER HEATER
OTHER
INSURANCE COVERAGE �,/
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES L� NO El
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERA BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY El 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 El
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 kno edge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pe . t • e
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME DN/ '1- OS k^) LICENSE# 334 35 SIGNATURE
MP El MGF❑ JP` JGF El LPGI❑ CORPORATION El# PARTNERSHIP El# LLC❑#
&d COMPANY NAME C $ Pla.+M-J/i ADDRESS /8.-Sio-ee/
CITY efAr kr ✓� STATE �� ZIP dl�g !'TEL 4i/3-777h r6 11FAX CELL EMAIL cA/c.D e -6 q/�,a,��..GaAl
y"-,y"se
`co 2v!JT3'24. 1 2 2 -- 2/ -
C k ° /001,0 I A(/J
. . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
K awfi�r 3j
avl_' � CITY FLORENCE I MA DATE 06/14/2022 PERMIT#6e-2022"02 f
c JOBSITE ADDRESS 65 WARNER ST OWNER'S NAME NU-WAY HOMES 1 I
,! OWNER ADDRESS 10 WHITE AVENUE,EAST LONGMEADOW,MA I TEL(413)563-0085 IFAX
, . I
—TYPE TT-�� C Qiii U�O •ANCYTYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL
cc,,,-'CLEARI 1 N :as RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑
',APPLIANCES 1 I,FL•ORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER 1 1 1 r
BURNER
COOK STOVE
DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR ikllll'iiIillhi
GRILLE
INFRARED HEATER
LABORATORY COCKS I Y
MAKEUP AIR UNIT
OVEN 1 LU a IN'; & c 5 1 j bP: T
POOL HEATER 1 'UH i A O I' `
ROOM/SPACE HEATER PP' •V I i OT . PP` O F.r'
IIE::T:ERIORLINEII
NITIR 1r II
OOM HEATERER _•._ !I �1ineO EXISTING INTERIOR LINE
1
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES ❑NO Li
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 Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. C
PLUMBER-GASFITTER NAME Stephen Constantine I LICENSE# 3063 Ix SIGNATURE
MP 0 MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION❑#I I PARTNERSHIP:It.. LLC Q#I _ I
COMPANY NAME:Osterman Propane LLC ADDRESS 339 Amherst Road I
CITY Sunderland STATE MA ZIP 01375 TEL 413 5491000 _ I
FAX 413 549 9360 CELL EMAIL
_m. n„
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