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23D-214 (2) 61 WAE NFR S; / CO inu Sr: Man:1k,ck:Lot: COMMONWEAVIII OF MASSACHUSETTS P-2021-21 i 5 23D-2 14-001 CITY OF NORTHAMPTON Pennit: New Build PERSONS CONTRACTING WITH 1JNREGISTERF.D CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2021-2115 PERMISSIONLS HEREBY GRANT I TO: Project# NEW HOUSE Est. Cost: 325000 Contractor: License: Const.Class: JOHN HANDZEL 013693 Use Grou Exp.Da te:07/20/2023 p Owner: NU-WAY HOMES INC Lot Size (sq.ft.) Zoning: • Applicant: JOHN HANDZEL Applicant Address I0 White Ave. Phone. Insurance: 4135630085 EAST L.ONGMEADOW, MA 028 ISSL/ED ON:10/28/2021 TO PERFORM THE FOL L O 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 Underground: Service: - ��`a3 Meter: Footings: Rough: 2 Z7 ,Rough: 3 '2> a. a- ( (� House # Foundation: Final: Final: �^c�. V� �. 6 -S-Z2 i!� S�ZGIP� I,r f f final: Rough FrameaV 3-� Z Z Gas: Fire Department Fireplace/Chimney: RoughiS,—/2 ,0 Z-, Oil: Insulation: v tl• 'A- 11• Z K. Final: oke° -� G p . Final:6 I1 6-29-Z2 ier2 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLA ION OF ANY OF ITS RULES AND REGULATIONS. Signature: I` ofTI • Fees Paid: $1,075.90 212 Main Street,Phone(413) 587-1240,Fax:(413)587-1272 Office of the Building Commissioner .17/7 The Commonwealth of Massachusetts 1� ' t t City of Northampton Certificate of Occupancy 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-2021-2115 Nu-Way Homes Inc. Identify property address including street number, name, city or town and county Located at 61 Warner Street HERS Rating Florence, Hampshire, Massachusetts 52 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 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 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-214 Building Official ` /� Issuance 06/29/2022 Home Energy Rating Certificate Rating Date: 2022-06-19 Final Report Registry ID: 102622724 Ekotrope ID: zvwWgeav HERS® Index Score: Annual Savings Home: 52 Your home's HERS score is a relative 61 Warner St performance score.The lower the number, P the more energy efficient the home.To Northampton, MA 01062 Builder: am learn more,visit www.hersindex.com Relative to an average U.S.home Nu-Way Homes Inc Your Home's Estimated Energy Use: This home meets or exceeds the Use[MBtui Annual Cost criteria of the following: Heating 47.4 S664 2018 International Energy Conservation Code Cooling 1.2 $48 Hot Water 12.6 $173 Lights/Appliances 21,7 S815 Service Charges $192 Generation (e.g. Solar) 0.0 S0 Total: 82.8 $1,893 HERS Index Home Feature Summary: Rating Completed by: rer.w Home Type: Single family detached Model: John Handzel Custom Energy Rater: Paul DellaTorre Em;si,,g o Community: Northamton RESNET ID: 8776762 M°mes 1 l ao Conditioned Floor Area: 2,422 ft2 Rating Company: Energy Compliance Services 110 3� Number of Bedrooms: 4 27 Hudson Dr.Southwick MA 01077 1 , PrimaryHeatingSystem: Furnace•Natural Gas•95 AFUE 413-427-2423 Reference t00 Nome Primary Cooling System: Air Conditioner•Electric•14 SEER yo Rating Provider: Building Efficiency Resources is Primary Water Heating: Residential Water Heater•Natural Gas•4.93 Energy P©Box 1769 Brevard,NC 28712 a ,� Factor III ,0 House Tightness: 842 CFMSO(2.48 ACH50) 800-399-9620 so— 52 Ventilation: 69 CFM.8 Watts 40 This Home Duct Leakage to Outside: 12 CFM @ 25Pa(0.5/100 ft') .....« so Above Grade Walls: R-21 '0 ` Ceiling: Attic,R 49 Pall( )e('Y. T Zero Energy o^ Window Type: U-Value:0.3,SHGC:0.46Ho r tt r ( 1 Foundation Walls: R-28 Paul DellaTorre,Certified Energy Rater Digitally signed:6/27/22 at 2:09 PM mtetiRtYV Framed Floor: R-30 e Cotro a Ektot rope RATE R-Verssion:4.0.1.2938 The Energy Rating Disclosure for this home is available from the Approved Rating Provider. This report does not constitute any warranty or guarantee. 61 Warner St Northam•ton MA HERS*Index Score: Rating Date: Jun 19,2022 5 2 HERS Registry ID: 102622724 Annual Estimates: Rating Company: Electric(kWh): 6,231.7 Energy Compliance Services Rating Provider Natural Gas(Therms): 564.1 Building Efficiency Resources CO2(Tons): 73 Rating Provider Address: Br Approx.Energy Cost: $1,8 POBox 1769 Breva2d,20 87NC12 HERS Inies4 Home Feature Summary: Single family detached,4 bedrooms,2,422 ft2 Heating:95 AFUE Heroes Cooling: 14 SEER SAP or, Hot Water:0.93 Energy Factor Referent* , Hone """ Air Leakage: ye 842 CFMSO(2.48 ACI-150) Ventilation:69 CFM.8 W 60 Ilk """' Duct LTO: 12 CFM Ctt 25Pa(03'100 f121 Above Grade Walls:R-21 Ceiling:Attic,R-49 Zero Energy Hem 0 Window:U:03•SHGC:0.46 1,110$601011, 0010.106•10 Foundation Walls:R-28 kotrope RA1TR Versiort 4,0 12938 I ekotrope Thn report does na toozittute any warranty ot guarantee. IECC 201 : Performance Compliance Property Organization Inspection Status 61 Warner St Energy Compliance Servic 2022-06-19 Northampton. MA 01062 Paul DellaTorre Rater ID (RTIN): 8776762 Model: John Hanezel Custom RESNET Registered Community: Nort amton Builder (Confirmed) Nu-Way Homes Inc 0008_John Hand.el_61 Warner St Northampton 11107 HERS_0727_000:_John Handzel61 War er Annual Energy Cost Design IECC 2018 Performance As Designed Heating $756 $695 Cooling $121 $104 Water Heating $299 $299 Mechanical Ventintion $57 $10 SubTotal - Used o determine compliance $1,233 $1,108 Lights &Applianc-s wiout Ventilation $828 $828 Onsite aeneratio 50 $0 Total $2.062 $1,936 R405.3 Sour - Energy Exception: The proposed home uses 9.39 MBtu LESS source energy than the reference home. Requirements O 405 3 Performance-based compliance passes by 10.1% O R402 4 1 2 Air Leakage Testing Air sealing is 2 48 ACH at 50 Pa It must not exceed 3 00 ACH at 50 Pa. • R402 5 Area-weighted average fenestration SHGC 4 R432 5 Area-weighted average fenestration U-Factor • R404 1 Lighting Equipment Efficiency • R403 6 1 Mechanical Ventilation Efficacy code requirements that are not Mandatory heciffist cheMaricevior must be met. O IRO I.1150-4 Mechanical Ventilation Rate O R405.2* Duct Insulation Desig exceeds requirements for IECC 2018 Performance compliance by 10.1%. As a 3rd part extensio of the code jurisdiction utikzing these reports. certify that this energy code compliance document has been created in accordance wail Inc requirements of Chapter 4 of the adopter International Energy Conservation Code based on HAtAPSHIRE 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 inspectedlested 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: Paul DeitaThne Organiza ion: Energy Compliance Services Digitally signed: 6/27/22 at 2:09 PM Ekotrope RATER-Version 4.0.1.2938 IECC 2016 Performance compliance results calculated using Ekotrope RATER's energy and code compliance algorithm Ekotrope RATER is a RESNET Accredited HERS Rating Toot All results are based on data entered by Ekoirope users Ekotrope disclaims all liabiliti'for the information shown on this report - . • .- . . , . . *;•at 4.***,*j **jb1':****;1;1*****1**;° . ";**141* **';;e:*/..;**S.1 . 1;*.4*.4.***;;l'e:**/*;*j.° . •;*f****;*;4 ***4 ** ° . °;*.**:1*4'1''I.;''*44..4**'S'I . •;*'**1.1*:* * *'ig• . °.:°''';*'.. *,„*' -,j0,,1*/ ,„4 * *1.1* .14 °" * to° .. * ' • ' .4.1 ' • vi .— ..• — ‘,.. . . .., ... 61 Warner St ... .,., ,.... .... ... .,...„ . :., .. . Northampton, MA 01062 . .- Builder: Nu-Way Homes Inc `..°',... . , ,..., Model: John Handzel Custom Communi : Northamton ..,-...- - . -•° **::-..-- -..-• 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 ..: Above Grade Walls R-21 Duct Leakage to Outside 12 CFM ta 25Pa (0.5/ 100 ft') ..-' -.' . - . - . ... , ., ,• Foundation Walls R-28 Total Duct Leakage 120 CFM @ 25Pa (Post-Construction) -::• 4:-4 — , .-- . . Framed Floor R-30 Heating Furnace• Natural Gas • 95 AFUE „. ... -'" Slab R-0.0 Perimeter. R-0.0 Under Cooling Air Conditioner • Electric • 14 SEER ..- ' —' ( : ) Infiltration 842 CFM50(2.48 ACH50) Water Heating Residential Water Heater• Natural Gas • 0.93 Energy Factor -..; -*- Window U-Value: 0.3, SHGC: 0.46 *.•.•, ,-. . ..-, . --. `-- - .::. t.,....- ,-.... . 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 HAMPSHIRE County if rating is Projected,I certify that the building design described herein is consistent with -- -• 1 ° ,• ' .'• the buiiding plans.specifications.and other calculations submitted with the permit application If rating is Confirmed.I certify that the address referenced above has been inspecteddested . — . , :C and that the mandatory provisions of the!ECG have been installed to meet or exceed the intent of the IECC or will be verified as such by anotner party; )1 4 ;: Di Name: Paul DellaTorre Signature: Paa'Odra Tio 4, ... Organization: Energy Compliance Services Digitally signed: 6/27/22 at 2:09 PM . -•. .„• -. -.... , :•..7: --* „, ,..... Ekotrope RATER-Version 4.0.1.2938 2018 IECC compliance results calculated using Ekotrope RATER's energy and code compliance algorithm, •...• Ekotrope RATER is a RESNET Accredited HERS Rating Tool At results are based on data entered by Ekotrope users Ekotrove,disclaims all liability fni the information shown on thls report 4 . . t .— • 4 . . , ,,, , s 6 ,, . 'or, . . .011.rt.tOr t't, ,.'ttt tt tOr t 4°,1, ,*As, '°1 t '' 4 *° j1 °,,e, ...At, ,j:4' j .,%;.,,;•',' .1::.1• . '*,*,*,*,*t *,**,**,* !,,.i,,..,!..e,' w ',• 40.t.s,s 1,' ,,v '.,il a' ...,•,s..* .. • ...' • .*,„!,*,!„I;s,,„y 0,,' . ' ,t 4,`.4. ,*,II.67.,fr,* w -..''...•„'• , ,, - , . . . - • •- —• IECC 2018 Label 61 Warner St Model: John Handzel Custom Ekotrope RATER- Version:4.0.1.2938 HERS t Index Score: 52 -41KM:tft„' • x.„.„, „ „, , „,•r9Cv:(4`,",,c'v*34-'47, Ceiling: R-49 Above Grade Walls: R-21 Foundation Walls: R-28 Exposed Floor: R-30 Slab: R-0 Infiltration: 842 CFM50(2.48 ACH50) Duct Insulation: Supply: R8, Return: R8 Duct Lkg to Outdoors: 12 CFM @ 25Pa (0.51100 ft2) Window& boor Specs U-Value: 0,3,1SHGC: 0.46 Door- R-6 Mechanical Equipw„.;',,,Specs Natural Gas • AFE Cooling:Air Conditioner Electric• 14 SEER Hot Water: Residential Water Heater• Natural Gas • 0.93 Energy Factor Average Mechanical Ventilation: 69 CFM Professional Signature (p! c vI-f iC-/V V - r Commonwealth o/7amackudettd Official Use Only 1 -_ �i c� Permit No.v�f�2022n/ 3'7 A 'i' . 2epartment ofc7 ire Services -.-=_1 " ' Occupancy and Fee Checked -- BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ry All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: OW /5 ; 2, Cityor Town of: No v+l1 a ill i n 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) (7 / W(it✓net`' ,Sh-r-e-e - Owner or Tenant 3-01,n H0,n z A.11 Telephone No. (LI)3)Sc.3--002S. Owner's Address I 0 J A-c_ -(Ave) S� tp, 8-c,.^:+ rvk R CA 0 2.b Is this permit in conjunction with a building permit? Yes l "I No E (Check Appropriate Box) / Purpose of Building /v ZW Co►`l3.4-✓1-t C'24b✓t Utility Authorization No. 105-,2 SS-50 Existing Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters New Service 2QTh Amps I 20 /240 Volts Overhead d Undgrd ❑ No.of Meters 1 Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 4/eu0 c n s+r t f-ron I i 5 h+tt Ct rt.od liveV �J Completion of the following table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grnd. grnd. Battery Units r No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Detection and No.of Switches No.of Gas Burners Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices g Tons No.of Waste Disposers Heat Pump Number Tons KW 'No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area HeatingKW Local❑ Municipal ❑ Other P Connection s:* — No.of Dryers Heating Appliances KWecN of DeviSysteces s or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent No.H dromassa a Bathtubs No.of Motors Total HP Telecommunications Equivalent Y g No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: v?,�l 5/2.2 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 equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Er BOND ❑ OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: it It E/ h'/tCtC.4 LLC LIC.NO.: Licensee: V/CA alI..S C1,V Q i 1 t y Signature 1/Z-r4e/ ',:-t. * LIC.NO.: s6 S C/7-13 (If applicable,enter. "exempt"in the license number line.) «//Bus.Tel.No.: (y)313 78 3c1 Li 7 Address: y3 foc,/t �✓e 1111. S ib e Id, /)/1f) 01 v8 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 coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one 0 owner ❑owner's agent. Owner/Agent PERMIT FEE: S .2 00 Signature Telephone No. A Pp12,CD7D FEB 17 2022 By:✓, t ,�c,,,�f .2-0-3 -aa QoCISls eri ��.�. 6k,410 33 � �•� -_ PIASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY-TcjWN N 4, .41•J MA DATE LA-/ ZZ PERMIT#PP ZaZ' 69-0 '�L_ v-1 JOFriSITE ADDRESS 4 i t e-/-r-e-A--' OWNER'S NAME J'ig (es' ,/J P � n OVrIN�fi ADDRESS �� �`�'�"� ��• � �dN ��"9�EL yl� ' � s FAX TYPE OR OCCUPIINC TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL LY' PRINT CLEARLY• NEW: RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 ---- FLOOR—f BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB j CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK / rLUflr6ING & GAS I\ISPECTOR ROOFAVATORA NORTHAMPTON SHOWER STALL DRAINAPPF OVEU NOT O VED � APPROVED SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION f WATER HEATER ALL TYPES 1 WATER PIPING OTHER INSURANCE COVERAGE: I have a current liability insurance policy er its eidrfanKal arrivalnnt ulhie•h MAOM"in.s,...--- - • ••___ -- :_ "`_+ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [y/ 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 o1 the L..__4_ A __��I I �_.._ J•�- - -..YYb�W iii.i iris iii V.6NNI 41YY LLiL requirement :sment CHECK ONE ONLY: OWNER El 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 a to t be knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complia I in sion of the Massachusetts State Plnmmh Corte and Chanter 149 of the C neral I awe h PLUMBER'S NAME (_ d/" , N LICENSE# 33y3 5 SIGNATURE MP❑ JP[W' CORPORATION 0# PARTNERSHIP El# LLC❑# r,CMPANY AME U,s1 •"s ?Itt i'1. ADDRESS_i8 S'p.it 1'-el CITY 3jati d4 r 0 STATE /44 ZIP a UU g TEL 03 --9?q'6`1 Z 6 FAX CELL EMAIL Or C a^1-smi �I '`� ` ('4 61 ' ?„V'! 9c1V 22 42-Z cA /06 i 4/05 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK fir.'- � ,�J i -i=$,y_ CITY / �u��vlu `MA DATE S— 3;/L� PERMIT#6e2-02Z'�0 y i JOBSITE ADDRESS 67�C..veZ fr OWNER'S NAME J2)4A, , f.*►2'e/ G — OWNER ADDRESS /v -4 t /Q/e 671/►-9 TEL 03-55:/55�7 FAX i TYPE Off; / PRINT' OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL El RESIDENTIAL❑� i CLEARLY NEW:RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES Z FLOORS-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 BOOSTER CONVERSION BURNER COOK STOVE / DIRECT VENT HEATER DRYER FIREPLACE / FRYOLATOR FURNACE f GENERATOR GRILLE INFRARED HEATER 1 LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER , ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER 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 NO 0 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVE E BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY 0 BOND 0 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 I edge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME �bN — Gs dgN LICENSE# 334 3 s SIGNATURE MP❑ MGF❑ JP ErJGF❑ LPG'❑ CORI?ORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME ClSS ��it,M4l,1� ADDRESS /`8 SO.e�'�-1ind CITY ,S/— ./7 STATE ZIP .07632)8 TEL 4/l3" ?? - 6 Y&279 CELL EMAIL OS --2--n`vN'-e—''L l J 7 - • '-b M Z2-- 9 ;30 g-0sc2 'd 29Z' - __ ri0/0 33 //5' - MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK T==tea,', _''' ITY I A/i+'"4.4 01 MA DATE 2/Z V2-Z- PERMIT#,f)--2022--007 Li ,J 4013 TE ADDRESS {O/ 64-)G✓ /' ,f7 OWNER'S NAME J` �,^' 44-12-di'L GbWN R ADDRESS/0 wGuh .41:'°-: ‘41i+4-4/6 l r TEL "sL3-Q-egs" FAX TYPE 6�R OCc AN Y TYPE COMMERCIAL❑ EDUCATIONAL 0 RESIDENTIAL PRINT CLEARLY NEW: RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO 0 APPLIANCES 1 FLOORS-. 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 I FRYOLATOR /NI/ FURNACE GENERATOR GRILLE INFRARED HEATER ' LABORATORY COCKS PEA.M BING & GAS INSPECTOR MAKEUP AIR UNIT NORTHAMPTON OVEN A�'RKOvtLl NU1 p1-' WOVED POOL HEATER I ROOM/SPACE HEATER ROOF TOP UNIT TEST j UNIT HEATER UNVENTED ROOM HEATER 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 NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGEBY 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 0 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 • e best of ge and that all plumbing work and installations performed under the permit issued for this application will be in compliance wi • - ' nen n of t e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME or•-'""Fn' 4-/1 LICENSE# 33`{3 3 --SIGNATURE MP 0 MGF 0 JP E JGF❑ LPG!yi CORPORATION 0# PARTNERSHIP 0# LLC,❑# COMPANY NAME D5d^'f (/ k4-49)'N ADDRESS /9 ce-e-/, P--iJ CITY 34AJ4 / i d STATE /"� ZIP a& 1 ., TEL y/3 - 9?7- 6 147-47 FAX CELL EMAIL OS ZlS^.,N2✓ r t itax.4 I C-DA4 6- , ' , wn-G