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30B-131 (2) L 1 ' ~' BP-2021-2162 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Permit: New Build PERSONS CONTRACTING WITI-1 UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2021-2162 PERMISSIONISHEREBYGRANTE TO: Project# NEW SINGLE FAMILY Contractor: License: Est. Cost: 328000 NU-WAY HOMES INC 013693 Const.Class: Exp.Date:07/20/2023 Use Group: Owner: Lot Size (sq.ft.) Zoning: Applicant: NU-WAY HOMES INC Applicant Address Phone: Insurance: 10 WHITE AVE (413)563-0085 EAST LONGM EADOW, MA.01028 ISSUED ON:01/11/2022 TO PERFORM THE FOLLOWING WORK: NEW SINGLE FAMILY HOUSE POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector l nderground: Service: Meter: Footings: ale, 6.9-22 a Rough:ilk ` e' II17/Zz house# Foundation:0•14 6-12_ 2 JZt2 � Rough:Yl -�enx Final:ii_aa_ 0A� Final: Rough Frame: ©,)C 8-1)q-ZZ ie.e F., /t-Z2.-z- - 6v Rough: A946,Fire Department Driveway Final: Fireplace/Chimney: Final: Oil: Insulation:0,w_ q-i-Z 4 g,R Smo •• �'2, 4" ` Final:all )1- Z3 ZZ Q THIS PERMIT MAY BE YOKED BY THE CITY OF NORTHAMPTON UPON VIOL• TION OF ANY OF ITS RULES AND REGULATIONS. r Signature: 1) li Fees Paid: $1,356.80 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner * The Commonwealth of Massachusetts a.. 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 Nu-Way Homes Inc. BP-2021 2i62 Identify property address including street number, name, city or town and county Located at 8 Liberty 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 ar herein specified has been inspected fin.general.fire and life safety features. This certificate shall allow fbr 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 Kevin Ross Date ofF'inal Map/Plot Building Official Inspection 11/23/2022 Signature of Municipal Date of Building Official /727 Issuance 11/28/2022 3UB-131 Home Energy Rating Certificate Rating Date: 2022-11-25 Final Report R..gistry ID: 326/99179 Ekotrope ID: zvwWw39v HERS® Index Score: Annual Savings Home: 8 Liberty St Your names' HERS score is a relative perforrla .ce sc..re. The lower the nu,-,..be!, Northampton. MA 01062 52 the more energy efficint tne home.To Builder: learn more •.-izit www.hersincier-com $ if *Relative to an average U.S.home Nu-Way Homes Inc Your Home's Estimated Energy Use: This home meets or exceeds the criteria of the following: use EIVIStui Ailaual Cost Heating 244 $1,015 2018 International Energy Conservation Code Cooling 0.9 $37 Hot Water 2.2 $92 ..ightsb,ppliances 22.i $941 .3e-vice Cha ges $48 Q.ene,ation (e.g.Solar) 0.0 $0 Total: 50.1 $2,134 HERS Index Home Feature Summary: Rating Completed ;Jy: 46. More I nom Home Type: single family detached Model: John Handzel Custom Energy Rater: Paul DellaTorre 130 , HESNE f D 8776762 Existing , uko Community: Northamton Mornes , ,30 Cundit oned Flu.).Area: ;..972 ft2 Rating Cemdany: Ene g. ,:ornpliattce Services ! oo Al i •the,o,..,edroo,,,s: "-, 2/ Hud,on Dr.Soothwick MA 01G,r Refe,ente M:1 . Pr many He t ng Syste t: Al'So..rte Heat rum p•tlechic ... 5 HS?r :1.3 427 -..423 164 90 p,:mai y Cool ng 4,tent: Ail Source Heat Pu 1p,Electric. 1,4 DEER Rating Prcivider: Building'ificien,y Resources I •--imaty'Aiatei H i,eating: Resent 41Water Heater•Electric-J.85 UE7 PO Box 17,9 Brevard,NC.28712 67: House T ghtness: 68/Ci-i.150 t,.73 ACH50) 800-399-9620 ",.....• Ventilation: i.•,•v OM.:74 Watts so ill rel Duct Lealcacie to Outsiue: I I (FM ,INz•25Pa(0.37/ 100,r) • 0 Thts Some so Above Grade Walk: R-23 ,. Ceiling: Atti. R-49 Pt-Id. 7)cli re) t) , (, (•tt Window Type: 0-Vae:0.3,51-4tot:046 Zero toot r Hro, L 0 Foundation Walls: R-13 Paul DellaTorre,Certified EDE.-Etry f:-..nt?' ,' - west/wily Framed Floor: R 30 Digitally signed: 11/28/22 at 1:09 PM cm.>ort.rr t kotropr‘RA11 R Version 4 0.1.1019 ekot rope Tito 1 porgy Rating Dist I,'sure for this homo is avallabli,from tho Approved,;.ding Prt wit lor z •,:- i his report(toes,lot•on lit•Ito any t.v•t,'tlEltylir,,,41,1 atficto Home Energy Rating Certificate Rating Date: 2022-11-25 Final Report Registry ID: 326799179 Ekotrope ID: wwWw39v HERS° Index Score: Annual Savings Home. Your home's HERS score is a relative 8 Liberty St performance score.The lower the number.5 Northampton, MA ©10 2 the more energy the hon e.To Builder: 2 learn more, visit www,hersindex.com $ 3 164 'Relative to an average U.S,home Nu-Way Homes Inc Your Home's Estimated Energy Use: This home meets or exceeds the Use cMBtu) Annual Cost criteria of the following: Heating 24,1 51,006 2018 International Energy Conservation Code Cooling 0,9 $37 Hot Water 2.2 $94 Lights/Appliances 22.5 5936 Service Charges 546 Generation {e.g, Solar) 0.0 50 Total: 49.7 $2,120 HERS Index Home Feature Summary: Rating Completed by: um.r,...Ry Home type: Single family detached Model: John Handzel Custom Energy Rater: Paul DellaTorre tiro FM;s,>,ag ISO Community: Northamton RESNET ID: 8776762 Homes 130 Conditioned Floor Area: 2,972 ft2 Rating Company: Energy Compliance Services 10 Number of Bedrooms: 3 27 Hudson Dr.Southwick MA 01077 "° 413-427-242.3 eere•ence 100 Primary Heating System: Air Source Heat Pump•Electric•8.5 HSPF Home , o„ Primary Cooling System: Air Source Heat Pump••Electric•• 14 SEER Rating Provider: Building Efficiency Resources so Primary Water Heating: Residential Water Heater•Electric•3.88 UEF PO Box 1769 Brevard,NC 28712 �o House Tightness: 687 CFMStr(1.73 ACH50) 800-399-9620 61 52 Ventilation: 90CFM•54 Watts Duct leakage to Outside: 11 CFM a 25Pa(0.37/100 ft2) .0 MN None „, .w w Above Grade Walls: R-23 zo Ceiling: Attic,R-40 r" zero Engrg "' Window Type: t1•Valur_.0.3,SHGC_0.46 Tau I}eiiu./(c ie NaTe 0 Foundation Walls:: R-13 Paul DellaTorre,Certified Energy Rater �. r"'r""rr` Framed Floor: R•30 Digitally signed: 11/28/22 at 1:09 PM 0 e kot r©pe Ekotrope RATER-Version:4.0.13039 The Energy Rating Disclosure for this home is available from the Approved Rating Provider. This report does not constitute any warranty or guarantee. Energy savings cakulated without•.rod:ficati,.ns to the ene.gy moue,(As Mode.ed) 8 Libert St Northa n•ton MA HERS.index Score: Rating Date: Nov 25,2022 52 HERS Registr 'D:32617S-'19 Annua.Estio4.tes• Rating Company: Eetk(kWh): 14,5/2 I Energy Compliance Services Rating Provider CO2( 3 Building Efficiency Resources Approx.Ene'gy C,.st: az,1.40 Rating Provider Address: PO Box 1769 Brevard,NC 28712 HERS Inde.). Home Feature Summary: Single family detached,3 MOMUIvwx. bed eL....s 2,9/2 f leafing S HSP1- SELr, tet r 3,83 ,Ei- AL Le?kaye: 68"/L_FIV153(4 73 ALH50) Ventilate 90 CF:'..1 54 W Ddt.t L10: Taus tforn 11(FM 259a:0.37 00 ft') e " Au°,e orede R 23 1,4 ,ktti rq 49 4,3 lesgy Morne0 Windo,L?:U:03.SH.3C:0.46 Foundation Walls.R-1 7› 7-1 fkotrtmeRMER-Vergart ekotrope 4ukt3239 oz. SEIM 41111.4:11,110116131115Mft MT a yawl, ammo IECC 2018 Performance Compliance Property organization Inspection Status 8 Liberty St Energy Compliance Servic 2322-11-25 Northampton, MA 01062 Paul DellaTorre Rater ID RTIN): 8; 6762 Model: John Handzel Custom RESNET Registered Community: North-amton Builder RConfirmedi Nu-Way Homes Inc 0006 John Handze 8 Liberty St . lorance 211026 HERS 0727_00©6 John Handzel_8 Liberty St_Florance_221129 Annual Energy Cost Design 'ECC 2018 Performance As Designed Heating $1,348 .1994 Cooling $101 $88 Water Heating $102 $102 Mechanical Ventilation $55 $70 SubTotal - Used to determine compliance $1.605 $1 253 Lights &Appliances Mout Ventilation $900 $900 Onsite generation $0 $0 Total $2.505 $2.153 R405.3 Source Energy Exception: The proposes home uses 25"8 M6tu LESS source energy than the ref rence home. tiequirements The r.rc.00set cis -�� --: 27, R ei#arman e refe e<,ce energy bill R405 i Performance-based compliance passes 0%• R402 4 .2 Ar Leakage-est€.ng sea _ -aIf It must not exceed 3 00 AC .a 5.Pa. R402.5 Area-weighted average fenestration SHGG all owe value • R462.r Area-v.;eighteo average fenestration U--actor R404.4 g mama _, I CP-:are high_ • R403.6.1 Mer _: ._ . aelcn Efficacy Mandatory Check hs Je requrceme =at are not ;r�Manual rr+st must be checke as sample _9,,_ _a s i=i;otnope must, yet- • 1RC M1505 4.3 .e_•nan,cal Ventilation Rate R405:2 :ats,=th enveiope must be insulated to a least RS_fl Design exceeds requirements for IECC 2018 Performance compliance b 22%. As a 3rc party extension of the code junsdic3cr. ,: tic%'eports, •ertity That this energy code co ptance o cumero nas been-created in accordanc=with toe requirements of Chapter 4 c the adopted international Energy Conservation Code based on HAMPSHIRE County if rating is Protected,7 certify that the building design•-- 'r"bed herein is consistent with The building plans sperircations and tithe' : .': iations submitted with toe permit aeration, :t rating is onfirrned 1 Gettig'that Me address rer,,enced above has been inspected/tested and that the mandatory°provisrc tie IECC have been installed to meet or exceed the intent of the;_CC Cr will be vertried as such by a ether party. Name: T^..,. Signature: Pau/l) f( r6,i°tc Organization: Energy Compliance Services Digitally signed: 11/28/22 at 1:69 PM Ekotrope RATER-Version 4.0.1.3039 tECC 201E Performance compleance results calculated using Ekotrope RATERS energy and code compliance algorithm. Ekotrope RATER is a.cESNE r Accredited>rE,,o Ratlt.ij Tool.kg results are based on data entered by E;atrope asers. Ekotrope disclaims all tiabilit;aor the itkarmatiot she m of this report f "A..lA•4.4*.*'+y lad!`}. ®e .4"Rtl4} �.+.4A•'4'4.. 'i 4§!';`y.,'•.4'4 R�!•'4» :k 4{!°4`•,°"• a4 "R"R•a"+!`4,*.A'4ek 1• a Yax4�4mA`i s:::, 1A.4,1 44, 444 4414.t1.A:l 4,4 .0.4,: ' tg*,4+{t,.;: 4444,4A,f44A,:°,,1,,;:,4444}1yRAl4AR.44:.0+,.g q�R*4*1.4i,A R 4444f,,44',•**,*0A0.04,00444#.#e./"i0.00401+*a#4R a'..A• 0*t *, .. 1 t$ 44"4 14 44 Rf ~ 04 " 4! 4�4 `44 a 44 'v 4/ •1 04 ' 41 44 8LibertySt ......:. • ;�,•1. Northampton, MA 01062 ." .. Builder: Nu-Way Homes Inc Model: John Handzel Custom Communit : Northamton � : 4 .: ) THIS HOME IS CERTIFIED TO MEET THE ,.. 2018 INTERNATIONAL ENERGY CONSERVATION CODE °yM a b Building Features .., 4„:: Ceiling Attic, R-49 Duct Supply R-8.0. Return R-8.0 < ».z) .tE : Above Grade Walls R-23 Duct Leakage to Outside 11 CFM ©25Pa (0.37/ 100 ft2) Foundation Walls R-13 Total Duct Leakage 164 CFM @ 25Pa (Post-Construction) - ...; . 4�: Framed Floor R-30 Heating Air Source Heat Pump•• Electric•• 8.5 HSPF E ' : Slab R-0.0 Perimeter, R-0.0 Under Cooling Air Source Heat Pump• Electric• 14 SEER -' `,.. Infiltration 687 CFM50(1.73 ACH50) Water Heating Residential Water Heater•• Electric•• 3.88 UEF `� '' Window U-Value: 0.3, SHGC:0.46 ;., •., 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 i of the adopted International Energy Conservation Code based on HAMPSHIRE County It rating Is Projected.I certify that the building design described herein is consistent with the building plans,specificat?ons_and other calculations submitted with the permit appricatlon If rating is Confirmed,I certify That the address referenced above has been inspected teste' }� 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_ , Name: Paul DellaTorre Signature: Pau/%) lli/6'r ire "= Organization: Etiotuv Compliance Services Digitally signed: 11/28`22 at 1:09 PM :, Ekotrope RATER-Version 4.0.1.3039 2018 1ECC compliance rest Ns calculated using Ekotrope RATER's,energy and cede compliance algoritnrrr • Ekotrope RATER Is a RESNET Accredited HERS Rating Toot.All results are based on data entered by Eke-trope users "y 4 :, ) Ekotrope disclaims all liability for the information s<=o,,n en this report ( :k4' is • s4 a: 11 44 '. •.. 44 • R4 :; 41 .. . . ,..sele. .. se ,. 4f 4 44 ,.! y,.s•1f*A444• 444R4t4:4• 4°1444a AA.ls'4444*44i et>tR4•M*'4Y'44441R!`Jw4+4 tj'4j R 1'it'f8R 4.44!1 yj, +44A*4444'iA'4A4444!.w‘ •!44*1**'44'4�4�44"4R;�y44!1***44'A',•4441•� t� ..*r_. ♦ '4,0, !4#!,,,4.4!! 1 4,4"44 , E4•44, >4.444A.,,!•444. .44"!44..,.444,444. 444R4.,.4444 A. . ,4la Rl.,,44 f4`• .44r AA'..44A44• '* IECC 2018 Label 8 Liberty St Model: John Handzei Custom Ekotrope RATER-Version: 4.0.1.3039 HERS'' Index Score. 52 Building Envelope Specs llllllllltdlil Ceiling: R-49 Above Grade Walls: R-23 roundatiol Walls: R-13 Exposed Hoor: R-30 Slab: R-0 Infiltration: 687 CFM50(1.73 ACH50) Duct Insulation: Su,nrly: R8, Return: R8 Duct Lkg to Outdoors: 11 CFM © 25Pa (0.37/ 100 ft2) Window & Door Specs U-value. 0.3, SHGC: 0.46 Doc : R-6 Mechanical Equipment Specs Heating:Air Source Heat Pump • Electric • 8.5 HSPr Cooling:Air Source Heat Pump • Electric• 14 SEER Hot Water: Residential Water Heater• Electric• 3.88 UEF Average Mechanics Ventilate— 90 Builder or Design Professional. S gnature qay► fv -i192Z poi/ C. Os 6(4411. 7y 2 85.° MASSACHUSET TS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK W�„ — '" CITY 6✓ Z :� MA DATE 2/ '/Z 2— PERMIT#PP Zd Z2"0 271 €I:� � 2q7 / JOBSI RESS _ OWNER'S NAME TDAN Lie,N p— OWNER ADDRESS AO . /..//+-J r TEL 4/13'Se3•'b 1517 FAX TYPE OR OCCUI'AN TYPE COMMERCIAL❑ / EDUCATIONAL ❑ RESIDENTIAL[[9 PRINT CLEARLY NEW: RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 FLOOR-, BSM 1 Z 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) KITCHEN SINK / LAVATORY / / 5 ROOF DRAIN SHOWER STALL / / PLUMBING & GAS INSPECTOR SERVICE/MOP SINK NCRTHAMPTON TOILET / / Z APPROVED NOT APPROVED URINAL WASHING MACHINE CONNECTION / � WATER HEATER ALL TYPES WATER PIPING / / / OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 1NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE E 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 best of m kn and that all plumbing work and installations performed under the permit issued for this application will be in compliance Massachusetts State Plumbin Code and Chapter 11442�of the General Laws. PLUMBER'S NAME d/v/vt 3 SN LICENSE#33435` SIGN URE MP❑ JP D/ CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME �S�NS La+..4, n y7 ADDRESS /6 r✓ / -b CITY 4 /,.J14,,J STATE/�,1 ZIP O/61 e • TEL 4/3 -?7?- 6"I Z$ FAX CELL EMAIL 65L"L4,r' r- ` 0 o 23"-3 22' UrtaS,P26/20. -A g� / eve,Pv __- V1-5 2� S CI 0C-K-TV, T 1 Commonwealth of Massachusetts Official Use Only �-_' = 1, Permit No.—2O22— 0S6 5 - _,�,= Department of Fire Services ,=T-i='c „u' Occupancy and Fee Checked / I� 2 z� = BOARD OF FIRE PREVENTION REGULATIONS• [Rev. 9/05] �.� �� � (leave blank) m 3 r-- CT o -�APIt CATION FOR PERMIT TO PERFORM ELECTRICAL WORK A' CO o All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527( CMR 12.00 EAS;`' 1 ININK-OR 1 YPEAT,T,INFORMATION) . Date: Q 7�/22. • c., o 2 ^' MT or Town of: WoKo a,rv►Pd�n To the Inspector of Wires: a : this a! •.':tion the undersigned ves notice of his or her intention to perform the electrical work described below. y . cation� eet&Number) ' fi/& y& ‹.-174"--Ce-/-* • • ,•. -- I ---I ant ' in dancia.e,/ Telephone No. (Y(3)5-6.3"OOt Owner's Address /0 1A)h i 4e f tw_ AIA.-e! S+• LongNt,e u,c(o-0 ) am- ci O2 - Is this permit in conjunction with a//building permit? Yes [1 No 0 (Check Approprizte Box) � l�Purpose of Building IV enicd—ruGMiY) Utility Authorization No. 305gi 5600 • Existing Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters New Service 2 Amps 12.0 /2)10 Volts Overhead Z Undgrd❑ No. of Meters t Number of Feeders and Ampacity • Location and Nature of Proposed Electrical Work: 14$./ jj �0 u2.,— j fec v )ervi�c:e Completion of the following table may be waived by the Inspector of Wires. NNo. of Recessed Luminaires No.of CeiL-Susp.(Paddle) of Total A Fans Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires - Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting 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. Tool No..of Aler ipg Devices No. of Waste Disposers Heat Pump Number .Tons___• KW --_ No.of Self-Contained Totals: Detection/AlertingDevkes No. of Dishwashers Space/Area HeatingKW Local❑ Municipal 0.Other P Connection - No. of Dryers Heating Appliances KGV Security Systems:* --No.of Devices or Equivalent No. of Water KW Ballasts of - No. of Data:Wiring: . Ballasts No.of Devices or Equivalent Heaters Sigma No.H dromassa a Bathtubs• ' No. of Motors Total HP Telecommunications Wiring: y g ,. No.of Devices or Equivalent OTli R: - Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of E ctri al Work: (When required by municipal policy.) • Work to.Start 7 fy 22 Inspections to be requested in accordance with MEC Rule 10, and upon:ompletion. INSURANCE C VERAGE: 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 cove age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑a Specify.) I certify, under the pains and penalties'of perjury, that the information on this application is true and complete. FIRM NAME: 5;f 5(e.G�►"l c4,il z-t-C D' LIC,NO.: Licensee: v�aoks �3!l - Signature `e/g'b( /:;-% . - LIC.NO.: 5-6sg7-g- - (If applicable, en "exempt"in the license number line) Bus.TeL No.:(`ft3)37d" 39�V7 Address: 73 nbtA Avew€ ,'5C1d, M fit o/O&S Alt.Tel.N..: • *Security System Contractor License required for this work;if applicable,enter the license number here: 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)❑ owner 0 owner's agent. Owner/Agent PERI�IIT FEE. $. p Signature Telephone No. I `(V ( te - rt -I/ -\-cle -,.,nos -ce - '9e-A ^i?J M 1 L n Dy t L j -