25A-195 (3) Dr-LULL-um,
70 SHERMAN AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
25A-195-00I CITY OF NORTHAMPTON
Permit: New Build
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
JPDO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) 400
BUILDING PERMIT
Permit # BP-2022-0887 PERMISSION IS HEREBY GRANTED TO:
Project# NEW 2 FAMILY Contractor: License:
Est. Cost: 247000 EQUITY RANGER 109931
Const.Class: Exp.Date:04/10/2024
Use Group: Owner: MATHENA MORRISSEY,
Lot Size(sq.ft.)
Zoning: Applicant: EQUITY RANGER
Applicant Address Ph ne: Insurance:
PO BOX 1021 (413)374-4060 WS514546
AMHERST, MA 01002
ISSUED ON:07/29/2022
TO PERFORM THE FOLLOWING WORK:
CONSTRUCT 2 FAMILY HOME - SLAB ON GRADE
POST �'_'ARD SO IT IS VISIBLE FROM THE STREET
lnspe or of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter: Footings: '
Rough:r/l r/)3 Rough: ,, 1 ! '33 House# Foundation:
final: /�,.,. Final: k-1 : Final: Rough Frame:
Gas: f Fire Departrn Driveway Final: Fireplace/Chimney:
Rough: /� Insulation:
Smoke: 1/77 11A4 Final: 0,11 8-17.234R
THIS PERMIT MAI 8E1E�tiliED is i i kit CIT r-tI:F '- ' r•, w Irnr N UPON Nan; ATK IN OF
ANY OF ITS RULES AND REGULATIONS.
Signature: Q
10f Y • 315.7
Fees Paid: $967.00
212 Main Street, Phone(413)j877-1240,Fax:(413)587-1272
Office of the Buildirs Commissioner
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,k The Commonwealth of Massachusetts
Ati
� City of Northampton
tl .'''Cli''" A*
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
Mathena Morrissey BP-2022-0887
Identify property address including street number, name, city or town and county
Located at
70 Sherman Ave. HERS Rating
Northampton, Hampshire, Massachusetts Unit A-49
Unit B-50
Use Group
Classification(s) Two 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 Two 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 Kevin Ross Date of Final Map/Plot:
Building Official Inspection 08/17/2023
Signature of Municipal Date of 25A - 195
Building Official / / Issuance 08/25/2023
Home Energy Rating Certificate Rating Date: 2023-08-03 (4111
Final Report Registry ID: 725992112 POWERHOUSE
WW1 COMIU
Ekotrope ID: mvoyXWxL F "114.
HERS° Index Score: Annual Savings Home:
Your home's HERS score is a relative 70 Sherman Ave Unit B
50 performance score.The lower the number, Northampton, MA 01035
the more energy efficient the home.To Builder:
learn more, visit www.hersindex.com $ 2.87 1
Relative toan average U.S.home Jim Morrissey
Your Home's Estimated Energy Use: This home meets or exceeds the
Use(MBtu] Annual Cost
criteria of the following:
Heating 11.3 $784 2018 International Energy Conservation Code
Cooling 0.7 $46
Hot Water 1.5 $103
Lights/Appliances 14.3 $992
Service Charges $84
Generation(e.g.Solar) 0.0 $0
Total: 27.9 $2,010
HERS Index Home Feature Summary: Rating Completed by:
. mir,, Mom twiny Home Type: Duplex,single unit
iso Model: N/A Energy Rater: Adin Maynard
Exist
IF Community: N/ARESNETID 9463452
ei
Conditioned Floor Area: 1,118 ft2 Rating Company: Power House Energy Consulting
PO Box 9571,North Amherst,MA 01059
Number of Bedrooms: 2
deference Prima Heatin S stem: Air Source Heat Pum Electric•10 HSPF413 83S 5162
Home ry g y p•Primary Cooling System: Air Source Heat Pump•Electric•19 SEER Rating Provider. Energy Raters of Massachusetts
Primary Water Heating: Residential Water Heater•Electric•3.8 UEF 2 Woodlawn Street Amesbury,MA 01913
328.1 CFM50(1.94 ACH50)(Adjusted Infiltration:1.35 978-270-3911 House Tightness: ACH50), 50
Ttas 11sr Ventilation: 101 CFM•75 Watts•ERV
Duct Leakage to Outside: Forced Air Ductless °_ ai,w� + L•Above Grade Walls: R-26
Zero Ene� Ceiling: Attic,R-59
Window Type: U-Value:0.27,SHGC:0.27 Adin Maynard,Certified Energy Rater
LassWag Digitally signed:8/10/23 at 11:31 AM
03013 USW Foundation Walls: N/A
Framed Floor: R-42
e kot ro a Ekotrope RATER-Version:4.1.13217
p The Ei iergy Rating Disclosure for this home is available from the Approved Rating Provider.
This report does not constitute any warranty or guarantee.
RESNET HOME ENERGY
RATING Standard Disclosure wFR"°
For home(s) located at: 70 Sherman Ave Unit B,
Northampton, MA
Check the applicable disclosure(s):
Wt1. The Rater or the Rater's employer is receiving a fee for providing the rating on this home.
—12. In addition to the rating, the Rater or the Rater's employer has also provided the following consulting services
for this home:
A. Mechanical system design
. _B. Moisture control or indoor air quality consulting
11 C. Performance testing and/or commissioning other than required for the rating itself
I ID. Training for sales or construction personnel
, E. Other(specify)
iWit3. The Rater or the Rater's employer is:
._JA. The seller of this home or their agent
B. The mortgagor for some portion of the financed payments on this home
Witc. An employee, contractor, or consultant of the electric and/or natural gas utility serving this home
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 nRater ! 'Employer ,Rater f jEmployer
Thermal insulation systems Rater Employer Rater Employer
Air sealing of envelope or duct systems I [Rater tiEmployer Rater Employer
Energy efficient appliances Rater Employer Rater Employer
Construction (builder, developer, construction contractor, etc) Rater Employer j 'Rater DEmployer
Other(specify): Rater Employer Rater Employer
I. j5. 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: Power House Energy Consulting Digitally signed: 8/10/23 at 11:31 AM
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.
IECC 2018 Label
70 Sherman Ave Unit B
Ekotrope RATER-Version: 4.1.1.3217
HERS®Index Score: 50
velope Specs
Ceiling: R-59
Above Grade Walls: R-26
Foundation Walls: N/A
Exposed Floor: R-42
Slab: R-10
Infiltration: 328.1 CFM50 (1.94 ACH50)
Duct Insulation: N/A
Duct Lkg to Outdoors: Forced Air Ductless
Window& Doarnecs
U-Value: 0.27, SHGC: 0.27
Door: N/A
Me .
Heating: Air Source Heat Pump• Electric• 10
HSPF
Cooling: Air Source Heat Pump • Electric• 19
SEER
Hot Water: Residential Water Heater• Electric • 3.8
UEF
Average Mechanical Ventilation: 101 CFM
Builder or Design Professional
Signature:
Air Leakage Report
Property Organization Inspection Status
70 Sherman Ave Unit B Power House Energy Con: 2023-08-03
Northampton, MA 01035 Adin Maynard Rater ID (RTIN): 9463452
RESNET Registered
PHEC-2557 70 Sherman Ave Unit B Builder (Confirmed)
confirmed Jim Morrissey
General Information
Conditioned Floor Area [ftz] '1,118
Infiltration Volume [ft3] 10,136
Number of Bedrooms 2
Air Leakage
Measured Infiltration 328,1 CFM50(1.94 ACH50)
ACH50 (Calculated) 1.94
ELA [sq. in.] (Calculated) 18.00
ELA per 100 s.f. Shell Area (Calculated) 0.479
CFM50 (Calculated) 328
CFM50/s.f. Shell Area (Calculated) 0.087
HERS Rated Home Adjusted Infiltration 1.35 ACH50
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] 101 CFM
Hours per day 24.0
Fan Power 75 Watts
Recovery Efficiency % 62.0
Runs at least once every 3 hrs? true
Average Rate [CFM] 101.0 CFM
2010 ASHRAE 62.2 Req. Cont. Ventilation 33.7
2013 ASHRAE 62.2 Req. Cont. Ventilation 56.0
Ekotrope RATER-Version 4.1.1.3217
All results are based on data entered by Ekotrope users.Ekotrope disclaims all liability for the information shown on this report.
Home Energy Rating Certificate Rating Date: 2023-08-03 (illii
Final Report Registry ID: 426604586 POWERHOUSE
Ekotrope ID: 5dYeyRPd MAMA cua1trim,
HERS® Index Score: Annual Savings Home:
Your home's HERS score is a relative 70 Sherman Ave Unit A
49 performance score.The lower the number, $ 21 608 Northampton, MA 01035
the more energy efficient the home.To Builder:
learn more, visit www.hersindex.com *Relativet an average U.S. home Jim Morrissey
Your Home's Estimated Energy Use: This home meets or exceeds the
Use[MBtu] Annual Cost
criteria of the following:
Heating 10.0 $689 2018 International Energy Conservation Code
Cooling 0.5 $37
Hot Water 1.5 $102
Lights/Appliances 13.7 $944
Service Charges $84
Generation (e.g.Solar) 0.0 $0
Total: 25.6 $1,857
HERS Index Home Feature Summary: Rating Completed by:
Mom lama Home Type: Duplex,single unit
iw Model: N/A Energy Rater: Adin Maynard
Existing 110 Community: N/A RESNET ID: 9463452
Homes RatingCompany: Power House EnergyConsulting
Conditioned Floor Area: 939 h� P Y
i0 PO Box 9571,North Amherst,MA 01059
Number of Bedrooms: 2
i
RefeHrence ometoo
Primary Heating System: Al,Source Heat Pump•Electric•10 HSPF 413-835-5162
90 Primary Cooling System: Air Source Heat Pump•Electric•19 SEER Rating Provider: Energy Raters of Massachusetts
80 Primary Water Heating: Residential Water Heater•Electric•3.8 UEF 2 Woodlawn Street Amesbury,MA 01913
70 198.3 CFM50(1.41 ACH50)(Adjusted Infiltration:0.90 978-270-3911 ��•z•.,
60 House Tightness: ACH50) a' •a.
so_ � 7
~o Ventilation: 101 CFM•75 Watts•ERV
This Home V, •` wax'F.
30 Duct Leakage to Outside: Forced Air Ductless '` titr4f,J
20 Above Grade Walls: R-26 / G9%�L� ' ... ,• "- ,'
to
Zero Energye 0 Ceiling: Adiabatic,R-0
Window Type: U-Value:0.27,SHGC:0.27 Adin Maynard,Certified Energy Rater
'' UssEnergy Digitally signed:8/10/23 at 11:28 AM
rd,S [.M• Foundation Walls: N/A g Y g
Framed Floor: N/A
i e kot ro p e Ekotrope RATER-Version:4.1.13217
The Energy Rating Disclosure for this home is available from the Approved Rating Provider.
This report does not constitute any warranty or guarantee.
RESNET HOME ENERGY
RATING Standard Disclosure POWER HOUSE
EMEIGYCONSULTING
For home(s) located at: 70 Sherman Ave Unit A,
Northampton, MA
Check the applicable disclosure(s):
11. The Rater or the Rater's employer is receiving a fee for providing the rating on this home.
2. In addition to the rating, the Rater or the Rater's employer has also provided the following consulting services
for this home:
LiA. Mechanical system design
fB. Moisture control or indoor air quality consulting
_IC. Performance testing and/or commissioning other than required for the rating itself
0D. Training for sales or construction personnel
O E. Other(specify)
filf3. The Rater or the Rater's employer is:
A. The seller of this home or their agent
fl B. The mortgagor for some portion of the financed payments on this home
SIC. An employee, contractor, or consultant of the electric and/or natural gas utility serving this home
04. 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 [Rater Employer Rater J [Employer
Thermal insulation systems Rater Employer Rater J [Employer
Air sealing of envelope or duct systems j [Rater Employer LRater Employer
Energy efficient appliances I—Rater _Employer ERater [Employer
Construction (builder, developer, construction contractor, etc) Rater J [Employer _Rater j [Employer
Other(specify): II Employer paterI [Employer
� J .Rater � L_�
_15. 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: Power House Energy Consulting Digitally signed: 8/10/23 at 11:28 AM
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.
IECC 2018 Label
70 Sherman Ave Unit A
Ekotrope RATER-Version: 4.1.1.3217
HERS® Index Score:49
Building En
Ceiling: R-0
Above Grade Walls: R-26
Foundation Walls: N/A
Exposed Floor: N/A
Slab: R-10
Infiltration: 198.3 CFM50 (1.41 ACH50)
Duct Insulation: N/A
Duct Lkg to Outdoors: Forced Air Ductless
Window& Door
U-Value: 0.27, SHGC: 0.27
Door: N/A
Mechanical Equipment Spetti—
Heating: Air Source Heat Pump • Electric• 10
HSPF
Cooling: Air Source Heat Pump • Electric • 19
SEER
Hot Water: Residential Water Heater• Electric • 3.8
UEF
Averse Mechanical Ventilation: 101 CFM
Bulid�er or br §gn Professional
Signature:
Air Leakage Report j
Property Organization Inspection Status
70 Sherman Ave Unit A Power House Energy Con: 2023-08-03 POWER HOUSE
Northampton, MA 01035 Adin Maynard Rater ID (RTIN): 9463452 E.YE�4Y COKAIL7IMG
RESNET Registered
PHEC-2556 70 Sherman Ave Unit A Builder (Confirmed)
confirmed Jim Morrissey
General Information
Conditioned Floor Area [ft2] 938.8
Infiltration Volume [ft'] 8,449
Number of Bedrooms 2
Air Leakage
Measured Infiltration 198.3 CFM50 (1.41 ACH50)
ACH50 (Calculated) 1.41
ELA[sq. in.] (Calculated) 10.88
ELA per 100 s.f. Shell Area (Calculated) 0.346
CFM50 (Calculated) 198
CFM50/s.f. Shell Area (Calculated) 0.063
HERS Rated Home Adjusted Infiltration 0.90 ACH50
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] 1101 CFM
Hours per day 24.0
Fan Power 75 Watts
Recovery Efficiency% 62.0
Runs at least once every 3 hrs? true
Average Rate [CFM] 101.0 CFM
2010 ASHRAE 62.2 Req. Cont. Ventilation 31.9
2013 ASHRAE 62.2 Req. Cont. Ventilation 50.7
Ekotrope RATER-Version 4.1.1.3217
All results are based on data entered by Ekotrope users.Ekotrope disclaims all liability for the information shown on this report
„ r
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK •
I=ri ,alith
CITY Northamptonn 2 l�L
•
u _ MA DATE 9.29.2022 j PERMIT#Pz- 03'7/
JOBSITE ADDRESS 70 Sherman St (DUPLEX) 1st Floor OWNER'S NAME Mathena Morrisey #
POWNER ADDRESS ^ TEL 413-297-2305-Jim FAX J
TYPE ORC4CUPANCY TYPE COMMERCIAL I I EDUCATIONAL I I RESIDENTIAL 0
PRINT
CLEARLY NEW: v I RENOVATION:L_ REPLACEMENT:Li PLANS SUBMITTED: YES I I N01
v
FIXTURES-1FLOOR—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB —II I, II If
CROSS CONNECTION DEVICE i - _
DEDICATED SPECIAL WASTE SYSTEM JI r 1L 1 -- -1
DEDICATED GAS/OIUSAND SYSTEM 11
DEDICATED GREASE SYSTEM IT - ' 1- �i 7- ii
DEDICATED GRAY WATER SYSTEM I'
DEDICATED WATER RECYCLE SYSTEM j -- .-. ---if- —6
DISHWASHER —'i 1 r �,
DRINKING FOUNTAIN IT —7][ I ,
FOOD DISPOSER --II ii - r >r;._)
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK _-Hr-1 -11---__,,_
LAVATORY 2
ROOF DRAIN II
SHOWER STALL C i - 1 NAT �ON IN PE eC�
SERVICE/MOP SINK _ 2 T4Rd
TOILET 2 -lT k AE PRG FD11 NO
URINAL
WASHING MACHINE CONNECTION i 1 ;`- ]j..r, y1, I -��-L
--4
WATER HEATER ALL TYPES I 1 11 _-_1 1 1
WATER PIPING P _� I[-_I ,I I I
OTHER ” 1 1I I I;- -- I !- '—_ .I .(
_ IL I 1_ II I '`
[ 1 1
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES 7] NO I I
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY(+1 OTHER TYPE OF INDEMNITY ri BOND I i
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 rue 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 c•i'fiance wit all erti nt p v sion of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. I ,
PLUMBER'S NAME GARY STAHELSKI LICENSE# 9621 SIGNATURE
MPI +I JP Q CORPORATION 1# 2617C JPARTNERSHIP # LLCI 1#
COMPANY NAME EWS PLUMBING&HEATING, INC. ADDRESS 339 MAIN STREET
CITY MONSON STATE MA ZIP 01057 TEL 413-267-8983
FAX [413-267-4523 CELL EMAIL EWSPH@COMCAST.NET
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MASSACHUSETTS UNIFORM APPLICATION FOR A PERT TO PERFORM PLUMBING WORK
l el- = CITY Northampton MA DATE 9.29.2022 PERMIT# PP 2C,?_2 t.3 72.__
JOBSITE ADtRESS 70 Sherman St (DUPLEX)2nd Floor l OWNER'S NAME Mathena Morrisey
POWNER ADDRESS TEL 413-297-2305-Jim FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL EI
PRINT
CLEARLY NEW:i i I RENOVATION: REPLACEMENT:II PLANS SUBMITTED: YES LI NO
FIXTURES-1 FLOOR-, BSM 1 2 3 4 5 6 8 9 10 11 12 13
BATHTUB I (a-- --,, —
CROSS CONNECTION DEVICE I
r — I- —
DEDICATED SPECIL _� 'I_[ llf��
DEDICATED GAS/OIL/SANDTSYS SYSTEM SYSTEMIIIIIIIIII� I '111111 _111M 1.1111111111.111111111.1
DEDICATED GREASE SYSTEM 1
DEDICATED GRAY WATER SYSTEM i' 1L I I
DEDICATED WATER RECYCLE SYSTEM i I IIIIII no MIK , Ill '
DISHWASHER _1
DRINKING FOUNTAIN r-- r 1r_ _ - I_I I 1
FOOD DISPOSER y_ —III I i�
FLOOR/AREA DRAIN
INTERCEPTOR INTERIOR �� tr.(INTERIOR) I �l �s
KITCHEN SINK 1__�— �y I��
LAVATORY 2-1 I- I —I I_11�11,WWII
SHOWER STALL [ I to IF ' PR 'VEI _-_
�. 1 r- _ J
ROOF DRAIN ' i' A'PR � __ y'
SERVICE/MOP SINK 2 rlr. �-� i _
TOILET 'gm ....
URINAL 1 MS MI .•-lei - ____ I
WASHING MACHINE CONNECTION 1 M
WATER HEATER ALL TYPES M 1
WATER PIPING
OTHER alill i
INSURANCE COV' 'AGE:
I have a current liability insurance policy or its substantial equivalent which ' ts the requirements of MGL Ch. 142. YES i r,lo
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING T APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY H C i HER TYPE OF INDEMNITY , BOND j
OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurancverage iguired by Chapter 142 of the
Massachusetts General Laws,and that my signature on this permit application waives this require t. _
CHECK ONE ONLY: 016 411 AG Nliir
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 i pliance t all P rtinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
d
PLUMBER'S NAME GARY STAHELSKI LICENSE# 9621 SIGNATURE
MP JP CORPORATION I I# 2617C PARTNERSHIP _ #r LLC # 411
COMPANY NAME EWS PLUMBING&HEATING, INC. ADDRESS 339 MAIN STREET
CITY MONSON STATE MA ZIP 01057 TEL 413-267-8983
FAX 413-267-4523 CELL EMAIL EWSPH@COMCAST.NET 1
la--/Ssag 7)eiX/Dere6ee/vrt.i0
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Comnsonsvaalth o/Massachusetts Official Use Only
— =t Permit No. et zo 22— d o2 0'
_ _; cc�� c7 n
�1_ a 2apartment o f..tire Services
__�= ' Occupancy and Fee Checked '2.3i5�
_! BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
'Q All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL I FORMATION) Date: fs/ -/�(� 3
City or Town of: /1/�j1To the Inpector of Wires:
By this application the undersigned gives notice of hips 6r her intention to perform the electrical work described below.
Location(Street&Number) 70 S k e../1"c n A v
Owner or Tenant j eS Alor f S s e V Telephone No.11/3 a..cl 7 2.3 D c
Owner's Address p...3 (3 (c,Gk b icy 1-4-•..
Is this permit in conjunction with a building permit? Yes d No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No. (30 7 6 87 3 a7
Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters
New Service 41 00 Amps 1 ).P /2-y c Volts Overhead Er Undgrd n No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: (,�is /lf'tJ ?._'frc.eletf/y
Completion of the following table may be waived by the Inspector of Wires.
Total
No.of Recessed Luminaires 0 No.of Ceil:Susp.(Paddle)Fans No.of
3 KVA
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires I Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting
grnd. grnd. Battery Units
No.of Receptacle Outlets Li 6 No.of Oil Burners FIRE ALARMS No.of Zones
No.of Detection and
No.of Switches .3 `f No.of Gas Burners Initiating Devices T
No.of Ranges �- No.of Air Cond. Tans) No.of Alerting Devices
No.of Waste Disposers Heat Pump Nu ter Tons KW No.of Self-Contained
Totals: ` - Detection/Alerting Devices
No.of Dishwashers Space/AreaHeating KW Local❑ Municipal ❑
a- Connection Other
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Water h„; No.of No.of Data Wiring:
Heaters ? Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
,..1.—flA Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of lectrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE CO ERAGE: 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 cov age is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete
FIRM NAME: ( _ i..es7er C_CTO/eC LIC.NO.: 3)-6 g 9/2
Licensee: Sec Signature e� „LIC.NO.: 5oc.c.o
(If applicable,enter "exempt"in the license numbef line.) Bus.Tel.No.• N/3 32-0 //5 6
Address: Li 0)- S''r/t t.e_� si, /O1 a vi C-c_ 04. 4r 0/U 6 Alt.Tel.No.:
*Per M.G.L.c. 147,s.57-61,sCcurity 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)❑owner ❑owner's agent.
Owner/Agent PERMIT FEE: $ L(DO, '
Signature Telephone No.
rf
.3.144