30A-012 (2) BP-2023-1634
333 FLORENCE RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
30A-012-001 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-2023-1634 PERMISSION IS HEREBY GRANTED TO:
Project# INSULATION 2023 Contractor: License:
Est. Cost: 8000 HOMEWORKS ENERGY INC 106148
Const.Class: Exp.Date: 07/30/2024
Use Group: Owner: MCGUIRE ARDITH A
Lot Size (sq.ft.)
Zoning: WSP Applicant: HOMEWORKS ENERGY INC
Applicant Address Phone: Insurance:
235 ESSEX ST 781-205-4484 1847910
WHITMAN, MA 02382
ISSUED ON: 11/20/2023
TO PERFORM THE FOLLOWING WORK:
INSULATION/WEATH ERIZATI 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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
i � 19,YIT
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
'►`x 1C�3
FEE: $65.00 Ple se mit to WXPermitting@homeworksenergy.com
City of Northamptoni C/
,
DePFOR
Building Department NOV
212 Main Stre�t
gg " (90(93IN$UL4 TION
L Room 100%` D�No `Fc,
Northampton, MA 01060� g1,r, �r; s,
phone 413-587-1240 Fax 413-587-1�72 ;N MFbo/oNs ONLY
APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY
SECTION 1 -SITE INFORMATION INSULATION PERMIT
1.1 Property Address: This section to be completed by office
Map Lot Unit
333 c re n e F Zone Overlay District
Elm St. District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Ardith McGuire-Majkowski 333 Florence Road
Name(Print) Current Mailingg Address:
See Attached 401 868 5533
Telephone
Signature
2.2 Authorized Agent:
Adam Glenn 235 Essex Street, Whitman, MA 02382
Name(Print) Current Mailing Address:
781-205-4484
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 8000 (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
#CO c
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 +2+ 3+4+5) 8000 Check Number I 6 7 7/
This Section For Official Use Only
Building Permit Number:Zi9• Az I 3-i�3 y sssuu
ed:
Signature: )1" ZD ZOZ3
Building Commissioner/Inspector of Buildings Date
wxpermitting @ homeworksenergy.com
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 4-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder:Adam Glenn 106148
License Number
235 Essex Street, Whitman, MA 02382 07/30/2024
Addreas Expiration Date
781-205-4484
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable El
HomeWorks Energy 181138
Company Name Registration Number
235 Essex Street, Whitman, MA 02382 03/02/2025
Address Expiration Date
g-4/t/I, 1 Telephone 781-205-4484
SECTION 5-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 I r l No 0
Brief Description of Proposed Work
Residential weatherization/ Air sealing. No structural changes. SITE ID CAP-14627
Adam Glenn , as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Adam Glenn
Print Name
,, -)Oet—d 11/10/2023
Signature of Owner/Agent Date
l Ardith McGuire-Majkowski as Owner of the subject
property
hereby authorize HomeWorks Energy
to act on my behalf, in all matters relative to work authorized by this building permit application.
See Attached 11/10/2023
Signature of Owner Date
City of Northampton
-Massachusetts ^� = ;
�!it DEPARTMENT OF BUILDING INSPECTIONS
: 0„ 212 Main Street • Municipal Building
Northampton, MA 01060 �'s'i�. .1
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes. Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L. Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition, or construction of an addition to any pm-existing owner-occupied building containing
at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered.
Type of Work:Weatherization Est. Cost:8000
Address of Work:333 Florence Road
Date of Permit Application: 11/10/2023
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law(explain):
_Job under$1,000.00
Owner obtaining own permit(explain):
Building not owner-occupied
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
11/10/2023 Adam Glenn 181138
Date Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
City of Northampton
j Massachusetts
- ;f DEPARTMENT OF BUILDING INSPECTIONS 19)
212 Main Street •Municipal Building
Northampton, MA 01060 f jti. k.i‘1,
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building
permit all debris resulting from the construction activity governed by this Building Permit shall be disposed
of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
333 Florence Road
(Please print house number and street name)
Is to be disposed of at:
McNamara Waste Services LLC, 24 E Longmeadow Rd, Hampden,MA 01036
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
i
1/10/2023
Signature of Permit Applicant or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
H.M City of Northampton .
?o d ,s`S .r,,:
i'.. ` Massachusetts *"'
1 t '4' i w
a 4 DEPARTMENT OF BUILDING INSPECTIONS y 'r
212 Main Street •• Municipal Building J�f� •`��`D
�, Northampton, MA 01060 NY 3':'
MANDATORY FOR HOUSES BUILT BEFORE 1945
Property Address: 333 Florence Road
Contractor
Name HomeWorks Energy
Address: 235 Essex Street
City, State: Whitman, MA 02382
Phone: 781-205-4484
m Property Owner
Name: Ardith McGuire-Majkowski
Address: 333 Florence Road
City, State:
Adam Glenn (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 c. 3' }r. -`LA._
Date 11/10/2023
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Lafayette City Center
2Avenue de Lafayette, Boston,MA 02111-1750
www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): HomeWorks Energy
Address:235 Essex Street
City/State/Zip:Whitman,MA 02382 Phone#: 781-205-4484
Are you an employer?Check the appropriate box: Type of project(required):
LEI I am a employer with 500+ 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
workingfor me in anycapacity. employees and have workers'
P n $ 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.
required.] 5. [1 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' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' lip Other Weatherization
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: Federated Mutual Insurance Company
Policy#or Self-ins. Lic.#:#1847910 Expiration Date: 1/1/2024
Job Site Address: 333 Florence Road City/State/Zip:Northampton MA 01062
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
fine 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 under the pains and pe es of perjury that the information provided above is true and correct.
Signature: rJ kA
Date: 11/10/2023
Phone#: 781-205-4484
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(check one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing
Inspector 6. Other
Contact Person: Phone#:
ACCM Et DATE D/YYYYI
CERTIFICATE OF LIABILITY INSURANCE 12/30/2r.,of2022
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. THIS
CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR
PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If
SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this
certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
FEDERATED MUTUAL INSURANCE COMPANY NAME: CLIENT CONTACT CENTER
HOME OFFICE:P.O.BOX 328 (AJCNNo,Eat):888-333-4949 FAX
No):507-446-4664
OWATONNA,MN 55060 ADDRESS:CUENTCONTACTCENTER(caFEDINS.COM
INSURER(SI AFFORDING COVERAGE NAIC It
INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935
INSURED 419-899_0 INSURER B:
HOMEWORKS ENERGY,INC. INSURER C:
101 STATION LNDG
MEDFORD,MA 02155-5134 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:0 REVISION NUMBER:1
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS
AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS
LTRINSR WVD IMMIDD/YYYY) (MM/DDIYYYY)
X COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE $1,000,000
CLAIMS-MADE 7-I OCCUR DAMAGE TO RENTED $100,000
PREMISES(Ea°narranml
MED EXP(Anyone person) EXCLUDED
A N N 1847909 01/01/2023 01/01/2024 PERSONAL ADVINJURY $1,000,000
G EN'L AGOR TE LIMIT APPLIES PER: GENERAL AOOREOATE $2,000,000
POUCY 1 JECT LOC PRODUCTS-COMPIOP ADO $2,000,000
OTHER:
AUTOMOBILE LIABILITY CO lEsCBI E tlSINGLE LIMIT $1,000,000
X ANY AUTO BODILY INJURY(Poe person)
OWNED AUTOS ONLY SCHEDULED
A — _AUTOS N N 1847908 01/01/2023 01/01/2024eoDILY INJURY(Pa aedNnp
NON-OWNED PROPERTY DAMAGE
HIRED AUTOS ONLY
AUTOS ONLY
—
(Per accident
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $1,000,000
A EXCESS LIAB CLAIMS-MADE N N 1847911 01/01/2023 01/01/2024 AGGREGATE $1,000,000
DED I I RETENTION
WORKERS COMPENSATION X PER STATUTE OTH-
AND EMPLOYERS' ABILITY Y/N ER
LIABILITY
--
ANY PROPRIETORIPARTNER/EXECUTIVE E.L EACH ACCIDENT $500000
A OFFICERIMEMEIEREXCLUDED? NIA N 1847910 01/01/2023 01/01/2024
(Mentletory In NH) E.L DISEASE-EA EMPLOYEE S500,000
IT yes,describe under E.L DISEASE-POLICY LIMIT
DESCRIPTION OF OPERATIONS below $SOD,D00
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD tbt,Additional Remarks Schedule,may be attached 1t more space is required)
THIS COPY IS NOT TO BE REPRODUCED FOR ISSUANCE OF CERTIFICATES.
CERTIFICATE HOLDER CANCELLATION
01
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
A CERTIFICATE HAS BEEN FILED WITH EACH OF YOUR CERTIFICATE ACCORDANCE WITH THE POUCY PROVISIONS.
HOLDERS.
AUTHORIZED REPRESENTATIVE G
ikA
®1988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2018/03) The ACORD name and logo are registered marks of ACORD
Rest' k Construction Supervisor Specialty
ided
,... . .. CSSL-IC -'•nsutat on Contactor
ADAM GLEN)
19 CHANGE POUND RiD-
WAREHAM MA 02571
+ Failure to possess a current edition of the Massachusetts
State Build ng Code is cause for revocation of this icense.
For information about this license
Call(617) 727-3200 or visit w'wv. nass.gov'dpl
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: Corporation
HOME WORKS ENERGY, INC. Registration: 3
101 STATION LANDING STE 110 Expiration: 0 03//022/2/2
025
MEDFORD, MA 02155
Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the
HOME IMPROVEMENT CONTRACTOR expiration date. If found return to:
TYPE: Corporation Office of Consumer Affairs and Business Regulation
Registration Expiration 1000 Washington Street -Suite 710
181138 03/02/2025 Boston,MA 02118
HOME WORKS ENERGY, INC.
ADAM GLENN �� f (/
101 STATION LANDING STE 110 �Gtiz .!�. �wGG�i" --
MEDFORD,MA 02155
Undersecretary Not valid without signature
•
•
Massachusetts Low-Income Weatherization Assistance Program
Ciient Education i ef-zer;ai: Coni1:ii'natio'a
Agency Name: eOMMIAkl.l I`( Ate T10N PIONIGE(- VA LA .'(' : CAN
Auditor: I --
Client Name; L • Job Number:
Address: City/'iowii:
Phone No: J
• � 49 w;? a F i.rr1+takfi�.k' Of
^ JS 7 E
I have received the following Information as part of my participation In the Massachusetts Weatherization Assistance Program
and consent to proceed forth with weatherizatlon work at my dwelling.
❑Asbestos Education/General information regarding asbestos,asbestos dangers,and ways to avoid asbestos
exposure are provided In the EPA's"Protect Your family"information sheet. Education was provided to me
relating to the following specific to my dwelling: DAsbestos shingles/siding DAsbestos on pipes/heating
systems 0 Potential asbestos in vermiculite insulation
❑ Lead-Safe Education/A copy of the EPA pamphlet"The Lead-Safe Certified Guide to Renovate Right",
informing me of the potential risk of lead.hazard exposure from weatherization/renovation activities to be
performed at my dwelling unit.
❑ Mold&Moisture Education/A copy of the EPA pamphlet"A Brielf Guide Mold,Moisture and Your Home"
informing me of best practices in cleaning up residential mold problems as well as how to prevent mold growth.
❑ Pest Prevention Education/A copy of the EPA pamphlet:"Preventing Pests at Home"informing me of best
practices in pest prevention.
❑ Radon Education/The fol:owing were provided to me; 1)Copy of the EPA's"A Citizens Guide to Radcn"or the
EPA's"Basic Radon Facts",2)Massachusetts"Radon Fact Sheet"informing me of the natural presence of radon in
the ground and the hazards of exposure to radon,and 3)Massachusetts"WAP Radon Information Sheet".
❑ Ventilation&Indoor Air Quality Education/General information egarding the purpose and need for
mechanical ventilation as well as a copy of the EPA pamphlet:"Care for Your Air:A Guide to Indoor Air Quality".
-cy� a-�N,e.•,'•1,\' t- 1..i• —a i,'d,•{. r ti .Jf." 2 "r,:k;/;r'J.
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Leah+ f ; ?4 6.i Yn'',0.c'.ZFt'!1';ija-olio i? `d1�M a '.
0 Sign Here: Date:
❑ Refusal to Sign/I certify that I have made a goba faith erfort to deliver the information to the client of the
dwelling unit listed above on the date indicated,and that the client has refused to sign the Client Education
Confirmation of Receipt and Consent form. I certify that I have left copies of the information listed(checked)
above at the dwelling unit with the client. F
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0 Sign Here: Date: _�
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Final Invoice
Client Info: $7,938.60
Ardith Majkowski 333 Florence Road Northampton Grand Total:
CAP: ABCD
Contractor: HomeWorks Energy Invoice Number: CAP-14627
101 Station Landing,Suite 110 Medford MA,02145 Invoice Date: 11/8/2023
Measure Category Measure Description Qty Price per Unit Total Cost
ATTIC INSULATION R-49 unrestricted - settled cellulose or equivalent 920.00 2.83 2603.60
MISCELLANEOUS MEASURES Attic/basement blower door guided sealing with one-part foam 7.00 105.00 735.00
MISCELLANEOUS MEASURES Electrical -cover open junction boxes attic& Basement 1 .00 50.00 50.00
BASEMENT INSULATION Garage ceiling,overhang or cantilever cavity filled Cellulose or equivalent 40.00 3.66 146.40
ATTIC VENTILATION Accu vent or durable equivalent 60.00 9.78 586.80
ATTIC VENTILATION Rectangular soffit vent 2.00 47.00 94.00
ATTIC VENTILATION Roof vent 135 (1 sq ft NFV) large 2.00 161 .00 322.00
BASEMENT INSULATION Sill/mudsill seal & insulate to R-19 (TMAX) 80.00 3.96 316.80
DOORS 1 " THERMAX or equivalent on door 1 .00 91 .00 91 .00
DOORS Basement/outside door - w/ jambs 1 .00 760.00 760.00
DOORS Fixed Sweep triple flange 3.00 27.00 81 .00
DOORS Weatherstrip w/Q-Ion or equivalent 3.00 76.00 228.00
MISC INSULATION Domestic water pipe wrap 30.00 4.58 137.40
MISC INSULATION Duct insulation R8 (unconditioned space) 20.00 6.08 121 .60
MISCELLANEOUS MEASURES Blower door set-up with pre & post tests 1 .00 71 .00 71 .00
MISCELLANEOUS MEASURES CAZ Testing 1 .00 85.00 85.00
MISCELLANEOUS MEASURES Labor per hour 4.00 104.00 416.00
MISCELLANEOUS MEASURES Recessed Light enclosure 1 .00 50.00 50.00
MISCELLANEOUS MEASURES Seal ducts with mastic or butyl backed tape 6.00 105.00 630.00
MISCELLANEOUS MEASURES Vent kit/bath fan 1 .00 153.00 153.00
MISCELLANEOUS MEASURES weatherstrip(Q-Ion or equivalent)&R-code attic hatch side slide-1/2"plywood 1 .00 104.00 104.00
MISCELLANEOUS MEASURES Building Permit 1 .00 50.00 50.00
WALL INSULATION Test drill 4 sides 1 .00 106.00 106.00
Measure Category Measure Description Qty Price per Unit Total Cost
Authorized Signature: Date Total Owed to HWE I $7,938.60