32C-207 (7) BP-2023-1668
81 WILLIAMS ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
32C-207-001 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-2023-1668 PERMISSION IS HEREBY GRANTED TO:
Project# 2023 RENO Contractor: License:
Est. Cost: 2700 BRADSHAW ENTERPRISES LLC 108517
Const.Class: Exp.Date: 12/10/2024
Use Group: Owner: RUTH FRANCIS,
Lot Size (sq.ft.)
Zoning: URC Applicant: BRADSHAW ENTERPRISES LLC
Applicant Address Phone: Insurance:
246 CONNECTICUT AVE 413-310-8010 A0158300004
SPRINGFIELD, MA 01104
ISSUED ON: 02/02/2024
TO PERFORM THE FOLLOWING WORK:
INSULATION/WEATHERIZATION
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: ( 1915-
) .
i • r •
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
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-�_Vj The Commonwealth of Massachusetts 7A' ��'�
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oard of Building Regulations and Standards FOR 20 Massachusetts State Building Code,780 CMR MUSE LITY ` iLg
23
oFpr Revised Mar 201/
^lsoo' Hgti�rm.y,,/NSF .1di g Pe it Application To Construct,Repair,Renovate Or Demolish a
'~T nr FcrioNs One-or Two-Family Dwelling
4 n12
' --_..._ This Sectio For Official Use Only
Building Permit Number: , /60 Date Applied:
JUi rJ �s // //G, Z Z ZOzI
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
81 Williams Street,Northampton Ma NA
1.1a Is this an accepted street?yesYES no Parcel ID
1.3 Zoning Information: 1.4 Property Dimensions:
NA NA NA NA
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
NA NA NA NA NA NA
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Ruth Francis Northampton,Ma 01060
Name(Print) City,State,ZIP
81 Williams Street 413-464-5934
No.and Street Telephone Ismail Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied ® Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:_Insulation
Brief Description of Proposed Work2Adding insulation to the attic and air sealing wall plates
Work Order attached.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 2700 1. Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ Total All Fees:$
Suppression)
Check Not011 Check Amount: Cash Amount:
6.Total Project Cost: $ 2700 0 Paid in Full 0 Outstanding Balance Due:
Treasurer's Approval: Board of Health DPW Conservation Comm Approval:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CS 108517 12/10/2024
SEAN MATTHEW BAILEY BRADSHAW License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) U
246 CONNECTICUT AVENUE
No.and Street Type Description
SPRINGFIELD,MA 01104 U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofmg Covering
Signature WS Window and Siding
SF Solid Fuel Burning Appliances
413-301-8010 SEAN@BRADSHAWENTERPRISESLLC.COM I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 194456 02/07/2025
BRADSHAW ENTERPRISES,LLC HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name eouooP verified
246 CONNECTICUT AVENUE S''e f .0 11/20/231026AMEST mi.
GW%-8MAD-%VZL.2SUH
No.and Street Signature Email
SPRINGFIELD,MA 01104 413-301-8010
City/Town,State,ZIP Telephone
SECTION 6: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 ® No ❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Ruth Francis
Print Owner's Name Signature Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accura a to the hest of my knowlelve and understanding
C .0'l A dotloop11/20/23 2
ied
SEAN BRADSHAW k/ 10:6SJSA-001R-UACVBX4B
Print Owner's or Authorized Agent's Name Signature Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,fmished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
WEATHERIZATION CONTRACT EVERS_URCE
CUSTOMER PHONE DATE CLIENT# WORK ORDER
Ruth Francis (413)464-5934 09/01/2023 546881 10102
SERVICE STREET BILLING STREET PROPOSED BY:
81 Williams Street 81 Williams Street Heather Lieber
SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Program
Northampton, MA 01060 Northampton, MA 01060 EGMA-HES Page 1
DESCRIPTION QTY COST INCENTIVE TOTAL
INCENTIVE 75%
For eligible weatherization measures, Eversource is offering an
incentive of 75°/D for insulation measures and 100°/0 for the air sealing
measures, both with no limit. You are eligible to apply for the 0%Heat
Loan to finance your co-pay, applications must be submitted before
the weatherization work begins.
HOME AIR SEALING 4 $426.36 $426.36
Seal areas of your home against wasteful, excessive air leakage.
Materials to be used to seal your home can include caulks,foams
and other products. Primary areas for sealing include air leakage to
attics, basements, attached garages and other unheated areas
(windows are not generally addressed.)
WEATHERSTRIP DOOR 2 $72.64 $72.64
Provide labor and materials to install Q-Ion weatherstripping to
door(s)to restrict air leakage.
ATTIC DAMMING 10 $27.80 $20.85 $6.95
Provide labor and materials to install an approved damming material
in the attic
ATTIC FLAT- 10"OPEN R-37 CELLULOSE 430 $1,014.80 $761.10 $253.70
Provide labor and materials to install a 10"layer of R-37 Class I
Cellulose to open attic space.
HATCH-INSULATE RIGID BOARD 1 $53.96 $40.47 $13.49
Provide labor and materials to insulate the back of an attic hatch with
2"rigid insulation board at R-10.
BASEMENT CEILING-6" FIBERGLASS 360 $957.60 $ 0 $239.40
Provide labor and materials to install R-19 faced fiberglass batt rt,ais)
insulation to the basement ceiling. This will be installed with the
paper backing up against the floor above. The un-papered fiberglass
side will be facing the basement, and these exposed fiberglass fibers
will be the visible side when standing in the basement. Your initials
are your agreement and understanding of this measure
VENTILATION CHUTES 4 $18.72 $14.04 $4.68
Provide labor and materials to install ventilation chutes in the rafter
bays to maintain air flow from the soffit ventilation.
INSULATED BATH EXHAUST HOSE 4 INCH 1 $32.23 $24.17 $8.06
Provide labor and materials to install an insulated 4"exhaust hose to
existing bathroom fan(s).
WEATHERIZATION CONTRACT EVERSeURCE
CUSTOMER PHONE DATE CLIENT# WORK ORDER
Ruth Francis (413)464-5934 09/01/2023 546881 10102
SERVICE STREET BILLING STREET PROPOSED BY:
81 Williams Street 81 Williams Street Heather Lieber
SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Program
Northampton, MA 01060 Northampton, MA 01060 EGMA-HES Page 2
DESCRIPTION QTY COST INCENTIVE TOTAL
SOFFIT VENT 4 $159.88 $119.91 $39.97
Provide labor and materials to install rectangular aluminum soffit
vents to increase ventilation in attic areas. Specify color:White or Gray.
KNOB&TUBE WIRING-OK
Because the weatherization recommendations are in readily
accessible areas and your energy specialist verified they do not
contain knob and tube wiring, your weatherization can proceed without
an electrician's inspection.
Total: $2,763.99
Program Incentive: $2,197.74
Client Total: $566.25
I.DESCRIPTION OF WORK TO BE PERFORMED
Contractor will perform or cause to be performed the above work at the Client's Address in a professional manner and in accordance with the terms of this Contract:
II.PAYMENT
Client agrees to pay the Contractor for the Work,the C . are of the Contract Cost is• e to the Indepe -nt Installation Contr-, or(IIC)upon satisfactorycompletion
of the Wo• understands thatth- will not•' ,. ed to pay the Program Incenti are of Contr- co- ha ., . •individ line' and/. previous
incen rease or dec -t - . • • ..rfn Incent. hare. ( / /
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•Date of Acceptance
mass save
Savings through energy efficiency
PERMIT AUTHORIZATION FORM
I, Ruth Francis owner of the property located at:
(Owner's Name)
81 Williams Street Northampton
(Property Street Address) (City)
hereby authorize the Mass Save® Home Energy Services Program assigned Participating
Contractor to act on my behalf and obtain a building permit to perform insulation and/or
weatherization work on my property.
This form is only valid with a signed contract. The permit will be secured by the
sub tractor, at no additional cost.
(4*
Owne g ature
FOR OFFICE USE ONLY
We have assigned the following Mass Save Home Energy Services Participating Contractor
to the above referenced project:
Participating Contractor Date
The()Metal Webstte of the Execufvve Office of EOHED the Divsion of Profession E ws on of Standar&
IOW
Public Safety ! _
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Mass vF t:3t: ! Mass.
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Licensee Details
Demographic Information
Full Name: SEAN Matthew Bailey BRADSHAW
weer Name:
License Address Information
City: South Hadley
State: MA
Zipcode: 01075
Country: United States
License Information
License No_ CS-108517 License Type: Construction Supervisor
Profession: Building Licenses Date of Last Renewal: 1/612023
Issue Date: 4/28/2015 Expwation Date: 12/10/2024
License Status: Active Today's Date: 1/9/2023
Secondary License Type:
Doing Business As Bradshaw Enterprises, LLC
Status Change Reason License Renewal
Prerequisite Information
No Prerequisite Information
No Available Documents
Close Window
OD 2011 Commonwealth of Massachusetts Site Policies I Contact Us
I
S
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: LLC
Registration: 194456
BRADSHAW ENTERPRISES, LLC Expiration: 02/07411111
246 CONNECTICUT AVE
SPRINGFIELD, MA 01104
Update Address and Return Card.
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE: LLC before the expiration date. If found return to:
Registration Expiration Office of Consumer Affairs and Business Regulation
194456 02/07/2023 1000 Washington Street -Suite 710
BRADSHAW ENTERPRISES, LLC Boston,MA 02118
SEAN M. BRADSHAW
34 FRONT STREET 4•i ,c/ 0,4
SPRINGFIELD,MA 01151 Not valid without signature
Undersecretary
dotloop signature verification:dtip.us/RpfP.6GzK.CaSc
•
DEBRIS DISPOSAL AFFIDAVIT
In accordance with the provisions of MGL c.40,s.54,is that the debris resulting from this work
shall be disposed of in a properly licensed solid waste disposal fa 0lity as defined by MGL c.111,
s.150A.
ANY AND ALL DEBRIS PROUCED AS A RESULT OF WORK PERMITTED UNDER THE
ATTACHED APPLICATION WILL BE DISPOSED OF IN:
USA Waste Recycling
Name of Licensed Solid Waste Disposal Business/Facility
15 Mullen Rd, Enfield CT 06082
Address of Licensed Solid Waste Disposal Business/Facility
USA Waste Recycling
Name of Hauler
Sean Bradshaw 9/20/2020
Print Applicant Name Date
❑ I,Sean Bradshaw do hereby cerdfy carder the pains and penalties of perjury that the
Information provided above is true and correct,and that clicking this checkbox and typing my
name in the,field above will act as my*nature.
-�� BRADENT-01 BROOKE
Acc)RIJ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
`....---- 8/15/2023
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 POLICIES
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 'C NMTEACT Brooke Barre
Phillips Insurance Agency,Inc- riRONE FAx
97 Center Street lac,No,Ext) (413)594 5884 (A/C,No):(413)592-8499
Chicopee,MA 01013 D"a'Ess,brooke@phillipsinsurance.com
INSURERISIAFFORDING COVERAGE NAIC#
.INSURER A:Middlesex Insurance Company 23434
INSURED INSURER B:Sentry Insurance '24988
Bradshaw Enterprises,LLC INSURER C
PO Box 944 INSURER 0:
Chicopee,MA 01021 _._.._
INSURER E c-_._._ .... .,_. ..._....
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
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 -.._ IADDL SUBR3--- POLICY EFF POLICY EXP - .............. __..
TYPE OF INSURANCE POLICY NUMBER LIMITS
LTR BUM�WVO� MlDDIYYYY) fMM/ODIYYYYI
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE X OCCUR X A0158300 ' 8/12/2023 8/12/2024 DAMAGE TO RENTED 500,000
i PREN))$E$(Ea occurrence) $
MEDEXP(Anyone person) , $ 10,000
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 3,000,000
pp
POLICY X PECT LOC PRODUCTS-COMP/OP AGG_$ 2,000,000
OTHER $
A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
(Ea accident) $
X ANY AUTO X A0158300003 8/12/2023 8/12/2024 BODILY INJURY(Per person) $
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
HIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY (Per accident) $
S
A X UMBRELLA LIAB X:OCCUR EACH OCCURRENCE $ 2,000,000
EXCESS LIAB CLAIMS-MADE A0158300 8/12/2023 1 8/12/2024 AGGREGATE S 2,000,000
DED X RETENTION$ 0 $
B WORKERS COMPENSATION X PERTUTE ER
AND EMPLOYERS'LIABILITY Y/N A0158300004 8/12/2023 : 8/12/2024 1,000,000
OANFFICY ER/MEMTBEERR EXCLUDED AECUTIVE Y N/A RTNER/EXE-L.EACH ACCIDENT $
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000
If yes,describe under 1,000,000
DESCRIPTION OF OPERATIONS below ' E.L.DISEASE-POLICY LIMIT $
I
' DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Springfield Partners for Community Action,Inc: National Grid USA it's direct and indirect parent and subsidiaries and affilliates;G.L.C.A.C,Inc.;and
Eversource Gas of MA shall be named as Additional Insureds on the Commercial General Liability and Automobile Liability policies where required by written
contract.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Springfield Partners for Community Action THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
g ty ACCORDANCE WITH THE POLICY PROVISIONS.
721 State Street
Springfield,MA 01109
AUTHORIZEDRI' REPRESENTATIVEy
j
ACORD 25(2016/03) cU 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
dotloop signature verification:dtlp.uslltpFP-6GzK-Cd8t
�.' The Commonwealth of Massachusetts
• Department of Industrktl AaJdents
1 Congress Street,Suite 100
Boston,MA 021 1 4-201 7
www.mass.gov/dia
Workers'Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Aaalicant Information
Name IBusiness/orgam;ationai/indivrdeal>_Bradshaw Enterprises, LLC
Address: 34 Front St Indian Orchard Mills Suite G60 City: Springfield
state:MA P: 01051 Phone#: 413-250-4746
�Are yoti an employer?Check the appropriate box: Type of project(required):
J11. I am an employer with 1 1 employees(full and/or part time)' I 7. New cortstructlon
�))2. I ant a sole proprietor or partnership and have no employees working for me in any II 18. Remodeling
capacity.{No workers'comp.insurance required.) t—�
I 19. Demolition
3. I am a homeowner doing all work myself.(No workers'comp.insurance requlredjt r0 Building addition
n4. I am a homeowner and will be hiring contractors to conduct all work on my property. ri1. Electrical repairs or additions
I will ensure that all contractors either have workers'compensation insurance or are
sole proprietors with no employees. r112. Plumbing repairs or additions
15. 1 am a general contractor and i have hired the sub-contractors listed on the attached 13. Roof Repairs
sheet. These sub-contractors have employees and have workers'comp.Insurance.± ��
6. We are a corporation and Its officers have exercised their right of exemption per MGL. I J f14. Other
c.152,41{4),and we have no employees.[No workers'comp.insurance required.) t w__
'Any applicant that checks box el must also fill out the section below showing their workers'compensation policy information.
rHomeowners who submit this affidavit indicating they ate doing aft work and then hire outside contractors must submit a new affidavit indicating soth.
aContractors that check this box must attach 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.polity number.
l am on employer that Is prov/dhip workers'c MpensatIon insurance for my employees. Below is the policy and job site information.
Insurance Company Name: Sentry Insurance (Agent- Phillips Insurance 413-594-5984)
Policy Si or Self-Ins.Lk.#: A0158300004 Expiration Date: 8/12/2024
Job Site Address:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL.c.152,§25A is a criminal violation punishable by 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. A copy of this
statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification.
[fir , ,do hereby certify under the pains and penalties of perjury that the information provided above Is true and correct,and that clicking this
checkbax and typing my name hi the field below will act os my signature.
Name: Sean Bradshaw Date: 9/29/20
Phone*. 413-250-4746 Emath seenabradshawenterpriseslc.com
... Commonwealth of Massachusetts
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1 Division of Occupational Licensure
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Board of Building Re ulations and Standards
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,' , a 212 Main Street • Municipal Building s ��`
Northampton, MA 01060 s1`,471 1^
Property Address: 61 41; //iMS
37Lre el
Contractor Name: &ads/a
AJ 116
Address: / N / 4601 O y i a 1 Or✓e ,S7E /67
City, State: ()1 /Lo10 ee, /11 P Di 020
Phone: 141.3 36/ Foie)
Property Owner , /
Name: /� ti AI N /5--aJ'2G AS
Address: ?/ 41,14 a Alf 574 e-7
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City, State: /VO`"Ma ii/ 04 7114
I, ..Jenel BlztQ'S��k./ (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
Date / - " /