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25C-124 (14)
BP-2024-0257 212 BRIDGE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 25C-124-001 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-2024-0257 PERMISSION IS HEREBY GRANTED TO: Project# 2024 WEATHERIZATION Contractor: License: Est. Cost: 6662.16 BRYAN HOBBS CS-083982 Const.Class: Exp.Date: 05/02/2024 Use Group: Owner: A SHULMAN NAOMI Lot Size (sq.ft.) Zoning: URB Applicant: A SHULMAN NAOMI Applicant Address Phone: Ipsurance: 212 BRIDGE ST NORTHAMPTON, MA 01060 ISSUED ON: 03/11/2024 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHERIZATION OF BASEMENT &ATTIC,BATH VENT FAN &TURBINE VENT 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: Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner I ! The Commonwealth of Massachusetts MUNICIPALITY Board of Building Regulations and Standards FOR y Massachusetts State Building Code, 780 CMR USE r ,,;e' AC- ilding Permit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling E _ This Section For Official Use Only Building Permit Number:i 1 20V4—02.5 7_ Date Applied: WE-Vit.) Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers C'ala )n�c ss- 25` --/26L-00/ 1.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 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 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private 0 Zone: Outside Flood Zone? _ Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 11 Owner'of Record: �w QyM. ��man til J U S Name(Print) City,State,ZI a�a ZY\.C151L c\ t-11?s- -ON3t No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) ❑ Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0)Specify: (4) n Brief Description of Proposed Work':C1ammwyj toot CYatS Zasem„4- S i\\c 2 2" P,b8m h rt.k1 us, ( rS i C r_S1. Y Z" cl.cLri $" cvx,1,1 1 ca.l\uk c c.. '10 \t1 AL,n rt 1 4J. SlN,a.4.1-ws. a(Less, Ue n1- bah (col, 1i),-6na. �x tl- SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ (47 ( a. KO 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) Total All" Fees:l $ 6.Total Project Cost: $( Check tvo' 22heck Amount:/Q6j.— Cash Amount: `D ��, 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) O b c 76 3r1 l�— License Number Expira ion ate e o CSL Holder V��IJS k3L_ '��C List CSL Type(see below) VNo.and Street i J Type Description a..02...c\sz. (1 kA 131 cx> U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 1413 10V.9da0 I Insulation Telephone Em I address D Demolition Registered Home Impr vement Contractor(HIC) t g(vOZ!S kplarJaC i ( JJ.- HIC Registration Number Expiration Date o ny Name oar HIC Registrant Name �,UAikae �/ 1 crrIcka. N nd Stre Email addre@sl � .ensi5�- )� vv yl3'�s��t 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. Print Owner's Name(Electronic 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 con fined in this application is true and accurate to the best of my knowledge and understanding. 3d� wner or Authorized Agent's Name(Electronic 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" mass save Savings through energy efficiency PERMIT AUTHORIZATION FORM 1, Naomi Shulman owner of the property located at: (Owner's Name) 212 Bridge 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 subcontractor, at no additional cost. Alaotui Skiltuaa Owner's Signature 12-21-2023 Date FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: 2-)Y\ACAIN Participating Contractor Date Document Ref:GIUVS-5VYUR-OOXVR-9N2MY Page 4 of 4 Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Regulations and Standards CS-083982 W Iitpires:06/02/2024 BRYAN G HBS PO BOX EL r GREENFIELd!',fAA 01302 :v; b0 ffj. y , � 1.1,v AP` • Commissioner t l°. `L /4/1. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston,Massachusetts 02118 Home Improvement Contractor Registration Type; LLC BRYAN HOBBS REMODELING,LLC. Re 96045 P.O,BOX 1535 Exxppiration:ration: 05l25/2025 GREENFIELD,MA 01302 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:LW Office of Consumer Affairs and Business Regulation }iegistratloti gj olration_ 1000 Washington Street -Suite 710 196045 08/2512025 Boston,MA 02118 BRYAN HOBBSREMOOELING,LLC. BRYAN HOBBS 576 LEYDEN RD GREENFIELD,MA 01301 Undersecretary Not valid without signature The Commonwealth of Massachusetts Department of Industrial Accidents r=9 Office of Investigations r1 tit Lafayette City Center 2 Avenue de Lafayette, Boston,MA 02111-1750 wwx.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Bryan Hobbs Remodeling, LLC Address:576 Leyden Rd PO BOX 1535 City/State/Zip:Greenfield, Ma 01302 Phone #:413-775-9006 Are you an employer? Check the appropriate box: Type of project(required): 1.❑■ I am a employer with 7 4. ❑ I am a general contractor and I 6. New construction employees (full and/or part-time).* have hired the sub-contractors 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 working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. 9. ❑ Building addition required.] 5. ❑ 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.❑ 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 Weatherization employees. [No workers' 13.❑■ Other 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:AIM Mutual Policy#or Self-ins. Lic. #:ECC60040011332023A Expiration Date:1 0/20/2024 Job Site Address:(DI a eindi sz. S\— City/State/Zip: 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 penalties of perjury that the information provided above is true and correct. Signature: _ V�Q•,, h�rob Date: ,5) S , D y Phone#: L113- -1-") 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): 1DBoard of Health 20 Building Department 31:1City/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone#: AC0 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDYYYY) `/ 07/25/2023 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 CONTACT Adina Edgett,CISR NAME: Alera Group,Inc. PnHO,Nr o,Exq: (413)586-0111 FAX No): (413)586-6481 Webber&Grinnell Division E-MAIL aedgett@webberandgrinnell.com ADDRESS: 8 North King Street INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A: Selective Ins Co of S Carolina 19259 INSURED INSURER B: Selective Ins Co of America 12572 Bryan Hobbs Remodeling,LLC INSURER C: AIM Mutual PO Box 1535 INSURER D: Evanston/XS Brokers INSURER E: Greenfield MA 01302-1535 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 08/24 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD VI/VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGETORENIED 500,000 PREMISES(Ea occurrence) $ MED EXP(My one person) $ 15,000 A S2289042 08/04/2023 08/04/2024 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 1-1PROT ( POLICY ES I LOC PRODUCTS-COMP/OP AGG $ 2'°0�'Ol)0 $ JEC OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 - (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED ..,,/ SCHEDULED A9105300 08/04/2023 08/04/2024 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X Fs! NON-OD PROPERTY DAMAGE $ AUTOS ONLY AUTOS WNE ONLY (Per accident) Underinsured motorist BI $ 20,000 X UMBRELLA LIAB - OCCUR EACH OCCURRENCE $ 2,000,I)00 EXCESS LIAB CLAIMS-MADE S2289042 08/04/2023 08/04/2024 AGGREGATE $ 2'000'000 DED RETENTION $ $ WORKERS COMPENSATION X STATUTE EORH AND EMPLOYERS'LIABILITY C ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 1000000 OFFICER/MEMBER EXCLUDED? 1-7 ' • N I A ECC60040011332023A 10/20/2023 10/20/2024 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Pollution Per Occurance $250,000 D CPLMOL121333 01/19/2024 01/19/2025 Aggregate $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE l 11,L -D V--.4 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD City of Northampton _ (7-r— Massachusetts ? _ (.r w; w ;3 DEPARTMENT OF BUILDING INSPECTIONS y° '1I : i ��_ +`� 212 Main Street • Municipal Building J- :�a� Northampton, MA 01060 ssd '''''O CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: The debris will be transported by: Name of Hauler: US( (j29z,\52__ Signature of Applicant: �Q„„ 1/4z, Date: SI S H — mass save 2022-23 Weatherization Barrier Incentives eintatei on your Emorgy Spaci*.mt.t.r•.;c:tor••tonci4V•orts.your Noma Can Der.trt front orogrern-iicirtpLe Insulation and/ex rah-sealing nPrOVernemS difOre moving fr... •:: lasso follow V"thu u.1uri below:0 remedied•your wfratherIZatiOn berrierS CUSTOMER INSTRUCTIONS Li Alt a Ncorrted con evaluate g' or rernidiate rho weuthnritation lbarrior(t) NI.1071-1 signed and comp:sew.r nples of th7es forrri arra a copy of the paid contractor invoice(s)*man Go dere of your Mons:Munro 4,44:synnnt to:RISIE,MAUI/G.2 Lane.Hyannis.MA 112.9t eniaf t0110003inelPildraseineeHrla-corn 3.Comp-e....-,1et'VCOrilfril.P.e.44,Yo.Pothibri,aT.r.r..-4•••rwr 4-Mu watz.1•4:tuib.cti att;artira oe issuipa as a%WU:.f.4bek or 00a0111410o and ilia:ming of ii woulhe•i=diOr cuirromor?INF -4., • • Naomi Shulman 458915 „..,, 212 Br:dge Street Northampton s NA zp• 01060 43-230-0438 jor.athanfine@gmail.com cmtow monet.u.re 1/29/24 Data - - - • " 1111.1111111 cotrer•*to:r".nvrt:74 arty Active at,.,..,ay IL,'JAI*wit;r-G, COntr-71.c.tty. ev7 ritt !o.asc set* vo.11:.-urikstion retecrirraandations!lave L.•ieen rranu• Atto 1-10nr : Y•ht, ::•.:-r!or If ri•••,-..prrarrr Otntr :I -naein'cri ar<i Inant. r,*=Oyu;auk,.11.,,j tut* •7fa,,-ts.%K.:lc-rod beim., ti:Lc Ruvr 4:411 Attoz 0* i-starlor',Val 1 Pastz-to- _ :74'..:1-1Tractot Name: Don wv:41.4 401„:,15.52 CamaGe St. East arnplon MA Z/F:rrr 01027 " = A22453 Nr-or '••••••••T • A • Coottar.t.cr - Date: 94F r.4-narr: .1pectc,n "ro4•• ;!.. :...fi:e3no nave corr...-21X13ny barer:nA iraikaqtat. thr h:pia mu'and rtlrr•:: c zat & ' -i c zr tl,r cf Vila form -17 •**''' ". • - 4igh Carbon fieboxId*: rorctian;cat syrerr::5)r rrduco ttio carbor Irionoxidit;eve lt.le Da: tr.,‘:-E.tow -• araft Faure:Contr.:K-1w tr.to=mot. tz'art althf.• 'Z'Art7. Ter du.:L-ZtaLMOCm":'andef . Dean failure • _ -set 7•1.•".rorn MA: -iceited Draft Ps Hoot.og_System Hot Water rier.ter Other •'-C11:1:'411r La correct tilt L4*..5131' tIL•FIS.r.AT. n'te"Ea)r..•:00.•:c".:of vat-labor. 44••••wesnt SYstato Wa•Ar Heote. :1•110.- Narrie, Addrer Otertatiny Nwne Ixense 4:renhor .orfrrz-ztet Sionstura: Dater_ •• - . -•,.: : ",1"?1, tett btu*C44:"*CIted any Ontraller%Att ' • ,••• *.., • " ••••• .• •cm outlined or:ere Darr o7 this Fryer t 4010ik mass save. 2022-23 weatherization Barrier Incentives Oared sn y 'Cry Spoei&i t'a reedmrwrxtrrtirantr,vuur hunt caw bupreflt fore prour»tii-gip:bit imittioutm.w44,r air tsaspina lrroruvt nnnt r..k fora-owing frewa d.niamr fniirw art rho in,tnutiraa hak:w to:srrncdinra your wenthar.rnticn h;trr;em. CUSTOMER INSTRUCTIONS 1.Hire a qualified. sensed con-,-acts-X eve:uste v'"1/c'rerned.ate the weathenzat►an ner(s). 2.5ta.vrnit:.igratd and exxnpktioe corXes or L*ha:form are a copy of iha prod eon;rector inv iox(s)within G0 days or your Homo Cmorov Areatr anent to:AME.761S&ducats Locro,lijannht.MA412tpt er rx-:ail to iNissaave441:1SSEarigirteering.`om.. s•Cr mr.'er.e the rer_omrnar<eV we etherization-mprovementi 4.P't vosrYherize!kxr ii wives A. tie issued as a reb**check won.co'110lecion obi 41vo1Ci. of Ire'n+aait•elza Th.r CLtSro*1 R INFC]RMAitoN ::uttunxer Nom. Naomi Shulman ur Ss.i:a'IZ: 458916 sit,„„„,..,„ 212 3rid c€ S:ree Northampton MA _ 01060 _rate y"txtrr f':•.rr:tur. 41 3-230-0438 - i!.jonethanfineggma11.com Customer/siameowra:5lgteeuire; IV 1/29/24 To etwrnind if there;s any active knob c•t Luca wiring,the sxwr:r.4=;or wt` t^e tOffowing area:where eIIgitie Maas Save' went.hort:nts.'?n ra orn'iene..nro: urt nee,""Itrier Y Ete,ife Wail 1 B:15eMert •C rer f:`har. •..• &V!lu- • - ' -Ave performed my to oectinn ar.ricanarrr nay•PM'i-nn nc:•iv.Z•k-- b ann r..bc wiring'n the arctre::smicc-ted'ovrwv. r Attic-;a? AtticW'a.:' %,IL::5lc a Tr.xtirIei'Wig+ :ialernent :)rose- other. CrritrAcrn.'ga va `4Uitit4l Aacr::sc 52 COttiVe St. .. _;14..E 5:haraiptGtt 5t :f" zIP 01027 l:7r�.,rrn;rd s*r c Whitely E:e'cr-C A22 Can Sigral:am: , -, �_ a _ Dttitee //;��/ zY toyas�salurc•!clrsr :. ,:_:'is .:. .: '..:nap.. ":r • w•_..: .. .•_,diectrkai systems listed above and corrected 8►:j barriM`r as indicated fly sipflr..ro ar.o c J'•. :have.reaet en •ai ee:t:=rile 1errrn and Condition fi srad c:n the bock of treat form. High Caipplt Monortele:Corrtrector is service and re-e5►aluate tribe selected mechanical systerncs):rid reduce-he carting.moneyed**veil, to rosewood r.tope v.rldiiuttoJ flue gat.to tr&luw 100 pans pierrF u' ',PM) 7raft eatitsr a: ..unt:acur is to ce.rrat::1,..a e-af::•'t!ne smbCf4e f3_ ;.Re!*.to Note•3"><t'Verr.4 for atCe nabSo dr eft_rer . High C?rbon Monoxide braft Fettlum rAtir,g tO,t. ' anvl+ti ti'G porn Fs;srttre isr rrt i�r. -rrwaert Wan.E sc tleaung System • Wattsr Hooter other Soilage:1_u:re49t: r.to'_et-n:.'. :"t'.ttilit>naCer+ff;ieQati.;r:the St`:ectedIntre^aniCa-SyS.sm,S),I . irin_5I7 after 5CIaconC7 COI Op Prater '1 leetirio Sylearin i kit V .ter Heater Other C:entractnr Nome Adtbcxs City. Stara. ZIP' Cerret.ny Noma: _._ Liccvrsc Mummer Contractor etfgnetarge Date: My tign-tturw confiner th. 1 howl performed my enpat:txx+of::^.a rrccnmtico.aysiarree?attend aUCve anti?gave corrected any barriers as indicated.My SiDni.W4 at'SCY s^rtnt)ms tray:!ham roars and name xa.o 'arms and Conditions out trod en:he bock of this form.