9 KOSCIUSKO ST - BUILDING INSPECTION (2) The Comnwnealih of Massachusetts
Board of Buildingw Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR SALEM
Revi.ved.tlar 201/
Building Permit Application To Construct, Repair, Renovate Or D h a
/ One-or Tivo-FunrUv Dwelling
This Tection For/CIITicial Use Only
\\JIB Building Permit Number: Date Applied:
*`T (0 50m
1 Building 011icial(Print Name) _ Signature Date
SECTION 1:SITE INFORMATION
1.1 Pro rty Address; 1.2 Assessors Nlap& Parce Numbers
l��SOu,P,�o
I.I a Is this an accepted street?yes--1G no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use - Lot Area(sq 11) Frontage(11)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.1.c. 40.§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Oavne�(p0Record: t6 V(r 3o, `�(
Name(Print) (� / Cil �.State,ZIP
Gl 4rf�000U-Mi S� L �
No.and Street 'telephone Email Acidness -
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner•Occupied ❑ 1 Repairs(s) ❑ Alteration(s)�B Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work': 101 .
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials)
I. Building S ,S Sr S I. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
'_. Electrical S
❑Total Project Cost(Item 6)x multiplier x
7. Plumbing S 2. Other Fees: S
4. \lechanical (11\'AC) S List:
5. ,\lechanical (Fire $Suppression) Total All Fees: S.
Check No. C ck Amount: Cal nuunt
6. Total Project Cost: S �_ r�'� St [� ❑ Paid in.Full 0 Outstanding Balance Due: - ---
SECTION 5: CONSTRUCTION SERVICES p 5.1 nstruction Supervisor License(C'SL)
I.icense Number lisp ratio Date
Nance ol'CSL I[older
I.ist CSI, I)pe(see below)
No. and Street Type Description
1.1 Unrestricted Buildings u' to 35,000 cu. tl.)
R Restricted 1&2 FamilyDoellin
Ciq/IU��n, late.ZlP M Mason
ry
RC Roofing Covering
WS Window and Siding
r m SF Solid Fuel Burning Appliances
( V I Insulation
Telephone [.mail address D Demolition
5.2 Re istcred Home Improvement Contractor(HIC) /� /'�4S J
t (�,j^ /�t�/I' 77
a(/iC ,j(�Y�`"Y/' Pam✓ IIIC Registration Number
I? pirati n Dutc
IIIC'C'on��t) N;u»c or I�' ', rant NamefJ J �{ ,. . .ems,
Nu. and voti 0 /� m�[7�01 Email address
6 /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 .......... 0,— No........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, 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:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below,1 hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
?11)M q (t(n 6 2,
Print Owner's or Authorized Agent's Name(Elecronic Signature) Oate
NOTES:
I. 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. I42A.Other important information on the HIC Program can be found at
Information on the Construction Supervisor License can be found at dips
2. When substantial work is planned, provide the information below:
Total fluor area(sq. ft.) (including garage, finished basement'attics,decks or porch)
Gross living area(sq. It.) Habitable room count
Number of fireplaces—
Number of bedrooms --- ------_—
Number of bathrooms Number of halfbaths ----------_---
-------------------
1)Pe of heating system --------------—.— Number of decks, porches -------__—_----
1)pc of cooling system Enclose)
3 ,r[',,,,,l Project Square Footage-may be substituted for"Waal Project Cost"
CITY OF SALEM
�' 1r PUBLIC PROPRERTY
DEPARTMENT
J UI:: NI I Y:Inl,4.11 1
Ntt,w
I�:'.\{rAMr1A1a U,\IIyCL•1'a ),1t I.ve, M.\\1.14.111 4 11s
Ccl; Y7};1Y/i'IS a 1i t.x. 97104C•9.146
Yorkers' Compensation Insurance 11/7davit: Sul lders/Con tractors/Electriclans/Plumbers
Iti 1 rlicunt InGtnnation
R /� Plcrs tint Le 'hl
Villne IlJueiksvr7rgmintinrvinJlvu'uull:_ // ROT
�tldress: 2 �S D / �C!
Ciry,Srl[c•/.ipr
l�0 Phone iJ W// 7/Qzz 7a
Are)ou an vugtloycr:'Chvck a approprlate box:
111371 am a rmpluyvr with 4. 0 1 am a dunenl contractor and 1 I'yM of project(rvqulrsd):
enlpluycux(lull and/or port-tiurc).• have hired the sub•cunaacturs /t' ❑New construction
2.0 1 ,1411 a sole proprietor or partner- lisrcd on rho anaehed sheet f y ❑ Reanodeling
ship and Itave no wnpluycv's These subcontractors have S. 0 Demolition
working 'ix my in any capacity, workers'comp, insurance.
(No workers'eump. insurance 3. ❑ We aro a cmpontinn and its 9' ❑ Building addition
required.) of icers have e(enisLd their 10.0 Electrical repairs or additions
3.0 1 ant a holrh uwnvr doling all work right of exemption par hfOL 11.0 Plumbing repairs or additinne
myself.(No wnrkvrs'comp, c. 152,¢I(4),and wt Anve no 12.0 Roul'repuin
insurance required.) r c'"Pluy:cs. (No workers'
cmnp, insurance required.J 13.0 other
�,q.gipla'an IhW cEvcb Aue rl Mow:11W IiI'uW dw,6<IIYrI Wow r'xi 1
'I lumw,wrwn wile rubmil 011ie;off oovit,neiu6n Ilk e
' � At Work
Aa,him
cumlwnuutua lwlfny wlinmutire�
•C.mrnwlun Ihrl eAcck Ihie Doe n1uM altaAwl nn aJJlllury I..IIw1 Ariwine rho 113M erlhe rlla•:earaelax and their n,n"IteA��m,levit i Inflowile vpA,
rang.pJlcy InMlnanly,
/ain moo
in.sormw rufpleyrr that lr prvvidlnx wurArr�'rurnpenmlloa Inorarnnee/w nq anpluprrr. Br/Ory!s thepit/ley and/ub xit�
l mi �
Insurance Company Nmne; G �'
I'ulicy4lxSclf-ins. Lic.r+: CZ �2�2Z - _ - _--_E.
piration •J7L�_('1[��/
lob lily Addre.sx: / !7'�S'/'6.1.! A((}
City,SfateLlp:
Altach it copy ur'he workers'cumpcnxatloa Polley declaration page(showing rho policy number and expirsedua date).
I'alluru to secure cotcruye as required uod r.S'cclien_t3A ut'.NIOL c. 132 cau lead to rite imposition Or criminal penalties Ora
fin:I'll 10 11,300.01f)and/ur oue•yeor impris,mmcnt, as well us civil pcnallics in the f'unn,ol'a STOP WORK ORDER and a fine
of up nt S250.0A)it Jay .lgainat the violator. Itc advised that i copy urthin amtclnoa may be IurwardcJ to the 011ice uC
III\':,115-JIIn1's uI Ille DIA IOr Ilt,llrine: Gi1Kra.,v 1:1114 allnn.
/Ju hereby r:ni�y rem/vr the p,rinr,mJ pe�nG' a prr/rtry that the/e/brrlmNen provided above is true rind correeG
11/jlriel lee OJI/y, Oo not wriu in r..Lr urea, lit Ar runlyleltd by city Uptown a//4 iuL
( r1nlrire o n: _. Penninl.lerna e
hsuin Authority R • y (circle one):
II. III,,1rJ ,If Ifvalth 1. Iluddin; IJcparhncul 1. l:it)r'I'u,1u C'Icrk J. Llcefrical lutp:etur :, Pluwbinq In,ycelor
6. Olhvr
l'nuacl I'srwu:
_.-__ Phone Yt
Information and Instructions A
Lon in the service of another under any con't"' of hire,
\L1liaellaaetts tJenCrah LJ\vs ehuyler 132 1'egWres JII ,Illl)lo)ers to provide workers wmpensauun nix their employees.
ptrrsuaatl to tills aatuld, an employed
is defined as"...every pc
c sPrns or nnplled, oral Of written." or an two or snore
,\n ernploydr is ictined as"an individual,partnership,asaoeianon,corporation or other kbal enhry, Y
armenhlp,assoelation or other legal cndty,employing employees. However the
a the loregolllg engaged in a loin enterprise,and including the legal represrutarives of a deceased Ces.employer,or t t
ecetver or trualed of.tn individual, phe
cupant a' the
owner of a dwelling house having not fore than ens to ee maintenance.constructioneor repair work onsu h dwelling halloo
.Iwclling Iwusa of another who employ. pe
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.'
\IGL chapter 132. �33C(b) also states that "every slate or local llcensiag ageeey shall withhold the Issuaace or
renewal;&license
ens n or par,ot pf,lallit to operate&aced acceptable bevidence of usiness or campgaoce with the insurance cavil
Ildings In the Comings irequlredr
nypllt tin � slates'•Neiiher•the conunonwcalth not any of ill political sub the ionsihall
nsurance
\dditionally, %IGL chapter l s2, g_SCI�)
enter in any contract for the performance tit'public work until acceptable evidence ul'cunlyliance with
requirements of this chapter have been Presented 10 the contracting authority.
Applicants p to our situation and,if
hone numbers)along with their certi icate(s)of
Plc:lse nil{.cat the workers' , atftdavit completely,by checking the hoses that•a P Y Y
necessary.supply sub-contractors)nameW,addresses)and p with no employees usher than the
insurance Limited Liability Companies CaM(LL workan'tcomPOn"lioed Liability e insurance-rships(It an)LLC or LLP does have
members or partners, are not required to carry
employees,a policy is required. lie advised that this alndavit maybe submitted to the aMdavnent of Industrial
he rcltlnled to time city or town that the application for the permit or license f being rrequired, not the Dewar kegs' of
\ccidents for confirmation of insurance coverage' Also be sure to sign red data the u fsted. R rim apartvit shoal
Industrial Acoide cisLs. Should you have any questions regarding the law Or it'you ate required to obtain a workers'
ensation policy.please call the Depamillat at the
comp number listed below. Self-insured companies should enter their
Colt-insurance licelue number on the a ro riate lino'
City or'rown Omcials
the a licanL
pknsc he sure that the affidavit is complete :old printed legibly. The Department has provided u space at the stem
Of the affidavit for you to Intl out in the event the Otiiee of 1nVesllgatlOn3 has IO contact YOU regarding laP
I'I.Jsc be sure to till in the permidlicense numb,
,o in anwhich lll be g en eear�Headonlyreference
one f. In
rt 'davit iadditiondicating cuang current
Y y tit ur
Mat must submit multiple perniulieelse applithe cations resided ro the
Policy information(if rilict:the utildavi�hu has been officially stad tinder"Job Site mped or marked lbys tile city oretown nay bepin (' Y
town).",\ copy
applicant as proof that a valid affidavit is on rate to Yultue permits or licenses. t now afusinesf must be lidded out each
venture
year. Where a hulna owner or citizen is obtaining a license or permit not related to any business d eominercial venture
Jug license or permit to burn leaves etc.)said person is NOT required ro complete this uffldavit• umuons,
Itc ,>liice tit,Investigations would like l0 think you in advance fur your cooperation and should you have:tnY q
please du nut hesitate to give us a call.
the U.P�lr(lncltr'.j address, tolcphone and Cut number
The Commonwealth of Massachusetts
Deparunent of Industrial Accident
Office of[svadgadons
600 Washington Street
Boston, MA 02111
Tel. p 617-727-4900 ext 406 or 1-877-MASSAFE
Fax 0 617.727-7749
www.maw.gov/die
CITY OF SM..&M NLASSACHUSETTS
BCILDLNG DEPART%L&NT
110 WASHNGTON STREET, 3"FLOOR
TEL (978) 745-959S
FAX(978) 740.9844
Ki�®F.RLBY DRISCOLL
MAYOR THomu ST.PtEns
DIRECTOR OP PLBLIc PROPERTY/KaMLYG CONNISSIONER
Construction Debris Disposal Affldavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit At is issued with the condition that the 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 transported by:
WM
(name of hauler)
The debris will be disposed of in
/3 /
(name of facility)
ltr 4ei,- r�
(address of facility) �—
signature o permit applicant
�aI
I.bn vf Lw
06/05/2011 21:11 17815955820 AMBROSE INSURANCE PAGE 01/01
Heil CERTIFICATE OF LIABILITY INSURANCE 6iAI/io Gi"Y)
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(SI, AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the eartiReate holder Is an ADDITIONAL INSURED,the pollcy(Ies) must 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 endorsemeirl
RODUCER CONTACT
Ambrose Insurance Agency, Inc. NAl PHONEa .781-592-8200 N N,781-59S-5820
56 Central Ave- ADORES::
ti
Lynn, MA 01901
olm4R 0a
IMURER(al ArFOFOINe COVERAGE xAICA
xsURED American Building Technologies LLC INSURER A:Atlantic Casualty
INsuRERB:Arbella Protection
2 Neptune Rd. , #439 NsuRERc:Liberty Mutual
Boston, MA 02128 INSURERD;National Union of Pittsburgh
INSURER E;
INSURER F:
:OVERAGES 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.
an rroE OF INSURANCE IxaR wvo POLICY NUMBER MMN rIVYY EXP
MMNDIYYYYI LIMITS
GENERAL LIABILITY EACH OCCURRENCE S 1,000,000
R COMMERCIAL GENERAL LIABILITY PREMISES Ee aeurenee S 50,00()
CLAIMS-MADE Z OCCUR MED EXP(My Ono paraan) a 5,000
A L035-008370 16/17/10 10/17/11 PERSONAL B AM INJURY $ 1,000,000
GENERAL AGGREGATE s 2,000,000
GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPlOP AGO S 11000 ,000
POL10Y P O 77 LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
(toweloeng a 1,000,000
ANYAUTO BODILY INJURY(Par parson) a
_ ALL OWNED AUTOS 200ILY INJURY(Paraccldenu 4
g Ry SCHEDULED AUTOS 90593400003 3/9/11 3/9/12 PROPERTY DAMAGE
HIRED AUTOS (PAT ccdduntl S
NON-OWNED AUTOS S
s
UMBRELLA UAS OCCUR EACH OCCURRENCE B 1,000,000
D g EXCESS UAB CLAWS-MADE AGGREGATE S 1,OLIO,000
DEDUCTIBLE E3U901456042 30/17/10 10/17/11 $
RETENTION S S
WORKERS COMPENSATION WRBTATIT- S OTH-
AND EMPLOYERS LIABILITY 3/10/11 3/10/12
nxr PROPRIsrdlnPAaTNERrdECUTT2 YINNIA WC2313372122 E.L.EACH ACCIDENT S 1, 00,000
OFFICETLMEMIIF-a "CLU ID?
1 000 000
(M---N In NH) E.L.DISEASE•EAEMPLOYEE Il , f
Ifya¢,f wibauntlnr ' 1 DDO 000
DESCRIPTION OF OPERATIONS beb E.L.OISGSR.-POLICYLIMB P , ,
ESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Allah ACORD 101,Additional Remarks SrLedule,If moo.pnm IO rnq ll
arpentry 6 Insulation
ERTIFICATE HOLDER CANCELLATION
COnSs=ation Service$ Group SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
40 Washington St. , Ste. 300 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Westborough, MA 01581 ACCORDANCE WTH THE POLICY PROVISIONS,
i
AUTHOR12E0 REPRESENT
7 88-2009 ACORD CORPORATION. All rights reserved.
CORD25(2009109) The ACORD name and logo are registered marks of ACORD
\lasx:tt'husun - Department of Public safel
OtTice ofousumer A ays B siness egu a ou
HOW IMPROVEMENT CONTRACTOR
Registration: i Buartl of Building Rccul.uiun. unl S[:uul:u'
" ' Construction Supervisor License
69145 Type: !
Expiration 5l29l2013 iLC License: CS 96385
VAICAN OL BUILDING TE,-f—OLG-e—,"IES LLC.
J ROMAIN STRECKER
ROMAIN STRECKER 10 CHURCHILL PLACE
12
2 NEPTUNE RD LYNN, MA 01902 `'
BOSTON,MA 02t28 M�`� ,:` Uudet� _
Expiration: 10/8/2012
f ........imu r Tr#: 4344
American Building Technolo ie:
Weatherization
General Contractor
Project Management
Construction Consultants
Romain Strecker
Managing Partner
t r 2 Neptune Road Suite%a39 Boston,MA 0212
t Romain@American BuildingTechnologies.cor
ACTION, INC
47 Washington Street
Gloucester, MA 01930
Agency: NSCAP
PROGRAM: AARA WAP NGRID Application#:
JOB NUMBER: - 0 0
DOE Work Order# p
Work Order Date: performed? No
06/08/11
Primary Contractor: - American Building Technologies
Other Contractor: - NA - .
. #Bulbs installed - $0.00
Client: Celia Oliver: - Cost of Bulbs $0,00 .
Street: 9 Kosciusko Street, I st Floor Inspt$175.00 Max $0.00
City; State;Zip: Salem,MA Other In Kind so.00
Telephone: (978) 745-5989 01970 Electrical Work $0.00
$Amount KeySPan $0.00
Blower Door Test: $Amount National Grid $0.00 Other Utility $0,00
No .Inspect Knob&Tube: No � - -
Date Job Completed:
• Estimated Repair Total $937.00
Weatherization Est Actual Repair Total $0.00
Door Kit 3 Act Cost Est Cost ' Act Cost
Re [at Door Swe $43.00 2 $129.00 Automatic Door Swee $15.00 $30.00
1 -
Air Sealing 2- art Foam( er hour) q $22.00 $22.00 -
Attic Air Sealing2-pertF.. per hour) $75.00 $300.00 Wea[hershi Window( er side) $75.00
Seal Ducts-Mastic $5.00
W/S&Insulate Attic Hatch R30 $62.00 -
$30.00
$0.00
$0.00
$0.00
$0.00
$0.00
Weatherization Totals: $0.on
$48L00 $0.00
Insulation Est Act
Attic Flat R38 o en Cost Est Cost Act Cost
Attic Flat R30 o n $1.40
Attic Flat/Slo s R30 restricted $1.30
Attic Flat/Slo es R20 restricted $1.41
Attic Kneewal R13 FG $1.35
Attic Kneewall R 15 Cell w/Membrane $125
Attic Kneewall Floor R30 restricted $1.65
Insulate Attic Stairs&Walls $1.41
Sidewalls-Vin I R15 DP $130.00
735 $1.70 $1,249.50
Interior Wall-Piaster R 15 DP 195
1"Ri id Foam Board $1.81 $352.95
Duct Insulation R5&Seal Seams $1.85
Basement Overhead R-30 FG 300 $2.95
$1.73 $5I9.00
Steam Pi a Insul to 1.25"RS
DHW Pi a Insuation RS $5.25
Insulate Door 1 $2.50
Sill 2-part Foam w/FG Batt R 19 106 $44.00 $44.00
Insulation Totals: $2.00 $212.00
$2,377.45 $0.00
Celia Oliver Page 2
Other Measures DOE p
a Est Act Cost
Roof Vent•small Est Cost Act Cost
Gable Vent-recta, la, - $76.00
Recessed Can Cover $88.00
Cut/Finish Attic/Kneewall Access $30.00 -
Test Drill Sidewalls-4 sides $100.00
Blower Door Test $60.00
Vinyl Replacement Wiindow-lolui $45.00
Steel Pre-hun Door w/Lite $350.00
Solid Coor Door w/Hardware $610.00
Faucet Aerator $350.00
Low Flow Showerhead $15.00
$25.00
$0.00
$0.00
OtherTotals: $0.00
$0.00 . $0.00
EnerSY CV,LlbcrYallon - -
Totals:(Max$10,000.00) Est Cost Act Cost
$2,858.45 $0.00
Repairs Est
Re air/Refit Door Act Cost Est Cost Act Cost
Ad'ust Door Striker Plate
1 $50.00 $50.00
Door Threshold $20.00
Re air Door Hin - $40.00
Slide Bolt $25.00
Sash Lock 2 $20.00 $40.00
Glass Re lacement•to 64 ui 2 $9.25
Site-built Int.Bulkhead Door e,/Jambs 1 $42.00 $84.00
Buildin Permi[Fee 1 $415.00 $415.00
Frame out basement door $100.00 $100.00
Health&Safe
1 $150.00 $125.00
Vent Clothes D er to Exterior I
Vent Bath Exhaust Fan to Exterior $85.00 $85.00
Re lace D er Hose $85.00
Knob&Tube Ins action
$38.00 $38.00
Bathroom Exhaust Fan $175.00
$500.00
Repair Tot:(Max$2500.00
$937.00 $0.00
Work Order Sub Total _ _
$3 795 45 $0 00
Measures Es[
Act Cost Est Cost O
ther Act Cost
$0.00
"•HeatRe air $0.00
"•Action approval only $0.00
Job cannot exceed$10,000.00 Estimated Job Total: $3,795.45
Job minimum=$500.00
Job Grand Total: $0.00
AUDITOR: Doug Cranford