24C-078 (7) CfM,k ig7if`y -((/J
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY Northampton MA DATE 11/17/17 PERMIT# OY-� CY'OC/Ir�
JOBSITE ADDRESS 12 Massasoit St OWNER'S NAME.Construct(welk2r)_..
POWNERADDRESS 36Seruice Center Rd Norhampton,MA01060 TEL 413-5841224 FAX
TYPE OR OCCUPANCYTYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
PRINT
CLEARLY NEW: RENOVATION: + REPLACEMENT: PLANSSUBMITTED: YES NO
FIXTURES 1 FLOOR— BSM 1 2 3 4 5 6 7 8 9 i 10 11 12 13 14
BATHTUB 1 -
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GASt011JSAND SYSTEM
DEDICATED GREASE SYSTEM - —
DEDICATED GRAY WATER SYSTEM
DEDiCATED'WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR I AREA DRAIN
INTERCEPTOR INTERIOR
KITCHEN SINK
LAVATORY
ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK
TOILET
URINAL -
WASHINGMACHINECONNECTION
WATER HEATER ALL TYPES
WATER PIPING
OTHER
INSURANCE COVERAGE:
I have a current liahility nsurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY + OTHER TYPE OF INDEMNITY BOND
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
CHECKONEONLY: OWNER AGENT �. .
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding Uis application am true and seartate to the best or my knowledge
and that all plumbing vvik and installations Performed under the permit issued for this application will be in one"I liance wi1ty4l Pertmenl pivvision of the
Massachusetts State Plumbing Cade and Chapter 142 of the General Laws. ( L/�,
PLUMBER'S NAME GARY STAHELSKI LICENSE# 9621 b J SIGNATURE
61P + JP CORPORATION + # 2617C :PARTNERSHIP # LLC #
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
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE I'.SE ONLY FINAL INSPECTION NOTES
Yw Na
THIS APPLICATION SERVESAS THE PERMIT ❑ ❑
FEE: $ PERMIT#_
PLAN REVIEW NOTES
I
nr+�al[svrt3f`-Y �'••. ->T < nr-1018-05u5 -GIS#: COMMONWEALTH OF MASSACHUSETTS
Mam:Block:24C-078 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category: Bath reno BUILDING PERMIT
Pennell BP-2018-0505
Proiect# JS-2018-000904
Est.CmL$2348000
Fee:$152.00 PERMISSION IS HEREBY GRANTED TO:
Const Class: Contractor. License.,
Use Groom ROBERT WALKER 034783
Lot Sizefso. IL): 15942 96 Owner. FALLON JONATHAN M&LAURA A
Zoning:URB(100)/ Applicant: ROBERT WALKER
AT: 12 MASSASOIT ST
ApplicanlAddress: Phone: Insurance:
36 Service Center (413)584-1224 Workers Compensation
NORTHAMPTONMA01060 ISSUED ON:11/14/20170:00:00
TO PERFORM THE FOLLOWING WORK.-REMODEL 2 SECOND FLOOR BATHROOMS
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:
Drwcew ,Final:
Final: f/Z Z�p Final:
Rough Frame:
Gas: Fire Demartment Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final: OdL(9 //Z3(�G
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occuoanc,2 . 1--;CX 7-- signature:
FeeTvoe: Date Paid: Amount:
Building 11/1420170:00:00 $152.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner