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16A-020 (23) 417 FAIRWAY VLG SP-2018-1307 GIS 4: COMMON '-'VEj',',1�"1-JTH OF MASSACHUSETTS h4 NGRT-qAMW"'T0N qp-.Block: 16A-020 L.A: -000 PERSC \S C3N'`,C-(-r, U NiZ-E'--ISTERED CONTRACTORS Penriii: QuiKM Do NOT HN,,�-: ACCEZ-8 .-1 " UARINTY FUND (MGLc."42A) PERMIT y Eats.mro N. %--T 2019-002^27 :Cf %'5-J :;st.Cys X15000.00 - L�, -P o '1-)5.00 F—Ekt'1SS1JJ"I ZRZ2 �:NTED TO: Const.Class: Con&&. tor: +3 HomeowneraO.-as Conur !.ol S:ze(sq. ft.): Owner: DELISO ELIZABETH Zoning:URA(102)/WP(17)/WSP(15)/ Applicant. DELISO ELIZABETH AT: 417 FAIRWAVVI-G Applicant Address: Phone: Insurance: 417 FAIRWAY VILLAGE (413) 454-4336 LEEDSMA01053 ISSUED ON.611112018 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMOVE SHOWER STALL AND JACUZZI AND INSTALL WALK IN SHOWER, VANITY AND TOILET POST THIS CARD SO IT IS VISIBLE FROM THE SiREET' Inspector of Plumbing Inspector of Wiring D.P.W. r Rui'ding Inspector Underground: Service- T'Aeter: Footings: Rough: L9//F Rough: Hou;e#L. r1. I"; Foundation: Driviv4 -,Fi at: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chiraney: Rough: Oil: Insulation: Final: Smoke: Final: 'Ac 9 � 61 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES PD REGULATIONS. C--� —4 fi�A &— 'e't' 4 -�7 1 Certificate of Or ;rev 1Signature: FeeType: Date Paid: Amount: Building 6/11/2018 0:00:00 $95.00 212 Main Street,Phone(413)587-!240,Fax: (413)587-1272 Louis Hast ouck—Building Comm sslo ier � ' { ..... 1.1� L!``:�� K��«! ) s nE .'n.•.br:�..Ar.A .11 w M9Yi.M a AEf � .' ili �_ ��►�:i'1. lts"`'.�fY�+�.�ll'Lc` f°a..: `f!4y'}Si, _ � i": r -�7 �� ("I d J(-) MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY; ? P� _ MA DATE f�� PERMIT# JOBSITE ADDRESS Lll_7.. �rlvaA k OWNER'S NAME�� rT zciV t1 .. OWNER ADDRESS /yf' -�� w m TELA ( �,,2 5 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL €., RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES N FIXTURES-1 FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB r,__ CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM _ I � DEDICATED GAS/OIL/SAND SYSTEM . � DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM _ WW E v T DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN I _ INTERCEPTOR(INTERIOR) __ �- 7-- r KITCHEN SINK _L ___•_ _ LAVATORY I ' ROOF DRAIN SHOWER STALL SERVICE/MOP SINKi '[ _ TOILET URINAL ITUTI — _ WASHING MACHINE CONNECTION _ ( _ ! ;3N T PH VE WATER HEATER ALL TYPES WATER PIPING i OTHER E INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO IF YOU CHECKED YES,PLEASE INDICATETHE TY OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY BOND w 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. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance wh all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. _ PLUMBER'S NAME( y Gyp" ,_._ .._. LICENSE# /Cf�l SIG MPJP CORPORATION# AVPARTNERSHIP # LLC0#[ COMPANY NAME ADDRESS�s/ ��T e�L-dYWWJ= CITY STATE STATE ZIP QLyZ._7 TEL FAX G? CELL EMAIL /�S C C a S. •.tom-- — ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES zg z- /z �r�