16A-020 (23) 417 FAIRWAY VLG SP-2018-1307
GIS 4: COMMON '-'VEj',',1�"1-JTH OF MASSACHUSETTS
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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
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2019-002^27
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'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.
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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
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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
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