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22B-015 (7)MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY N2t. MA DATE F 9g -,x -c1 I PERMIT# JOBSITE ADDRESS 7& OWNERS NAME POWNERADDRESS L64 P*AA-, I TEL y:3 - 1-T-1 - t%t3 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL F-1 RESIDENTIAL'19 PRINT CLEARLY NEW: 17 RENOVATION:n REPLACEMENT: PLANS SUBMITTED: YES F-1 NoF-1 FIXTURES I FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND 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 WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: I have a current liability -insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES NO F-1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [Z OTHER TYPE OF INDEMNITY � BOND F-1 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 F-1 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 with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LICENSE# 1 SIGNATURE MPNQ JPM CORPORATION []g# r 3 PARTNERSHIPF—J# LLCE]#[�= COMPANY NAME 10'rj'��Lqal( ADDRESS CITY STATE ZIP[ e2 TEL Aa:6 i i FAX -rAqac CELL EMAIL F_4��,>6;� e-oContje %-r-0 -sal # (3o .01 POWNER TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY _ Elr-e-j �'�' MA DATE ° ` PERMIT # ff-K- JOBSITE ADDRESSr OWNER S NAME ADDRESS TEL FAX OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL [ NEW: ❑ RENOVATION: )V REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO ❑ FIXTURES 7 FLOOR- BSM 1 2 3 4 s 6 7 a 9 14 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEMRcli DEDICATED GASJOIUSAND SYSTEM - _- n-_ DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER OF eur DRINKING FOUNTAIN - ^M FOOD DISPOSER FLOOR /AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK w LAVATORY 9 ' J ROOF DRAIN'EO SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL Ch. 14Z 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 wanes 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 'installation performed under the permit issued for this application will be in complianco, with all Pertinent pyovision of the Massachusetts State Plumbing COP and/Chapter 142 o the General Laws. PLUMBER'S NAME C ('GII LICENSE # I / %' 2 SIGNATURE MP ( JP ❑ CORPORATION [:1# PARTNERSHIP ❑ # LLC El# COMPANY NAME lP3 "ar" C 4ewri4eYv'i•' ADDRESS Lf 7 t?q ,^ CITY . 5 STATE ZIP 010,o17 TEL Y 4 I FAX CELL �� " �?J S EMAIL Q /y �� G� �'" r .�' �y, �-.� :yam _2S MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATE S - a - c -i PERMIT # Iwo JOBSITE ADDRESS 'OWNER'S NAME 1hick,� AX OWNER ADDRESS TE !;: TYPE OR OCCUPANCY TYPE COMMERCIAL—' EDUCATIONAL RESIDENTIAL PRINT CLEARLY1 NEW:� RENOVATION: REPLACEMENT: PLANS SUBMITTEDi YES 77 NO" . APPLIANCES 7- FLOORS — 2 3 4 5 6 j 8 9 1 i i 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER is _ E E ------ L FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCl MAKEUP AIR UNIT =0 =I UNIT HEATER UNVENTED ROOM WATER HEATER INSURANCE COVERAGE FV, NO I have i current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES I^- I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY _7 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 CHECK ONE ONLY: OWNER F—tr AGENT L-2 SIGNATURE OF OWNER OR AGENT 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 compiiance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER -GASFIT ER NAME LICENSE #i t SIGNATURE T (a C ,7 lri MP MGF JP JGF LPG]-* CORPORATION 5�# G CPARTNERSH I P#LLCj - ----- COMPANY NAME:' ADDRESS ' 'y SIA TE ZIP TEL L A61 FAX CELL 4— 'EMAIL! is -14-143 56 MEADOW ST Map: 22B Lot: 015 EP -2015-0203 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON ELECTRICAL PERMIT Permit: Electrical Category: WIRE NEW HOUSE Permit # Electrical PERMISSION IS HEREBY GRANTED TO: Project # JS -2014-001743 Est. Cost: Contractor: License: Fee: $200.00 CHESTER C GOLEC Journeyman 32699E Owner: BEHRENS MICHAEL Applicant: CHESTER C GOLEC AT. 56 MEADOW ST Applicant Address Phone Insurance P O BOX 193 (413) 586-8745 Liability, MP053756 LEEDS MA01053 ISSUED ON:8/29/2014 0:00:00 TO PERFORM THE FOLL OWING WORK. WIRE NEW HOUSE Call In Date: Date Requested Inspection Date/SignOff: Reinspect?: Trench/UG: Special Instructions X Rough -e-1A57�/`li ?�aw— Special Instructions: Final: G- 3L ?- jS— Pw. SRE Called In: 14fa ?0 Op & I J 01 - '� - II/ Rel'-, Signature: Fee Type:: Amount: DatePaid Electrical $200.00 8/29/2014 0:00:00 1028 212 Main Street, Phone (413) 587-1244, Fax (413) 587-1272 - Inspector of Wires - Roger Malo