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42-180 (8) 125 GLENDALE RD BP-2019-0208 GIS#: COMM-ONWEALTH OF MASSACHUSETTS Map:Block:42- 180 CITY OF NORTHAMPTON Lot:- PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:New Single Family House BUILDING PERMIT Permit# BP-2019-0208 Project# JS-2019-000340 Est. Cost: $236372.00 Fee: $613.50 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: PIONEER VALLEY HABITAT FOR HUMANITY 046013 Lot Size(sq.ft.): Owner: MINERAL HILLS REALTY LLC zoning: Applicant: PIONEER VALLEY HABITAT FOR HUMANITY AT. 125 GLENDALE RD Applicant Address: Phone: Insurance: P O BOX 60642 (413) 586-5430 WC FLORENCEMA01062 ISSUED ON:8/17/2018 0:00:00 TO PERFORM THE FOLLOWING WORK-2 STORY SINGLE FAMILY F=OUNDATION AND FINISH POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspe9loro lumbing Inspector of Wiring D.P.M1. Building Inspector /U erg ou L%;J Service: Meter: Footings: Rough: Rough: House# Foundation: n Driveway Final: Final: Final: 'f 7-43 Z,.6 -;7 Rough Frame: V� r:AiLGo I-W-zozo Kat- v✓drL --� Gas: Fire Department Fireplace/chimney: Rough: Oil: Insulation: Final: Smoke: Final: Q,V -7-W-2020 k THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REOLAXIONS. Certificate of Occupancy sianatr,rc: FeeType: Date Paid: Amcuat: Building 8/17/2018 0:00:00 $613.50 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner '�i �, � ry! ,pl - 125 GLENDALE RD EP-2020-0425 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Map: 42 Ut: 180 ELECTRICAL PERMIT Permit: Electrical Category: WIRE NEW SFH WITH 200 AMP SERVICE Permit# Electrical PERMISSION IS HEREB Y GRANTED TO: Project# JS-2019-000340 Est.Cost: Contractor: License: Fee: $200.00 KEVIN WHITE ELECTRIC Journeyman Electrician 10297 Owner: MINERAL HILLS REALTY LLC Applicant: KEVIN WHITE ELECTRIC AT. 125 GLENDALE RD Applicant Address Phone Insurance 792 Front St (413) 530-5855 C- Liability, 6801 H660511 CHICOPEE MA01020 ISSUED ON:11/12/2019 0:00:00 TO PERFORM THE FOLLOWING WORK: WIRE NEW SFH WITH 200 AMP SERVICE Call In Date: Date Requested Inspection Date/SipnOff: Reinspect?: Trench/UG: Special Instructions X Routh x Special Instructions: Final: 7' d II ,w0?-jn^j'- r 1 SRE Called In: Sienature• Fee Type:: Amount: DatePaid Electrical $200.00 11/12/2019 0:00:00 1073 212 Main Street,Phone(413)587-1244,Fax(413)587-1272-Inspector of Wires -Roger Malo 125 GLENDALE RD EP-2020-0576 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Map: 42 Lot: 180 ELECTRICAL PERMIT Permit: Electrical Category: LOW VOLTAGE,WIRE ENERGY MONITORING SYSTEM Permit# Electrical PERMISSION IS HEREBY GRANTED TO: Project# JS-2019-000340 Est.Cost: Contractor: License: Fee: $50.00 BERGERON ELECTRICAL SERVICES MASTER ELECTRICIAN A12680 Owner: MINERAL HILLS REALTY LLC Applicant: BERGERON ELECTRICAL SERVICES AT.- 125 GLENDALE RD Applicant Address Phone Insurance 36 GUNN RD EXT (413) 527-2032 C- Workers Compensation, 4220048580 SOUTHAMPTON MA01073 ISSUED ON:1/14/2020 0:00:00 TO PERFORM THE FOLLOWING WORK: LOW VOLTAGE, WIRE ENERGY MONITORING SYSTEM Call In Date: Date Requested Inspection Date/SianOff: Reinspect?: Trench/UG: Special Instructions X Rough (2PV✓* — x Special Instructions: Final: _L2 La U SRE Called In: Signature: Fee Type:: Amount: DatePaid Electrical $50.00 1/14/2020 0:00:00 8081 212 Main Street,Phone(413)587-1244,Fax(413)587-1272-Inspector of Wires -Roger Malo The Commonwealth of Massachusetts , City of Northampton Certi icate of Occu anc In accordance with 780 CMR, (Tlte Ninth Edition of the Massachusetts Residential Building Code) this Certificate of Occupancy is issued to the premise or structure or part thereof as herein identified. Identify Name of Building of Space Within, Building Owner, or Permit Holder Certificate No. Issued to Pioneer Valley Habitat For Humanity BP-2019-0208 Identify property address including street number, name, city or town and county Located at 125 Glendale Road Florence, Hampshire, Massachusetts Use Group Single Family Dwelling Classification(s) This Certificate of Occupancy is hereby issued by the undersigned to certify that the premise,structure or portion thereof as herein specified has been inspected for general fire and life safety features. This certificate shall allow for the use as herein described and in conformance with any and all conditions as identified below. It shall be posted in a conspicuous place within the space as directed by the undersigned. Failure to post the certificate,failure to comply with conditions or, tampering with the contents of the certificate is strictly prohibited. Conditions of Use Single Family Dwelling All fire protection and life safety systems must be maintained, and all means of egress must be kept clear Name of Municipal Date of Final Map/Plot: BuildingOfficial KiROSS Inspection 07/30/2020 Signature of Municipal Date of 42-180 Building Official Issuance 07/30/2020 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMITTOPERFORM PLUMBING WORK CITY/TOWN //�V(D(�" C1"myf6n MA DATE Ib q/�U PERMIT# IC`r'1D JOBSITE ADDRESS►aS Gif—f ole, Fd OWNER'SNAME /4,'fn+ kc- PumaP OWNERADDRESS J11 Elm, 5f Florence, /1A TEL 7fUG-S yid FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:x RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO FIXTURES 7 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 ALI FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAINlumbi 8 a 'ns SHOWER STALL N rt,am SERVICE/MOP SINK TOILET URINAL PLOMBl 4G &.GAS INSIF ECT R WASHING MACHINE CONNECTION NO 4THAMPT N WATER HEATER ALL TYPES AP RO ED N APF ROVIED 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 ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICYk OTHER TYPE OF INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAI : I a are that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts Ge al La , nd a y signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT SIG TURE 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=1' 'thl Perti ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. f S!r►�2 � PLUMBER'S NAME krma J La MO iJr LICENSE# IS-0 7� SIGNATURE MP JP❑ CORPORATION ❑# PARTNERSHIP ,(❑# / LLC E]# COMPANY NAME S/�il �� ��ft�lli'o/��t :9f1 Sc hr- ADDRESS U U LocuSf S-F CITY 46t1�61neje11 STATE/'1/7 ZIP W666 TEL FAX CELL W 3".�1C-eP220 EMAIL r r12 6R a+►v,r.�or,�,�yr,^ R; !.�,�.�^ �� •`:i� AOT034aAl ZAa 8 t0Wi8rAUJ9 NOT ,IAHT8014 03VOA99A TON 03VOA99A MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK /n CITY/TOWN IV��� MA DATE .'��� PERMIT# `30 JOBSITE ADDRESS !aS G04 OWNER'S NAME GT POWNER ADDRESS 1�4 P! Fr TEL y/��S��y3D FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIALV PRINT CLEARLY NEW. J RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES'l FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM a DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM APAI f DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER Alm F.Gj,fi - DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTORINTERIOR KITCHEN SINK LAVATORY ROOF DRAIN Ejj SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES ;)AR—r p WATER PIPING OTHER INSURANCE COVERAGE: 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 INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY X 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. CHECK ONE ONLY: OWNER El AGENT F]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 inomplia ce withl Pert- nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME (1i LhQe` J (y\0 0-A ,52 LICENSE# M i IGNATURE MP❑ JP❑ CORPORATION®# PARTNERSHIP❑# LLC❑# COMPANY NAME 0-(-04r), enc . ADDRESS L4 5aAv-, CITY 1A1Z1A&V1JM - STATE ZIPy 10391 TEL Lli S l FAX H13-Abri e 1371 CELL EMAIL x6 Q ArnM ®4%C_ C-cyy,\ .L Commonwealth of Massachusetts Division of Professional Licensure Board of State Examiners of Plumbers and Gas Fitters 1000 Washington Street . Boston . Massachusetts • 02118-6100 PUBLIC CAREERNOCATIONAL TECHNICAL HIGH SCHOOL PROGRAM APPLICATION TO PERFORM PLUMBING AND/OR GAS FITTING WORK RESIDENTIAL PROJECT APPLICATION This application must be filed with the Board and Approved prior to issuance of a plumbing or gas fitting permit by the Local Inspector. PLEASE PRINT CLEARLY To be filled out by the Lead Plumbing& Gas Fitting Instructor Name of School: Submit al D te: Address: y, City/Town: State: Zip Code:/ LO 11 L15 666 Name of Plumbing and Gas Fitting Department Head: Phone&Extension: Name of School Instructor who will be the Plumbing/Gas Fitting Permit Holder of Record for this Project: Master License Number: /n1 Or - 1 /S`d 76 Department Head email: School Instructor email: ) ALL OF THE FOLLOWING ITEMS Mtr5T BE INITIALED BY THE SCHOOL INSTRUCTOR/ PER HOLDER OF RECORD. IF LEFT BLANK.THE APPLICATION WILL BE DEEMED INCOMPLETE AND WILL NOT BE ACCEPTED. 1. 1 have included a copy of the lesson plan,signed by my local school administration with this application INITIAL BELOW L 2.All of the plumbing and/or gas fitting students performing work on this project shall be under the direct supervision INITIAL BELOW of Board certified instructors. All instructors are identified on this form.Any changes must be approved by the Board. 94, 3. 1 certify that all plumbing and/or gas fitting performed on this project shall be limited to the work specified in the INITIAL BELOW included lesson plan. 4.1 understand and agree that each Board certified plumbing and/or gas fitting instructor is limited in the number of INITIAL BELOW students that they may supervise in compliance with Board designated instructor to student ratios. TIn� 5.1 certify that no plumbing and/or gas fitting work has been performed by any students on this project to date. INITIAL BELOW A- 6.1 certify that I shall file a permit with the local inspector of plumbing and gas prior to work commencing and shall be INITIAL BELOW responsible for ensuring that required rough and final inspections take place. k 7.1 certify that I have read and fully understand the current Board Vocational School Policy for School Projects INITIAL BELOW 9L 8.1 certify that all students taking part in this project have completed a minimum of 110 hours of the Board approvedINITIAL BELOW Tier Program for Licensure. 119L I certify, under pains and penalties of perjury that the information on this form is true and accurate. Signature of Applicant I1r1'Y� � /� Date: /1// 1 LESSON - PROJECT INFORMATION PLEASE PRINT CLEARLY Name of party for whom the work is to be performed: �l bi fU Gr Nvmawi i Address: / City/Town: /S+tate: Zip Code: 1 yl I lofelice /� ©loao Location where work is to be performed if different than above: 1�5 ldq Gly , k Address: City/Town: State: Zip Code: ias /� 133 Ti c��1e N�,< � c .fo� 14F oiao New: Renovation: Please check the boxes for other Licensed Trade programs within your school which will be working on the project at this location: Electrical: M Pipe Fitting: ❑ Refrigeration: ❑ Sheet Metal: ❑ Other: F re.5 T r L Brief description of plumbing work related to this project: �/Voll ����rr/'�✓E,�, �/l✓l� ��J��der D,'p,'!; Si��Fn fs ��i/� ('�,r Brief description of gas fitting/work related to this project: 4V) 641S 0 0 r�1 �C� �c: 0/0 :J 2 Explain how this project lesson will benefit the students of your program: TX 1s Pfd pec, w�11 e �13 6L)r >fuPrJS bec►)-P exotr,enc_e. ox, k L Q— r obi:fie. (in) L", 447 m I froks mc--ii- boom �O 6icc nrPA/5A f1 [L-,41 goell. What grades will be participating in this project? Freshman: Sophomore: Junior: Senior: vu What is the projected number of plumbing and/or gas fitting students who will be participating in this project? 9 Sftje kits Please list the names and Master license numbers of certified plumbing/gas fitting instructors who will be participating in this project? 1 Name: J S D cot L I n Le(S6,1% Master License Number: 1126s" Name: / l� n� W5 d�( Master License Number: /5-0 V/ k jj// / Name: fi �� /p D F IA s'y), Master License Number: Name: Master License Number: OFFICIAL BOARD USE ONLY ' APPROVED APPROVED BY: }Q"SUBJECT TO RULES '0 <l/ AND REGULATIONS LU =,/ � / o Q CHECKED N DATE FOR �I if BOARD 0 APPROVAL DATE: 0�, PLA EXAMINER �y>' 3