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37-101 (3) 03 ICE POND DR BP-2021-0087 COMMONWEALTH OF MASSACHUSETTS Ms r�_ CITY OF 'NORTHAMPTON IVImE31ock: 37 - 101 Lot: 001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) ateSingleFamilyFuse BUILDING PERMIT Category. New I __ Permit# BP-2021-0087 Project# J S-2021-000135_ Est.Cost:$190000.00 Fee_$2166.60 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use.Groin_ TIMOTHY SENEY _ 061088 l,ottSize(sa•ft.): 64904.40 Owner: JURCZAi�_±FNNIFER Applicant: TIMOTHY SENEY AT: 63 ICE POND DR rifiplicant Address: Phone: Insurance: 371 PROSPECT ST __ (413) 667-0230 NORTHAMPTONMA01060 ISSUED ON:7/23/2020 0:00:00 TO PERFORM THE FOLLOWING WORK:BUILD 2 STORY SINGLE FAMILY HOUSE POST THIS CARD SO 1T IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector r-/ci -ZeLht Meter: ! unnaergrounp: ervice: I Z Footings:� � �- 1•Z0� O Rough/„.`2 Rough:)-/q -a 1 House# Foundation:6(K. g_iq_z_020 1C l Driveway Final: sir Ut3,T 12-1$-Z020 Z/ Final: l inal:s c. 1 Rough F'ramc:(�4 i•� ZI 1�Q , � Rpm Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation:v.e, z.2Z- Zi )/ Smoke: 04. / / Final: O.r 5-i3 Z I w. e THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND RE II 'HONS. >2 T i Certificate of Occupancy/ / _ _.--. _-____-- Sigrjature. ,-` - - -_ _ —lib I+.,ve..N.pe: .__� _Dat+t Paid. ...�1.tra__ay.ta:t: Building 7/23/2020 0:00:00 $2 I.''.0.60 212 Main Street. Phone(413)587-1240. F'ax: (413)587-1272 Louis Hasbrouck-- Building Coneuissioner *.y , The Commonwealth of Massachusetts l ,rt I. ,),0,t. yb City of Northampton ton .Certificate of Occupancy ' In accordance with 780 CMR, (The 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 Timothy Seney BP-2021-0087 Identify property address including street number, name, city or town and county Located at ' 63 Ice Pond Drive HERS Rating Northampton, Hampshire, Massachusetts 49 Use Group Classification(s) Single Family Dwelling 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 cor fbrmance 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: Building Official evil BOSS Inspection 05/13/21 Signature of Municipal / Date of Building Official Issuance 05/13/2021 37-101 S Home Energy Rating Certificate Rating Date: 2021-05-07 Registry ID: 011745181 Final Report Ekotrope ID: PdaXoBoL HERS® Index Score: Annual Savings Home: Your home's HERS score is a relative 63 Ice Pond Rd performance score.The lower the number, 7 1 0 8 Florence, MA 01062 the more energy efficient the home.To49 Builder: learn more, visit www.hersindex.com *Relative to an average U.S.home Seney Construction Your Homers Estimated Energy Use: This home meets or exceeds the Use[MBtu] Annual Cost criteria of the following: Heating 75,3 $2,088 2015 International Energy Conservation Code Cooling 1.4 $96 Hot Water 10.7 $295 Lights/Appliances 36.0 $2,406 Service Charges $84 Generation (e.g.Solar) 0.0 $0 Total: 123.4 $4,969 HERS Index Home Feature Summary: Rating Completed by: Ma.(net Ry Home Type: Single family detached Oa Model: N/A Energy Rater: Rafael Loveszy ErHorn**«[ to Community: N/A RESNET ID: 5182405 Nnef ix, 2 RatingCompany: Power House EnergyConsulting vo Conditioned Floor Area: 5,326 ft w Number of Bedrooms: 3 PO Box 9571,North Amherst,MA 01059 Reference 413-835-5162 some S00 Primary Heating System: Furnace•Propane•95 AFUE to WIPrimary Cooling System: Air Conditioner••Electric••14 SEER Rating Provider: Energy Raters of Massachusetts "' Primary Water Heating: Water Heater•Propane•0.95 UEF 2 Woodlawn Street Amesbury,MA 01913III 978 270-3911 House Tightness: 1424 CFM50(1.71 ACH50) rD� Ventilation: 138 CFM•157 Watts+Q n .ra• This Home Duct Leakage to Outside: 10 CFM @ 25Pa(OA 9/100 ft2) 30 4,42",d/ ''. ' „ w Above Grade Walls: R-21 Zero Energyro Ceiling: Vaulted Roof,R-42 M0rt1Q a Window Type: U-Value:0.3,SHGC:0.31 Rafael Loveszy,Certified Energy Rater xrrom+ lw «pr rd Foundation Walls: R-23 Digitally signed:5/7/21 at 1:42 PM I ekdt r(�►pe I kotrop RRAl Ui V' rsirsti 1.i..1 fatal 1C The Energy Rating Disclosure for this times is available from the A;'pros d hating Pro idc r. I Ills re rurl does not reon,tftute.'an bv<rrr i d, e,r,=,tdrantc . 63 ICE POND DR EP-2021-0565 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Map: 37 Lot: 101 ELECTRICAL PERMIT Permit: Electrical Category: WIRE 2 STORY SINGLE FAMILY HOUSE&ATTACHED GARAGE,200 AMP UNDERGROUND SERVICE Permit# Electrical PERMISSION IS HEREBY GRANTED TO: Project# JS-2021-000135 Est.Cost: Contractor: License: Fee: $200.00 STEELE KOTT/STEELE'S ELECTRICAL SERVICE, INC MASTER ELECTRICIAN 22437 Owner: JURCZAK JENNIFER Applicant: STEELE KOTT/STEELE'S ELECTRICAL SERVICE, INC AT.• 63 ICE POND DR Applicant Address Phone Insurance 54 POMEROY ST (413) 563-8265 C- Liability, BMA0024924 EASTHAMPTON MA01027 ISSUED ON:1/5/2021 0:00:00 TO PERFORM THE FOLLOWING WORK: WIRE 2 STORY SINGLE FAMILY HOUSE & ATTACHED GARAGE, 200 AMP UNDERGROUND SERVICE Call In Date: Date Requested Inspection Date/SignOff: Reinspect?: Trench/UG: Special Instructions Rough 1' /%-a 1 ►W V1 Special Instructions:Final: rl l.0` u(,t'n SRE Called In: 30095925 Signature: Fee Type:: Amount: DatePaid Electrical $200.00 1/5/2021 0:00:00 468 212 Main Street,Phone(413)587-1244,Fax(413)587-1272-Inspector of Wires -Roger Malo 63 ICE POND DR EP-2021-0469 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Map: 37 Lot: 101 ELECTRICAL PERMIT Permit: Electrical Category: RELOCATE METER SOCKET 2 FT TO THE RIGHT OF BUILDING Permit# Electrical PERMISSION IS HEREBY GRANTED TO: Project# JS-2021-000135 Est. Cost: Contractor: License: Fee: $60.00 STEELE KOTT/STEELE'S ELECTRICAL SERVICE, INC Journeyman 14225B Owner: JURCZAK JENNIFER Applicant: STEELE KOTT/STEELE'S ELECTRICAL SERVICE, INC AT: 63 ICE POND DR Applicant Address Phone Insurance 54 POMEROY ST (413) 563-8265 C- Liability, BMA0024924 EASTHAMPTON MA01027 ISSUED ON:11/30/2020 0:00:00 TO PERFORM THE FOLLOWING WORK: RELOCATE METER SOCKET 2 FT TO THE RIGHT OF BUILDING Call In Date: Date Requested Inspection Date/SignOff: Reinspect?: Trench/UG: Special Instructions x Rough x Special Instructions: Final: SRE Called In: 30287480 ha- Signature: Fee Type:: Amount: DatePaid Electrical $60.00 11/30/2020 0:00:00 508 212 Main Street,Phone(413)587-1244,Fax(413)587-1272-Inspector of Wires -Roger Malo 63 ICE POND DR EP-2021-0249 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Map: 37 Lot: 101 ELECTRICAL PERMIT Permit: Electrical Category: WIRE UNDERGROUND SERVICE TO HOUSE&GARAGE Permit# Electrical PERMISSION IS HEREBY GRANTED TO: Project# JS-2021-000135 Est.Cost: Contractor: License: Fee: $200.00 STEELE KOTT/STEELE'S ELECTRICAL SERVICE, INC Journeyman 14225B Owner: JURCZAK JENNIFER Applicant: STEELE KOTT/STEELE'S ELECTRICAL SERVICE, INC AT: 63 ICE POND DR Applicant Address Phone Insurance 54 POMEROY ST (413) 563-8265 C- Liability, BMA0024924 EASTHAMPTON MA01027 ISSUED ON:9/21/2020 0:00:00 TO PERFORM THE FOLLOWING WORK: WIRE UNDERGROUND SERVICE TO HOUSE & GARAGE Call In Date: Date Requested Inspection Date/SignOff: Reinspect?: Trench/UG: Special Instructions x Rough x Special Instructions: Final: SRE Called In: 30095925 /0 ' / - 2d RPM-• Signature: Fee Type:: Amount: DatePaid Electrical $200.00 9/21/2020 0:00:00 478 212 Main Street,Phone(413)587-1244,Fax(413)587-1272-Inspector of Wires -Roger Malo MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK n t,... CITY Northampton —1 MA DATE 11/08/20 PERMIT# Pg d I - `60 .„.„, ... JOBSITE ADDRESS 63 Ice Pond OWNER'S NAME POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW:0 RENOVATION:El REPLACEMENT:I I PLANS SUBMITTED: YES El NO❑ FIXTURES Z FLOOR BSM 1 2 3 4 5 6 7 _ : 9 10 11 12 13 14 BATHTUB 1 1 I: _.I,.. I I CROSS CONNECTION DEVICE 1111111' MEI MI'EN',MO,,ENIIIM UM Mil ILVi _ '. DEDICATED SPECIAL WASTE SYSTEM !.! 1 _i DEDICATED GAS/01USAND SYSTEM 1 11 DEDICATED GREASE SYSTEM i NO j DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM ?Moo DISHWASHER gym; -DRINKING FOUNTAIN �,��I '! n i �'` s�A o�� ',' FOOD DISPOSER �Imil FLOOR/AREA DRAIN =El INTERCEPTOR(INTERIOR) IIIMMOIMI'MIMMIIMI MN� LAVATORYKITCHEN INK NrmINI ROOF DRAIN l SHOWER STALL !III !!11 !III L \ � g3 T' SERVICE/MOP SINK • ' ' ' JI.t� 1► TOILET 2 1 P' �•• Sh O 1 . 'P � • DURINAL it 1!IIMIIM,P il� i,iWASHING MACHINE CONNECTIONalrlicilailli= 11111.111,N�I�WATER HEATER ALL TYPES �� j��WATER PIPING �; �I�'I�'!I�'I�'� 1I�!'� = OTHER �I ! .1 ! , , , , 'r - INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO I 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q 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 ❑ 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,James walunas LICENSE# m12631 �'''4/ SSIIGNNAATUREi MPEI JP❑ CORPORATION Di#2667 PARTNERSHIP❑# ILLC0# COMPANY NAME Walunas plumbing and Heating Inc ADDRESS 218c College Highway CITY Southampton STATE MA ZIP 01073 TEL 413-529-2675 FAX 413-529-2675 CELL 413-246-9850 EMAIL jimwalunasltgmail.com .R;17 v„c ✓ f9nel /2-2/ -/ ,,.r., . s.�y lj Q.kA 0/ // Llc V2I___ /U5 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 0. '= — xfi— r- -=�,Ia-� CITY Northampton —1 MA DATE 02/05/21 PERMIT it �� 7� 1U JOBSITE ADDRESS 63 Ice pond OWNER'S NAME GOWNER ADDRESS I TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL® RESIDENTIAL 0 PRINT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO U APPLIANCES- FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER !NEM= TMIonm PR1� �I CONVERSION BURNER I�I=� �i�i� '�' COOK STOVE 1 1111 illii illil DIRECT VENT HEATER ' T' I " R DRYER = _ mm m ,Is FIREPLACE Im ! ' aEim FRYOLATOR � I_1 MINO WEI�I�MOM__ i FURNACE !PIM _,_�' ■ �'� GENERATOR = .: I GRILLE �� T TT' I� INFRARED HEATER �wiI won_'__ � ____ LABORATORY COCKS ��I it T-n 1 mI MAKEUP AIR UNIT 1�� i ��M!� ��' OVEN Mir—S 1I.M M - iMI POOL HEATER ROOM I SPACE HEATER .11, ,M111111WW111111.11111 _,�,�in.," ROOF TOP UNIT IMIIII a ' 'h01110111 TEST O- -A PT 4 UNIT HEATERWWII 1' • .L�,� s II�L• , 1 • a UNVENTED ROOM HEATER SS�IS' 1' S��I I�, II WATER HEATER "Mill ��riii___IIPP OTHER le�s I— - ilifinin 11 1 '— ,, Um INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES n NO 1 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE 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 ❑ 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 co fiance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. )//� PLUMBER-GASFITTER NAME James Walunas LICENSE#m12631 I ANAN TIRE MP El MGF❑ JP❑ JGF 0 LPGI 0 CORPORATION Q# 2667 PARTNERSHIP®# LLC❑# COMPANY NAME:Walunas Plumbing&Heating Inc ADDRESS 218 College Highway CITY Southampton STATE MA ZIP 01073 TEL 413-529-2675 FAX 413-529-2675 CELL 413-246-9850 EMAIL jimwalunas1@gmail.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN,REVIEW NOTES 2 - f- 2/ cr a2'n,e: c ' /2 2 4 i-,SP- -- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - tY--NORTHAMPTON MA DATE 4/27/21 PERMIT#6P-242,1^0.36 / '' JOpE ADDRESS 63 ICE POND DR OWNER'S NAME TIMOTHY SENEY T PE OWNI-Ii ADDRESS 371 PROSPECT ST TEL 413-626-1797 FAX (r RIN cc"� � 1(s' OCGUHANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL CLEARLY NCW:- RENOVATION: ❑ REPLACEMENT: El PLANS SUBMITTED: YES❑ NO❑ APPLIANCES a- .:.FLOORS-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR __ FURNACE GENERATOR GRILLE , INFRARED HEATER PLUMBING & GAS INSPECTOR LABORATORY COCKS NORTHAMPTON MAKEUP AIR UNIT APPROVED NOT APPROVED OVEN ;0"S POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST -UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER - LINE FROM TANK TO HOUSE _ INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ® NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ® OTHER TYPE INDEMNITY El BOND El 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 ❑ 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 all •- ine ,. ., •n of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. I ( ll PLUMBER-GASFITTER NAME Timothy D'Astous LICENSE# LP 974 I : t •" g. MP❑ MGF El JP El JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP El# LLC El# COMPANY NAME Pioneer Valley Propane Inc. ADDRESS 40 O'NEIL ST CITY EASTHAMPTON STATE MA ZIP 01027 TEL (413) 568-4443 FAX (413) 568-6766 CELL EMAIL SALESPIONEERVALLEYOIL.COM ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES ci G -21 ))/hZs - /t 7FT- <-5---1/"" / , MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - is—k A- CITY NORTHAMPTON MA DATE 2/1/21 PERMIT#G�2021-OZ69' :,, ,. JOBSITE ADDRESS 63 ICF POND DR OWNER'S NAME TIM SENEY GOWNER ADDRESS TEL 413-626-1797 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ® RENOVATION: ❑ REPLACEMENT: ❑ _ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES 1 FLOORS-, BSM 1 2 3 4 5 6 7 5 7_/''� 11 12 13 14 BOILER f`' .�1. �� - BOOSTER i \�0 CONVERSION BURNER / 48 I COOK STOVE • I 8 2Q�, DIRECT VENT HEATER rr 1,_ / DRYER "'`iNI �nJ , FIREPLACE1+n,; ��,c FRYOLATOR �`�.`'r A,rf°piCNS FURNACE • o 1f GENERATOR GRILLE INFRARED HEATER • LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER PLUMB! JG & GAS INSPECTOR ROOM/SPACE HEATER NORTHAMPTON ROOF TOP UNIT APPROVED NOT APPROVED TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER - LINE FROM TANK TO HOUSE INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ® NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ® OTHER TYPE 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 ❑ 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 urate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complianc wi in vi • of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Timothy D'Astous LICENSE# LP 974 A �►� MP❑ MGF❑ JP❑ JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME Pioneer Valley Propane Inc. ADDRESS 40 O'NEIL ST CITY EASTHAMPTON STATE MA ZIP 01027 TEL (413) 568-4443 FAX (413) 568-6766 CELL EMAILSALES@PIONEERVALLEYOIL.COM ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES :' (�� c 14g337 $5f MA$SACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK =,�,ra ? z' -b p 1 MA DATE 05/09/21 1 PERMIT#6 •2 L 1 - - :_�i= ,' --� CITY 1•Ibttham ton 03'7.3 JOBS TElDDRESS 63 Ice Pond OWNER'S NAME Kirchen :.• I rc OWN -ADDRESS . TEL IFAX ___1 TYP OR__s OCC1 iCY TYPE COMMERCIAL❑ EDUCATIONAL El RESIDENTIAL El PR NT_ 1 CLEARLYNEW a RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES 1 FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 BOOSTER 111 J i. I� J CONVERSION BURNER COOK STOVE II OM i DIRECT VENT HEATERS it —1 i I F ' DRYER i FIREPLACE 1 1 II 1I I FRYOLATOR III _ �I'; 1 I i GENERATOR iil1 . 1 f I GRILLE Rm. _ i INFRARED HEATER {LABORATORY COCKS �= ' MAKEUP AIR UNIT 1 1 _l— �i ` OVEN MI i `I6 'Ma - Mil POOL HEATER _ L11'j ' 3�> ROOM/SPACE HEATER �1 U ROOF TOP UNIT f /. !� 1 i _ TEST 1 1 1J I i UNIT HEATER i , d I Q UNVENTED ROOM HEATER u .11 i WATER HEATER _ : L J I OTHER I Eli ini mil EN WNW i a ; 1_ I 1 —I II 1 J I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES El NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE 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 ❑ 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 corn fiance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME James Walunas LICENSE#m12631 SIGNATURE MP El MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION Q# 2667 PARTNERSHIP❑# LLC El# COMPANY NAME:Walunas Plumbing & Heating Inc ADDRESS 218 College Highway CITY Southampton STATE MA ZIP 01073 TEL 413-529-2675 FAX 413-529-2675 CELL 413-246-9850 EMAIL jimwalunasl@gmail.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES 7^ 11=, .ti „ �