29-281 (8) BP-2021-2240
367 BROOKSIDE CIR COMMONWEALTH OF MASSACHUSETTS
Map:Biock:Lot:
29-281-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2021-2240 PERMISSIONIS HEREBY GRANTED TO:
Project# BASEMENT RENO Contractor: License:
Est. Cost: 20000
Const.Class: Exp.Date:
Use Group: Owner: ZADWORNY ALLEN M& ANNA MARIE
Lot Size(sq.ft.)
Zoning: WSP 1 pplicant: MARIE ZADWORNY ALLEN M&ANNA
Applicant Address Phone: Insurance:
367 BROOKSIDE CIR
FLORENCE, MA 01062
ISSUED ON:12/03/2021
TO PERFORM THE FOLLOWING WORK:
BASEMENT RENO -ADDING 2 BEDROOMS AND LIVING SPACE
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter: Footings:
Rough: ough c.:3 -: ) House# Foundation:
3-2 - 22 yl'1 W 141.
Driveway Final: Final:to_z Final: Rough Frame: Uw O.( .12 '�2
<G 2y—
Gas: 211) .. ire Department Fireplace/Chimney:
Rough: Oil: Insulation: o14" 'Zo• 2-2. 16,/4
FAA-/2. 2q•Z 2- K.i r(Z
Final: Smoke: Final: Olt io•t g-ZN Sic
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
• • }4? •
a
Fees Paid: S 130.00
212 Main Street.Phone(413)587-1240,Fax:(413)587-1272
err_-- -r..._n-.ruc-•- ^-•---••'--'. ._
37 Bk0O<S(L)- Cii W
C.o,, ,zweJil't of li"laodackt9effi Official Use Only
1= _,� ep Zoya�„� i: c� cc77 Permit No. � -0/�
► .Z epartment o/.}ire Service.
-T V* ' Occupancy and Fee Checked /O7
':ice' Rev.BOARD OF FIRE PREVENTION REGULATIONS 1/07] /
� (leave blank)
a)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code EC), CMji 12,Q0
4PLEASE PRINT IN INK OR TYP ALL INFORM TION) Date: —
Cit'or Town of: �W(1 vtath( ) cIo ra.oc .e. To the Inspector of Wires:
By this application the undersigned ryes notice of his or her intention to per m the electrical work described below.
(Location(Street&Number) .j 7 Rt4_>vs•5(de G, I •fot-0,-►K
Owner or Tenant ,41le✓)_ 2c, &o.10 r'Vty Telephone No. ('3 c46,9 6 7/ ?
Owner's Address
Is this permit in conjunction with a building permit? Yes W1 No n (Check Appropriate Box)
Purpose of Building IJtNt((t te-7 Utility Authorization No.
n
Existing Service f03 Amps / )4d Volts Overhead❑ Undgrd❑ No.of Meters 1
New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Se PAt el-4' btJ,18 0 ofi — g �o —
I LA - L l Jr to y 4 •- tit-E/dl n e,-1 - le,a5e 5a 0,c V..e-0,.-r
Completion of the following table may be waived by the Inspector of Wires.
NoNo.of Recessed Luminaires No.of Ceil: Tr m KVATota Susp.(Paddle)Fans of
Tr of
KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ -No.of Emergency Lighting
grad. grnd. Battery Units i___ _
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
Heat Pump Number Tons 1KW No.of Self-Contained i
No.of Waste Disposers Totals: I Detection/Alerting Devices
Municipal
No.of Dishwashers `Space/Area Heating KW Local❑ ❑ Other
�_ Connection _
No.of Dryers Heating Appliances KW Security Systems:*
No.of)bevices or Equivalent
No.of Water KWNo.of No.of Data Wiring:
Heaters KW Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total Iih Telecommunications Wiring
No.of Devices or Equivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of - ectrical Work: (When required by municipal policy.)
Work to Start: a Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE, BOND ❑ OTHER El (Specify:)
I certify, tinder the pains and penalties of perjutWhat the information on this application is true and complete.
FIRM NAME: 0(1-) Dv\\-' (e.c4ca;lo.v\ LIC.NO.: rj(Q I(i)
Licensee: O J..tf\ OV t,~t t,t' Signature C.----..... -- LIC.NO.:
(If applicable,en r "exempt"in the license m nber line. ,,�y �� Bus.Tel.No.'
Address: 2' cQ W'Gt Anstn a- 12. COvtnt4tw -fan lV`A Ul 6 Alt.Tel.No.: 4/ 3�/0�
*Per M.G.L.c. 147,s. 57-61,security work requires Department o Pu lT is Safety"S"License: Lic.No. `fV(pCy
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. 1 am the(check one)❑owner ❑owner's agent.
Owner/Agent
PERMIT FEE: $ (
Signature Telephone No. —
g"at zt"- 0.5-E
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( c 733 67():-
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
n '
ram-
6 =-'"— CITY N1 c 0-o - orer•G . 1 MA DATE 3-'--1 -2.2_ J PERMIT#P-2022- -00$S
n1 0BSITE ADDRESS 1.6/
�I(.P S:c�K, `i('�1� � OWNER'S NAME �-1►�A �lorry
pOWNER ADDRESS .,_..._._ 1 TEL 1.117-S 4$-671i FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL I EDUCATIONAL ❑ RESIDENTIAL -
PRINT `T
CLEARLY liEW:Q RENOVATION:0 REPLACEMENT: PLANS SUBMITTED: YES.,J NOfig-
FIXTURES 1 FLOOR— BSM 1 2 3 4 5 6 T 7 8 9 10 11 12 13 14
BATHTUB . __ �,_
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIUSAND SYSTEM
DEDICATED GREASE SYSTEM ± 1
DEDICATED GRAY WATER SYSTEM
_
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK ________
LAVATORY / PL tj ."I8 NG 8, Gr\5 INS I.'L-(... I-k)rt
ROOF DRAIN NORTHAMpTcN __
•
SHOWER STALL O �� _ /�
/ n rJ n (-1 V/ 1 .. .lY _ ,C�fi''1 U 1/t L)
SERVICE/MOP SINK '
TOILET #211?
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES _.
WATER PIPING r w_
OTHER _____
,i
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 POLICY E 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 corn liance with all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. - /
PLUMBER'S NAME Hic . Wy fr-oI^KIL� iLICENSE#f„3'15< iSIGNATURE
MP JP I] CORPORATION OK- —"PARTNE --1
RSHIP _,^;�# ,LLC _;#�
COMPANY NAME ADDRESS 3` Cel erg, KOtrr
CITY 561A,'Mosel Flo" ISTATE NID ZIP 010 71 TEL N(3- Zt2- a rig
FAX I CELL EMAIL N;choi A,• Li Y Vf.0 his VC.: a &Pta I . C 6," 1
214-u_r 22 -A2 -9/
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