17C-220 (24) Wiice Cse chly
JJJ ne Commonwealth of Massachusetts
• re�.ft Xo.
Department of Public Safety
• occur+ncy i Fee Checked
BOARD OF FIRE PREVENTION.REGULATIONS S27 Chi F..12-00 3/90 (leave blank)
APPLICATION FOR- PERMIT TO PERFORM ELECTRICAL WORK
All work to Ix periormed In accordance with theMa"achuscru Electrical Code.527 CMR 11:000
(PLEASE IMMIT IN = -OR -TYPE ALL INF0MATION) Date
City or Torn of 410,4eTIf#Ap/ 4'y To.the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Humber) /7 Nd�1j/ /J PLf •�/
Owner or Tenant S ER V/c F41,r >AIG
Owner's Address faq >\1 N G N I9 o-4v
Is this permit in conjunction with a building permit: Yes ED' No ❑ (Check Appropriate Box)
Purpose of Building Too dl:rfj c Es Utility Authorization NO.
Existing Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters
New Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters
Number of Feeders and Ampacity 6,19"'P C-/A)C 0,7,.T
Location and Nature of Proposed Electrical Work IWO
7-2) %si Fzo oF.�ic
No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total
KVA
Above In-
No. of Lighting Fixtures Swimming Pool grnd. ❑ grnd. ❑ Generators KVA
No. of Receptacle Outlets No. of Oil Burners No. Emergency Lighting
Batter Units
No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones
No. of Ranges No_ of Air Cond. Total No. of Detection and
tons Initiating Devices
No. of Disposals No. of Heats Total Total No. of Sounding Devices
Tons KW
No. of Dishwashers Space/Area Heating KW No. of Self Contained
Detection/Sounding Devices
No. of Dryers Heating Devices KW Local❑ Municipal ❑Other
Connection
No. of Water Heaters KW No, of No. o Low Voltage
Signs Ballasts Wirin
No. Hydro Massage Tubs No. of Motors Total h?
Orr ER:
INSURANCE COVERAGE: . Pursuant to the requirements of Massachusetts General Laus
I have a current Li bility Insura;lce Policy including Completed Operations Coverage or—4s s substantial
equivalent. 'ES NO E] I have submitted valid proof of same to this office. YESZ NO
If you have checked YES, please indicate the type of Jcoverage by checking the appropriate box. �y
INSURANCE E' BOND ❑ OTHER ❑ (Please Specify) L 1I�1'/G /Ty �� T
cpiration Date
Estimated Value of Electrical Work S
Work to Start 7 Inspection Date Requested: Rough a 7 Final
-'igned t,;der thu renalties of perjur;:
FIRM NAME JC0W1Q.PD ��C✓ u LIC. No. 3711 y E
Licensee _ Q_Signature 0A`C11 �tJ'`� _ LIC. NO.
Address o ffz l F C,PWT 49 ��L Cli EP 175�Acs Bus. Tel. No. 111 s'-3arz?� S/OS�U
" Alt. Iel. Ho.
0VNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub-
stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit
•application.waives this requirement. Owner Agent (Please check one)
Telephone No. PERHIT FEE S
U_•ner or Arcnt
I �
1
FILE #
APPLIC�I N ' CONTACT PERSON: % �� �, �r �� ', ��,. Lq
ADDREA. . ONE: c.
PROPERTY LOCATION: 17
MAP / 7d, PARCEL: ZONE 11-7
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
Fee Paid
Rif lrjin2 Permit Filled id ,
Fee Paw L/
V
- > r.
NewCongfriirtinn
THE LLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
Approved as presented/based on information presented
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under:§ w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval-Bd of Health Well Water Potability-Bd Health
!Permit from Conservation m iss'
Signature of Building lase r Date
NOTE:issuanoo of a zoning permit does not relieve an applicant's burden to comply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Public Works and other applioable permit granting authorities. _
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City of Northampton
ELECTRICAL INSPECTION LABEL
APPROVED
Type of Inspection /� -
Date /L)/-�-e
Electrical Inspector P O.-M►
City of Northampton REQUIRED INSPECTIONS
1. Footings and Walls
BUILDING DEPARTMENT 2. Structural Components in Place*
3. Complete Building*
NO. 946 Office of the Building Inspector
Zoning Form No. 961568 Date 10/11/96 Fee$40.00 (-bcek#p 143
Page, 17C Parcel 220 ,Zone GB Section 127 ❑ Yes ® No
BUI]LDING PERAM
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT R Joseph Murphy III before Building Inspections
has permission to construct interior walls,non-bearing partition walls Inspection r office space on Site—Foundations
�
situated on 17 North Maple St - ServiceNet Inspection of Plumbing—Rough
provided that the person accepting this pen-nit shall in every respect Inspection of Plumbing—Finish
conform to the terms of the application on file in this office, and to the Gas Inspection
provisions of the Statutes and the Ordinances relating to the Construction, Inspection of Wiring—Rough
Maintenance and Inspection of Buildings in the City of Northampton.
Any violation of any of the terms above noted is an immediate revocation Inspection of Wiring—Finish
of this pen-nit.Expires six months from date of issuance,if not started. Building Inspection—Rough
Note:A certificate of occupancy will be issaed by this office upon return Insulation Inspection
of this card signed by the Plumbing,Wiring and Building Inspectors.
Building Inspection—Finish
Smoke Detectors(Fire Department)
Other
THIS CARD MUST BE DISPLAYE IN A CONSPICUOUS PLACE ON THE PREMISES
Certificate of Occupancy