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Express Plumbing Heating and Solar Services LW
September 16,2016
City ofNorthampton Building Department
Attn:Larry Eldridge-Plumbing and Gas Inspector
212 Main St
Northampton,MA 01061
413-587-1243
To whom it may concern,
Express Plumbing,Heating&Solar Service is requesting a partial inspection on work complete and
that the plumbing permit%r Debra Truskinoff of 42 Lexington Ave.Florence,MA be terminated
immediately.
Respectfully,
Mark Wendolowski-President
Express Plumbing,Heating and Solar Services LLC
S •
h tl (j v � / cto 70 �e —
61,0iMASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
'al; CITY/TOWN Norl 4W1/l/OlJ MA DATE g7t7((6 --�PERMIT# PD 1 7��--y7c)
co JOBSITE ADDRESS Lid. Phe tt eiStnJ Ave OWNER'S NAMEJ)'bf1 T �L is Kr r)ei ff
pl OWNER ADDRESS TEL FAX
� j I
CTYPE OR OCCUPANCY TYPE COMMERCIAL I7 EDUCATIONAL ❑ RESIDENTIALILI
PF�17
CLEARLY NEW:0 RENOVATION:$ REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO 0
FIXTURES 1 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/AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK
LAVATORY 14. a
ROOF DRAIN PLUMBING& GAS INSPECTOR
SHOWER STALL NO ON
SERVICE/MOP SINK 0 1tPf`f1pVED
TOILET /
URINAL f
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 0
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICYS 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 0
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are hue and accurate to the best of my knowledge
and that all plumbing Pork and installations performed under the permitissuedfor this application will with all provisJ
ion of the
Massachusetts State Plumbing Code mpeof the General Laws.
PLUMBER'S NAME(/ fNIZhdlf6'U,/L
LICENSE# P397 7 SIGNATURE
MP r JP 0 CORPORATION❑// # PARTNERSHIP❑# LLQ # 3 t
COMPANY NAMEFXp✓P44j P/i1Mbj 5 ADDRESS /3 ( P(aye c J'' St-
CITY tAll—tit/ STATEAtZIPff([1- TEL(0?-44.26' 3Sca
FAX CELL EMAIL `/i((iLfvn(fn((j ra54,(` (O.110-[ST
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