31B-200 (4) al
21 HENSHAW AVE BP-2017-0471
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31B-200 CITY OF NORTHAMPTON
"'i' Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:renovation BUILDING PERMIT
Permit it BP-2017-0471
Project# JS-2016-002375
Est.Cost:$365000.00
Fee:$2555.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: KEITER BUILDERS 102457
Lot Size(sq.ft.): 13590.72 Owner: SMITH COLLEGE OFFICE OF TREASURER
Zoning: EU(100)'URC(100)/ Applicant: KEITER BUILDERS
AT: 21 HENSHAW AVE
Applicant Address: Phone: Insurance:
35 MAIN ST (413) 586-8600 () WC
FLORENCEMA01062 ISSUED ON:10/20/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:MISC INTERIOR & EXTERIOR RENOVATIONS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET 6)-17-1 7 .AA y
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector o1 Ij YV`
�uiltit ae I H &44,j J
Underground: Service: Meter:mar
1
Footings:
Rough:,..-2/2d7 Rough: S."70 � House# Foundation:
a6 Driveway Final:
Final: 6A07/ Final: •(4., l ?_
�� IA' Rough . ramex
Gas: Fire Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: 4/4?://7 Smoke: Final: ' rlO -17
, a
THIS PERMIT AY BE REVOKED BY THE ati TY S F NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND RE L I i ..
Certificate of Occupancy g I' Signature: /6t-aet:0
FeeTvpe: Date Paid: Amount:
Building 10/20/2016 0:00:00 $2555.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
•
r t
3Ttr $
y r 4 •
i.- r T r t � ' r c It {�r v,} ..-:-.,.':::-.;-- --•r
�'t. � r �j__- / cr N' .Fx.P �` to '�.� �"/�+ � .r a -t 4r :. ;
s 4, ,"�`ir ` �4 - .t a 4'x i'�J- rr i t• } ' i rj F .-';'`,?-4.,,,* , f Me
s rE � fir. z +� �" '� ''-'4i:.-7?;-:;
` .} v� • ' r .r. i r
!{f: z. t H AO'. ay,{V.".:� 4 i..,r�,r� r'•',cell'.i•4 t �' a yds,'
� �� ..4°F + 7 �j y x�� ,� >� � 1 � +�9 y y :14;V::-4,
` �'3-.2. x.,�ml , '""� r > rf`� °1 t c?
L d g 5.''x ,r ',,,‘•'. ' 1.�;;,..+,,,t.S t: `44 to nY+. " Y�� � 't^it r i,�✓zx + ., 4- t.T% g Y�,k-'," s`:':.kkc7 ss ,� ?I.
•
.xxr, t t j .JE tt .t ;F t!' a y ��:r�.•'�F` z tig ��Yt f�. ,% �'': � "f%'7� � � . :;�+& �:�•�1'� .�# �. ( r,
: T i'' T s ry a ,!r•_ - ,,r, ! fs! -fY� ' ��,;. ? �d;'�yy. J S�;n i,; t P tel t-. '' .: a r r�r t
rs 3,y v t -,i ,�.r y .tIiirp4 `J '4,Gfr -.01,..o7 /7.;..1;---7.7;.,---`.-,
�, '4� .1 --• r,+�y'f3+! a§'t1 e yet- ,.a 7n�X - `O 7�' ✓
.;.: yY lA, j.- +' a�+,.. ,4,- ro y+ls N - t , ,' ,t.i. e`ri t;z"'1 7+�„fe h-,: k 3' ' . 3{'' '41'- „f.-'.45 .,'a,r .I
3-J ? .4y vSy ;S ;1:';,'"
`. . r y}� y�'/ t,0t, ,�,1J,44.' c. .,..,,,e.,/,.. ,..4g y i T %,-;,.--4';',..:,'
t a�RFs =r k 4 f,
� rt :+ SrfJr �rj, �� ����t"���. �.�'"rkj�+c�w� '. �:`e ��s,?..--..•r7A'',4-;e1,. -4'i
,i'i "1'„[..,�1 '' � at!! �'v } t >�
b 4r -2i.Y.T b Y}.at`:t t, x 5 t. .•y4ry;.s{• e f ,t-! SiM` 7 C. , I 'g t"
iitt
e a r / s '� x-. s"3. ,+h .37!At t x x 4,4F'. s `t`- t9z t +ndrs� a r?.b',1,.w m -t.-,'
¢'' v xrt;Ci f 1 t.:� .,g s, t {�` r,s��d,. r� fi�' asw.'{b .i.04%.,,;. ',.'�• > r '''''':';'''''' ''24.'!,.'
�3•.-r'.:1:-.1-t--4k � .:F F�' f 'r�sv!S '}"�`d'.r<'�f u�pv..'t%��yy � bw Eg �-;:Z.4,1.,4;.,,:;,'
>s�y,�. Sr,�- ir. 4r .0 � .tom �� 7 k 4' � �
:t`r5 i.14 1 � ¢. .t. t,r ;: •"tY� ^. 'yn £s" r .4 r 7y- 1•Yr ii,,X ;fes •tpr$ ' '?�..Y,t'e-r T 7 t Y
� ., .it S ,,;'' k'e' p 1 `file L+ ,' 4 ' r+k T- O.v k.. rc. �' ,i. r. •'1',ra, 4t,`'Ch r�", n ' .� 7 .hr,. #. >t+
,r rp•.: <. �7 �C�' +��,-. �r 4 3 -::r f'. a�.t.'.1"��e"�� ^� ��' - s{s i. J #r",41161:�•rrq .. .`tom• 'r.i. .�,ti@ �",s.;�r �..., . 0:a.�� a� �,i.•%� t+.� h� ,
' ,'-'4W.44-'2",i'' t r'3y 1•Y' ; + i'Ur�Yd;.s „t3 .•l rf ., • ? �w '�sii -, - • 4• + .' a+c St"•tr-
're, r '-.� . r' :41:. 91 i �N iF �'a ..a`:',E''Z "1-: xu s d,
• N::::.J,/b.7,r.-, t'Y d r; r ,:..'''';/.:4;;;M:*:;-';
:7 ,", ,,- �Y + `T- ):- [ +fs 1 A? n..: yrs ..Z-) {¢t" `''. 7 r t �rt°yrrN fy, -
YH.�4 + f f�a� 5 19 xn d A P rfR •t ..< +[rf'F Yet.k !(`J. t y. lf �Sli
r. ',+' -.0:71.-40.1"k%:
�-•is:F Z;: 4,', 7 w rx4;T an a r . Ins ,•r 4,,, , '', � + ss r.d,, ( r t
j d F y,,•;;:<„5-•?:;F�yY, Z t>v Y+s, :f'' y.. r j'''':
�x+. A; s-.•2+'t.'r' is -S4 •4 L,ryr,f„r } z +. 7 �y n i..t? �F :Tty+'�s r
T �? ib s � }i.. ';'-'.‘MAY } p Q i a s c g e r
twTt= :rE - > `��13 �: ,n, d rsP. ly s 3 apt. . r ;:� ri 4 d
'''6':5•14
.-`` < f 9Tr .:� :stt i3' ,t' t F ',.•.{:,.-n'•F t '�dl¢ ;R 0+ y.'.jr S.•+I•��'s' ''C .. rt #qt r. •Y
:kW L. r - t4xn? < ‘-'1!.''''':--'''''''''' '':''4,47;::'''t:
:) a :'T �`,:�A'/ � -t g.. -�.-'�C( Y �n'yt t +f.,; � .y'�t<' a�titt1S t
v 3 • r d . 7> x F r :� r J , fi r
r''r 1 i,+ sG:;.}`13 A ''. °',+u r-.i d1 a. r'S f' rg R r+•,- 'q�.„ t M. ,: 9b'r �' 'a'r 9' 'l r - ;'ii''''
.I-';:;;;.`!-
�..'�` � i'C+s �.• � a r�.'�'. t ,y, i+`.'ts�;j 4>� �� ./„f� ^'sr': r1 ttEyc ti4i. s 7 tis t • :.3 4t .� Y�'''>3, ,wt ',.
-:-':,,A,
� � > .� 1t n ., t>�. ,C'r yy t� , _}y f tj 4-3 .t. .r ` a ,riC"�'I.'�"�...
i 3'$'1;s g2nAi`4th.' I £�._ ` ' H r 7 x yr 4_,��r "7! :"1.:1;:
Y.- ,� ';ti f :. t a " 'G ,-. r wit } _:,` �S C.7 " ''r ;
l rr"{a�;a } �` A' S'�i. x �`"'r'r + V a�32��? t�r�.!'.,',.r'_,t^ "'} i"47'Nk a Y"+rr - 'f>w Itv .i -.a"t +,T ` rF. ,..'; : -4'
y
�' '7{ '"'-V/` " i <z,.: 4.0'< :. +Y{ 4 I:j. .`t��, ." y'a t,. iir '�2 '*. H i,'z :',1:•-
l .4, +w •' .Y
r_ k •t �' ,�, x h +` � .;�-'n �i -a` y3., 'vF• xd, 4 s1b.�&: v< st''-`,'4''f
dr e� y C.
_Tt'" r p k - 4 . 'r' !� 1 '.+ .y t r ti {; - ,t P ia' +' �
i'- . 'c+ f t Yc t.,1 i >:;rrx5' -� ', § c it`-e ,, u ? (� , 7'
� 4 T P
i.,.r'�.. ...,y'� ;,1-1'40.,,-.
r 1. ` ��t,�"7 � 7;,y§ ��:}�,, �o.R.., T^r ¢�.:'k k r f ir r �t `b '+u �
{15t.. -+T�. •-: � 7 rat .. �`4 �R+.- Vin€ �4 r Y aa.--..k-;'t• % ,X.i,3.1...-- -•::-v" i f a.-:t3.,.-s r 't„ijF . ``.•. I :y 1 .v �., t '/ r p VA ,}p bfN.'r.
•: ri - k '`..''',';'''4,.1xl it d'y�J, N Y '� t �e+• .. . RAF' �,�• uts'i- -'N3 av'e'r ' ayr'P, r-'t J O e 4 c rA 'Sc h l'y 'r3r,•'3'j-,°. :
I -f _ '" v 3r f7� i fl-c t'trl,,� :d }-,b.•,rj'1r� y P;:, d i .a 3 ;fid x.r',�' 4
%
`} �k`ZC' ;a7" ,s[,^ i.v� -j4, .,4 v,- uc:aYs i.r r tyfr o-l�-* `iv. y.. "'t."A+� t: i'� r a `4 -t z, Fry >'r J s id s
+ta;:- .ytF %' r 7 4- (1+r is7-9, ''- ' ' ''. '--f:b �i. 7" `4:: (� , q. 41- .rte; a '''s mfr r
'���i?#-��j r?8'4z1•'.;4:,,-.6-'7.-,;:;0.04:;11-:;-,:
`T r�_� {` 7? -[ t r-;6�.,as, J, �r1 .8�! _,_�Y/ �.�L ti'`a s -y 1 r :�<,r u� f -`lF a. }�a.S',6•,S•p ,�., � x y 1'•r
•
•'`' ej�y� Yw7',n.3. -- '+C 3 tr h x< ./yti5 s rM1;,"`p +1',r ^z -i� i::1..4-.;4]ic "°r !S ft' .(os�t+ .! �y'LY F. ..;',1,,,z1-0‘;'.1..-17e, ,,:,
::},�+y7k
"-i,1 f-e+1,, rg. s z - d P Y = 4?,. t; F"fi,7;. ry F :z.,yhS, ; ` _t;�,. r' f y �t5, N le•a. n'� $
:�t+ 7., ti r+ '.r } r• 7t 'i"j 4 r'x r J-'� � i"j' '•7 �'..tt� 'cY,�fi - r is�3'r � i.4 � a. .t.- y 7tih� .a +A`wh
� � ys.5 �a r.r+h3 '> s t �:.t+ "'� °f -� sz S-s>:7t y '.�� •��+ < y:��F d .y'_ + � � Y �Jfr r
• } 7 '"":��9 1 +.syl 3 ?;';;;;;;i4,
- 4r } nx b e F .;bs6 : If:.., tet.. YxcE iy. f y: ' r '`
k:1 k'7 'i.�' �+ T i` s4�:5.A.+ �, �� ; <.`'�' .! M r tt I' L .r e. 4"�} '#2~g t..�t g� 5 7 '.'Etx ,$•y ,�,; y a. v Sr'r 9. 't.,a,,'N
r "1,x. r t" 7.� p- �t k >`��k'da`'- ea} 1 .., d n<c +. ,t':r it R� -x- a �2 � . 'L ,- t,'.'4' �` ::•,!.}`ir..,,...P. s L`i ,'yy,. ''.-yrs+',
S 7 ..rim $Y vtP^t3'^Y: , S+Y t v S '.YHA 4t� b <r.' s';i4,-;;;,-;-:.. i•••,,,...,-'44,'.,,:..;.91-ay5'.- 5 '- < s^'KF•, pT�'# L ' x yt'.. S ,-{ the �. t'
:,. •,.ii, :
+. �" r4r�i,Yr '� `r r r< r 9 k T t - 4yv urt 7: k '•T .:, 4>d.r- _ f^ -" 'y.'Id 5 r r' ?Y�r,O:.tr'A`:( i i+ 7,:
s'f.�.A: :,;ri T 6 1 , 4 li, ti'N r< aK : •4"'t, b -. AO, . :.,,, r, y +SN ''1' C•. r fF+,_. +.. xc"-r t y• r fit. r
�,a 4.Yr -4' R� Y • .F S .�.. 1r d. w j<�t �t .. .
s � rH � ii �.�' s`rd<T '� a1. � 1 �ry� tkt, +�t`r'sb .�- r �...� - �J ', �a;% M-
�,a'1 x' 3 TAS i ,,' ,; T >fi --_.; -. :,. < >`4 �, :�" .�..l
,,,
L 53
' r �1 x.fi 1 &. d Y •�l '�: � moi' F
. . . --,
" k7���r 1•9' Fr tr r sjS- 1r��� �, ta4 � `�yv r� t ���j�( L-. z ,�,. ., ...::::,_:.:,.,,..,7:,;,..., -. -
�:, ',-'1:i.,- ;;
o n d+klYf }s<'"aa"r'i�., -4 $.t7kv1� 'd iA� rL i'X'
+t
r • �: y t� 3t.• +r•>� kfT - ;--,,....,... 7.,,,
r 3 � .�� �y- .. :
< r.a.-..•.:_...�9 7X.L t4.tz {r '4,4' v'' 4 �'� Y.'--"..t."-.4.:.----7-.k+7---7. - ,1,-'-''u., lits C -t � ..
--`. -.A. .. .-.,,�....,,.... .'^r > `3'X5 '
��'c4•. 7 - + t ' �y�"�'b t. X"t vA. dlL•�'.+T'r!;'+k ;
k F:Y v4. �Jo : X.3*y�t''�'+. 5'',
•
--;;:`,-','.1:',, 1. _ r
S�M r�� - . Y- L Ltd g f s •,r 3 ' r: rti'�'°j
tr °
r4v
d\ ) fir•
•
Y•i• • -
,.
d.
�f A n: • f i1 5.:
•
'7-...,5•0;',1:6-4,,,,,:,----
.fi • N h. .r
� 'ril t< `� t7�4'yv
if
rr��rtf`' :_;••••••:•:- .,-..,•!:',,,. .-.4,. ..,•�
•
Y
�.i��S'+' Ftf� '� � J ••
.,ys 1<it- 7r' }fi, § ! r i-1 1 5' i y''' Y+ 4J� '
p •
4 qt. S' ••'tf f a ,d'r ff t
t t 7 tt f'yrgv x `0 1
> �.k a +.r •ft 'k '' f:< rc - .'r 1r -,;(4;:-!.64'1.0i0,;;';';
c � F,��ti
•
1f$ it • a c.7 • .2• ,'.. .-:,c1: :?; •� +7t - � ;
ry,., i Jr);r^_, fy .1' i-^S t Y i.,::,..
Q k"1 ��4,, '� ..t'.1;4::.:' :'1:'.);::".:
r :t� s I ''.:4.)4,1",.' :: +G' Lt•„ ,ro
h`'���� �"s�. ,.��,t �� LU���: .`4x;r.k k"'� '�r,�qtr� `�`' <,e��a��i�,� � �r �z t .',.:i..,
�3 bx`�*�� � � •N
--.-X,
,!F5e x.2._ 'S t r3 tat.r'`a 611 f+`.. f s i /ii,.,•v.; ".r r` ✓' F", e.b J 1 l a r 5;, .'!..4'j*tr. ' + .r:•.5 �`l} "Y r
r l , ?•k. >r•,Cy.,.s3'� f s t 3 r',t °t,•041..;' +`t+e y st, n -Rr t rt 4• .t o r :za
",-;:1:4;2:-,,,,N:11.4,*. .! r+�_ : b; ,v :.rFir4 x (, A .�.ey v��>Yt:r� vaGt�;i}i � �`a- ',y t 44:`.r,•.Z d.E VSit -.ev-f f '„I. ..'„;:14r
`;•y4s ..�j v 1
xz”' x '; .^ fra�i.t [ F ?`'a yt"7z`r .�... ` • t'?�. 9ta' -"- •`r �t.:t +-.,• =..•; f`-1_ 'r,t l-.-•
��,y, 474kV 2rg y x�`t - :: L.F"- ,tt,sr.s X• :?'.y„4 ,, z'v c' - . s,t ?, a • ti
�' lH ) Fi '4,(; ^!4 U7�`- T, tom,., x rat y�r .a r .t 1Hi 4 y": i:' t E,t:' t' .irl
h�'.""' ra s , J F f> vr{'7 ,' ' •-i'
'.'L 4` '''4T`c , ''` :a.?�c? E .,•
ted ``31: a �•is •
.� ttA i1::-.,.41-#.0•,30,4:--,•-4.: t.,-,
f$t• t r rs: J;„t ,R tai '''' ',-.4:;(117'70-1P.
`r"" �.. 41,%:44''4‘.'sy $ y + ,-. s ire: y d
r3'E b +G a�>R ,y; ti,f+ �� ".,-x h, > .d' s= : .r. "�' 9
>' r.r r"'..trt( � Jf x ,ax' � �����` .r: � '�.� v � A ,� � r , ,f
A t ''''''.'-''''-','1,,;'4,-‘.
'L * v •.'>F v A (R n ' rf Act a t ?s« 7 at 4'` d s* -- ::1 75 to '7'1V4 :-....C:'''''
+ ..
,� �Ty�� fir•° � t .��„�� �x �,•'� � f s� a' : ,�zr��� �z t :`� a � a "4 � ;y
'� `amu f a°r r t;''fi; -,-1.'.;”•,%",t1,,'''''-'-',V.,;41,,', -yy.Lfyu'a" r Yf F > ♦ rpy nrP''R 9• * 1' `^t,.• , ' r. r•) ,1 '
f
�. ,r "'..r! t .`1' •tr y3:` yr :' ?1,4-:4 ;<'%.';';.':.-`..41'.4'
tF✓�ceyi.} r t r r t7y .td'''') iY r`-`cF�r• n �fy' .7�{cS y .,}4'7'''4_,4-,_':',';i:;:,..;
'<
9..k,"::"1...,:✓s:rsr'x ,/,14‘,,,,,,. ' ." =i v'e.".?'. ,: d"..,sat'ti. r54r`.'r^�.'v'.c- ^4.ts✓_ .$"._J'"'.s..iy. .... +F'r �i'�`Xk'z 7�Y::r. `r,G'xri':.. �,.� '�'.`', :'l Fi..{ r`t i'`...3.c-`"L. .....
brn
21 HENSHAW AVE — i? }. EP-2017-0626
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Map: 3113
Lot:200 ELECTRICAL PERMIT
Permit: Electrical
Category: INSTALL WIRING FOR BUILDING RENOVATIONS
Permit 4 Electrical
PERMISSION IS HEREBY GRANTED TO:
Project JS-2016-002375
Est.Cost: Contractor: License:
Fee: $269.00 CROCKER COMMUNICATIONS INCMASTER ELECTRICIAN 14899 a
Owner: SMITH COLLEGE OFFICE OF TREASURER
Applicant CROCKER COMMUNICATIONS INC
AT: 21 HENSHAW AVE
Applicant Address Phone Insurance
P O BOX 710 (413) 772-1800 C- Liability, b4023044910
GREENFIELD MA01302 ISSUED ON:1/19/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:
INSTALL WIRING FOR BUILDING RENOVATIONS
Call In Date: Date Requested Inspection Date/SignOff: Reinspect?:
TrenehluG:
Special Instructions
p
Rough J-/0 - /l flex-,
x
Special Instructions:
Pin&j (e-/4 -/7 ?i'-
SRE Called In:
Signature:
Fee Type:: Amount: DatePaid
Electrical $269.00 1/19/2017 0:00:00 13932
212 Main Street.Phone(413)587-1244,Fax(413)587-1272-Inspector of Wires -Roger Male
p . we v arY « `_st .. /fes �LC-JS. 07at/ca di./(>21C, OO___
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
�. ."CITY !4 a / lin.,____„_ __j MA DATE ////t/AZ „ I PERMIT#_I P-1T I C
JOBSITE ADDRESS: it j OWNER'S NAME- J'scS( LO LILY Mi
G
OWNER ADDRESS . iTEL FAX _
TYPE OR OCCUPANCY TYPE COMMERCIAL_I EDUCATIONAL/1(j RESIDENTIAL__I
PRINT
CLEARLY NEW:J RENOVATION:XJ REPLACEMENT: J PLANS SUBMITTED: YES J NODI
APPLIANCES1 FLOORS- PSM 1 2 3 4 5 a 2 a 9 10 it 12 13 14
BOILER _ . L. ____i __. ....
BOOSTER _ — _,_.. -.-
ICONVERSION BURNER .. ' 1 7 m
COOK STOVE •
DIRECT VENT HEATER
DRYER ---- .._ MB III Irk r n
FIREPLACE
FRYOLATOR
” FURNACE -_____ : ._ , _.. _ - _.. _ _ A, ncarnanoron .uou
GENERATOR
GRILLE _ _ ._. _
INFRARED HEATER .._ _ _. �. .. _ _. -.
LABORATORY COCKS
MAKEUP AIR UNIT =_s,_ _ . _ . . _ '
OVEN
POOL HEATER
ROOMI SPACEHEATER
ROOF TOP UNIT i I .. i. i I _ .� rilli " (
TESLn ,
UNIT HEATER i,. f_. . __ .5 •_.__I___-..`__ r„ I . 1 _._-.' _....-
UNVENTED ROOM HEATER f f__ ` ' _ I J 1 _ _
WATER HEATER _ ._( ._ _ �� .._
OTHER (hp, .‘....&- . !—Li: r 1- . -
„_;
.. r I ! ...
INSURANCE COVERAGE
1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL.Ch.142 YES IJ NO _.
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY'%I OTHER TYPEINDEMMNITY J BOND LI
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 J AGENT J
SIGNATURE OF OWNER OR AGENT
I hereby cerafy that all of the details and information I have submitted or entered regarding this application are trruuueea_and accurate to the best of my knowledge `
and that ail plumbing work and installations performed under the permit issued for this application wIDgg in m� :�ae11`- Pao the '
Massachusetts State Plumbing Coda and Chapter 142 of the General Laws. jt,a t
PLUMBE_R-GASFITTER NAME t\dS-d I MF+e'�t=`.f`- i LICENSE#Walt j c . OR,. .____/
MP 74l MOF ._i JP J JGF I [PO.,J CORPORATION iAcf# Io'9t'i PARTNERSHIP J# „f LLC I#___.,__j
COMPANYyNAME: Mf man tn4.. I ADDRESS,,PO t,,,ox_, '� � __SHN,,iLit I
CITY ta*W t`t}t i C STATEW{`t+4 I ZIP'6 ID Ofl TEL s-41..268 12-CI__-_'
FAX 10 Z fr,Inc!CELL ._ EMAIL _ __�_, _......�� ___
Jr
•
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT D D
FEE: $ PERMIT it
i$7/4 PLAN REVIEW NOTES
SlYIP C._.
Arr.-
%{/J
- - J
•
/6 /O Srn v-t -rt �5 as 2)o -,3/ 0. ov
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -1 /`
CITY_ tQo Ti H_�T`^. _ _'", Vr'NI r..4'7 DATE ,,.__:PERMIT'# VP-it2-'aI0
JOBSNTE ADDRESS. 2/ /iex5/.wt,.. FI-c IOWNER'S NAME Srn;r/s Lo//r;e..-_ _
P . OWNERADDRESS:___ =TEL' y FAXI_ _ J
Pin OR OCCUPANCY TYPE: COMMERCIAL EDUCATIONAL 2( RESIDENTIAL
PRINT
CLEARLY NEW:❑ RENOVATION:2/ REPLACEMENT❑ • PLANSSUBMITTED: YES❑ NO❑
FIXUTRES7 FLOORS. Bunt 1 2 3 4 1 5 6 7 8
BATHTUB - �� �II
DEDICATED
— � 11
DEDICATED SPECIAL WASTE SYS I -
DEDICATED GAS/BIUSAND SYSniii_ a
DEDICATED GREASE SYSTEM - '
DEDICATED GRAY WATER SYS euwi�irvse . . I
DEDICATED WATER.REUSE SYS -
DISHWASHER . — I
DRINKING FOUNTAIN I / • i.
FOOD WASTEGRINDERDNIT I • _
FLDORIAREA DRAIN - -I _ - �
INTERCEPTOR INTERIOR '
KITCHEN SINK I •• —
LAVATORY I I _
ROOF DRAIN •
SHOWERSTAU2 - — —
—
-
SERVICE/MOP SINK I a
TOILET - ' I I _ -
URINAL _ - _
WASHINGMACHINE CONNECTION _ •_ '
WATER HEATER ALLTYPES _ • • - _
WA]ER PIPING r/ ✓ ✓ -
•
INSURANCE COVERAGE
I have a currenttiability insurance policy or its substantial equivalentwhich meets the requirements of MGL.Ch.142 YES III NO D.
If you have checked YES,please indicate the type of coverage by checking the appropriate boxbelow,
LWBIUTY'INSURANCE POLICY Kv- OTHER TYPE INDEMNITY D BOND ❑
OWNER'S INSURANCE WAIVER I em 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 D.
SIGNATURE OF OWNER ORAGENT .
I hereby certify that all of the details and information I have submitted for entered)regarding this application are true and accurate to the Crest of my. •
Knowledge and that ai plumbing work and installations performed underthe permit issued fortis applicationwll be in compliance With all Pertinent
provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws, .
-
PLUMBER NAME: i i 61_,GLI I ?yettAY1, .T+Z __i LICENSE# Milt la I IGNATURE
COMPANY NAME:IM.S. 1+1n[znra 2 C, IADDRESS: 'I Sou-kin Main Stf2 '} __
CII(: tteIsmktii;It_ _ __1 STATE: m2 IJP: i- 011/39_______I FAX INt3_dbt-931 I
TEL Iii i-a1/4. a51 .J.CELL ____________I EMAILI_ „ryy nivn_crzanine , ePin ________-1
MASTER JOURNEYMAN 0 ' CORPORATION 10# IAi C PAK I NERSHIP 0 ft I ILC❑Pt _ . _.