23D-149 (19) 115 -W HINCKLEY ST-BLD 1 BP-2017-0446
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23D- 149 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:NEW TWO FAMILY BUILDING PERMIT
Permit# BP-2017-0446
Project# JS-2017-000747
Est. Cost: $279984.00
Fee: $1266.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: WRIGHT BUILDERS 101536
Lot Size(sq. ft.): 54450.00 Owner: FRIEDMAN THOMAS H&
Zoning:URB(100)/ Applicant: WRIGHT BUILDERS
AT.- 115 - 'P�HINCKLEY ST - BLD 1
Applicant Address: Phone: Insurance:
48 Bates St (413) 586-8287 (116) Workers Compensation
NORTHAMPTONMA01060 fy,SUED ON.•10/17/2016 0:00:00
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IQX MASSACHUSETTS UNIFO_iZM C��.
APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
. CITY •(A?,- � MA DATE / PERMIT#
JOBSITE ADDRESS OWNER'S NAME1 - --
POWNER ADDRESS TEL
FAX E-=
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL [ RESIDENTIAL
PRINT
CLEARLY NEW: ( RENOVATION: „ REPLACEMENT: j PLANS UBMITT�E� YFFS NO
FIXTURES Z FLOOR— BSM 1 2 3 4 5 6 7 8 9' '1,1 11 12 13 14 '
BATHTUB
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIUSAND SYSTEM I
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
-
DISHWASHER
DRINKING FOUNTAIN ---
FOOD DISPOSER
FLOOR/AREA DRAIN
3 m _
INTERCEPTOR(INTERIOR) _s� _. �'"_• I _ __ m
KITCHEN SINK
LAVATORY
ROOF DRAIN .
SHOWER STALL . • _ ....�.....•.,.
SERVICE/MOP SINK
TOILET I---
URINAL - --- -
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES i
WATER PIPING �
OTHER
S
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YESkV
j NO [ "l
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY!'-1OTHER 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.
SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER ,__..I 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 P inent provision n the
Massachusetts State Plumbing}Code and Chapter 142 of the General Laws.
MP JP[ CORPORATION #L'
PARTNERSHIP[)#=LLC D#E=
COMPANY NAME ADDRESS ��d
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CITY -------
STATE /yjZIP �Q�~�........�..� TEL
FAX CELL[::=EMAIL