23A-253 (8) MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY'Northampton_ tl ��, MA DATE( 11/22/2017 PERMIT#
JOBSITE ADDRESS 193�k St� µ OWNER'S NAMERebecca�Muller
OWNER ADDRESS1 3 Nonotuck St _ U „µ N TEL 413-427-0689 FAX
�__...
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
PRINT
CLEARLY NEW:% RENOVATION: REPLACEMENT:t. PLANS SUBMITTED: YES`E NOD
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 I
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN ¥
INTERCEPTOR INTERIOR Ie c P u b'n 4 as IT
KITCHEN SINK
LAVATORY 1
ROOF DRAIN
SHOWER STALL
SERVICE 1 MOP SINK _ r_. _ ..
TOILET 1
URINALWASHING MACHINE MACHINE CONNECTION t
WATER HEATER ALL TYPES
WATER PIPING
OTHER ; C ,. M . i ,
I YL AL
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 D OTHER TYPE OF INDEMNITY - BOND 0
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 ONL OWNER Fj AGENT U
SIGNATURE OF OWNER OR AGENT
1 hereby certify that all of the details and information I have submitted or entered regarding this application A tr a an c rat o the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will b n c m lian w' Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAMEJohn T.Geryk __-- LICENSE# 16479 SIGNATURE
MPS;' JP CORPORATION #; PARTNERSHIP # LLC[J# _ 1
COMPANY NAME Jahn T.Geryk Plumbing&Heating ADDRESS'20 Jackson St.First Floor
CITY[Northam town STATEMA ZIP
101060 TEL413-727-3057
FAX I CELL[4j:3-3j6-3893 EMAIL ice. lohnt erykpiumbing comMu
Id/a�/,�
193 NONOTUCK ST EP-2018-0353
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Map: 23A
Lot:253 ELECTRICAL PERMIT
Permit: Electrical
Category: WIRE NEW 2ND BATHROOM
Permit# Electrical
PERMISSION IS HEREBY GRANTED TO:
Project# JS-2018-000736
Est.Cost: Contractor: License:
Fee: $65.00 IAN T DURYEA ELECTRICIAN Journeyman Electrician 13109B
Owner: RAVETT ABRAHAM & REBECCA J MUL
Applicant. IAN T DURYEA ELECTRICIAN
AT. 193 NONOTUCK ST
Applicant Address Phone Insurance
120 MORGAN ST (413) 262-0142 C- Liability, MPT9085E
HOLYOKE MA01040-2016 ISSUED ON.1119/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:
WIRE NEW 2ND BATHROOM
Call In Date: Date Requested Inspection Date/SignOff• Reinspect?:
Trench/UG:
Special Instructions
X
Rou h
X
Special Instructions:
Final: //'/q l7 lZ
SRE Called In•
Signature:
Fee Type:: Amount: DatePaid
Electrical $65.00 11/9/2017 0:00:00 0542
212 Main Street,Phone(413)587-1244,Fax(413)587-1272-Inspector of Wires -Roger Malo
193 NONOTUCK ST BP-2018-0419
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23A-253 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ADD BATH BUILDING PERMIT
Permit# BP-2018-0419
Proiect# JS-2018-000736
Est. Cost: $25000.00
Fee: $163.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: HANS DALHANS 101628
Lot Size(sq. ft.): 10672.20 Owner: RAVETT ABRAHAM&REBECCA J MUL
Zoning:URB(100)/ Appitcant. HAMS DALHANS
AT. 193 NONOTUCK ST
Applicant Address: Phone: Insurance:
11 CHERRY ST (413) 977-6094
EASTHAMPTONMA01027 ISSUED ON.•1012312017 0:00:00
TO PERFORM THE FOLLOWING WORK.-ADDING A BATHROOM IN A 2ND FLOOR
BEDROOM
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: �� J7 i7 Rough: House# Foundation:
Driveway Final:
Final• Final: ,r
/3/-- �^ Rough Frame:
Gas:. Fire Department Fireplace/Chimney:
Rough: Oil
Insulation: (7k �Z/S/�-7 �,�•{
Final: Smoke: Final: C'/ - (P
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS. p�
Certificate of Occupancy��'iL - si nature:
�T c.t.a /414 Y6 oj'
FeeType: Date Paid: Amount:
Building 10/23/2017 0:00:00 $163.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner