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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY: / EA-af-li!6-j MA DATE: 4- 141 -1 6Pp PERMIT# (.¢P- I )- �
JOBSITE ADDRESS: [! �� U�r� < So OWNER'S NAME .,1 M 1', I—Y.e—
G OWNER ADDRESS: TEL: Y/3 S V-71r4jX:
TYPPRI OR OCCUPANCY TYPE: COMMERSa,4L❑ EDUCATIONAL ❑ RESIDENTIAL
PRINT 1C��'/
CLEARLY NEW:❑ RENOVATION: REPLACEMENT:❑ PLANS SUBMITTED: YES❑ N
APPLIANCEST FLOOR-• Bsmt 1 2 3 4 5 6 7 8 B iD 11 12 13 14
BOILER waw Iowa 01
BOOSTER
CONVERSION BURNER
COOK STOVE
DIRECTVENT HEATER
DRYER
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCK
- MAKEUP AIR UNIT
OVEN
PoOL HEATER PLU BING GAS N P
ROOM/SPACE HEATER TON ED
ROOFTOP UNIT
TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES ❑
If you have checked YES please indicate the type of coverage by checking the appropriate box below.
LIABILITY INSURANCE POLICY'Os— OTHER TYPE 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 pennk application waives this requirement
CHECK ONE ONLY: OWNER E] AGENT ❑
SIGNATURE OF OWNER ORAGENT
hereby certify that all of the details and information I have submitted(or entered)regarding this application are true aim
my
Knowledge and that all plumbing work and installations performed under the permit issued for this application will b� nent
provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER/GASFITTERRR NAME:_ Fri•°- G/q+�a' LICENSE# ZS` .L7 p
COMPANY NAME:_I-, U• T• N. ' -dADDRESS: �� � �
clTr: /Vorl L Soh 1/ STATE /vl/r ZIP: f 00 O FAX
TEL:_ CELL: EMAIL X--4+��4�w+a•%.sl2fne �g(L cot-+
MASTER❑ JOURNEYMAN P INSTALLER❑ CORPORATION❑# PARTNERSHIP❑# LLC❑#=
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MASSACHUSETTS UNIFORM APPLICATION FOR
A PERMIT TO PERFORM PLUMBING WORK
CITY NO(�i'/'n �^I MA DATE / '143 -/L PERMIT4
rt-r1r�
JOBSITE ADDRESS h ZdQ^X-4J (10 OWNER'S NAME SAIt
POWNER ADDRESS TEL n?` 7 S/Z I FAX
TYPE OR OCCUPANCYTYPE: ,C_O,MMMEElERCIAL❑ EDUCATIONAL El RESIDENTIAL
PRINT :❑ v
CLEARLY NEWRENOVATION:p� REPLACEMENT: PLANS SUBMITTED: YES❑ NO
FIXTURES T FLOOR- BSMT 1 2 3 4 5 6 7 8 9 10 11 '2 13 '4
BATHNB /
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYS
DEDICATED GASIOILSAND SYS
DEDICATED GREASE SYS
OEDICATD GRAY WATER SYS -
- -- -_- _--
DEDICATEDWATERRECYCLESYS
DRINKING FOUNTAIN
DISHWASHER
FOODDISPOSER
FLOOR/AREA DRAT IJ
INTERCEPTOR(INTERIOR
KITCHEN SINK
LAVATORY
ROOF DRAIN
SHOWER STALL PLUN IN
SERVICE I MOP SINK
TOILET
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES Z
WATER PIPING
OTHER
INSURANCE COVER
I have a current liabilib,insurance policy or its substantial equivalent which,r
IF YOU CHECKED YES,PLEASE INDICATE TYPE OF COVERAGE BY r„ !
LIABILITY INSURANCE POLICY OTHER TYPE OF INC
OWNER'S INSURANCE WAIVER:I am aware that the licensee does not he 00,n r_, yam. tf the
Massachusetts General Laws,and that my signature on this permit applta W — L vs
CHECK ONE BOX C
Signature of Owner or Owner's A ent _
I hereby certify that all of the details and information I have submitted (or am o the
best of my Knowledge and that all plumbing work and installations perfom be in
compliance with all Pertinent provision of the Massachusetts State Plumbing C
PLUMBERNAME ��.�—��( Uq}r�-e SIGKA
LIC# Z.S //9 MP❑ JP LL'' CORPORATION ❑$ _ PAk INeH{J7HIF'�LU/# LL`C LJ#
COMP,A,��NJJY NAME j?. 4jt • Ht ADDRESS Ik'5
CITYAi—Y^�✓` +-A/ STATES A ZIP OLOfpO EMAIL �t-�"1V gTlr na �Z�J\`C/i YAh oa .G h
TEL CELL YR 32J- ZYY-L_ FAX
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19 EDWARDS SQ
GIs — s� `
Ma : Iock:31R, 117 COMCU N,
Lot:.Opl i� EALTH OF 117ASSAC BP 2o17-p125
—Pertmt BDIIdID PERSONS CONTRACTINGCITY�pg NOR 11USETTS
SSTHE GUNREGI IAMPTON
Category. � DO NOT
HAVE ACCESS T STEREO coNTR,IcroRs
renovation UARANTY FUND (MGL
P_itn UILDING p}� c.142A)
BP20j:7- 0125 1�(YjIT
Pro ectN
Fsr�Cosb g000.00 17-000209
F- 312.00
cons PER yJSSIONIS
useGroan COntractur: HEREBY GRINTEDTO:
Lot sire q n.Z 3049.20 H4neowner as Contractor License`
Zon"nom URC1, 1 Owned—OR SAMUEL&SHERRY
9.0—icantr TAYLOR cp—
2 00/cunt_ reams AT.• 19 EDIT/ O SO " & SHErR
URTII ST
NORTHAMPT Pkv
ONMA01p60 ISSUE 413 588-7421 zsur
TO PERFORM THE FOLLOWING Iy n016 0:00:00
SHEETROCK ORK RE
MODEL KITCHEN, REMODEL BEDROOM,
POST THIS CARD SG IT IS V
Inspector afPlumhing h� ISIBLE FROM TIiF, STREET
pector of Wiring
Underground: D.P.W.
Service: Building Inspector
Rough: /6 Rough: Meter; 7-
tCb–Ly–A(„
RSM Hous,# Footings;
Final: Drivm y Hash Foundation:
Final;
$ 31. 17 Nal R/ !G Aor e, _a t�1
Gas: 0.� Rou¢gb FramQ..
Fire De an., 0 w 47Xt 7
TTe��.. l.t�Y'Hi ad7`��Y MAir
Fireplace/Chimney; G./S
Uhl:
Final:
Insulation;
6 1 7 v ls>~
THIS PERMIT MAYBEREVO Final: � 0� ��. 1
ANY OF ITS RULES ANDRE KED B
THE C1Ty 7<—w
j_"/
N ORTHAMP'1'ON UPON VIOLATION OF '
ertficate of Occu ant y
d / p
nature: u2p ��'^
eeT e;
le D ount•
ilding
d.'7120160:00:00 $312.00
212 Main Sh!C14 Phone(413)587-1240,Fax:(413)SS7-1272
Louis yasbrouck—Building Commissioner {
t
19 EDWARDS SQ EP-2017-0185
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Map: 31B
Lot 117 ELECTRICAL PERMIT
Permit: Electrical
Category: REWIRE 2 FAMILY HOUSE
Permd9 Electrical
PERMISSION IS HEREBY GRANTED TO:
Project, JS-2017-000209
Esc Cost: Contractor: License:
Fee: $125.00 STEVEN KEYES MASTER ELECTRICIAN 21213A
Owner: TAYLOR SAMUEL & SHERRY
Applicant: STEVEN KEYES
AT.- 19 EDWARDS SQ
Applicant Address Phone Insurance
3B STATE RD (413) 422-1220 () C-(413) 695-4968 Liability, BDXGXZ
SOUTH DEERFIELD MA01373 ISSUED ON:8/30/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:
REWIRE 2 FAMILY HOUSE
Call In Date: Date Requested Inspection Date/S'¢nOfD Reinspect?
Trench/FG:
Special Instructions
X
Roush /0 - 1/- / (L 9FI.
Special Instructions:
Final: ' .31 - ,RI"'
2
SRE Called In: Ot `7 Or J�'Y3
Si-nature:
Fee Type:: Amount: DatePaid
Electrical $125.00 8/30/2016 0:00:00 5229
212 Hain Street, Phone(413)587-1244,Fax(413)587-1272-Inspector of Wires -Roger Malo