38B-293 (2) 138 WEST ST BP-2017-1526
GIs#: COMMONWEALTH OF MASSACHUSETTS
Mao:Block:38B-293 CITY OF NORTHAMPTON
Lot-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL C.142A)
Category:Plumbing BUILDING PERMIT
Permit# BP-2017-1526
Pr0im# JS-2017-002551
Est.Cost $69000.00
Fee 5448 PERMISSION IS HEREBY GRANTED TO.
Const Class: Contractor: License:
Use Group DAVID JAGODZINSKI 106068
Lot Size(sa ft) 10323 72 Owner: SAFE JOURNEY LLC
Zoning,URC(1001/WP(82V Applicant: DAVID JAGODZINSKI
AT: 138 WEST ST
Applicant Address: Phone: Insurance:
P O BOX 204 (4131230 9160 WC
NORTH HATFIELDMA01066 ISSUED ON.•7/20/20170:00:00
TO PERFORM THE FOLLOWING WORK.REMODEL INTERIOR OF HOUSE "'CHIMNEY
MUST BE REPLACED***
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: Rough: Room Foundation:
p Driveway Final:
Final:Z/3 /p Final: /_ (� .�
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Insolation:
Final: -2,12- Id Smoke: / $
Final: r/c-® 7-11-11F
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND
DRREG
QTiLA Ol/yS.��
Certificate of Occuganc4/ / Ail f L �V S nal e A,,. A- (ea,,C4
FeeTvpe: Date Paid, Amount:
Building 7202017 0:00:00 $448.00
212 Main StreeS Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
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NO LEC-
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138 WEST ST EP-2018-0019
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Map: 38B
Lot:293 ELECTRICAL PERMIT
Penns: Electrical
Category: WIRE RENOVATION
Pennit4 Electrical
PERMISSIONIS HEREBY GRANTED TO:
Project tt JS-2017-002551
Est.Cost: Contractor: License:
Fee: $125.00 STEVEN KEYES MASTER ELECTRICIAN 21213A
Owner: SAFE JOURNEY LLC
Applicant: STEVEN KEYES
AT: 138 WEST ST
Anulicant Address Phone Insurance
13 STATE RD (413) 422-1220 () C-(413) 695-4968 Liability, R1216217A
SOUTH DEERFIELD MA01373 ISSUED ON:7/11/20170:00:00
TO PERFORM THE FOLLOWING WORK:
WIRE RENOVATION
Call In Date: Date Re t d I tiDate/SienOff.. R ' t'
TrenchfUG:
Special Instructions
X
Rough -7- 3/ tK:f'
x
Special Instructions:
Final: -aa2'/T M v+ 0-3-/ tZ.n"-s /-,P Y/
SRE Called In:
Signature:
Fee Txue:: Amount: D t P 'd
Electrical $125.00 7/11/2017 0:00:00 5970
212 Main Street,Phone(413)587-1244,Fax(413)587-1272-Inspector of Wires -Roger Malo
— MASSACHUSE7'TSULLN,,IFQRM APPLICAT70N FOR APE—RMfIT—TO�PERFORM P�.UhiBIN 'r`//OR�K�
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PRINT
CLEARLY NEA:[] RENOVATION: REPLACEM—E'Fr,0 PIANS SUSMITTED: YES❑ No
FXNRES I FLOOR— 95M 1 2 u 4 5 6 rr a 9 to 11 12
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FEB DISHWASHER
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WATER HEATER ALLTYPES — .. -�. .. ;, ,`✓0.WATER PIPING
OTHER —7
INSURANCE COVERAGE '�-
I have a amen[) b+LN imoance pafieJ or Hssnbsierlmf equWatest wfiich meets the regniremmt5 cXMGL CF I YES u- NO ❑
t6 Y%CHECXEv YES PiFASE 1NL71LATc 5NE JYPE OF COVERAGE BY CHECKING.ME APPROPRIATE SOX BELOW
IJASIL INSURANCE POLICY [yam/ OTHERNPEOFINOENNITY ❑ BONO ❑
O1VNER"S INSURANCE WAIVER:t am aware that the tit:v¢ee does rvx have Ne irzstuarrce coverage reguued oy Chapter i42 of the
�MassaeMiSe¢s General Laws,and Ina[rtry signature an this permit application waives this requirement
CHECK ONE ONtY: OWNER ❑ .nGEN7
SIGNANRE OF OWNER Oft AGEN I ,I
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PlLMBE4'S NAME KJ��IC�, GJ�i�S-� 1� � f �� SYfit`617URE�1
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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORIN GAS FITTING WOR 11
CITY: �a� a.v�rjfbil MA. DATE: 3/ ccpp PERMIT#(,pP -3/
JOBSITEADDRESS: 138 Wl SE, OWNER'S NAME: c.7H�L L�cUrncv`S GL
GOWNERADDRESS: C3!y VC(n0/t Sf-. TEL:
TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL IM
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO❑
APPLIANCES? FLOOR— Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER
CONVERSION BURNER
COOKSTOVE
DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR
GRILLE
INFRARED HEATER Di
LABORATORY COCK
MAKEUPAIR UNIT
OVEN
POOL HEATER- nc, lumdn 8 Gas s ec1'
ROOM/SPACE HEATER o amps t
ROOFTOP UNIT
TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalentwhich meets the requirements of MGL.Ch.142 YES VNO NO ❑
If you have checked YES,please indicate the type of coverage by checking the appropriate box below.
LIABILITY INSURANCE POLICY 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 permit application waives this requirement.
CHECK ONE ONLY: OWNER ❑ AGENT ❑
SIGNATURE OF OWNER OR AGENT
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 Jib r�ompliance with all Pertinent
provision of the Massachusetts States Plumbing Code and Chapter 142 of the General Laws.
PLUMBERIGAS-TIER ME/1: ApI�fCtJ Wff f LICENSE# 3_ D��Q 5 ATURE
COMPANY NAME:_ �nC/Sv 2 h� ADDRESS: aOC C l..//c -�,4
CITY: n0cm0^1i STATE: At ZIP: 010FAX:
TEL CELL: 7�. Js% Sy MAIL: �� 0 /03 V�oljcoti
MASTER❑ JOURNEYMAN t
LP INSTALLER❑ CORPORATION❑# PARTNERSHIP❑# LLC❑k
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