23D-023 (7) 496 ELM ST BP-2018-0712
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map-.Block:23D-023 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categorv:ADD BATH BUILDING PERMIT
Permit# BP-2018-0712
Proiect# JS-2018-001303
Est.Cost: $10500.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const Class: Contractor: License:
Use croup: Homeowner as Contractor_
Lot Size(w.ft.): 4007.52 Owner: DUBINSKY JONATHAN
Zoni=URB(1001I Applicant: DUBINSKY JONATHAN
IT. AGC, CI A,1 ST
Applicant Address: Phone: Insurance:
496 ELM ST (913)900-9411 (4)
NORTHAMPTONMA01060 ISSUED ON.111112018 0.00:00
TO PERFORM THE FOLLOWING WORK CONVERT EXISTING PANTRY TO HALF BATH
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: Z/2�� Rough: n 'a' �1& House9 Foundation:
r ` h Driveway Final:
Final: .3�(���' Final: 3 ) `Y/'l / �t
a 3P� Rough Frame
10
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation: _
�- Final - Smoke: Final' G1ti 31/�ly7T/
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of OccuoanO62 -//z �� signature: �J I7TN+
FeeTvpe: Date Paid: Amount:
Building 1/IM0180:00:00 $65.00 -
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
496 ELM ST EP-2018-0596
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Map: 23D
Lot:023 ELECTRICAL PERMIT
Permit: Electrical
Category: WIRE BATHROOM
Permit# Electrical
PERMISSIONIS HEREBY GRANTED TO:
Project# JS-2018-001303
Est.Cost: Contractor: License.
Fee: $65.00 LUIS R ELIZA Joumeyman 38395E
Owner: DUBINSKY JONATHAN
Applicant: LUIS R ELIZA
AT. 496 ELM ST
AnolicantAddress Phone Insurance
1131 FLORENCE RD (413)222-1113 C- Liability, MPB45943
FLORENCE MA01062 ISSUED ON:2/I/20I80:00:00
TO PERFORM THE FOLLOWING WORK.
WIRE BATHROOM
Ca11In Date: Date Requested Inspection Date/S.lenOff: Reinspect?:
Trench/UG:
Special Instructions
x
Rough rh'
x
Special Instrucfioas:^^
Final: '9 -/3-/r/ �n
SRE Craned In:
Signature•
Fee Twe:: Amain: DatePaid
Electrical $65.00 2/1/2018 0:00:00 1832
212 Main Street,Phone(413)587-1244,Fax(413)587-1272-Inspector of Wires -Roger Malo
NuetlL LPSZP60-11�2 "`
.Qx MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
y
CITY I kh.-41 rp A'n MA DATE l d PERMIT#
JOBSITEADDRESS 4-911 Ell OWNERSNAMI NbAkl
P OWNER ADDRESS I I TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL El RESIDENTIAL®
PRINT
CLEARLY NEW.[j RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO[]
FIXTURES? 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 GASIOILISAND SYSTEM - --
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER - "PW
DRINKING FOUNTAIN - -
FOOD DISPOSER _
FLOOR I AREA DRAIN
INTERCEPTOR(INTERIOR) A _
KITCHEN SINK
LAVATORY
-
ROOF DRAIN
SHOWER STALLK�
SERVIMOPS94K
TOILET
URINAL -- - --
WASHING MACHINE CONNECTION-1214
WATER HEATER ALL TYPES
WATER PIPING
OTHER _ _
INSURANCE COVERAGE:
I have a current iability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El No 11
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY❑ OTHER TYPE OF INDEMNITY ❑ BOND
OWNER'S INSURANCE WAIVER:I am aware that the licensee dues 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 0 AGENT ❑
SIGNATURE OF OWNER OR AGENT
I hereby carafy Nat all of Ne details and infonnatian I have sudn or emend regarding N'w apprisation are true and acramte to Ne best of my knowledge
and that all plumbing work mid instillations pertonaed under Ne pemitissued for this application vett be inace vMh,aa"Pertinem pmWsbn o/the
ns
MassanhuseState Plumbs g Code and Chapter 142 of the Gal Laws. ' � C/
PLUMBER'S NAME I Q 6IIur* 13. Sc.), A.(' LICENSE* 4110 SIGNATURE
MP® JP El CORPORATION®# N{]3 PARTNERSHIP❑#=LLC❑#
COMPANY NAME 'derI�I...blry+-H,.j6 Sic. ADDRESSF150 Box 3A3
CIN1 Ile- STATE® Zip OI039 TELI(41-!) - cooa
FAX 13)21S R4P7 CELLEMAIL I 5 ti1634 P Yokm.Csr
A`dC s
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