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31D-123 (10) 0r10y30r& x/05 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY: lI`r Cf1MP MA. DATE: yI( `` 1 PE,R.MfIT#6-- 16 -175 JOBSITE ADDRESS: 76-76 M-INoh(.( S�, OWNER'S NAME: Alfa IrNR;Nk GOWNERADDRESS: TEL: FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:L?-, PLANS SUBMITTED: YES❑ NO❑ APPLIANCES) FLOOR- Bsmt 1 - - . - 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOKSTOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT OVEN ROOM I SPACE HEATER ROOF TOP UNIT APP cve 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 ❑ NO ❑ If you have checked VES please indicate the type of coverage y 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 will be in compliance all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. lr PLUMBERIGASFITTER NAME: I AA'Awr--o II 1� LICENSE#�n� COMPANYNAME:Jew+ I"W11,1 Oku� ,(i kv+Ne<�fli.x ADDRESS: r6 Qby 6�N CITY: •: STATE: m°! zip: Gla?L FAX- TEL:- AX:TEL: �/ CELL: NlZ-(o26-,�.'1�� EMAIL: MASTERtl JOURNEYMAN❑ LP INSTALLER❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# 3 t a—a2 ) ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PER IT ❑ ❑ S�/S��.G AP6�3 K6 2;;J FEE: $ PERMITA /7L PLAN REVIEW NO �S January 10,2017 Mr.Alex Ghieslin 70-78 Masonic Street Northampton, MA 01060 Dear Madam, Following the installation of 3 boilers and a Gas inspection of the above property in April 2016 you were given 30 days to ensure that there is proper Carbon Monoxide protection at this address. You should have been informed that the Plumbing&Gas Inspector would be checking back with you to make sure this was done. Our office has attempted to call you a number of times with no success. We also sent a letter on October 5`"2017. Please call our office as soon as possible to schedule an inspection. If our office is not contacted the Gas Inspector will have to contact Columbia Gas regarding the matter and your service could be interrupted. Thank you. Northampton Building Department Office of Inspections (413)587-1271 Ili I i rya;//NlA1117/.'Ili i— f f VIII IIIIIIIIIIIIIiIIIIIIII III II III 't1 US.POSTAGE)>W�—s L 2iro,DaD S 006.56° a 02 4n 0000340471 JAN 17 2078 7016 0910 001 6815 6180 RETURN IN 5 DAYS DEPARTMENT OF BUILDING INSPECTIONS 212 Main St. th Rm. 100 • 010%al Building o _ // „ U Northampton,MA 0106D3189 ��,111 ��(�' /� 70 - 7Cv NLaso�rc �{ pu'`m ! H� NIXIE 061 9E 1 8661/18/18 1 RETURN' TO SENDER E RETjRIIf'( EIPT REOUESTE ATTEMPTED - NOT KNOWN UNABLE TO cORWAP- _. 94009:14640:3'.'.0 ANK sc: 81069318999 •0344-03181-11-46 01060>3189 Jill ,I l�!I��III�!Il!"!"VIII^PIII" 'Ili S'I'P III!!p l'll�l!I O1O .0*3O26 1 ■ Complete Items 1,2,and 3. A. Signdtu o • Print your name and address on the reverse X ❑Agent so that We can return the card to you. ❑Add... ■ Attach this card to the back of the mallpiece, B. FeoWM by IPdrdedNs* a Dere of Delivery or on the from'd space penniR I. AraCIe AAdhaaaJ Us D. 6dNiveryaddreesdieeim[tromllanty ❑Yet M YES,enter delivery address ENvx: ❑W A.d.I�Ytx�1t1J/ Hh OlOtet� IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII WOW" 9590 D �. ❑MtlIlbWae DnyN..ataum D AaDtpMnttwatcbap.My D nau aa.bloted 9590940222046193896303 Dlauretwxrmnrtr otrmtwaDea Dca G m4Myti.etlaeD*a Nems,i P. DC ANds tllnlber fDaMsbom aerMro HUeO aYatMy D9ymmtlon" -,n.watr DeDwecaam 7016 0910 0001 6815 6180 tbt� j Ps Farm 3811,3uty2016 p9N 753a-o2-o0PWe3 Dmiwtic Nehm Heaelpt i