24A-124 (6) oka(L.
IN,ASSAOBi17SE5 i5-UNII�FORNI APPLiGNRO1M FOR A PERMOiT@ PUFTEORM GAS
�FE1DMMC WWOR+Kt 2Z
CITY MA DATE" -`I- f� PERMITk_C�'
JOBSITEADDRESS •sCaw/h ,5,� /
v�7I�C� OWNER'SNAME Si
G/fib
r OWNERADDRESS _ TEIT I'I' '76FAX_"_
"F O OCCUPANCYTYPE COMMERCIAL❑ EDUCATIONAL U RESIDEMIAIN
PRI...AR%Y NEW.0 RENOVATION:L-1 REPLACEMENT:YS PLANS SUBMITTED: YES[I NO Ll
APPLIANCFSI FLOOI_wsmT 1 2 _3 4 s 7 a s 10 11 12 13 14
BOILER "—
BOOSTER
CONVERSION BURNER �-
GOOKS—TO—VE a
DIRECTVENT HEATER
DRYER
FIREPLACE _
FRYOLATOR -�
FURNACE _
GENERATOR _
GRILLE
INFRAREDHEA1ER
LABORATORYCOCKS
MAKEUP AIR UNIT
OVEN _ ; g 8 G s Ioap
POOL HEAiER _ _ _ rr nnaea e e
ROOM I SPACE HEATER -
ROOF TOP UNIT _
TEST _
UNIT HEATER
]INVENTED ROOM HEATER O AP RO ED
WATER HEATER
OTHER
INSURANCE COVERAGE
I have a current URNIt insurancepolicy or dssuhstantial equivalentwhich meets the requirementsofMGL.Ch.142 YES ND ❑
I IPYCU CHECKED YES,PLEASE INDICATE I HE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY U BOND U
OWNERS INSURANCE WAIVER:I am aware thatthe licensee d0fm not lope theinsurance coverage required by Chapter 142 of the
Massachusetts General Laws,and that mysignature,an this permit application waives this nupdremeat.
CHECKONEONLY. OWNER ❑ AGENT ❑
SIGNATURE OF OWNER OR AGENT
I hereby cediy[hat all ofthe tletals antl informa[lon havesubmided uie-Abredregarding thisapplication neaten antl accent.to thebcstofmy knowledge
and that all plumbing work and installadons performed under the permit issued for this application will be In es den. 'th P din Provision ofthe —
Masnachuseds State Plumbing Code and Chapter 142 of the General Laws.
PLUMBERGASFITTER NAME rn1crae-1 J. Moanri.��� LICENSE#M�}T3'a GNANRE
MPU MGFU JPU JGFU IPGIU CORPORATION N 4 IOl9C PARTNERSHIPU# LLC El#
COMPANY NAMEf 'S. t1'lU2»Y�y SnC. __ADDRESS ti SWth It'ipin S'I;(Pe"t -P p,QpX���'
CITYSTATE ZIP C)I _ TFL
FAX 41'1.2b X 935 _ CELLEMAIL? ✓31+10 • COvr1
(�l(rL s lzD._ oa _
MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM PLUMBING WORK
CITY/TOWN!y U1{'h - MA DATE 5` � %_ PERMIT; /rY �u ••
JOBSITEADDRESB J CSI fir _.. fL$/�� OWNER'SNAME .f/ /Id a-61llln
POWNERADDRESS_ f ly ._ ..__ TEL*3 :_�FAX
TYPE OR OCCUPANCY TWE COMMERCIAL El EDUCATIONAL El RESIDENTIAL
PRINT _
CLEARLY NEW:E] RENOVATION:❑ REPLACEMENT:L PLANS SUBMITTED: YES❑ NO❑
__ . - '-- __
FIXTURES T FLOOF - PSM 1 2 3 4 5 fi 7 6 9 10 11 12 13 14
t -`� --- -
CROSS CONNECTION DEVICE - - - -
DEDICATED SPECIAL WASTE SYSTEM
_ —
DEDICATED GASIOWSAND SYSTEM
DEDICATED GREASE SYSTEM _ - -
DEDICATED GRAY WATER SYSTEM _
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER -
DRINKINGFOUNTAIN _ - --
FOOD Pl
1 FLOOR/AREA DRAIN - -
_ INTERCEPTOR(INTERIOR)
KITCHEN SINK
LAVATORY
ROOF DRAIN
SHOWER STALL --
SERVICE/MOP SINK
i TOILET
URINAL - - -
-
WASHINGMACHINECONNECTION
WATER HEATER ALL TYPES
WATER PIPING
_OTHER ____ -- - -- -
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YESX NO ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY X OTHER TYPE OF INDEMNITY ❑ BOND ❑
OWNER'S INSURANCE WAIVER:I am awarethatthe licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws,and that my signature on this permit application waives this requirement
SIGNATURE OF OWNER Oft AGENT - CHECK ONE ONLY: OWNER ❑ AGENT El
hereby certify that all of the details and information I have so miitetl or enteretl regarding this application are true and accurate to the best of my knovdedge
and that all plumbing
State work and mbinglCare.,,it pa,tc,1duf the Cannot
lssuetlfirthis applicatlonwlll be in mpha cewith Peru nne 1 provision of the
Massachusetts State Plumbing Codc antl Chapter"142 of the Genaml Laws_ 5�� ',Ta�-`1.-/y^�1 —
PLUMBER'SNAME_Ink ohQel J� Mo2An ,54. LICENSE# "N-4 .� IGNATURE
MP❑ JP❑ CORPORATION®# wig_(I_ PARTNERSHIP[1N__ _- LLC E:]# _
COMPANY NAME Cn.S.dhc7LH'1y SnC . ADDRESS-LL SOsA C1h tree I. "eDbOy—
CITY STATE My ZIP 0)o3) TEL YI'l,- ab$-4aSI
FAX At 3-ab8-�3 s_ CELL EMAIL 'rw1 e n'1 rYcibfP11Nn C_ COOT
C&N of
Larry Eldridge <leldridge@northamptonma.gov>
5 Calvin Terr.
1 message
Jim Moran <Jim@mjmoraninc.com> Tue, Jul 17, 2018 at 2:08 PM
To: "leldridge@northamptonma.gov" <Eldridge@northamptonma.gov>
Cc: Scott Cernak<SCernak@mjmoraninc.com>
Hi Larry. This is to inform you that M.J.Moran Inc. is withdrawing the plumbing and gas permits for this
project. Jim Moran