36-046 (6) 75"x., X 70,0-1n
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY=- � MA DATE aSI 11 PERMIT# P19-0-'Sl O
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JOBSITE ADDRESS ' /o? (,J�n��°S��„>f r�r-�i,t_..�_� OWNER'S NAMEF �. ....._.__
OWNER ADDRESS _ mr z > I'rir4 O�U 4 TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
PRINT _ NOL
CLEARLY NEW:� �' RENOVATION:? REPLACEMENT: 5 PLANS SUBMITTED: YES�ml NOS._..
FIXTURES Z 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 GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
{
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK _ _. .. Ed
_ ..::.._ ..
LAVATORY
ROOF DRAIN
SHOWER STALL _
SERVICE/MOP SINK
I F
TOILET f URINAL �
WASHING MACHINE CONNECTION
..._.. ..
WATER HEATER ALL TYPES
WATER PIPINGMUM—
-
- -
OTHER
^--- r-. ..... �.....,...
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 CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY F� BOND L
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 1_ AGENT
SIGNATURE OF OWNER OR AGENT
I 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 with all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME LICENSE# /JZ70 SIGNATURE
MP, JP CORPORATION€ # PARTNERSHIP #� LLCE3#
COMPANY NAME ADDRESS
CITY STATE [2j,4::,] ZIP TEL5
FAX CELL , EMAIL .
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT#
PLAN REVIEW NOTES
. 5
12 WINCHESTER TER BP-2019-0897
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36-046 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
Bath BUILDING PERMIT
Category --
Permit# BP-2019-0897
Proiect# JS-2019-001496
Est.Cost: $8750.00
Feg, $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: KAREN CARTER 70008
Lot Size(sa.ft.): 10018.80 Owner: BRAIDMAN MICHAEL A&KATHERINE E HAMILL
Zoning: Applicant: KAREN CARTER
12 WINCHESTER TER
Applicant Address: Phone: Insurance:
223 MAIN ST (413) 221-7419
LEEDSMA01053 ISSUED ON:2/15/2019 0:00:00
TO PERFORM THE FOLLOWING WORK:BATHROOM RENO
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: House# Foundation:
Driveway Final:
Final: 2/�� /� Final:
G/�✓� Rough Frame:
��
Gas: Fir a rtme t Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final: d e. Z- 2747
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REU TIONS. p `l
Certificate of l Signature:
FeeType• Date Paid: A!nount:
Building 2/15/2019 0:00:00 $65.00
212 Main Street, Phone(413)587-1240,Fax; (413)587-1272
Louis Hasbrouck—Bui,aing Commissioner