11C-066 (8) 83 FLORENCE ST SP-2019-0794
GIs a: COMMONWEALTH OF MASSACHUSETTS
Mao:Block: IIC-066 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category, Bath reno BUILDING PERMIT
Permit a BP-2019-0794
Project x JS-2019-001321
Est Cost, $5000.0
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO.
Const, Clens: Contractor: License:
Use Group: JIM R BOYLE 107889
Lot Size(so.ft.): 20885.24 Owner: KOLODZIEJ PETER J&MARILYN J
Zoning:URA(100)/ Applicant: JIM R BOYLE
AT: 83 FLORENCE ST
Applican(Address: Phone: Insurance.,
P O BOX 241 (413) 586-8010 WC
HADLEYMA01035 ISSUED ON:111 512019 0:00:00
TO PERFORM THE FOLLOWING WORK.-RENO 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: 2-121,, y Rough: House R Foundation:
Driveway Flnd:
Final: 3 Final:
Rough Frame;
Gaal Fire Dcnurlment FlrsplaedChimary:
Roughs im. laauledmin
Final: Sjpykg; Final: 0-� 31I-I9 KQ
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS/RULES AND RFaGULATIONS.
Certificate of8—wegi iew / Signature.
FecTYpe: Date Paidt Amount:
Building 1/15/20190:00:00 $65.00
211 Main Street, Phone(413)5§7-1140.Fax:(413)587-1272
Louis Heshrouek-Building Commiesionor
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2L, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TOPERFORM PLUMBING WORK�R
UTCITY 6A.) : MA AT PERMIT#
JO SITE ADDRESS J — OWNER S NAME
POWNERADDRESS TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL': EDUCATIONAL _ RESIDENTIAL
PRINT )/
CLEARLY NEW..F-1 RENOVATIONX REPLACEMENT�'7 PLANS SUBMITTED: YES NO-N�
FIXTURES] FLOOR BSM 1 2 3 4 5 6 7 9 9 10 11 '2 13 1 14
BATHTUB
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GASIOIUSAND SYSTEM
DEDICATED GREASE SYSTEM _
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER
FLOORIAREADRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK
LAVATORY -
ROOF DRAIN
SHOWER STALL
SERVICE I MOP SINK
TOILET _
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES N
WATER PIPING Ar IM
OTHER
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YE�No
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
UABILITY INSURANCE POLIQA& OTHER TYPE OF INDEMNITY �j 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 Lam,and that my signature on this permit application waives this requirement.
CHECKONEONLY: OWNER _ AGENT ❑
SIGNATURE OF OWNER OR AGENT
I hereby certify Mal 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 usplumbing work and iCodeatid performed under Me per l issued for this application will be Ir�tbm wiM all Pertinent pryvR�o�f Me
MassachuaeKs Slate Plumbing Cade and Chapter 142 of the General Lava. „Jc' r/N)
� O
PLUMBER'S NAME i11 gwaiLl LICENSE# ATORE
MP❑ JP CORPORATION❑# PARTNERSHIP❑# LLC❑#�
COMPANY NAME I ADDRESS
CITY ,�S7T�A,T�,E® ZIP G TEL
FAX jg !�CELL "MAIL
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yea No
THIS APPLICATION SERVES At THE PERMIT ❑ ❑
FEE: $ - PERMIT#
PLAN REVIEW NOTES
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12157—
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