24D-118 (5) BP-2020-0213
11 CHURCH ST
COMMONWEALTH OF MASSACHUSETTS
GIS H
CITY OF NORTHAMPTON
Map:Block: 24D- 118
Lot: 131000 1 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
Category: PlumbinBUILDING PERMIT
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Permit 4 BP-2020-0213
Project# JS-2020-000354
Est.Cost: $17500.00
Fee: $114.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: KARAS HOME IMPROVEMENT 087657
Lot Size(sq. ft.): 7100.28 Owner: HANNAH RACHEL&: PAMELA BOCKOL
7_onine11RB(100)/ Ap_plicant• KARAS HOME IMPROVEMENT
A T. 11 C'.-LURCH S T
Applicant Address: Phone: Insurance:
10 WOODHAVEN DR (413) 374-8638 WC
BELCHERTOWNMA01007 ISSUED ON.812112019 0:00:00
TO PERFORM THE FOLLOWING WORK:ADDING BATH IN EXISTING SPACE
POST THIS CARD SO IT 1S 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: Final:�('�-�-/9� /�Rough Frame: oe b-1-I lze
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final: Pe I 4 e(.?
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS %ULES AND RE ULATIONS.
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Certificate o cSi nature:
FeeType: Date Paid: Amount:
Building 8/21/2019 0:00:00 $114.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
F CITY;
MA DATE 3----- HERMIT#�
JOBSITE ADDRESS _ OWNER'S NAME
P _
OWNER ADDRESS ' TEL'__ FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL. _ EDUCATIONAL , RESIDENTIAL
PRINT
CLEARLY NEW:^� RENOVATION: ] REPLACEMENT: PLANS SUBMITTED: YES 1\10
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)
i
KITCHEN SINK
LAVATORY I
ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK
TOILET
URINAL all
114
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES VF-
WATER
FWATER PIPING
OTHER
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142, NO
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 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
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 comp4apce with all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 42 of the General Laws.
PLUMBER'S NAME LICENSE# E= SIGNATURE
MP�' JP0 CORPORATION # PARTNERSHIP # w�'LLCE4
COMPANY NAM DDRESS4 f
W.
CITY �j �� STATE ZIP , �j TEL /
FAX CQ[I - EMAIL
NO alt
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes NO
THIS APPLICATION SERVES AS THE PERKO ❑ ❑
FEE: S PERAIIIT#
PLAN REVIEW NOTES
11 CHURCH ST EP-2020-0163
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Map: 24D
Lot: 118 ELECTRICAL PERMIT
Permit: Electrical
Category: ROUGH&FINISH WIRING OF 2ND FLR BATHROOM
Permit# Electrical
PERMISSION IS HEREB Y GRANTED TO:
Project# JS-2020-000354
Est.Cost: Contractor: License:
Fee: $65.00 MAREK DYBACKI ELECTRIC Journeyman Electrician 51672 E
Owner: HANNAH RACHEL & PAMELA BOCKOL
Applicant: MAREK DYBACKI ELECTRIC
AT. 11 CHURCH ST
Applicant Address Phone Insurance
1468 CENTER STREET (413) 763-3605 () C-(413) 695-4060
LUDLOW MA01056 ISSUED ON:8/23/2019 0:00:00
TO PERFORM THE FOLLOWING WORK:
ROUGH & FINISH WIRING OF 2ND FLR BATHROOM
Call In Date: Date Requested Inspection Date/SiunOff: Reinspect?:
Trench/UG:
Special Instructions
X ` r
Rough n -J 'c
X
Special Instructions:
Final: /V- / - �q
SRE Called In:
Signature:
Fee Type:: Amount: DatePaid
Electrical $65.00 8/23/2019 0:00:00 2885
212 Main Street,Phone(413)587-1244,Fax(413)587-1272-Inspector of Wires -Roger Malo