31B-121 (9) 5 EDWARDS SQ BP-2020-0778
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:31 B- 121 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TOTHEGUARANTY FUND (MGL c.142A)
Category: Bath reno BUILDING PERMIT
Permit# BP-2020-0778
Project# JS-2020-001350
Est.Cost: $9000.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: ALEXANDER CHAPIN 111678
Lot Size(sa. ft.): 3789.72 Owner: DAY IYKO
Zoning: URC(100)/ Applicant: ALEXANDER CHAPIN
AT. 5 EDWARDS SQ
Applicant Address: Phone: Insurance:
19 HARWOOD DR (413) 522-9105 SOLE PROPRIETOR
BERNARDSTONMA01337 ISSUED ON:1/6/2020 0:00:00
TO PERFORM THE FOLLOWING WORK.-BATH 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: 1-2 -Z a Final: n
02� Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS,,RULES AND IRGU TIONS. //
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Certificate of Si nature:
FeeType: Date Paid: Amount:
Building 1/6/2020 0:00:00 $65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck-Building Commissioner
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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITYYl>z .fik�l�l 010A, _�_� MA DATEj1Zj4jAfla6 I PERMIT#
JOBSITE ADDRESS [OLvA OWNER'S NAMEJ Ty KO 1)A y
P OWNER ADDRESS D latq tZ�S Q- TE I -6t Q-S 4I-0`iR FAXF�
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL (~1 RESIDENTIAL❑
PRINT
CLEARLY NEW:( f RENOVATION:[, J REPLACEMENT: PLANS SUBMITTED: YES[`) NO['-]
FIXTURES-1 FLOOR- aSH 1 2 1 3 4 5 s 7 a s _9--]:-4t--4-42- 13 14
BATHTUB - - - --- - ._._ _
CROSS CONNECTION DEVICE -
CEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIUSAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER __ s
DRINKING FOUNTAIN - -
FOOD DISPOSER
FLOOR/AREA DRAIN
INTERCEPTOR INTERIOR
KITCHEN SINK
LAVATORY __--
ROOF DRAIN
SHOWER STALL !
SERVICE/MOP SINK T �
TOILET - - -- -_--- - ---.
URINAL R
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES D
WATER PIPING
OTHER ---- --- --- - -- - --�
CIRCLE 1:GAS TRAP/LNDRY TRY
BACKFLOW PREV/WATER CLOSET
HOT WATER TANK
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YESa NO (j
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHcR TYPE OF INDEMNITY f 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 (_-I 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 pliance wilh ertinent rovision of the
Massachusetts Stale Plumbing Code and Chapter 142 of the General Laws. S L IS to� M
PLUMBER'S NAME L�,�j)ll►91C►_ ��I I ---]LICENSE# 3 r Sa SIGNATURE
MP❑ JP4 49 :5e(6 CORPORATION❑# PARTNERSHIPQ# LLC❑#�
COMPANY NAME ADDRESS -AVC
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CITY[ AWkeo'r TI STATE® ZIP I TEL Y13-- 7$ 9
FAX ����CELL��EMAIL
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