24A-057 (3) 110 JACKSON ST BP-2020-0647
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24A-057 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING P E RM I T
Permit# BP-2020-0647
Project# JS-2020-001104
Est.Cost: $13120.00
Fee: $91.00 PERMISSION IS HEREBY GRANTED TO.-
Const.
O.Const. Class: Contractor: License:
Use Group: EDWARD RICKEY 96159
Lot Size(sa. ft.): 14853.96 Owner: VINSKEY GEOFFREY JAY& HEATHER D VINSKEY
Zoning: URB000)/ Applicant: EDWARD RICKEY
AT. 110 JACKSON ST
Applicant Address: Phone: Insurance:
P O BOX 62 (413) 695-7059
WILLIAMSBURGMA01096 ISSUED ON.]112012019 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPLACE EXISTING RAILING AND FRONT
DECK, RENO 1ST FLOOR 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: Rough: House# Foundation:
Driveway Final:
Final:-ICI-2e; Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final: 0i 7•3)-Zpw 11f7
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS MULES AND R IONS. �A ,
Cot',�crE'or�
Certificate of Signature:
FeeType: Date Paid: Amount:
Building 11/20/20190:00:00 $91.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
yS7,12 v6
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
owCITY MA DATE oL PERMIT#
JOBSITE ADDRESS /0 . � �` _ OWNER'S NAME.
J {
P OWNER ADDRESS �! '� ?11°-� TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
PRINT
CLEARLY NEW: RENOVATIONA) REPLACEMENT PLANS SUBMITTED: YES NO
FIXTURES 7 FLOOR— BSM 1 4 5 s 7 3 9 10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE _
DEDICATED SPECIAL WASTE SYSTEM l _
DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM , ,
DISHWASHER } - AllF�
DRINKING FOUNTAIN
FOOD DISPOSER W W._ ,.. I
--
FLOOR l AREA DRAIN _ f _
INTERCEPTOR(INTERIOR)
KITCHEN SINK I
--
LAVATORY �x
ROOF DRAIN
SHOWER STALL
SERVICE I MOP SINK -
TOILETt —
_ I
URINAL —
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES
WATER PIPING—,
OTHER
I r � � _
l
INSLI E�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 BOND
OWNER'S INSURANCE WAIVER:I a 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 compliance wi II Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
^moi
PLUMBER'S NAME ` �jC LICENSE# URE
MI, JP CORPORATION # PARTNERSHIP #_ LLCems#
COMPANY NAMEJ �Syr0"t'.s (� + � ACDRESS
CITY ����f� I 'D�;�:.�✓ STATE ` ZIP TEL
FAX CELL EMAIL
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