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31B-188 (8) BP-2019-1492 76 GOTHIC ST GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31B- 188 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL C.142A) Category: CONDO BUILDING PERMIT Permit# BP-2019-1492 Project# JS-2019-002416 Est.Cost: $805000.00 Fee: $4271.20 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: CHRISTOPHER FONTAINE 075432 Lot Size(sq. ft.): 13808.52 Owner: Patrick Melnik Zoning: URC(100)/ Applicant: CHRISTOPHER FONTAINE AT: 76 GOTHIC ST Applicant Address: Phone: Insurance: 296 AMES RD (413) 335-5131 SOLE PROPRIETOR HAMDENMA01036 ISSUED ON:8/15/2019 0:00:00 TO PERFORM THE FOLLOWING WORK: NEW BUILDING:FOUNDATION ONLY PENDING PLAN REVISIONS THREE STORY 3 UNIT RESIDENTIAL POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Rough: Rough: e Footings: t ,/( Q-2.1.)q IC rP �,M House# Foundation: ..ii �/ 2a Driveway Final: . v°It. 10-Z_ 0to Final: Final: g-�77•o9-S h NcL Hoot• at Cjs. Rough Frame: •j/( L-3-ZOZO r I ��'���? 2 sr 3 '/� rv> r �Cis P r i9n 4 t-ki--i r 811;':V`142/ Gas: Fire Department pp `' '� W�O�S ©� DC 7 Fireplace/Chimney: Li- Rough: oil: Insulation:d ar! /"� y-e-zoapieq2 Final: Smoke: !l).Z 2~°.`yc r1 2 q.zOzL'.1 k e Final:/4/4'k'rt .7 ,S-tZ-Z6Zoy/? O 10-27 ZGZ.o K',,e 1,3Z" +COHt1D1. Ode, e_18-20zo ea THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLA Of N OF ANY OF ITS RULES AND RE 1 ' ONS. 1/1111 Certificate of Occupancy Si nature: FeeType: Date Paid: Amount: lib Building 8/15/2019 0:00:00 $4271.20 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner I BP-2019-1492 76 GOTHIC ST COMMONWEALTH OF MASSACHUSFTTS cis_ CITY OF NORTHAMPTON Man:Block: 31B- 188 Lot: -001 PERSONS CONTRACTING TOTHEFGUARAISTERED CONTRACTORS NTY FUND (MGL c 42A) Permit: Building DO NOT HAVE ACCESS BUILDING 'PERMIT Category:CONDO ...... Permit# BP-2019-1492 Project# JS-2019-002416 Est.Cost: $805000.00 Fee: $4271.20 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group_ CHRISTOPHER FONTAINE 075432 Lot Size(sq. ft.): 13808.52 Owner: Patrick Melnik Zoning: URC(I00)/ Applicant: CHRISTOPHER FONTAINE Air,, AT: 76 GOTHIC ST Applicant Address: Phone: Insurance: ,. , 296 AMES RD (413) 335-5131 SOLE PPTh R1L' +: :: HAMDENMA01036 ISSUED ON:1 0/23/201 9 0:00:00 TO PERFORM THE FOLLOWING WORK: NEW THREE STORY 3 UNIT RESIDENTIAL BUILDING: FULL PERMIT. SEE NOTES RE FIRE SEPARATION 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 --ZO Final: M_ d 1, Rough Frame: Gas: Fire Department Fireplace/Chimney: q—Ci—..7C) 7ft Rough: Oil: Insulation: Final: Smoke: Or.._�W�-�� Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND RF T IONS. k 1 :r Certificate of Occupancy Signature: Fee: pe• Date Paid: Amount: Building 815/2019 0:00:00 $4271.20 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck --Building Commissioner 4 � a -�� Cr- 0/ *Ati The Commonwealth of Massachusetts f City of Northampton •� Certificate of Occupancy In accordance with 780 CMR, (The Ninth Edition of the Massachusetts Residential Building Code) this Certificate of Occupancy is issued to the premise or structure or part thereof as herein identified. Identify Name of Building of Space Within, Building Owner, or Permit Holder Certificate No. Issued to Patrick Melnick BP-2019-1492 Identify property address including street number, name, city or town and county Located at 76A Gothic Street Unit 1 HERS Rating Northampton, Hampshire, Massachusetts 48 Use Group Classification(s) Single Family Dwelling This Certificate of Occupancy is hereby issued by the undersigned to certify that the premise, structure or portion thereof as herein specified has been inspected for general,fire and life safety features. This certificate shall allow for the use as herein described and in cor fimnance with any and all conditions as identified below It shall be posted in a conspicuous place within the space as directed by the undersigned. Failure to post the certificate,failure to comply with conditions or,tampering with the contents of the certificate is strictly prohibited. Conditions of Use Single Family Dwelling All fire protection and life safety systems must be maintained, and all means of egress must be kept clear Name of Municipal Date of Final Map/Plot: Building Official Kevin Ross .Inspection 10/27/2020 Signature of Municipal j Date of r� Q Q BuildingOfficial !/C ///� Issuance 04/06/2021 J����vv Home Energy Rating Certificate Rating Date: 2020-08-19 'f ,. Registry ID: 791568252 Final Report Ekotrope ID: d2RC)Raqv HERS° Index Score: Annual Savings Home: Your home's HERS score is a relative 76 Gothic St Unit 1 IIo performance score.The lower the number, 57 Northampton, MA 01060 the more energy efficient the home.To Builder: learn more, visit www.hersindex.com 1 *Relative to an average U.S.home Patrick Melnik Jr. Your Homers Estimated Energy Use: This home meets or exceeds the criteria of the following: Use[MEttui Annual Cost Heating 15.6 $682 2015 International Energy Conservation Code Cooling 0.5 $21 Hot Water 2.7 $119 Lights/Appliances 19.2 $837 Service Charges $0 Generation(e.g.Solar) 0.0 $0 Total: 38.0 $1,658 HERS Index Home Feature Summary: Rating Completed by: More Ertolfry Home Type: Apartment,end unit Energy Rater: Rafael Loveszy vo Model: N/A RE5NET ID: 5182405 bourn 340 Community: N/A WOWS 130 Conditioned Floor Area 022Rating Company: Power House Energy Consulting 120 : 2 ft, PO Box 9571,North Amherst,MA 01059 113, Number of Bedrooms: 3 413-83S-5162 k k•t 1 Primary Heating System: Air Source Heat Pump•Electric•3.09 COP 9') Rating Provider: Energy Raters of Massachusetts 80 Primary Cooling System: Air Source Heat Pump•Electric•17 SEER 2 Woodlawn Street Amesbury,MA 01913 Primary Water Heating: Water Heater•Electric•3.48 UEF 978-270-3911 60 . - House lightness: 768 CFM50(14 1 ACHSO) 48 Ventilation: 24 CFM,25 CFM•5 Watts,5 Watts 40 30 Duct Leakage to Outside: 0 CFM @ 25Pa(0/100 s.f.) a. Above Grade Walls: R-24 Ki Zero Energy 0 Ceiling: Adiabatic R-37 Home fZdfoel Lovcs,y,t€roliol Llicir.D, ilotor Window Type: U-Value:0.28,SHGC:0.25 itts Enemy Digitally signed:8/24/20 at 1:52 PM .vr,Pev4f Foundation Walls: R-18 I ekotrope ikotr,TH.RATER Version•12.3.2510 The Energy Rating Disclosure for this home is available from the Approved Rating Provider. This re ort does not constitute an warrant or r uarantee. * The Commonwealth of Massachusetts i l ,, o , I ,�� City of Northampton . Certificate of Occupancy a n c p y In accordance with 780 CMR, (The Ninth Edition of the Massachusetts Residential Building Code) this Certificate of Occupancy is issued to the premise or structure or part thereof as herein identified. • Identify Name of Building of Space Within, Building Owner, or Permit Holder Certificate No. Issued to BP-2019-1492 Patrick Melnick Identify property address including street number, name, city or town and county Located at 76 Gothic Street Unit 3 HERS Rating Northampton, Hampshire, Massachusetts 47 Use Group Classification(s) Single Family Dwelling This Certificate of Occupancy is hereby issued by the undersigned to certify that the premise, structure or portion thereof as herein specified has been inspected for general fire and life safety features. This certificate shall allow for the use as herein described and in conformance with any and all conditions as identified below. It shall be posted in a conspicuous place within the space as directed by the undersigned. Failure to post the certificate,failure to comply with conditions or, tampering with the contents of the certificate is strictly prohibited. Conditions of Use Single Family Dwelling All fire protection and life safety systems must be maintained, and all means of egress must be kept clear Name of Municipal Date of Final Map/Plot Building Official Kevin Ross Inspection 10/27/2020 Signature of Municipal Date of Q Building Official / Issuance 11/03/2020 31B�1vS Home Energy Rating Certificate Rating Date: 2020-08-19 Final Report Registry ID: 855864532 46, Ekotrope ID: gdoBWxQv HERS® Index Score: Annual Savings Home: Your home's HERS score is a relative 76 Gothic St Unit 3 2 4 performance score.The lower the number, Northampton, MA 01060 the more energy efficient the home.To 21 20 Builder: learn more,visit www.hersindex.com *Relative to an average U.S.home Patrick Melnik Jr. Your Homers Estimated Energy Use: This home meets or exceeds the Use[MBtul Annual Cost criteria of the following: Heating 8.0 $349 2015 International Energy Conservation Code Cooling 0.6 $25 Hot Water 2.6 $115 Lights/Appliances 18.0 $785 Service Charges $0 Generation (e.g.Solar) 0.0 $0 Total: 29.2 $1,274 HERS Index Home Feature Summary: Rating Completed by: „isitp, Wilt PW*11r# i lame Type: Apartment,end unit Model: N/A Energy Rater: Rafael Loveszy ISO RESNET ID: 5182405 ,,ig SAO Community: N/A HorneS 130 Conditioned Floor Area: 1 710 fir2 Rating Company: Power House Energy Consulting —-, •ir, , PO Box 9571,North Amherst,MA 01059 - , Number of Bedrooms: 3 413 835-5162 Primary Heating System: Air Source Heat Pump•Electric•3.09 COP ' ' Rating Provider: Energy Raters of Massachusetts i 1 Primary Cooling System: Air Source Heat Pump•Electric•17 SEER 2 Woodlateiro Street Amesbury,MA 01913 L - Primary Water Heating: Water Heater•Electric•3.48 UEF 978-270-3911 House Tightness: 656 CFM50(2.56 ACHSO) / \ — , ,r Ventilation: 24 CFM,23(FM•S Watts,5 Watts • Duct Leakage to Outside: 0 CFM @ 25Pa(Of 100 s.f.) % 7 .. , Above Grade Walls: R-24 /etc)Eneq Ceiling: Adiabatic,R-49 Window Type Rafael Loveszy,Certified Energy Rater : U-Value:0.28,SHGC:0.25 mItIttrver '411100fr L"'"'"1" Foundation Walls: N/A Digitally signed:8/24/20 at 1139 AM kotrope 1 kotropP HAl ER Version:3.7.1 751 0 ille 1 nergy Rating Disclosure for this home is available from the Approved Rating Provider. This re mrt(10+-,nut r onstitute ari'warrant or i rim or Bee * The Commonwealth of Massachusetts . ; A. I j:r City of Northampton m` Certificate of Occupancy In accordance with 780 CMR, (The Ninth Edition of the Massachusetts Residential Building Code) this Certificate of Occupancy is issued to the premise or structure or part thereof as herein identified. Identify Name of Building of Space Within, Building Owner, or Permit Holder Certificate No. Issued to Patrick Melnick BP 2019-1492 Identify property address including street number, name, city or town and county Located at 76A Gothic Street Unit 2 HERS Rating Northampton, Hampshire, Massachusetts 45 Use Group Classification(s) Single Family Dwelling This Certificate of Occupancy is hereby issued by the undersigned to certify that the premise,structure or portion thereof as herein specified has been inspected for general fire and life safety features. This certificate shall allow for the use as herein described and in conformance with any and all conditions as identified below. It shall he posted in a conspicuous place within the space as directed by the undersigned. Failure to post the certificate,failure to comply with conditions or,tampering with the contents of the certificate is strictly prohibited. Conditions of Use Single Family Dwelling All fire protection and life safety systems must be maintained, and all means of egress must be kept clear Name of Municipal Date of Final Map/Plot: Building Official Kevin Ross Inspection 08/18/2020 Signature of Municipal Date of 31B-188 Building Official Issuance 04/06/2021 Home Energy Rating Certificate Rating Date: 2020-08-19 ist Registry ID: 105691552 g g- t Final Report Ekotrope ID: bLbamYb2 HERS° Index Score: Annual Savings Home: Your home's HERS score is a relative 7Gothic St $ 2performance score,The lower the number, Northampton,305 MA (}1($ { the more energyefficient the home,To Builder: 4 f Buy r learn more, visit www.hersindex.com Relative to an average U.S.home Patrick Melnik Jr. Your Home's Estimated Energy Use: This home meets or exceeds the Use(M tul Annual Cost criteria of the following: Heating 8.4 $366 20 i 5 nt=rnational Energy Conservation Code Cooling 0 0 $26 Hat Water 2 4 $1041 Lights/Appliances 12.2 $703 Service Charges $0 Generation(e.g.Solar) 0.0 $0 Total: 28.6 $1,198 HERS Index Home Feature Summary: Rating Completed by: Moroftwevo Home Type. Apartment,inside unit i t Model N/A Energy Rater: Rafael Loveszy Existing RESNET ID: 5182405 Homes l Community: N/A x Rating company: Power House Energy Consulting Conditioned Hoar Area: 1,710 ft P4 Box 9571,North Amherst,MA 01 059 sus Number of Bedrooms: 3 Ref*rents 47.3-835-516?. a00 Monte Primary Heating System: Air Source Heat Pump•Electric•3.09 COP Rating Provider: Energy Raters of Massachusetts SO Primary Cooling System: Air Source Heat Pump.Electric•17 SEER 2 Woodlawn Street Amesbury,MA 01913 Primary Water Heating: Water Heater.Electric•3.48 UEF 9/8-270-3911 ,. s House Tightness: 668,5 CFMSO(2.61 ACHSO) <,""."' 45 Ventilation: 57 CFrM.7,6Watts -mistime Duct Leakage to Outside: 0 CFM @ 25Pa(0/100 s.f.) r, `' Above Grade Walls: R-24 Ceiling: Adiabatic R-418 m� o tessrnRry� Window Type: U atue:0.28F SHGC:0.25 Ra de] Lo,,,e.zy,Certified Energy i;rtcr ASP Digitally signed:WO/20 at 8:51 AM Foundation Walls: N/A kot I kutro FiATI P lion: un 3 7_a,P,oi, fiS _. . ih�_Iluttciy Rutirtn CVs,lc sirrotor ih homo 3s,rArifablo from(1w Appre° I P,,lira.:Provid r. ihic rE"',or t tl -s not 4,I1T-tit#4te.01"L°,,,rainy or t oor<nt,". 76 GOTHIC ST EP-2020-0745 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Map: 31B Lot: 188 ELECTRICAL PERMIT Permit: Electrical Category: INSTALL FIRE ALARM SYSTEM Permit# Electrical PERMISSION IS HEREBY GRANTED TO: Project# JS-2019-002416 Est.Cost: Contractor: License: Fee: $50.00 FIRE SERVICE GROUP LLC Electrician 21832 Owner: Patrick Melnik Applicant: FIRE SERVICE GROUP LLC AT: 76 GOTHIC ST Applicant Address Phone Insurance 1010 THORNDIKE STREET C- PALMER MA01069 ISSUED ON::4/1/2020 0:00:00 TO PERFORM THE FOLLOWING WORK: INSTALL FIRE ALARM SYSTEM Call In Date: Date Requested Inspection Date/SignOff: Reinspect?: Trench/UC: Special Instructions Rough Special Instructions: ^_ Final: / /9- az SRE Called In: Signature: Fee Type:: Amount: DatePaid Electrical $50.00 4/l/2020 0:00:00 4647 212 Main Street, Phone(413)587-1244, Fax(413)587-1272-Inspector of Wires -Roger Malo 76 GOTHIC ST EP-2020-0602 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Map: 31B Lot: 188 ELECTRICAL PERMIT Perrnit: Electrical Category: WIRE 3 NEW CONDO APARTMENTS,LIGHT&POWER;400 AMP SERVICE,200 AMP PER POSITION,4 METERS AND PANELS Permit# Electrical PERMISSION IS HEREBY GRANTED TO: Project# JS-2019-002416 Est.Cost: Contractor: License: Fee: $535.00 RUDIN ELECTRIC LLC MASTER ELECTRICIAN 22726 Owner: Patrick Melnik Applicant: RUDIN ELECTRIC LLC AT: 76 GOTHIC ST Applicant Address Phone Insurance 410 MONTGOMERY RD (413) 214-5688 C- Liability, VBA664795 WESTFIELD MA01085 ISSUED ON:1/21/2020 0:00:00 TO PERFORM THE FOLLOWING WORK: WIRE 3 NEW CONDO APARTMENTS, LIGHT& POWER; 400 AMP SERVICE, 200 AMP PER POSITION, 4 METERS AND PANELS Call In Date: Date Requested Inspection Date/SignOff: Reinspect?: Trench/UG: 3-//- 22) �M Special Instructions x Rough 2 -3 0 - Q, x Special Instructions: Final: ' 8 -i) - - root- 254- 3" I002 f-, N.9 /0- /Q`2d 0 SRE Called In: t/' j 4,r`"h Signature: Fee Type:: Amount: DatePaid Electrical $535.00 1/21/2020 0:00:00 1075 212 Main Street,Phone(413)587-1244,Fax(413)587-1272-Inspector of Wires -Roger Malo . \ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1.51_—-, CITY [Northampton MA DATE 04/06/2020 —1 PERMIT# JOBSITE ADDRESS 76 Gothic st. OWNER'S NAME Pat Melnik GOWNER ADDRESS I TEL 413-537-5208 IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL I I RESIDENTIAL 0 PRINT CLEARLY NEW:) i I RENOVATION:7 REPLACEMENT:❑ PLANS SUBMITTED: YES ID NOn APPLIANCES 1 FLOORS-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 I BOILERBOOSTER NIIII� re- Egg ____ CONVERSION BURNER COOK STOVE EMI 1 r I ! � �I��DIRECT VENT HEATER i--DRYER I1111111 FIREPLACE Imo: FURNACEOR EN —1111 i1111�__ GENERATOR EMI alal���111*MIMI �� GRILLE _ INFRARED HEATERIII LABORATORY COCKS III ME 1 MAKEUP AIR UNIT En__ 111111111 IIIIII MIMI OVEN Fill= - _____IIIMIMIIMI1111- POOL HEATER Mill1P MI ROOM I SPACE HEATER f E_ LAM is, �` ROOF TOP UNIT M N'I:Fr-71 J'pTim TEST '� _ •-,i -� .I • i , tiUNIT HEATER 11111012411 i UNVENTED ROOM HEATER r -! ^WATER HEATER OTHER i eg �.� Mall INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ❑NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Et J OTHER TYPE INDEMNITY j BOND E -_ 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 I 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 conce 't all Pertinent rovision o the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME[oleg Shevchenko (LICENSE#L 16564] SIGNATURE MP U j MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION❑# PARTNERSHIP n# ' , LLC Q# 4295 COMPANY NAME: Pipedex LLC ADDRESS 30 White st CITY Westfield . STATE CMAI ZIP 01085 ITEL FAX CELL 413-505-9278 IEMAILI olegshev159@gmail.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No 1f17/20 oas 7€5 6S THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ /a/Sae FEE: $ PERMIT# L f" PLAN REVIEW NOTES son inspections done ubject: Re: Questions on inspections done rom: PaulS Plumbing and Heating <paulsplgxhtg@aol.com> ate: 10/28/2020, 8:47 AM o: "bwillard@northamptonma.gov" <bwillard@northamptonma.gov> ----Original Message From: Beth Willard <bwillard@northamptonma.gov> To: paulsplgxhtg@aol.com Sent: Tue, Oct 27, 2020 2:45 pm Subject: Questions on inspections done Hi Paul, Larry said to email you copies of what we had questions about. See attached. 144 Acrebrook- Need your notes -the permit actually came in after you inspected the location (10/23/2020) Passed Final 76 Gothie#Need your notes -there was nothing noted on the back of the permit as to whether it passed the final inspection (10/23/2020). Gas w On Wed. 10/21/2020 you did a final Plumbing on "74 Grove St Temp" at 11:00. Was that actually 74 Grove Ave/Andy- Prestige Plumbing, which you had gone to the previous day &failed? If so, I'll email it to you It failed the first time and went back the following day and it passed for your notes. Thanks. Beth Beth Willard Principal Clerk Building Dept. 1271 10/28/2020,9128 AM MASSACHUSETTS UNIFORM AICATION FOR A PERMIT TO PERFORM PLUMBING WORK {-'� CITY 4 64-2 G)✓7 MA DATE%G /.. PERMIT# - — \ 7- '7 OWNER'S NAME % '/ r JOBSITE ADDRESS �{ � - - - (, 1: 1 /k._,...v, POWNER ADDRESS d TEL? FAX L TYPE OR OCCUPANCY TYPE COMMERCIAL I] EDUCATIONAL RESIDENTIAL, PRINT CLEARLY NEW: ' RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES.>�' NO, FIXTURES T FLOOR-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB / i / ' CROSS CONNECTION DEVICE �v DEDICATED SPECIAL WASTE SYSTEM _ DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM f-y DEDICATED WATER RECYCLE SYSTEM ' DISHWASHER / / / _ t . ,..-- DRINKING FOUNTAIN FOOD DISPOSER , d, FLOOR/AREA DRAIN _ __.._ '_3� -.� / ., s''i_�..� INTERCEPTOR(INTERIOR) KITCHEN SINK I LAVATORY ,- ROOF DRAIN SHOWER STALL / ,/ SERVICE/MOP SINK TOILET i " I URINAL WASHING MACHINE CONNECTION I r /` ,v Ly d c, 4,� ,i ay WATER HEATER ALL TYPES ,� / - 1� ,.s `gym Y P., 3s 4ati WATER PIPING OT - 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 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 at 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 provisiorof the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / / PLUMBER'S NAME ,;',„,/ '/ %,/ C© LICENSE# . -L, SIGNATURE MP JP`; ,,j CORPORATION # PARTNERSHIP # ,LLC;; # ,2 gS 1 COMPANY NAME; /2 P .- ,: z2 C ADDRESS-7O ' 77 _.., m ..._... 1 CITY .�C C'Z STATE ' ZIP ;, ram s TEL SOS c 7. FAX CELL 3 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 7vC7e. eir 11C // 2-e2 /34-iry- Z/1/1715v 2 '� ate 4I Y3350 SZ CEO t /O MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK FF CITY( tiQK1‘c10 e lcc). . �t MA DATE I( j i PERMIT# 12:21,11t,g-- JOBSITE ADDRESS 16 Goan, c_ 5+ : P... OWNER'S NAME t F cr late-Av.; .S&. . OWNER ADDRESSitz C, 's-e.sc td 5$7. 62,0 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 0 RESIDENTIAL PRINT CLEARLY NEW: — RENOVATION:II REPLACEMENT: PLANS SUBMITTED: YES Ii NO FIXTURES 7 FLOOR-0 BSkI 1 2 3 4 5 6 7 r 8 9 r 10 11 12 13 14 BATHTUB _ �{ 1j 11 I[^ it ][ l i II [ [ I II CROSS CONNECTION DEVICE f 1_ I I[ r ( �_ I{ DEDICATED SPECIAL WASTE SYSTEM r if-. I1 ii _II ?�_ I 1I 11 i iI DEDICATED GAS/OILISAND SYSTEM { —II [ _._1[ — 1{f--41— -1 __ II 41.-_—iI !I__-- 11-- [— -II _I DEDICATED GREASE SYSTEM { ,{- [ 11 --� �1 � _ �{- _ I . �{ { �_ I i DEDICATED GRAY WATER SYSTEM I fl I _. 1I II II 'I II ) II !I ,{ 'I II i1 DEDICATED WATER RECYCLE SYSTEM I II d( _. I =1 11 li IL ,I Il 11 _11 DISHWASHER _. y[.-- ,I 'I . I _'I I I__.- I{ �..._..� DRINKING FOUNTAIN I II { _.. rp '�� f��� 4 I{ II 11 M II FOOD DISPOSER I - 11 p[ .9 I FLOOR/AREA GRAIN [_ 1I [ ,L_._ f{ _um_ INTERCEPTOR(INTERIOR) KITCHEN SINK II{_:=..�,- .ck LAVATORY II { 111 _` 1 II I{ [_^.�L 1 _ II st,c ROOF DRAIN _ F NI { SHOWER STALL ctr'I �o III _ SERVICE/MOP SINK - ' II [[ _ TOILET I- C URINAL _ _ ,_ I WASHING MACHINE CONNECTION I -i{__ U 1 Cl- 7 • • WATER HEATER ALL TYPES I X i{ .__7 {_ { __ O [ HA F4 PTZ N { WATER PIPING f- i �I ?PPI�QV�p � O1�ILPFftQ_ D OTHER I [ —II-- __ �{ i[ _ :I- � it _ L ;,. 11- 1 - �1 [ - f�...[ .�{ f[. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES"I,'NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY V OTHER TYPE OF INDEMNITY L_ l BOND Li 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 L_, 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 a and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will b e with all Pe inent provisign of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ����� J' PLUMBER'S NAME NQrm(�irn_,L, ! .. rc�OY`� LICENSE# � �i.t0. I IG ATURE MPV JP❑ CORPORATION❑# PARTNERSHIP El LLC COMPANY NAME (;o, p 'N G ADDRESS 1 5 ,A a cs .t- �� . 96. , CITY K, ,115 . . STATE t ZIP O k�� TEL 41?, 7"4 t-( CC I,`�� I FAX l tiAa ��rb (CELL EMAIL cr,ke,r?h�lc�t.`<Cd �O 'OA C.o'rY� FEE SCHEDULE FOR PLUMBING PERMITS For applicpfinrifl rnmef^ (Effective 4/1/2010) Make checks to Town of For inspections ouestions All new res=1 dwelling units: $ I(covers all fixtures&includes all inspections) All residential remodel work: $' per permit(includes on fixture/appliance)plus $ per additional fixture/appliance All commercial work: $ per permit(includes one fixture/appliance)plus (res=1 or com=1) $ per additional fixture/appliance All other work: ---per inspection( 'Dr re-inspections) (res=1 or com=1) Solar Systems:, er permit(includes domestic hot water storage,back flow prevention Prevention and domestic water supply) COMPLETE APPLICATION AND FEE REQUIRED•FEES ARE NON-REFUNDABLE CONTRACTORS MUST SUBMIT PROOF OF NEW INSURANCES AND LICENSES PERMIT FEES DOUBLED FOR WORK BEGUN PRIOR TO FILED APPLICATION All sections of the Massachusetts Plumbing&Fuel and Gas Code, CMR 248&NFPA 54-2000,will be strictly adhered to. OFFICIAL USE ONLY FINAL INSPECTION PROGRESS INSPECTIONS JZ--/d /7 to SKETCH /Z-/J-J9' ' DEVELOPMENT AND ENFORCEMENT CENTER TOWN OF .3SACH11SFTTS MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -4" CITY \ 5 MA DATE'10��,ii l I �j PERMIT# � JOBSITEADDRESS }G (3v���C `j OWNER'S NAME GOWNER ADDRESS :i2(-t,'� C�t� > ( i..cf,k 1)c 1-4-'4A ' TEL L1 5'Zv- TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIALX PRINT CLEARLY NEW: RENOVATION:__ REPLACEMENT: '. PLANS SUBMITTED: YES NO1 APPLIANCES-1 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER • FIREPLACE �j FRYOLATOR [� Q r _. FURNACE GENERATOR r GRILLE INFRARED HEATER �� OC - LABORATORY COCKS MAKEUP AIR UNIT • cl S , OVEN Etect,c• . n tun POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES AO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY I/ OTHER TYPE 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 co lia ce with all Pe inent evasion he Massachusetts State Plumbing Code and Chapter 142 of the General Laws. -it. PLUMBER-GASFITTER NAME 1VvA ec.N0,am L.l\ L- \A.- LICENSE# I 1.1C13 SIGNATURE MP V MGF JP JGF LPGI`—I CORPORATION # PARTNERSHIP;.;.—# LLC 1 #i..,3 COMPANY NAME: �-t � �.j N\At_tR. LL(� ADDRESS i 3 N\ 11coc 5 Co, CITY (v; n � a r<� \5 t STATE VAN ZIP 0131 ( TEL 4t C a . FAX qb"' 75-3 . CELL .EMAIL C \\( _. . ...z, _,,,, ,,?; ,s/-oi '.z, cr , p/iy ci, 4e-ty, s /- 1/- 2/ .._ .;:,,i,...;7•-;itin• 1 /y, ilrf.i421,,,-1(..A. s.;?•71,4 /-// lL,......_. ii i„ /0, , re. ,;,, :.•.:2:,.....:,ii ii r1 V• f. t fei. Ft •/' ...„....,g.......z...4.:_. 4%4 'I ....., [ . j MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK aF —Id— CITY /vU'� � �f% � MA DATE C� PERMIT# ( 1" �' 3 y9 �� 4 6O '---- �. JOBSITE ADDRESS � .71— ] OWNER'S NAME,74--- - .� P OWNER ADDRESS /P/r I Q n 0vxh -LJTEL X _ , I TYPE OR OCCUPANCY TYPE COMME IAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW:; RENOVATION: ,„J REPLACEMENT:[ PLANS SUBMITTED: YES ,,j NO` FIXTURES 1 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 I DEDICATED GRAY WATER SYSTEM ` ~�� If .11t ,1 ,.,.rr DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN1. ,;u t,, . — — FOOD DISPOSER ' FLOOR/AREA DRAIN i INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ' ROOF DRAIN Ir SHOWER STALL ,C U " .. ___ SERVICE I MOP SINK _PT a ,�a i'or TOILET - — 7- PROVE URINAL • T p .v.Eb -� WASHING MACHINE CONNECTION WATER HEATER ALL TYPES iiiii WATER PIPING OTHER I MEM -- —_ 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[J 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 . E 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 accurat e m I e and that all plumbing work and installations performed under the permit issued for this application will be in complianc • all Perti e Massachusetts State Plumbin Code and Chapter 142 of the General Laws. PLUMBER' NAME I"C /7 T 'LICENSE# '5 IGNATURE MP JP LJ CORPORATION #i JPARTNERSHIPL#[___ I LLC # 9,.7c. COMPANY NAME r // t� / `�e-C LCL ADDRESS 3 G��I/ if- CITY .. �.S 717W1 STATE rfrrn ZIP (n/G... J --1 TEL L CYS /; 7 ,.._ FAX CELL; EMAIL / 6X LLC C.,,d,i14.147 . 6o /17 ;-// 1d- f 022.,//