32C-187 (5) 408 PLEASANT ST UNIT A BP-2021-0856
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C- 187 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
or
Categ Y: renovation BUILDING PERMIT
Permit# BP-2021-0856
Project# JS-2021-001209
Est.Cost: $2000.00
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BAYSTATE EXTERIOR RESTORATION INC CS-089485
Lot Size(sq.ft.): 15812.28 Owner: NIEDBALA STEVEN
Zoning: GB(100), Applicant: BAYSTATE EXTERIOR RESTORATION INC
AT: 408 PLEASANT ST UNIT A
Applicant Address: Phone: Insurance:
87 SHATTUCK RD _ (413) 549-6824 WC
HADLEYMA01035 ISSUED ON:2/3/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:KITCHEN & BATH RENOVATION
POST THIS CARD SO IT IS VISIBLE FROM THE STREET BuildingInspector
Inspector of Plumbing Inspector of Wiring D.P.W. P
Underground: Service: Meter:
Footings:
Rough:
Rough: House# Foundation:
G- 0/ g.-lZ Driveway Final:
Final: 2_6 Final: 7_a I
Rough Frame: C)•1 2-Ic,-2 r )GQ
Gas:
Fire Department Fireplace/Chimney:
Rough: Oil:
Insulation:
Final:j--`ZD.—Z/ Smoke:
Final: (Y it,-)-7 2 1 e
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND RE, ULATIONS.
I.OHtt .Ov , 5121,,,,
Certificate of Signature:) U
FeeType: Date Paid: Amount:
Building 2/3/2021 0:00:00 $100.i`0
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
408 PLEASANT ST UNIT A EP-2021-0614
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Map: 32C
Lot: 187 ELECTRICAL PERMIT
Permit: Electrical
Category: REWIRE APARTMENT,INSTALL NEW PANEL
Permit# Electrical
PERMISSION IS HEREBY GRANTED TO:
Project# JS-2021-001209
Est.Cost: Contractor: License:
Fee: $125.00 ROBERT MAJOWICZ Electrician 15316A
Owner: NIEDBALA STEVEN
Applicant: ROBERT MAJOWICZ
AT: 408 PLEASANT ST UNIT A
Applicant Address Phone Insurance
PO Box 80796 (413) 563-9182 () C-(413) 784-0445 Liability, BMA0019507
SPRINGFIELD MA01138-0796 ISSUED ON:1/22/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:
REWIRE APARTMENT, INSTALL NEW PANEL
Call In Date: Date Requested Inspection Date/SignOff: Reinspect?:
Trench/UG:
Special Instructions
x
Rough /- A 7-a1 TV•
x
Special Instructions:
Final: li—7- 21 '-"N
SRE Called In:
Signature:
Fee Tvpe:: Amount: DatePaid
Electrical $125.00 1/22/2021 0:00:00 162
212 Main Street,Phone(413)587-1244,Fax(413)587-1272-Inspector of Wires -Roger Malo
Vira
408 PLEASANT ST UNIT B EP-2021-0349
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Map: 32C
Lot: 187 ELECTRICAL PERMIT
Permit: Electrical
Category: REWIRE APARTMENT
Permit# Electrical
PERMISSION IS HEREBY GRANTED TO:
Project# JS-2021-000766
Est.Cost: Contractor: License:
Fee: $125.00 ROBERT MAJOWICZ Electrician 15316A
Owner: NIEDBALA STEVEN
Applicant: ROBERT MAJOWICZ
AT.• 408 PLEASANT ST UNIT B
Applicant Address Phone Insurance
PO Box 80796 (413) 563-9182 () C-(413) 784-0445 Liability, BMA0019507
SPRINGFIELD MA01138-0796 ISSUED ON:10/20/2020 0:00:00
TO PERFORM THE FOLLOWING WORK:
REWIRE APARTMENT
Call In Date: Date Requested Inspection Date/SignOff: Reinspect?:
Trench/UG:
Special Instructions
x
Rough
x
Special Instructions:
Final: / - �' c9U rt — /pst_cc ` - 7_a f1^-
SRE Called In:
Signature:
Fee Type:: Amount: DatePaid
Electrical $125.00 10/20/2020 0:00:00 11004
212 Main Street,Phone(413)587-1244,Fax(413)587-1272-Inspector of Wires -Roger Malo
. Gk. 0i-1, 402-7 Si tp oa
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
r!
-77
-E1_-4 CITY- - 1..CA 103 _ _ - ----, MA DATE j aoo4SPERMIT#P LO 2f -U2I L
I�BSIT DD SS 4O8 P Plegeactri '' Vr J OWNER'S NAME %II:MN 'N led bcr ► i I
POWNER ADDRESS, _. _.__ -- TEL FAX
TYPE OR 9€CUP, .__ PE COMMERCIAL 0 EDUCATIONAL I_11 ' RESIDENTIAL V
CLEARLY §W:0 "ENOVATION:1 REPLACEMENT:0 PLANS SUBMITTED: YES 0 NOD
FIXTURES 1. F I+il-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB ' ___ _ I 1!—__1 _111�_ .____I__'`___=1._ 1 ^___I 'C I_.__D
CROSS CONNEC .-"..,"'.,rel I-- 2:L=_- I_- iL_--'1 II- I k-..._ -.J'-_. I--- i 'I _. T'
DEDICATED SPECIAL WASTE SYSTEM --II 1i 1I-_ ___i m .__-1 -.
DEDICATED GAS/OIUSAND SYSTEM I g1` II I____ L__I_ L _ ___;I _-JI- ---1L____,L___-_J_T 1[[ -11-
DEDICATED GREASE SYSTEM `_._>il_.. , I-- �_� _ _ - - ---- 'ThJL_ `
II-
DEDICATED GRAY WATER SYSTEM I L_ - __ _-II_--.- -1I-----o_ _I .w-a'_= 11 -1 _-> J il _._._II _----IL_.._
DEDICATED WATER RECYCLE SYSTEM I^1 I 11 I_ 1.____II _ _. L^ _ I!__.._3I. __ IFIll.� J1 _-,__
DISHWASHER I _ I 11 1= I'__ ----'1--
__.I ;i_ II. II l l�_
DRINKING FOUNTAIN I__ II _ _ fI tl�L. _'L_ IL -'i 1 r_�'
FOOD DISPOSER S____1 !LLI- .J._-L-,_.°L__ _' --_1L_�__l _ l
FLOOR/AREA DRAIN JL L -.I-- - L - _'
INTERCEPTOR(INTERIOR) - I✓ - � I ' I it
_�
-=- - = -L=-GII k IL__ 11- __ I__ _ .--I--JL _- L= I
KITCHEN SINK L_�I. ':._____,!____11______ -- __-
LAVATORY ` ,FI__Ji_--==1�-_Ir_ ___ _L 1L--_t_ I_ - rz1
ROOF DRAIN r_ ! `� __ _ I L - 71'-_-
SHOWER STALL I _._ _II__ 1L i _II__ _M
SERVICE/MOP SINK MW11111_ i __-,II_�L_JI 1ezkfflinui_IllmMlnii
WI L -IE
TOILET I - - -
URINAL __ _ q I—_-- L -- i -
WASHING MACHINE CONNECTIONL � J� � - -- fi
- - fil-li_ � . G
im
WATER HEATER ALL TYPES I-__J.__ _ II___. 1__' __--J i� i i
11.
WATER PIPING I -:1 11_JI_t__III--1— _- -tl-_ i!-- ,� _ L--1[�m�L _I
OTHER L—_— --- _ ,hl --A- --+(--- II---al IL --;L—_—'r�dm I- - IMI---i1—_-I
- -- - -- - - - =_ I_-- - II_
_ _ 1 I_ - 1--.-11 - -_-_
_ II 1 ,- .1� I__- II ..,! -IL Cr'I - - ,
RiMiWiiiiMUMMITIMMIME-IiM
INSURANCE COVERAGE: ,�
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES L.{NO 0
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY Yr OTHER TYPE OF INDEMNITY El BOND Ca
OWNER'S INSURANCE WAIVER:1 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 LI AGENT LI
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this applicati are t and accurate to the best of my knowledge
and that at plumbing work and installations performed under the permit issued for this application will b in comp! nce with all rtinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. y
PLUMBER'S NAME 1%6Sc i,5 __ __ . _.._jLICENSE# .110%!_.1 SIGNATURE
MP(c( JP 11 CORPORATION 0#, . _. PARTNERSHIP El#I I LLC( #I
COMPANY NAME Zd,srauS 94.1w . . - _ ADDRESS�t..O- aOX, b) .. .. . .. .,
CITY . '- ><.:3----. . _ STATE I `( 1i ZIP ._.._. - .. .. TEL 11 .65. "C )q ---__
FAX 1 CELL tLti�1, D I EMAIL I b } rls_ocl .t.�►r#Qr. `1' —. ____ _
/ Cr/ #003Y 4 66
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
iii6V f. CITY:`'3 u i hCi,' \ or) MA. DATE —09 ` aa A 1 PERMIT#6 P di'd 3I
JOBSITE ADDRESS b? �'.4�S3.(-\ `;;:;1. OWNER'S NAME: . 1 6 G V
GOWNER ADDRESS: TEL: i(, )— 1 6 -1 "1tAr. a6S-1:, 6c
TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL E
PRINT
CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:1Yr PLANS SUBMITTED: YES❑ NO❑
APPLIANCES? FLOOR-4 Bsmt 1 2 3 4 5 6 7 8 - 9 ' 10 s i --112i 131 14
BOILER = ,,_ .4,� "
BOOSTER
CONVERSION BURNER _ �� 1 71 ) I t
COOK STOVE
DIRECT VENT HEATER _
DRYER —
FIREPLACE ,,,,.\I! ;" iN. jy alY - .
FRYOLATOR _
FURNACE
GENERATOR ' ' ; —�
GRILLE
INFRARED HEATER
LABORATORY COCK
MAKEUP_ AIR UNIT
OVEN
POOL HEATER. - PLtl tN& tiAS INSPECTOR.
ROOM I SPACE HEATER F1iMIVIP I ON
ROOF TOP UNIT APThDvtU NOT APPROVED
TEST
UNIT HEATER _
UNVENTED ROOM HEATER
WATER HEATER
'- s(l '4 '--:'--° .1
INSURANCE COVERAGE ��,{
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES CJ NO ❑
If you have checked YES,please indicate the type of coverage by checking the appropriate box below.
LIABILITY INSURANCE POLICY [R 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.
,4 CHECKONE ONLY: OWNER ❑ AGENT ❑,
SIGNATURE OF OWNER OR AGENT `. _. '
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 app. io will be in compliance with all Pertinent
provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER/GASFITTER NAME: bUi" 9-11
(Nun% LICENSE# 1$0 I SIGNATURE
COMPANY NAML 0 C-- 14\ A 4" t4 ADDRESS: T ,-6O )C L.
CITY: '-0 C.10 Ir1 STATEnU ZIP:O \Ci I (,) FAX(_
TELO I �fbT31 S q CELL `N\Q— EMAIL:4cb IDv+.1V�nSP1 h4.-:e.,r-v '\ r
MASTER] JOURNEYMAN 0 LP INSTALLER 111 CORPORATION❑# PARTNERSHIP 0# LLG 0#
l z5
Ck:0610602 '(.6
---------) MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
• rry: 0 C ' n G rfl `t Cal MA. DATE:3•' Ci •'�C)‘', I PERMIT# 6,-Z021--032 ci
• JOBSITE.ADDRESS e�_�R �`�—
OWNER'S NAME ��-' '\ '" e d l
1 , L ,c C. 1'
c' `l5WNERSICDRESS: TEL: FAX:
TYP DR
�
PR�I' CCUP�(GY TYPE: COMMERCIAL❑ EDUCATIONAL E RESIDENTIAL
2
CLEeLY NEW: ❑'.' RENOVATION:" REPLACEMENT:E PLANS SUBMITTED: YES❑ NO ❑
APPL, LOOn- Bsmt . . 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
FRYOLATOR— --- '
FURNACE i - -
GENERATOR - -
GRILLE _ —
INFRARED HEATER _ .
LABORATORY COCK _ _ _ _ _
MAKEUP AIR UNIT - -
OVEN - -
POOL M
- PLUMBING-& GAS INSPECTOR
HEATER. 1ttORTHAMPTO4
ROOM I SPACE HEATER _
ROOF TOP UNIT APPROVED NOT APPROVED
•
TEST :
UNIT HEATER - _ _
UNVENTED ROOM HEATER
WATER HEATER _
INSURANCE COVERAGE ,,,
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO Ill
If you have checked YES,please indicate the type of covers -by checking the appropriate box below.
LIABILITY INSURANCE POLICY 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. .
. • zCHECK ONE-ONLY: OWNER ❑ AGENT ❑
SIGNATURE OF OWNER OR AGENT
hereby certify that all of the details and information I have submitted(or entered)regarding this ap-Oication are true end accurate to the best of my
Knowledge and that all plumbing work and installations performed under the permit issued for this a►.lica'...wtlt'be in compliance w'th all Pertinent
provision of the Massachusetts St lumbiing Code and Chapter 142 of the General Laws. ' ? tr _O
PLUMBER/GASFITTER NAME: TC-C-IL' S S-S) LICENSE#141\2,I •SIGNATURE
COMPANY NAME�� -1 ~ "8 ADDRESS: fir. 0 ' X ' t
- CI : ' ' 1er1 STATE GI ZIP:O 1 zYZ1(.7 FAX:
ui �)Q O . tin 1 Chci74Q5t °�1'
TEL. � c. CELL: �--Lim EMAI � `�"
\MASTER JOURNEYMAN❑ LP INSTALLER❑ CORPORATION ❑# PARTNERSHIP❑# LLG ❑#
=zo- zi F
NMAS,S•CHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
'L-zip 1.' - _--
._
__j=' oITY , I Q c- -fla_..t�cl 151-0 r)._.. ' MA DATE _.�a-tib'a0a- 'ERMIT#PP 21"62 6 Ca' ih�rr) 4'0)
d6BSITE nSi- SS 4OS. '01 Ec1SS,c\i- 5 T'_ I OWNER'S NAME $T�jI�iN N'Q4 _S. ___�
(
3.- QVNER f i i• SS 9 TEL FAX
TY""AIR 4CUP. < PE COM CIAL 0 EDUCATIONAL D • RESIDENTIAL El
PN Fir o
CL: .o 1_Y NEW: Km. NOVATION: . REPLACEMENT:0 PLANS SUBMITTED: YES U NO.
FIXT i RES-1 tc—Fro j•-1 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BAT .: ` --AL-I J� _-_—6L_-it_-�i.�_ i._--=1 --- --_!
CROSS CONNECTION DEVICE —J—I ��i _ ��L- _ -
DEDICATED SPECIAL WASTE SYSTEM L-,_ -;[ iI___JL qL. J:._ ij-.___ I ..., IL „- I __._.-_? _-; ___ _... .
DEDICATED GAS/OIL/SAND SYSTEM t_ _ql__-=-ii-_._11 L__I ___jh_`L__;I___i __ii___ ,L_-_JL 17---A__ _I
DEDICATED GREASE SYSTEM � _., _ f __L _i;-- - -_(i-___ ___ I -i__ ;`1; :
DEDICATED GRAY WATER SYSTEM �_- T _ �_ _1__ I _. II __ _-_IL II_- I .1 ___.
DEDICATED WATER RECYCLE SYSTEM [ir - —- _ I-�. I . -it _g' ; _ I—171
DISHWASHER I _ _.11_a._ L _,,L- l _IL� !_ I_ , L --- '�'- -._�i_ .1 _ 7; -.-_
DRINKING FOUNTAIN i ^I' s- L -'I _.__aL I _ _ -J(- _.I__ -L�-.J
FOOD DISPOSER _ - IL___i,T____II- __-I[.-.,_ L.._�-J1 'L.--. _ -Jf-,_-._ L JL_,.,__I--_ �«,w._AL._._ A
FLOOR/AREA DRAIN I________I___. Jr _ I____I _____I_.__ ' ..-_ L. dl •il_ ;I
INTERCEPTOR(INTERIOR) I_____s 1I___ =L____k_-. ! _$i ?1__
KITCHEN SINK r i!
LAVATORY -__.A 1 1i,____Al--1 IF if_-i1._.. 1_
ROOF DRAIN i____II� _i.��-1I_-.__jI�--IL-_ I 1'--- '— _,I ! --I
SHOWER STALL L____hEI _- 1 -)-- L-__I!_. __.:' _L_.
SERVICE/MOP SINK __ L _Ji___ -mont t' ' -4b
TOILET C.11__L__ i_ ,I____ Ili--:__. - �
URINAL L_- -A IL--- ■ ; . 1, • ,Cn� Ii• • •_0
WASHING MACHINE CONNECTION L_ _,I UL -� a ' )1 4 I. _ __? _ '1 - __I ._
WATER HEATER ALL TYPES - 1____- (__ _ ( _ I , _Air-
1
WATER PIPING I--1_-I- -s __.1 !-_J!_- _I L-�I L---I - --1 vt
OTHER • 'I-- ---IL7_-_ __ _, _fl - I
_..._ _11__.i ._-!..,L - -'�-- ____AWL_ - - - - `L - ) I
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YESI5f1 NO L_-I
•
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY el . OTHER TYPE OF INDEMNITY j BOND 0 .
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 Q AGENT LI
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this applica' are e and accurate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will e in co pliance with all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. _ Q, �,�
PLUMBER'S NAME a6Er�- jv � c T��
_. ._�_._._.__._._ __. . _..._LICENSE#'_1.____ ._._I SIGNATURE
MP V JP CORPORATION 0PARTNERSHIPD#1 i LC Litt ,
COMPANY NAME J�jS'4"I ADDRESS 0• c-� b 1
CITY fqc)nc(1n {STATE )I\q ZIP 070 Sr-2 TEL 61) 537-9 sisq .FAX . .. ; CELLS , i EMAILeS... t5ziGr-i-er. NEB(' - --
L5%20- N / Lid
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
it,=_77t.
'1-gt CITY ' ' iam Mon c _... . . _ MA DATE .L-Ja9-tdcy f,i PERMIT# Pik-?-d Zl--bZ-7l
JOBSITE ADDRESS L�Ql3 t f �`�lt$r R OWNER'S NAME $jam& N1 kA 1CA ., i
POWNER ADDRESS .. TELN 1:3) 1-h9b&4F' I
TYPE OR OCCUPANCY TYPE COMM CIAL 0 EDUCATIONAL Q • RESIDENTIAL 0 2
PRINT i o 0
CLEARLY NEW:fl RENOVATION: REPLACEMENT:Q PLANS SUBMITTED: Y si ':1 NOWo.9-
FIXTURES-1 FLOOR-0 BSM 1 2 3 4 5 6 7 8 9 10 11
z.4
BATHTUB ` - 1 IM 1 MMM—� - Less_
CROSS CONNECTION DEVICE I_ �__(i_ill-._.JI �'I 4 DEDICATED SPECIAL WASTE SYSTEM I ji I t-7 __ tElL I u".,.
DEDICATED GASIOIUSAND SYSTEM
DEDICATED GREASE SYSTEM ! I_ '_I;__ _ ' u
DEDICATED GRAY WATER SYSTEM I_ _ il_. _1 -___1 i_ ._ _II__. 3'_.__ 1 -_ _
DEDICATED WATER RECYCLE SYSTEM j I . 7 iL 11_ 2L JI -i I j r _II
DISHWASHER I J _.. L_ ___I -; . _ ' A'„-.1 i,_ j _ ___ . Ram
1 jai
DRINKING FOUNTAIN �-1.-- L-z'_ _;I JI itn1 . ) L__•
FOOD DISPOSER _ �___' ____IL___l
d ^
FLOOR I AREA DRAIN 1-1-._. _I I____I L____1,._-_J --� -- -�I--- 1_ __
INTERCEPTOR(INTERIOR) .�_-1-- 1__RL^__?1___ 1 1y__Ii„_?j-_ E— ____
KITCHEN SINK .=II__ - - L._-_fh !I.. i' 1_ _- -____1--- AI- _-_�
LAVATORY _� �_ _ _ 9I9_ - Q r ==4 1_ ___1; a _ _
ROOF DRAIN 7__. L __..11=_� I==-;L_1! - _II__ I'=---�1
SHOWER STALL - -k( _-'-- l - -) 'L ''nri�___ w
SERVICE I MOP SINK r- ___ I.-LJL____1 _=-11__��- I.,-__1I I� :_ iA,--L�--I_-1! -
TOILET - .JI.1__L-_-11--. ._,I___ —1- ,_ I _ - - - 4i -'`- -
URINAL E 1 --._I _I_,______ d- —C1�__.L fir_ -7,7j � • I', ' ' - •
WASHING MACHINE CONNECTION e i I _ __
��-��--;� t7 3 I I
WATER HEATER ALL TYPES I ____JI _ -j _J____ L,- _1:-- =I'__-- i -1- - i_ _ ,I
WATER PIPING I- - 1-_.j___ 1�-__1__.j_____-11-- ' -I ..=-I - �L- _� —- `
v ,
OTHER I- ---'�I __ -,)----_it__{I A- =�i= -11= - '1 11--- - i __a
Imo, J��I il fi J i
- J 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 L OTHER TYPE OF INDEMNITY Q BOND 0
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 0 AGENT 0
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or a itered regarding this appli e true and accurate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application I be in mpliance with all Pertinent provisionvi of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ,• Jt �'�AA A -J
PLUMBER'S NAME�t cb ' A-%'c b_-_ _ _ .-_,LICENSE# .'I. I_Ut ..j SIGNATURE
MPH' JP 11 CORPORATION0# _. 1PARTNERSHIPEl# ILLC(I.I# 1
COMPANY NAME 0a`6r1 ��0-G. ADDRESS 1�.0._ Y. b I -I
I 4 Z
STATE \Cl I ZIP 0i O 1_ TEL 0 �73t) 'cq_a 1
CITY ��CX150'tl. . . i
FAX r(ZQ, 1 CELL VVQ. _1 EMAIL _( S-. '1'.1- '(-5pl g w' Q.t`-- Ne '--- --- -. —-- 1
2-iz -z/ 4,1 e7)0-6
74,