38A-134 (12) 86 MOSER ST COMMONWEALTH vi MASSACI i L K I S
Map:Block:Lot: CITY OF NORTHA�' PTO
38A-1 4-001
Permit: Ails Renovations
Repair
ORS
P NOT HAVE ACCESScTO THE WITH IGUARANTY�FUND}(MGL 1
DO c.142A)
•
BUILDING PERMIT
-0965 PERMISSION IS HEREBY GRANTED TO:
Permit# BP 202�2 _ License:Project#
BASEMENT RENO contractor:
Est. Cost: 55000 Exp.Date:
Coast.Class: PASTRICH-KLEMER KATHERINE MA tIE &
Owner: DEBORAH LEEPASTRICH-KI.EMER
Use Group: �
Lot Size (scion.) PASTRICH-KLEMER KATHERINE MAIUE&
Zoning:.
PV Applicant: DEBORAH LEE PASTRICH-KLEMER
Applicant Address
Phone: insurance:
5{6 MOSER ST
NOR CHAMPTON, MA 01060
ISSUED ON:08/12/2022
TO PERFORM THE FOLLOWING WORK:
BASEMENT RENO
POST THIS CARD SO IT IS VISIBLE FROM THE STREET Building Inspector
Inspector of Plumbing Inspector of Wiring D.P.W.
Underground:
Service: Meter: Footings:
Rough: —' - Rough:e" 3dg °• House # Foundation:
cv�- Final: Rough Frame:0'K 8 3l-Z 2 Kp
t�inal:
Ninal:, / y 1- l ),
�� Fire DepartmenP Driveway Final: Fireplace/Chimney:
Gas:
Insulation:
Rough: Oil:
Smoke: Final: 0.14' II- II-I-Zz k'Q
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
irk,I ' I T-1
i . •
'
4 -
Fees Paid: $357.00
!,;, sx7-1240,Fax:(4l3)587-1272 ,
un, _ 20 E232 ,LiIc3 ,d�,
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
It 2-Aiip el
klitillir-gD CITY fb/�,-i1'i"L7 l--r -II MA DATE e)-,c J- 3' -Q PERM T# 20=2"03 i-2
,+~^'� t/e) a ltL /� � OWNER'S NAME `�`< P'M�
JOBSITE ADDRESS ;
.( OWNED DRESS L / 0 S c'"fe 5-'J '` - TEL FAX
t
TYPE OR OC POICY TYPE: COMMERCIAL❑ EDUCATIONAL 0 RESIDENTIAL Elv/
PRINT NE : RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES 0 NO EL
CL�ABLY Jtiti
FIXTURES 1 ��I"i 00R-. BSMT 1 2 3 4 5 r 6 7 8 9 10 11 12 .13 14
BATHTUB
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYS
DEDICATED GAS/OIL/SAND SYS
DEDICATED GREASE SYS
DEDICATD GRAY WATER SYS
DEDICATED WATER RECYCLE SYS _
DRINKING FOUNTAIN
DISHWASHER _ _
FOOD DISPOSER
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR) — ..—,
KITCHEN SINK PI UMBING & GAS INSIIECTrH
LAVATORY f NORTHAMPTION
ROOF DRAIN APPRQVFD NOT APPROVED
SHOWER STALL
SERVICE I MOP SINK .. _
TOILET
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES '
WATER PIPING )
OTHER
INSURANCE COVERAGE: J
I have a current liability Insurance policy or its substantial equivalent which,meets the requirements of MGL Ch. 142. Yes 0 No❑
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY 0 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 L s,and t at my signature on this permit application waives this requirement.
_, ��/ CHECK ONE BOX ONLY: OWNER ❑1 AGENT 0
Signature of Owne or Owner's A ent
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 ail plumbing work and installations performed under the permit issued for this application will be in
compliance with all ertinent provision of the M'assih Betts State Plumbing Code and Chapter �of the General Laws.-----,
PLUMBER NAME G-J�N //C SIGNATURE_ � -� _-----, -��C�-�/�rc '�cl 1
LIC# MP 0 JP ! CORPORATION 0# PARTNERSHIP ❑# LLC 0#
COMPANY NAME4-11---e f Y lAitL,;11-5 ADDRESS: ' (9 / ff, l3 a-0 t%-/te
CITY to 5 .� 7 _� STATE /T ZIP 0,0.47/1 EMAIL
TEL • CELL Ll/ 1 56 7 7 i FAX
F-30'&z Pc)cr6 71,g
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X(o al bS Gde- 57—
Commonwealth of Massachusetts Official Use ly
i_1J1 ' lio, 'I Department of Fire Services Permit No.Er 2022--
^� _ ARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked ig /I 7
lease add zi codes 8 electrician's cell#• [Rev. 1/07]
G,
!...:_ contract# 8 bid permit#if applicable.) (leave L.L1
s A-PPL1 ATION FOR PERMIT TO PERFORM ELECTRICA WORK
II work to be performed in accordance with the Massachusetts Electrical Code(MEC). 527 CMR 1I.00
(PLEASE f� TIN INK OR TYPE ALL INFORMATION) Date: $— 6
City ,r Town of: Worivt klxw op [0ti To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street& Number) S b C1 o ser Ser
Owner or Tenant Dr. Telephone No.6 L u-nM_2I 0,
Owner's Address $a in....A,
Is this permit in conjunction with a building permit? Yes n No )ti (Check Appropriate Box)
Purpose of Building IZR S:at Vtcl'ct.( Utility Authorization No.
i
Existing Service '.00 Amps k'a..e/7,D Volts Overhead E Undgrd ❑ No.of Meters '
New Service Amps / Volts Overhead n Undgrd n . No.of Meters
Number of Feeders and Ampacity s' Gj ve,ull S ULYIv mil htt... room S t in
Location and Nature of Proposed Electrical Work: No t e i,,,.�,,,L,i 1 ' itt hzisc> .9--
Completion of the following table may be waived by the Inspector of Wires.
Total
No. of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No
Transformers KVA
No. of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting
L( grnd. grnd. Battery Units
No. of Receptacle Outlets 1).4) No. of Oil Burners FIRE ALARMS No.of Zones
No.of Switches b No.of Gas Burners No. InitiatingDete a
on Devi ses tTota
No. of Ranges No. of Air Cond. Tons No.of Alerting Deices
No.of Waste Disposers Heat Pump Number Tons KW 'No.of Self-Contained
p Totals: Detection/Alerting Devices
No. of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Other
HeatingAppliances 'ecurity Systems:*
No. of Dryers pp KW No.of Devices or Equivalent
No. of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No. H dromassa a Bathtubs No.of Motors Total HP TelecommunicationsofDceor Wiring:
al
y g No.of Devices Equivalent
OTHER:
Attach additional detail if desired. or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
I certify, under the ains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: (q$? D f ciAtict LIC NO.: $?,g+q I3
Licensee: Signature t!,V L1C� NO.:
(If applicable. enter "exempt"in the lice se number line.) Bus.Tel. No.: Lill KC, 24 24
Address: as-0 vi ,o d6W S1- A pT 3 2 4 Sawa 1M /4 4 O(Ob. Alt.Tel.'No.:
*Security System Contractor License required for this work; if applicable,enter the license number here:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent.
Owner/Agent PERMIT FEE: $ I�� DD
Signature Telephone No.
?-3°'a Rov�� �
1frR' 92