16D-015 (4) V1 -arv� - -
I
189NORTH MAIN ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot: CITY OF NORTHAMPTON
16D-015-001
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED Col MGL RACTORS A)
DO NOT. HAVE ACCESS TO THE GUARANTY FUND
BUILDING PE MIT
Permit# BP-2022-0632 PERMISSION IS HEREBY GRANTED 0:
BATH BED RENO Contractor:
License:
Project#
Est. Cost: 17000
ConExp.Date:
Use Class: Owner: GUILLAUME AUBERT CAREY L &
Use Group:
Lot Size (sq.ft.) ft pplicant: GUILLAUME AUBERT CAREY L&
Zoning: URB
Applicant Address
Phone: Insurance:
189 NORTH MAIN ST
FLORENCE, MA 01062
ISSUED ON:06/06/2022
TO PERFORM THE FOLLOWING WORK:
BATH/BED RENO
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:g'',5".,
22-2 Rough: Clouse# Foundation:
Final:
Final: Final: Rough Frame:
�"� j Fire Department Driveway Final: Fireplace/Chimney:
/2 "��� i6���`�Rough: Oil: Insulation:
i
Smoke: Final: CI* ) /iS/ ) j..Tii
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOL• TION OF
ANY OF ITS RULES AND RECULATIONS.
Signature:
, o
Fees Paid: $111.00
212 Main Street, Phone(413) 587-1240,Fax:(413)587-1272
Office of the Buildine Commissioner
L!c#/oo
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
VOA.:
`' = CITY !' /v ri'n: c- MA DATE 5-/ t? PERMIT#pe- 2-0 l
JOBSITE ADDRESS / g a r"fk -Sr OWNER'S NAME Cam.r e� V e,r J`'
6o
11P
TYPE OWNEll ADDRESS TEL " g y3 7 EMAIL
OR PRINT OCCUPANCY TYPE COMMERCIAL❑ RESIDENTAIL ❑
CLEARLY
NEW: Et1 RENOVATION AO REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO ❑
FIXTURES " 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 _
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER _
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK
LAVATORY PLUMBING & GAS INSPECTOR
ROOF DRAIN N O R THAM PTON
SHOWER STALL j APPHUVED NOT APPROVED
SERVICE/MOP SINK
TOILET l�
URINAL
WASHING MACHINE CONNECTION I
WATER HEATER ALL TYPES
WATER PIPING C
OTHER
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Ai NO ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY cj OTHER TYPE OF INDEMNITY El 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 corn ' ce with II Pertipent provision of the
Massachusetts State Plumbing� Code and Chapter 142 of the General Laws.
PLUMBER'S NAME H << LA)F3L+ LICENSE#3-30 t SIGNATURE
MP El JP ity CORPORATION
//❑# PARTNERSHIP/El'' ❑# LLC ❑#
COMPANY NAME �cl3k4-S ,�1✓..►k;3 a..c� h�� • ADDRESS (;)1. iceve>1.IC !d f f%v:enot- CITY
STATE nil ZIP O►b TEL Y/ 3 FAX YIs-- FAX CELL
EMAIL S pyc1 er 010 ei Act.. co...
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