38A-129 (9) BP-2023-0131
104 MOSER ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38A-129-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2023-0131 PERMISSION IS HEREBY GRANTED TO:
Project# BASEMENT RENO 2023 Contractor: License:
Est. Cost: 40000
Const.Class: Exp.Date:
Use Group: Owner: KANNAN COE, TERRENCE M&JAYALAXMI
Lot Size (sq.ft.)
Zoning: PV Applicant: KANNAN COE, TERRENCE M&JAYALAXMI
Applicant Address Phone: Insurance:
104 MOSER ST
NORTHAMPTON, MA 01060
ISSUED ON: 02/06/2023
TO PERFORM THE FOLLOWING WORK:
BASEMENT RENO
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Undee gr und: Service: Meter: Footings:
Rough: Rough:)'ail- House# Foundation:
00 Final:t/,,�� �i Final:s`r�"'' �' �rz L.j Final: Rough Frame:O•,1J Z'2-7-2.�5K.'�
`i/�V�3 W 'IL i3r' 't 0 iG 3- I3-2.3 K,,Z
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation: ()•( 3.2-Z3 W
'(L 1:;14Z-wt V iL 3•t3-2.3I<l?
Smoke: Final: 0 le 14...z4.23 ill
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
fi
eA� , _ (I Ili
Fees Paid: $260.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
P2mc- re:41p G 50*-t
(0 9 111 Ose 1C- . —
Commonwealth.o//Y/aieachuietti Official Use Only
,l�T hit—, Permit No. V ic 0
_ e epartlnent ol Jire Servicei
_
.�_ ff ;c Occupancy and Fee Checked 91I/6b2-
N BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank)
v'APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
OLEASE PRINT IN INK OR TYPE ALL INFORMATION) ate: fekvar y 2( ! Z oa 3
City or Town of: JO f i4 A M }O A to the Inspector of Wires.
By this application the undersigned gives notice of hii or her intention to perform the electrical work described below.
Location(Street&Number) joy M O re r ,f l (J
Owner or Tenant Terry COe "'telephone No. an6yj' /771
Owner's Address loci //t ere,- (1 /Vo.4haese 4OA MA
Is this permit in conjunction with a building permit? Yes ❑ No Er (Check Appropriate Box)
Purpose of Building reJlQ+4r44 ( Utility Authorization No.
Existing Service 100 Amps / Volts Overhead Er Undgrd❑ No.of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: ea)?)?men 4- f19hfi Q 4 of Qvf-/Lff,
Completion of the followin&table may be waived by the Ins ctor of Wires.
Total
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Tf
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting
grnd. grad. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Total No.of AlertingDevices
g Tons
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local 1-1 Municipal ❑ Other
Connection
No.of Dryers Heating Appliances KW Security :*
f Devices or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
dromassa a Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.H
y g No.of Devices or 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:Oz,/ZZ./as 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 fore ,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑ BOND 0 OTHER 0 (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: S 0 S rE Le c,-Fri c LIC.NO.: 53 7 o y
Licensee: MOO Solnin , 7oVrntyMatt-Signature 4Lj — LIC.NO.:
(If applicable,enter"exempt"in the lice/use num er line.) Bus.Tel.No.: Y/3 Z65—1,1'(7
Address: 4 Pale If- we/#4ge(c1 1,14- DOFF Alt.Tel.No.:
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No.
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 0 owner's agent.
Owner/Agent PERMIT FEE: $,�j'°-=
Signature Telephone No.
"1t7G 505 dGG i-yi ugy1 k4(, C4 rs-
47-1 v c
m% 1 Er-hr
or
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
IF,.,-; /; CITY " 0e.-1 rb a r Dom/ MA DATE o3 --to 7��7)� PERMIT#/' -2n 23 -O/O/
JOBSITE ADDRESS i O / d5e-g- S7 7`— OWNER'S NAME ��le C17t2�
P TYPE I OWNER ADDRESS 0 K-y tt 4 A./r/0/ mk— TEL 7i7 6 l i ii(
OR PRINTL OCCUPANCY TYPE COMMERCIAL❑ RESIDENTAIL [J/ E
CLEARLY
NEW: ❑ RENOVATION: SWREPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO a"
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 d
ROOF DRAIN
SHOWER STALL P_UMbING & GAS INSPECTOR
SERVICE/MOP SINK NOR1 HAIVIPTOI\TOILET / APPROVED N-i APPFiUVT D
URINAL
WASHING MACHINE CONNECTION 717;:-
WATER HEATER ALL TYPES
WATER PIPING /
OTHER
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 s,and that my signature on this permit application waives this requirement.
/� —� 2 CHECK ONE ONLY: OWNER 1K 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 d accurate to the best of my wledge
and that all plumbing work and installations performed under the permit issued for this application will be in c ce with all PertiIrnvisio f he
Massachusetts State Plumb'ng Code and Chapter 142 of/the
_GGene�rjl Laws.
PLUMBER'S NAME c9 T'�SJ�T/ LICENSE# �o�Y SIGNATURE
MP ❑ JP ID CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME al-67 7 '5 flf
, ADDRESS l/I/ 'V `SeVie/al'l �")� �,
� }�_ � � CITY
^
STATE I`l T�' ZIP �D�7 TEL if (3 16 7 !7,FAX CELL
3 -9- 3 ctik P/G rp
y,z ..L3 -,- c
, The Commonwealth of Massachusetts
f 1.
c
Department of Industrial Accidents
1 Congress Street,Suite 100
< Boston,MA 02114-2017
`' www mass. ov/dia
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1fio'xkers'Compensa ,n Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO FILED WITH THE PERMITTING AUTHORITY.
&nolicant Information Please Print Legjblv
1 , , -
Name(Business/Organization/ .ividual): ' i �`
Address: / V /7:/ '//
City/State/Zip: -S�x! evt • , A) '''''Ocf hone#: 6/7) '1'6. 7 /2
Are you an employer?Check the appropriate box: Type of project(required):
1.0 I am a employer with " 0 employees(full or part-time). 7. °New construction
2.01 am a sole proprietor or partnership and have no emp..yees working 'r me in 8. ['Remodeling
any capacity.[No workers'comp.insurance required.
9. ❑Demolition
3.0 I am a homeowner doing all work myself.[No workers'c. .p.insurance r:,uired.]t
10❑Building addition
4.❑I am a homeowner and will be hiring contractors to conduct. I work on my p .perry. I will
ensure that all contractors either have workers'compensation .surance or are-.le 11.❑Electrical repairs or additions
proprietor with no employees. 12umbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors list-•on the attache. heet. 13.0 Roof repairs
These sub-contractors have employees and have worker'comp.'. urance.t
6.0 We are a corporation and its officers have exercised their right of exe ption per MGL. 14.El Other
152,§1(4),and we have no employees.[No workers'comp.insuranc.. quired.]
*Any applicant that checks box#1 must also fill out the section below showing i,eir workers'co...ensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and .'-.hire outside co•tractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the na..-of the sub-con ctors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their worke -'comp.policy n "ben
I am an employer that is providing workers'compensation insura e for my emp i yees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expirat••n Date:
Job Site Address: City/State 'ip:
Attach a copy of the workers'co e tion policy declaration page(s owing the poli number and expiration date).
Failure to secure coverage as require under MGL c. 152,§25A is a crimin violation punis•able by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a ST S ' WORK ORD ' and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the 0 ice of Investigat •ns of the DIA for insurance
coverage verification.
I do hereby certi h der the pains and 'es of per' ry that the informa 'n provided abov: is true and correct
Si nature: sate: 03 O • 92'0r
y
Phone#: [ i d'n 9-6 7_Sr--77 ,
Official use only. Do not write in this area,to be completed by city or town o dal.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrica Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#: