18C-083 (9) Request to Cancel-242 Jackson St Permit
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Subject: Request to Cancel - 242 Jackson St Permit
From: Carol Moran <Carol@westernmassheatingcooling.com>
Date: 6/6/2023, 10:13 AM
To: Beth Willard <bwillard@northamptonma.gov>
Hi Beth—when you have a chance can you cancel permit PP-20230094? It's for 242 Jackson St Northampton.
Thank You!
Carol Moran
Project Coordination Specialist
(413)268-2803
WESTERN MASS www.westernmassheatingcooling.com
4 South Main St Suite K Haydenville, MA 01039
1 of 1 6/6/2023, 10:15 AM
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
-"=:a° CITY/TOWN Northampton MA DATE 02/27/2023 PERMIT# Pp.z 2 —°091
J—M JOBSITE ADDRESS 242 Jackson Street OWNER'S NAME Jenny Katz-Brandoli
P= OWNER ADDRESS 242 Jackson Street TEL 413-548-6504 FAX
TYPE dR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL ❑ RESIDENTIAL 21
PRINT
CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT: ® PLANS SUBMITTED: YES El NO El
FIXTURES 1 FLOOR-0 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 Iry c EC)r'c)w
ROOF DRAIN NORTHAMPTON
SHOWER STALL APPROVED NOT APrpnvr-n
SERVICE/MOP SINK
TOILET 42
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES 1
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 Laws,and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER El 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 compliance with all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Rae�.Q/za/az,,taf
PLUMBER'S NAME Richard Scott Cernak II LICENSE# 15672 SIGNATURE
MP El JP El CORPORATION ®# 4386-PL-C PARTNERSHIP❑# LLC El#
COMPANY NAME Western Mass Heating Cooling&Plumbing, Inc. ADDRESS 4 South Main Street(Suite K)
CITY Haydenville STATE MA ZIP 01039 TEL 413-268-7777
FAX CELL EMAIL info@westernmassheatingcooling.com