32C-104 (26) 50 CONZ ST-WWII CLUB
BP-2017-0766
GIs#: COMMONWEALTH OF MASSACHUSETTS
Mao:Rlock:32C- 104 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category. WATER DAMAGE BUILDING PERMIT
Permit# BP-2017-0766
Proiect# JS-2017-001278
Est.Cost $54908.00
Fee:$385.00 PERMISSION IS HEREBY GRANTED TO:
Const Class: Contractor. License:
Use Group: BAYSTATE RESTORATION GROUP 056785
Lot Size(sa. ft.): 25047.00 Owner: WORLD WAR II VETERANS ASSOC OF HAMPSHIRE COUNTY INC
Zmine:N13000)/ Applicant: BAYSTATE RESTORATION GROUP
AT: 50 CONZ ST-WWII CLUB
Applicant Address: Phone. Insurance:
69 GAGNE ST (413) 532-3473 WC
CHICOPEEMA01013 ISSUED ON.•IZ/2812016 0:00:00
TO PERFORM THE FOLLOWING WOR%WATER DAMAGE - REPAIR WIRING DAMAGE,
RE-INSULATE, DRYWALL, RESET APPLIANCES
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: O& Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy sienature: h -
FeeType: Date Paid: Amount:
Building 12/28/20160:00:00 $385.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM OAS FITTING WORK
crryl n n (gyp, MA DATE PERMIT#CQP- A$-10
JmrTE ADDREss OARIER'S NAME
GWI AGWNE
PRINT BREs6 "'I�JFAXO
7OCCUPANCY TYPE COMMERCNLA EDUCATIONAL❑ RESIDBRN ❑L
PRINT
CLEARLY I NEW:❑ RENOVATION:El REPLACEMENT:❑ PIANS SUBMITTED: YES❑ NOQ
APPLIANCES 1 FLOORS-r I BBLI I 1 2 S 4 s 0 7 s s 10 11 12 13 14
BOILER
BOOSTER
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR is
GRILLE
INFRARED HEATER
LABORATORYCOCKS
MAKEUPARUIYT ..
OVEN
POOL HEATER
ROOM I SPACE HEATER
ROOFTOPUNIT
TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER TER
OTHER
INSURANCE COVERAGE
I have a current HabfiKy Insurance policy or Its substantial equivalent which meets the requirements of MGL.Ch.142 YEs Q NO ❑
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECIONG THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY ❑ OTHER TYPE INDEMNITY U BOND U
OWNER'S INSURANCE WAIVER:I am aware that the licensee time not have the Insurance coverage required by Chapter 142 of the
Massachusetts General Laws,and that my signature on this permit application waives thls requirement.
CHECK ONE ONLY: OWNER LEI AGENT E3
SIGNATURE OF OWNER OR AGENT
I hereby certify thetal ofme detale and IMoimadon I have eubmMed or wdwM reganAng this applicatlon a sue and as nnb toms bear of my knowledge
and that all plumbing work end Installations performed under the Pemat Rued for the applkeHon will he Dnp OnanlroNabn oltls
Massachusetts Slab Plumbing Code and Chapter 142 of the General Laws. y
PLUMBER-OASFITTER NAMEPVUI Duda LICENSE#9964 SIGNATURE
MP El MGF❑ JP El JGF❑ LFGI❑ CORPORATION[I# 1881C PARTNERSHI/L3#L=LLC❑#=
COMPANY NAMElBoulangss Plumbhg d Holding,Inc. ADDRESS 1PO Bax 89,373 Maln Street
CITY lEashampion sTATEF 01027 TEL 413527:YL40
FAX 413528@387 CELLEMAILWulangersplumbin .wm
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DF Massachusetts WARNING NOTICE — AVISO
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THE FOLLOWING PROBLEM MUST BE CORRECTED IMMEDIATELY: PIi NA9 ❑ iu iwe x AME
LOS SIOUIEN[TES PROBLEMAS D'ESEN`SER CORREOIDOS IMMEDNITAMENTE: ❑ MwcrDuwE ❑ Opp�.ipE OE yEKpN
YOU MUST CONTACT A QUALIFIED CONTRACTOR FOR REPAIR:
COMUNWUESE CON UN CONTRATMTA ESPECUILIL100 PARA EFECTOS OE LA REPARACION:
�RGIMq ❑ ELKTAK:ULA ❑ KFISONA WE LIW$A EL CANON ❑ omll:
O HUMERO DE CHIMENEA Dila:
THIS WARNING NOTICE IS FOR YOUR SAFETY AND PROTECTION. AFTER ESTE AVISO ES PARA SU SEGURIDAD Y PROTECCION. PARA LA RE-
REPAIRS ARE MADE CONTACT COLUMBIA GAS OF MASSACHUSETTS STAURACION DEL SERVICIO COMUNIOUESE CON COLUMBIA GAS
OF MASSACHUSETTS DESPUES BE DUE LAS REPARACIONES HAYAN
FOR RESTORATION OF SERVICE. n SIDO HECHAS.
OAS LEFT ❑ON-CONECTADO METER LOCKED Q YES-51
CONTADOR APPLIANCE LOCKED ❑ YES-SI
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ENCUEMM OFF-DESCONECTADO CCONL VE ❑NO-NO OEMACTO N Wr�E ❑ NO.NO
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KEEP
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\ DO NOT TAMPER WITH LOCKING DEVICE.
M REMOVAL SHALL ONLY BE MADE BY A COLUMBIA GAS \
OF MASSACHUSETTS SERVICE REPRESENTATIVE. 3
AVISO
NO MANIPULE LACERRADURA.
7 L REPRESENTANTE DEL COLUMBIA GAS OF M USETTS
ES LA UNICA PERSONAAUTORIZADA PARA R RLA.
"CONDEMNED"
DECLARADO INUTILIZABLE 1^
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FOR UNBENUTZBAR ERKLART IT
DtCLARRt INUTILISABLE V
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WHEN YOU HAVE REMEDIED THIS CONDITION AND
WANT THE GAS TURNED ON,
COLUMBIA GAS OF MASSACHUSETTS
Brockton Division: 1-800-677-5052 \�
Lawrence Division: 4r8-685-6382 \
SprinOtieltl Division: 413-781-3610
Springiieltl Division: 413-586-2400 V�
(Nortampton Area)
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WARNING NOTICE - AVISO
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THE FOLLOWING PROBLEM MUST BE CORRECTED IMMEDIATELY: ❑ TUEeeLe ❑ NELA�FrR�ar of AME
LOS SIGUIENTES PROBLEMAS BEGIN SER CORREOIDOS IMMEDIATAMENTE: OuaEs 6t cG�14EI&M KveNrEAc+aN
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YOU MOST CONTACT A QUALIFIED CON11111CTOR FOR REPAIR:
COMUNIQUESE CON UN CONTRATISTA ESPECMLITADO PARA EFECTOS BE LA REPARACION:
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OTMR:
{LIL M1WERo ❑ ELFGINICMTA E] PER80NA WELIMPIA ELCMION ❑
O HUMEM m CNIMENEA pTlp;
THIS WARNING NOTICE IS FOR YOUR SAFETY AND PROTECTION.AFTER ESTE AVISO ES PARA SO SEGURIDAD Y PROTECCION. PARA LA RE-
REPAIRS ARE MADE CONTACT COLUMBIA GAS OF MASSACHUSETTS STAURACION DEL SERVICIO COMUNIQUESE CON COLUMBIA GAS
OF MASSACHUSETTS DESPUES DE DUE LAS REPARACIONES HAYAN
FOR RESTORATION OF SERVICE. SIDO HECHAS-CON
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GAS LEON ECTADO METER LOCNEO ❑YES-SI 045
CONTADOR APPELLNCE seemC E� .E5.81
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OFF-DESCONECTADO COIN LLLLAAVVE RHO-NO DE OAS � ��CON�LLAVE ❑ NO-NO
CURT ER SIGNATURE: )C y �N� El 'NnN F-1Mp
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2� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS
//FITTING WORK
1
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CITY /rli:,� fN/F/j�/ I C A-- MA DATE d -3C-17 PERMIT#
JOBSITE ADDRESS SO CUtiy 5'` OWNER'SNAME /6VOK/d GGA, �2 (-(C,?
IOWNER ADDRESS TEL FAX
r PE
�RIN ,I L
OCCUPANCYTYPE COMMERCIA / EDUCATIONAL Wm: RESIDENTIAL.. .
Y: NEW: RENOVATION: REPLACEMENT'. PLANS SUBMITTED'. YES NO
�-- 1 FLOORS- BSM 1 2 J 4 5 6 ] B 9 10 11 12 13 14
BOILER
BOOSTER
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN /
POOL HEATER
ROOM/SPACE HEATER
ROOF TOP UNIT
TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER _ .
OTHER
-'PAJ( J�1/r
INSURANCE COVERAGE
I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES � NO . .
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY .f OTHER TYPE INDEMNITY e„ 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 wa=ves this requirement.
CHECK ONE ONLY: OWNER E3 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 accurele to the beat of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. V d/;,— 4z
PLUMBER-GASFITTER NAME .. /7 A/-r� ,z-/ 5A LICENSE#is-Py, SIGll TlumE
MP MF _ JP JG//F LPGI CORPORATION # PARTNERSHIP # LLC #
COMPANY NAME LXADDRESS
CIN Ciq PDQ STATE, ZIP TEL
FAX E' CELL EMAIL
3 C�qe._..
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Ya No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT#
PLAN REVIEW NOTES
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