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32C-171 (26) 256 PLEASANT ST- FIT OUT BP-2019-1502 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C- 171 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2019-1502 Project# JS-2019-002433 Est. Cost: $261377.00 Fee: $1827.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SALOOMEY CONSTRUCTION 018780 Lot Size(sg. ft.): 17119.08 Owner: LUMBER YARD NORTHAMPTON LIMITED PARTNERSHIP Zoning: C13000) Applicant: SALOOMEY CONSTRUCTION AT. 256 PLEASANT ST - FIT OUT Applicant Address: Phone: Insurance: P O BOX 1203 (413) 269-4360 WC WESTFIELDMA01086 ISSUED ON:6/2712019 0:00:00 TO PERFORM THE FOLLOWING WORK.1 ST FLOOR OFFICE SPACE FIT OUT POST THIS CARD SO IT IS VISIBLE FROM THIS, STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: [louse# Foundation: Driveway Final: Final: Final:Final: 7-30 - /9 P f-'N Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smokc: Final: OX, THIS PERMIT MAY BE REVOKED I3Y THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND RE 1 TIONS. _ Certificate of Occu anc signature: FeeTyae: Date Paid: Amount: Building 6/27/2019 0:00:00 $1827.00 212 Main Street, Phone('413)587-1240, Fax: (413)587-1272 Louis Hasbrouck - Building Commissioner 256 PLEASANT ST EP-2018-0580 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Map: 32C Lot: 171 ELECTRICAL PERMIT Permit: Electrical Category: ELECTRICAL WORK ASSOCIATED WITH THE CONSTRUCTION OF 55 LIVING UNITS AND 3 RENTAL SPACES,3 METERS Permit# Electrical PERMISSION IS HEREBY GRANTED TO: Project# JS-2018-001071 Est.Cost: Contractor: License: Fee: $5835.00 GABLE ELECTRIC INC MASTER ELECTRICIAN 16563 Owner: VALLEY COMMUNITY DEV CORP Applicant: GABLE ELECTRIC INC AT. 256 PLEASANT ST Applicant Address Phone Insurance 5 WESTVIEW RD (413) 443-4082 C- Liability, BKS55617694 PITTSFIELD MA01201 ISSUED ON:1/30/2018 0:00:00 TO PERFORM THE FOLLOWING WORK: ELECTRICAL WORK ASSOCIATED WITH THE CONSTRUCTION OF 55 LIVING UNITS AND 3 RENTAL SPACES, 3 METERS Call In Date: Date Requested Inspection Date/SignOff: Reinspect?: TrenchXG: . ��- 3 /� 5�� u�l�/ SZ�'� r�"�y j� S�ti�3,✓Pty �� 9., Special Instructions ��'/3`/ fl �fM.�� yM S— -� )" / k�tc,� LA, X 4A c 1, �„ (IJA a"w- 1-1-"/-/ u 'r/ Roueh y� F(O'Q s,LL- 7-/4 R --- U� f� 1 1�slyoK� /o Jo rq �a .. X (Myolµ C,,lc_ // / (S /L� �'� Y6r2 W4 S s Special Instructions: 1Y(c�o" Nalydll� - ) -3 '/�f- 3 R��C!/G+e 30� —3��ZA)C:-- . 3 Final: y � �- S� /s /g �'8T'vo� - 3 a floor J' N4 W� SRE Called In: 24019445 - �7' �1 �^ 7'3e� /� r Q� r2 � M,,.h Si n tur Fee Type:: Amount: DatePaid Electrical $5835.00 1/30/2018 0:00:00 29560 212 Main Street,Phone(413)587-1244,Fax(413)587-1272-Inspector of Wires -Roger Malo Vl MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY ��6��,o �G.(/ MA DATE 2/Sf/6 PERMIT# PP-6--�4`1 JOBSiTE ADDRESS tS/-0 '/ OWNER'S NAME POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL -] EDUCATIONAL RESIDENTIAL PRINT 'I-/. CLEARLY NEW: ----'RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO -1 FIXTURES Z 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/OL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER ZAL 116 1-6 DRINKING FOUNTAIN FOOD DISPOSER % FLOOR/AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK AO 1A 16 LAVATORY / /, / ROOF DRAIN SHOWER STALL SERVICE I MOP SINK / TOILET /- PE TO URINAL F CM7 4wi FT-UT WASHING MACHINE CONNECTION V E T 6PPRIIM WATER HEATER ALL TYPES WATER PIPING — OTHER INSURANCE COVERAGE: I have a torrent laWlty insurxloepely or its substantial equivalent which meets the requirements of MOL Ch.142- YES - NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY r 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 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 hmat of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in ncewith�N P provision qf the Massachusetts State PlumbbV Code and Chapter 142 of the General Laws. PLUMBER'S NAME David Ftedenbufgh LICENSE# 11406 SIGNATURE MP JP CORPORATION #2344 PARTNERSHIP # _1LLC[�#L. COMPANY NAME D F Pkwbng&Metltalnical Contractors,Inc ADDRESS P.O.Box 1086 9 Stadler Street CITY Belchertown STATE MA ZIP 01007 TEL 413-323-6116 FAX 413323-7532 CELL EMAIL dfpkimbingbelchertown@yahoo.com 3RIb ~A 7 1�1-9A Sn/�C1 , �z�� d ��S��d ok9�J �oZ G✓�r/ - 77yo114J 060 �/� ✓��-ter-., Ile x1. �,r�� i / /�V - �c�- = 2som'} Aj ('y 0 • C* -- - - --- r-- - --- - / , / / 7 • 0 0 + 1 6 . 00 + S 16 . 00 + - ----- - 1 6 • 0 0 + �p ow 7 . 00 + 1 6 . 00 + ( tQ _ 1 6 • 0 0 + / 16 • 00 + 7 • 00 + 16 • 00 + - - y - --------- l ? p 1 • 00 + ip ✓t�J /f'L 1 6 . 0 0 + 3 . 00 + 7 . 00 + 1 6 . 00 + 1 6 • 0 0 + 16 . 00 + 13 . 00 + 16 . 00 + Li 16 . 00 + W 1 6 . 0 0 + -- - 1 • 00 + 1 • 0 0 + - --- --- ---- 1 • 0 0 + ---7T-( (,p U � 13 • 00 + - --- - 16 . 00 + r n 16 . 00 + 6 . 0 0 + - T q-�/n( .l rO.S 2 . 00 + r 1 . 00 + �.- -- -- 034 369 • 00 U \ -dM 1 A-x) y i _- --fro T ; - L Vtr i{ L Cy) IQ .Y 256 PLEASANT ST EP-2018-0242 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Map: 32C Lot: 171 ELECTRICAL PERMIT Permit: Electrical Category: INSTALL POST MOUNTED 200A TEMP SERVICE TO ACCOMDATE CONSTRUCTION OF NEW HOUSING BUILDING Permit# Electrical PERMISSION IS HEREBY GRANTED TO: Project# JS-2017-002285 Est.Cost: Contractor: License: Fee: $60.00 GABLE ELECTRIC INC MASTER ELECTRICIAN 16563 Owner: WHITE GAIL M A K A LABARGE GAIL M C/O NORTHAMPTON LUMBER CO Applicant. GABLE ELECTRIC INC AT.- 256 PLEASANT ST Applicant Address Phone Insurance 5 WESTVIEW RD (413) 443-4082 C- , PITTSFIELD MA01201 ISSUED ON:10/11/20170:00:00 TO PERFORM THE FOLLOWING WORK: INSTALL POST MOUNTED 200A TEMP SERVICE TO ACCOMDATE CONSTRUCTION OF NEW HOUSING BUILDING Call In Date: Date Requested Inspection Date/SignOff: Reinspect?: Trench/UG: Special Instructions X Rough X Special Instructions: Final: SRE Called In: 24651120 `S - 94)'IR 01111- Signature: Fee Type:: Amount: DatePaid Electrical $60.00 10/11/2017 0:00:00 29316 212 Main Street,Phone(413)587-1244,Fax(413)587-1272-Inspector of Wires -Roger Malo C 256 PLEASANT ST EP-2019-0492 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Map: 32C Lot: 171 ELECTRICAL PERMIT Permit: Electrical Category: RUN INTERNET CABLES,INSTALL EXTERIOR DISCONNECT&SMART METER SOCKET ONLY(AT THIS TIME) Permit# Electrical PERMISSION IS HEREBY GRANTED TO: Project# JS-2018-001071 Est.Cost: Contractor: License: Fee: $60.00 PIONEER VALLEY PHOTOVOLTAICS MASTER ELECTRICIAN 13764A Owner: VALLEY COMMUNITY DEV CORP Applicant: PIONEER VALLEY PHOTOVOLTAICS AT. 256 PLEASANT ST Applicant Address Phone Insurance 311 WELLS ST- SUITE B (413) 772-8788 C-(413) 834-8390 GREENFIELD MA01301 ISSUED ON:1/8/2019 0:00:00 TO PERFORM THE FOLLOWING WORK: RUN INTERNET CABLES, INSTALL EXTERIOR DISCONNECT & SMART METER SOCKET ONLY(AT THIS TIME) Call In Date: Date Requested Inspection Date/SiEnOff: Reinspect?: Trench/UG: Special Instructions X Rough X Special Instructions Final: r- --k) —/4i apvN SRE Called In: Signature: Fee Type:: Amount: DatePaid Electrical $60.00 1/8/2019 0:00:00 9753 212 Main Street,Phone(413)587-1244,Fax(413)587-1272-Inspector of Wires -Roger Malo J0Lq13&031W' 0(-) MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY INorthampton I MA DATE 08/22/18 j PERMIT# 69 I'_` ` — v JOBSITE ADDRESS 1256 Pleasant Street OWNER'S NAME I Lumber Yard Northampton Limited GOWNER ADDRESS 1120 Maple Street 4th Floor,Springfield MA 01103 TE 413-233-1724 I FAX I N/A TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL RESIDENTIALF-1 PRINT CLEARLY NEW:O RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES❑ NOQ APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 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 nw OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST — UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER JUG Line INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES r7 NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY F-i OTHER TYPE INDEMNITY F-1 BOND n _ censee does not OWNER'S INSURANCE WAIVER: I am aware that the Ili ave the insurance coverage required by Chapter 142 of the n this permit app Massachusetts General Laws,and that my signature o !cation waives this requirement. <AGNT SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate-tot best of y knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance wi alf Pert' ent `vis n of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Ho ewell Budd III I LICENSE# 1194 NATURE MP❑ MGF❑ JP❑ JGF❑ LPGI 0 CORPORATION❑# PARTNERSHIP❑ LLC COMPANY NAME:Osterman Propane LLC ADDRESS 1339 Amherst Road CITY ISunderland STATE MA ZIP 01375 TEL 413 549 1000 FAX 413-549-9360 CELL NIA EMAIL N/A o s � Z• ILL r, ROUGH GAS INSPECTION NOTES THIS PAGE FOWNS TOR USE ONLY FINAL INSPECTION NOTES Yes THIS APPLICATION SERVES AS TH PERMIT ❑ C� FEE: s PERMIT# PLAN REVIILW.NOTES j Cj0ae '541zl 71,l0000� Z,00� �n( ��q 7!!#'v CJV c Va Z 4,0 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - CITY lNorthampton MA DATE 10-18-18 PERMIT# JOBSITE ADDRESS256 Pleasant St OWNER'S NAME Lumry beard Northampton Limited Partnership LC OWNER ADDRESS 120 Maple St Springlfield, MA 01103 TE 413-223-1724 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL - EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES[ NO[—' APPLIANCES-1 FLOORS— BSM 1 2 3 4 5 6 7 8 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 s OVEN POOL HEATER I 1 ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER r` WATER HEATER OTHER gas line to temp heater INSURANCE COVERAGE I have a current liability insurance 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 OTHER TYPE 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 ENT I_ 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 f myxrnowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with rti provisi n of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME HOPEWELL BUDD III LICENSE# 1194 SIGNATURE MP® MGF[D JP® JGF® LPGI® CORPORATION®# PART44SHIP # LLC # COMPANY NAME:OSTERMAN PROPANE LLC (ADDRESS 1339 A� MHERST RD CITY ?SUNDERLAND _ STATE MA IZIPI01375 TEL 800 287 2429 uW -� FAXCELL 508-944-7176EMAIL SSYMONDS(.OSTERMANGAS.COM ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES //Ael� A7zne 4 . - C- S ejtmc 'wa 00 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GASB FITTING WORK CITY INorthampton MA DATE 10-5-201 PERMIT# JOBSITE ADDRESS 1256 Pleasant St —OWNER'S NAME I Lumberyard Northampton Limited GOWNER ADDRESS 120 Maple St 4th FL Springfield MA TE 413-223-1724 IFAXF —� TYPE OR OCCUPANCY TYPE COMMERCIAL[ EDUCATIONAL ❑ RESIDENTIAL P PRINT CLEARLY NEW: RENOVATION: REPLACEMENT:` PLANS SUBMITTED: YES❑ NO APPLIANCES -1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR r.. FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER Nod lommov "a ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER - OTHER Tem Gas Line to Heater 25� 2� INSURANCE COVERAGE I have a current liability insurance 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 . OTHER TYPE 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: OWNE GE 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 ccura o the best y knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complian wi Perti ro sion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME 1HOPEWELL BUDD III LICENSE# 1194 SIGNATURE MP El MGF F--1 JP❑ JGF® LPGI CORPORATION®#F777771 PATNERSHIP❑# LLC[J#� COMPANY NAM60STE�RMAN-.PROPANE LLC ADDRESS 339 AMHERST RD CITY SUNDERLAND ((�� STATE �ZIP 375 TEL 800-287-2429 FAX ._._ CELL 508-9447176 EMAIL�SSYMONDS�OSTERMANGAS.COM ROUGH GAS INSPECTION NOTES THIS PAGE WR LECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES A5 HES PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES i of .K �P 7 <Y /dU of MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY lNorthampton MA DATE12-13-18 PERMIT# of--4"t–2.�� JOBSITE ADDRESS&EL,?easant St Q� WNER'S NAME Saloomey Construction OWNER ADDRESSPI o Box 1203 Westfield MA 01086 TEL 413-269 4360 FAX r TYPE OR OCCUPANCYTYPE COMMERCIAL EDUCATIONAL' RESIDENTIAL® PRINT CLEARLY NEW: „ RENOVATION: REPLACEMENT iPLANS SUBMITTED: YES ® NO APPLIANCES Z FLOORS BSM 1 2 3 4 5 6 7 8 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 IJ .. OVEN _ POOL HEATER ROOM/SPACE HEATER r ROOF TOP UNIT TEST F LUN! 31NG & G S I SPE TO UNIT HEATER ORT AM TO UNVENTED ROOM HEATER PPR VEPPROVE WATER HEATER -----_ _ OTHER INSURANCE COVERAGE I have a current liabiliinsurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES I NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE 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: OWN N7 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 accur e jelfie of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliancert' nt ovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME IHOPEWELL BUDD III v LICENSE#31194 SIGNATURE MP[jMGF' JP F7111 JGF f LPGI CORPORATION®# PAPXERSHIP L3# LLC L1#L= COMPANY NAME:;OSTERMAN PROPANE LLC 1 ADDRESS 1339 AMHERST RD CITY SUNDERLAND STATE. MA 'ZIP 01375 TEL 800-287-2429 FAXI j CELLj508-944-7176JEMAILFSSYMONDSna.OSTERMANGAS.COM ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL,INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES 7-10 ILI- 72V64 ,� 7G�l� �i U U k---j MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK qk �7 CITY ��/� ,C � MA DATE/�D/�y PERMIT#.60' JOBSITEADDRESSS� �_��P f OWNER'S NAME SplJQ�P OWNER ADDRESS - -- 7f1. yam. 0 FAX I TYPE OR OCCUPANCY TYPE COMMERCIAL PST EDUCATIONAL RESIDENTIAL CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES 1 FLOORS— BSM 1 2 3 4 5 6 7 8 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 1 SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER PLU BINIMCASINSPECTOk UNVENTED ROOM HEATER tAr PT N WATER HEATER D NOTAPPRDYED OTHER ____ INSURANCE COVERAGE I have a current liability-insurance 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 . OTHER TYPE 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 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 accurate to the best.&f my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in cornpTanc4 witty all Pertin ovist n oft e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME David Fredenburgh LICENSE# 11406 SIGNATURE MP v MGF JP JGF LPG[ CORPORATION # 2344 PARTNERSHIP # LLC # COMPANY NAME:D F Plumbing&Mechanical Contractors, Inc ADDRESS 9 Stadler Street P.O. Box 1086 CITY Belchertown STATE MA ZIP 01007 TEL 413-323-6116 FAX 413-323-7532 CELL EMAIL dfplumbingbelchertown@yahoo.com i t 'sem �• � �. � �