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31B-121 (9) 5 EDWARDS SQ BP-2020-0778 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:31 B- 121 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TOTHEGUARANTY FUND (MGL c.142A) Category: Bath reno BUILDING PERMIT Permit# BP-2020-0778 Project# JS-2020-001350 Est.Cost: $9000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ALEXANDER CHAPIN 111678 Lot Size(sa. ft.): 3789.72 Owner: DAY IYKO Zoning: URC(100)/ Applicant: ALEXANDER CHAPIN AT. 5 EDWARDS SQ Applicant Address: Phone: Insurance: 19 HARWOOD DR (413) 522-9105 SOLE PROPRIETOR BERNARDSTONMA01337 ISSUED ON:1/6/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-BATH RENO 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: 1-2 -Z a Final: n 02� Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS,,RULES AND IRGU TIONS. // OI1IOLerloN �I�-t,Lt'.o /� a-,4 Certificate of Si nature: FeeType: Date Paid: Amount: Building 1/6/2020 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck-Building Commissioner � t(_ aaS Jli(). 6 Qi� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITYYl>z .fik�l�l 010A, _�_� MA DATEj1Zj4jAfla6 I PERMIT# JOBSITE ADDRESS [OLvA OWNER'S NAMEJ Ty KO 1)A y P OWNER ADDRESS D latq tZ�S Q- TE I -6t Q-S 4I-0`iR FAXF� TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL (~1 RESIDENTIAL❑ PRINT CLEARLY NEW:( f RENOVATION:[, J REPLACEMENT: PLANS SUBMITTED: YES[`) NO['-] FIXTURES-1 FLOOR- aSH 1 2 1 3 4 5 s 7 a s _9--]:-4t--4-42- 13 14 BATHTUB - - - --- - ._._ _ CROSS CONNECTION DEVICE - CEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER __ s DRINKING FOUNTAIN - - FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY __-- ROOF DRAIN SHOWER STALL ! SERVICE/MOP SINK T � TOILET - - -- -_--- - ---. URINAL R WASHING MACHINE CONNECTION WATER HEATER ALL TYPES D WATER PIPING OTHER ---- --- --- - -- - --� CIRCLE 1:GAS TRAP/LNDRY TRY BACKFLOW PREV/WATER CLOSET HOT WATER TANK INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YESa NO (j IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHcR TYPE OF INDEMNITY f 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 (_-I 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 pliance wilh ertinent rovision of the Massachusetts Stale Plumbing Code and Chapter 142 of the General Laws. S L IS to� M PLUMBER'S NAME L�,�j)ll►91C►_ ��I I ---]LICENSE# 3 r Sa SIGNATURE MP❑ JP4 49 :5e(6 CORPORATION❑# PARTNERSHIPQ# LLC❑#� COMPANY NAME ADDRESS -AVC �j( — CITY[ AWkeo'r TI STATE® ZIP I TEL Y13-- 7$ 9 FAX ����CELL��EMAIL � � 1 5� �� .P 7-/ Z -/