23A-144 (9) 121 PINE ST BP-2019-0618
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23A- 144 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:KITCHEN&BATH RENO BUILDING PERMIT
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ermit# BP-2019-0618
Prg1ect# JS-2019-001015
Est.Cost: $18000.00
Fee: $117.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License: sw
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 20603.88 Owner: SIPPEL R THOMAS
Zoning:URB(100)/ Applicant: SIPPEL R THOMAS
AT: 121 PINE ST
Applicant Address: Phone: Insurance:
121 PINE ST (413) 329-0690 ()
FLORENCEMA01062 ISSUED ON:1/18/2019 0:00:00
TO PERFORM THE FOLLOWING WORK:RENO BATH AND KITCHEN IN IN-LAW APT
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
�9� r Footings:
Rough: Rough: y / � House# Foundation:
Driveway Final:
Final: 2'4 z/ Final: /,a 9
n Rough Frame: 0 e. 2-Iq- it.
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final: 0.IL II-26.21 J/,2
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS AULES AND TIONS.
(CHGIrT‘or
Certificate of Occupaney / Signature: _
FeeType: Date Paid: Amount:
Building 1/18/2019 0:00;00 $l 17.00
212 Main Street,Phone(413)587-1240,Fax: (4l3)587-1272
Louis Hasbrouck -Building Commissioner
121 PINE ST EP-2019-0505
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Map: 23A
Lot: 144 ELECTRICAL PERMIT
Permit: Electrical
Category: RENO BATH AND KITCHEN IN IN-LAW APT
Permit# Electrical
PERMISSION IS HEREBY GRANTED TO:
Project# JS-2019-001015
Est.Cost: Contractor: License:
Fee: $125.00 MICHAEL LONG Electrician 50407
Owner: SIPPEL R THOMAS
Applicant: MICHAEL LONG
AT: 121 PINE ST
Applicant Address Phone Insurance
17 DICKINSON ST (413) 584-7665 C-(413) 587-3174 Liability, MP197313
NORTHAMPTON MA01060-1503 ISSUED ON:1/14/2019 0:00:00
TO PERFORM THE FOLLOWING WORK:
RENO BATH AND KITCHEN IN IN-LAW APT
Call In Date: Date Requested Inspection Date/SignOff: Reinspect?:
Trench/UG:
Special Instructions
Rough „-! �J /9 �'/ ftPe
Special Instructions:
Final: I " 9`-121- firs-\
SRE Called In:
Signature:
Fee Type:: Amount: DatePaid
Electrical $125.00 1/14/2019 0:00:00 780
212 Main Street,Phone(413)587-1244,Fax(413)587-1272-Inspector of Wires -Roger Malo
CJL?1c-7 �`C aU
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY r � .0 ®. MA DATE_ r 8' PERMIT#
My
JOBSITE ADDRESS
J2 ..�_1..,A x� vI .. ..; OWNER'S NAME, m ,,52)02-
OWNER ADDRESS1C:r r,--, /� TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
PRINT
CLEARLY NEW: RENOVATION REPLACEMENT: PLANS SUBMITTED: YES NO
FIXTURES 1 FLOOR-I BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE 1 I
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIL/SAND SYSTEM + + t
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
. - �
DISHWASHER
DRINKING FOUNTAIN fi
FOOD DISPOSER
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK w.
LAVATORY l
ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK _. ...
TOILET J
URINAL __.� ..'°'.'T;11\71 Or''
WASHING MACHINE CONNECTION �` 7 7 /-- ° ,
WATER HEATER ALL TYPES
WATER PIPING
OTHER a I fir r�
1 ! . i
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 Li 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.
PLUMBER'S NAME LOS L 11 i c-,0 f f h LICENSE# 1:O SIGNATURE
MPS E
JP' CORPORATION, # PARTNERSHIP~ m# LLCEj#IL
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COMPANY NAME Cv f 'S P1(),r �1�:^,. , ADDRESS O. ,? () ' A...
CITY ora ._ STATE fa& ZIP . .._ D �. TEL' .._ ( r _,:
FAX i CELL l90 21'0 EMAIL
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT#
PLAN REVIEW NOTES
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