17A-157 (7) u1-bubi+-v Zvi
61 FOX FARMS RD COMMONWEALTH OF M SSACHUSETTS
Map:Block:Lot:
17A-157-001 CITY OF NORTH PTON
Permit: Acc Structure
PERSONS CONTRACTING WITH UNREGI.TERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARA TY FUND (MGL c.142A)
BUILDING PI RMIT
Permit# BP-2022-0781 PERMISSIO IS HEREBY GRANTED TO:
2021 ZONING ADD AUX
Project# BUILDING Contractor: License:
Est. Cost: 55000 SCOTT NICKERSO 053156
Const.Class: Exp.Date:01/10/202'
Use Group: Owner: CIAM'A DOSTAL ERIC D& ELENA L
Lot Size (sq.ft.)
Zoning: URA Applicant: SCOTT NICKERSON
Applicant Address Phone: Insurance:
PO BOX M (413)896-33470
LAKE PLEASANT, MA 01347
ISSUED ON:07/01/2022
TO PERFORM THE FOLLOWING WORK:
ADD I2'X24'X5' MODULAR BACKYARD STUDIO WITH 1/2 BATH & 3'Hit CRAWL SPACE
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbin Inspector of Wiring D.P.W. Building Inspector
TZ
dde ground: Service: Meter: Footings: 0,i4 t - % z•z I<e
Rough:/o_.F--L Rough:�0 -p J House# Foundation:t),II. U.rG Z-Z K,Q.
Final: Final: Final: Rough Frame: iC•Zt•2.2 14
1(as t? � Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation: 0 e 11-3- 2 Z
Smoke: Final: Olt 03 )"
THIS PERMIT MAY BE REVOKED BY THE CITY OF NOR HAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
c Ucry
Fees Paid: $58.00
212 Main Street, Phone(413)587-1240,Fax: '413)587-1272
Office of the Building Commissioner
Commonwealth o/Massachusetts Official Use Only
1g+- c7 Permit No.C .
./Department o }ire ServiceJ
Occupancy and Fee Checked /3 717/
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank)
ftPPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PaASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 8/04/22
City or Town of: NORTHAMPTON To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street& Number) 61 FOX FARMS ROAD
Owner or Tenant Eric Dostal Telephone No. 413-218-6344
Owner's Address 61 Fox Farms Road, Florence, Ma. 01062
Is this permit in conjunction with a building permit? Yes n No ❑ (Check Appropriate Box)
Purpose of Building Residential Utility Authorization No.
Existing Service 200 Amps 120 / 240 Volts Overhead 2 Undgrd n No.of Meters 1
New Service Amps / Volts Overhead n Undgrd n No.of Meters
Number of Feeders and Ampacity 1 feeder @ 200 AMPs
Location and Nature of Proposed Electrical Work: Wire New Out Building
Completion of the following table may be waived by the Inspector of Wires.
No.of
Total
ranss KVA
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting
grnd. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
oNo.of Switches No.of Gas Burners No. Initiating
nDete and
I Devices
No. of Ranges No.of Air Cond. Total No. of Alerting Devices
g Tons
No.of Waste Disposers Heat Pump Number Tons KW No. of Self-Contained
p Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
Wiring:
No. Hydromassage Bathtubs No.of Motors Total HP TelecommunicationsNo.of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: 8/4/2022 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: LIC. NO.:
Licensee: Thomas Herbert Signature ,_ LIC. NO.: 52843-B
(If applicable,enter "exempt"in the license number line.) Bus.Tel. No.:413-977-0349
Address: 176 Batchelor Street Granby, Ma. 01033 Alt. Tel.No.:
*Per M.G.L.c. 147,s. 57-61,security work requires Department of Public Safety"S" License: Lic.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the(check one) ❑owner 'Downer's agent.
Owner/Agent PERMIT FEE: $q0 oro
Signature Telephone No.
8- /. 9; c
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J 9 3 No oNo--
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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY/TOWt'; Northampton MA DATE 0$/09/2022 PERMIT Pp2,02 -—b3is
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N I
OBSIYE ADDRESS 61 Fox Farm Road OWNER'S NAME Elena Ciampa
pWNER ADDRESS 61 Fox Farm Road TEL 413-218-4391 FAx
TYPE OR TCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL
PRINT Q
CLEARLY NEW: El RENOVATION: ® REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO❑
FIXTURES-1 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/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 t PLU BIN & GAS INSPECTOR
ROOF DRAIN NO- HA PTON
SHOWER STALL APP'OV: D NOT APPROVED
SERVICE/MOP SINK :011
TOILET 1 ' r moo
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES 1
WATER PIPING 1
OTHER
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES® NO El
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY ® OTHER TYPE OF INDEMNITY El 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 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. /Gce-haita L,e2�z�rA‘
PLUMBER'S NAME Richard Scott Cernak II LICENSE# 15672 SIGNATURE
MP 12q JP❑ CORPORATION ®# 4386-PLC PARTNERSHIP El# LLC❑#
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
222- /9erv6 ,c) -*6- 2if-E
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