38B-031 (3) BF-2023-1096
15 LASELI, AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38B-031-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2023-1096 PERMISSION IS HEREBY GRANTED TO:
Project# KITCHEN RENO 2023 Contractor: License:
Est. Cost: 1000 JUSTIN SQUIRES 115236
Const.Class: Exp.Date: 09/02/2024
Use Group: Owner: HYLAND M THEODORE
Lot Size (sq.ft.)
Zoning: URB Applicant: JUSTIN SQUIRES
Applicant Address Phone: Insurance:
177 E HADLEY RD 4136409647
AMHERST, MA 01002
ISSUED ON: 08/14/2023
TO PERFORM THE FOLLOWING WORK:
KITCHEN 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: ,�
Final: 9- -23 Final:7-/ .-p3 Final: Rough Frame: /—pti_tO 6 -k,.z )LQ_
1' 0 gl a-IL-23 4.1Z
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
i!,y.4,>G 9—.2/ -1z3
y% Smoke: Final:0.1G q • ly- Z.3 14.1Z
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
.; • . cs-A75,
Fees Paid: $100.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
COI fig ZI LI =�Z1 o M "'It el etC).G y?to
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(4 d t r Commonwealth of Massachusetts Official Use Only
:, , pi Department of Fire Services Permit No. Pe-?,D Z3'O(b L
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E. Occupancy and Fee Checked 1'�'et 2-4 Z
=1�_ BOARD OF FIRE PREVENTION REGULATIONS p y
,.'`CNJ [Rev. 1/07] (leave blank) ' )2,6'_'
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE RINT IN INK OR TYPE ALL INFORMATION) Date: 7/14/2023
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 15 Lasell Ave Unit#1
Owner or Tenant Devon Moore Telephone No.413-896-2687
Owner's Address Same
Is this permit in conjunction with a building permit? Yes ❑ No El (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead El Undgrd ❑ No.of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Update wiring
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Fixtures No.of Ceil.Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Lighting Outlets No.of Hot Tubs Generators KVA
No.of Lighting Fixtures 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
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local 0 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
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.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: 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 under-
signed certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify) General Liability 1-1-24
(Expiration Date)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: Paciorek Electric, Inc LIC.NO.: 20318-A
Licensee: Timothy M. Paciorek Signature Tihnotivy M. Paciorek LIC.NO.: 38731 E
(If applicable,enter "exempt"in the license number line.) Bus.Tel. No.: 413-747-0334
Address: 65D Elm St. Ste 104,Hatfield MA 01038 Alt.Tel. No.: 413-561-7724
*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)0 owner ❑owner's agent.
Owner/Agent PERMIT FEE: $125
Signature Telephone No.
N-^12) �n� Q E e_ b i
c MASSAC H 3S'•ETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
7_ GIT r' /1/cALTOLpyvli)/7lb✓ A_ DATE q Ik`ZOL3 PEP?tl1T ?rH Z(}?Z-0 35-
0- JOBSITEADDRESS IS L.,1'SFLt_ iir/13 OWNER'S NAME I itvrn 1- ,/doirn '
OWNER ADDRESS l� GrrSF�� � TEL `l b-�L -L6'Y7 FAX
1_L:
`rJ OCCUPANCY TYPE: COI`NIERCIAL EDUCATIONALRESIDENTIAL�'��t�� � Q Q cp
PRINT .
CLc; FZI 'f NEW:fill RENOVATION:0 REPLACEMENT:El PLANS SUBMITTED:ED: YES ❑ NO ❑
FIXTURES? FLOOR'- I BSNI T 1 2 { 3 4 5 6 7 8 9 10 11 I 12 13 14
BATHTUB:
CROSS CONNECTION DEVICE •
DEDICATED SPECIAL WASTE SYS •
DEDICATED GAS/OIL/SAND SYS I I I {
DEDICATED GREASE SYS I • I
• DEOICATO GRAY WATER•SYS
{: { I
DEDICATED WATER RECYCLE SYS I ( { I I { I {
DRINKING FOUNTAIN
DISHWASHER { �—
FOOD DISPOSER - M ( I I - j I
FLOOR/AREA DRAIN + I I ( { I
INTERCEPTOR(INTERIOR) { I
KITCHEN SINK I I J I ) ) •
--LAVATORY I I
ROOF DRAIN ,
SHOWER STALL 1
• SERVICE/MOP SINK PLUM BINC4 & GAS irrPEC1 OH
TOILET I ''' N .
URINAL I AIPPHOVED OT APP9OVED
WASHING MACHINE CONNECTION I 1 } „ i
•
WATER HEATER ALL TYPES I I� I I I
WATER PIPING I I I I I I
( OTHER I ___J
{ I F I I—
f !• I I I I .
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which,meets the requirements of MGL Ch.142, Yps 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: Lam(/aware that the licensee does hot 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 BOX ONLY: OWNER DI AGENT ❑
Signature of Owner or Owner's 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 a tion will be in
compliance with all MPertinent provisi n of`the aassachusetts State Plumbing Code and Chapter 142 of the Gene
PLUMSER S=R NAME I Ia lY"t ' ° VV .'eivin^ SIGNATURE
LIC , 6q 7/ MP a JP❑ CORPORATION ❑4' PARTNERSHIP T LLC ❑A
COMPANY NAME ADDRESS: 9 / H-eVidocii IV _
CITY D VLi Q I '�S STATE Ad ZIP Q I o j a Et L-.iL 40 1/Ol GZ� t/ �' P / COW ,r
TEL _ CELL `i i 3 N SS=9R FAX •
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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
_ -T NRr[ ltm/ MA. DATE: PERMIT# CA 'Zvi`.43
J513SITE ADDRESS: lc LpLL OWNERS NAME:
GOWNER ADDRESS: )s' 1 t3cL.4 n TEL: Ii 3-n6`21 Y7 FAX:
LL:
•
TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ . EDUCATIONAL ❑ RESIDENTIAL LE
PRINT
CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO ❑
APPLIANCES FLOOR- Bsmt . . 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 COCK
MAKEUP AIR UNIT •
OVEN
POOL HEATER. - PLJMBING & GAS INSP LC 1 UH
ROOM/SPACE HEATER NORTHAMPTON
ROOF TOP UNIT TEST • APPROVED NOT APPHUVLD
{ -
UNIT HEATER _UNVENTED ROOM HEATER
WATER HEATER
G", U1 L� 72�/1c �-l.'1/�3i -
/ !' INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YEs71 NO ❑ •
If you have 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 .
Massachu•setts General Laws,and that my signature on this permit application waives this requirement. •
•
• *CHECKONEONLY: OWNER ❑ AGENT
'SIGNATURE OF OWNER OR AGENT • •
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/GASFITTER NAME: M I lakik..l, ' -56 TOCkAk LICENSE# /10 7( •SIGNA
COMPANY NAME: ADDRESS: 't ' /4?_,V1.tho/1 t •
CITY: r /H1t 4 STATE: / 'i ZIP: OC 0 3 FAX:
TEL: CELL: t() 14 631 61 EMAIL: ke.9-U rtt,_ C%0714
MASTE y►7 JOURNEYMAN ❑ LP INSTALLER❑ CORPORATION ❑# PARTNERSHIP❑# LLG ❑#
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