43-131 (5) 9 I GREENL EAF' DR
NIaF:s�ock:I.ot: COMMONWEALTH i 45 .�l��ILT BP-2024-00tiff
43-131-001 SF,T TS
Permit: flits Renovations CITY OF N Off T�H�A 1[PTON
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
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Permit# eP-2024-0027
PERMISSION IS HEREBY GRANTED TO:
Protect# KITCH KENO 2024
Est. Cost: 137533 Contractor:
Const.Class: KEITER CORPORATION License:
Use Group: Exp.Date: 06/20/2024 102457
Lot Size(scl.ft,) Owner: A WALSH JEFFREY A& MHLISSA
Zoning: WSP
Applicant: KEITER CORPORATION
-t-LF' l! »t Adclr,_:tss
35 MAIN ST,2ND FLOOR Ph- -nne•
FLORENCE, MA 01062 (41.31586-£�600 !nuance
aSSUF,,D ON:01/08/2QZQ MCC'20020005382022
TO PERFORM THE FOLLOWING WORK:
RENO 1ST FLOOR KITCHEN
POST THIS E'ARB SO IT IS Inspector Of Plumbing Inspector of WiringER0:1j .THE
P.W STREET
Underground: Building Inspeetor
Service:
Meter:
Rough: , -G.�,.2y Rough:A �' '2U Footings:
Plum: /i v �r'1 I House#
Final: f. _ Foundation:
_ y `� Final:
Gas: 2P+i Rough Frame:lj.j{ 3 7.z
v� department `, lcl�
Driveway Final:
h Fireplace/Chimney:
�"' � � Oil: Fir ney:
��� Insulation:
6' �,Z Smoke: 4 k 3 �.z�,c,/I
THIS P T '`Y BE REVOKED BY T CITY OF NORTHAMPTON
TI ANY OF ITS RULES AND REGULATIONS.
v Z y.Zit rc.,?
LATIQNS. UPON VI(31_A�'tt)1` OF
Signature:
ii
Fees Paid: S894.00
212 Main Street,Phone(413)587-1240 Fax:
3)5$7_1272
Office of the Building>Commissioner
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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
4,4nfi Florence �,r�
CITYITOWN MA DATE 01/22/2024 PERMIT#P/ -?07,4—6°3 B
JOBSITE ADDRESS 91 Greenleaf Drive OWNER'S NAME Keiter Builders
p= OWNER ADDRESS 91 Greenleaf Drive TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL El RESIDENTIAL
PRINT
CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT: ® PLANS SUBMITTED: YES El 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 1
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK 1
LAVATORY
ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK
TOILET URINAL PLUN BING & AS INSPECTOR
WASHING MACHINE CONNECTION NORTHAMPTO
WATER HEATER ALL TYPES AI'NHOVE OI ANpHUVEU
WATER PIPING
OTHER
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES In 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 El AGENT El
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. %C%'a/.a2le 99 .
PLUMBER'S NAME Richard Scott Cernak II LICENSE# 15672 SIGNATURE
MP[l JP El CORPORATION 2# 4386-PL-C PARTNERSHIP El# LLC El#
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
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_ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
ti=,-,‘,1"' MA CITY Florence MA DATE 01/22/2024 PERMIT#6/>.2'0i —OD.32
JOBSITE ADDRESS 91 Greenleaf Drive OWNER'S NAME Keiter Builders
GOWNER ADDRESS 91 Greenleaf Drive TEL 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 1
DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATER
ROOM/SPACE HEATER
ROOF TOP UNIT PLUN BING & GAS INSPECTOR
TEST NORTHAN PTO V
UNIT HEATER APPFOVED NOT APPROVED
UNVENTED ROOM HEATER
WATER HEATER Y'f' .
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 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 Re:
9�/a? P7//O
PLUMBER-GASFITTER NAME Richard Scott Cernak II LICENSE# 15672 SIGNATURE
MP a MGF❑ JP❑ JGF❑ LPG'❑ CORPORATION®# 4386-PL-C PARTNERSHIP❑# 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
1 .Z. )) 2- 9
q I G-v-U*1 L -P ' ```'t/ IYL77
I I FE$ 2 9 2024 /� 1
Commonwealth o setts 1 1 Use O ly , 7/
r, ( {+Permit No.: •r 01 t
r Department of Fire_S�ervicie ,cPr.^;,ONS Occupancy and Fee Checked.
!I.? BOARD OF FIRE PREVENTION REGUbA`LIONS i [Rev. 1/2023] 3,{go p t
',,-•''e APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),5 7 C 12.00
City or Town of: bc,- - vC>a/tit0 /1/A Date: 2.�Z(e 24
To the Inspector of Wires:By this application,the undersigned gives notices of his or her intention to perform the electrical work described below.
Location(Street&Number): ett cni- .t,1i k(A-c Unit No.:
Owner or Tenant: Email:
Owner's Address: ,c:,Vt, ,.SZ Phone No.:
Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No❑Permit No.:
Purpose of Building: T i e\.i vca, Utility Authorization No.:
Existing Service: Amps / Volts Overhead 0 Underground 0 No.of Meters:
New Service: Amps / Volts Overhead❑ Underground 0 No.of Meters:
Description of Proposed Electrical Installation: 1•)-3 c'Lc CC \ 1/ ‹.)L! C C_C V\
Completion of the following table may be waived by the Inspector of Wires.
No.of Receptable Outlets: No.of Switches: Generator KW Rating: Type:
No.Luminaires: No.of Recessed Luminaires: No.Wind Generators: Wind KW Rating:
No.Appliances: KW: No.Water Heaters: KW: No.Transformers: Total KVA:
Space Heating KW: Heating Equipment KW: No.Motors: Total HP: Total KW:
No.Heat Pumps: Total KW: Total Tons: Fire Alarm System 0 No.of Devices:
Swimming Pool:In-Grnd.0 Above-Gmd.❑ Hot-Tub 0 No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System 0 No.of Devices:
No.Air Conditioners: Total Tons: Telecom System❑ No.of Outlets:
No.Energy Storage Systems: KWH Storage Rating: Security System ❑ No.of Devices:
Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment:
No.of Modules: Roof-Mount 0 Ground-Mount❑ Level 1 0 Level 2 0 Level 3❑ Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy)
Date Work to Start: 7 f Z6,I 2.4 Inspections to be requested in accordance with MEC ule 10,and upon completion.
FIRM NAME: C c ii-e_sr- 5`y_.0- L( (_C A-1 or C-1 ❑LIC.No.:
Master/Systems Licensee: LIC.No.: A - 1f3b(6 q
Journeyman Licensee: LIC.No.: if. • ,56(34p(o
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.1 No.:
Address: C 7g N. 1A 1ck_R c jC i— Gti 1.60\c' ..k b to 3C�
Email: 4-c„yq\ ewe/' CCnt�CGG. -r. A- Al// Telephone No.: it 13— j`Ca1
I certify,under the 1 'r>s and penalties of perjury,that the information on this application is true and complete.
Licensee: Print Name: 3c:,yA r C Cell.No.: 1-43-550-4 3/13
INSURANCE COVERAGE:Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee
provides proof of liability including"completed operation"coverage or its substantial equivalent.The undersigned certifies that such coverage
is in force and has exhibited proof of s the permit issuing office.
CHECK ONE: INSURANCE BOND El OTHER❑ Specify:
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 0 Owner's agent❑
Owner/Agent: Tel.No.:
Signature: Email.:
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