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31C-082 RECORDS REQUEST Subject: Re: American Fire & Casualty v. Frank B. Paige Plumbing & Heating / BSL File No. AR1.4865 - Public Records Request 3/C _v 82 _0 0 / From: Beth Willard <bwillard@northamptonma.gov> Rio Ou3N/-Ci Date: 9/16/2024, 8:58 AM To: "Sesona, Erica" <esesona@boyleshaughnessy.com> CC: "McCormick, Jeffrey L." <JMcCormick@boyleshaughnessy.com>, "kross@northamptonma.gov" <kross@northamptonma.gov>, Kim Carson <kcarson@northamptonma.gov>, Larry Eldridge <leldridge@northamptonma.gov>, Roger Malo <rmalo@northamptonma.gov> Hi Ms. Sesona, I checked with the Building Dept. inspectors. None were called to the site for an incident on or about 12/23/2021. Building, Electrical, Plumbing, and Gas permits were issued for the parcel - notes on inspections are generally recorded on the backs. I've attached copies of the Electrical, Plumbing & Gas. The building permits as well as material pertaining to the building of#140 Olander Dr. are publicly available on our website. The direct link to that parcel (31C-082-001) is: http://archive.northamptonit.info/WebLink/Browse.aspx?id=690980&dbid=0&repo=CityOfNorthampton I requested notes and emails, but as our department was not contacted concerning the incident at the aforementioned location on or about 12/23/2021, there were no emails concerning it, and any notes concerning the building are scheduled inspection notes recorded as mentioned above. As city departments other than the Building Dept. might possibly have been involved, I forwarded your email to Pamela Powers, the City Clerk. Beth On 9/10/2024 2:54 PM, Sesona, Erica wrote: Good afternoon Ms. Willard, Please see the attached public records request. Responsive materials can be emailed, faxed, or mailed to our office. Thank you. Erica J. Sesona Legal Assistant BOYLE I SHAUGHNESSY LAW PC 100 Front Street,Suite 1510 Worcester, MA 01608 T 508.552.3100 I F 508.506.1549 Massochurens.Connecncur-New Humpahi e•Rhode Island-Maine-fermomr-New York • BOYI,E I SHAUGHNESSY LAW Beth Willard Principal Account Clerk Northampton Building Dept. 212 Main St. , Room 100 413-587-1271 Attachments: ParcelHistory-2024-09-13-12-51-12.pdf 221 KB Xerox Scan_09132024125541.pdf 370 KB • BOYLE I SHAUGHNESSY LAW BOYLE I SHAUGHNESSY LAW P.C. 100 FRONT STREET,SUITE 1510 WORCESTER,MA 01608 (508)762.4497 TEL (508)506.1549 FAX www.boyleshaughnessy.com PETER L.BossE pbossc@boyleshaughnessy.com JEFFREY L.MCCORMICK,JR. jmccormick@boyleshaughnessy.com September 10, 2024 VIA EMAIL Bwillard@northamptonma.gov City of Northampton Building Department ATTN: Beth Willard Municipal Building 212 Main St. Northampton, MA 01060 RE: American Fire& Casualty Company a/s/o Saloomey Construction, Inc. v. Frank B. Paige Plumbing and Heating Services, Inc. Hampshire Superior Court Docket No.: 2380CV00115 BSL File No.: AR1-4865 Dear Ms. Willard: This is a request pursuant to the Massachusetts Public Records Law, M.G. L. Ch. 66 §10. I request copies of all documents in the possession or control of the City of Northampton Building Department related to the plumbing inspection at 140 Olander Drive,Northampton,MA and an incident that occurred on or about December 23, 2021. These documents include, but are not limited to, the following: 1. The logs, runsheets, 911 call recordings, and other documents and materials generated as a result of, or in connection with this incident. 2. All photographs taken, generated or otherwise obtained during, in connection with, and/or as a result of this incident. 3. All reports, data, investigation material, reconstruction reports, citations, notes, memorandum, correspondence. email or other paperwork and/or documents generated or otherwise obtained during, in connection with, and/or as a result of this incident. 4. All materials taken from the scene relative to this incident. 5. All statements taken from any person or company associated with this incident. (81483597.1) Massachusetts - (.'am wcticvt - New Hampshire - Rhode Island - Maine - I''e.rmant. - Veit. York 6. Any and all documents, reports, notes, photographs, videos, diagrams and/or other materials related to inspections, including plumbing inspections, prior to December 23, 2021. 7. Any and all documents, reports, notes, photographs, videos, diagrams and/or other materials related to inspections, including plumbing inspections, following December 23, 2021. 8. If for some reason not included in 1-7 above, any documents, photographs, sketches or other material generated or otherwise obtained during, in connection with, and/or as a result of the incident. We will pay the reasonable costs incurred in producing these documents. Further, if there are certain categories of documents that are more easily collected than other categories, please notify me of those documents as soon as they have been gathered. Please do not wait for all responsive documents to be collected. I appreciate your time and consideration in this matter and please do not hesitate to contact me with any questions that you may have. Very truly yours, Peter L. Bosse Jeffrey L. McCormick, Jr. JLM/as (814113597.1 140OLANDER DRIVE COMMONWEALTH OF MASSACHUSETTS EP-2021-1376 Map:Block:Lot:31 C-082- 001 CITY OF NORTHAMPTON Permit: Solar System PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) ELECTRICAL PERMIT Permit # EP-2021-1376 PERMISSION IS HEREBY GRANTED TO: 2021 SOLAR Project# SYSTEM Contractor: License: Est. Cost: PIONEER VALLEY PHOTOVOLTAICS 3361013764 Exp.Date:07/31/202207/312022 Owner: NORTH COMMONS AT VILLAGE HILL LLC Applicant: PIONEER VALLEY PHOTOVOLTAICS Applicant Address Jag= Insurance: 311 WELLS ST - SUITE B (413)772-8788 BKS57072282 GREENFIELD, MA 01301 ISSUED ON: 10/05/2021 TO PERFORM THE FOLLOWING WORK: INSTALL 132 PANEL 58.74 KW ROOF MOUNTED SOLAR SYSTEM WITH INVERTERS IN ATTIC Call In Date: Date Requested Inspection Date/SignOff: Reinspect?: Trench/UG: Special Instructions Rough a. "4,2-(9-,3„ x Special Instructions: Final: t/. /N- 72 dta'N SRE Called In: Signature: Fees Paid: $150.00 • 212 Ma in Street,Phone(413)587-1244,Fax(413)587-1272-Inspector of Wires too 1(7ln/6 • . i Commonwealth o/t'/lassachu.ief Official Use Only '• = rt Permit No.E-e 002Z-- 03) y- cc�� 2o22O y 271(6,740 �;�-:'� -�L— ; I �C.1ePartmenl o��ire�eruice� U N�Pay I'_s 4 i - I Occupancy and Fee Checked 7 �` ; _44, ;Bf7 RD OF FIRE PREVENTION REGULATIONS [Rev. 1/07 '.,�... 1 :< j (leave blank) Irp3! *PLIC=. TION FOR PERMIT TO PERFORM ELECTRICAL WORK 1 i Al work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEVE PRINT N INK OR TYPE ALL INFORMATION) Date: A P a l Z 6 Z 0 Z 2 Citylor. own of: Noe / A o ,v. p-}G 1.., To the Inspector of Wires: By this application he undersigned gives notice of His or her intention to perform the electrical work described below. Location(Street&Number) / y 6 0 L D P r n 1),- s,., e Owner or Tenant ---r 1, t V , 11 G e /7/, // C0-r..,c% s Telephone No. /- 9l 7 19/4.-d 3C S" Owner's Address / Ll0 0 /4.,.../.0,- 0 e, ..e ,c'e, .#c,-, , #o/✓ /14. G I 0 6 0 Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building /4 p e a,ft'1't e J . 5-- Utility Authorization No. Existing Service Amps / Volts Overhead ❑ 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: 1 N S-i-A 1 I e /e c•/r , C Vc h ' e /e Cigreic 4- CoIJ,-, cr• •I To W1 ,r,/.. ct Pray , c/c/ by o- 1 ,- , s- Complelion of the followin&table may be waived by the Ins ector of Wires. No. Total No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans TransfKVAormers No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires SwimmingPool 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 and on 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❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Securi Not of Devices or Equivalent No.of Water K,,, 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: / SU 0. 0 0 (When required by municipal policy.) Work to Start:Aprt 12 5' 7 02 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 penaltiesof perjury,that the information on this application is true and complete. FIRM NAME: P, 3, I a c /U/4 d- Sou r ?iv c . LIC.NO.: Licensee: R I e k . (A)v /o t Signature LIC.NO.: ZO 3 5-2 f1 (If applicable,enter "ekempt"in the license number line.) C Bus.Tel.No.: Au 6 2 3 g99 / Address: 3 7 1 .$o i 4-il. P1 a, [•-, 5 4 c c e W,a,dsor Locks c r Alt.Tel.No.: ff'6O 250 7 t ?r'/ *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)'Downer ❑owner's agent. Owner/Agent $FEE: �� Signature Telephone No. PERMIT7 -ee,-e -•/) 3 CHECK #35820 $150.00 ACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK =z r: - .?� 's n' CITY s ORTHAM PTON MA DATE 6/1/2021 PERMIT#69 2-02d•-0421 N.COMMONS AT JOBSITLA DRESS 140 0LANDER DRIVE OWNER'S NAME VILLAGE HILL I .OWN - DRESS_ TEL 413-349-4322 FAX `- fJ psitts OR OCC ,IBA Y TYPE COMMERCIAL® EDUCATIONAL ❑ RESIDENTIAL❑ LEAItL'k' 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 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE 1 GENERATOR GRILLE BBQ _ INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN PL MBING & GAS INS1ECTOK POOL HEATER N RTFiXI\TPTON ROOM/SPACE HEATER AP ROVED NOT APPROVED ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER EXTERIOR LINE 1 TO BUILDING INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 5d NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY C 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 Pert" e t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. % � PLUMBER-GASFITTER NAME ALF RED H. GEORGE LICENSE# 3809 SIGNATURE MP ❑ MGF Nj JP❑ JGF❑ LPG!❑ CORPORATION ®#130C PARTNERSHIP❑# LLC❑# COMPANY NAME_ GEORGE PROPANE INC. ADDRESS 3 BERKSHIRE TRAIL WEST. PO ROX 102 CITY GOSHEN __ _____ STATE MA ZIP 01030-010? TEL (413)268-8360 FAX_(413)268-0206 CELL EMAIL mgeorgeAgeorqepropane.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# • PLAN REVIEW NOTES �-2/ ReS4"4.-ttar 'Zr 72Pnio Are 140 OLANDER DR EP-2021-0444 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Map: 31C Lot: 082 ELECTRICAL PERMIT Permit: Electrical Category: WIRE NEW 53 PASSIVE UNIT HOUSE APARTMENT BUILDING Permit# Electrical PERMISSION IS HEREBY GRANTED TO: Project# JS-2021-000413 Est.Cost: Contractor: License: Fee: $5300.37 GABLE ELECTRIC INC MASTER ELECTRICIAN 16563 Owner: NORTH COMMONS AT VILLAGE HILL LLC Applicant: GABLE ELECTRIC INC AT: 140 OLANDER DR Applicant Address Phone Insurance 5 WESTVIEW RD (413) 443-4082 C- Liability, co-5n641341 PITTSFIELD MA01201 ISSUED ON:11/20/2020 0:00:00 TO PERFORM THE FOLLOWING WORK: WIRE NEW 53 PASSIVE UNIT HOUSE APARTMENT BUILDING Call In Date: Date Requested Inspection Date/SignOff: Reinspect?: Trench/UG: Special Instructions x Rough x Special Instructions: l` (()) �] Final: I - )- n_ `� V-r m SRE Called In: 29900615 - t 1 f(p alb Lt BJ Signature: (r r i10 k•cdkr Fee Type:: Amount: DatePaid 0144n 'vr Electrical $5300.37 11/20/2020 0:00:00 31528 / iN g l /� 212 Main Street,Phone(413)587-1244,Fax(413)587-1272-Inspector of Wires -Roger Malo \4,g �{ -ce -L - --JP 7°°I J 1 b N'I -k IT -Le- C Q / ° -N,9413 Ayr,, 1-- ;u�. - Q1 -I �n 1\ ,f1)C 9) ) \\"N ,S°11. _s -6 It-ty-c- o/ \ 110 �S \iNg(,1 1 e ,! -C�) jsi°11 T411 -ry - 1)qt rc le-3 rAirrrji -o1 -� t- \p ‘A i"o1\ N(*H - 11"1A ss-e - ) e- Et - L - .k4oLj rre \'‘ '"off Li %r �rC_ Tr� - 9 -woo- -\\9)('C-`)4 140 OLANDER DR EP-2021-0443 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Map: 31C Lot:082 ELECTRICAL PERMIT Permit: Electrical Category: TEMPORARY 200 AMP 1 PHASE SERVICE FOR CONSTRUCTION Permit# Electrical PERMISSION IS HEREBY GRANTED TO: Project# JS-2021-000413 Est. Cost: Contractor: License: Fee: $60.00 GABLE ELECTRIC INC MASTER ELECTRICIAN 16563 Owner: NORTH COMMONS AT VILLAGE HILL LLC Applicant: GABLE ELECTRIC INC AT: 140 OLANDER DR Applicant Address Phone Insurance 5 WESTVIEW RD (413) 443-4082 C- PITTSFIELD MA01201 ISSUED ON:11/20/2020 0:00:00 TO PERFORM THE FOLLOWING WORK: TEMPORARY 200 AMP 1 PHASE SERVICE FOR CONSTRUCTION Call In Date: Date Requested Inspection Date/SignOff: Reinspect?: Trench/UG: Special Instructions x Rough x Special Instructions: Final: SRE Called In: 30224168 1 ( r1 3 ' 3.0 QOr" r N ti Signature: Fee Type:: Amount: DatePaid Electrical $60.00 11/20/2020 0:00:00 31528 212 Main Street,Phone(413)587-1244,Fax(413)587-1272-Inspector of Wires -Roger Malo 3 c 2 F3,-4-714">rres 5- :s �,, 7 ' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBI WWURK o0 _ .}J, ck021 Li29 L,z35.- "'"i- CITY Notch ampton MA DATE 11/12/2020 I PERMIT#PP,2bZ1-OI$D t JOBSITE'A' DRESS 140 Olander Drive OWNER'S NAME Community Builders Inc. 1 pOWNER AD RESS 95 Berkleley Street / Suite 900 ' TEL FAX TYPE OR 3CCUPANe TYPE COMMERCIAL® EDUCATIONAL LI RESIDENTIAL 0 PRINT CLEARLY NEW:ElIll RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO® FIXTJRES Z Fed R-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB IMF Q AU 'I- AMM.MIM PmW_ tN_ CROSS CONNECTION DEVICE ' DEDICATED SPECIAL WASTE SYSTEM 111111111 11111 j DEDICATED GAS/OIL1SAND SYSTEM 1 ' I 1 DEDICATED GREASE SYSTEM � ICI g Iiii •_. _ . .: i. DEDICATED GRAY WATER SYSTEM l_ ` DEDICATED WATER RECYCLE SYSTEM r DISHWASHER NM NM I MN MR NE int no um MI MI DRINKING _ n um ism MI FOOD DISPOSER FOUNTAIN 16 8 19 mI_ ___,11 IIINJFLOOR/AREA DRAIN 'I— N, AI; mung MI MIN Me MI NIS IIIIIIniiiii iiiim l_ INTERCEPTOR(INTERIOR) WRRRiRR_ KITCHEN SINK LAVATORY MB' 19 i 20 '� MI MIum ROOF DRAIN SHOWER STALL 111-1111111W1111111111115E 'E ii NS SERVICE/MOP SINK �� - . : ,- nit . TOILET likg /' URINAL I a, 20MR r 'R .. R WASHING MACHINE CONNECTION . ...n' 4 I .;MI ME Ur't VW I .i —n _ _ WATER HEATER ALL TYPES ingsmummo MIK NM UM NMI NM 111111111,111111111111111111111',I;N;MIK',NM WATER PIPING M Imo!; 167 19- !I M j Ns me um `111111111.11111111111111111111111111111111.111MR111111- . OTHER ��' I I 111101.111111.1111111110Mlialliiiiiliffillirtinialirliiii . INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES 0 NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY LI 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 0 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 all rtineroion e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Richard Paige LICENSE# 111257 SIGNATURE MP Q JP C] CORPORATION 0#2365 PARTNERSHIP©# . , LLC C]#_ COMPANY NAME IF. Paige plbg. & Htg. 1 ADDRESS F19 Knollwood dr CITY East Longmeadow STATE MA I ZIP `01028 TEL I413 736 2554 FAX —I CELL 413 218 2002 EMAIL paigeplbg@gmail.com • y�,,../d:d ,ram, Ps-,' 1s�rY/ 9)r'3f yre 79 /2-22-L "'q^.,�,, yt"1W /2-72-L oi J .r/ /! 6.��"l 9�/�Z .17/1l Hcix'av -7-4/6/2 /2- 9--L ( , ?l- 7.1/ ,' -mil-i t 4"11 `(11 Qrts, ,i__A'i d AZ--12 . W.LI- ZS' ;3/ ' L/Z' f2--v?- 2/ •,9rtn/ Apt.eu /2-92=.5' , , / ,kzeuic 3rna '7 /"mac/ 3 447c y ,/ cat-' . raV4Frias cV 4°2X 1201/2 j $l Iui/d 12 -6(-r7/, Q i r't/,w c4^'71 c:7-Z,/2-2/ W,, / _ ems' s -u! - "�,�� wQ�� '?.141-1Z1 /z-•i/-O/ A.0/ so, ?o/ /of �. /" Likr Vae- CIF- 9 2!-ci© O -•phi �l?�Y'i' °2'7-'2,/ Sf-I• �e t to aa127-d cZN2 — 9/1•Vi 1. u�u�� /Z S'/— H" '9 '9'L Za, /2--92-2 9rn W-r 6:1 /Z-L2-- •� �" = /2- f 2 '7° / 97-Z. a _2d.7-7'I3 ��� / ><'-'71i37 ' rro1414100l f c-k *z9Ltaq 4145-fs • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 7-_ = ' CITY 1 N'ol# ampton I MA DATE 11/12/2020 PERMIT#cP?'2(^0173 i OBSITEAI RESS 140 Olander Drive — 'OWNER'S NAME Community Builders Inc. I C -OWNER WIRESS 95 Berkeley Street I TEL FAX TYf? OR "3 PRINT oCCUPAN��TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 0 CLEARLY IEW: �iT RENOVATION:CI REPLACEMENT:❑ PLANS SUBMITTED: YES El NO❑ APP4IAN S -+ BSM 1 J 2 1 3 4 5 j 6 1 7 J 8 1 9 10 11 J 12 J 13 14 BOILERt BOOSTER 1 CONVERSION BURNER 1 COOK STOVE I I DIRECT VENT HEATER - DRYER FIREPLACE FRYOLATOR - --- ,_ -— _-_ -- J - i FURNACE GENERATOR �, . GRILLE i — l INFRARED HEATER ;!r LABORATORY COCKS MAKEUP AIR UNIT - - OVEN 1I POOL HEATER ROOM!SPACE HEATER �LU$f3IN I S T 4 r ROOF TOP UNIT I 1 `JOI1 HA TEST _APPmO 9 ' OT PPIpVFJ UNIT HEATER AK - UNVENTED ROOM HEATER WATER HEATER 1 OTHER — I I 1 - - a. INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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 complia a with al ertir,nt provi 'o the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 7 PLUMBER-GASFITTER NAME Steven Paige LICENSE# 15606 SI OF MP EI MGF F JP❑ JGF 0 LPG!0 CORPORATION❑# 2365c PARTNERSHIP❑# LC❑# COMPANY NAME:IF. Paige Plbg. & Htg. Serv. Inc. ADDRESS 19 Knollwood Dr. CITY [East Longmeadow STATE MA ZIP 01028 TEL 4137362554 FAX CELL 413-219-2660 EMAIL paigeplbg@gmail.com s w / /�-P/