30A-056 (12) BP-2024-0431
32 LIBERTY ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
30A-056-001 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-2024-0431 PERMISSION IS HEREBY GRANTED TO:
Project# BATH RENO 2024 Contractor: License:
Est. Cost: 47000 Alexander Lane 117411
Const.Class: Exp.Date: 05/04/2026
Use Group: Owner: DOEHNE ZINK MICHAEL& ANDREA
Lot Size (sq.ft.)
Zoning: URB Applicant: ALEXANDER LANE
I Applicant Address Phone: Insurance:
57 Prospect Ave. 9174704122
NORTHAMPTON, MA 01060
ISSUED ON: 04/12/2024
TO PERFORM THE FOLLOWING WORK:
BATH 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: tV 7/'in.& �� House # Foundation:
Vtr2
Final: 9`/eo-e Final:y-G/ at,/ Final: Rough Frame:0j . -7 7-2yK.i�
i 12n
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final: Olt 9• i 2- Z Y 1
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
te./P
Fees Paid: $312.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
//
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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
L)'
G(r / /grin MA DATE (v`274y PERMIT#pP-202q-v2/z
JOBSITE ADDRESS 3 'Z Likrj]l J r OWNER'S NAME r`I.,at'rt. Dpehn�.
WN R ADDRESS 3•�- L��0 � TEL 1/31,23'�� ,2 EMAIL //5+-4^SKI �ier,-
P TYPE C
OR PRINT OCCUPANCY TYPE COMMERCIAL❑ RESIDENTAIL ❑
CLEARLY
NEW: ❑ RENOVATION: ❑ REPLACEMENT: [ PLANS SUBMITTED: YES❑ NO ig
FIXTURES " 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 GZ
ROOF DRAIN
SHOWER STALL •
I
SERVICE/MOP SINK
—
TOILET I PLUMBING GA S INSPECT i OR
URINAL NORTHAMPTON
WASHING MACHINE CONNECTION APPROVED NOT APPROVED
WATER HEATER ALL TYPES
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 [e NO ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY Vi 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 ❑ 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 co liance with all Pe 'nett p visio f the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAMET4S r L,'Sal,pr k/ LICENSE# /�Q(p 6 SIGNATURE
MPrg JP ❑ I CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME 'SRO &A a). +p f iettfinj ADDRESS 30 Jzu/Q 2�. La Alr CITY
STATE /I A ZIP e 001'1 TEL ff3 '3 'lo7S93 FAX CELL
EMAIL I ,/ �i4$b J1 O. tLOQ . C 0N't
_ \ The Commonwealth of Massachusetts
_'� —_ 1. Department of Industrial Accidents
=�1- 1 Congress Street,Suite 100
;.-=_:�� Boston,MA 02114-2017
www.mass.gov/dia
Workers'kers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERNIITTING AUTHORITY.
Applicant Information Please Print Legibly
t �
Name (Business/Organization/Individual): TOO49"5 lukii//4 17 ) /hid//7
Address: 3 O _cut r4 Rd_
I A,A
City/State/Zip: CaJ f li4 kf 1Y'I 114- 413D 2Phone#: '/3-3/3 _67/3
Are you an employer?Check the appropriate box: Type of project(required):
1.pliarn a employer with I employees(full and/or part-time).* 7. ❑New construction
2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling
any capacity.[No workers'comp.insurance required.]
3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
9. ['Demolition
10 El Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees.
12..t Plumbing repairs or additions
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance.:
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. II
Insurance Company Name: ftrocikre SS/ve- _[wz/i h0,-lit OS.S boy_ #eM.Stk.
Policy#or Self-ins.Lic.#: 3 I„ p 1 Q s,73 d Expiration Date: /O i/C�j'Op2
Job Site Address: 3.2 L4ei/,j J 7 City/State/Zip: Ad tl //`�� O/dlo0
Attach a copy of the workers' compensation policy declaration page(showing the policy number an expitation ate).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify under the p ',is a pen lties of perjury that the information provided above is true and correct.
Signature: Date: �p / 7 /OZ 7
Phone#. •/l3 - /S (97Y3
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other .
Contact Person: Phone#:
7.-/-21i R14,14( ,Ce-/Pg't 4,----
L—/C.,LY f -i— /1711 e#T It/kr-Dv
3 ../b-e r-1-,i--1
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o7 in
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c Z '' Commonwealth of Massachusetts Official Use Only 4/,....-
OccupancyT� � Permit No.: _Lr%I� 01 y'
` �;� Department of Fire Services and Fee Checked:
61
Z .r r (!: :;OARD OF FIRE PREVENTION REGULATIONS [Rev. 1/2023] Ooa
r—,APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
0 - ' •.s to be performed in awith the Massachusetts Electrical Code(MEC),527 CMR 12.00
to City or Tow of: /J''jt hQ Mp accordanc
7 7 Date: 696 -oW--at7y
or of Wires:By this application,the dersigned gives notic of his or he intention to perform the electrical work described below.
Location(Street&Number): ~ Ol-1-- e- Unit No.:
Owner or Tenant:/4,e/Ae>1e eat i'fl' i' Email: -7
Owner's Address: 07 G j�e ?re& 7- hone No.:Vf a.-7,7 3-9/7(g
Is this permit in conjunction with buil g permit? Check appropriate box)Yes®No 0 Permit No.:
Purpose of Building: ,�/��L� l�lf f/�� Utility Authorization No.:
Existing Service: l Amps / / Volts Overhead❑ Underground 0 No.of Meters:
New Service: Amps / Volts Overhead❑ Undergroupd El No.of Meters:
Description of Proposed Electrical Installation: ,/5?'f�10p/j'! /e/4 O I't /1O7I
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-Gmd.0 Above-Grnd.0 Hot-Tub❑ No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System ❑ 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❑ Ground-Mount 0 Level 1 0 Level 2❑ Level 3 0 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: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: Q / G, /2? O/7 A-1 ❑or C-1 ❑LIC.No.:
Master/Systems Licensee: ,t / LIC.No.:
Journeyman Licensee:/li L Aa e/ ,: / 0 rf 9 LIC.No.: i� /�j
7d
Security System Business requires a Division of Occupatio j Licensure"S"LIC. S-LIC.No.:,_. 0D078J 7
Address: /7 s lC//,f '/7 .,']I/-G'e7/'M/7I0417 ' 1 Al", ®f 060
Email:///'pI " /7/?9 r ivet/cfre e(e/)7,s/4.G6.s7 Telephone No.: tf3--5-gg 74-‘c
I certify,under the ains a d e a 'es of perjury,that the information on this application is true and complete.
Licensee: "nt Name: e Io'e/ tT 104 Cell.No.: y�S� /��
INSURANCE COVE E:Unl aived by the owner,no permit for the performance of eV
work may issue unless the licensee
provides proof of liability including" mpleted 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 0 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❑ Owner's agent❑
Owner/Agent: Tel.No.:
Signature: Email.:
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