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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 // Qom/ 7( 4Z - 0/ c� 5i2 �I��Dr 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 v --- o7 in i n 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.: ))e-h -1 ' T f $ ?/ '/L 712 5��