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I INSURANCE COVERAGE::. •
i have # current Jiahllhy insurance policy or Its equivalent which meets the requirements of M.G.L Ch, 112 Yes u No 0
_ I
I If you have checked Yes, indicate the type of coverage by checking the appropriate box below:
I A liability insurance policy u Other type of indemnity u Bona
ivniR'3 1NfilialANCE WAIVER: i au rage that tie liceaseerd = " ai m the insuranciti coverage IeyLIICY uj Chapter 112 of the
Massachusetts General Laws, and that my signature on this permit applicagoniszabies this requirement.
Check One Only "
Owner u Agent 0
Signature of Owner or Owner's Agent
By checking this hasp, I hereby certify that all of the details and information i nave submitted (or entered) regarding this application are true and
accurate to the beat of my imotlrlosig3 and *atoll sheet metal wort and inabilat one performed under the permit untmx t r is application will be
In compliance with all pertinent provision of the Masseclrueetts Building Coda and Chapter 112 of the General Laws.
Duct inspection required prior to insulation installation: YES i40
Progress inspections
Date mmpnti
1e'inal in Toot
n to Comments
ii T.pe of License: •
e■ , u Master 1
Title _ . ❑ Master - Restricted
"p , noumeyperson
Signature o f lc
Permit IS nioumeyper son-Re eiriled
license Number
Fee $ ..._...
Check at Witt* nt3cc nnvkil,l
Inspector Signature of Permit Approval
,nnral 7r7T1ornT:, vus 0'•7T TTn7i7ninn
•
RECEIVE
Commonwealth of Massachu a APR - 4 2012
Ci ty Northampton OF UILDIN INSPECTIUNg
N MA 07060
Sheet Metal P
Date: 3�09�ao1� Permit # 5m /a a ?
Estimated Job Cost: $ Q 0 Permit Pec: $ ,00
Plans Submitted: YES NO x Plans Reviewed: YES NO X
Business License # 3 B Applicant License # 5) 6
Busine for -i re ion: Property Owner / job Location Information:
Name: EWS P /Uff1b' Jk � f/ �v.T.�x Name: _ r d 14P.rro I d
Street: sg3 ° 2 Main St street: 83 Massa-so SL
Cityffown; O n Sa m Cityfrown: 7J r fc n
Telephone: 4/ 3 - z (g7 9 2 3 Telephone:
Photo I.D. required / Copy of Photo i.Il. attached: YES X NO .
Staff Initial
- / arVinrestricted license
J -2 / M-2-restricted to dwellings 3 - stories Driest and cvr::*nertia_l up to 10,000 ea. it i 2-stories or less
Resident l: 1 -2 Emily X . Multi-fatni1y Condo / Townhouses Other
Commercial: Office Rail indushial Educational
Institutional Other
Square Footage: under 10,000 sq. ft. over 10,000 sq- ft Number of S tories:
Sheet metal work to be completed: New Work: Renovation:
1-1%AC Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney / Vents Air Balancing
Provide Wiled description of work to be done:
S r� vs. f e c-�1 e c^ k o . Pc( (
v�
Fees with -Building Permit: $25.00 Residential, $50.00 Commie'. Fees for jobs without a Bui1dit g Permit $5,00 per $1000
fees for jobs without &Ming Pent* $50.00 Residential, mow Commeicia1
File # SM- 2012 -0028
APPLICANT /CONTACT PERSON EWS PLUMBING & HEATING ..-- 7
ADDRESS/PHONE 339 MAIN ST (413) 267 -8983 0 If 0 d
PROPERTY LOCATION 83 MASSASOIT ST
MAP 24C PARCEL 099 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE , 1 C ' d' r V
ZONING FORM FILLED OUT r ,� 6
Fee Paid � P
�=�
Building Permit Filled out • i ;, _
Fee Paid
Typeof Construction: DUCTWORK foal
New Construction ,pr
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 391
3 sets of Plans / Plot Plan
THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
Approved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER : §
Intermediate Project : Site Plan AND /OR Special Permit with Site Plan
Major Project: Site Plan AND /OR Special Permit with Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received & Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
dr i om lm Street Commission Peimut DPW Storm Water Management
40tv
r -1 /Z
Signa re of Bui ding Offic al Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health, Conservation Commission, Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact the Office of
Planning & Development for more information.
83 MASSASOIT ST SM- 2012 -0028
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS #: 3774 �ZHAMP\
[ Map: 24C
099 ���' ,
Lot: ool 44� r SHEETMETAL PERMIT
Permit: SHEETMETAL
[Category SHEETMETAL
Permit # SM 2012 -0028 PERMISSION IS HEREBY GRANTED TO:
Project # JS- 2012 - 001115
Est. Cost: Contractor: License: Expires:
[ Fee Charged: $25.00 EWS PLUMBING & HEATING Sheetmetal - 391 05/12/2013
Balance Due: $.00 Owner: HEROLD JORDI
# of Fixtures: Applicant: EWS PLUMBING & HEATING
DigSafe # AT: 83 MASSASOIT ST
UseGroup
ConstClass
ISSUED ON: 05- Apr -2012 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
DUCTWORK - *DUST BLAST TESTING REQUIRED*
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
Fixtures:
Floor: Type: # of Fixtures Floor: Type: # of Fixtures
Fee Type: Receipt No: Date Paid: Check No: Amount:
Sheetmetal REC- 2012- 005216 04- Apr -12 14017 $25.00
212 Main Street, Phone:(413) 587 -1240, Fax:(413) 587 -1272, Email :Ihasbrouck @northamptonma.gov
GeoTMS® 2012 Des Lauriers Municipal Solutions, Inc.