23A-165 (4) INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes❑ No❑
If you have checked Yes,indicate th pe of coverage by checking the appropriate box below:
A liability insurance policy Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee eine`s not have`the insurance coverage required by Chapter 112 of the
Massachusetts General Laws,and that my signature on this permit application waive`sthis requirement.
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
By checking this boxCJ,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 sheet metal work and installations performed under the permit issued for this application will be
in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the Gener Laws.
Duct inspection required prior to insulation installation: YES NO
Progress IncpP'tinnc
nate Comments
Final Igcpection
at Comments
Type License:
By Master
,_.... 121i7)604,...„.....t........./----
Title ❑ Master-Restricted
City/Town ❑Journeyperson
Signature of Licensee
Permit#
❑Jou rneyperson-Restricted
License Number..____cfil______
Fee$ ❑
Check at www macs dnv/rlp(
Inspector Signature of Permit Approval
RFcE-i �,
Commonwealth of Massachusetts V /
City Of Northampton AV
2 3?0/3
Date: 4/�/ /3 Sheet Metal Permit Permit# o�...o Art p"G rvs J
30 -
y - .i -iii,+A 0'Qfi0 r
Estimated Job Cost: $ 6 Permit Fee: $ a�'_ 3w 3 9
Plans Submitted: YES NO Plans Reviewed: YES NO
Business License# Applicant License#
Business Information: Property Owner/Job Location Information:
Name: �o V1 I
A kt. Name: '4/6-112r- CJ " 9,.4.,j
Street: 68 WAN,/lb, 3 it. Street: 6" 1 Seca,'— c-571---r
City/Town: (NN , l4/ o/8Q/ City/Town: 7I/4,4y%4A
Telephone: �3 " 3 7032_ �
Gf
Telephone: r/,.. "53,1' Y ■9b
L d
Photo I.D. required/Copy of Photo I.D. attached: YES NO
Staff Initial
J-1 unrestricted license
J-2 /M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft./2-stories or less
Residential: 1-2 family ✓ Multi-family Condo/Townhouses Other
Commercial: Office Retail Industrial Educational
Institutional Other
Square Footage: under 10,000 sq. ft. 7 over 10,000 sq. ft. Number of Stories:
Sheet metal work to be completed: New Work: Renovation: 7
HVAC Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney/Vents Air Balancing
Provide detailed description of work to be done:
/4) L 74 � D 2 t_ I/ AN9 pc,c,--frizo.tk A.
3*rAt ,/An 57-5. 744i1/ o. ' 4--..se r:1,2/ , S`rio/`frp
37 0 7-1445,
Fees with Building Permit:$25.00 Residential,$50.00 Commercial. Fees for jobs without a Building Permit$6.00 per$1000
Minimum fees for jobs without Building Permit$50.00 Residential,$100.00 Commercial
File#SM-2013-0064
APPLICANT/CONTACT PERSON POWERS AIR
ADDRESS/PHONE 68 HAMILTON DR (413)539-7032
PROPERTY LOCATION 61 CRESCENT ST UNIT 8
MAP 24D PARCEL 243 000 ZONE URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out d ar"
Fee Paid 3 Y'�� (� V
Typeof Construction: DRYER VENT,BATH EXHAUSTS,FAN
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 504
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER: §
Intermediate Project: Site Plan AND/OR Special Permit with Site Plan
Major Project: Site Plan AND/OR Special Permit with Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
)•: ' Elm Street Commission Permit DPW Storm Water Management
/—/$
Sign71117 of etxild' •ffi 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.
71 PINE ST SM-2013-0065
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS#: 12868 0,1 M
Ma 23A �- ,
Block: 165 n.'
Lot. ao (1y404 SHEETMETAL PERMIT
Permit: _SHEETMETAL
ERCENCENP
Category: SHEETMETAL
Permit# SM-2013-0065 PERMISSION IS HEREBY GRANTED TO:
Project# JS-2013-000004
,Est. Cost: $2,000.00 Contractor: License: Expires:
Fee Charged:$25.00 POWERS AIR Sheetmetal-504 02/28/2014
Balance Due:$.00 Owner: DEVILLIERS PETER A&JILL G
#of Fixtures: Applicant: POWERS AIR
,DigSafe# AT: 71 PINE ST
UseGroup
ConstClass
ISSUED ON: 17-Jun-2013 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
WARM AIR FURN/AIR CONDITIONING UNIT,ALSO ERV-need equipment spec,line drawings,manualj before final
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Sheetmetal REC-2013-006670 13-Jun-13 3430 $25.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @northamptonma.gov
GeoTMS®2013 Des Lauriers Municipal Solutions,Inc.