31A-076 (4) INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yesr No❑
If you have checked Yes, indicate the type 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 does not have the insurance coverage required by Chapter 112 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 Owner's Agent
By checking this bow,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 General Laws.
Duct inspection required prior to insulation installation: YES ` NO
Progress Inspections
Date Comments
Final Inspection
Date Comments
Type of License:
By Master
Title r ,j_ ilm-ekv/i'
city To,'n
I, t
-- — ❑Journeyperson Signature of Licensee
Per r,t h
j ❑Journeyperson-Restricted � ,
License Number: "�
FeeS_ —
❑ Check at www.mass.gov/dp€
Inspector Signature of Permit Approval
RE' s
Commonwealth of Massachusetts
oUN I 201 Sheet Metal Permit
DEPT OO,F�„.B_LI) DINt N4A V
NOTh�tO tSfJ 7 �+ Permit#
f#ff{i•
Estimated Job Cost: $ Permit Fee: $ \L}
Plans Submitted: YES _ NOS Plans Reviewed: YES NO
Business License # Applicant License#
Business Information: Property Owner/ Job Location Information:
` Name: b, WIC S
Name: t:� � ..;�, _
Street:�_� �" { � `� lV ' , K-_,., Street: r
•
City/Town: ' ' =' City/Town:jLJU C t K `
Telephone: `1 f 4` Telephone: ‘'-'{/ j j ` ( 1.6-
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. over 10,000 sq. ft. Number of Stories:
Sheet metal work to be completed: New Work: Renovation:
HVAC Metal Watershed Roofing _ Kitchen Exhaust System
Metal Chimney/Vents Air Balancing
Provide detailed description of work to be done:
I. Disconnect, remove and dispose of one AC split system with indoor air handler in closet and outdoor condensing
unit on grade.
2. Provide packaged cooling unit with economizer,barometric relief and programmable thermostat.
3. Package unit to be located on grade on the northwest side of the building.
4. Provide connections to the existing supply duct system through the closet window.
5. Provide one central return grille located near the existing AC closet.
6. Provide allowances for sub-contract of electrical wiring,ductwork insulation, concrete pad services.
7. Check,test and start up system operation.
Not including off hours work.temporary heating/cooling systems,duct cleaning, repairs or modifications to existing
duct distribution system.
File#SM-2013-0066
APPLICANT/CONTACT PERSON HURLEY&DAVID INC
ADDRESS/PHONE 90 Fisk Ave (413)732-3141
PROPERTY LOCATION 264 ELM ST I
MAP 31A PARCEL 076 000 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out )11101- q�l�
Fee Paid IMP/
Typeof Construction: HVAC
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFQ4 iATION PRESENTED:
t/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
Permit from Elm Street Commission Permit DPW Storm Water Management
Signature of :J ilding ficial 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.
264 ELM ST I SM-2013-0066
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS#: 11473 '"`"""'
Map: 31A
Block: 076 i �' �;�.�
*1 SHEETMETAL PERMIT
Lot. 000 �r �
(Permit: SHEETMETAL
(Category: SHEETMETAL
Permit# SM-2013-0066 PERMISSION IS HEREBY GRANTED TO:
Project# JS-2013-000725
Est.Cost: $14,728.00 Contractor: License: Expires:
Fee Charged:$100.00 HURLEY&DAVID INC
(Balance Due:$.00 Owner: MILLER ALEXANDER RON&DEBORAH JEAN MARKS
j#of Fixtures: Applicant: HURLEY&DAVID INC
;DigSafe# AT: 264 ELM ST I
UseGroup
IConstClass
ISSUED ON: 19-Jun-2013 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
HVAC
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-2013-006709 17-Jun-13 9482 $100.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:Ihasbrouck®northamptonma.gov
GeoTMS®2013 Des Lauriers Municipal Solutions,Inc.
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