35-162 (2) INSURANCE COVERAGE:
I have a current liahility insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes l 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 El
OWNER'S INSURANCE WAIVER: I am aware that the licensee dnpc not have the insurance coverage required by Chapter 112 of the
Massachusetts General Laws,and that my signature on this permit application waivPsthis requirement.
Check One Only
Owner Cl Agent El
Signature of Owner or Owner's Agent
By checking this box❑,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
Prngrpcc Tncp etinns
Tate Comments
Final Tncp etinn
nate Comments
Type of License:
By ❑ Master
Title ❑ Master-Restricted
City/Town
faJourneyperson Signature of Licensee
Permit#
❑Journeyperson-Restricted License Number: C6 �
Fee$ ❑
Check at www macc gnv/ripl
Inspector Signature of Permit Approval
RECEIVE
Commonwealth of Massachusetts
JUL 1 B 2013 City Of Northampton
- 1�VvS1':C'tIG
�E •QB± TON,,•_ 1W Sheet Metal Permit 5/111t4
N�7n� Permit#
Estimated Job Cost: $ SAO°a Permit Fee: $ /d 3 CI a
Plans Submitted: YES NO Plans Reviewed: YES NO
Business License# CG c Applicant License# ‘016-
Business Information: Property Owner/Job Location Information:
Name: i-<-.5 i O S ,k(7 h 4 AC Name: 1-'1('91a. ` Y ckiC p
Street: ��i tiff 5A-014( `� Street: r i s 'i� gy Ay.
City/Town: ci cyt City/Town: ' a r .-e kil
Telephone: tf f3 - ?}S ,Q8'35- Telephone: E t 3 - e4 6 - 8 4 I
Photo I.D. required/Copy of Photo I.D. attached: YES f/ NO
Staff Initial
J-1 /M-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 t 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: a,
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:
1�"11�c e `, 6.1u. Cj h c�y -}ru \L
1-A A oxIa-1 et e 6^3 el`4(I pion
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-2014-0006
APPLICANT/CONTACT PERSON LIVINGSTONE HVAC
ADDRESS/PHONE 6 LIVINGSTONE AVE (413)335-9835
PROPERTY LOCATION 793 RYAN RD
MAP 35 PARCEL 162 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQJ I DATE
ZONING FORM FILLED OUT r
Fee Paid , 05,, G/
Buildin! Permit Filled out . wr wr, et,„
Fee Paid
Typeof Construction: SHEETMETAL INSTALLATION feP I (
New Construction /40' / tV(
Non Structural interior renovations
Addition to Existing ' 0,5
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan V
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ION PRESENTED:
pproved 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
er
SignYiro Building Of`cia
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.
793 RYAN RD SM-2014-0006
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
rGIS#: 6978 -NAMP
Map 35 in
Block:____ 162 _1c 0y SHEETMETAL PERMIT
Lot. 001 _��
Permit: SHEETMETAL TeR�N 0
Category: SHEETMETAL
Permit# sM-2014-0006 PERMISSION IS HEREBY GRANTED TO:
Project# JS-2013-001997
[Est.Cost: $5,000.00 Contractor: License: Expires:
— —
Fee Charged:$25.00 LIVINGSTONE HVAC
;Balance Due:$.00 Owner: KULYAK OLEG&LILIYA
#of Fixtures: Applicant: LIVINGSTONE HVAC
DigSafe# AT: 793 RYAN RD
jUseGroup
ConstClass
ISSUED ON: 26-Jul-2013 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
SHEETMETAL INSTALLATION
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-2014-000347 23-Jul-13 1036 $25.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @northamptonma.gov
GeoTMS®2013 Des Lauriers Municipal Solutions,Inc.