31A-192 (2) 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 the type of coverage by checking the appropriate box below:
A liability insurance policy ik Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee rinec not have the insurance coverage required by Chapter 112 of the
Massachusetts General Laws, and that my signature on this permit application waivBsthis requirement.
Check One Only
Owner ❑ Agent ❑
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
Progress invert-ions
D2te f nmm?nts
Final Tncpertinn
Date Comments
Type of License:
By ❑ Master
Title ❑ Master-Restricted
City/Town ❑Journeyperson
Signature of Licensee
Permit#
❑Journeyperson-Restricted
License Number:
Fee$
❑ �f 1
Check at www macs gnvlrlpl 17 a .....1 s 1 5
Inspector Signature of Permit Approval
D EcEn9G,,: n
.]
OCT - 7 �. i Commonwealth of Massachusetts
2013 :Li
City Of Northampton
Electric, Piumb,ng g
G;s ir:: ,Ttions
North:;tim- rs, MA L l ut,0
Date: (ON/
Sheet Metal Permit Permit# (9/n—I `f'
�j
Estimated Job Cost: $ Z5-00,00 Permit Fee: $ 3g1.5 26
Plans Submitted: YES NO ✓ Plans Reviewed: YES NO
Business License# Applicant License#
Business Information: Property Owner/Job Location Information:
Name: t.r,ikt}vv\gf Name: p-,-6,4i A/(
Street: /`fS IA)f V. R 6 °C)(cf Street: 75 liti`L\StAl'', S`NA�12
City/Town: GaStNe`\ /hi City/Town: A.1)4Lv.,p lU',
Telephone: Lit-6 2lo w x.27 76 Telephone:
Photo I.D. required/Copy of Photo I.D. attached: YES NO
Staff Initial
J-1 / � estricted 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 1,7- 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 V Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney/Vents Air Balancing
Provide detailed description of work to be
done:
P Ro U v L `6(oC l gcol k betse t i t G r RA't r/
oc !
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-2014-0019
APPLICANT/CONTACT PERSON JOHN THOMAS PLUMBING&HEATING
ADDRESS/PHONE P 0 BOX 614 (413)626-2976 0
PROPERTY LOCATION 75 WASHINGTON AVE
MAP 31A PARCEL 192 001 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
Fee Paid a O J
Typeof Construction: HRU UNIT INSTALLED IN BASEMENT FOR 1ST FLR
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statem-• or icense 1081
3 sets of ' .ns/Plot Plan
THE a LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF a RMATION 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
'- •m Elm Street Commission Permit DPW Storm Water Management
/o-77-75
Signature of Building Official
ate
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.
75 WASHINGTON AVE SM-2014-0019
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
;GIS#: ;5801 / -ic`
31A •
1192 iA
424-310 SHEETMETAL PERMIT
Lot: 001
Permit: SHEETMETAL
Category: SHEETMETAL
Permit# SM-2014-0019
PERMISSION IS HEREBY GRANTED TO:
Project# JS-2014-000346
Est. Cost: $2,500.00 Contractor: License: Expires:
Fee Charged:$25.00 JOHN THOMAS PLUMBING&HE Sheetmetal- 1081 07/28/2015
Balance Due:$.00 Owner: PITONIAK MATTHEW M&BARBARA A
#of Fixtures: Applicant: JOHN THOMAS PLUMBING&HEATING
- —
,DigSafe# AT: 75 WASHINGTON AVE
UseGroup
ConstClass
ISSUED ON: 15-Oct-2013 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
HRU UNIT INSTALLED IN BASEMENT FOR 1ST FLR
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-2014-001587 07-Oct-13 3883 $25.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck@northamptonma.gov
GeoTMS®2013 Des Lauriers Municipal Solutions,Inc.