31A-076 (10) INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes tNo❑
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: 1 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 bo 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 y knowledge and that all sheet metalwork 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 Gen eral Laws./
Duct inspection required prior to insulation installation:YES v NO
Progress Inspections
Date Comments
Final Inspection
Date Comments
Type of License:
By ❑Master
Title
❑ Master-Restricted
City/Town
❑Journeyperson Signature of Licenses_„
Permit#
❑Journeyperson-Restricted License Number: Soy
Fee$
❑ Check at www.mass.gov/dpl
Inspector Signature of Permit Approval
J
Commonwealth of Massachusetts
Ile Pons Sheet Metal Permit
Date: �" 1 Permit# se y�
Estimated Job Cost: $ Permit Fee: $ O 0
Plans Submitted: YES c� NO Plans Reviewed: YES NO
Business License# L—. Applicant License# SW4
Business Information: Property Owner/Job Location Information:
Name:H(A r e,,j �� Name:-1>y. &_d
Street:�j Es s i-- Q.U(?- . Street: � �C37 �I m stce e+
( � City/Town:
Q
Telephone: H 15) 13 2— 2
Telephone: �5AID —
Photo I.D. required/Copy of Photo I.D. attached: YES NO
Staff Initial
J-1 / -11 nrestricted 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. J 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:
1. File for sheet metal and building permit with the City of Northampton.
2.Modify the exterior ductwork to relocate from the window opening to the brick below the window.
3. Modify the interior ductwork to line up with the new exterior ductwork.
4. Provide subcontract of general contracting work to cut&patch brick masonary opening,provide new glazing in
existing window frame with new custom storm window.
File#SM-2014-0063
APPLICANT/CONTACT PERSON HURLEY&DAVID INC
ADDRESS/PHONE 90 Fisk Ave (413)732-3141
PROPERTY LOCATION 264 ELM ST
MAP 31 A 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
Fee Paid
Typeof Construction: HVAC
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 804
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFS7RMATION 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 Pen-nit 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
C,-71� d-=� 6 h 9 �
Signature of Building Official 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 SM-2014-0063
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
-- -;
IGIS#: 1 1473
Map: 31A
\,
BI°ck: 076 - - --- SHEETMETAL PERMIT
of 000 „.• .
,Permit: SHEETMETAL
Category: renovation
Permit-# SM-2014-0063 PERMISSION IS HEREBY GRANTED TO:
- -- - -- ------
Project# JS-2014-002135
- Contractor: License:
Est. Cost: Expires:
Charged:$100.00 HURLEY&DAVID INC Sheetmetal- 804 06/28/2015
(Balance Due:$.00 ]Owner: MILLER ALEXANDER RON&DEBORAH JEAN MARKS
#of Fixtures Applicant: HURLEY&DAVID INC
DigSafe# AT. 264 ELM ST
UseGroup
ConstClass
ISSUED ON: 23-Jun-2014 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-2014-007012 06-Jun-14 11113 $100.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lbasbrouckgnorthamptonma.gov
GeoTMSO 2014 Des Lauriers Municipal Solutions,Inc.