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35-118 (7) i 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 � Other tYP a 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 box[],I hereby certify that all of the details and information 1 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. x Duct inspection required prior to insulation installation:YES NO Progress Inspections Date Comments Final Inspection Date Comments Type of License: By ❑ Master Title ❑ M ) aster-Restricted. l City/Town ❑Joumeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted License Number: Fee$ ❑ Check at www.mass.gov/dpl Inspector Signature of Permit Approval `t Ii Commonwealth of Massachusetts Sheet Metal Permit Eiec �ortP,amPto�, p p1060 Date: `7 Permit Estimated Job Cost: $ Permit Fee: $ Plans Submitted: YES NO ...._-_Plans Reviewed YES NO Business License# © Applicant License # Business Information: Property Owner/Job Location Information: Name: CZ-t4 ;16I13iame: 44e r!!t Og?�n Street4-al e/y sue' Zek Street: 441V /; /" 3� 0/'? City/Town: -t 'r City/Town: �af Telephone: �I � — C� r� Telephone: A73o Photo I.D. required/Copy of Photo I.D. attached: YES 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_V 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 C/ Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: File#SM-2015-0047 APPLICANT/CONTACT PERSON DURFEY HEATING SYSTEMS ADDRESS/PHONE 131 CROSS RD (413)357-6132 PROPERTY LOCATION 49 DREWSEN DR MAP 35 PARCEL 118 001 ZONE 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: DUCTWORK FOR AC JOB 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 INFOR ATION 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 rmit fro Elm Street Comm, sion Permit DPW Storm Water Management Zgn;iuilding fficial 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. 49 DREWSEN DR SM-2015-0047 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON GIS#: 6934 Map: -4 35 Block: SHEETMETAL PERMIT Lot: ool I .,,.,• Permit: SHEETMETAL Category: SHEETMETAL Permit# SM-2015-0047 PERMISSION IS HEREBY GRANTED TO: Project# JS-2015-002349 Est.Cost: $4,000.00 Contractor: License: Expires: ,Fee Charged:$511.00 DURFEY HEATING SYSTEMS Balance Due:$.00 Owner: GRIPPIN LEA A #of Fixtures _ Applicant: DURFEY HEATING SYSTEMS DigSaf_e# AT: 49 DREWSEN DR UseGroup ConstClass ISSUED ON: 16-Jun-2015 AMENDED ON: EXPIRES ON: TO PERFORM THE FOLLOWING WORK: DUCTWORK FOR AC JOB 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-2015-006706 10-Jun-15 16970/16974 $50.00 212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:Ihasbrouck @northamptonma.gov GeoTMS®2015 Des Lauriers Municipal Solutions,Inc.