23B-046 (4) i
INSURANCE COVERAGE:
I have a current liah_ ilit= insurance policy or its equivalent which meets the requirements of M:G.L. Ch. 112 Yes L'1 No ❑
If you have checked Yes, indicate the type of coverage by checking the appropriate box below:
A liability insurance policy 9 Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee anp¢ not have the insurance coverage required by Chapter 112 of the
Massachusetts General Laws, and that my signature on this permit application Waims 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 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
Proorpcc incnPrtionc
Date C ommenfc
Final T_n Quinn
Date CnmmPntc
Type of License:
B y IiKmaster
Title ❑ Master - Restricted
City/Town
❑Journeyperson Signature of Licensee
Permit #
❑Journeyperson- Restricted
License Number: y 1 2- i 1L
Fee $
Check at www mace gn
Inspector Signature of Permit Approval
RE
L U 2011 ° monwealth of Massachusetts
ity Of Northampton
DEPT. OF BUILDING INSPECTIONS
NORTHAMPTON MA01060 Sheet Metal Permit
Date: 10 -1 9 _// Permit # S — l0
Estimated Job Cost: $ // Permit Fee: $ /OCR, 00
Plans Submitted: YES NO Plans Reviewed: YES NO
Business License # 0 1 H Applicant License # ,?) I.Z
Business Information: Property Owner / Job Location Information:
Name: JQe e A c°t2 , ee f /h ?tryL r yt`, Name: Coat ,may At l-,, Scan, 114>�cp; m
Street: 6S - U2 e .s> c�_/ a.2. R61 Street: 3 o L) e r S r
City /Town: LvrL w 4 94 /u s . City /Town: 1 O 1 0& /- S u4' i
Telephone: '/113 _ - S ? 9 / 9'_5_5/ Telephone: 4 1 1 3 S A
Photo I.D. required / Copy of Photo I.D. attached: YES NO
Staff initial
3-1 / 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 Multi- family Condo / Townhouses Other
Commercial: Office Retail Industrial Educational
Institutional Other i/ f lvs p, to L
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:
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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 0 Residential, $100.00 Commercial
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