38A-117 (2) INSURANCE COVERAGE:
I have a current Iiabilit insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes u No ❑
If you have checked Yes, indicate t type of coverage by checking the appropriate box below:
A liability insurance policy Other type 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 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 7 I Laws.
Duct inspection required prior to insulation installation: YES
�narecs inenertinnc
Date con3ments
Final Inc eetion
Date Comments
Type f License:
By LYJ Master
Title ❑ Master - Restricted
CitylTown ❑Journeyperson
Signature of Licensee
Permit # ❑,lourneyperson- Restricted T
License Number:
Fee $ El
Check at laww macc_gnvnvidpi
Inspector Signature of Permit Approval
r
i
Commonwealth of Massachusetts
OCT 2 0 2 011 City Of Northampton
IEK °F BUILDING
' Sheet Metal Permit
Permit #
Estimated Job Cost: $ _�J 8'o Permit Fee: $ AS` Gv
Plans Submitted: YES t/ NO Plans Reviewed: YES NO
Business License # Applicant License #
Business Information: Property Owner / Job Location Information:
Name: �� "Zs Name: WA - /2 rZ S
Street: 6 �AM - 1��/ %2 Street: l--or 2, 3.3 (./('�'►!'xl� V
City /Town: (fo A/ ti/�F 4 013 4 1 1 City /Town:
Telephone: 4l 3 ' , 3 �3 z - Telephone: c�c J d d S
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
in
Residential: 1 -2 family ✓ 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 t be completed: New Work: ✓ Renovation:
HVAC Metal Watershed Roofing Kitchen Exhaust System ✓
Metal Chimney / Vents Air Balancing
Prov detailed description of work to be done:
/i/¢ N/ h/,4a i2 .i/ - �{i2 Ca✓ ri.�r/ir/G �S' STS'
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
lo 7G