39A-039 •
` COMMONVVEAt_TH' OF NfA- SSAC.HUSETTS
DIVISION OF PROFESSIONAL LICENSURE - BOARD OF
BOA OF ' ' u' ' S
AS: A: MASTER- UNRESTRIcT ,
ISSUES TY1E ABOVE LICENSE TO:
`,HLFGH K MA RT.LM__JR _ To
'38 MILL RD
qw
L ONGMEADOW MA 01828 -3022 .
897 • 02/28/12 ' -
LICENSE NO. EXPIRATION DATE SERIAL NO.
. .
Fold, Then Detach Along All Perforations
INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes ❑ No LI
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: I am aware that the licensee r+npc not have the insurance coverage required by Chapter 112 of the
Massachusetts General Laws, and that my signature on this permit application waivecthis 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
Prngrecc In c r ertinn s
Date Comments
Final Incrertinn
Hate f'nmments.
Type of License:
By ❑ Master
Title ❑ Master - Restricted
City/Town ❑Journeyperson
Signature of Licensee
Permit #
❑Journeyperson- Restricted License Number:
Fee $ ❑
Check at www macc gnv /rip(
Inspector Signature of Permit Approval
RECEI 0 Commonwealth of Massachusetts
NOY - 7 in
Of Northampton
-� Sheet Metal Permit Permit # 5'09 0 ��
DEPT : " •
NORTH AMPTON , SP EC C 1 41 0 .1 1 1
✓
Estimate• • t: '. Permit Fee: $ ,
Plans Submitted: YES AO Plans Reviewed: YES
Business License # Applicant License #
Business Information: Property Owner / Job Location Information:
Name: f /V / •9; ?. U , %4 Name: C /73 C
Street:36 717 ( cc /2D Street:] 1 /4i/ C.KA/Lio7 /
City /Town: 6- £&-G / C /ate City /Town: / U /7M (Vg -
Telephone: Telephone: - //.3 ( 3€--(Y
`- /! c. Telephone:
Photo I.D. required / Copy of Photo I.D. attached: YES NO
Staff Initial
J -1 / M- 1- unrestricted lice se`
J- 2 = res d 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 C Educational
Institutional Other
Square Footage: under 10,000 sq. ft. over 10,000 sq. ft. Number of Stories: 3
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:
24 (/ /4 44/V/'2— )✓7
///v�'? e /'L�c..e/ 6 74 « / /1 c - - --
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- 2012 -0012
APPLICANT /CONTACT PERSON KEN MARTIN HVAC
ADDRESS/PHONE 38 MILL RD (413) 525 -3496
PROPERTY LOCATION 33 HOCKANUM RD
MAP 39A PARCEL 039 001 ZONE GB /SC(11)/URC(89) //WP
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 6 -
Fee Paid
Typeof Construction: REPLACE ROOF UNIT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 897
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOfcMATION 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
Permit from Elm Street Commission Permit DPW Storm Water Management
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.