16A-016 (2) INSURANCE COVERAGE:
I have a current liahiiify insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes ICJ No ❑
If you have checked Yes, i irate 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 ring not have the insurance coverage required by Chapter 112 of the
Massachusetts General Laws, and that my signature on this permit application waivos this requirement.
C C eck One Only
l ,,, ivy/ Owner Agent El
Signature of er O wner's Agent
By checking this box❑, 1 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
PrngrPes tncpertions
natP Comment%
Final Inepectinrt,
m (nmmente
Type of License:
By ❑ Master
Title ❑ Master - Restricted
City/Town ❑Journeyperson
Signature of Licensee
Permit #
❑Jou rneyperson- Restricted
License Number:
Fee $ ❑
Check at Itkw.wanas
Inspector Signature of Permit Approval
ECER /E i ommonwealth of Massachusetts
JAN l 9 2012 City Of Northampton
DEPT pF l
Da "oq BUI �wcws " w_ Sheet Metal Permit Permit # „Sin/02 -02-i
Estimated Job Cost: $ Gip et), OD Permit Fee: $ 49 5.0a
Plans Submitted: YES NO Plans Reviewed: YES NO
Business License # a,CI Applicant License # 9
Business Information: Property Owner / Job Location Information:
Name: -c Name: (A r E— iTy\'
Street: q 3 ' y� c Street: 93
City /Town: irThlso,j MR City /Town: t-- b Q PM CJ it*
Telephone: y 1 3--a y'> - cj y a. Telephone: r 3 .- 3q ( D r-�
Photo I.D. required / Copy of Photo I.D. attached: YES NO 7
Staff Initial
J -1 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 f 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: V Renovation:
HVAC Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney / Vents Air Balancing
Provide detailed description of work to be done:
— Ir44fl(1 LA 5'' 1 yr \ u)n &Au ^ A5 Gc ,lts
�b �G :: V1 sAS ins 1 1�Cfd� i)ov? ZOCA V' �,� f' �•
2)0'111)-6 „Qc),),„
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
Z'
File # SM- 2012 -0021
APPLICANT /CONTACT PERSON ALL SEASONS HEATING AIR
ADDRESS/PHONE 93 ELM ST (413) 247 -9842
PROPERTY LOCATION 431 SPRING ST
MAP 16A PARCEL 016 001 ZONE URA(100) //WSP
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out V 999
Fee Paid / �•�
Typeof Construction: INSTALL DUCT WORK
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 129
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFQRMATION 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
f72 3/ ( ?—
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.