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JUN -03 -11 08:49 AM WILSON SERVICES NORTHAMP 413 584 3377 P.01
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« COVERAGE:
t l i 1 a current Mitt Insurance policy or Its equivalent which meets the regtdrements of M.G.L. Ch. 112 Yee left ❑
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'; have checked Xs, Indicate the type of coverage by checking the app va �:ti box below:
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3 ' - NUANCE WAIVER :1 am aWa a that the licensee Atizzatte the knurance coverage f egtdred by Chapter 112 Of the
1 - i General Laws, and that my sign on this permit apps ca ti o n : this requirement
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1'r Check One Only
� Owner [33 Agent .0
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F' _- � of Owner or s Agent
{ , . this box°, i hereby cat* !hotel tithe &the sad Wombs thaw submitted (or mite* mpardfnp die spppcsdon anlnn #pd
# " , • t�o the best of my knowledge nd that'll sheet m aiworksad in te= Wormed under the permit YwedforNs application be
%' vAlhd perlsu+tprovision site Megechuse�
_1' and Chic* 11I Mho Omni Larn.
I Duct Inspection required prior to Insulation Installation: YES 140
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: Z Progress Inspections,
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:: •:;, := i 81 Comments
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a :: • Final Tasnectlnn
INSURANCE COVERAGE: t
I have a current liahilityy insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes ❑ No 0
If you have checked Yes, indicate the type of coverage by checking the appropriate box below: - 1
A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee rinP¢ nnf have. the insurance coverage required by Chapter 112 of the
Massachusetts General Laws, and that my signature on this permit application waivPsthis 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
prngr'Cs Incpertinns
Date COmmPntq
Final Tncpertiun
Date rnmmentq
Type of License:
By ❑ Master
Title ❑ Master - Restricted
City/Town ❑Journeyperson
Signature of Licensee
Permit #
❑Joumeyperson- Restricted License Number:
Fee $ ❑
Check at WWW macc grwIrtp(
Inspector Signature of Permit Approval
x ;E EIVED . /
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Commonwealth of Massachusetts 3 "
1 1u — 2 2011 City Of Northampton
i
o s Sheet Metal Permit
:'+►� / Permit #
2
Estimated Job Cost: $ 3 0, CV tNC Fee: $ ) 136
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Plans Submitted: YES NO Plans Reviewed: YES NO
Business License # 5 Applicant License # S - 1
Business Information: Property Owner / Job Location Information:
Name: L.) A'N Se/ v l C.Q,S �/1 C, Name: Sa 00 (I I (G 04 S
)� M( ,Si
Street: tin u\ __ ��' . Street: I ('
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City /Town: \ N!)CY1 IV\ / jito City /Town: Nj i U (lir) i
C I Telephone: v tt�� d t' 3 5'- 33 ) 7 Telephone: I \ " 7 27 - �3 KY
Photo I.D. required / Copy of Photo I.D. attached: YES NO
Staff Initial
J - / M- 1- unrestricted license
J - / 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
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:
\ J tilk . V O ($ 0 SyIe s we
1f\ a A. L 12)1(-- - 2: - F ( 0u buori9 space
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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 $50.00 Residential, $100.00 Commerci
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