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DRAW in16- nbr To ,ScALE...
.
INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes K No ❑
If you have checked Yes, indicate the type of coverage by checking the appropriate box below:
A liability insurance policy Ell Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee rinPC not 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 boxy, 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
Date 1 Progress InCpe „�
Date nrments
Final TncpPCtinn
natP Comments
Type of License:
By ❑ Master
Title ❑ Master - Restricted
City /Town ❑Journeyperson
Signature of Licensee
Permit #
❑Journeyperson- Restricted
License Number:
Fee $ ❑
Check at www macs rfnvlrip(
Inspector Signature of Permit Approval
Commonwealth of 1Vlassachuseus y' /
JUN 24 MI "•
City Of Northampton ",
DEPT. OF BOWING INSPECTIONS
NORTHAM• .•N MA01,;! Sheet Metal Permit P / /�R f
Date: -, p (/' Permit #
Estimated Job Cost: $ l a t{ 0 . tst Permit Fee: $ ps f C0
1
Plans Submitted: YES V NO Plans Reviewed: YES NO
Business License # Applicant License #
Business Information: Property Owner / Job Location Information:
Name: �� / /
�l�YA {S �'-'. ��'/'�Glll�l �l'c;�i G � l� - t'`�l/�ame: �-/v'1 V RE i Sr�
l /' V
Street: O /i2 L' ,6l Street: 3 (' , , R v'/& A u
City /Town: 6/,- eA/ I / ei' J , ! City /Town: Al v RT1,1 fl4
Telephone: 7/y - ‘ ,22f33 Telephone: 9/32) 72 - 9237
Photo I.D. required / Copy of Photo I.D. attached: YES NO
Staff Initial
J -1 / M -1- unrestricted license . 76
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 X Multi - family Condo / Townhouses Other
Commercial: Office Retail Industrial Educational
Institutional Other
Square Footage: under 10,000 sq. ft. x over 10,000 sq. ft. Number of Stories:
Sheet metal work to be completed: New Work: X Renovation:
HVAC X Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney / Vents Air Balancing
Provide detailed description of work to be done:
/! e.,J I . s s v /goo s6(4-- c'oNa ,77e��.v G,��c t�vcT`
Ta is SuL 7i t) . ucT ; • ?u4KS rn 3c sN.c. 7 - -41., i3 #2i1 - /' s re
6NSuL4 -7F ,Z,Ex ALL Duct w, LL /SC I. t q1 SZi` - V COnl lac T7i+G ;a re-Re AEG
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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 Commercial