22B-046 INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes �� .`. Aoit
If you have checked Yes, indicate the ty 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 dnPC 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 boxD, 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
Progre s incper•tinne
Date Ccoaments
Final incpprtinn
Date Comments
Type of License:
By ❑ Master
Title ❑ Master - Restricted
City/Town ❑Joumeyperson
Signature of Licensee
Permit #
❑Jou rneyperson- Restricted
License Number:
Fee$ ❑
Check at www mace gnv/dpt
Inspector Signature of Permit Approval
Commonwealth of Massachusetts
City Of Northampton
AR 2 3 2012 Sheet Metal Permit
Date: Permit it Sin / d "'L� 3 0
DEPT. OF BUILDING INSPECTIONS
NORTFiAMP_' N MITI
a e I o . ost: $ / Permit Fee: $ /3/ 0
Plans Submitted: YES NO V Plans Reviewed: YES NO
Business License # 5 3 3 Applicant License #
Business Information: Property Owner / Job Location Information:
Name: I Name: CT: f�.5 - l�eil (o°J
Street: 1 -l0 %g -sI' °ems Street: y Pv - 1i.c. -e
City/Town: t951 f 4 14-44 n City/Town: /e—/lc-e____ 0100-
Telephone: f( 3 —'a7 rf w Telephone:
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 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. over 1 0,000 sq. ft. Number of Stori s: 2
Sheet metal work to a completed: New Work: Renovation:
HVAC Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney / Vents _ Air Balancing _
Provide detailed description of work to be done:
,5 cry cl, 7Lwo r 4t&&1i rz-rwho l- --
to,w -1 *
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 -0030
APPLICANT /CONTACT PERSON AARON MORIN
ADDRESS/PHONE 140 WEST ST (413) 247 -0550 0
PROPERTY LOCATION 4 FLORENCE RD
MAP 22B PARCEL 046 001 ZONE NB(100)/WP(100)/WSP(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out Yrti
Fee Paid
Typeof Construction: NEW DUCTWORK FOR NEW FURNACE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 533
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
V 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
om Elm Stre Co 'on Permit DPW Storm Water Management
te
Signature of Buildi g ffic al 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.