31B-252 (8) •
INSURANCE COVERAGE: :"Y i 1
I have a current liahilify insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes No ❑
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 dnPC not hauP the insurance coverage required by Chapter 112 of the
Massachusetts General Laws, and that my signature on this permit application waivP this 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
PrngrPcs Tncrertions
Date Comments
Final TncpPrfinn
note Co' rnentc
Ty e of License:
By Master
Title //
❑ Master - Restricted ��
1.117
City/Town ❑Journeyperson
signature of Licensee
Permit # ❑Journeyperson- Restricted -2-2.2,,,r
Fee $ License Number:
Check at www mace gnvlript
Inspector Signature of Permit Approval
RE ,
► �- Commonwealth of Massachusetts
•
AUG 1 2012 ity Of Northampton
i
Date: ; 11 .. _ n Q Sheet Metal Permit Permit # cS j 1- /3
,
Estimated Job Cost: $ (Q 6, Permit Fee: $ 6
Plans Submitted: YES NO — A I FIE Plans Reviewed: YES NO
Business License # 37g Applicant License # 2223'
Business Information: Property Owner / Job Location Information:
Name J‘'4 f V/1 ge/da Name: S1 S 1.8 1/ E
Street: Y2 2. 9 . (42416/2rt /20,9Gf Street: / - 4 I P Oktr
City /Town: CI /Town: /o i tuyt
Telephone: g(42 ' .22 -40r Telephone:
Photo I.D. required Copy • Photo I.D. attached: YES X NO
Staff Initial
J -1 M -1- unrestricted 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 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 X Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney / Vents Air Balancing
Provide detailed description of work to be done:
X€1± M ( axs
y
S e Re c Dgck///((2
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- 2013 -0011
APPLICANT /CONTACT PERSON NORTHEASTERN SHEET METAL CO INC
ADDRESS /PHONE 32 LAWNIACRE RD (860) 292 -6883
PROPERTY LOCATION DEWEY HOUSE - 4 NIELSON DR
MAP 31B PARCEL 252 001 ZONE EU(100)/URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid �t
Building Permit Filled out bij:V �/ ISCet
Fee Paid
Typeof Construction: SHEETMETAL DUCT SYSYEMS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 2223
3 sets of Plans / Plot Plan
THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION 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
• ".- n.' eet ..� ssi. i Permit DPW Storm Water Management
71
Signature of Building i fficial 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.
DEWEY HOUSE - 4 NIELSON DR SM- 2013 -0011
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
'GIS #: 9565
Map 31B
Block_ 252 '1:r! v-) \
7-Xw' SHEETMETAL PERMIT
�ot. ool i"
iss C'F�"- �'`ay
Permit: SHEETMETAL 4 r eR�ENiENp
Category: SHEETMETAL
Permit # SM- -2013 -0011 _ PERMISSION IS HEREBY GRANTED TO:
Project # JS -2012- 001313
: - $67,860.00 - C License:
Est. Cost: Expires:
Fee Charged: $50.00 NORTHEASTERN SHEET METAL Sheetmetal - 2223 08/28/2013
Balance Due: $.00 Owner: SMITH COLLEGE OFFICE OF TREASURER
I# of Fixtures: Applicant: NORTHEASTERN SHEET METAL CO INC
,Di Safe #
g AT: DEWEY HOUSE - 4 NIELSON DR
I UseGroup
ConstClass
ISSUED ON: 23- Aug -2012 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
SHEETMETAL DUCT SYSYEMS
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
Fixtures:
Floor: Type: # of Fixtures Floor: Type: # of Fixtures
Fee Type: Receipt No: Date Paid: Check No: Amount:
Sheetmetal REC -2013- 000719 20- Aug -12 25518 $50.00
Inspection Type: Inspector: Date Inspected: Date Signed Off: Status:
SHEETMETAL Charles Miller 21- Aug -12 FULL COMPLY
212 Main Street, Phone:(413) 587 -1240, Fax:(413) 587 -1272, Email :lhasbrouck @northamptonma.gov
GeoTMS® 2012 Des Lauriers Municipal Solutions, Inc.