31B-225 INSURANCE COVERAGE:
I have a current liability insurance policy or 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 rinPC not haves the insurance coverage required by Chapter 112 of the
Massachusetts General Laws, and that my signature on this permit application waivasthis requirement.
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
By checking this boxi, 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
progreec Inc/lertion%
Date Comments
,}Final TnepPrtinn
Date Cnmmints
Ty e of License:
B y Master
Title ❑ Master-Restricted
s st cte
City/Town ❑Joumeyperson
Signature of Licensee
Permit #
❑Journeyperson Restricted License Number: -2-2.2
Fee $ ❑
Check at www macs rgnv /rapt
Inspector Signature of Permit Approval
1 .
Com onwealth of Massachusetts �, � „
t Of Northampton �� ^i
L �
°` "' Sheet Metal Permit
Date: / 2 Per # c ��1 '�� 3'� y/6
�-
00
Estimated Job Cost: $ / C/r Permit Fee: $ , °��
Plans. Submitted: YES NO — t7/E Plans Reviewed: YES NO
Business License # �� Applicant License # .222,
Business Information: Property Owner / Job Location Information:
NameJ`Y�6r'�!1 6 (S/1f (I. 1C. Name: U al/Z.
Street: 32 Lenv✓lc0 / Street: 1)t fiwE - /(4L4 V 4
City /Town: CI /Town:
Telephone: g 69 - 222 -‘ar Telephone:
Photo I.D. requiredf 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: x
HVAC X Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney / Vents Air Balancing
Provide detailed description of work to be done:
aeor- /14.4( Y Lf/rrotP
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 -0014
APPLICANT /CONTACT PERSON NORTHEASTERN SHEET METAL CO INC
ADDRESS/PHONE 32 LAWNCACRE RD (860) 292 -6883 ,q v.)
PROPERTY LOCATION DAWES HOUSE - BEDFORD TER
OIC
�S 1
MAP 31B PARCEL 225 001 ZONE EU(100)/URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out o/�y/ orbs
Fee Paid � U
Typeof Construction: SHEET METAL DUCT SYSTEMS
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 FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF RMATION 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
• - lm Str- ommissio Permit DPW Storm Water Management
Signature of Buildi g Of ci. 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.
DAWES HOUSE - BEDFORD TER SM- 2013 -0014
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
�
GIS #: 9543 0
Map: 31B I ��;�,
Block: oo� :� � a ;� ' SHEETMETAL 4 PERMIT
4
Permit: SHEETMETAL rEaccNTi
Category: SHEETMETAL
Permit # sM -2013 -0014 PERMISSION IS HEREBY GRANTED TO:
'Project # JS- 2013- 000322
Est. Cost: $370.00 Contractor: License: Expires:
Fee Charged: $100.00 NORTHEASTERN SHEET METAL Sheetmetal - 2223 08/28/2013
Balance Due: $.00 Owner: SMITH COLLEGE OFFICE OF THE TREASURER
I# of Fixtures: Applicant: NORTHEASTERN SHEET METAL CO INC
pigSafe # AT: DAWES HOUSE - BEDFORD TER
UseGroup
ConstClass
ISSUED ON: 28- Aug -2012 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
SHEET METAL DUCT SYSTEMS
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 - 000768 22- Aug -12 25687 S100.00
212 Main Street, Phone:(413) 587 -1240, Fax:(413) 587 -1272, Email :lhasbrouck @northamptonma.gov
GeoTMS® 2012 Des Lauriers Municipal Solutions, Inc.