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17A-255 (2) INSURANCE COVERAGE: 1 have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes No If you have checked Yes, indicate t type of coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 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 waivRcthis requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this boxO, 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 PrngrPes Tnirwctions .Date Comments Final Jneppctinn Date. Comments Type icense: By Master Title ❑ Master - Restricted 9 City/Town ❑joumeyperson Signature of Licensee Permit # 7' nourneyperson- Restricted (5-0 / License Number: Fee $ Check at www macs gnv /rfpi Inspector Signature of Permit Approval of imonwealth of Massachusetts SEP i 3 2012 City Of Northampton s GINSPECTIONS Q • °F -�� Sheet Metal Permit Permit # o 13- 1 / 3 Estimated Job Cost: $ de Permit Fe $ ` .42' ' °G Plans Submitted: YES t/ NO Plans Reviewed: YES NO Business License # Applicant License # Business Information: Property Owner / Job Location Information: Name: T O AS Name: 6<4/717 f / �if,2f Street: 6 f e f7Vi✓ T L Street: /.2 / '`O4� &r City /Town: c231 A� _ , r/4 , f City /Town: " /0?f^/Ce . Telephone: y /Y.' 3Z- Telephone: / 1,'_ 3.�5 — 4, / 8 Photo I.D. required / Copy of Photo I.D. attached: YES NO Staff Initial J -1 / -1- nrestricted 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. 17over 10,000 sq. ft. Number of Stories: 2_ Sheet metal work t be completed: New Work: V Renovation: HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney / Vents Air Balancing Provide detailed description of work to be done: / „s .berm 6.1k1 4 ,z �v t,s ,y 7TWo 0/1,e "‘f 04,v) 4,✓ 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 -0019 APPLICANT /CONTACT PERSON POWERS AIR ADDRESS/PHONE 68 HAMILTON DR (413) 539 -7032 PROPERTY LOCATION 121 OAK ST MAP 17A PARCEL 255 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out .] 4 /) Fee Paid V Typeof Construction: INSALL GAS FIRED FURNACE W/2 ZONES New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 504 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFQRMATION 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 Permit from Elm Street Commission Permit DPW Storm Water Management V P/12— Signature of Building Official 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. 121 OAK ST SM- 2013 -0019 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON GIS #: 1563 " " IMap 17A Block: 255 � ,.� - SHEETMETAL PERMIT Lot. OO]����a IPermit: SHEETMETAL NENTENP- Category: SHEETMETAL Permit # SM- 2013 -0019 FERMISSION IS HEREBY GRANTED TO: Project # JS -2012- 001800 Est. Cost: $3,000.00 Contractor: License: Expires: Fee Charged: $25.00 POWERS AIR Sheetmetal - 504 02/28/2014 Balance Due: $.00 Owner: ITTERLY KATHLEEN C [# of Fixtures: Applicant: POWERS AIR DigSafe # AT: 121 OAK ST UseGroup ConstClass ISSUED ON: 18- Sep -2012 AMENDED ON: EXPIRES ON: T ERFORM THE FOLLOWING WORK: IN LL GAS FIRED FURNACE W/2 ZONES 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 - 001087 14- Sep -12 3301 $25.00 212 Main Street, Phone:(413) 587 -1240, Fax:(413) 587 -1272, Email :Ihasbrouck @northamptonma.gov GeoTMS® 2012 Des Lauriers Municipal Solutions, Inc.