17C-076 (4) INSURANCE COVERAGE:
I 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 indicate the type of coverage by checking the appropriate box below:
A liability insurance policy Other type of indemnity ❑ Bond El
OWNER'S INSURANCE WAIVER: I am aware that the licensee dium not havp the insurance coverage required by Chapter 112 of the
Massachusetts Gene Laws, and that y signature on this permit application waivosthis requirement.
• (// Check One Only
/
d / ,, , A. i, ,,- Owner Agent ❑
Signature of Ow - . , / ner's Agent
By checking this bo 0, 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
prngrecs incrwctions
Date Cents
Final incppetinn
Date Cnmmerts
Type of License:
By ❑ Master
Title ❑ Master - Restricted
City/Town ❑Journeyperson
Signature of Licensee
Permit #
❑ Jou rneype rson- Restricted
License Number:
Fee $ ❑
Check at www mass grwi ipi
Inspector Signature of Permit Approval
RECEIV e,
Commonwealth of Massachusetts
k' -12012
City Of . L rthampton ..__J
DEPT. OF BUILD TN3INSPEOTIONS
NORTHAMPTON, MA 01060
Date: \O —110— V).„ Sheet Metal Permit Permit n 0 ' I b _0 •
Estimated Job Cost: S 3 aDo °° Permit Fee: S J , `, l
Plans Submitted: YES N'£N Plans Reviewed: YES N O )
Business License ft '1a9 Applicant License 11 \WI
Business Information: Property Owner / Job Location Information: `_I� _ _ 1��
Name: (�\ rZ A \ek 3t\ \` Name: _6\2V� so I tu\`� -�'� ta,
Street: 93 E'v� -, 9,....4-
Street: (^ �L���CQ
City/Town: own: ��tc L_Mh______ City/Town: own: Fko^e.tis(u- MA 0)0(64).
Telephone: l � -a Li) — 9 v Telephone: _ -- 3 7 9 - 3 3D R
cam- 413- fag - 4060
Photo I.D. required / Copy of Photo I.D. attached: YES No
J_1 . !l1 - tr r es (ri, z le i li
J - / M -2- restricted to dweliini s 3- stories or less and commercial up to 1'J.000 sq. ft. 1 2-stories or less
Residential: 1 -2 famis 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:
I VrC Metal Watershed Roonnn Kitchen Exhaust System
Metal Chimney Vents Air Baiancin
Provide detailed description of work to be done:
1 ., - ' � f_ ' . (4,A to -)
Fees with Building Permit: $25.00 Residential. $50.00 Commercial. Fees for lobs without a Building Permit $6.00 per $1000
Minimum fees for jobs without Building Permit $50.00 Residential. $1 +00,00 Commercial
File # SM- 2013 -0025
APPLICANT /CONTACT PERSON ALL SEASONS HEATING AIR
ADDRESS/PHONE 93 ELM ST (413) 247 -9842
PROPERTY LOCATION 39 GARFIELD AVE
MAP 17C PARCEL 076 001 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 Adg
Fee Paid
Tvpeof Construction:_ERV INSTALLATION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 129
3 sets of Plans / Plot Plan
THE FO LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO 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
Permit from Elm Street Commission Permit DPW Storm Water Management
40111
. e of Building Official 1�ate
g
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.
39 GARFIELD AVE SM- 2013 -0025
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
jGIS #: 1711 6 , `" 11/-114 0 z �
Map: 17C /.
Black: 076 = SHEETMETAL PERMIT
Lot: 001 ,A:`���
s�et �'.���9e
[Permit: SHEETMETAL r R E N ±. i
Category: SHEETMETAL
Permit # sM -2013 -0025 PERMISSION IS HEREBY GRANTED TO:
Project # JS- 2011- 000045
Est. Cost: $3,200.00 Contractor: License: Expires:
Fee Charged: $25.00 ALL SEASONS HEATING AIR Sheetmetal - 129
Balance Due: $.00 Owner: SUPERBA STEVE
# of Fixtures: Applicant: ALL SEASONS HEATING AIR
DigSafe # AT: 39 GARFIELD AVE
UseGroup
rConstClass
ISSUED ON: 05- Nov -2012 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
ERV INSTALLATION
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- 001773 02- Nov -12 4097 $25.00
212 Main Street, Phone:(413) 587 -1240, Fax:(413) 587 -1272, Email :Ihasbrouck @northamptonma.gov
GeoTMS® 2012 Des Lauriers Municipal Solutions, Inc.