24C-158 (7) INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 YesR ❑
If you have checked Las, indicate the type of coverage by checking the appropriate box below:
A liability insurance policy I21 Other type of itid9mnity ❑ Bond ❑
f
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
Prngreec lincp i.tinns.
-
Date Comments
Final Tncpirtinn
bate Comments
Type of License:
B y ❑ Master
Title ❑ Master - Restricted
City/Town ❑Joumeyperson
Signature of Licensee
Permit #
❑Journeyperson- Restricted License Number:
Fee$ ❑
Check at www macc gnv/dpt
Inspector Signature of Permit Approval
Commonwealth of Massachusetts
City Of Northampton
Date: ` l/67 / 2 - Permit # 5/0
Estimated Job Cost: $ `�, ermit Fee: $ alj �� '�1 �✓
�, �.� � 4.6 2612
Plans Submitted: YES NO _ Pla s viewed: YES NO
DEFT. OF B LDWOJ br %',TIONS
NORTHAMPTON MA 01060
Business License # 5 11 ) 0 1— r i • pp leant ICense #
Business Information: �I rIIrr Property Owner / Job Location Information:
Name: .� CAks'ANA.c3 Plvt-.�o ,) Name: rC Sc) l�
Street: YO Qo) 6( y Street: ..2-3 {t .
City /Town: CAS l,-e,` City /Town: AJo-,p
Telephone: y/3 Telephone: u
Photo I.D. required / Copy of Photo I.D. attached: YES NO
Staff Initial
J -1 M -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 tV 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: l✓ Renovation:
HVAC Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney / Vents ✓ Air Balancing
Provide detailed description of work to be done:
2 - E°i-L / „ Dryer V eat
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 -0027
APPLICANT /CONTACT PERSON JOHN THOMAS PLUMBING & HEATING
ADDRESS/PHONE P 0 BOX 614 (413) 626 -2976 0 1 o
PROPERTY LOCATION 28 ARLINGTON ST 1 V
MAP 24C PARCEL 158 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid 371 / $ 9- 5
Building Permit Filled out
Fee Paid
Typeof Construction: 2 BATH FANS & DRYER VENT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 1081
3 sets of Plans / Plot Plan
THE FO OWING 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
.m lm Street Commission Permit DPW Storm Water Management
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.
28 ARLINGTON ST SM- 2013 -0027
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS #: 3833 iaf " -A - o
Map: 24C ��
Block: 158 * � �
Lot: 001 F1 A SHEETMETAL PERMIT
Permit: SHEETMETAL ,RC ery (ESN
�,
Category: SHEETMETAL
Permit # SM- 2013 -0027 PERMISSION IS HEREBY GRANTED TO
'Project # JS- 2012- 001637
Est. Cost: $500.00 Contractor: License: Expires:
Fee Charged: $25.00 JOHN THOMAS PLUMBING & HE Sheetmetal - 1081 07/28/2013
Balance Due: $.00 Owner: SANDERS ERIC H & LISE A
# of Fixtures: Applicant: JOHN THOMAS PLUMBING & HEATING
DigSafe # AT: 28 ARLINGTON ST
UseGroup
ConstClass
ISSUED ON: 07- Nov -2012 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
2 BATH FANS & DRYER VENT
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 - 001861 08 Nov - 12 3731 $25.00
212 Main Street, Phone:(413) 587 -1240, Fax:(413) 587 -1272, Emai l:Ihasbrouck @northamptonma.gov
GeoTMS® 2012 Des Lauriers Municipal Solutions, Inc.