18D-010 (4) INSURANCE COVERAGE:
I have a current liahiliy insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes No ❑
If you have checked Yes, ' dicate 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 rinpa net have. the insurance coverage required by Chapter 112 of the
Massachusetts General s, and that my signature on this permit application WalvPsthis requirement.
Check One Only
,, . A Owner ❑ Agent ❑
Signature of Ow dryn 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
Prngrpcs tncpertions
Date f nmments
Final Incpection
Date Comments
Type of License:
By Master
Title ❑ Master - Restricted C
City/Town ❑Journeyperson
Signa of Li -nsee
Permit #
❑Jou rneype rson- Restricted
License Number:
Fee $ ❑
Check at wvinaL.?r
Inspector Signature of Permit Approval
Commonwealth of Massachusetts
i i L - 5 20 12 City Of Northampton
pep ---- •- °_.____ ,,�
Sheet Metal Permit
Date:
NORTHgM T�.'N NA,O o► T ONg
Permit # �
�� — fa, 2- (-50./-
i
Estimated Job Cost: $ 07 .oc , , �� Permit Fee: $ `0 r 76 .$ d fj
Plans Submitted: YES NO )( Plans Reviewed: YES NO
Business License # \ a°t Applicant License #
Business Information: �ny Property Owner / Job Location Information:
Name: M � 05 -k C) \( - ' Name: ■\5 Ccvk QC
Street: q E\•-‘ Street: 'a Cook, At- e.
City /Town: pI ■C\ & t v\ fi op) tb City /Town: 1Q0c)\-Npp-, N
Telephone: 4 )3 a y 7 —9 ct LJ Telephone: G (g - c4 7 3
Photo I.D. required / Copy of Photo I.D. attached: YES NOS
Staff Initial
J -1 / i 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 i Townhouses Other
Commercial: Office Retail Industrial Educational
Institutional Other
Square Footage: under 10,000 sq. I over 10,000 sq. ft. Number of Stories:
Sheet metal work to be completed: New Work: Renovation:
i -iVA Metal Watershed Roofing Kitchen Exhaust System
N'etai Chimnev / Vents Air Balancing
Provide detailed description of work to be done:
�. l[ 5A r- ;..a 0 K l 5k ■ ►V C:,, 11 o \ CJ) 0 ( C;=' NC' 0-.
\AS's i S 'Flo a f
Fees with Building Permit: $25.00 Residential. $50.00 Commercial. Fees for Lobs without a Building Permit $6.00 ocr $ 10010
Minimum fees for jobs without Building Permit $50.00 Residential. $100.00 Commercial
File # SM- 2013 -0032
APPLICANT /CONTACT PERSON ALL SEASONS HEATING AIR
ADDRESS /PHONE 93 ELM ST (413) 247 -9842
PROPERTY LOCATION 3 COOKE AVE
MAP 18D PARCEL 010 001 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 171/70
Fee Paid 7� l
Typeof Construction:_INSTALL DUCTWORK FOR ADDTION
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 FOL ING 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
P - . 't from Elm Street Commission Permit DPW Storm Water Management
111111-11.111.
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.
3 COOKE AVE SM- 2013 -0032
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GI /20 SHAMPT
GIS #: 22 P• I O
0 p87 /
( Block: 010 .. If� �' * \)
SHEETMETAL PERMIT
Lot: 001 � lE ya
Permit: SHEETMETAL �'
Category: ADDITION
Permit # SM-2013-0032 PERMISSION IS HEREBY GRANTED TO:
Project # JS- 2013- 000127
Est. Cost: $2,000.00 Contractor: License: Expires:
Fee ALL SEASONS HEATING AIR Sheetmetal - 129
e Charged: $25.00
Balance Due: $.00 Owner: CARTER LEWIS G & JOAN C
# of Fixtures: _ _ Applicant: ALL SEASONS HEATING AIR
DigSafe # _ AT: 3 COOKE AVE
UseGroup
ConstClass
ISSUED ON: 07- Dec -2012 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
INSTALL DUCTWORK FOR ADDTION
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- 002405 05- Dec -12 4170 $25.00
212 Main Street, Phone:(413) 587 -1240, Fax:(413) 587 -1272, Email :Ihasbrouck @northamptonma.gov
GeoTMS® 2012 Des Lauriers Municipal Solutions, Inc.