17A-159 (3) INSURANCE COVERAGE:
1 have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes to ❑
If you have checked Yes, indicate the type of coverage by checking the appropriate box below:
A liability insurance policy 1731 Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: l am aware that the licensee does not have the insurance coverage required. by Chapter 112 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
By checking this box❑, 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
Progress Inspections
Date Comments
Final Inspection
Date Comments
Type of License:
By ❑ Master ///
Title ❑ Lw
Master- Restricted
City/Town ❑Journeyperson
Signature of Licens e
Permit #
❑Journeyperson Restricted License Number: C am)
Fee $ ❑
Check at www.mass.dov /dpl
Inspector Signature of Permit Approval
RECE1VPD
1 Commonwealth of Massachusetts
FED 12 2013 Sheet Metal Permit
DEPT. . 0 IN,PEC IONS Permit # 5rn '3 5(
NUR THA M - *� AA _gA010:s
J
Estimated Job Cost: $ 7 '0 Permit Fee: $ ( - 7 2 5 .. '-Z /,J 7T o
Plans Submitted_ YES _NO PlansReviewed: YES NO
Business License # 0 2 g 3 Applicant License #
Business Information: J/ Property Owner / Job Location Information:
Name: DGvl- A 4J o .5 Name: 6 ravnil 5
Street: / 3 / &rv s l Street: y * / / ..,-r_____q_alA/GOT
City/Town: gr`G/vn -e-i / € � g7 4 City /Town: `` _6 V : .
Telephone: eh' 3 ? 57- 6/ 3 2 Telephone: 1— y/3 — 3 i 30/ Cc. +i i)
Photo I.D. required / Copy of Photo I.D. attached: YES 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:
HVAC IV Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney / Vents Air Balancing
Provide detailed description of work to be done:
in/ `1 iii,t-eick- Poi /4-je- S v s'i-e-r-v. r:eu_s,k /LI
File # SM- 2013 -0040
APPLICANT /CONTACT PERSON DURFEY HEATING SYSTEMS
ADDRESS /PHONE 131 CROSS RD (413) 357 -6132
PROPERTY LOCATION 43 FOX FARMS RD
MAP 17A PARCEL 159 001 ZONE URA(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT )‘
Fee Paid (Tth»
Building Permit Filled out /51'6' 456' Q �`
Fee Paid
\ ;,t Tvpeof Construction: DUCTWORK ,,
New Construction 2
Non Structural interior renovations v
Addition to Existing (19,,ki
Accessory Structure
Building Plans Included: ‘
Owner/ Statement or License 2837
3 sets of Plans / Plot Plan
THE FOLLO ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ION PRESENTED:
pproved 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
' e s' • m Elm Stre - Commission Permit DPW Storm Water Management
Air
/ -- -- 7
Suture of Building • ficial 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.
43 FOX FARMS RD SM- 2013 -0040
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
1 GIS #: 1468
Map. 17A - -- ! � � �� �,�
Block: 159 == 1 Vast SHEETMETAL PERMIT
Lot: 001 A'
Permit: ISHEETMETAL �R�
Category: SHEETMETAL
Permit # SM- 2013 -0040
Project # JS-2013-000291 PERMISSION IS HEREBY GRANTED TO:
Cost: $4,000.00 Contractor: License: Expires:
Charged: Charged: : $25.00
Est.
— " DURFEY HEATING SYSTEMS Sheetmetal - 2837 08/28/2013
Balance Due: $.00 Owner: GRANT GERALD S & BERNICE B
# of Fixtures: Applicant: DURFEY HEATING SYSTEMS
igSafe # AT: 43 FOX FARMS RD
UseGroup
[ConstClass
ISSUED ON: 12- Feb -2013 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
DUCTWORK - PROVIDE LINE DRAWING OF DUCTS
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Sheetmetal REC -2013- 003337 12- Feb -13 15745 $25.00
212 Main Street, Phone:(413) 587 -1240, Fax:(413) 587 -1272, Email :lhasbrouck @northamptonma.gov
GeoTMS® 2013 Des Lauriers Municipal Solutions, Inc.