36-309 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 Yes, indicate 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 not have. the insurance coverage required by Chapter 112 of the
Massachusetts General Laws, and that my signature on this permit application waivagthis 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
Prngrecs InereetinnS
Pate, Cats
Final Inere.etinn
Pate, Comments
Type of License:
By L'4YMaster •
Title ❑ Master - Restricted
City/Town ❑Journeyperson
Signat a of Licensee
Permit #
❑Jou rneyperson- Restricted
License Number: Mt 9
Fee $ ❑
Check at mr n; . v1czt
Inspector Signature of Permit Approval
Commonwealth of Massachusetts 2013
City Of Northampton 5
Sheet Metal Permit
NORTHAMPTON "'
Date: ° i 6 -a.0�� Permit #
a, pa 3
Estimated Job Cost: $ � ‘ OU ., Permit Fee: $ ai
Plans Submitted: YES NO \. / Plans Reviewed: YES NO
Business License # Va Applicant License # 1 act
Business Information: Property Owner / Job Location Information:
Name: \ \\ SeHSD!o 5 \-NeuNi 'v�� Name: Vj p _r`1
Street: 9 I v'- 51-r Street: \35
City /Town: ,� � !, \R 003`b City /Town: V NIA of
Telephone: 413—a...1'7-9% y Telephone:
Photo I.D. required / Copy of Photo I.D. attached: YES NO
Staff Initial
J -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. V over 10,000 sq. ft. Number of Stories:
Sheet metal work to be completed: New Work: Renovation:
HVAC ., Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney / Vents Air Balancing
Provide detailed description of work to be done:
\ 1—•" O
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 -0046
APPLICANT /CONTACT PERSON ALL SEASONS HEATING AIR
ADDRESS /PHONE 93 ELM ST (413) 247 -9842
PROPERTY LOCATION 125 CARDINAL WAY
MAP 36 PARCEL 309 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 0)4 1 rJ � Fee Paid O �
Typeof Construction: DUCT WORK FOR BASEMENT REMODEL
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 OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF 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
- • !• Elm Street Co 'ssion Permit DPW Storm Water Management
Signa e 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.
125 CARDINAL WAY SM- 2013 -0046
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
j GIS #: 11064 a as HAMTO ry
—Map: k: 3�9 ,� 16 • ! SHEE TMETAL PERMIT
Lot: 001 - ;.goi
Permit: SHEETMETAL � cENTE g'
Category: renovation
Permit # SM-2013-0046 - PERMISSION IS HEREBY GRANTED TO:
Project # JS- 2013 - 001051
Est. Cost: $2,200.00 Contractor: License: Expires:
Fee Charged: $25.00 ALL SEASONS HEATING AIR Sheetmetal - 129
Balance Due: $.00 Owner: BAYUK JONATHAN L & LISA L
# of Fixtures: Applicant: ALL SEASONS HEATING AIR
DigSafe # AT: 125 CARDINAL WAY
UseGroup
ConstClass i.
ISSUED ON: 18- Mar -2013 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
DUCT WORK FOR BASEMENT REMODEL
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 004167 15 Mar - 13 4326 $25.00
212 Main Street, Phone:(413) 587 -1240, Fax:(413) 587 -1272, Email :lhasbrouck @northamptonma.gov
GeoTMS® 2013 Des Lauriers Municipal Solutions, Inc.