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23A-165 (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 Yes,indicate th pe 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 eine`s not have`the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waive`sthis requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this boxCJ,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 Gener Laws. Duct inspection required prior to insulation installation: YES NO Progress IncpP'tinnc nate Comments Final Igcpection at Comments Type License: By Master ,_.... 121i7)604,...„.....t........./---- Title ❑ Master-Restricted City/Town ❑Journeyperson Signature of Licensee Permit# ❑Jou rneyperson-Restricted License Number..____cfil______ Fee$ ❑ Check at www macs dnv/rlp( Inspector Signature of Permit Approval RFcE-i �, Commonwealth of Massachusetts V / City Of Northampton AV 2 3?0/3 Date: 4/�/ /3 Sheet Metal Permit Permit# o�...o Art p"G rvs J 30 - y - .i -iii,+A 0'Qfi0 r Estimated Job Cost: $ 6 Permit Fee: $ a�'_ 3w 3 9 Plans Submitted: YES NO Plans Reviewed: YES NO Business License# Applicant License# Business Information: Property Owner/Job Location Information: Name: �o V1 I A kt. Name: '4/6-112r- CJ " 9,.4.,j Street: 68 WAN,/lb, 3 it. Street: 6" 1 Seca,'— c-571---r City/Town: (NN , l4/ o/8Q/ City/Town: 7I/4,4y%4A Telephone: �3 " 3 7032_ � Gf Telephone: r/,.. "53,1' Y ■9b L d Photo I.D. required/Copy of Photo I.D. attached: YES NO Staff Initial J-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. 7 over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: 7 HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: /4) L 74 � D 2 t_ I/ AN9 pc,c,--frizo.tk A. 3*rAt ,/An 57-5. 744i1/ o. ' 4--..se r:1,2/ , S`rio/`frp 37 0 7-1445, 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,$100.00 Commercial File#SM-2013-0064 APPLICANT/CONTACT PERSON POWERS AIR ADDRESS/PHONE 68 HAMILTON DR (413)539-7032 PROPERTY LOCATION 61 CRESCENT ST UNIT 8 MAP 24D PARCEL 243 000 ZONE URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out d ar" Fee Paid 3 Y'�� (� V Typeof Construction: DRYER VENT,BATH EXHAUSTS,FAN New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 504 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER: § Intermediate Project: Site Plan AND/OR Special Permit with Site Plan Major Project: Site Plan AND/OR Special Permit with Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee )•: ' Elm Street Commission Permit DPW Storm Water Management /—/$ Sign71117 of etxild' •ffi al 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. 71 PINE ST SM-2013-0065 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON GIS#: 12868 0,1 M Ma 23A �- , Block: 165 n.' Lot. ao (1y404 SHEETMETAL PERMIT Permit: _SHEETMETAL ERCENCENP Category: SHEETMETAL Permit# SM-2013-0065 PERMISSION IS HEREBY GRANTED TO: Project# JS-2013-000004 ,Est. Cost: $2,000.00 Contractor: License: Expires: Fee Charged:$25.00 POWERS AIR Sheetmetal-504 02/28/2014 Balance Due:$.00 Owner: DEVILLIERS PETER A&JILL G #of Fixtures: Applicant: POWERS AIR ,DigSafe# AT: 71 PINE ST UseGroup ConstClass ISSUED ON: 17-Jun-2013 AMENDED ON: EXPIRES ON: TO PERFORM THE FOLLOWING WORK: WARM AIR FURN/AIR CONDITIONING UNIT,ALSO ERV-need equipment spec,line drawings,manualj before final 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-2013-006670 13-Jun-13 3430 $25.00 212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @northamptonma.gov GeoTMS®2013 Des Lauriers Municipal Solutions,Inc.