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31A-076 (4) INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yesr 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 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 bow,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 r ,j_ ilm-ekv/i' city To,'n I, t -- — ❑Journeyperson Signature of Licensee Per r,t h j ❑Journeyperson-Restricted � , License Number: "� FeeS_ — ❑ Check at www.mass.gov/dp€ Inspector Signature of Permit Approval RE' s Commonwealth of Massachusetts oUN I 201 Sheet Metal Permit DEPT OO,F�„.B_LI) DINt N4A V NOTh�tO tSfJ 7 �+ Permit# f#ff{i• Estimated Job Cost: $ Permit Fee: $ \L} Plans Submitted: YES _ NOS Plans Reviewed: YES NO Business License # Applicant License# Business Information: Property Owner/ Job Location Information: ` Name: b, WIC S Name: t:� � ..;�, _ Street:�_� �" { � `� lV ' , K-_,., Street: r • City/Town: ' ' =' City/Town:jLJU C t K ` Telephone: `1 f 4` Telephone: ‘'-'{/ j j ` ( 1.6- 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. 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: I. Disconnect, remove and dispose of one AC split system with indoor air handler in closet and outdoor condensing unit on grade. 2. Provide packaged cooling unit with economizer,barometric relief and programmable thermostat. 3. Package unit to be located on grade on the northwest side of the building. 4. Provide connections to the existing supply duct system through the closet window. 5. Provide one central return grille located near the existing AC closet. 6. Provide allowances for sub-contract of electrical wiring,ductwork insulation, concrete pad services. 7. Check,test and start up system operation. Not including off hours work.temporary heating/cooling systems,duct cleaning, repairs or modifications to existing duct distribution system. File#SM-2013-0066 APPLICANT/CONTACT PERSON HURLEY&DAVID INC ADDRESS/PHONE 90 Fisk Ave (413)732-3141 PROPERTY LOCATION 264 ELM ST I MAP 31A PARCEL 076 000 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 )11101- q�l� Fee Paid IMP/ Typeof Construction: HVAC New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFQ4 iATION PRESENTED: t/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 Permit from Elm Street Commission Permit DPW Storm Water Management Signature of :J ilding 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. 264 ELM ST I SM-2013-0066 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON GIS#: 11473 '"`"""' Map: 31A Block: 076 i �' �;�.� *1 SHEETMETAL PERMIT Lot. 000 �r � (Permit: SHEETMETAL (Category: SHEETMETAL Permit# SM-2013-0066 PERMISSION IS HEREBY GRANTED TO: Project# JS-2013-000725 Est.Cost: $14,728.00 Contractor: License: Expires: Fee Charged:$100.00 HURLEY&DAVID INC (Balance Due:$.00 Owner: MILLER ALEXANDER RON&DEBORAH JEAN MARKS j#of Fixtures: Applicant: HURLEY&DAVID INC ;DigSafe# AT: 264 ELM ST I UseGroup IConstClass ISSUED ON: 19-Jun-2013 AMENDED ON: EXPIRES ON: TO PERFORM THE FOLLOWING WORK: HVAC 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-2013-006709 17-Jun-13 9482 $100.00 212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:Ihasbrouck®northamptonma.gov GeoTMS®2013 Des Lauriers Municipal Solutions,Inc. - x: