25A-181 (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 t e type of coverage by checking the appropriate box below:
A liability insurance policy Other type of
Yp 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 El Agent El
Signature of Owner or Owner's Agent
By checking this box0,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 ❑ Master-Restricted
City/Town
DJourneyperson
Signature of Licensee
Permit#
❑J o u rn eype rson-Restricted
Fee$
License Number:
❑ Check at www.mass.gov/dpl
Inspector Signature of Permit Approval
f66,V COI '7 ef5
RECEIVED
Commonwealth of Massachusetts
8 2013
Sheet Metal Permit
DEPT.OF BUE y�
NORTHA ILDING y!;INSP
MA 0-0• - ,
Permit# S/�'—14
Estimated Job Cost: $ 6/L% U Permit Fee: $
Plans Submitted: YES NO t•' Plans Reviewed: YES NO
Business License# Applicant License# k1.? _ a:sQ
Business Information: Property Owner/Job Location Information:
Name: /V(0/2 t% (C/C V/a t/ 1((l. Name: IW t �� gs-c �- • t U PS)r)
Street: 7 ( S/ i4/I�✓� Street: 1 S 1(1 -i
City/Town: ASS ��( U City/Town: ��t-+A ct-"-teb F�
Telephone: ( t 7-- 2 / !! 7 6 Telephone: Lc(3
Photo I.D. required/Copy of Photo I.D. attached: YES L'' 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 Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney/Vents Air Balancing
Provide detailed description of work to be done:
/2(4 C/ Guui2/c `t 7? (fiiZ/(J / ),z
�iiz - 4r47'
File#SM-2014-0001
APPLICANT/CONTACT PERSON MCCORMICK-ALLUM CO INC
ADDRESS/PHONE 165 Stafford St (413)737-1196
PROPERTY LOCATION 115 INDUSTRIAL DR
MAP 25A PARCEL 181 001 ZONE GI(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out S`7 C" /
Fee Paid
Typeof Construction: DUCTWORK®ISTERS FOR MAKE UP AIR SYS
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 FOLL CTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
I FO TION 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
Permit from Elm Street Commission Permit DPW Storm Water Management
400111
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.
115 INDUSTRIAL DR SM-2014-0001
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS#: 9371
Map: 25A
Block: 181___-- --_-__-- ' SHEETMETAL PERMIT
Lot: 001 �{
"�-��
Permit: SHEETMETAL TE ENT N g�
Category: SHEETMETAL
Permit# SM-20 14-0001 _ PERMISSION IS HEREBY GRANTED TO:
Project# JS-2013-001977
Est. Cost: $2,000.00 Contractor: License: Expires:
Fee Charged:$100.00 MCCORMICK-ALLUM CO INC Sheetmetal-812 04/28/2014
Balance Due:$.00 Owner: WAM LLC
#of Fixtures: Applicant: MCCORMICK-ALLUM CO INC
DigSafe# AT: 115 INDUSTRIAL DR
UseGroup
ConstClass
ISSUED ON: 26-Jul-2013 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
DUCTWORK®ISTERS FOR MAKE UP AIR SYS
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-2014-000297 22-Jul-13 72845 $100.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @northamptonma.gov
GeoTMS®2013 Des Lauriers Municipal Solutions,Inc.