32C-133 (5) INSURANCE COVERAGE: ,.,/
I have a current liability Insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes lY No❑
If you have checked Yes,indicate a type of coverage by checking the appropriate box below:
A liability insurance policy Other type of indemnity El Bond ❑
OWNER'S INSURANCE WAIVER:I am aware that the licensee'Ingot 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 boxt�,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
prngroce inerartinne
Date Comments
Final inerpetinn
Date Comments
Typ of License:
By Master
Title ❑ Master-Restricted
O'S'
om _...•//:
City/Town ❑Journeyperson
Signature of Licensee
Permit#
❑Joumeyperson-Restricted License Number: be-,13
Fee$ ❑
Check at www macs gnviripl
inspector Sianature of Permit Aooroval
Commonwealth of Massachusetts
U`i` OCT I 0 2013 ' City Of Northampton
Sheet Metal Permit Permit# S � )ElectN iu mrintg&G p,ction
U
Estimated Job Cost: $ %Co 0 0. U 0 Permit Fee: $ Urd 0
Plans Submitted: YES NO Plans Reviewed: YES NO
Business License# /65/3 Applicant License#
Business Information: Property Owner/Job Location Information:
n , f
Name: / 1,1 /,M flea f�.. tf,,Y;rC0►1d(� et( Name: I 1 I F'"
Street: ,3/ Sp f h Street: c (1 ir'i Cc. C61 -6 rr 56r
,17,„City/Town: \ ii7��7�z�'y�� 4 City/Town: , I61 f/ia 10 o9
Telephone: �, J 7_ Telephone:
Photo d,/Copy of Photo I.D. attached: YES NO
Staff Initial
J-1 /M-1-unrestricted lice
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:
a u.S4-. aebS
1?-e a w►o re fury dud-
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, $100.00 Commercial
File#SM-2014-0021
APPLICANT/CONTACT PERSON TIN MAN HEATING AND AIR COND
ADDRESS/PHONE 38 SPRING ST (413)527-7722
PROPERTY LOCATION 59 SERVICE CTR RD
MAP 32C PARCEL 133 001 ZONE GB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 3 9 b o YS.5--
Fee Paid
Typeof Construction: 2 EXHAUST FANS,REVAMP RETURN DUCTS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 4043
3 sets of Plans/Plot Plan
THE FOL NG ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
pproved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER: §
Intermediate Project: Site Plan AND/OR Special Permit with Site Plan
Major Project: Site Plan AND/OR Special Permit with Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
' s�' from Elm S eet C 'ssion Permit DPW Storm Water Management
Ale /17$ 7
Si Or Buil. g w fficial 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.
59 SERVICE CTR RD SM-2014-0021
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
- sHMap ti GIS#:
110137 aa�
Map: 32C
s—� l
Block 133 " . SHEETMETAL PERMIT
fLot. 1001 a
Permit: SHEETMETAL ` r R p y
�_ _..
Category: SHEETMETAL
Permit# SM-2014-0021 PERMISSION IS HEREBY GRANTED TO:
Project# JS-2014-000414
Est. Contractor: License:
Est. Cost: $1,600.00 Expires:
Fee TIN MAN HEATING AND AIR CO Sheetmetal-4043
Fe Charged:$50.00 11/28/2015
- ---- ---_..----...--------
Balance Due:$.00 Owner: COLE ELIZABETH J
#of Fixtures: Applicant: TIN MAN HEATING AND AIR COND
DigSafe# _ AT: 59 SERVICE CTR RD
rUseGroup
ConstClass
ISSUED ON: AMENDED ON: EXPIRES ON: 15-Oct-2013
TO PERFORM THE FOLLOWING WORK:
2 EXHAUST FANS,REVAMP RETURN 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-2014-001672 11-Oct-13 3488 $50.00
Inspection Type: Inspector: Date Inspected: Date Signed Off: Status:
FINAL Charles Miller 15-Oct-13 FULL COMPLY
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @northamptonma.gov
GeoTMS®2013 Des Lauriers Municipal Solutions,Inc.