36-361 (4) INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes Ir No❑
If you have checked Yes indicate the 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 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 boxE,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 tense: ?"1/0 atzkovy4
By Master
Title ❑ Master-Restricted \ ✓
City/Town
❑Joumeyperson Signature of Licensee
Permit#
❑Journeyperson-Restricted License Number: C�
Fee$
Check at www.mass.govtdoI
Inspector Signature of Permit Approval
RECEIVED Commonwealth of Massachusetts
Sheet Metal Permit
��ti� - 5 2013 �,(
Date: Permit# 5' - J q
NOR HAMPTON !AA C^060 0.
Estimated Jo. ost: $ Permit Fee: $ 02. 4
Plans Submitted: YES NO___ Plans Reviewed: YES NO
Business License # Applicant License#
Business Information: Property Owner/Job Location Information:
�f I
Name:S.�i - evcy- 14,V4 C. -inc. . Name: L. a u / . ili 'v
Street: •2 2-1 a L.', b e r ' 1 S&- e-f Street: I 1 i Em e,i—o n Njcc J
�I I
City/Town: Ee.ic.be.r+0Wni O/CO City/Town: rid ��mnTD�
Telephone: 1413- 3 a,' t-//a 3 Telephone: 41 3 -4 rjc —Q s cn Donn.!
Photo I.D. required/Copy of Photo I.D. attached: YES NO 5e 3c co n
Staff Initial
J-1 111-1-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: I/ Renovation:
HVAC Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney /Vents Air Balancing
Provide detailed description of work to be done:
flee -meia../ Da e work i n &sic& Z1ia i 1-i om e
(ti—ty
fr(Aittli
File#SM-2014-0009 J
tie, / w"fi APPLICANT/CONTACT PERSON SWIFT RIVER HVAC INC 6�" -4 C-
ADDRESS/PHONE 221 N LIBERTY ST (413)323-4123 rr+�� 1 s
PROPERTY LOCATION 111 EMERSON WAY-LOT 12 r11 ,�
MAP 36 PARCEL 361 001 ZONE / ei C PIK-
THIS SECTION FOR OFFICIAL USE ONLY: 2 01464?-(7 A/`
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
jS
Fee Paid J ' r/
Typeof Construction: SHEETMETAL DUCTWORK SFH
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 220
3 sets of Plans/Plot Plan
THE FOL ING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO 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
o.' Elm Street Co I. 'ssion Permit DPW Storm Water Management
irdi6o. 0
fdr...-4,_,■—„„Zy
:nature of Building Offici. 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.
,
111 EMERSON WAY - LOT 12 SM-2014-0009
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS#: 11765 �oazHnn,T'a
Map: 36 4*`'
Block: 361
41111-6549 , SHEETMETAL PERMIT
Lot 001
Permit: SHEETMETAL a T£RCENT
Category: New Single Family House
Permit# SM-2014-0009 PERMISSION IS HEREBY GRANTED TO:
Project# JS-2013-001752
Est.Charged: Contractor: License: Expires:
SWIFT RIVER HVAC INC Sheetmetal-220
Fee Charged:$25.00 08/28/2015
Balance Due:$.00 Owner: HAMPSHIRE PROPERTY MANAGEMENT
�#of Fixtures: Applicant: SWIFT RIVER HVAC INC
IDigSafe# AT: 111 EMERSON WAY-LOT 12
UseGroup
[ConstClass
ISSUED ON: 01-Nov-2013 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
SHEETMETAL DUCTWORK SFH
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-2014-000549 05-Aug-13 155 $25.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @northamptonma.gov
GeoTMS®2013 Des Lauriers Municipal Solutions,Inc.