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23A-070 (7) 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 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 boxes,t 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 c./ NO Progress Inspections Date Comments Final Inspection Date Comments 14.1( Type of License: By 2<aster Title ❑ Master-Restricted • 4 City/Town ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted License Number: Fee$ ❑ Check at v,ww.mass.ctovldpl Inspector Signature of Permit Approval \, `__( _i ir=E Commonwealth of Massachusetts 1 City' ' OCT 3 0 2013 Of Northampton I __ -J Sheet Metal Permit r.� ] Electric, Piumbinc ate:in., Fc ioa 4 3 Permit# 5M/ / Pt Northamptcn, MA 01060 Estimated Job Cost: $ --A. S .1 '`' Permit Fee: $ 0-0,: Pe Plans Submitted: YES ✓ NO Plans Reviewed: YES NO Business License# .!;77 A plicantJ.icense# 3o Business Information:Il roperty wner/Job Location Information: Name: Val 1 1, (c .f i�ibLit? Name: (1\Jae l vi p c t L-rt X f ►r (.1-04 Street: .7 c Met-L i `jr. Street: D7: E G,4')‘')e.. S.7 City/Town: \-Lt>r cr■ e., City/Town: eh c 12-ee,. Telephone: 13 777 3 'i / Telephone: 4/3 C3-7 ?Yip Photo I.D. required/Copy of Photo I.D. attached: YES 1-� NO Staff Initial J-1 /unrestricted license J-2 I 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 i/ 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 c------ Provide detailed description of work to be done: 1 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-2014-0028 APPLICANT/CONTACT PERSON NEW ENGLAND MECHANICAL SERVICES,INC ADDRESS/PHONE 166 TUNNELL RD (860)871-1111 0 PROPERTY LOCATION 70 MAIN ST-Valley Medical-Florence MAP 23A PARCEL 070 001 ZONE GB(97)/URB(3)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Fee Paid Building Permit Filled out Fee Paid Typeof Construction: HVAC DISTRIBUTION FOR BLDG ADDITION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 306 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ION 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 'r 't from Elm Street Commission Permit DPW Storm Water Management 01017,,, f( 7/-7-7 . ' Si_ • r:=.uilein. dffi ial 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. 70 MAIN ST - Valley Medical - Florence SM-2014-0028 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON GISp#: 9007 ooAMp,o� • Block: -070 --- _ -- ������ � i'�L.:� SHEETMETAL PERMIT Lot: 001 . Permit: SHEETMETAL 9 T£RCENTENPRt Category: SHEETMETAL Permit# 1sM-2014 0028 PERMISSION IS HEREBY GRANTED TO: ,Project# JS-2013-001342 Est. Cost: $76,500.00 Contractor: License: Expires: NEW ENGLAND MECHANICAL S Sheetmetal-306 Fee Charged:$50.00 07/28/2015 Balance Due:$.00 Owner: MIDDLE HAMPSHIRE DEV GROUP LLC I#of Fixtures: Applicant: NEW ENGLAND MECHANICAL SERVICES,INC DigSafe# AT: 70 MAIN ST-Valley Medical-Florence UseGroup ConstClass ISSUED ON: 04-Nov-2013 AMENDED ON: EXPIRES ON: TO PERFORM THE FOLLOWING WORK: HVAC DISTRIBUTION FOR BLDG ADDITION 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-2014-001975 30-Oct-13 1118 $50.00 212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Emailahasbrouck®northamptonma.gov GeoTMS®2013 Des Lauriers Municipal Solutions,Inc.