31C-041 (2) 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 a 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 dnpg nn+havp the insurance coverage required by Chapter 112 of the
Massachusetts General Laws,and that my signature on this permit application waive this requirement.
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
By checking this box❑,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
Prnarecc lncnPrtinnc
Daw Comments
Final 1ncnprfinn
Dzte cnmments
Type f License:
By Master
Title ❑ Master-Restricted
City/Town ❑Journeyperson
Signature of Licensee
Permit# �y
❑Journeyperson-Restricted License Number: (/
Fee$ ❑
Check at www mass,
Inspector Signature of Permit Approval
Commonwealth of Massachusetts
City Of Northampton
Date: I Z' Z O•/1 Sheet Metal Permit Permit# 5 ry'j q _L16
Estimated Job Cost: $A OV Permit Fee: $
Plans Submitted: YES NO Plans Reviewed: YES NO
Business License# Applicant License#
Business Information: Property Owner/Job Location Information:
Name:l;Vi4,,J �Q Name: �I�/t'7 J✓•
Street: $ 4ryi ,�/ ?It Street:
City/ own: tiw U/ City/Town: d a M f
Telephone: �3 3 U Z Telephone: v0 �
_T_ I . — I K
Photo I.D. required/Copy of Photo I.D. attached: YES NO
Staff Initial
J-1 Ounrestficted 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. V 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:
l�
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-2014-0040
APPLICANT/CONTACT PERSON POWERS AIR
ADDRESS/PHONE 68 HAMILTON DR (413)539-7032
PROPERTY LOCATION 10 FORD CROSSING-LOT 5
MAP 31c PARCEL 041 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Tvneof Construction: INSTALL 4 ZONE WARM AIR GAS FURNACE DUCTWORK,EXHAUST FOR SFH
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 504
3 sets of Plans/Plot Plan
THE FOV.OWTNG ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF0161ATION 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 StIrVet Commission Permit DPW Storm Water Management
/,�7--761T
Signature of Iruilding 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.
10 FORD CROSSING - LOT 5 SM-2014-0040
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS#: IV2, 13'7
Map: 131C
Block:
Lot: ,�•
Permit: SHEETMETAL
Category: SHEETMETAL
Permit# SM-2014-0040 PERMISSION IS HEREBY GRANTED TO:
Project# JS-2014-000101
Est.Cost: $4,000.00 Contractor: License: Expires:
Fee Charged:$25.00 POWERS AIR Sheetmetal-504 02/28/2014
Balance Due:$.00 Owner: WRIGHT BUILDERS
#of Fixtures:---------Applicant. POWERS AIR
DigSafe# _ AT: 10 FORD CROSSING-LOT 5
UseGroup
LcrostClass
ISSUED ON. 20-Dec-2013 AMENDED ON: EXPIRES ON.
TO PERFORM THE FOLLOWING WORK:
INSTALL 4 ZONE WARM AIR,GAS,FURNACE,DUCTWORK,EXHAUST FOR 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-2014-002592 20-Dec-13 3522 $25.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:Ihasbrouck @northamptonma.gov
GeoTMS®2013 Des Lauriers Municipal Solutions,Inc.