36-399 (3) INSURANCE COVERAGE:
I have a current liar insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 YesK 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 dnpg nnr havo 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
Proarece TnenPptinne
Dae Alts
Final inenaptian
Date
Type of License:
By KMaster
Title ❑Master-Restricted
City/Town ❑Journeyperson
Signature of Licensee
Permit#
❑Journeyperson-Restricted
License Number:
Fee$ ❑
Check at xuww mace 9^yrt^I
Inspector Signature of Permit Approval
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R CEIVED
ommonwealth of Massachusetts
FEB 14 2012 City Of Northampton
OF G ulspECTiONa Sheet Metal Permit j
Permit# t5� / d
Estimated Job Cost: $ ►of ,D PCB Permit Fee: $ C5
Plans Submitted: YES NO Plans Reviewed: YES NO
Business License# Applicant License#
Business Information: Property Owner/Job Location Information:
BL_R" S ElJ*-A NS KOh�_ Cp�vsTZuc��ci
Name: Pare-CoruTRrAc-Ci "Gr Name: 'c) / S HwR�
Street: \\ a AvOv 3a uy iZ0 Street�-D F M 5 ZS04 > LQ A`-t
City/Town: LF-O 5.0 M A . D ► 0 5 3 City/Town: F 1 n%Nef—C r , rv\'A
Telephone: \13 v L� �'3 Telephone:
Photo I.D. required/Copy of Photo I.D. attached: YES NO
Staff Initial
J-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 K Multi-family Condo/Townhouses Other
Commercial: Office Retail Industrial Educational
Institutional Other
Square Footage: under 10,000 sq. ft. X 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:
-Vwa 20&>V_ GAS / C 0S�'Ch 0 B I Z H eA7 /COc>�_
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-2012-0023
APPLICANT/CONTACT PERSON ALAN J EVANS
ADDRESS/PHONE 112 AUDUBON RD (413)586-5183
PROPERTY LOCATION 80 EMERSON WAY-LOT#55
MAP 36 PARCEL 399 001 ZONE SR(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out •K L�
Fee Paid �'J
Typeof Construction: 2 ZONE GAS/FORCES AIR HEAT/COOL
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 5673
3 sets of Plans/Plot Plan
THE FOLLOWING 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
Permit from Elm Street Co sion Permit DPW Storm Water Management
/4�2
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.
SO EMERSON WAY - LOT #55 SM-2012-0023
COMMONWEALTH OF MASSACHUSETTS
-_- CITY OF NORTHAMPTON
rGIS#: 111803
Map: 36
B'ock: 399 SHEETMETAL PERMIT
Lot: 001
Permit: SHEETMETAL
(Category: New Single Family House
Permtt# sM-20 12-0023 PERMISSION IS HEREB Y GRANTED TO:
[ - -
Project- 0# JS-2012-000787 i
,Est. Cost: Contractor: License: Expires:
- -- ALAN J EVANS Sheetmetal- 5673
Fee Charged 1$25.00
iBalance Due:�$.00 Owner: OAK RIDGE ROAD LLC
1#of Fixtures: Applicant: ALAN J EVANS
D # AT: 80 EMERSON WAY-LOT#55
seGroup
ConstClass
ISSUED ON. 26-Dec-2013 AMENDED ON. EXPIRES ON. 26-Dec-2013
TO PERFORM THE FOLLOWING WORK:
2 ZONE GAS/FORCES AIR HEAT/COOL
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-2012-003218 16-Feb-12 3445 $25.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:Ihasbrouck @northamptonma.gov
GeoTMS@ 2013 Des Lauriers Municipal Solutions,Inc.