17C-251 (8) INSURANCE COVERAGE:
I have a current liar 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 fines not hay P 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
Progress Tncnerfionc
Date f nmmPntc
Final TnspPCtipn
Date Cnmments
Type of License:
By ❑Master
Title ❑Master-Restricted
City/Town ❑Joumeyperson
Signature of Licensee
Permit#
❑Jo u rneyperson-Restricted
License Number:
Fee$
Check at w-.w ma.cc g�v�l
nspector Signature of Permit Approval
Commonwealth of Massachusetts
City Of Northampton
Date: ,? Sheet Metal Permit permit# JS n/ `qS
Estimated Job Cost: $ ,-?, ®0 Permit Fee: $ OU
Plans Submitted: YES NO Plans Reviewed: YES NO
Business License# Applicant License# 3p S
Business Information: Property Owner/Job Location Information:
Name: "")/ S SQ 1 yo, Name: oa K J c�vt a6 e f
Street:J8,) Q jdr�ctOW n t�� _- Street:
City/Town:14)a r o City/Town: POIC P c(r
Telephone: t.1/j-;3-5�_q rj Telephone:
b
Photo I.D. required/Copy of Photo I.D. attached: YES NO
Staff Initial
J-1 /M-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: Renovation:
HVAC Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney/Vents Air Balancing
Provide detailed description of work to be done:
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, $100.00 Commercial
File#SM-2014-0045
APPLICANT/CONTACT PERSON CHRISTOPHER SALVA
ADDRESS/PHONE 200 OLD BELCHERTOWN RD (413)230-9705
PROPERTY LOCATION 41 NORTH MAIN ST
MAP 17C PARCEL 251 001 ZONE URB(100)/SI(0)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: KITCHEN VENT HOOD
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License 13051
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO$A9FATION 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
from Elm Street C mmission Permit DPW Storm Water Management
Signature of ARildirg 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.
41 NORTH MAIN ST SM-2014-0045
COMMONWEALTH OF MASSACHUSETTS
GIS#. j 1851
CITY OF NORTHAMPTON
'Ma j 17C_
'Lot: 1001 1 .. SHEETMETAL PERMIT
II i
Category-rY
o• SHEETMETAL
(Permit# SM 2014-0045 PER
!Project# rJS 2014-000660 1 MISSION IS HEREBY GRANTED TO:
Est. Cost. j$200.00 Contractor: License: Expires:
Fee Charged:,$25.00 (CHRISTOPHER SALVA Sheetmetal- 13051
Balance Due:;$.00 (Owner: SCHNABEL BROOKE
#of Fixtures: !Applicant: CHRISTOPHER SALVA
DigSafe# I AT: 41 NORTH MAIN ST
Use Group
ConstClass
ISSUED ON. 03-Mar-2014 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
KITCHEN VENT HOOD
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-2014-003811 27-Feb-14 311 $25.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @northamptonma.gov
GeoTMS®2014 Des Lauriers Municipal Solutions,Inc.