39A-034 (11) 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 [Xj 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 boxE1,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 License:
By X] Master
Title ❑Master-Restricted
City/Town
❑Journeyperson Signature of Licensee
Permit#
❑Journeyperson-Restricted License Nu/ber 363
Fee$ ❑
Check at www.mass.gov/dpl
Inspector Signature of Permit Approval
i
F__ _
Rill, WA I 0 2Ui4 Commonwealth of Massachusetts
City Of Northampton
Electric, Pijl wC ��.vections
Date J�-/ Sheet Metal Permit Permit#
Estimated Job Cost: 0 80 / _3 Permit Fee:
Plans Submitted: YES X NO Plans Reviewed: YES NO
Business License# Applicant License# _
Business Information: Property Owner/Job Location Information:
Name: Name: rcf t"Ir P,e&-ziv1
Street: 8 9 4-qe-Sf /kvsa kd! c-s-t Street: 66,y 2,.
City/Town: 014-11c'.1 City/Town:
Telephone: Telephone: WZ?
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 Multi-family Condo/Townhouses Other
Commercial: Office Retail Industrial Educational
Institutional Other
Square Footage: under 10,000 sq. ft. over 10,000 sq. ft. x Number of Stories:
Sheet metal work to be completed: New Work: K Renovation:
HVAC Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney/Vents Air Balancing
Provide detailed description of work to be done:
/l5 ll �u�t l y'orK cry+-% pttys
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-2014-0048
APPLICANT/CONTACT PERSON FOUR SEASONS HEATING AND COOLING
ADDRESS/PHONE 134 E HOUSATONIC ST (413)684-4500
PROPERTY LOCATION 115A CONZ ST-FAIRFIELD INN
MAP 39A PARCEL 034 001 ZONE GB000 /U (0)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildinp,Permit Filled out
Fee Paid —VrIJ041
Typeof Construction: INSTALL DUCTWORK FOR BATHROOM FANS&COMMON AREA HVAC
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included• -
Owner/Statement or License 7381
3 sets of Plans/Plot Plan
HE F OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
2nRMATION 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
m Elm Stree Co Sion Permit DPW Storm Water Management
Signature of uilding Of icial 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.
115A CONZ ST - FAIRFIELD INN SM-2014-0048
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
'GIS#: 110450
Map: 39A
stock: d SHEETMETAL PERMIT
034
Lot. 001 �. ,�,�...
Permit: - �SHEETMETAL
Category: SHEETMETAL
(Permit 8
# ISM-2014-0048 _ PERMISSION IS HEREBY GRANTED TO:
_ -
Project# IJS 2013-000826
f -- Contractor: License: Expires:
Est. Cost $180,153.00
_- - - FOUR SEASONS HEATING AND CSheetmetal-7381
(Fee Charged:'�$1,081.00 - 04/28/2014
iBalance Due:l$.00 Owner: H S GERE&SONS INC
i#of Fixtures: Applicant: FOUR SEASONS HEATING AND COOLING
',DigSafe# - AT: 115A CONZ ST-FAIRFIELD INN
UseGroup
ConstClass -
ISSUED ON: 11-Mar-2014 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
INSTALL DUCTWORK FOR BATHROOM FANS&COMMON AREA HVAC
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-2014-004273 10-Mar-14 16317 $1,081.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:Ihasbrouck @northamptonma.gov
GeoTMS®2014 Des Lauriers Municipal Solutions,Inc.