31A-057 (2) INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes 57 Nc
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 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.
Progress Inspections
Date Comments
.............
Final Inspection
Date Comments
------- -;F-y—pe of License:
By F-Aaster
Title El Master-Restricted
0!y/Town ❑uourneyperson Signature of Licensee
Permit# �t
. ....... �Jou rneypersor-Restricted License Number:
Fec. ............
Check at www.mass.gov/dpI
Inspector Signature of Permit Approval
Commonwealth of Massachusetts
MAR 18
I! Sheet Metal Permit
toy Svn-/yd
Electric, f [3dtc
_ - Permit #
Estimated Job Cost: Q Pen-nit Fee:
Plans Submitted: YES NO Plans Reviewed: YES NO
Business License 4_ �1 Applicant License
Business Information: Property Owner/Job L cation Information:
.gutldcr -6c,,y ChaJno,1
Narne: 11 1t n ACA U a C _.
Street: D 1-,n ci,3 t Street:
City/Town:
E(4416wT)fta City/Town: %�U a vy1�_�.?�o d__�
Telephone: 4 I, a 10 —01-31 G S" Telephone:
Photo I.D. required /Copy of Photo I.D. attached: YES / NO
Building T_yhe:
Residential: 1-2 family,/ Multi-family Condo I Townhouses
Commercial: Office Retail Industrial Educational Institutional
Building Cubic Footage: under 35,000 cu. ft. over 35,000 cu. ft.
Sheet metal work to be completed: New Work: Renovation:
HVAC�Z Metal Roofing Kitchen Exhaust System Chimney ,, Vents
Provide brief description of work to be done:
File#SM-2014-0050
APPLICANT/CONTACT PERSON TIN MAN HEATING AND AIR COND
ADDRESS/PHONE 38 SPRING ST (413)527-7722
PROPERTY LOCATION 262 CRESCENT ST
MAP 31A PARCEL 057 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid MVJ
Typeof Construction: ADDED SUPPLY FROM FURNACE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 4043
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION 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
m Elm Street Commission Permit DPW Storm Water Management
Signature o mlding 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.
262 CRESCENT ST SM-2014-0050
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS#: 5676
IMap: 31A
,Block:Lot: X..001 057 -- - SHEETMETAL PERMIT
Permit: !SHEETMETAL
'Category: SHEETMETAL
;-Permit# SHEET PERMISSION IS HEREBY GRANTED TO:
'Project# JS-2014-001418
Est. Cost: ~$680.00 Contractor: License: Expires:
_ TIN MAN HEATING AND AIR CO Sheetmetal-4043
'Fee Charged:$50.00 11/28/2015
(Balance Due:$.00 Owner: SABACH PATRICE&JAN
#of Fixtures: Applicant: TIN MAN HEATING AND AIR COND
DigSafe# AT: 262 CRESCENT ST
UseGroup
ConstClass
ISSUED ON: 19-Mar-2014 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
ADDED SUPPLY FROM FURNACE
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-2014-004713 19-Mar-14 3606 $50.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:Ihasbrouck @ northamptonma.gov
GeoTMS®2014 Des Lauriers Municipal Solutions,Inc.