24D-131 (4) INSURANCE COVERAGE:
I have a current liability insurance policy or Its equivalent which meets the requirements of M.G.L.Ch. 112 Yes dNo❑
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 el—not ha—the Insurance coverage required by Chapter 112 of the
Massachusetts General Laws,and that my signature on this permit applicationwsluasthis requirement.
Check One Only
Owner ❑ Agent ❑
nature of Owner or Owner's Agent
By checking this boxFJ,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 Inepeefinne
Date Comments
Final Inenarfinn
Date commena
Type of License:
By Master
Title ❑Master-Restricted
City/Town ❑Journeyperson
Signature of Licensee
Permit# `
❑Journeyperson-Restricted License Number: �-,E
Fee$ 0 /y
Check at n/� - masses go uld i
Inspector Signature of Permit Approval
Commonwealth of Massachusetts
_ Q L> t t. City Of Northampton
APR Sheet Metal Permit
E`Q °T3at Permit
Estimated Job Cost: $ 0,`0 Permit Fee: $ 3 `A
Plans Submitted: YES NO X Plans Reviewed: YES NO
Business License# Applicant License# (q3 l
Business Information: Property Owner/Job Location Information:
Name: ��� ,��r.c�c� Name:
Street: 'J,�( C00(1 '00%' fl (Z�- Street: .,-)-I t-�dK�� f�1•c'
City/Town: L��`P�L' City/Town:
Telephone: Tele p hone: ` _72.10
Photo I.D. required/Copy of Photo I.D.attached: YES i 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. 4/ 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:
�.m,*,.act �x:S�:�. �.✓c,-�+.vvC I� �Cy n -�� �'.c S-� -�Irx.( tint Ce c�m�Pc,�
Cjktie;r.pn-E +u Serve �",r -\ Ichrr
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-2014-0052
APPLICANT/CONTACT PERSON S&J JAMROG
ADDRESS/PHONE 481 LONG PLAIN RD (413)548-9024
PROPERTY LOCATION 22 HOOKER AVE
MAP 24D PARCEL 131 001 ZONE URC(100)
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildiniz Permit Filled out
Fee Paid
Typeof Construction: REPLACE 1 ST FLR DUCTWORK BASEMENT FURNACE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 6931M
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF03MATION 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 Pen-nit 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
ermit from Elm Street Comnu ion Permit DPW Storm Water Management
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.
22 HOOKER AVE SM-2014-0052
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS#: 3977 1
'Map: 24D
-
Lot: 131 d SHEETMETAL PERMIT
—- — —
Lot: oo l � ,...
Permit: SHEETMETAL
Category: SHEETMETAL
Permit# sM-2014-0052 PERMISSION IS HEREBY GRANTED TO:
Project# JS-20S-20 14-001259
iEst_-Cos-_._ - - Contractor: License:
. t: $6,000.00 Expires:
- - - - --- S&J JAMROG Sheetmetal-6931M
Fee Charged:$25.00- -- _-- 12/28/2014
Balance Due:$.00 Owner: VALLEY BUILDING COMPANY INC
#of Fixtures I Applicant: S&J JAMROG
I,-
DigSafe# 22 HOOKER AVE
UseGroup
ConstClass I 1
ISSUED ON: 07-Apr-2014 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
REPLACE 1ST FLR DUCTWORK BASEMENT 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-2014-005709 04-Apr-14 8153 $25.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @northamptonma.gov
GeoTMS®2014 Des Lauriers Municipal Solutions,Inc.