16C-002 (3) INSURANCE COVERAGE:
I have a current liahi�insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes lJ 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 have the insurance coverage required by Chapter 112 of the
Massachusetts General Laws,and that my signature on this permit application walvecthis requirement.
Check One Only
CQ .ac--Q a Cj �-7 Owner Agent ❑
Signature of Owner or Owner's Agent
By checking this box0,I hereby certify that all of the details and Information 1 have submitted(or entered)regs uing 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
Pros ess YncnS ,
Date Cents
IF-inn] Ynenert-ion
Date Comment-,
Type of License:
By O Master
Title ❑Master-Restricted -
City/Town ❑Joumeyperson
Signature of Licensee
Permit# ��
❑Journeyperson-Restricted License Number:
Fee$
Check at w^-.w miass gmr/T
nspector Signature of Permit Approval
I l� ,
9 r Commonwealth of Massachusetts
Hrr< 2 8 2014 ,J City Of Northampton
Electric Plumbin o I�ndVio
ta Sheet Metal Permit Permit# 5�1 /
�J
Estimated Job Cost: $ 3 q U Cr) Permit Fee: $
Plans Submitted: YES NO_� Plans Reviewed: YES NO
Business License# Applicant License# 6q 6&
Business Information: Property Owner/Job Location Information:
Name: `;� 6{e.
Street: — '� �D(`� Q f Q � Street: 6 q r C'"
City/Town: r.: f y1 r-
_ City/Towli: u,-em c e c9 l o
Telephone: g 13 2-9 q qS 2-3 Telephone: 1 S 4 8
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. 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: r r
CA i r- C-c" cl t4 t ou c,T
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-2014-0054
APPLICANT/CONTACT PERSON MUTTIS SHEETMETAL
ADDRESS/PHONE 224 NORTH ST (413)244-4523
PROPERTY LOCATION 364 SPRING ST
MAP 16C PARCEL 002 001 ZONE URA(100)/WSP(93)
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out ALSO
Fee Paid
Typeof Construction: INSTALL DUCTWORK FOR AC
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 6466
3 sets of Plans/Plot PIan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
1NFqAMATION 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
fr S ion Permit DPW Storm Water Management
i re o Buildi g O cial 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.
364 SPRING ST SM-2014-0054
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIs#: 1252
Map: 16C�----
Black:" 002
Lot: ool SHEETMETAL PERMIT
�- - `
Permit:_ SHEETMETAL
Category: SHEETMETAL
Permit,# SM-2014-0054 PERMISSION IS HEREBY GRANTED TO:
Project# ]S-2014-001917
Contractor: License:
Est.Cost: $3,900.00 Expires:
MUTTIS SHEETMETAL Sheetmetal-6466
Fee Charged:$50.00 � 1 09/28/2014
Balance Due:$.00 Owner: FORD EMORY A&SUSAN R
#of Fixtures .Applicant: MUTTIS SHEETMETAL
DigSafe# AT: 364 SPRING ST
UseGroup _
CanstClass
ISSUED ON.• 01-May-2014 AMENDED ON.• EXPIRES ON.
TO PERFORM THE FOLLOWING WORK:
INSTALL DUCTWORK FOR AC
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-2014-006310 30-Apr-14 2653 $50.00
212 Main Street,Phone:(413)587-1240,Fax:(413)387-1272,Email:lhasbrouck@northamptonma.gov
GeoTMS®2014 Des Lauriers Municipal Solutions,Inc.