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31A-133 INSURANCE COVERAGE: I have a current liability,insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes i4o❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy LrJ 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 CJ,I hereby certify that all of the details and information 1 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 Insaection Late Comments Type of License: By Master Title ❑ Master-Restricted ��( .. City/Town ❑Journeyperson Signature of Licensee Permit# Fee$ ❑Journeyperson-Restricted License Number: } 53�. Check at www.mass.gov/dpi Inspector Signature of Permit Approval Commonwealth of Massachusetts 0 Sheet Metal Permit .I z ci N e: RP , 14 0.11 4 Permit# >ro jrn an mated Job Cost: $ 3��c Permit Fee: $ 5,3q N s Submitted: YES NO Plans Reviewed: YES NO Business License # Applicant License # Gxp,uc� Business Information: Property Owner/Job Location Information: Name: R,1CN►Ei � P)klzS () •.Name: C,rN CGa'f iSawt Qz� )UDW x44-: Strcct: k Gzz,( 4O'7 Street: UYT 01 A h1 f-- City/Town: A fA, M-R . Qll'!Jj- )�70ty/Town: btG4L�P{�cCtf''�CQ� IYl - Telephone: Lill IC- [aL44 Telephone: 413 -71W% Photo I.D. required/ Copy of Photo I.D. attached: YES NO'/ OR MlC Staff Initial J-1 /M-1-unrestricted license 3-2 /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. V over 10,000 sq. ft. Number of Stories: ot+ 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: :ZAScK-L GomP>1ETE }iik pyrx S*1.ST(tm 1A C-.yo14 Q TA Fha Ay�i—s. %gTQAGA F?�a FRGSh Ai o. w4iT RENT„ File#SM-2014-0055 APPLICANT/CONTACT PERSON RICHIES AIR CONDITIONING&HEATING INC ADDRESS/PHONE P O BOX 407 (413)789-1244 Q PROPERTY LOCATION 90 MOSER ST-LOT A2 MAP 38A PARCEL 133 ZONE PV THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out , /��y �► Fee Paid Typeof Construction: INSTALL COMPLET AIR DUCT SYSA +w (� New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• Owner/Statement or License 273 3 sets of Plans/Plot Plan THE FOLLOWJNG ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOR ION PRESENTED: proved 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 it mg Of tcial 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. 90 MOSER ST - LOT A2 SM-2014-0055 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON IGIS#: 12,105 -- - IMap: 38A :Black, - 133` T - SHEETMETAL PERMIT Lot:... _ ��..• Permit: SHEETMETAL Category: New Single Family House Permit# sM-2014-0055 PERMISSION IS HEREBY GRANTED TO: Project# 75-2013-001987 w Cost: $8,000A0 Contractor: License: Expires: Est 8000 RICHIES AIR CONDITIONING& Sheetmetal-273 03/15/2014 Fee Charged:$2 Balance Due:$.00 Owner: KENT PECOY&SONS CONSTRUCTION INC �#of Fixtures —Applicant. RICHIES AIR CONDITIONING&HEATING INC DigSafe# _ AT. 90 MOSER ST-LOT A2 �UseGroup CGonstClass ISSUED ON. 06-May-2014 AMENDED ON: EXPIRES ON. TO PERFORM THE FOLLOWING WORK. INSTALL COMPLET AIR DUCT SYS BEDROOM OVER GARAGE 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-2014-006319 30-Apr-14 16534 $25.00 212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @northamptonma.gov GeoTMS9 2014 Des Lauriers Municipal Solutions,Inc.