15B-049 (3) '} z
x.
INSURANCE COVERAGE:
I have a current IiahilitT insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 YesK] 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 does ant haves the insurance coverage required by Chapter 112 of the
Massachusetts General Laws,and that my signature on this permit application waive 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.
Duct inspection required prior to insulation installation: YES NO
Prnaress 1—ppetionc
DW,P- f nmmentc
Final TncTerfinn
Late f'nmmantc
Type of License:
By ❑ Master
Title ❑Master-Restricted
City/Town ❑Journeyperson
Signature of Licensee
Permit#
❑Journeyperson-Restricted
License Number: 1 / (0 07
Fee$ ❑
Check at www,macenn_vlcfp_I
Inspector Signature of Permit Approval
Commonwealth of Massachusetts
NAY ' � � City Of Northampton
Electric, Plumbing&Gas Inspections
Nortnamrton. IA 06Q Sheet Metal Permit Permit#
Date:
Estimated Job Cost: $ — 1 2.{0 o 0 Permit Fee: $'J/v 1�f'
Plans Submitted: YES NO Plans Reviewed: YES NO
Business License# I -O o` �/�°� j�� Applicant License#
Business Information: Property Owner/Job Location Information:
Name: p� �-� Name: I-, ��e , I (�
Street: 5C�` Ev rn erJ �!1� "0- Street: 2S CI C h e S�e 401'Q 1�0
City/Town: v City/Town: 111brf L,c,n-yp740vt
Telephone: Lt(;�, -2Je--I- a I Telephone: / 3 -
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. -_V over 10,000 sq. ft. Number of Stories: 3
Sheet metal work to be completed: New Work: Renovation:
HVAC Z Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney/Vents Air Balancing
Provide detailed description of work to be done:
��v��' S c.�/�`jt°ln... � r' �U/-�C.r Sc.r�"� V►n _ _
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-2014-0058
APPLICANT/CONTACT PERSON PVHC
ADDRESS/PHONE 504 TURNERS FALLS RD (413)364-3210
PROPERTY LOCATION 259 CHESTERFIELD RD
MAP 15B PARCEL 049 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: INSTALL ENTIRE DUCT SYS FOR SFH
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building-Plans Included:
Owner/Statement or License I I 607
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION 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
Permit from Elm Street Commission Permit DPW Storm Water Management
Si re of Buil mg fficial 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.
259 CHESTERFIELD RD SM-2014-0058
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS#: 12152
Map:—--15B
Block: 049 -- - - - SHEETMETAL PERMIT
Lot: 001_ .
Permit: SHEETMETAL
Category: SHEETMETAC-- -
Permit# SM-2014-0058 PERMISSION IS HEREBY GRANTED TO:
Project_# JS-2014-000134
Est.Cost: $12,000.00 Contractor: License: Expires:
Fee Charged:$25.00 v' PVHC Sheetmetal- 11607M 06/28/2014
Balance Due:$.00 —_.Owner: MELNIK PATRICK J&ALICE E
�#of Fixtures _Applicant: PVHC
kDigSafe# - AT: 259 CHESTERFIELD RD
IUse_Group_
�ConstClass
ISSUED ON. 07-May-2014 AMENDED ON: EXPIRES ON.
TO PERFORM THE FOLLOWING WORK:
INSTALL ENTIRE DUCT SYS FOR SFH
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-2014-006505 06-May-14 512 $25.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @ northamptonma.gov
GeoTMS®2014 Des Lauriers Municipal Solutions,Inc.