32C-159 (3) INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes 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 tiaP-z nn+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
Prnarecc TnQpeetionc
Dale Comments
Eiinal insnP�rfi_nrn
Date C nmmantc
Type of License:
By AWaster r
Title ❑ Master-Restricted U
City/Town ❑Journeyperson
Signature of Licensee
Permit#
❑Journeyperson-Restricted X' 9 i
y
License Number:
Fee$ ❑
Check at-►Hass gnv/rir
Inspector Signature of Permit Approval
-�'� Commonwealth of Massachusetts
JUN 2 0 2oI4 i City Of Northampton
Electric,Plumbin &Gas 1 Sheet Metal Permit
Northamp A a (yari Permit#5 ry) Iy -o
Estimated Job Cost: $ �2z) Permit Fee: $ W. 7 31
Plans Submitted: YES 7& NO Plans Reviewed:' YES NO
Business License# Applicant License# a711
Business Information: Property Owner/Job Location Information:
Name: Zia c°yfi.. �i`-�-- Name: Tom' % My� Ph
Street: S l o& (ZO Street: �t;' ►,C 5/e , I,�-
City/Town: City/Town: Q" �tACt
Telephone: Telephone:
Photo I.D. required/Copy of Photo I.D. attached: YES NO
Staff Initial J-1 /O1- nrestricted 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. 1p"', 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:
/C_V
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-2014-0067
APPLICANT/CONTACT PERSON NYZIO HEATING&A/C
ADDRESS/PHONE 56B BUCKLEY BLVD (413)534-3320
PROPERTY LOCATION 9-11 KINGSLEY AVE
MAP 32C PARCEL 159 001 ZONE URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildinp,Permit Filled out
Fee Paid
Tyneof Construction: INSTALL DUCTWORK FOR HEATING SYSTEM
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 2711
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOR N 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
om Elm Street Commissio Permit DPW Storm Water Management
Signature of Buildi g 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.
9 -11 KINGSLEY AVE SM-2014-0067
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIs#: 6627 -- - -
Map: 32C
Bl°°k:_-- 159 ---- - - SHEETMETAL PERMIT
'Lot- 001 �.._
Permit:
—SHEETMETAL
Category: SHEETMETAL
Permit# SM-2014-006 7 —_ PERMISSION IS HEREB Y GRANTED TO:
Project# JS-2014-00205.7_ __ _
IEst.Cost: Contractor: License: Expires:
_- - - - — NYZIO HEATING&A/C Sheetmetal-2711
Fee Charged:$25.00
07/28/2014
Balance Due:$.00 Owner: NGUYEN TIMOTHY
#of Fixtures _ _ Applicant: NYZIO HEATING&A/C
DigSafe# AT: 9-11 KINGSLEY AVE
IUseGroup
ConstClass
ISSUED ON: 23-Jun-2014 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
INSTALL DUCTWORK FOR HEATING SYSTEM
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-2014-007245 20-Jun-14 1731 $25.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @northamptonma.gov
GeoTMSO 2014 Des Lauriers Municipal Solutions,Inc.