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38A-140 (6) 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 ER/ 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 bo>rf_I,I hernhy certify that=!!:)f ;nfe;;nstivn 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 Progress Inspections Date Comments Final Inspection Date Comments Typ of License: By aster Title : (1 El Master-Restricted ✓ "t��,,,,y J City/Town ❑Journeyperson Signature of Licensee Permit# �� ❑Journeyperson-Restricted . License Number: Fee$ ❑ Check at www.mass.laov/dpi Inspector Signature of Permit Approval Commonwealth of Massachusetts 2 6 2014 L Sheet Meta l Permit &Gas ptions A Electric, rtumbingn 1 )rlli Mort \ e�+Ll Permit# �l CP Estimated Job Cost: $ Permit Fee: $ a� - Plans Submitted: YESr ., NO'S Plans Reviewed: YES NO Business License# Applicant License # S"'At Business Information: Property Owner/Job Location Information: Name: R1,!h%dS f�1R CrJ%40• LI .ZuC. Name: P, 4y Co Street: I1 +��t1S'I'QiPI. %A- C0 3 (41*1/ Street: _LT A-5 mr3,%eR %T y City/Town: NAL-ORM, MR. O\Mt-QP01 City/Town: Mfy - Telephone: L413 '1%1- AD-U' Telephone: N►3 1$1- 9WW Photo I.D. required/Copy of Photo I.D. attached: YES NO (bN piLpa) 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 L--� Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Institutional Other er� Square Footage: under 10,000 sq. ft. r/ over 10,000 sq. ft. Number of Stories: c� Sheet metal work to be completed: New Work: 1/ Renovation: HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney /Vents Air Balancing Provide detailed description of work to be done: Fe,AZ�q POP S043T1r'�.L bUGZ'w©RAc PZA $1yJtC - -4MM Pt,Sc� Ate. r M t4eD+ 1;:44 uc-r . , 6PIA pfo gc--14CA File# SM-2014-0070 APPLICANT/CONTACT PERSON RICHIES AIR CONDITIONING&HEATING INC ADDRESS/PHONE P O BOX 407 (413)789-1244 Q PROPERTY LOCATION 95 MOSER ST-LOT A5 MAP 38A PARCEL 140 ZONE PV 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: DUCTWORK FOR SFH New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 531 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION 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 Permit from Elm Street Commission Permit DPW Storm Water Management S re of Building 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. 95 MOSER ST - LOT A5 SM-2014-0070 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON GIS#: 12108 Map 38A � � �Lotck. 140 -- SHEETMETAL PERMIT Permit: SHEETMETAL �I Category: New Single Family House'` Permit# sM=20 14-0070 ___ i PERMISSION IS HEREB Y GRANTED TO: Project# JS-2014-001452 Est. Cost: $7,400.00 Contractor: License: Expires: Fee Charged:$25.00 RICHIES AIR CONDITIONING& Sheetmetal-531 03/15/2016 Balance Due;$.00 Owner: KENT PECOY&SONS CONSTRUCTION INC of Fixtures Applicant: RICHIES AIR CONDITIONING&HEATING INC DigSaf_e �JAT: 95 MOSER ST-LOT AS UseGroup ,ConstClass ISSUED ON. 27-Jun-2014 AMENDED ON: EXPIRES ON.• TO PERFORM THE FOLLOWING WORK: DUCTWORK 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-2014-007357 26-Jun-14 16617 $25.00 212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:Ihasbrouck @ northamptonma.gov GeoTMS®2014 Des Lauriers Municipal Solutions,Inc.