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32C-047 (25) INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 YeslD 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 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 box0,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 Inspection Date Comments Type of License: ^ By ® Master '\v► Title ❑ Master-Restricted City/Town David R. Scudder, Vice President ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted License Number: 522 Fee$ ❑ Check at www.mass.gov/d2l I i Inspector Signature of Permit Approval �� 2014 I Commonwealth of Massachusetts �., JUL 2 :.J City Of Northampton c irsocctions Sheet Metal Permit 90 - a- Date: s 122/14 Permit# 4//(10 Estimated Job Cost: $ Permit Fee: $ r0. 0 no Plans Submitted: YES X NO Plans Reviewed: YES NO Business License# 53 Applicant License# 22 Business Information: Property Owner/Job Location Information: Name: David R. Nji lUW Electric Qatracttrs, Name: Tattoo Afterlife Irv, Street: 73 Bowles Rd., P.O. Box 249 Street: 110 Pleasant Street City/Town: Agawam 0 City/Town: Northampton Telephone: (413) 786-8930 Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES NO x 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 X 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: X Renovation: HVAC X M;,tal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: New dux-twork for new roof tQP unit 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-2015-0002 APPLICANT/CONTACT PERSON DAVID R NORTHUP ELECTRICAL CONTRACTORS ADDRESS/PHONE P O BOX 249 (413)786-8930 PROPERTY LOCATION 110 PLEASANT ST MAP 32C PARCEL 047 001 ZONE CB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out t i l d22 yl n Fee Paid Typeof Construction: DUCTWORK FOR ROOF TOP UNIT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 522 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOR T ION 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 rmit from Elm Street Commission Permit DPW Storm Water Management �7-. �F _�� Signa ure of Buil g facial 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. 110 PLEASANT ST SM-2015-0002 COMMONWEALTH OF MASSACHUSETTS S _ CITY OF NORTHAMPTON Map: 32C �GI #: 10109 � - (Block: 047 SHEETMETAL PERMIT Lot: �OU 1 Permit: SHEETMETAL Category: SHEETMETAL Permit# sM-2015=0002 PERMISSION IS HEREBY GRANTED TO: Project# J_S-2014-002010 Est. Cost: Contractor: License: Expires: Fee Charged:$50.00 DAVID R NORTHUP ELECTRICA Sheetmetal-522 10/28/2015 Balance Due:$00 Owner: OLIVIERI MATTHEW #of Fixtures Applicant: DAVID R NORTHUP ELECTRICAL CONTRACTORS DigSafe# AT: 110 PLEASANT ST UseGroup ConstClass ISSUED ON.• 31-Jul-2014 AMENDED ON.• EXPIRES ON. TO PERFORM THE FOLLOWING WORK: DUCTWORK FOR ROOF TOP UNIT 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-2015-000393 25-Jul-14 41633 $50.00 212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @northamptonma.gov GeoTMSO 2014 Des Lauriers Municipal Solutions,Inc.