38A-129 (2) INSURANCE COVERAGE:
I have a current liability ,insurance policy or its equivalent which meets the requirements of M.G.L. 1:�,,412 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 El 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 ,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
Progress Inspections
Date Comments
Final Inspection
Date Comments
Type of License:
By Master _
Title
❑ Master-Restricted V
City/Town ❑Journeyperson
Signature of Licensee
Permit# y
❑Journeyperson-Restricted License Number: S 3 1
Fee$ ❑
Check at www.mass.aovldpl
Inspector Signature of Permit Approval
E
Commonwealth of Massachusetts
SEP
Sheet Metal Permit
Electryc,Plumbing g
wort m °^ 14 Permit# u
c�
Estimated Job Cost: $ CX}n Permit Fee: $ $ f �
Plans Submitted: YES NO ✓ Plans Reviewed: YES NO
Business License # � Applicant License # 5'1�i
Business Information: Property Owner/Job Location Information:
Name: R�CNI @�S NL Name: QeMY r SaAX QZ4& ALC>V1t)0
Street: P(3 IO)c Li 31 Street: LPI f .— A-16
o loot-oyd�
City/Town: R WPM MP- City/Town: H®PMA A M'P_1tb , Mfg-
Telephone: GIQ �l I' I.14y Telephone: L113
Photo I.D. required/Copy of Photo I.D. attached: YES NO
l Cpl 1~IvC�� staff loitiai
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
ft
Square Footage: under 10,000 sq. ft.\j over 10,000 sq. ft. Number of Stories:
Sheet metal work to be completed: New Work Renovation:
Mau, rvat�l ed Roofing Kltcli�en�xHaust Sy51em __-
Metal Chimney /Vents Air Balancing
Provide detailed description of work to be done:
Fm f,,Ncc M-1E " q Kl
P44O 1+y%1V-,t.j R MA p4`�Ei2.U G-aTS
k11—,,1aGrA Ffa04
File#SM-2015-0010
APPLICANT/CONTACT PERSON RICHIES AIR CONDITIONING&HEATING INC
ADDRESS/PHONE P O BOX 407 (413)789-1244 Q
PROPERTY LOCATION 104 MOSER ST-LOT A10
MAP 38A PARCEL 129 ZONE PV
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildiny,Permit Filled out
Fee Paid
Typeof Construction: INSTALL DUCTWORK FOR SFH_
New Construction
Non Structural interior renovations
Addition to Existin¢
Accessory Structure
Buildina Plans Included:
Owner/Statement or License 531
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOR PATION 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
it Street Commission Permit DPW Storm Water Management
Signa re o uil mg icial 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.
104 MOSER ST - LOT A10 SM-2015-0010
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
IGIS#: 12124-
'Map: 38A
Block: 129
Lot: - ---`-- SHEETMETAL PERMIT
Permit: SHEETMETAL
Category: SHEETMETAL
Permit# ` SM-201 5-00 10 _ PERMISSION IS HEREB Y GRANTED TO
Project# ,IS-2015-000125
Est. Cost_ $7,000.00 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 j—'Applicant: RICHIES AIR CONDITIONING&HEATING INC
DtgSafe#
104 MOSER ST-LOT A10
�UseGroup
[ConstClass
ISSUED ON: 19-Sep-2014 AMENDED ON: EXPIRES ON.'
TO PERFORM THE FOLLOWING WORK:
INSTALL 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-2015-001240 18-Sep-14 16739 $25.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @northamptonma.gov
GeoTMSO 2014 Des Lauriers Municipal Solutions,Inc.