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3900-05 TIRE 1
ROOM 3 ROO 2
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 policyy�, Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee tines not have 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 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
PrnarPec TncnPrfinnc
Date (nmmPntc
Final TncnPrfinn
Date (�nmmPntc
Type of License:
BY ster
r
Title ❑Master-Restricted
City/Town ❑Journeyperson
Signature of Licensee
Permit#
❑Journeyperson-Restricted �(
License Number:
Fee$ ❑
Check at- macs gnv/rlr
Inspector Signature of Permit Approval
� F ,
Commonwealth of Massachusetts
OCT 3 12014 City Of Northampton
Electric, Pluminc& C s mspeciiens Sheet Metal Permit
°"fe ='`yam - 'ff Permit#
Q 'O
Estimated Job Cost: $ i Permit Fee:
Plans Submitted: YES V NO Plans Reviewed: YES NO
Business License# jo Applicant License#
Business Information: Property Owner/Job Location Information:
Name: /2�`v r�,�Fh� �C Z2—<- Name: C 14 4 4D,}
Street: AU6 Street: 2�3 KiyU St' l-Sji1L 11Z-
City/Town: CAi�& ,�c. City/Town: 174p �
Telephone: Telephone:
Photo I.D. required/Copy of Photo I.D. attached: YES NO
Staff Initial
J-1 M-1 estricted 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. over 10,000 sq. ft. Number of Stories:
Sheet metal work to=ershed d: New Work: Renovation:HVAC Roofing Kitchen Exhaust System
Metal Chimney/Vents Air Balancing
Provide detailed description]j of work to be/>done:
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-2015-0017
APPLICANT/CONTACT PERSON NYZIO HEATING&A/C
ADDRESS/PHONE 56B BUCKLEY BLVD (413)534-3320
PROPERTY LOCATION 243 KING ST-SUITE 4112
MAP 24D PARCEL 185 001 ZONE HB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildina Permit Filled out
Fee Paid
Tyneof Construction: INSTALL DUCTWORK FOR HVAC
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 FOLL G ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOR TION 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
Pamit from Elm Street mmi 'on Permit DPW Storm Water Management
16 - 31-1
Signatt re of Building 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.
243 KING ST - SUITE #112 SM-2015-0017
COMMONWEALTH OF MASSACHUSETTS
- - CITY OF NORTHAMPTON
iGIS#; 9292
Map: — -- 24D
Block� 185 SHEETMETAL PERMIT
Permit: T SHEETMETAL
Category: SHEETMETAL_
,Permit# SM-2015 0017
Proj P ect# JS-2014-002335 ERMISSION IS HEREBY GRANTED TO.
CEst_Cost $12,500.00 Contractor: License: Expires:
fee Charged:$50.00 NYZIO HEATING&A/C Sheetmetal-2711 07/28/2016
Balance Due:$.00 Owner: COOLIDGE NORTHAMPTON LLC
#of Fixtures _ Applicant. NYZIO HEATING&A/C
- —
DigSafe# SAT. 243 KING ST-SUITE#112
UseGroup
�ConstClass L
ISSUED ON: 04-Nov-2014 AMENDED ON.• EXPIRES ON.
TO PERFORM THE FOLLOWING WORK.•
INSTALL DUCTWORK FOR HVAC
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-2015-001938 31-Oct-14 1846 $50.00
212 Main Street,Phone:(413)-587-1240,Fax:(413)587-1272,Email:lhasbrouck@northamptonma.gov
GeoTMS®2014 Des Lauriers Municipal Solutions,Inc.