17A-300 (5) INSURANCE COVERAGE: /
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes 6( No❑
If you have checked Yves,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 dnPQ nest hay the insurance coverage required by Chapter 112 of the
Massachusetts General Laws,and that my signature on this permit application wal— this requirement.
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
By checking this boxA,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
Brogrecc In-peetionc
Date Comments
Final lospection
17ate !^nmmantc
Type of License:
By ❑Master
Title ❑Master-Restricted
City/Town ❑Journeyperson
Signature of Licensee
Permit#
❑Journeyperson-Restricted License Number:
Fee$ ❑
Check at wwamass gnu_ dpl
Inspector Signature of Permit Approval
LN011tewp Commonwealth of Massachusetts
5 City Of Northampton
Ins'eafont Sheet Metal Permit
Pen-nit#
Estimated Job Cost: $bO'S DO Permit Fee: $AL9 16'b 5P*7
Plans Submitted: YES NO ZC_ Plans Reviewed: YES NO
Business License# 3.' Applicant License# 1r n
Business Information: Property Owner/Job Location Information:
Name: %i Sefx:o Hr��d, ,s A�C Name: C ti''W'dot"
Street: Street: 1 Zlz
City/Town: City/Town: lar vts,
Telephone: Telephone:
Photo I.D.required/Copy of Photo I.D. attached: YES NO
staff initial
J-1 M4 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
Square Footage: under 10,000 sq. ft.'�(_ over 10,000 sq. ft. Number of Stories:
Sheet metal work to be completed: New Work: Renovation: X
HVAC Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney/Vents Air Balancing
Provide detailed description of work to be done:
Lk
'�,�.►.,�cu C-�-c,f, j a1�nr ��� ���`i��r. �11 '�J c'� S 1�
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-2015-0029
APPLICANT/CONTACT PERSON ALL SEASONS HEATING AIR
ADDRESS/PHONE 93 ELM ST (413)247-9842
PROPERTY LOCATION 135 HILLCREST DR
MAP 17A PARCEL 300 001 ZONE URA(100)
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid , `
Tvyeof Construction: ADD HEAT&RETURN DUCTS FOR FINISHED BASEMENT
New Construction
Non Structural interior renovations
Addition to Existin¢
Accessory Structure
Building Plans Included:
Owner/Statement or License 129
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
1NF PAMATION PRESENTED:
Approved 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
e t Street ommis ' n Permit DPW Storm Water Management
—/.%-457
Si re o Buil g ffi 1 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.
135 HILLCREST DR SM-2015-0029
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS#. 1605 _
Map: 17A
Block: — SHEETMETAL PERMIT
Lot: 001 _
Permit SHEETMETAL
Category: SHEETMETAL
Permit#_ SM-2015-0029 PERMISSION IS HEREB Y GRANTED TO:
(Project# 75-2(115-_001513 _
Est Cost: _$2,500.00 ,Contractor: License: Expires:
Fee Charged:$25.00 ALL SEASONS HEATING AIR Sheetmetal- 129
Balance Due:,$.00 Owner: CARDOSO ANDRE&KATE
#of Fixtures Applicant: ALL SEASONS HEATING AIR
DigSafe# _ JAT: 135 HILLCREST DR
UseGroup _
�ConstCiass
ISSUED ON. 13-Feb-2015 AMENDED ON: EXPIRES ON.
TO PERFORM THE FOLLOWING WORK:
ADD HEAT&RETURN DUCTS FOR FINISHED BASEMENT
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-2015-003107 12-Feb-15 5673 $25.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouckgnorthamptonma.gov
GeoTMS®2015 Des Lauriers Municipal Solutions,Inc.