38A-110 (5) INSURANCE COVERAGE:
I have a current liahili 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 ® Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee rinag not have the insurance coverage required by Chapter 112 of the
Massachusetts General Laws,and that my signature on this permit application walvPsthis 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
PrnarP_�_c�Inc1 eCtianc
Date comments
Final IngpeCtinn
Date Comments
Type of License:
By Master N Title ❑ Master-Restricted City/Town ❑Journeyperson of Licensee
Permit# ❑Journeyperson-Restricted 5 X /&
Licen
Fee$ ❑
Check at-mass gcL,nl
Inspector Signature of Permit Approval
D C C� V [E
Commonwealth of Massachusetts
FEB 2 3 2015 City Of Northampton
Electric,Plumbin &Gas I Sheet Metal Permit Permit# ��,/ /"
Northampd&Ga 0 5
Estimated Job Cost: $ 150 000 Permit Fee: $ ,.50
Plans Submitted: YES NO Plans Reviewed: YES NO
Business License#—196 Applicant License# 235-0
Business Information: Property Owner/Job Location Information:
�� //
Name: T, BAFAK 0 S/V Name:-A e Rer►o14,ncef at (A&471�18r'2 f/e N S
Street: q wl/\T YT PO &k 743 Street: r,D VI
City/Town: S I3 City/Town: Ala�+kamAfia✓l/ M/4 C11060
Telephone: ��g- �S� - �01°� Telephone: —
Photo I.D.required/Copy of Photo I.D. attached: YES X NO
Staff Initial
3-1/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
Square Footage: under 10,000 sq. ft. over 10,000 sq. ft. _ Number of Stories: 3
Sheet metal work to be completed: New Work: X Renovation:
HVAC Metal Watershed Roofing_ Kitchen Exhaust System X
Metal Chimney/Vents Air Balancing
Provide detailed description of work to be done:
XInslg�, nieuy NBC sysTe S and VI TL PA' ef��9VS
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-2015-0031
APPLICANT/CONTACT PERSON J J BAFARO INC
ADDRESS/PHONE PO BOX 943 (508)757-7429
PROPERTY LOCATION 50 VILLAGE HILL RD
MAP 38A PARCEL 110 001 ZONE PV(100)/SG b(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out �b
Fee Paid
Typeof Construction: INSTALL HVAC SYS&KITCHEN EXHAUST
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 2350
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOR 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
t Street Commission Permit DPW Storm Water Management
Signature of Buil in ffi ial 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.
50 VILLAGE HILL RD SM-2015-0031
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS#: X11837
Map: 38A
Bl°ck: '° -- - SHEETMETAL PERMIT
Lot:001 i „�..•
Permit: SHEETMETAL
Category: SHEETMETAL
'Permit# SM-2015 0031 _ PERMISSION IS HEREBY GRANTED TO:
Project# JS-2015-000499'_ _
Est. Cost: $150,000.00 Contractor: License: Expires:
Fee Charged:$50.00 IJ J BAFARO INC Sheetmetal-2350 03/28/2016
Balance Due:$.00 Owner: NORTHAMPTON HEIGHTS ALF LP
k#of Fixtures __]Applicant: J J BAFARO INC
DigSafe# T AT. 50 VILLAGE HILL RD
UseGroup
ConstClass
ISSUED ON. 24-Feb-2015 AMENDED ON. EXPIRES ON.
TO PERFORM THE FOLLOWING WORK.
INSTALL HVAC SYS&KITCHEN EXHAUST
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-2015-003231 23-Feb-15 29673 $50.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @northamptonma.gov
GeoTMSO 2015 Des Lauriers Municipal Solutions,Inc.