12C-130 (4) k
INSURANCE COVERAGE: ;
I have a current liability[insurance policy or its equivalent which meets the requirements-of M:G.L. Ch. 112 Yes�k"ICt n
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 rime ant hav°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 bOXE3,1 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
PrngieSS Tncnn-=
Date l nmmantc
Final Tncrnrfinn
Date-
Type of License:
By Master -�
n
Title ❑Master-Restricted ✓
City/Town
❑Journeyperson
Permit#
❑ Signature of Licensee
Journeyperson-Restricted
Fee$ ❑
License Number:
Check at xamm mass gnv/rani r
/ ( /--� �(
Inspector Signature of Permit Approval
� 2 4 2015
i ommonwealth of Massachusetts
City Of Northampton
E%dric,Plumbing&Gas InspaCOOMS
Northampton,IdIA 01080
Date: . Sheet Metal Permit permit#
u �
Estimated Job Cost: $r 0, r;C Permit Fee: $ ,9
Plans Submitted: YES NO Plans Reviewed: YES NO ,V
Business License# Applicant License# 5 G�
Business Information: Property Owner/Job Location Information:
Name: j �t�`�f)( i� r.Si I��Name: tic 17e
Street: 1 i �'� c'�' S - Street: ��� C Gr jc-' i J 6_1 1e
City/Town: C'� )i , 01 I /D 3� City/Town: J- I (,+ ki e
Telephone: �l ,6 ( ` Telephone:
Photo I.D. required/Copy of Photo I.D. attached: YES NO
Staff Initial
J-1 M-1,uP)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.4— over 10,000 sq. ft. Number of Stories:
Sheet metal work to be completed: New Work Renovation:
HVAC Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney/Vents Air Balancing
Provide detailed description 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-2015-0032
APPLICANT/CONTACT PERSON EXPRESS PLUMBING
ADDRESS/PHONE 131 PROSPECT ST (413)626-3862 Q
PROPERTY LOCATION 37 CLOVERDALE ST
MAP 12C PARCEL 130 001 ZONE RI(100)/URA(100)/WSP(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
B Permit Filled out (�
uildin
Fee Paid
Typeof Construction: INST LL HVAC HIGH VELOCITY UNICO DUCT SYSTEM
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOR ATION PRESENTED:
roved 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
i o Street C iss' Permit DPW Storm Water Management
n vildnis Ctificial 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.
37 CLOVERDALE ST SM-2015-0032
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS#: 1"1689
Map: 12C
Block: _001 10I
Lot: --�- - SHEETMETAL PERMIT
_ __� ��..•
ertuit: SHEET_METAL _ I
Category: SHEETMETAL_ _
Permit## SM-2015-0032 _ PERMISSION IS HEREB Y GRANTED TO:
Project# 75-2013-001276
Est. Cost: $20,000.00 Contractor: License: Expires:
Fee Charged:$25.00 EXPRESS PLUMBING
Balance Due:S.00 T Owner: STIEBEL FRANK
#of Fixtures __ Applicant: EXPRESS PLUMBING
DigSafe# AT: 37 CLOVERDALE ST
UseGroup
ConstClass
ISSUED ON. 24-Feb-2015 AMENDED ON. EXPIRES ON.
TO PERFORM THE FOLLOWING WORK:
INSTALL HVAC HIGH VELOCITY UNICO DUCT SYSTEM
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-2015-003264 24-Feb-15 3620 $25.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @ northamptonma.gov
GeoTMS®2015 Des Lauriers Municipal Solutions,Inc.