11A-006 (7) INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes 10 No❑
If you have checked Yes, indicate the type of coverage by checking the appropriate box below:
A liability insurance policy Z Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee rings nn+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 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
J!rnorPCC TncnPrtinnc
Date L..ommelats
Finni incnPrtinn
Date
Type of License:
By IN Master
Title ❑ Master-Restricted
City/Town ❑Journeyperson
Signature of Licensee
Permit# 850 8
❑Journeyperson-Restricted
License Number:
Fee$ ❑
Check at-macs gnv_/T
Inspector Signature of Permit Approval
SEP — 9 2014 - Commonwealth of Massachusetts
City Of Northampton
Electric, Plumbing&Gas Inspections
Noriharrptcn. VIA 01,�E0
Date: - - / Sheet Metal Permit permit# S� 6 'a
Estimated Job Cost: $ Permit Fee: $
Plans Submitted: YES NO Plans Reviewed: YES NO
Business License# .391 Applicant License# 6J 0 8
Business Information: Property Owner/Job Location Information:
Name: EA1 S iol ani&A9 e AkadtI4. 257x Name: ff t(q_ EI kirg Soda )%arer-
Street: X 39 main S6 Street: q lCh es4 uu Ax—,
City/Town: MdnShc) City/Town: LeeA S _
Telephone: X113-267-M3 Telephone: 61 M O }3"32�6.#A�r
Photo I.D. required/Copy of Photo I.D. attached: YES X NO
Staff Initial
J-1 6unrestricted 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 X Multi-family Condo/Townhouses Other
Commercial: Office Retail Industrial Educational
Institutional Other
Square Footage: under 10,000 sq. ft. _7X_ 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:
CC ZOA2Y t2MFA92,
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-2015-0008
APPLICANT/CONTACT PERSON EWS PLUMBING&HEATING
ADDRESS/PHONE 339 MAIN ST (413)267-8983 Q
PROPERTY LOCATION 41 CHESTNUT AVE
MAP I I PARCEL 006 001 ZONE URA(130)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: INSTALL NEW DUCTWORK FOR SFH
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 8508
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOIjMATION 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 ' fro Elm Str Co . sion Permit DPW Storm Water Management
Sign ure f Building Official /ie
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.
41 CHESTNUT AVE SM-2015-0008
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS#: T 643 _
Map:— —11 A
Bl°° := °od SHEETMETAL PERMIT
Lot: 001
.Permit: SHEETMETAL
Category: SHEETMETAL
Permit# SM-2015-0008 PERMISSION IS HEREB Y GRANTED TO:
[project# JS-2011-002339
Est.Cost: Contractor: License: Expires:
IFee Charged:$25.00 EWS PLUMBING&HEATING Sheetmetal-8508 06/28/2016
;Balance Due:$00 Owner: ELKINS NIRA&BILENDA MAURER
I#of Fixtures Applicant: EWS PLUMBING&HEATING
DigSafe# I AT. 41 CHESTNUT AVE
�UseGroup
[ConstClass -
ISSUED ON: 21-Oct-2014 AMENDED ON. EXPIRES ON. 23-Dec-2014
TO PERFORM THE FOLLOWING WORK:
INSTALL NEW 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-2015-001072 09-Sep-14 14984 $25.00
Inspection Type: Inspector: Date Inspected: Date Signed Off: Status:
FINAL Charles Miller 23-Dec-14 PASSED
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @northamptonma.gov
GeoTMS®2015 Des Lauriers Municipal Solutions,Inc.