23C-055 (8) hr
INSURANCE COVERAGE:
I have a current liahilit insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes o❑
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: l am aware that the licensee rinPS not hay P 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
PrUgrPcc TncnPrtionc
Mte commeats
Final TnczneCfinn
Dalz
Type of License:
By Master
Title ❑ Master-Restricted
City/Town ❑Journeyperson
Sigrz of Licensee
Permit#
❑Journeyperson-Restricted License Number:
Fee$ ❑
Check at lamas macs gayljj431
Inspector Signature of Permit Approval
51 -
11E WW
Commonwealth of Massachusetts
f 2 T 2015 City Of Northampton
Electric, Piumbing&Gas Insp Sheet Metal Permit
Northampto , 01060 Permit#
Estimated Job Cost: $ �v Permit Fee: $ �v
Plans Submitted: YES NO Plans Reviewed: YES NO
Business License# �Ll�(� Applicant License#
Business Information: 1,,�,� Property Owner/Job Location Information:
Name: S ���� 1� Name: /'124 kA-)
Street: � zz�& 1-�� Street:
City/Town: vt/'06' cv City/Town: /7' ✓V G
Telephone: Telephone: �- �— Jl' �-' 3l /_-S
Photo I.D. required/ Copy of Photo I.D. attached: YES NO
Staff Initial
J-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. 4— over 10,000 sq. ft. Number of Stories: _.1;711
Sheet metal work to be completed: New Work: —2 Renovation:
HVAC Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney/Vents Air Balancing
Provide detailed description of work to be done:
& 1VVvs4
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-2015-0037
APPLICANT/CONTACT PERSON SYSTEMS PLUMBING&HEATING
ADDRESS/PHONE PO BOX 593 (413)695-5218
PROPERTY LOCATION 82 WILLOW ST
MAP 23C PARCEL 055 001 ZONE URA(100)/WSP(100)/WP(83)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT AN OQ 04 4L4
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: HRV UNIT DRYER VENT&BATHROOM EXHAUST
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 14163
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOR TION 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
Elm Street Commission Permit DPW Storm Water Management
4 1. ature of B6fidiRglb f icial 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.
82 WILLOW ST SM-2015-0037
COMMONWEALTH OF MASSACHUSETTS
_ CITY OF NORTHAMPTON
GIS#: 3119
Map: 23C
Block: , 0
Lot; 0U1 SHEETMETAL PERMIT
...
Permit: SHEETMETAL
Category: SHEETMETAL
Permit# SM-2015.0037 PERMISSION IS HEREBY GRANTED TO:
Project# JS-2013-001304
Est.Cost: $5,000.00 Contractor: License: Expires:
Fee Charged:$25.04 SYSTEMS PLUMBING&HEATIN Sheetmetal- 14163
Balance Due:$00 Owner: LEDERMAN HOWARD C
#of Fixtures Applicant. SYSTEMS PLUMBING&HEATING
DigSafe# AT. 82 WILLOW ST
UseGroup
ConstClass --- v
ISSUED ON. 27-Mar-2015 AMENDED ON. EXPIRES ON.
TO PERFORM THE FOLLOWING WORK:
HRV UNIT,DRYER VENT&BATHROOM 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-2015-004881 27-Mar-15 1297 $25.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @northamptonma.gov
GeoTMS®2015 Des Lauriers Municipal Solutions,Inc.