32C-041 (7) INSURANCE COVERAGE:
I have a current liabilit insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes❑ No❑
If you have checked Yes, indicate the pe of coverage by checking the appropriate box below:
A liability insurance policy Other type of indemnity ❑ ❑
Y yp y Bond
OWNER'S INSURANCE WAIVER: I am aware that the licensee rines nnf haves 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 box0,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
PrngresQ Tncpertionc
Date
Final Tncrerfinn
Date
Type of License:
By ❑ Master
Title ❑Master-Restricted
City/Town ❑Journeyperson
Signature of Licensee
Permit#
❑Journeyperson-Restricted
License Number:
Fee$ ❑
Check at Ur—macs gnv�l
Inspector Signature of Permit Approval
Commonwealth of Massachusetts
City Of Northampton
Date: I �' Sheet Metal Permit permit# _I 17) 141
Estimated Job Cost: $ 32W,pb Permit Fee: $ 1 S O
Plans Submitted: YES NO Plans Reviewed: YES NO /
Business License# Applicant License# /631
Business Information: Property Owner/Job Location Information:
Name: Name: aA-It`
Street: Po&)'Sl Y W wee t-0'- Street: 4 2 �I crO`t 4a r,
City/Town: 6-o 5tyh City/Town: /Ior 1 �
Telephone: L f l Telephone:
Photo I.D. required/Copy of Photo I.D. attached: YES NO
Staff Initial
J-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 an
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:
HVAC Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney/Vents Air Balancing
Provide detailed description of work to be done:
ov�e Kill .
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-2016-0014
APPLICANT/CONTACT PERSON JOHN THOMAS PLUMBING&HEATING
ADDRESSIPHONE P O BOX 614 (413)626-2976
PROPERTY LOCATION 42 PLEASANT ST
MAP 32C PARCEL 041 000 ZONE CB(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
Typeof Construction: INSTALL DUCTED MINI SPLIT A/C UNIT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 1081
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
*Bui1d6g'5ffiic1aI Elm Street Comm . n Permit DPW Storm Water Management
Si re o 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.
42 PLEASANT ST SM-2016-0014
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
11517 —
Map: 32C
Block:_ ooh SHEETMETAL PERMIT
Permit; SHEETMETAL
Category: SHEETMETAL
Permit# S -2016-0014
Project# JS 2016-OOO542 PERMISSION IS HEREBY GRANTED TO:
Est.Cost: $3,200.00 Contractor: License: Expires:
Fee Charged:$25.00 JOHN THOMAS PLUMBING&HE Sheetmetal- 1081 07/28/2015
Balance Due:$.00 Owner: TRIDENT REALTY CORP C/O HAMPSHIRE PROPERTY MGT
#of Fixtures — Applicant: JOHN THOMAS PLUMBING&HEATING
DigSafe# AT: 42 PLEASANT ST
UseGroup
ConstClass
ISSUED ON: 16-Sep-2015 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
INSTALL DUCTED MINI SPLIT A/C UNIT
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-2016-001083 15-Sep-15 532 $25.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:ihasbrouck@northamptonma.gov
GeoTMSO 2015 Des Lauriers Municipal Solutions,Inc.