36-395 (2) ......... _ . .._____._ .... .__ __ ....-_ ___....-__ ..
INSURANCE COVERAGE:
I have a current lLabil& 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 does not have the insurance coverage required by Chapter 112 of the
Massachusetts General Laws,and that my signature on this permit application waives this requirement,
Check One Only
Owner Agent ti
Signature of k_)wner or Owner's Agent
-__-
By checking this box! i hereby certify that all of the details and information l have submitted for 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
Progress Inspections
Date Comments
Final Inspection
Date Comments
-- __..____ _ ____ ___ .__... _. _.... ____ -_..._
Type of License
By_ -----------
Master
Title Master-Restricted
City/Town_
aourneyperson Signature of Licensee
Permit _
lourneyperson-Restricted License Number __-...
D(
i-ee s
---------._.�..__ Check at www.mass.gov1dpl
Inspector Signature of Permit Approval
rE d M � Commonwealth of Massachusetts Pin 9 20is Sheet Metal Permit
ng& rt ' Permit# / ��ton, MA 01060
Estimated Job Cost: $ Permit Fee: $/�?�? Ad 6_
Plans Submitted: YES NO Plans Reviewed: YES NO
Business License# Applicant License#
Business Information: Property Owner/Job Location Information:
Name: Name:
Street: _� � /V, Z-) el-Al St. Street: 1. C' K(����-9
City/Town: E'��� � �Z;G�P r0,1 City/Town: 1Vo4__h _rz,0h)1V
Telephone: " �i
p 4/3 -1 3 1.x.3 Telephone: 4/.3 - C� - D U 7 7
Photo I.D. required/Copy of Photo I.D. attached: YES NO
1 /M-1-unrestricted-
license staff initial
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 L/ 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:
Skeet metal work to be completed: New Work: L-'� Renovation:
HVAC Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney /Vents Air Balancing
Provide detailed description of work to be done:
File#SM-2015-0034
APPLICANT/CONTACT PERSON SWIFT RIVER HVAC INC
ADDRESS/PHONE 221 N LIBERTY ST (413)323-4123
PROPERTY LOCATION 120 EMERSON WAY
MAP 36 PARCEL 395 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
T_ypeof Construction: HVAC SYSTEM FOR SFH
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Buildiniz Plans Included:
Owner/Statement or License 220
3 sets of Plans/Plot Plan
THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO 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
Pe lm&reet Co Permit DPW Storm Water Management
6
re n cial 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.
120 EMERSON WAY SM-2015-0034
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS#: 11799
Map: 36
Bloc : - _ 395 SHEETMETAL PERMIT
Lot: 001 „�..•
Permit:> SHEETMETAL
Category: SHEETMETAL
Permit# SM-2015-0034 PERMISSION IS HEREBY GRANTED TO:
Project# JS-2015-000575
Est.Cost: Contractor: License: Expires:
Fee Charged:$25.00 SWIFT RIVER HVAC INC Sheetmetal-220 08/28/2015
'Balance Due:$.00 Owner: HAMPSHIRE PROPERTY MANAGEMENT
of Fixtures Applicant: SWIFT RIVER HVAC INC
D1gSafe# AT: 120 EMERSON WAY
UseGroup _
ConstClass
ISSUED ON: 30-Sep-2015 AMENDED ON: EXPIRES ON.-
TO PERFORM THE FOLLOWING WORK:
HVAC SYSTEM 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-2015-004424 18-Mar-15 16949 $25.00
212 Main Street,Ph one:(413)587-1240,Fax:(413)587-1272,E mail:lhasbrouckgnorthamptonma.gov
GeoTMS®2015 Des Lauriers Municipal Solutions,Inc.