23B-011 (4) INSURANCE COVERAGE:
I have a current liability 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 $1 Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER:I am aware that the licensee dnp-.not have the insurance coverage required by Chapter 112 of the
Massachusetts General Laws,and that my signature on this permit application waive this requirement.
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
By checking this box❑,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and
accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be
in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws.
Duct inspection required prior to insulation installation: YES NO
Progress inspections
.Date, commew;
l inal TnQyecct^nn
Dale
Type of License:
By ❑ Master
Title ❑ Master-Restricted
City/Town ❑Journeyperson
Sig a of censee
Permit# rn lay
❑Joueyperson-Restricted License Number:
Fee$ ❑
Check at www mass_g v� /dol
Inspector Signature of Permit Approval
Commonwealth of Massachusetts
UAJ o City Of Northampton
> N
LIJ? IJate: ,�-\-7 o`�O 15 Sheet Metal Permit Permit# 51n ^l�
W i
X Esjimated Job Cost: $ D Permit Fee: $ b
Pl�ns Submitted: YES NO Plans Reviewed: YES NO
Business License# Applicant License# OA9
Business Information: Property Owner/Job Location Information:�p
Name: 0M `ate° Ka c �C Name: 1)m, P@t �c�TC c 5
Street:9Z r\Y"1 D� Street: \ate
City/Town: 1�A��C NAA City/Town:
Telephone: ��—�y��� t�� Telephone: 41,3 ?lD
Photo I.D. required/Copy of Photo I.D. attached: YES NO
Staff Initial
J-1 �-lnrestricted 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_X1 Retail Industrial Educational
Institutional Other
Square Footage: under 10,000 sq. ft. —X— over 10,000 sq. ft. Number of Stories:
Sheet metal work to be completed: New Work: Renovation:
HVAC X Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney/Vents Air Balancing
Provide detailed description of work to be done:
s�'i V c, C%,- [ L n� -`O g
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-2016-0021
APPLICANT/CONTACT PERSON ALL SEASONS HEATING AIR
ADDRESS/PHONE 93 ELM ST (413)247-9842
PROPERTY LOCATION 193 LOCUST ST-NORTHAMPTON AREA PEDIATRICS
MAP 23B PARCEL 011 001 ZONE SI(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid IV5
Building Permit Filled out
Fee Paid
Typeof Construction: HVAC DUCTWORK
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 129
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ION 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
fro Elm Street Co is ' Permit DPW Storm Water Management
�4T
u
ildirelYflcial 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.
193 LOCUST ST - NORTHAMPTON AREA PEDIA SM-2016-0021
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS#: 9082
Map: 23B
Block: Oil
SHEETMETAL PERMIT
Lot: 001
Permit: _ SHEETMETAL
Category SHEETMETAL
Permit# SM-2016-0021 PERMISSION IS HEREBY GRANTED TO:
Froj ect -- 6-
—# 7S 2016-00021 7_
Est. Cost $6,450.00 Contractor: License: Expires:
Fee Charged:$50.00 ALL SEASONS HEATING AIR Sheetmetal- 129
-_ 0 ---
Balance Due:S.00 Owner: 193 LOCUST ST ASSOCIATES LLP
#of Fixtures 'Applicant: ALL SEASONS HEATING AIR
DigSafe# AT. 193 LOCUST ST-NORTHAMPTON AREA PEDIATRICS
UseGroup
ConstClass
ISSUED ON. 19-Nov-2015 AMENDED ON: EXPIRES ON.-
TO PERFORM THE FOLLOWING WORK:
HVAC DUCTWORK
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-2016-002265 18-Nov-15 1240 $50.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @northamptonma.gov
GeoTMS®2015 Des Lauriers Municipal Solutions,Inc.