11-001 (25) INSURANCE COVERAGE:
1 have a current liabill insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes 5l-No❑
If you have checked Yes,indicat�e,the type of coverage by checking the appropriate box below:
r
A liability insurance policy yr Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee daps nn+hays the insurance coverage required by Chapter 112 of the
Massachusetts General Laws,and that my signature on this permit application walV4 s-this requirement.
Check One Only
i / Owner � Agent El
Signature of Owner or Owner's Agent
By checking this box❑,I hereby certify that all of the details and information 1 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
PraareQc inenPONnne
Date .commeni5
Final lnenPgtinn
Hate
Type of License:
By ❑ Master
Title ❑ Master-Restricted
City/Town ❑Journeyperson
Signature of Licensee
Permit# ,�/
❑Journeyperson-Restricted )l
License Number: �,"fW
Fee$ ❑
Check at www macs clayay/ripi
Inspector Signature of Permit Approval
Commonwealth of Massachusetts
- City Of Northampton
z
Sheet Metal Permit Permit#5i'j'j- f(� '3l
> o e: r 17 cel l tP �a
cv 7�
W CI imated Job Cost: $ SCM .( Permit Fee: $ 015.M �J
L1J $' ns Submitted: YES NO Plans Reviewed: YES NO
L Z
W
B siness License# )ki Z?� Applicant License#
Business Information: Property Owner/Job Location Information::
Name: 1(��-��Uwl�01V1[i c l��iry Name: So jG� l ��✓� L�
Street: l a1 Aoutv\ 54Ce_-I Street: 47 1 MDV-4(\ AqA A S�-
City/Town: City/Town: S
Telephone: 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
Residential: 1-2 family Multi-family Condo/Townhouses Other
Commercial: Office Retail Industrial Educational
Institutional Other
Square Footage: under 10,000 sq. ft. >e-' over 10,000 sq. ft. Number of Stories: Z
Sheet metal work to be completed: New Work: _� Renovation:
HVAC Metal Watershed Roofing Kitchen Exhaust System�L
Metal Chimney/Vents Air Balancing
Provide detailed description of work to be done:
Zn-,Azi-1l 1M��W�-�oy - v� � �-�v�G , uv--�
z r� -�L vv� . �-;t-�o (�.�+n ��_ +mac(�,�►�-E 5 0,-, ����
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-2016-0031
APPLICANT/CONTACT PERSON SCHNEIDER PLG&HTG
ADDRESS/PHONE P O BOX 323 (413)268-0002 Q
PROPERTY LOCATION 425 NORTH MAIN ST
MAP 11 PARCEL 001 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORNI FILLED OUT
Fee Paid G� y / ot/ Z S +r �►�
Building Permit Filled out
Fee Paid
Typeof Construction: BLDG B-5 ON 1 ST FLOOR&2ND FLOOR-KIT&BATH VENTING&MAKEUP
AIR
New Construction
Non Structural interior renovations
Addition to Existiniz
Accessory Structure
Building Plans Included:
Owner/Statement or License 5400
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOIjMATION 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
ermit from Elm Street Commission Permit DPW Storm Water Management
y
Sign f Buil
mg facial 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.
425 NORTH MAIN ST SM-2016-0031
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
8741
Map: 11 w
Bl°ck:-- °°1--- _ SHEETMETAL PERMIT
-- --
Lot: 1001
Permit: (SHEETMETAL
Category: SHEETMETAL j
_Permit# SM-2016-0031 pERMISSIONIS HEREBY GRANTED TO:
EProject#_ JS-2013-000735
Est.Cost: $8,000.00 Contractor: License: Expires:
Fee Charged:$50.00 SCHNEIDER PLG&HTG Sheetmetal-5400 03/28/2016
r e - r
Balance Due:$.00 Owner: UNITED STATES VETERANS ADMINISTRATION V.A. HOSPITAL
#of Fixtures Applicant: SCHNEIDER PLG&HTG
DigSafe# -- _ AT. 425 NORTH MAIN ST
UseGroup _
ConstClass
ISSUED ON. 02-Feb-2016 AMENDED ON. EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
BLDG B -5 ON I ST FLOOR&2ND FLOOR-KIT&BATH VENTING&MAKEUP AIR
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-2016-003471 01-Feb-16 64418&64421 $50.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck@northamptonma.gov
GeoTMSO 2016 Des Lauriers Municipal Solutions,Inc.