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11-001 (26) INSURANCE COVERAGE: I have a current l"�insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 YesoNo❑ If you have checked Yes,indicate the type of coverage by checking the appropriate box below: A liability insurance policy r—V Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee dnac nest have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application wai— this requirement. Check One Only Owner � Agent ❑ Signature of Owner or Owner's Agent By checking this box❑,1 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 ftouress Inepertione Cnmments F*nal inciprtion Date Cnmments Type of License: By ❑ Master Title ❑ Master-Restricted City/Town ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted License Number: L4 U) Fee$ ❑ Check at www macs gnvirir Inspector Signature of Permit Approval Commonwealth of Massachusetts City Of Northampton © D ��U/i� Sheet Metal Permit Permit# 5 30 W r- E < < ated Job Cost: $ r7�t�Xy), Permit Fee: $ - LU Submitted: YES NO Plans Reviewed: YES NO 0 sIness License# f Applicant License# r f -Business Information: ' f ' Property Owner/Job Location Information: Name: `�i np Il �1� IYU a 1•-t�Ky j Name: Sc7 l 4 Street: �� •�CL�Il1 p J Street: 14Z1 Qp7 f l- ) ACS to S-6-m4 City/Town: k�71)&9A V I ( �t~'_, City/Town: V--e J5 Telephone: Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES V 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 C Condo/Townhouses Other Commercial: Office Retail Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft. 1)( 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: f(/ � Ea ?i i ( "�'�" O r► l t--rt-4,100f, - /ob e- 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-2016-0030 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 FORM FILLED OUT Fee Paid GAG F G 51y 9 19 Building Permit Filled out Fee Paid Typeof Construction: BUILDING A-5 ON I ST&2ND FLOOR-KIT&BATH VENTING AND MAKEUP AIR New Construction Non Structural interior renovations Addition to Existing 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 INF RMATION 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 Pegit from Elm Street Commission Permit DPW Storm Water Management %f Sign' re of Building Official 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-2016-0030 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON GIS Map: 11 Block: _ °°' SHEETMETAL PERMIT Lot: 001 _-- „�••° Permit: SHEETMETAL Category: SHEETMETAL Permit# sM-20 1-00073 PERMISSION IS HEREBY GRANTED TO: Project JS-201..3-000735 --_ --- -__- -_-- Contractor: License: Est. Cost: $8,000.00 Expires: - _ SCHNEIDER PLG&HTG Sheetmetal-5400 Fee Charged:$50.00 03/28/2016 !Balance Due:$.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: BUILDING A-5 ON 1 ST&2ND FLOOR-KIT&BATH VENTING AND 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-2016-003468 01-Feb-16 64419&64420 $50.00 212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:Ihasbrouck @northamptonma.gov CeoTMSOO 2016 Des Lauriers Municipal Solutions,Inc.