24D-185 (25) 225 KING ST - U MASS CREDIT UNION SM-2017-0005
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS#: 9292
Map: 24D
BID< : 185
SHEETMETAL PERMIT
Lot 001 erPermit. SHEETMETAL .rr,tr.nw
Category:
SHEETMETAL
Permit# SM-2017-0005 - PERMISSION IS HEREBY GRANTED TO:
pProject# JS-2016-001776
'Esc Cost: $26,000.00 'Contractor: License: Expires:
NORTHEAST MECHANICAL SOL Sheetmetal-2397
Fee Charged:$50.00 08/28/2017
Balance Duea$.Op (Owner: COOLIDGE NORTHAMPTON LLC
#of Fixtures Applicant: NORTHEAST MECHANICAL SOLUTIONS INC
DigSafe#
AT: 225 KING ST-U MASS CREDIT UNION
UseGroup
IConstClass
ISSUED ON: 18-Jul-2016 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
FURNISH AND INSTALL DUCTWORK&RODS
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: Cheek No: Amount:
Sheetmetal REC-2017-000087 08-Jul-16 5078 $50.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck@norlhamptanma.gov
GcoTMSF 2016 Des Lauriers Municipal Solutions,Inc
File# SM-2017-0005
APPLICANT/CONTACT PERSON NORTHEAST MECHANICAL SOLUTIONS INC
ADDRESS/PHONE II COMMERCE RD (508)925-5592
PROPERTY LOCATION 225 KING ST-U MASS CREDIT UNION
MAP 24D PARCEL 185 001 ZONE HB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid G:.17P• f 071 444
Building Permit Filled out
Fee Paid
Typeof Construction: FURNISH AND INSTALL DUCTWORK&RODS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 2397
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
Ibly.ORMATION 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
Permit from Elm Street Commission Permit DPW Storm'7Water Management
111 der
AC
Sig . re . uildin 0 ficia 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 40&Contact the Office of
Planning&Development for more information.
Commonwealth of Massachusetts
City Of Northampton
—Date: 7/i i Sheet Metal Permit Permit#
r---1 Estimated Job C st: $$p/6�WO Permit Fee: $ 1 CO
',Plans Submitted: YES NO Plans Reviewed: YES NO
2' pOiness License# 511 Applicant License# 2 39 7 — ? z 27/7 .r
(c iness Information: Property Owner/Job Location Information:
N. e: FJorOa,r+ar Keu+wniptnA SoUilw Name: (MASS C.cent - (Amo.%
Street: Itee,vvM,a v[Q Street: -a")S ICI ns S-
City/Town: 5H-r¢,.,,;ry,i N.a Oi5'iT City/Town: rlori't.rnnoL.-. HP.
Telephone: Sae- B2 S- SSy)- 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 JL Retail Industrial Educational
Institutional Other
Square Footage: under 10,000 sq. ft. I>z 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:
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,$100.00 Commercial
•
INSURANCE COVERAGE:
I have a current LahWty Insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes< No❑
If you have checked Vas,Indicate the type of coverage by checking the appropriate box below:
A liability insurance policy Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee drag not Tuve the insurance coverage required by Chapter 112 of the
Massachusetts General Laws,and that my signature on this permit application.walvesthis requirement.
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
By checking this!map,I hereby certify that all of the details and Information I have submitted(or entered)regarding this application are true and
accurate to the best of my knowledge and that all sheet metal work and Installations performed under the permit Issued for this application will be
in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws.
Duct inspection required prior to insulation installation: YES_NO
prngrwee tnvpnrtinne
Date comments
Final Thermion
Date comments
Type of License:
By ❑ Master
True ❑ Master-Restricted �//
City/Town ❑Joumeyperson ✓✓✓
Signature of Licensee
permits ❑Journeyperson-Restricted 97
X3
Fee$ License Number: J
Check at www mass G
Inspector Signature of Permit Approval
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 =; igt= t Office of Investigations
E =^1.1-- 600 Washington Street
I.
vs, Boston, MA 02111
�� www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plul
Applicant Information Please Print I
Name (Business/Organization/Individual): t.4o-41xv sr- 11(e nn A\ Sov. 4 c.n
Address: tt CsW v use 2.Jk
City/State/Zips, ws4,;,.1 F(p oiSvs Phone #: $0B-Cas-Ss`t�
Are you an employer? Check the appropriate box: Type of project (requir
I.2-I am a employer with 1 S 4. 0 I am a general contractor and I 6. jC New construction
employees (full and/or part-time).* have hired the sub-contractors
72.El am a sole proprietor or partner- listed on the attached sheet. '+ ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.0 Electrical repairs
3.0 I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs
myself. [No workers' comp. c. 152, §1(4), and we have no 12.0 Roof repairs
insurance required.] i employees. [No workers' 13.0 Other 44KAC
comp. insurance required.]
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indica
=Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy inft
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy ana
information.
Insurance Company Name: Q4l-ra-.r t c.
Policy# or Self-ins. Lic. #: W CNptgc 19 DO& Expiration Date: 6 /0 In
Job Site Address: 3-as- k..,S sr City/State/Zip: ,s1,-ttehrh,,do 0/66e
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expira
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal pei
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDI
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Offic
Investigations of the DIA for insurance coverage verification.
Ido hereby cerci under the pains and penalties of perjury that the information provided above is true and cors
Signature: 1/4�� Date: 7/774'
Phone#: J—d2-92S- 5Sf/1