31b-053 (4) File 6 SM-2016-0038 a
fital
APPLICANT/CONTACT PERSON BLVD HEATING
& a
ADDRESS/PHONE 56B BUCKLEY BLVD (413)534-3320
PROPERTY LOCATION 26 LANG WORTHY RD
MAP 31B PARCEL,053 001 ZONE URA(I001/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
Zd i, FORM FILLED OUT 7a- $02�
Feeee Paid .2 2
Building Permit Filled out
Fee Paid
TvoeoLCo t ti : NSTALL DUCTWORK FOR HEATING/COOLING SYS
New Construction
Non Structural interior renovations
ddition t . fling
Accessory Structure
Building Plans Included:
Owner/Statement or License 2711
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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 Nan 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 Water Management
Signature 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 MOL 40A.Contact the Office of
Planning&Development for more information.
Commonwealth of Massachusetts
City Of Northampton
Date: J� Sheet Metal Permit Permit# SIYI/(o— 3S1
C", to
l'.0 o Estimated Job Cost: $ /07 te'b Permit Fee: $ pi/pt 99 $cP
.;i t !Plans Submitted: YES NO Plans Reviewed YES NO
".', usiness License# b67,
it Applicant License# a 71
Business Information: Property Owner/Job Location Information:
Name: N/ 2 0 Hai ',ix. t Ai Name: 5 ve ',to/
Sfreet: 90 AS
,�t� r�')zy bC V n Street: 2& /a�w„.14
City/Town: t-�lttupfe. /r�l�. City/Town: I\ vie
Telephone: t-(3—t-UUy 3120 Telephone:
Photo I.D. required/Copy of Photo I.D. attached: YES NO
Staff Initial
J s• estricted 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. 1..__.--<:10,000 sq. ft. Number of Stories:
Sheet metal work to b completed: New Work: Renovation:
HVAC Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney/Vents Air Balancing
Provide detailed description of work to be done:
�uwaCwk � L
/a(o41 IDIc*// jV °Y/ Oz/a/ he- i H?
CTIndr)((145 si ce �'Ll.
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, $100.00 Commercial
INSURANCE COVERAGE:
I have a current liahiiity insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes 0 No❑
If you have checked Yes,indicate the type of coverage by checking the appropriate box below:
A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑
r
OWNER'S INSURANCE WAIVER:I am aware that the licensee flnrs not have the insurance coverage required by Chapter 112 of the
Massachusetts General Laws,and that my signature on this permit application w'ivp this requirement.
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
By checking this box❑,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and
accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be
in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws.
Duct inspection required prior to insulation installation:YES NO
prngrece Tneperfinnc
Deft f nmmrnfs
•
Fin21 in cp Prfinrt
Date Pnmmrntc
Type of License:
By 0 Master
Title 0 Master-Restricted
Cityfrown ❑Journeyperson
Signature of Licensee
Permit#
❑Jeurneyperson-Restricted License Number:
Fee$ ❑
Check at www masa gnvldnl
Inspector Signature of Permit Approval