25A-139 (5) File#SM-2017-0032
APPLICANT/CONTACT PERSON RK SOLUTIONS
ADDRESS/PHONE P O BOX 262 (413)374-8500
PROPERTY LOCATION 42 BATES ST
MAP 25A PARCEL 139 001 ZONE URB(LOO)1
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OU
Fee Paid t(t60
Btin Filled out 7f t!
Fee Paid
Tfpeof Construction: PROVIDE&INSTALL NEW HVAC SYSTEM
New Construction
Non Structural interior renovations
Addition tq Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 5644
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
j2tApproved 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/ORSpecial Permit with Site Pian
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cm 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
Pe 't Elm Street Commission Permit DPW Storm Water Management
fr- �/
Oreo:lull ng O 'cial 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
November 16, 2016 Sheet Metal Permit
Permit ft
1
N esti{nated Job Cost: $ 50000.00 Permit Fee: $ 50.00
Pl 1s Submitted: YES X NO Plans Reviewed: YES
NO
Bu Mess License#508 Applicant License# 5644
Business Information: Property Owner/Joh Location Information:
Name:Rx Solutions Name:Montessori School of Northampton
Street PO Box 262 Street:Bates Street
Cityltown:Agawam City/Tows Northampton —
Telephone:41 3--374-8500 Telephone:
Photo I.D. required i Copy of Photo I.D. attached: YES NO X_
srsutmrial
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 X
Institutional Other
Square Footage: under 10,000 sq. ft. X _ over 10,000 sq. II. Number of Stories: 1
Sheet metal work to be completed: New Work: Renovation:
I-1VAC.; X Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney I Vents Air Balancing
Provide detailed description of work to be done:
Provide and install new HVAC systems.
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,$100.00 Commercial
INSURANCE COVERAGE
I have a current tiahihty insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes 4 No❑
If you have checked Yes,indicate the type of coverage by checking the appropriate box below:
A liability insurance policy ® Other type of indemnity D Bond ❑
OWNER'S INSURANCE WAIVER:I am aware that the licensee+tea%not base the insurance coverage required by Chapter 112 of the
Massachusetts General Laws,and that my signature on this permit application.w,iv sthis requirement.
Check One Only
Owner 0 Agent 0
Signature of Owner or Owner's Agent
By checking this box❑,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are tee and
accurate to the best of my knowledge and that as street metal work and installations performed under the permit Issued for this application will be
In compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws.
Duct inspection required prior to insulation installation:YES NO
pragratc Incpertinns
Date engnnents
final Inperfiee
Date t'nmments
Type of License:/ —.... .
By Master
0
Title Master-Restricted
City/Town ❑doumoyperson CCr !7
Signature of Licensee
Permit#
❑Joumeyperson-Restricted License Number: 56 y
Fee$_... 0
Check at.www masa gnuldpl
inspector Signature of Permit Approval
. ^^y RK$OL-i OP ID: BR
A�RQ CERTIFICATE OF LIABILITY INSURANCE °"'102 s
THis CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE ODES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED EC THE POLICIES
MOX. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER'S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER
IMPORTANT'. If the certmcae holder IS an ADOTDONAI INSURED,the pollcy(Ms)must be endorsed. R SUBROGATION IS WAIVED,subpet to
thetetms and conditions of the pony,cenant policies may require an endorsement A statement on this certificate does not confer rights to the
certMcate holder in lieu of such endorsement's).
PROOLKER
avi�ere ,PAR John Eag
anIsSeUt _
Insurance Agency,Inc. alt,EX:4135323291 I worms-413-534-8982
S31 Grattan Street/PO Box 59
Chicopee,MA 01021-OSS9 �!9REss: —.- --- ..
John Eagan NRAREFER KWRM°COVERAGE ___ TUC'
.,.—_.
AMBER IIPERA:Amelia Protection ln6. CA. .141360
.slam KDavof Sr.Western Mass. tea..KeithOB X David,Sr. NEARER s _
PO BOX 282
Agawam,MA 01001 Raunato.
INSURER F; I
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED_ NOTWRHSTANDNG ANY REQUIREMENT,TERM OR CONDgihh OF ANY CONTRACT OR OTHER DOCUMENT WRIT RESPECT TO WHICH THIS
CERTIFICATE MAY BE£$&IED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
CS AND CONDMONS Of SUCHREDUCED BY PAID CLAIMS
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CERTIFICATE HOLDER CANCELLATION
$110010 ANY of THE ABOVE DESCRIBED POLICIES RECANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH ME POL/CY PROVISIONS.
AUTDMlmREPPESENTATME
John Eagan
._..
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