32C-104 (24) 50 CONZ ST - WWII CLUB SM-2017-0049
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS#_ 10128 _. p e*"•"°'oti,
Map: 32C
a— �1
Block: 104 '_ SHEETMETAL PERMIT
Lot. 001
Permit SHEETMETAL --
Category: SHEETMETAL
Permit# SM-2017-0049 PERMISSION IS HEREBY GRANTED TO:
Project# 1S-2017-001278
Est.Cost: $12,00000 Contractor: License: Expires:
FeeeeCharged:harged:$50AO ONE CALL VENTILATION INC Sheetmetal- 14122 03/282019
Balance Due:$.00 Owner: WORLD WAR II VETERANS ASSOC OF HAMPSHIRE COUNTY INC
#of Fixtures: Applicant: ONE CALL VENTILATION INC
DigSafe# _AT:: 50 CONZ ST-WWII CLUB
UseGroup
ConstClass
ISSUED ON: 11-Apr-2017 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
INSTALL UI.LISTED HOOD SYSTEM PER CODE
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-2017-005464 11-Apr-17 1520 $5000
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Emailahasbrouckaaa northamptonma.gov
GeoTMSs 2017 Des Lauriers Municipal Solutions,Inc.
File#SM-2017-0049 .-
APPLICANT/CONTACT PERSON ONE CALL VENTILATION INC
ADDRESS/PHONE 64 ALTHEA RD (617)201-7972
PROPERTY LOCATION 50 CONZ ST-WWII CLUB
MAP 32C PARCEL 104 001 ZONE NB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
TyoeofConstruction: INSTALL UL LISTED HOOD SYSTEM PER CODE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 14122
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF9RMATION 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
P . it Street Comm' sion Permit DPW Storm Water Management
Sig mtin_40 -tai 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.
APR I u Commonwealth of Massachusetts
City Of Northampton
Sheet Metal Permit
Date: '7,///7 Permit# Sm�lp{- / 7— v9 r�
Estimated Job Cost: $ 1.1000, 00 Permit Fee: $ iJ 0 C�i 6a0
Plans Submitted: YES X NO Plans Reviewed: YES NO
Business License# 7 [q?6? Applicant License# , ‘7170? )
Business Information: Property Owner/Job Location Information:
Name: One Cod/ PLn %%r4vn Name: ( or I d Wer
Street: & u/ / /{1u, q iZ 4 Street: SO CoAl Z
City/Town: gc-npL City/Town: Nor-hr,ampi-neu IMO
Telephone: (017 a&1 75 7 - Telephone: Las -s-9 6 -31/1- f-n c C'&rind-
Photo I.D. required I-Copy of Photo I.D. attached: YES NO
Staff Initial
J-1 /M-1-unrestncted 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. over 10,000 sq. ft. Number of Stories:
Sheet metal work to be completed: New Work: Renovation:
HVAC Metal Watershed Roofing Kitchen Exhaust Systema
Metal Chimney/Vents Air Balancing
Provide detailed description of work to be done:
54., II (A L 115 lu,,,,,{ Sy S-Ron tl-e: Ccn Q
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, $100.00 Commercial
INSURANCE COVERAGE:
1 have a current lin hility insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 YeNo❑
If you have checked Yes,indicate the type of coverage by checking the appropriate box below:
A liability insurance policy Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licenseedor'=not havn the insurance coverage required by Chapter 112 of the
Massachusetts General Laws,and that my signature on this permit application waive=this requirement.
Check One Only
/� Owner�Cl Agent ❑
Signature of Owner or Owner's Agent
By checking this boxy,I hereby certify that all of the details and information I have submitted for entered)regarding this application are true and
accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be
in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws.
Duct inspection required prior to insulation installation: YES NO
prngrect lncpertinns
Date f'nmmantc
Final lncpertinn.
Date f'nmmrntc
Type of License:
By Xa stet
Title ❑Master-Restricted -/
City/Town
❑Journeyperson Signature of Licensee
Permit#
OJ ou rneyperso n-Restrictetl
License Number:
Fee$ D
Check at www mays gnvfdpl
Inspector Signature of Permit Approval
The Commonwealth of Massachusetts
Department of Industrial Accidents
Gini _ Office of Investigations
PIM 1 Congress Street, Suite 100
Boston, MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information
\ \ Please Print Legibly
Name (Business/Organization/Individual): ane x,yt\\ ki-0-4. }\' c I r\
Address: 62 vk r\A-INCA 1 A
City/State/Zip: Rcyx ''AiP1- Phone#: 7 ‘2.0 ( 7? 7
Are you an employer? Check the appropriate box: Type of project(required):
1.E,I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).*
have hired the sub-contractors 6. El New construction
listed on the attached sheet. 7. ❑Remodeling
2.❑ I am a sole proprietor or partner-
ship and have no employees These sub-contractors have S, ❑ Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance.:
9. ❑ Building addition
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL
12.0 Roof repairs
insurance required.] ' c. 152, §1(4), and we have no
employees. [No workers' I3. Other feejod S.I f
comp. insurance required.] 11
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. (l��
Insurance Company Name: ry-,
Policy#or Self-ins. Lic. #: (/)CC. — SOO -SQ i y 0 Expiration Date: 17- ?. 7— / 7
Job Site Address: SO (9hi2 54 City/State/Zip: klp{ \`q„w/xp1}.3t�]
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a-STOP WORK ORDER and a fine
of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certifyunder the pains and penalties of perjury that the information provided above is true and correct
Signature: Date: `( I it I l
Phone#: [Q[�) ' o110 V 79 7 a--
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
• 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
' 6.Other
Contact Person: Phone#:
Fold,Then Detach Along All Perlorelione
OMMONW ALTH OF MA c; ONUS;. S
DIVISION OF PROFESSIONAL LICENSURE
SHEET METAL WORKERS '
ISSUES THE FOLLOWING LIOENSE
MASTER-UNRESTRICTED
SCOTT MCQUADE•
.64 ALTHEA RA)
RANDOLPH,MA 02368-2954
14121 03/28/2018 257376