24B-002 (16) 95 BARRETT ST - BUILDING D SM-2019-0015
COMMONWEi .LTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS#: 13604
Map: 24B
Block: 002
Lot: 1001 SHEETMETAL PERMIT
j � ,�,..
Permit: SHEETMETAL
Category: ISHEETMETAL
Permit# SM-2019-0015
---- - - ----- PERMISSION IS HEREBY GRANTED TO:
Project# CJS-20.1_8-000_133
Est.Cast: Contractor: License: Expires:
-- .AARON MORIN Sheetmetal-533
Fee Charged:l$25.00 10/28/2019
Balance Due:',$.00 Owner: SUNWOOD DEVELOPMENT CORP
#of Fixtures: Applicant: AARON MORIN
DigSafe# AT: 95 BARRETT ST-BUILDING D
UseGroup
ConstClass
ISSUED ON: 27-Sep-2018 AMENDED ON. EXPIRES ON.
TO PERFORM THE FOLLOWING WORK:
INSTALLING MINISPLITS AND ERV FOR UNIT D
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-2019-001086 26-Sep-18 3560 $25.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck@northamptonma.gov
GeoTMS®2018 Des Lauriers Municipal Solutions,Inc.
File#SM-2019-0015
APPLICANT/CONTACT PERSON AARON MORIN
ADDRESS/PHONE 140 WEST ST (413)247-0550 Q
PROPERTY LOCATION 95 BARRETT ST-BUILDING D
MAP 24B PARCEL 002 001 ZONE URB000V
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ZONING FORM FILLED OUT ENCLO REQUIRED DATE
Fee Paid
Buildinp,Permit Filled out
Fee Paid
Typeof Construction: INSTALLING MINISPLITS AND ERV-R-UNIT D
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 533
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 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 Water Management
?12-6
r a
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 MGL 40A.Contact the Office of
Planning&Development for more information.
Commonwealth of Massachus tts RECEIVED,
Sheet Metal Permit SEP 2 6 2018
&In 16
Date: Pe it s
NORTHA PT 41
MA 01060
Estimated Job Cost: $ Permit Fee: $
Plans Submitted: YES NO Plans Reviewed: YES NO
Business License# ��/ Applicant License#
Business I ormation: Property Owner/Job Location Information:
Name• d Name: >�1/1112/gli
Street: / WAS�c' � Street:S Vre Sl -�
City/Town: 6f /�Sf 1'`ti�/� City/Town:
Telephone: (/r'-3 "- Telephone: qr-3 D
Photo I.D. re uired/ Copy of Photo I.D. attached: YES NO
Staff Initial
J-1 M-1-u stricted 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 1�ther
Commercial: Office Retail Industrial Educational
Institutional Other
Square Footage: under 10,000 sq.ft. Llover 10,000 sq. ft. Number of Stories:
Sheet metal work to be completed: New Work: Renovation:
HVAC -Z Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney/Vents Air Balancing
Provide detailed description of work to be done:
INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes❑ 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 ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
By checking this boxCIl 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
Progress Inspections
Date Comments
Final Inspection
Date Comments
Type of License:
By ❑ Master
Title ❑ Master-Restricted
City/Town
❑Journeyperson Signature of Licensee
Permit#
❑Journeyperson-Restricted License Number:
Fee$
❑ Check at www.mass.gov/dpl
Inspector Signature of Permit Approval
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
kv 600 Washington Street
Boston, MA 02111
www massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le ibl` [4o(KName (Business/Organization/Individual): ayok
Address: SAl
City/State/Zip: �� . M o ce I `
Are you an employer?Check the appropriate box:
Type of oject(required):
1.Z I am a employer with 4 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ew construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. E] Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.$
required.] 5. E] We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.E] Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 1322 6_tther
comp. insurance required.]
*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.
ZContractors 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.
Insurance Company Name: tA g W l"l
Policy#or Self-ins.Lic.#: C 1 ) Expiration Date:
Job Site Address: q5 Wn — 2 City/State/Zip:�GrTt���✓1Ypi 0 KO
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$250.00 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 ce under the p 'as and penalties of perjury that the information provided above is true and correct.
Signature: Date:
Phone#: A " Z 1
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#:
( a COMMONWEALTH OF MAUGRUBt`'
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