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25A-046 (57) 51 BATES ST BP-2019-0938 GIS 4: COMMONWEALTH OF MASSACHUSETTS Mao:Block:25A-046 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeorv: SHEETMETAL BUILDING PERMIT Permit 9 BP-2019-0938 Proiect4 JS-2019-001571 Est.Cost: $2000.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: KEITER BUILDERS 102457 Lot Size(sq.ft.): 71307.72 Owner: NORTHAMPTON MONTESSORI SOCIETY Zoning:GI(10I) Applicant: KEITERBUILDERS AT. 51 BATES ST ApplicantAddress: Phone: Insurance: 35 MAIN ST (413) 586-8600 Q WC FLORENCEMA01062 ISSUED ON:3/6/2019 0:00:00 ��,,�{� TO PERFORM THE FOLLOWING WORK.ENCLOSING A 22LLONG SECTION OF DUCTWORK FOR A NEW FRESH AIR SYSTEM. POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: 01: Insulation: Final: Smoke: Final: THIS PERtMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 3/6/2019 0:00:00 $100.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File 4 BP-2019-0938 APPLICANT/CONTACT PERSON KEITER BUILDERS ADDRESS/PHONE 35 MAIN ST FLORENCE (413)586-8600 Q PROPERTY LOCATION 51 BATES ST MAP 25A PARCEL 046 001 ZONE GI(101)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid 22' TvueofConstructiom ENCLOSING A!LONG ION OF DUCTWORK FOR A NEW FRESH AIR SYSTEM. New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans included: Owner/Statement or License 102457 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON I"MATION 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 Sheet Commission Permit DPW Storm Water Management Demolition Delay CZ 1 /4-11-112 3s1 Signature of Building Official Dat 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 Office of Planning&Development for more information. Vcrsionl.7 Co..un,,ial Budd a,Permit Mal 15.2000 Department use only City of Northampton Status of Permit Building Department Curb CuNDriveway Permit. 212 ermit - 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THA V DWELLING ECEIVEU SECTION 1 -SITE INFORMATION This section to be completed by office 511 Bates td—dress YAfl 1 2019 // QQ �J!e Map �p /1 Lot �11.T Unit DEPT OF nU1LDING INSP Overlay District NORTHAMPTON,MA 01080 Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Northampton Montessori School COI Mi Moran Name(Print) Current Mailing Address: Si nature5ee signed contract from MJ Moran Telephone 2.2 Authorized Agent: Keifer Builders, Inc. 35 Main Street Morence, MA 01062 Name(Print) Current Mailing Address'. 413-58 -8600 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 2,000 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4 Mechanical (HVAC) 00 5. Fire Protection 6. Total=(1 +2+3+4+5) $2,000 Check Number q(-Q� This Section For Official Use Only Building Permit Number Date Issued Signature' Building Commissioner/Inspector of Buildings Date Veccionl 7 Commercial Building Permit Mau 15.2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition El Repairs Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing Change of Use El Other ❑✓ Brief Description Enclosing a 22long section of duct work for a new fresh air system. The ceiling is already drywalled and Of Proposed Work: our soffit will be framed beneath the ceiling. SECTION 5-USE GROUP AND CONSTRUCTION TYPE See attached USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly 0 A-1 A-2 A-3 1A A-4 A-5 1B B Business 13 2A r E Educational a 2B F Factory F-1 ® F-2 ❑O 2C H High Hazard 3A I Institutional -1 1-2 FQ] 1-3 co 38 fpl M Mercantile © 4 R Residential R-1 ® R-2 R-3 5A S Storage S-1 O 5-2 O 5B U Utility Specify. M Mixed Use Specify. S Special Use ® Specify. COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group. Proposed Use Group: Existing Hazard Index 780 CMR 34)'. Proposed Hazard Index 780 CMR 34) SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1.r 1" 2m 2m 3,a 3ra 4m Orr Total Area(sf) Total Proposed New Construction(sf) Total Height(h) Total Height ft 7. Water Supply(M.G.L. c. 40,4 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public Private a Zone Outside Flood Zone❑ Municipal a On site disposal system❑, VersionL7 Commercial Building Permit Ma} 15.2000 IF NORTHAMPTON ZONING Existing Proposed Required by Zoning Phi,—1—o mberlIIM nby Nnilding Depanmeni Lot Size Frontage Setbacks Fmrt Side 1.: R:_ Rca Building Height Bldg.Square Footage 17 Open Space Footage k (I la area III inLIS bids&paved rkin It of Parkin-Spaces Fill: frOlumc&l.ace,ioN A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DON'TKNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW O YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property I YES O NO O IF YES, describe size, type and location: E Will the construction activity disturb(clearing, grading, excavation.or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Build in,Permit Mac 15.2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable 0 Name(Registrant)'. Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional En ineerie: Mechanical Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Keiter Builders, Inc Not Applicable irl Company Name' Scott Keifer Responsible In Charge of Construction 35 Main St. Florence, MA 01062 A ass 413-586-8600 Presidun.Kdl Signature Telephone Vorsion1,7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes O No O SECTION11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Chad Moran as Owner of the subject property Keifer Builders, Inc. hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application 3.1.19 See attached s tined contract Signature of Owner Date Keiter Builders, Inc I. as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Scott Keifer Print jive 3.1.19 SI n ure of OwnerlA ent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Scott Keifer CS-102457 Name of License Holder License Number 51 A Hatfield Street 6/20120 Atl ss Expiration Date 413-586-8600 nature Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§2SC(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes 0 No City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: 51 Bales St The debris will be transported by: Keiter Builders, Inc. The debris will be received by: valley Recycling Building permit number: Name of Permit Applicant Keiter Builder Inc 31 19 I'reeiJenL 1(111 Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' I Congress Street,Suite 100 Boston,MA 0211 4-2 01 7 www.neays.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Keiter Builders, Inc. Address: 35 Main Street Coy/State/Zip: Florence, MA 01062 phone #: 413-586-8600 Are you an employer? Check the appropriate box: Type of project(required): LE I am a employer with 20 4. 0 I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ® New 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 S. ® Demolition working for me in any capacity. employees and have workers' 9 ® Building addition [No workers' comp. insurance comp. insurance., required.] 5. 0 We are a corporation and its 120 Electrical repairs or additions 3.® 1 am a homeowner doing all work officer., 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' 13.2 Other comp. insurance required.] "Any applicant thin check,box HI mustalso fill out the section below showing their workers compensation policy information. Homeowners who submit thisarGdovitindicating they are doing all work and them hin,muside contractors must submit a new affidavit indicating such. :Contractors thin check this hox must attached an additional sheet shm.ing the name of the tab-contrachors and state whethr or not those critics hacc cmplgees. If the sub-ctmiuchms have employees,they most provide their work rs'comppolicy number, I am an employer that is providing workers'compensation insurance for an,emplovees. Below is the policy and joh.site information. AIM MUTUAL Insurance Company Name: Policy d or Self-ins. Lic. #: MCC20020005382018A Expiration Date:6/11/19 51 Bates St Northampton Job Site Address Chy/State/Zip: 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 torn ofa 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 herebyryrtify under the pains and penalties of perjury that the information provided above is ince and correct. V 3.1.19 Si naRlre' President, k131 Dale' Phone it: 413-586-860C Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License it Issuing Authority (circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6.Other Contact Person: Phone 7: ACORO® CERTIFICATE OF LIABILITY INSURANCE DATEIMM10oWYYY' 05/1712018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEN BY EXTEND OR ALTER TME COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the term.and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER u...PuT Cynthia Henderson DER Elite Webber&CUOMO Ard (413)566 0111 PAID xo.. (413)5066081 0 North Hmg Street EoResS. chorderson@veduaranbgrinneltcom INSURGEOG AFFORDING COVERAGE red Northampton MA 01060 INSURERA. Selective Ins CD of S Carolina INSURED /.,.Dan u, AIM MUWauAIM Reiter Builders Inc INSURER Are Scoll Reiter INSURER o 35 Main Street 10SURERE Florence MA 01062 INSURER F'. COVERAGES CERTIFICATE NUMBER: Master Exp See REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS IdYEXP LTq PEOFINSURANCE POLICYNUMBER MMrLCOMOMY ICY Err MMNOMRY LIMITS X COM MERCIAL GENERAL LIABILITY EACH OCCURRENCE y 1,000.000 CLAIMBMAOE F> DA REMISES Etoaun¢nc¢ a 500.000 m(GY—PL—) S 15,000 A S2265567 06/01/2010 06/01/2019 1E1AJNRL a Rol INJURY 5 1,000,000 GEN L AGGREGATE LIMIT APPLIES PER GENCRALAGGREGATE S 2,000.000 PoLICY I JECOT O LOC PRODUCTS-OOMPIOPTGG S 2000,000 OTHER S 4UTOMOBILE LIABILItt FCOME ecntleOSWGLE LIMB S 1,000,000 VTO BODILY INJURY Pw MOM— E A OVIN08DONLY X pCHo OLE. A9105217 06/0112018 0610112019 Cool LY wmeY me Naae.D S AUTEE NO7 AWNED vgOPERTYOFMR6C S X R RIg50NLY X AV OSONLY MedlCal payments s 5.000 X uMORRLA LOU OCCUR ER"OCCURRENCE S 5,066000 A EXCESS UAB CJAMSMADE 52265567 06101/2018 06/01/2019 AGGREGATE s 5000000 DED I X1 RETENTION S 10000 S WORNE RS COMPENSATION X PE. TAT TE X Op H. ANDEMPLOYERS'LIABILITY B NY ROPRETDRIPARTeaaIExEGpnvE O xla MCC20020005]82018A O6/it1201B O6ntl2pt9 EL EACH ACCIDENT 5 1000.000 or Ed a sREXCwcEO'I 1,000.000 MUMMM'in NHl EL DISEASE-EA EMPLOYEE S DESCR✓I�TION OF OPERATIONS Lai EL DISEASEPOLICYLIMIT 5 1000000 DESCRIPTION OF OPERATIONS I LOCATIONS I YENICLES S CORD 101.AJJifiontl RemeIXS SCRNUIe,MAY G UnTed It MOM USS,N Mr,ind) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2016ACORD CORPORATION. All rights reserved. ACERB 25(2016/03) The ACORD name and logo are registered marks of ACORD Kelter Builders, Inc. 35 Main Street Florence MA 01062 WEITER Work: (413) 586-8600 Work Fax: (413) 280-0124 skeiter@keiterbuilders.com OBUILDER SNC KeiterBuilders.com MA CSL 102457 PROPOSAL Customer. - M.J. Moran, Inc. 4 South Main Street Job Name SCOPE OF WORK 02.28.18 PO Box 278 Haydenville MA 01039 Job Number 302 Main: (413) 268-7251 Issue Date February 28, 2019 Item Amount SCOPE OF WORK GENERAL - Temporary floor protections for KBI work only -Project management/site supervision -Excludes any electrical work -Protections by M.J. Moran Excludes care drilling ROOM 001 -Remove glazing at(1)window and replace with(1)exterior rated insulated panel. Create opening(s)for MJM in new panel. Install 2"of roil faced polyiso rigid insulation at interior side. Sandwich with piece of finished, painted plywood at interior. Paint exterior side ofpanelgray. ROOM 003 -Frame/drywall/tape/finish/paint new 22'soHit Ckad Moraw 02/28119 p.o. number 19-530 SCOPE OF WORK 02.28.18, 4 South Main Street, PO Box 278 1 EKEITER BUILDERS35 Main StreebFlorence-MA•01062-Phone 4135868600•Fax:4132800124•keiterbuilders.com Commissioner Hasbrouck 03.01.19 Subject: Request for Waiver I request that you grant a modification to waive the requirement for control construction at 51 Bates St in Northampton because the work is of a minor nature, will not affect health, accessibility, life and fire safety, or structural requirements and is impractical in that the cost of control construction is considerable when compared to the cost of the proposed work. All work will be completed within the prescriptive requirements of 780 CMR. Thank you for your consideration. "Mass Amendments, sections 107.1 allows for an exclusion from control construction for this project" Respectfully, tt Keiter Keiter Builders, Inc. 35 Main St Florence, MA 01062 51 BATES ST SM-2019-0038 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON GIS 4: 9354 - Map: 25A _ Bloc": - 01 Lot: 0 001 -- - -- SHEETMETAL PERMIT Permit: SHEETMETAL Category: SHEETMETAL. eermit 4 SM-2019-0038 PERMISSION IS HEREBY GRANTED TO: Project It JS-2019-001571 ESL Cost }$18,000.00 Contractor: License: Expires: � Charged >108.00 - -- M I MORAN Sheetmetal-267 10/28/2019 Balance Due:S.00 Owner: NORTHAMPTON MONTESSORI SOCIETY p of Fixtures: Applicant: M 1 MORAN DigSafe 4 _---AT.* 51 BATES ST UseGroup ConslClass� ISSUED ON., 06-Mar-2019 AMENDED ON: EXPIRES ON.• TO PERFORM THE FOLLOWING WORK. HVAC FOR 001 AND 003 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fa Type: neteipt No: Dan,Pakl: Cheek No: Amount: Sheoenehl UC-2019-002824 05-Mar-19 27216 51(1800 212 Malo Street.Phone:(413)587-1240,Fms:(413)587-1272,Email:Ihasbmmck joomhmptooma.go GeoTMS9 2019 Des Laurim Municipal Solotloas,I.e. File q SM-2019-0038 APPLICANT/CONTACT PERSON M 1 MORAN ADDRESSIPHONE P O BOX 278 (413)268.7251 PROPERTY LOCATION 51 BATES ST MAP 25A PARCEL 046 001 ZONE GI0011/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid n n Building Permit Filled out I Fee Paid TvoeofConstmctiow HVAC FOR 001 AND 003 New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 267 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: § Findinq 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 l4- -" s S 19 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 Massachusetts City Of Northampton as/9- o4G 2_�6- �a Sheet Metal �71 v!.m !J, Date: / LJ Permit# " /" I � Estimated Job Cost: $ 1 019 ermit Fee: $ 109' 4 2019 Plans Submitted: YES N Pl 'awed: YES NO 0�5 Business License# e2 Applicant e# �6 7 Business Information: Property Owner/Job Location Information: Name: �T /10l2✓l r' 'Lc- Name: /41YA fCS)rW SCLOdI Street: l SG�/��- w�j $ T Street: S( yate.5, f C Ciwrown: IFiun d(fl V 1116 City/Town: /V"k4?/"At zVL Telephone: y/j Xf— Telephone: Photo I.D.required/Copy of Photo I.D. attached: YES_ NO sr.nmo:a.r J-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: ther_Commercial: Office_ Retail Industrial— Educational CJ Institutional Other Square Footage: under 10,000 sq.ft.,)Q_ over 10,000 sq. ft._ Number of Stories: Sheet metal work to be completed: New Work: Renovations HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents_ Air Balancing Provide detailed description of work to be done: YVaL f-Cr 00( -J 063 see wti-aa Ca( kovv,ha Fees with Building Permit:$25.00 Residential,$50.00 Commercial.Fees for jobs without a Building Permit$6.00 per$1000 Minimum fees forjobs without Building Permit$50.00 Residential,$100.00 Commercial iil�� INSURANCE COVERAGE: have a current gahUfbt insurance policy or its equivalent which meets the requirements of aal-Ch.H2 Y aM1 Mo❑ you have checked Yes,Indicate the type of coverage by checking the appropriate box below: A liability insurance policy ® Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does net hevc the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that mysignature on this permit application wai roathis requiremmo. Check One Only Owner ❑ Agent ❑ SignatureofOwner or Owners Agent By checking this hoAw,0 hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the beat of my knowledge and ghat all sheet metal work and Inslallatime,performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation:YES No pragae a LUR--t:on Date rem erste C RIBA Ingpeefi., Date con este Type of License: BY Master Te ❑Master-Restricted "Hyrrown Edourneypempn Signalum-af Licensee Parm@9 9,67 Qm loueypersarFResbfcted License Number. 6 ((9 Fee$ El Check at ana,rrn,gandi fol eclor Shinatum of Permit Approval 0 0 0 �©EN ti S t t�fj. x z , �,?ku T4s lryi:lT e �� Jillf eF;ll� X11■■■■■f l■■ ■■Ln_Iw���i��