36-259 (3) INSURANCE COVERAGE: \
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes III No ❑
If you have checked Yes, in 'sate 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 dnpc not have. the insurance coverage required by Chapter 112 of the
Massachusetts Gene I Laws, and that my signature on this permit application Waivesthis requirement.
heck One Only
(,h C- Owner Agent El
Signature of Ow or ner'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
Progress Incpeetionc
Date Cnrnments
Final Incpertintt
DatP Comments
Type of License:
By ❑ Master
Title ❑ Master - Restricted
City/Town ❑Journeyperson
Signature of Licensee
Permit#
❑Jou rneype rson- Restricted
License Number:
Fee $ ❑
Check at :Amat tp Fy s u >`
Inspector Signature of Permit Approval
ECEIVED Commonwealth of Massachusetts
JAN 19 2012 City Of Northampton
of IN$PE Sheet Metal Permit Permit # SO / d 0?0
Estimated Job Cost: $ \' DO .) Permit Fee: $ aSIDO
Plans Submitted: YES NO / Plans Reviewed: YES NO
Business License # \ .C3 Applicant License # "a,ci
Business Information: Property Owner / Job Location Information:
Name: Pi\\ ms's -nr ;, k{io -cs \c Name: - w. t(1 L e c \ --Th
Street: c- i =1 w. `� � Street: \ t Q'v cL �C_
City /Town: -�� Q \c, �
City /Town: Aerce,� � c 11r�A _ pin
Telephone: 4 13 - a, y - 9 qry Telephone: 5 - i-- 7 3
Photo I.D. required / Copy of Photo I.D. attached: YES NO
Staff Initial
J -1
4211 nrestricted 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 sg over 10,000 sq. ft. Number of Stories:
Sheet metal work to be completed: New Work: 1 Renovation:
HVAC Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney / Vents Air Balancing
Provide detailed description of work to be done:
OaJ 3 S( ye( \kL)f - 0 o a 661 I) 5 Fs�
e \Aok , Sle0 fie.^ - k - o kc 0.3, MAN+ l t")
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
File # SM- 2012 -0022
APPLICANT /CONTACT PERSON ALL SEASONS HEATING AIR
ADDRESS/PHONE 93 ELM ST (413) 247 -9842
PROPERTY LOCATION 131 MAPLE RIDGE RD
MAP 36 PARCEL 259 001 ZONE SR(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building 'Permit Filled out 1j
Fee Paid t �
Tvpeof Construction: INSTALL DUCT WORK
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 129
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO 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
l 23 (
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.