17A-255 (2) INSURANCE COVERAGE:
1 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 t type of coverage by checking the appropriate box below:
A liability insurance policy Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: 1 am aware that the licensee rinPc not haves the insurance coverage required by Chapter 112 of the
Massachusetts General Laws, and that my signature on this permit application waivRcthis requirement.
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
By checking this boxO, 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
PrngrPes Tnirwctions
.Date Comments
Final Jneppctinn
Date. Comments
Type icense:
By Master
Title ❑ Master - Restricted 9
City/Town ❑joumeyperson
Signature of Licensee
Permit # 7'
nourneyperson- Restricted
(5-0 /
License Number:
Fee $
Check at www macs gnv /rfpi
Inspector Signature of Permit Approval
of imonwealth of Massachusetts
SEP i 3 2012 City Of Northampton
s GINSPECTIONS Q
• °F -�� Sheet Metal Permit Permit # o 13- 1 /
3
Estimated Job Cost: $ de Permit Fe $ ` .42' ' °G
Plans Submitted: YES t/ NO Plans Reviewed: YES NO
Business License # Applicant License #
Business Information: Property Owner / Job Location Information:
Name: T O AS Name: 6<4/717 f / �if,2f
Street: 6 f e f7Vi✓ T L Street: /.2 / '`O4� &r
City /Town: c231
A� _ , r/4 , f City /Town: " /0?f^/Ce .
Telephone: y /Y.' 3Z- Telephone: / 1,'_ 3.�5 — 4, / 8
Photo I.D. required / Copy of Photo I.D. attached: YES NO
Staff Initial
J -1 / -1- 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 sq. ft. 17over 10,000 sq. ft. Number of Stories: 2_
Sheet metal work t be completed: New Work: V Renovation:
HVAC Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney / Vents Air Balancing
Provide detailed description of work to be done:
/ „s .berm 6.1k1 4 ,z �v t,s
,y 7TWo 0/1,e "‘f 04,v) 4,✓
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- 2013 -0019
APPLICANT /CONTACT PERSON POWERS AIR
ADDRESS/PHONE 68 HAMILTON DR (413) 539 -7032
PROPERTY LOCATION 121 OAK ST
MAP 17A PARCEL 255 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out .] 4 /)
Fee Paid V
Typeof Construction: INSALL GAS FIRED FURNACE W/2 ZONES
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 504
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFQRMATION 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
V P/12—
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.
121 OAK ST SM- 2013 -0019
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS #: 1563 " "
IMap 17A
Block: 255 � ,.� - SHEETMETAL PERMIT
Lot. OO]����a
IPermit: SHEETMETAL
NENTENP-
Category: SHEETMETAL
Permit # SM- 2013 -0019 FERMISSION IS HEREBY GRANTED TO:
Project # JS -2012- 001800
Est. Cost: $3,000.00 Contractor: License: Expires:
Fee Charged: $25.00 POWERS AIR Sheetmetal - 504 02/28/2014
Balance Due: $.00 Owner: ITTERLY KATHLEEN C
[# of Fixtures: Applicant: POWERS AIR
DigSafe # AT: 121 OAK ST
UseGroup
ConstClass
ISSUED ON: 18- Sep -2012 AMENDED ON: EXPIRES ON:
T ERFORM THE FOLLOWING WORK:
IN LL GAS FIRED FURNACE W/2 ZONES
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
Fixtures:
Floor: Type: # of Fixtures Floor: Type: # of Fixtures
Fee Type: Receipt No: Date Paid: Check No: Amount:
Sheetmetal REC- 2013 - 001087 14- Sep -12 3301 $25.00
212 Main Street, Phone:(413) 587 -1240, Fax:(413) 587 -1272, Email :Ihasbrouck @northamptonma.gov
GeoTMS® 2012 Des Lauriers Municipal Solutions, Inc.