23D-064 (6) INSURANCE COVERAGE:
I have a current Iiahility insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes ❑ No ❑
If you have checked Yss, 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 rtnpc not have the insurance coverage required by Chapter 112 of the
Massachusetts General Laws, and that my signature on this permit application waivPsthis 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 1 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 Jnsrprtions
Date Cnmrnent
Final Incppetinrt
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 rgnv /rirl
Inspector Signature of Permit Approval
Commonwealth of Massachusetts
City Of Northampton
Date: 1-2-`1'-13 Sheet Metal Permit Permit # 3 %/ l
,
Estimated Job Cost: $ 06 Permit Fee: $ 13 `�
Plans Submitted: YES NO V Plans Reviewed: YES NO
Business License # 1- /Q Applicant License #
Business Information: Property Owner / Job Location Information:
Name: J l'ie Ai ri, j Name: _..l Are ci AP
Street: 3( Street: /10 A) /t7 Q v z
City /Town:' S h f} ip Y\ CXd City /Town: Vo feAI c J P 0/06 2
Telephone: ILI /3 ) / 6 o ;9 S Telephone: SO/-/— 'i' O
Photo I.D. required / Copy of Photo I.D. attached: YES NO
Staff Initial
J -1 / M -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: Office Retail Industrial Educational
Institutional Other
Square Footage: under 10,000 sq. ft. 7 over 10,000 sq. ft. Number of Stories:
Sheet metal work to be completed: New Work: Renovation: l-
HVAC ✓ Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney / Vents Air Balancing
Provide detailed description of work to be done:
5ecot'
fr AL Puce, ]% 05 1- 1 vN lr
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
A,,
File # SM- 2013 -0041
APPLICANT /CONTACT PERSON TIN MAN HEATING AND AIR COND
ADDRESS/PHONE 38 SPRING ST (413) 527 -7722
PROPERTY LOCATION 40 NUTTING AVE
MAP 23D PARCEL 064 001 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
Fee Paid /3 L I
Tvpeof Construction: 2ND FLR AC DUCT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 4043
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO;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
' i. •� E S - et Co ssion Permit DPW Storm Water Management
2
� / / 7 5 : /Y
- Buil�m• O ici. 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.
40 NUTTING AVE SM- 2013 -0041
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
[GIs #: 3223
Map: 23D
jL SHEETMETAL PERMIT
Permit: SHEETMETAL
Category: SHEETMETAL
Permit # sM- 2013 -0041 PERMISSION IS HEREBY GRANTED TO:
(Project # JS- 2012 - 001986
[Est. Cost: $2,200.00 Contractor: License: Expires:
Fee Charged: $25.00 TIN MAN HEATING AND AIR CO Sheetmetal - 4043
Balance Due: $.00 Owner: KAJKA JARED A
# of Fixtures: Applicant: TIN MAN HEATING AND AIR COND
DigSafe # AT: 40 NUTTING AVE
UseGroup —
ConstClass
ISSUED ON: 20- Feb -2013 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
2ND FLR AC DUCT
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- 2013- 003388 14- Feb -13 1345 $25.00
212 Main Street, Phone:(413) 587 -1240, Fax:(413) 587 -1272, Email :lhasbrouck @northamptonma.gov
GeoTMS® 2013 Des Lauriers Municipal Solutions, Inc.