17C-214 (4) INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yet4 No❑
If you have checked Yes,indicate the type of coverage by checking the appropriate box below:
A liability insurance poll Other type of indemnity El Bond ❑
OWNER'S INSURANCE WAIVER:I am aware that the licensee stnac not halm the insurance coverage required by Chapter 112 of the
Massachusetts General Laws,and that ature on this permit application.maims this requirement.
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
By checking this boxD,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
prngrpsc Incpectinns
bate (''nmments
Final Inc ectinn
Date (Comments
Type of License:
By ❑Master
Title ❑Master-Restricted
City/Town ❑Joumeyperson
Signature of Licensee
Permit#
❑Joumeyperson-Restricted
License Number:
Fee$ o
Check at www mace anv/dpi
Inspector Signature of Permit Approval
RECEIVED Commonwealth of Massachusetts
7-77-1viton 5 2013 City Of Northampton
Date:, ,`" / : ,:1-611 s Sheet Metal Permit Permit
Estimated Job Cost: $ 7 , Permit Fee: $ 30?8d 4/00
Plans Submitted: YES )( NO Plans Reviewed: YES NO
Business License# r ( Applicant License# �! J I
Business Information: Property Owner/Job Location Information:
Name: Z:1//s/Z,-/o Name: —�
Street: „)$/ /<'C.;,: , ( , 1)/ Street: ?y /�L r , —cm-
City/Town: ( s ,_ V /7/k% J/14. City/Town: :r''k . ,r c 7%/;
Telephone: (//f-56 Telephone: (/ i - 7 .I r 5.
Photo I.D. required/Copy of Photo I.D. attached: YES NO
_ Sta ff Initial
-1-rmrestricted 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. 4, over 10,000 sq. ft. Number of Stories:
Sheet metal work to be completed: New Work: Renovation:
mv_HVAC Metal Watershed Roofing Kitchen Exhaust Syste
Metal Chimney/Vents Air Balancing
Provide detailed description of work to be done:
rt
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-2013-0057
APPLICANT/CONTACT PERSON ALLSTATE HOOD&DUCT INC
ADDRESS/PHONE 24 MAINLINE DR (413)568-4663
PROPERTY LOCATION 99 MAIN ST-SILK CITY TAVERN
MAP 17C PARCEL 214 001 ZONE GB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out �� pre)Fee Paid 1l
Typeof Construction: NEW 6'HOOD
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 25011
3 sets of Plans/Plot Plan
THE FOL ING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
pproved 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
' lm Street Commission Permit DPW Storm Water Management
Ae,
, / S /� i Si• �re— :of .m! •ffic' /
. 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.
99 MAIN ST - SILK CITY TAVERN SM-2013-0057
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS#: 8848 oaSHAMP,O
Map 17C :''?��
,Block: 214 �� SHEETMETAL PERMIT
Lot: ,001
Permit: ;SHEETMETAL v T£RCENiENj`�6
Category: 1HOOD EXHAUST SYST
Permit# ISM-2013-0057 PERMISSION IS HEREBY GRANTED TO:
Project# J5-2013-001809
Est.Cost: $7,000.00 Contractor: License: Expires:
— _- ALLSTATE HOOD&DUCT INC Sheetmetal-25011
!Fee Charged:;$1 00.00 12/28/2013
Balance Due:$.00 Owner: FLORENCE FAMILY ENTERPRISES LLC
#of Fixtures: Applicant: ALLSTATE HOOD&DUCT INC
DigSafe# AT: 99 MAIN ST-SILK CITY TAVERN
UseGroup
ConstClass
ISSUED ON: 16-May-2013 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
NEW 6'HOOD
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-2013-006269 15-May-13 3280 $100.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @northamptonma.gov
GeoTMS®2013 Des Lauriers Municipal Solutions,Inc.