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23D-061 (3) INSURANCE COVERAGE: I 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 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 rInPQ not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws, and that my signature on this permit application waivesthis requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner'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 Progrecs Tncpectionc Date comments Final Tncpertion lute Comments Type of License: By ❑Master Title ❑Master-Restricted City/Town ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted License Number: Fee$ ❑ Check at www macs rgnv/rid►( Inspector Signature of Permit Approval it JUN I r 2043 Commonwealth of Massachusetts FUN I 1 2013 City Of Northampton DEPT.OF BUILDING INSPECTIONS NORTHAMPTON,MAO $60 Sheet Metal Permit *5//' J `'f Date: , Permit Estimated Job Cost: $ 0:200_0 Permit Fee: $/OO ?- 04 ,Plans Submitted: YES NO /�C Plans Reviewed: YES NO K Business License# (Aa83 Applicant License# Business Information:/ Property Owner/Job Location Information: Name: ,4d1 S P/v A 1y vi-� Name: Do„.4, D Street:?6 30 7 Street: 6 L Ib4),4-/e 4' .s;da) City/Town: 7;�, „z/ City/Town: /g,e-/ ,,26,74-1% Telephone: S'/J- 030 3 Telephone: 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 /x Multi-family Condo/Townhouses Other Office Commercial: Office Retail Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft. over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: K- HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: 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-2013-0067 APPLICANT/CONTACT PERSON PAUL'S PLG&HTG ADDRESS/PHONE P 0 BOX 303 (413)238-0303 PROPERTY LOCATION 18 LONSDALE AVE MAP 23D PARCEL 061 001 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 /ea a 9 O' Fee Paid Typeof Construction: REDO 2ND FLR TRUNK FOR 2 ROOMS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 12283 3 sets of Plans/Plot Plan THE LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF RMATION 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 Permi from Elm Street Commission Permit DPW Storm Water Management 5 irr7 r 6 -N ‘4 3 Signature of Bu' ding 0 ial 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. 18 LONSDALE AVE SM-2013-0067 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON GIS#: 1220 HAMP ry 1Map: 23D Block: 061 ' 5 ' SHEETMETAL PERMIT iLot. 001 � I%� ,- Permit: ;SHEETMETAL '� `�ENp Category: SHEETMETAL Permit# SM-2013-0067 PERMISSION IS HEREBY GRANTED TO: Project# JS-2013-001772 Est. Cost: $200.00 Contractor: License: Expires: Fee Charged:$25.00 PAUL'S PLG&HTG Sheetmetal- 12283 11/28/2014 !Balance Due:$.00 Owner: MACDONALD CATHERINE M&CHARLOTTE ANN CAPOGNA&J KI C#of Fixtures: Applicant: PAUL'S PLG&HTG 1DigSafe# AT: 18 LONSDALE AVE [UseGroup ConstClass ISSUED ON: 19-Jun-2013 AMENDED ON: EXPIRES ON: TO PERFORM THE FOLLOWING WORK: REDO 2ND FLR TRUNK FOR 2 ROOMS 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-2013-006713 17-Jun-13 10022 $25.00 212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck®northamptonma.gov GeoTMS®2013 Des Lauriers Municipal Solutions,Inc.