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.