10B-002 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 MOPS not haves the insurance coverage required by Chapter 112 of the
Massachusetts General Laws, and that my signature on this permit application waives this 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
PrzgressInspections
Date Comments
Final incpirtinty
Date Comments
Type of License:
By N.Master ,,++
Title ❑ Master-Restricted r\� . 64eDiv\,■
City/Town ❑Journeyperson Signature of Licensee
Permit# -- ❑Journeyperson-Restricted
License Number: S 1
Fee$ __ _ ❑
— — Check at www mast gnv/ripl
Inspector Signature of Permit Approval
°` `E,D
i
I Commonwealth of Massachusetts
1 AUG - 9 Zpp City Of Northampton
e i ,: IN CTI•
N�_, �,F .N r �," — _ o�3 Sheet Metal Permit Permit# 5172-19— /1
Estimated Job Cost: $
Permit Fee: $ J le
DSO a�-�°
Plans Submitted: YES NO X Plans Reviewed: YES NO
Business License# Applicant License# sj G i 3
Business Information: Property Owner/Job Location Information:
pOfscti T. Ev+1+- c
Name: D C3A A- CovScWiacT;v-,1 Name: P\LN\--) E v lltiS
Street: i‘2 iV 30r- Al..) Street: \\a. 60 b<-7 o0-) -M)
City/Town: LitSb ,_P A 01.C2 3 City/Town: (....(1 I i PPP c> toe 3
Telephone: LA t3 S ak)- S 193 Telephone: ¼\3 8 ' t 8 8 3
Photo I.D. required/ Copy of Photo I.D. attached: YES NO
Staff Initial
J-1 /O''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. X over 10,000 sq. ft. Number of Stories: Q,
Sheet metal work to be completed: New Work: Renovation:
HVAC Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney/ Vents-X Air Balancing
Provide detailed description of work to be done: -{
IM\ UL L:S\eO S`liz,v∎\es iL�"-\€
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-2014-0011 f�'
APPLICANT/CONTACT PERSON ALAN J EVANS ' NNN "'"""
ADDRESS/PHONE 112 AUDUBON RD (413)586-5183
\leJ PROPERTY LOCATION 112 AUDUBON RD �
MAP 10B PARCEL 002 001 ZONE RR(100)/
THIS SECTION FOR OFFICIAL USE ONLY: rfl
PERMIT APPLICATION CHECKLIST V
ENCLOSED REQUIRE DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out �1 ""�
Fee Paid 353 o6
Typeof Construction: INSTALL CHIMNEY LINER
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 5673
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION 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
'00p2,Elm S S.eet Co •'ssion Permit DPW Storm Water Management
API,
lafP"
P--/,
Sig ire o Building Officia" 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.
112 AUDUBON RD SM-2014-0011
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GI5#: 480
CMap_ 10B
Block: 002 /51,r7=50
SHEETMETAL PERMIT
Lot: 001 ► -�� r,. SHEE
Permit: SHEETMETAL rEe�EN_
Category: SHEETMETAL
Permit# SM-2014-0011 _ PERMISSION IS HEREBY GRANTED TO:
Project# JS-2014-000290
Est. Cost: $450.00 Contractor: License: Expires:
Fee Charged:$25.00 ALAN J EVANS Sheetmetal-5673
Balance Due:$.00 Owner: EVANS ALAN J
#of Fixtures: Applicant: ALAN J EVANS
[DigSafe# AT: 112 AUDUBON RD
'UseGroup
IConstClass
ISSUED ON: 13-Aug-2013 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
INSTALL CHIMNEY LINER-*NEED LITERATURE ON UL PIPE*
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-2014-000649 12-Aug-13 3536 $25.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @northamptonma.gov
GeoTMS®2013 Des Lauriers Municipal Solutions,Inc.