23A-070 (7) 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 does not have 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 boxes,t 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 c./ NO
Progress Inspections
Date Comments
Final Inspection
Date Comments
14.1(
Type of License:
By 2<aster
Title ❑ Master-Restricted • 4
City/Town ❑Journeyperson
Signature of Licensee
Permit#
❑Journeyperson-Restricted License Number:
Fee$ ❑
Check at v,ww.mass.ctovldpl
Inspector Signature of Permit Approval
\, `__( _i ir=E Commonwealth of Massachusetts
1 City'
' OCT 3 0 2013
Of Northampton
I __ -J Sheet Metal Permit r.� ]
Electric, Piumbinc ate:in., Fc ioa 4 3 Permit# 5M/ / Pt
Northamptcn, MA 01060
Estimated Job Cost: $ --A. S .1 '`' Permit Fee: $ 0-0,: Pe
Plans Submitted: YES ✓ NO Plans Reviewed: YES NO
Business License# .!;77 A plicantJ.icense# 3o
Business Information:Il roperty wner/Job Location Information:
Name: Val 1 1, (c .f i�ibLit? Name: (1\Jae l vi p c t L-rt X f ►r (.1-04
Street: .7 c Met-L i `jr. Street: D7: E G,4')‘')e.. S.7
City/Town: \-Lt>r cr■ e., City/Town: eh c 12-ee,.
Telephone:
13 777 3 'i / Telephone: 4/3 C3-7 ?Yip
Photo I.D. required/Copy of Photo I.D. attached: YES 1-� NO
Staff Initial
J-1 /unrestricted license
J-2 I 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 i/ 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:
HVAC Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney/Vents Air Balancing c------
Provide detailed description of work to be done:
1
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-2014-0028
APPLICANT/CONTACT PERSON NEW ENGLAND MECHANICAL SERVICES,INC
ADDRESS/PHONE 166 TUNNELL RD (860)871-1111 0
PROPERTY LOCATION 70 MAIN ST-Valley Medical-Florence
MAP 23A PARCEL 070 001 ZONE GB(97)/URB(3)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: HVAC DISTRIBUTION FOR BLDG ADDITION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 306
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ION 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
'r 't from Elm Street Commission Permit DPW Storm Water Management
01017,,,
f( 7/-7-7
. '
Si_ • r:=.uilein. dffi 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.
70 MAIN ST - Valley Medical - Florence SM-2014-0028
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GISp#: 9007 ooAMp,o�
•
Block: -070 --- _ -- ������
� i'�L.:� SHEETMETAL PERMIT
Lot: 001 .
Permit: SHEETMETAL 9 T£RCENTENPRt
Category: SHEETMETAL
Permit# 1sM-2014 0028 PERMISSION IS HEREBY GRANTED TO:
,Project# JS-2013-001342
Est. Cost: $76,500.00 Contractor: License: Expires:
NEW ENGLAND MECHANICAL S Sheetmetal-306
Fee Charged:$50.00 07/28/2015
Balance Due:$.00 Owner: MIDDLE HAMPSHIRE DEV GROUP LLC
I#of Fixtures: Applicant: NEW ENGLAND MECHANICAL SERVICES,INC
DigSafe#
AT: 70 MAIN ST-Valley Medical-Florence
UseGroup
ConstClass
ISSUED ON: 04-Nov-2013 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
HVAC DISTRIBUTION FOR BLDG ADDITION
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-2014-001975 30-Oct-13 1118 $50.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Emailahasbrouck®northamptonma.gov
GeoTMS®2013 Des Lauriers Municipal Solutions,Inc.