31D-020 (21) INSURANCE COVERAGE:
1 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 [K 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 boxlg,1 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
Progress Inspections
Date Comments
Final Inspection
Date Comments
Type of License:
By ® Master
Title
❑ Master-Restricted
City/Town ❑Journeyperson Jeffrey E. aignault
Permit#
❑Jou rneyperson-Restricted Signature of Licensee
Fee$ License Number: 3810
Check at www.mass.q_ov/dpl
Inspector Signature of Permit Approval
ommonwealth of Massachusetts
Sheet Metal Permit
D e6r 1/'U.3-4 Permit# 6M'�T
Estimated Job Cost: $ 6 0, 0 00.0 0 Permit Fee: $ /6_q o?1 j
Plans Submitted: YES NO Plans Reviewed: YES NO
Business License# 128 Applicant License# 3810
Business Information: Property Owner/Job Location Information:
Name: Adams Plumbing & Heating, Inc. Name: Smith College - New Health services Bldg.
Street: 65 Printworks Dr. (P.O. Box 126) Street: Belmont Avenue
City/Town: Adams City/Town: Northampton
Telephone: 413-743-2308 Telephone:
Photo I.D. required/ Copy of Photo I.D. attached: YES X 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 Multi-family Condo /Townhouses Other
Commercial: Office x Retail Industrial Educational
Institutional Other
Square Footage: under 10,000 sq. ft. over 10,000 sq. ft. x Number of Stories: 2
Sheet metal work to be completed: New Work: x Renovation:
HVAC x Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney/Vents Air Balancing
Provide detailed description of work to be done:
Provide complete HVAC sheet metal system for heat, fresh air, and
exhausting of air.
File#SM-2014-0043
APPLICANT/CONTACT PERSON ADAMS PLUMBING&HEATING INC
ADDRESS/PHONE P O BOX 126 (413)743-2308
PROPERTY LOCATION 21 BELMONT AVE-WELLNESS&HEALTH CENTER
MAP 3 I PARCEL 020 001 ZONE EU(98)/URC(85)/RR(28)/WP(27,/)FFR(16V
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
wo
Building Permit Filled out
Fee Paid
Typeof Construction: PROVIDE COMPLETE HVAC SHEETMETAL SYSTEM
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building;Plans Included:
Owner/Statement or License 3810
3 sets of Plans/Plot Plan
THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF 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
Permit fr EIm Street Commission Permit DPW Storm Water Management
atu of uilding Official 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.
21 BELMONT AVE WELLNESS & HEALTH CEN SM-2014-0043
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
9646 2
Map: 31 1)
Block: SHEETMETAL PERMIT
Lot: ,001 ••
,Permit: ,SHEETMETAL
i
Category: SHEETMETAL
Permit# s 20 -0043 __ I PERMISSION IS HEREBY GRANTED TO:
Project# �JS- -14-2014-000267
Est.Cost: $60,000.00 ;Contractor: License: Expires:
Fee Charged: ADAMS PLUMBING&HEATING ISheetmetal-3810 07/28/2014
jBalance Due:i,$.00 Owner: SMITH COLLEGE OFFICE OF TREASURER
#of Fixtures! 'Applicant: ADAMS PLUMBING&HEATING INC
DigSafe# AT. 21 BELMONT AVE-WELLNESS&HEALTH CENTER
UseGroup
ConstClass
ISSUED ON: 27-Jan-2014 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
PROVIDE COMPLETE HVAC SHEETMETAL SYSTEM
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-2014-003258 27-Jan-14 159212 $50.00
212 Main Street,Phone:(413)587-1240,Fax-.(413)587-1272,Email:Ihasbrouck @ northamptonma.gov
GeoTMS®2014 Des Lauriers Municipal Solutions,Inc.