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32C-159 (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 tiaP-z nn+haves the insurance coverage required by Chapter 112 of the Massachusetts General Laws, and that my signature on this permit application waive 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 Prnarecc TnQpeetionc Dale Comments Eiinal insnP�rfi_nrn Date C nmmantc Type of License: By AWaster r Title ❑ Master-Restricted U City/Town ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted X' 9 i y License Number: Fee$ ❑ Check at-►Hass gnv/rir Inspector Signature of Permit Approval -�'� Commonwealth of Massachusetts JUN 2 0 2oI4 i City Of Northampton Electric,Plumbin &Gas 1 Sheet Metal Permit Northamp A a (yari Permit#5 ry) Iy -o Estimated Job Cost: $ �2z) Permit Fee: $ W. 7 31 Plans Submitted: YES 7& NO Plans Reviewed:' YES NO Business License# Applicant License# a711 Business Information: Property Owner/Job Location Information: Name: Zia c°yfi.. �i`-�-- Name: Tom' % My� Ph Street: S l o& (ZO Street: �t;' ►,C 5/e , I,�- City/Town: City/Town: Q" �tACt Telephone: Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES NO Staff Initial J-1 /O1- nrestricted 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. 1p"', 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 Provide detailed description of work to be done: /C_V 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-2014-0067 APPLICANT/CONTACT PERSON NYZIO HEATING&A/C ADDRESS/PHONE 56B BUCKLEY BLVD (413)534-3320 PROPERTY LOCATION 9-11 KINGSLEY AVE MAP 32C PARCEL 159 001 ZONE URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildinp,Permit Filled out Fee Paid Tyneof Construction: INSTALL DUCTWORK FOR HEATING SYSTEM New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 2711 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOR N 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 om Elm Street Commissio Permit DPW Storm Water Management Signature of Buildi g 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. 9 -11 KINGSLEY AVE SM-2014-0067 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON GIs#: 6627 -- - - Map: 32C Bl°°k:_-- 159 ---- - - SHEETMETAL PERMIT 'Lot- 001 �.._ Permit: —SHEETMETAL Category: SHEETMETAL Permit# SM-2014-006 7 —_ PERMISSION IS HEREB Y GRANTED TO: Project# JS-2014-00205.7_ __ _ IEst.Cost: Contractor: License: Expires: _- - - - — NYZIO HEATING&A/C Sheetmetal-2711 Fee Charged:$25.00 07/28/2014 Balance Due:$.00 Owner: NGUYEN TIMOTHY #of Fixtures _ _ Applicant: NYZIO HEATING&A/C DigSafe# AT: 9-11 KINGSLEY AVE IUseGroup ConstClass ISSUED ON: 23-Jun-2014 AMENDED ON: EXPIRES ON: TO PERFORM THE FOLLOWING WORK: INSTALL DUCTWORK FOR HEATING 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-2014-007245 20-Jun-14 1731 $25.00 212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @northamptonma.gov GeoTMSO 2014 Des Lauriers Municipal Solutions,Inc.