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23B-011 (4) 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 $1 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee dnp-.not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waive this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box❑,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Progress inspections .Date, commew; l inal TnQyecct^nn Dale Type of License: By ❑ Master Title ❑ Master-Restricted City/Town ❑Journeyperson Sig a of censee Permit# rn lay ❑Joueyperson-Restricted License Number: Fee$ ❑ Check at www mass_g v� /dol Inspector Signature of Permit Approval Commonwealth of Massachusetts UAJ o City Of Northampton > N LIJ? IJate: ,�-\-7 o`�O 15 Sheet Metal Permit Permit# 51n ^l� W i X Esjimated Job Cost: $ D Permit Fee: $ b Pl�ns Submitted: YES NO Plans Reviewed: YES NO Business License# Applicant License# OA9 Business Information: Property Owner/Job Location Information:�p Name: 0M `ate° Ka c �C Name: 1)m, P@t �c�TC c 5 Street:9Z r\Y"1 D� Street: \ate City/Town: 1�A��C NAA City/Town: Telephone: ��—�y��� t�� Telephone: 41,3 ?lD Photo I.D. required/Copy of Photo I.D. attached: YES NO Staff Initial J-1 �-lnrestricted 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_X1 Retail Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft. —X— over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: HVAC X Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: s�'i V c, C%,- [ L n� -`O g 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-2016-0021 APPLICANT/CONTACT PERSON ALL SEASONS HEATING AIR ADDRESS/PHONE 93 ELM ST (413)247-9842 PROPERTY LOCATION 193 LOCUST ST-NORTHAMPTON AREA PEDIATRICS MAP 23B PARCEL 011 001 ZONE SI(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid IV5 Building Permit Filled out Fee Paid Typeof Construction: HVAC DUCTWORK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 129 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ION 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 fro Elm Street Co is ' Permit DPW Storm Water Management �4T u ildirelYflcial 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. 193 LOCUST ST - NORTHAMPTON AREA PEDIA SM-2016-0021 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON GIS#: 9082 Map: 23B Block: Oil SHEETMETAL PERMIT Lot: 001 Permit: _ SHEETMETAL Category SHEETMETAL Permit# SM-2016-0021 PERMISSION IS HEREBY GRANTED TO: Froj ect -- 6- —# 7S 2016-00021 7_ Est. Cost $6,450.00 Contractor: License: Expires: Fee Charged:$50.00 ALL SEASONS HEATING AIR Sheetmetal- 129 -_ 0 --- Balance Due:S.00 Owner: 193 LOCUST ST ASSOCIATES LLP #of Fixtures 'Applicant: ALL SEASONS HEATING AIR DigSafe# AT. 193 LOCUST ST-NORTHAMPTON AREA PEDIATRICS UseGroup ConstClass ISSUED ON. 19-Nov-2015 AMENDED ON: EXPIRES ON.- TO PERFORM THE FOLLOWING WORK: HVAC DUCTWORK 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-2016-002265 18-Nov-15 1240 $50.00 212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @northamptonma.gov GeoTMS®2015 Des Lauriers Municipal Solutions,Inc.