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32C-020 (8) Wv d ( , File#SM-2020-0007 j J APPLICANT/CONTACT PERSON M J MORAN ADDRESS/PHONE P O BOX 278 (413)268-7251 PROPERTY LOCATION 21 PLEASANT ST-DOWN TOWN SOUNDS MAP 32C PARCEL 020 001 ZONE CB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Tyaeof Construction:_ADD SUPPLY DUCTS TO 4 NEW LESSON ROOMS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 267 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 from Elm Street Commission Permit DPW Storm Water Management "W"— I ,91� .- 1 Ao / Sig ture of Building Official 06 Daie 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. *Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact the Office of Planning&Development for more information. r . Sheet Metal Permit �] Date: !l Permit# Estimated Job Cost: $ 2 gelo�. ° — Permit Fee*: $ 2 S ' *Permit Fee based on estimated cost of job- $10/$1,000 (or fraction thereof)plus $30 administrative fee –round up to nearest$1,000, divide by 100 and add$30. Plans Submitted: YES NO Plans Reviewed: YES NO Business License# 172 Applicant License# 267 _ Business Information: Property Owner/Job Location Information: / Name: M.J. Moran, Inc _ Name: I)OW4 �w✓1 ")04•t4 s Street: 4 South Main Street Street: ,21 Plecis�..f Sf City/Town: Haydenville, MA City/Town: Telephone: 413-268-7251 Telephone: yl.3 0`r?? Y Photo I.D. required/Copy of Photo I.D. attached: YES NO Staff Initials 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 Retail ✓Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft. ✓over 10,000 sq. ft. Number of Stories: Z Sheet metal work to be completed: New Work: Renovation: L,--- HVAC /HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done–attach additional sheets if necessary: 14)d Sypp[,/ dads fv e/ New Lesso., /too,.•,s SMnspectionAPERNIIT APPLICATION FORMS\Sheet Metal-TOA I.doc - f OAISURAWCE COVERAGE: l have a.current Rialhin insurance policy or its equivalent Which meets the requirements of M.G.L.Ch.112 Yes ❑ 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 IMSURANCE WAIVER:I am aware that the licensee Anes not ha., the insurance coverage required by Chapter 112 of the Massachusetts General taws,and that my signature on this perrnit application wahie this requirement. Check One Only Omer ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this b.A, ,u hereby certifythat all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of any 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 192 of the General Laws. Duct inspection required prior to insulation installation:YES No 7�irIDasn��iftrne�pTtFoanmc Data ommantc i �➢+'ina➢linc�nnrfinn • Data o mento Type of license: By DU Master Title ❑Master-Restricted 10 City/Town _ ❑Journeyperson Permit# Signature-of Licensee❑Journeyperson-Restricted Fee$ License Number; 0?e�57 Check at ma ran m gs p cAn9 lector Signature of Permit Approval L