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31A-167 78 MAYNARD RD SM-2021-0041 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON GIS#: 5776 Map: 31 A Block: 167 SHEETMETAL PERMIT Lot: 001 `"•� Permit: SHEETMETAL _ __. fRCENTENpR Category: SHEETMETAL Permit# SM-2021-0041 PERMISSION IS HEREBY GRANTED TO: Project# JS-2020-000266 Est.Cost: $50,000.00 Contractor: License: Expires: Fee Charged:$25.00 RK SOLUTIONS Sheetmetal-5644 09/28/2022 Balance Due:$.00 Owner: RUDOLPH MARTA #of Fixtures:1 Applicant: RK SOLUTIONS DigSafe# AT: 78 MAYNARD RD UseGroup ConstC lass ISSUED ON: 23-Apr-2021 AMENDED ON: EXPIRES ON: TO PERFORM THE FOLLOWING WORK: NEW HVAC THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signat ( • at , Q)"r Fee Type: Receipt No: Date Paid: Check No: Amount: Sheetmetal REC-2021-003255 22-Apr-2I 6023 $25.00 212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck(a)north:un pion ma. oN GeoTMS®2021 Des Lauriers Municipal Solutions,Inc. Commonwealth of Massachusetts City Of Northampton Date: 3 - I S Z` Sheet Metal Pertui Permit#Srn-a./w'f/ APy (92 Estimated Job cost: $ �0 Y rmit'Fee: $ "ram Plans Submitted: YES NO 4 7,,'^ ;,`a.Planstfteviewed: YES NO tusiness License#_Si) aopaa. Appili I License# J t vy ` r Business Information: Property Owner/Job Location Information: -IR Name: c 0 L V T\D1-1/4-5- Name: L 4k Street: l' ©. o Street: 7 9 MAY it) '`-> City/Town: A GiN jin City/Town: xl Q IZT-14A-Nte Telephone: 405 - 3 74 - /500 Telephone: Photo I.D. required/ Copy of Photo I.D. attached: YES NO Staff Initial J-1 /SI 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: Sheet metal work to be completed: New Work: X Renovation: HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: )I 3 }- VAc s �p1 S ���z� - 3 'Z oiiT s kc%4 ±- Oo 0 /04 9 w 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, $100.00 Commercial INSURANCE COVERAGE: I have a current Jiahihty insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes.R1 No ❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy 9, Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee,rope not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waivPsthis requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box❑,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Progrees InCpPctiunC D:�P L� rrnarnputs Final inspection Date Comments Type of License: ByMaster Title ❑ Master-Restricted City/Town ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted License Number: Fee$ ❑ Check at 5)4e5f av� Inspector Signature of Permit Approval RKSOL-1 OP ID: BR '4L v�z1-1P CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) �--� 03/05/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAMEACT John Eagan LeBel/Lavigne&Deady PHONE FAX Insurance Agency, Inc. (NC,No,Ext):413-532-3291 (AJC,No):413-534-8982 637 Grattan Street/PO Box 59 E-MAIL Chicopee, MA 01 0 21-005 9 ADDRESS: John A O'Keefe INSURER(S)AFFORDING COVERAGE NAIC INSURER A:Arbella Protection Ins. Co. 41360 INSURED R K Solutions of Western Mass. INSURERB: Keith A. David, Sr. PO BOX 262 INSURER C: _ Agawam, MA 01001 INSURER D: INSURER E: INSURER F: _ COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD AND POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 8500046810 04/20/2020 04/20/2021 DAMAGE TO RENTED 300 000 PREMISES(Ea occurrence) $ , MED EXP(Any one person) $ 5,000 X EPL,addl insd,e PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY JERCOT- LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A ANY AUTO 1020000964 06/19/2020 06/19/2021 BODILY INJURY(Per person) $ ALL OWNED X .SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NAIJ QOWNED Pp OPERA DAMAGE $ ent) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ A EXCESS LIAB CLAIMS-MADE 4600065634 04/20/2020 04/20/2021 AGGREGATE $ 1,000,000 DEO X RETENTION$ 10,000 $ WORKERS COMPENSATION PER 0TH- AND EMPLOYERS'LIABILITY STATUTE ER Y 1 N A ANY PROPRIETOR/PARTNEPIEXECUTIVE 4220050268 02/20/2020 02/20/2021 EL.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N 1 A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS!LOCATIONS[VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN RK Solutions ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE John A O'Keefe ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD