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32A-202 (5) SM- 022-0020 59 PHILLIPS PL COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 32A-202-001 CITY OF NORTHAMPTON Permit: Sheet Metal PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# SM-2022-0020 PERMISSIONIS HEREBY GRANTE I TO: Project# SHEET METAL Contractor: License: WINDSOR SHEET METAL SERVICES Est. Cost: 5000 INC Const.Class: Exp.Date: Use Group: Owner: BERCUVITZ DEBRA Lot Size (sq.ft.) Zoning: URC Applicant: WINDSOR SHEET METAL SERVICES NC Applicant Address Phone: Insurance: 483 SPRING ST 31 WECEL3305 WINDSOR LOCKS, CT 06096 ISSUED ON:09/23/2022 TO PERFORM THE FOLLOWING WORK: REWORK DUCTWORK POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I • ' 1 - CIALIT Fees Paid: S25.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner Commonwealth of Massachusetts City Of Northampton e Date: CI 1 �� Z2 O - Shfte I SEP 2 � 2022 ti� 1J1'erinit. -_ hermit# �/'�~ /Z2o �O Estimated Job Cost: $ 3, 000 P emit Fee: $ AJ Plans Submitted: YES NO ' x P1 s Re/viewed: YES NO r)F•PT*A*1,1SPE,C;TION II Business License# I I 2— ^ n I p_rlic nt .icehse# Business Information: Property Owner/Job Location Information: Name: lJd1J5-ar 5 -f Mttkl Sys 1nc Name: V\CI"5 Thorn_c Street: L'' 3 5tr' oi S4 Street: 9 Pal,1►/i 1— City/Town: ''`85e' -d k S City/Town: nail)owe10 ►Y Telephone: S6 iJ ctI Z- 1 L 2-7 Telephone: _ /13 Off ` ePz Photo I.D. required/Copy of Photo I.D. attached: YES 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 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: 1C- HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: Re wt)111 udC % GLIot K xi, T uv Fees with Building Pe it:$25.00 Re ' ' ,$50.00 Commercial. Fees for jobs without a Building Permit$6.00 per$1000 Mini • ' s without Building Permit$50.00 Residential,$100.00 Commercial INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes D4 No ❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy IS Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee rinPc not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws, and that my signature on this permit application waivPsthis requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box❑,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Date Comments Final IncpPetipn Data Cnmments Type of License: By - - - ®Master Title - — ❑ Master-Restricted City/Town ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted 17� License Number: Fee$ ❑ Check at Inspector Signature of Permit Approval v COMMONWEALTH OF MASSACHUSETTS DIVISION OF OCCUPATIONAL LICENSURE BOARD OF SHEET METAL WORKERS ISSUES THE FOLLOWING LICENSE MASTER-UNRESTRICTED DANIEL M PELKEY z 483 SPRING ST WINDSOR LOCKS,CT 06096-1106 11172 07/28/2024 254812 LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER .4it C)Arl�$ DATE(MM/DD/YYYY) `.- CERTIFICATE OF LIABILITY INSURANCE 09/12/2022 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 SUBROGATIONIS 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 CONTACT NAME: JOHN M GLOVER AGENCY 31802496 PHONE (203)838-5554 FAX PO BOX 700 (A/C,No,Ext): (A/C,No): NORWALK CT 06852 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Hartford Casualty Insurance Company 29424 INSURED INSURER B: Hartford Fire and Its P&C Affiliates 00914 WINDSOR SHEET METAL CORP INSURER C: 483 SPRING ST INSURER D: WINDSOR LOCKS CT 06096-1106 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MM/DD/YYYY) (MM/DD/Y YYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED $300,000 PREMISES(Ea occurrence) _ X General Liability MED EXP(Any one person) $10,000 A 31 SBM IJ4389 01/01/2022 01/01/2023 PERSONAL BADVINJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PRO- )( LOC PRODUCTS-COMP/OP AGG $2,000,000 JECT OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) — ALL OWNED SCHEDULED _ AUTOS _AUTOS BODILY INJURY(Per accident) HIRED NON-OWNED PROPERTY DAMAGE AUTOS AUTOS (Per accident) _ UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- AGGREGATE MADE DEO RETENTION$ WORKERS COMPENSATION x PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY Y/N E.L.EACH ACCIDENT $1,000,000 B PROPRIETOR/PARTNER/EXECUTIVE N/A 31 WEC EL3305 01/01/2022 01/01/2023 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $1,000,000 (Mandatory In NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below EMPLOYMENT PRACTICES Each Claim Limit $5,000 A 31 SBM IJ4389 01/01/2022 01/01/2023 LIABILITY Aggregate A re ate Limit $5,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION Town Of Northhampton Mass SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Business Commissioners Office BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 212 MAIN ST IN ACCORDANCE WITH THE POLICY PROVISIONS. NORTHAMPTON MA 01060 AUTHORIZED REPRESENTATIVE �iceZL7 OI_ C�aZ ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD