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32A-135 (16) SM-2023-0012 1 KING ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 32A-135-001 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-2023-0012 PERMISSION IS HEREBY GRANTED TO: Project# INTERIOR FIT OUT Contractor: License: Est. Cost: 20000 JSD MECHANICAL INC Const.Class: Exp.Date: Use Group: Owner: D P HOLDINGS LLC Lot Size (sq.ft.) Zoning: CB Applicant: JSD MECHANICAL INC Applicant Address Phone: Insurance: 43 SHERIDAN ST 4136120145 08WECEK6943 CHICOPEE, MA 01020 ISSUED ON: 03/16/2023 TO PERFORM THE FOLLOWING WORK: HVAC FOR FIT OUT 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: Fees Paid: $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner Commonwealth of Massachusetts City Of Northampton iI MAR 1 6 2023 Sheet Metal Permit OW: Permit# '- .2,3 1 C C)r.rl IIri.!ru;. Estimated Job Cost$ Permit Fee: $ Plans Submitted: YES X NO Plans Reviewed: YES NO Business License# -g4 Applicant License # 5t4q�j Business Information: Property Owner/Job Location Information: Name: JS D me.c n 1iccl Name: .., P n'lor (1.I1 chase, k_. Street: l.I3 ,,-- rl 51' Street: V r15 City/Town: chi LUp.Q-2 City/Town: no(44,a, - Telephone: L u )�j1 Le i 01 -D 1�(S Telephone: Photo I.D. required/ Copy of Photo 1.D. attached: YES X 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. over 10,000 sq. ft. k Number of Stories: D. Sheet metal work to be completed: New Work: Renovation: X HVAC N( Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing X Provide detailed description of work to be done: kiwi-nu to& babiuthicon and �.n.�-&Q�c.Ly , �C- Ds ) -Pans d , co-) d.in sat. pip, 5 , 4I c p►p�h , V�� atetarte) ,'runes .S - st .r,n Q„v, kxtJloy,Cn 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, $100.00 Commercial INSURANCE COVERAGE: I have a current liahility insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes M No❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee dnPc not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waivpsthis requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box❑,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Prngrocc Incpectinns Date. Comments Final IncpPrtinn Date Cmmmentq Type of License: By l Master / Title ❑ Master-Restricted i eL City/Town ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted ��/2 ``�.''�' License Number: Fee$ ❑ Check at www mass dnv/drl 4/ci/ci3 Inspector Signature of Permit Approval • i'-.. #p 7L::+tom :. -..�s. kA4. 8 'WJ651 87 T 'F s 7:7xz-! V: , .7. ' ' 4.1-.-DICKSON iiiii,...1,1r1r. fATI , : _ ZJOIN-STEP1491.' .;), ...--!g.,. :- •.,.!' .„_,Is k,L., ? s. ,' 6 E OOSBAUQW#ItA i 2111374 r,k 1srris BLU ��yg ,' r" 15SEX Ill 16}IGT g'4 \'' f f4-,C 1 ,-' il: _ 5666C17f2019Rel!er 17Dts Li Q4/ 6/5 ' ,.as i5'� ..:i.'�VA�,:4AVeM+ fM.W9 A.d.,X s r g. t • • • p.w.. a• .,14'� 7... : .. ;ate ': O 'MON EA TH •F I. ' A H SE DIVISION OF OCCUPATIONAL LICENSURE BOARD OF _ s SHEET METAL WORKERS ISSUES THE FOLLOWING LICENSE ,, MASTER-UNRESTRICTED 1 1 Z JOHNS DICKSON y ; 145 STONEHILL RD y • E LONGMEADOW, MA 01028-1374 to J 5493 04/28/2024 204249 ' ICENSE NUMBER EXPIRATION OAT SERIAL NUMBER M pF PROFESSIONAL•LICENSURE pIVISION Spp I. ;jj pL I. SHEEt ISSUE THE FOLLO G LIE BUSING S DICKSOH ; ONpI!111 ;INC 15 S TAmEHILL- -.. mix 0 028 EAST LONGMEADOWe 134885 121004CP -- SSERIALSNUMB H' ��-..ip JSDMECH-01 JOCELYN AlC OR0 J DATE(MM/DD/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE 11/11/2022 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 have ADDITIONAL INSURED provisions or 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 NAME CT Jocelyn M Douglas Phillips Insurance Agency,Inc. 97 Center Street (ate No,�): FAX No): Chicopee,MA 01013 nI iss:jocelyn@phillipsInsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Ohio Security Insurance Co 24082 INSURED INSURER B:Ohio Casualty 24074 JSD Mechanical,Inc. INSURER c:The Hartford - 29459 43 Sheridan Street INSURER D:_ Chicopee,MA 01020 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 WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR BKS59086953 3/23/2022 3/23/2023 DAMAGE TO RENTED 300,000 X X PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X 78T LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ ANY AUTO X X BAS59086953 3/23/2022 3/23/2023 BODILY INJURY(Per person) $ _ OWNED ONLY X AUTOSyUyLEED BODILYO INJURYp (Per accident) $ X AUTOS ONLY X AUUTO ONLY (Perr acEciddent)AMAGE $ B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE X X US059086953 3/23/2022 3/23/2023 AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 $ C WORKERS COMPENSATION X PERTUTE TRH_ AND EMPLOYERS'LIABILITY YIN 08WECEK6943 8/23/2022 8/23/2023 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE N NIA X E.L.EACH ACCIDENT _ $ MFFICEtory in ER EXCLUDED? 500,000 andatory in NH) E.L.DISEASE-EA EMPLO"EE $ if yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Equipment Floater BKS59086953 3/23/2022 3/23/2023 Scheduled Equipment 340,000 DESCRIPTION OF OPERATIONS I 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 ACCORDANCE WITH THE POLICY PROVISIONS. 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