17A-054 04/26/2013 01:38PM 5088454823 CONTROL POINT MECH. PAGE 02/02
ACL , CERTIFICATE OF LIABILITY INSURANCE DATEII@IM(DO/YYYY)
12/21/2012
PRODUCER (781)942-2225 FAX (781)942-2226 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Gil bert Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
137 Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Reading, MA 01867-3922
INSURERS AFFORDING COVERAGE NAIC#
INSURED Control—Point Mechanical, Inc. INSURER A: ARBELLA MUTUAL INS. CO. 17000
165 Memorial Drive, Suite F INSURER B: Arbella Protection 41360
Shrewsbury, MA 01545 INSURER C:
INSURER D:
INSURER S:
COVERAGES _
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POuCY 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
I R TYPE OF INSURANCE POLICY NuMR!R DOUCY EFFECTIVE POLICY EXPIRATION
pwre mlumrvvvr pA'�RNM�IVYY1 LIMITS
GENERAL LIABILITY 8500050587 03/28/2012 03/28/2013 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
DgFMLSFS(Fa11raoral $ 100,000
ICLAIMS MADE f X 1 OCCUR MED EXP(Any one person) 5 5,000
A - PERSONAL S Apv INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 2 000 000
X POLICY JECT LOC ' r
AUTOMOBILE LIABILrry 57864400004 03/28/2012 03/28/2013 COMBINED SINGLE LIMIT
J ANY AUTO (EA accident) $
1,000,000
ALL OWNED AUTOS BODILY INJURY
B X SCHEDULED AUTOS (Per person) $
X HIRED AUTOS
-
BODILY INJURY $
X NON-OWNED AUTOS (Perecoident)
PROPERTY DAMAGE $
(Per ecrddant)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO EA ACC g
OTHER THAN _
AUTO ONLY: AGO $
EXCESS/UMBRELLA LIABILITY 4600050591 03/28/2012 03/28/2013 EACH OCCURRENCE $ 3,000,000
OCCUR U CLAIMS MADE AGGREGATC $ 3,000 odd
A $
idDEDUCTIBLE $
RETENTION $ 10,000 $
WORKERS COMPENSATION AND 9118520611 06/29/2012 06/29/2013 lTORSuMrrsf IA
EMPLOYERS'LUIBILITY
A ANY PROPRIETOR/PARTNER/EXECUTIVE E L.EACH ACCIDENT $ 1,000,000
(WINGER/MEMBER EXCLUDED?
EL DISEASE,EA EMPLOYEE $ 1,000,000
If yes Oe antler E.L,DISEASE-POLICY LIMIT $ 1,000,000
_
SPECIAL AL P ROUISIgN$petOw
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Evidence of Coverage
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES.
Evidence of Coverage AUTHORIZEDREPAESENTATIVE
Mark Gilbert, CIC
ACORD 25(2001/08) CACORD CORPORATION 1988
COMMONWEALTH OF MASSACHUSETTS
DIVISION OF PROFES`SIONAI I IGE'NSURE-BOARD OF
SHEET METAL WORKERS
AS A MASTER-UNRESTRICTED
ISSUES THE ABOVE LICENSE TD:
DEREK S MORRISEY a
92 PINEDALE ST *
SOUTHBRIDGE MA 01550-2342
4248 06/28/14 187958
LICENSE NO. EXPIRATION DATE SERIAL NO.
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STREET
V 5 0014t4iNhr A.li3Ni
INSURANCE COVERAGE:
I have a current!lability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes❑ No❑
If you have checked Xas,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 Liman not have the insurance coverage required by Chapter 112 of the
Massachusetts General Laws,and that my signature on this permit application 1lfasthis requirement.
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
By checking this box0,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
Pragrpec lgcrertinnq
Late C'nmments
ji in 91 I nepertinr,
T1211. Comments
Type of License:
By Master
Title 0 Master-Restricted //
_
Cm`/Town ❑Joumeyperson ' LI
Signature of Licensee I l�
f
Permit# ^ I
❑Joumeyperson-Restricted 248
License Number: "1 "i l�
Fee$ ❑
Check at www-mass,g itipl
inspector Signature of Permit Approval
RECEIVED -
1
APR 26 2013 1 Commonwealth of Massachusetts
City Of Northampton
DEPT.OF BUILDING INSFLOTIONS
NORTHAMPTON,MA 01060 1 Sheet Metal Permit
Date: /24h3 Permit# m 13 5-3
coo d
Estimated Job Cost: $ 13,OUO— Permit Fee: $ 19 ill 7,
Plans Submitted: YES NO ( Plans Reviewed: YES NO
Business License# 242. Applicant License# 4248
Business Information: Property Owner/Job Location Information:
Name: _ice-,r c Ic_ o r r _ ;Y- Name: {I0 �a�t c$- ao LA)Artrox,-,
Street: G c, PI r 42 c-Q.L St• (� Street: &.J' U'Rt4A9t. 'R d
„ 9,--, U
City/Town: co..) (}'. �,, d1 1 ,/"4� City/Town: N eir Art°M 1
Telephone: Q 2 8-, S'33 I Telephone:
Photo I.D. required/Copy of Photo I.D. attached: YES NO
Staff Initial
J-1 / 44111itt restricted 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: I
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:
R p lacA duck ci•x),- or 3 sa\A. 0A. 4- 'lc sLuis
- TO•Xv cre. 4 -Mc' (opag,kk cnA a, 2i -L-On fir- WbloA,
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-2013-0053
APPLICANT/CONTACT PERSON DEREK MORRISEY
ADDRESS/PHONE 92 PINEDALE ST (508) 887-5331
PROPERTY LOCATION 165 BRIDGE RD
MAP 17A PARCEL 054 001 ZONE URB(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 /q`fl 0 7 f
lj
� UI
Tvpeof Construction: REPLACE DUCTWORK ON 3 SPLIT HEAT/AC SYS ' //
New Construction �y 4 5
Non Structural interior renovations I/
Addition to Existing / I, ( - Cti
Accessory Structure I �V l• 47(Lit.i
�
Building Plans Included:
Owner/Statement or License 4248
3 sets of Plans/Plot Plan
THE FOLL WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN ATION 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
i' s Elm Street Commission Permit DPW Storm Water Management
M1 d .. _ Ir.■t a P r'
gie s---/-a
Signature o Bui sing Official 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.
165 BRIDGE RD SM-2013-0053
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
't t1AMP"
GIS#: 8824 � oti
Map: 17A
Block: 054
SHEETMETAL PERMIT
Lot: 001r�•
Permit: SHEETMETAL r =R�
4RCEAT iisN
Category: GAS _
Permit# SM-2013-0053 _ PERMISSION IS HEREBY GRANTED TO:
Project# JS-2013-001583
Est.Cost: $13,000.00 Contractor: License: Expires:
Fee Charged:$78.00 DEREK MORRISEY Sheetmetal-4248 06/28/2014
Balance Due:$.00 Owner: NORTHAMPTON CONGREGATION OF JEHOVAH'S WITNESS
#of Fixtures: Applicant: DEREK MORRISEY
DigSafe# AT: 165 BRIDGE RD
UseGroup
ConstClass
ISSUED ON: 01-May-2013 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
REPLACE DUCTWORK ON 3 SPLIT HEAT/AC SYS-line drawing required before final inspection
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-2013-005913 29-Apr-13 1941 $78.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck@northamptonma.gov
GeoTMS®2013 Des Lauriers Municipal Solutions,Inc.