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31D-142 (2) ACOiRa CERTIFICATE OF LIABILITY INSUFIANCE 3/DATE 4/2015 THIS CERTIFICATE L4 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGh-rS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEN, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BB-OW. THIS CERTIFICATE OF 9SURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPIiE9ENTATiVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate hoidW Is an ADDMONIt INSURED,the Poliey(res)must be endorsed. H SUBROGATION IS WAIVED,subject to tiM brass and condBbns of the policy,certetn PClfefes may regldre an endorsement. A statement on Lt1is certificate does not confer rights to the Certifksts 1loldsr In Neu of such endorsement(s). PRODUCER A a 8 INSURANCE W=p, LLC NAME:WE AX 239 Littleton Rd Suite 48 Et, (978)399-0025 1FArC. :(978)399-0079 Westford, NA 01886 'HESS°'®ady�abinsgr°w•Gasp AlFOROp16 COVERAGE NAIL, INSURER A:Acadia Insurance Company INSURED Allstate Hood and Duct Inc INSURER 6: 24 Main Line Drive INSURER C: Westfield, MA 01085 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE B O E INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CCLVDrrION OF OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, DCCLuslo S AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE ADM RIM VAM SUM POLICY NUMBER Ma.W LIMITS X 0011110CIAL GENOUL UA8LffY EACH OCCURRENCE E 1,000,000 AIMS-MADE ®OCCUR PREMISEs(Ea=roncee) a 300,000 WED EXP(Any one person) $ 10,0 00 A ADV 5175923 10/g/1410/6/1 PERSONAL&ADV INJURY $ 1,000,000 GEWL AGGREGATE LIMIT APPLIES PER " GENERAL AGGREGATE s 2,000,000 PD'JCT®1M ❑LOO PROOUCrs-comp/op ACG s 2,000,000 oOTHER: $ AUTOMOBILE LIABILITY Ea acudern s 1,000,000 ANYAUro 10/6/15 BODILY INJURY(Per person) $ ALL DINNED SCHEDULED AAA 5181274 12/21/1,1 A AUTOS X AUTOS BODILY INJURY(Per nodent) S X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per acdderd 5 S UMBRELLA UAB R 'OCCUR Ax EXCESS =A 5190537 2/10/1 10/6/15 EACH OCCURRENCE s 2,000,000 CLAIMS-MADE AGGREGATE $ 2,000,000 IDEDI 1RETENT;ONS $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY YIN STATUE ER ANY MWINEYOWPARMEWBOSOLMVe EL EACH ACCIDENT !$ OPFICBRIABNER E%CUME,Y! N/A tYyrrebs�laV~ ❑ EL DISEASE-EA EMPLO $ DESCRIPTION-04FWOPEMIIOW beW. E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES 101, itionaJ Remarks SchedUo,may be e)1aj ed a more space is required) Certificate holder is listed 'tional insured as per written contract. Seating or Combined Seat' Conditioning Systems or EQuiputent - dealers or distributors r- and installation seric Q duct system installation. CERTIFICATE HOLDER CANCELLATION Allstate good and Duct Inc SHOULD ANY OF THE ABOVE DESC POLICIES BE CANCELLED BEFORE 2d !lain Line Drive THE EXPIRATION DATE TH CE WILL BE DELVERED IN ACCORDANCE WITH THE POU ISI , Westfield, NA 01085 AUTHORI7ED REPRESEI, A i i ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD25(2014101) The ACORD dame and bgo are registered marks of ACORU OATEIMVODM`YY') c CERTIFICATE OF LIABIUTY INSURANCE 3/2/2015 THai CERMWATE IS ISSUED AS A NATTER OF INFORMATION ONLY AND CONFERS NO R11IRM UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICES 6ELOW. THIS CERTIFICATE OF 1114SURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERSI, AUTHORIZED Rt8'RI~4ENfATNfE OR PRODUCER,AND THE CERTIFICATE HOLDER. ■IPORTANT: 99w oarlM- I h-Ids►is an ADDITIONAL INSURED,Ow poacyon)wAM tw entiors-d. a SUBROGATION IS WANED,sUbjW to the t-ttat wd cwdNbm of dw POW,CslI I Pdw"sap/ngwm an w dorssmeft A statement on this cortiftate doss not confer rlghm to the awaaeab b~to a"of srei► } PRODUCER NAME Moyer Insurance ME 413-203-5190 1 tA.m,)413-2035183 186 Northampton St Suite E Eaat�taaeptoss, M 01027 Ess era Nan fares-famil .caNa NOW ERk AFFORDING CONHMOE PA CO INSURER Farm Family CaSU&lt INBUFMO All State Hood and Duct Inc INSURER s 24 Mainline Dr INSURER C Westfield, MA 01085-3314 INSURER 0 413-566-4663 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO GERM 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 WFACH 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 SHONIN MAY HAVE BEEN REDUCED BY PAID CLAM, L" TYPE OF INSURANCE MrIG POLICY K*AKR DOrYYYY UNITS csNrBc7II.61I11INAL LVAL" EACH OCCURRENCE S gJdM81YN w F7 OCCUR PROASES OO nM f MED EXP(Ary am parson) $ PERSONAL 3 ADY INJURY S GENT.AGGREGATE LIMIT APPLIES PER: " GENERAL AGGREGATE I POLICY D J F LOC PRODUCTS.COhWIOP AGG S OTHER = AUTOMOBILE LIABILITY L EI:s dark = ANYAUTO BODILY INJURY(Pw Pam") _ AL ALL OVMBO g SCHISMArED 8WILY*WRY(Per awd t) =APED HIED AUTOS amkwt = 3 UTAII1119 A LOS HCCCUR EACH OCCURRENCE S EXCESS LIAa CLAIMS-MADE AGGREGATE t OED IE'T@InON i = WORDS CNSAT(ON NOEMPL LtABILIT'Y VIN 2/10/2015 02/10/2016 STATUTE ER ANY 2001W7559 E.L EACH ACCIOENT = 500,000 A olwcEm ®NIA py�e�„e�IRpNp SL OMEASE-EA EMPt S 500,000 ode IDESC IP OF OPERATONS bWw E.L.DISEASE-POLICY LIMIT S 500,000 nF3f-1RIPTION of OPERATIONS I LOCATIONS I VEHICLES(ACORn 101.Addih"Remarks SOva ft.may be Macdad a mac spa=n'Mumd) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE G THE EXPIRATION DATE THEREOF. NOTICE WILL BE OELrVERED IN ACCORDANCE WITH THE POLICY PRDVISIONS. AU 7HORIZEO REPRESENTATIVE el 5WA13ACORDCOPPOFtATION. Ail rights reserved. ACORD23(2013M4). The ACORD name and logo are mgi!stered marks of ACORD e u� Y Vj ALLSTATE • • r : DUCT, 24 MAINLINE DRIVE WESTFIELD,MA 01085 OFFICE:413-568-4663 FAX:413-568-4665 DATE: To Whom it May Concern, I,Todd Duval,am allowing 1 A, T I I /�-�� To use my license, to pull a permit for the new hood system going into -f located at: Please call with any questions or concerns. Thanko , Todd Duval INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes pNo❑ If you have checked Yes,indicate t 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 does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only l 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 Progress Inspections Date Comments Final Inspection Date Comments Type of License: By ❑ Master Title ❑ Ma ter-Restricted CitylTown Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted License Number:3501 Fee$ ❑ Check at www.mass.gov/dpi Inspector Signature of Permit Approval File# SM-2016-0010 APPLICANT/CONTACT PERSON ALLSTATE HOOD&DUCT INC ADDRESS/PHONE 24 MAINLINE DR (413)568-4663 PROPERTY LOCATION 175 MAIN ST-FACES CAFE MAP 3 1 D PARCEL 142 001 ZONE CB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid 15,16 X24�1) Building Permit Filled out Fee Paid Typeof Construction: DUCTWORK FOR CAFE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 25011 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 mi o Im Street Commis ' Permit DPW Storm Water Management Si r B ing O ficial 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. �! Commonwealth of Massachusetts I a AUG 1 8 20154) L Sheet Metal Permit Eiec i c F ,' c,8.L fr,peciions fA01 r;0 a e: Permit# ��� Estimated Job Cost: $ 6() Permit Fee: $ Plans Submitted: YES ✓ NO Plans Reviewed: YES NO Business License# Applicant License# Business Information: Property Owner/Job Location Information: Name: -A 1(,5 H6cd Name: Po_cce Street: o��{ /"lCc-c,n 1, r,,e Q r. Street: 175 Ca-1 r\,S '- City/Town: U, 2.S e.(ol k-A City/Town: Jy p r k a4nPfel-,. m-4 Telephone: 1+13 Sloe cf(0(0,3 Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES V// 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 V 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: Renovation: HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: -sc.- Cam(a 175 MAIN ST - FACES CAFE SM-2016-0010 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON IGIS#: 9753 - Map: 31D -- -- tE B 14 - - - SHEETMETAL PERMIT Lot 001 iPermit: SHEETMETAL Category: SHEETMETAL Permit# SM-20 16-00 10 PERMISSION IS HEREB Y GRANTED TO: Project# JS-2016-000088 Est._Cost: $S,OOfl;pp Contractor: License: Expires: Fee Charged:$50.00 ALLSTATE HOOD&DUCT INC Sheetmetal-25011 12/28/2015 Balance Due:$.00 Owner: HANNOUSH TIFFANY 1#of Fixtures - jApplicant: ALLSTATE HOOD& DUCT INC IDigSafe# _ AT. 175 MAIN ST-FACES CAFE PseGroup IConstClass ISSUED ON. 26-Aug-2015 AMENDED ON. EXPIRES ON. TO PERFORM THE FOLLOWING WORK: DUCTWORK FOR CAFE 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-2016-000694 18-Aug-15 4028 $50.00 212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouckgnorthamptonma.gov GeoTMSO 2015 Des Lauriers Municipal Solutions,Inc.