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23B-046 (262) F - a31 - aLILO Commonwealth of Massachusetts AUG 2 9 2016 City of Northampton Sheet Metal Permit DEPT CP BUT ET.T ETPTEPONS / xoBn,. Prorv.0 _•. - Permit# 1 l! 7 7/ Estimated.lob Cost: $ 73,600.00Permit Fee: $ #'�� Plans Submitted: YES NO Plans Reviewed: YES NO Business License # 638 Applicant License # 1849 Business Information: Property Owner/Job Location Information: Name: Moran Sheet Meta! inc. Name: Cooley Dickinson Hospital- Breast Care Center Street: 613 Meadow Street Street: 30 Locust Street City/Town: Agawam, MA 01001 City/Town: Northamtpon, MA Telephone: 413-363-1548 Telephone: Photo I.D. required /Copy of Photo I.D. attached: YES X NO DWI Initial J-I /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 v! Other Square Footage: under 10,000 sq. ft. J_ over 10,000 sq. ft. Number of Stories: 1_-Ground Floor Sheet metal work to be completed: New Work: Renovation: V HVAC t/. Metal Watershed RoofingKitchen Exhaust System Metal Chimney/ Vents Air Balancing Provide detailed description of work to be done: Demo Duct Fab and Install Duct Furnish and Install-VAV's, Fire Dampers, MOD's and RGD's .11 INSURANCE COVERAGE: �/ I have a current liability insurance policy or its equivalent which meats the requirements of Mal.Ch.112 Yes!' No❑ If you have chocked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy m 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 Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this boil 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 ail 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 WMaster Tmk---- El Master-Restricted f9/eOtago" �Lr-----. _ Otago .— D,lourneyperson /" ` Signature ofi licensee Permit# ❑Joumeyperson-Restricted License Number: 1849 Fen Check at www.mass.gov/dpi Inspector Signature of Permit Approval ;comrortireHusens. SHEET AIHTALXORNERS ISSUE)THE FOLLOWING LICENSE AS A ,. v, MASTERUN1ERTRIC?EO {1 PRIAM E ' $ 18 HREVEREVERENO SOUTHWICK.MA $1077.$131:.. 3 1649 µ 01/20O111 r, 11343 A COMMONWEALI raidA+HOSMS, SHEET Al. NORRRS 1, I SSUES,ITNE COL 1ONWNO t I CENSE AS A BUSINESS IOMH R I EET . Tf36 IIEET TETAL INC 136 EAST )it A0014 ST. CHttOPEE MA 01013 038 04(28{16 ,.; 22]622 iii 6N4CnUSETT9 1 ! x 1 596SO3661 06416.1959 n ltrt yLai ,_ 7.4 4- xt .. of A� CERTIFICATE OF LIABILITY INSURANCE 8�25;Mo�6"Y"`I 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 NAECT Linda nda Aistede James a. Dowd and Sons Insurance Agency Inc. PHONE FAX - '-- 14 Bobala Road LAIC,No,Ea9:413-538.-7444--___—_. ___.-_ .(NC,NoJ:413-536-6020 Holyoke MA 01040 ADDRESS: lalstededdowd.com PRODUCER CUSTOMER 10 t MORASHE-Ol INSURERISI AFFORDING COVERAGE Niue*- . INSURED INSURER A.Regent InsuanCe Company _.,24449 Moran Sheet Metal, Inc. NSURERe.General casualtyCom ofWI613 Meadow Street - - ' . Pa�' I Agawam MA 01001 INSURER C: INSURER D r INSURER E: INSURER F: ' COVERAGES CERTIFICATE NUMBER:1626268159 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. NSR Iq OLSUBF POLICY EFF POLICY ERP LTR TYPE OF INSURANCE I INSR WVD POLICY NUMBER I IMMIODMYY) IMMIDD(IYYYI LIMIIs A GENERAL LIgMLIIY 6011903499 �9/t 0/2015 12016 • EACH OCCURRENCE $1 000.000 X I COMMERCIAL GENERAL (ABILITY ��(`TS(RE TO-RENTED 300 I _ I I RMS O CLAIMS-MADE OCCUR MEO E PlAny me person S 00 —. . PERSONAL E.ADV INJURY a 000,001 • I• GENERAL AGGREGATE $2 000,000 6EN'LAGGREGATE LIMIT APPLIES PER PRODUCTS-COMWOPAGG $2,000.0X POLICY x JFT LDC I E _. . B I AUTOMOBILEUABILITY I C5A_203099 9/1512G I 5 :9/18/2016 COMBINED SINGLE LIMIT $1 ANY AUTO (Ea accident_ 00.0]0 ALL OWNED AUTOS BOD INJURY'Per person; E 'x SCHEDULED AUTOS BODILYJu (Per R�.aeml, a PROPERTY DAMAGE E HIRED AUTOS (Per accident X NON-OWNED AUTOS "I _.....- ',. a • B x EXCESS Cue X C MSMADE COm]0]09a /15/2016 310 I EACH OCCURRENCE 5 0 UMBRELLA WB 1. I ,. AGGREGATE IS 0 OLO DEDUCTIBLE S RETENTION $10 000 $ • (WORKERS COMPENSA90H il 120ioo_y B,d015 / 1 • WC ST T IOIH AND EMPLOYERS' ETORI ARTNERIEXECUTVE YIN L IDETS E I ANY PROPR EL EACHACCIDENT S OLO :OG 6 OFFOERMEMBER EXCLUDED' II !— — - I(Mandatory e,d a i I IELDISEASE E EMPLOYEESl 555.000 Oyes describe codecI 110ESCRIPTION OF OPERATIONS below I ' E.L.DISEASE- POUCYLIMIT E3.000,005 • DESCRIPTHM OF OPERATIONS(LOCATIONS I VEHICLES(Attach ACORD lot,AddHional Remains Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION 30 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Ci[ OF Northampton BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED Y P IN ACCORDANCE WITH THE POLICY PROVISIONS, 212 Main Street Building Department Northampton MA 01060 AUTHORIZED REPRESENTATIVE Ti-T;. Cry 14 4 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD