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31B-169 (7)
19 ROUND HILL RD - UNIT D SM-2017-0021 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON 9515 ..sovasivn Map: 318 r Block: G9 '=" SHEETMETAL PERMIT Lot SII � o Permit SHEET METAr. Category: renovation Permit 4 sM-2017-0021 PERMISSION IS HEREBY GRANTED TO: Project# JS-2017-000791 Est.Cost. $35,700.00 _ - Contractor: License: Expires: "' -- NORTHEASTERN SHEET METAL Sheetmetal-519 Fee Charged$50.00O4'26.12016 Balance Due:$.00 Owner: SMITH COLLEGE #of Fixtures: Applicant NORTHEASTERN SHEET METAL CO INC DigSafe# - ,AT: 19 ROUND HILL RD- UNIT D UseGroup ConstClass ISSUED ON: 25-Oct-2016 AMENDED ON: EXPIRES ON: TO PERFORM THE FOLLOWING WORK: ALL HVAC SHEET METAL DUCTWORK 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 Pal& Check Not Amount Sheetmetal IDC-2017.001679 24-Oct16 31486 $50,00 212 Main Street.Phone:14131557-1240,Fax0413)587-1272,Emailahasbrourka narthamptonma.gov GcorNISD 2016 Des Laurlers Municipal Solution,Inc. File#SM-2017-0021 APPLICANT/CONTACT PERSON NORTHEASTERN SHEET METAL CO INC ADDRESS/PHONE 6 NIBLICK RD (860)265-3805 Q PROPERTY LOCATION 19 ROUND HILL RD- UNIT D MAP 3IB PARCEL 169 001 ZONE EU(100)/URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST _E CLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid 60 Building Permit Filled out Fee Paid Typeof Construction: ALL HVAC SHEET ETA___1204CfWORK New Construction t-- Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 519 3 sets of Plans/Plot Plan THE FOLL L G ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN TION 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 ermit from Elm Street Commission Permit DPW Storm Water Management Si�rrature of ailing 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. y NorthEastern _ 6 Niblick Road Enfield, CT 06082 Tel. (860)265-3805 Fax. (860)265-3815 To Whom It May Concern. Please mai] the Sheet Metal Permit to: NorthEastem Sheet Metal Attn: Nick Fournier 6 Niblick Rd. Enfield, CT 06082 Thank you, Nick Fournier General Manager ftNorthtastern \...,snrel meal co,m� 6 Niblick Rd. Enfield, CT 06082 Phone: (860) 265-3805 Fax: (860) 265-3815 Email: nfournier@nesmco.com Commonwealth of Massachusett, City Of Northampton OcT oEVtOB LPING:on.N;rne ONS DDate: I o I 1 g 1G Sheet Metal Permit Permit . sm- /Z a / Estimated Job Cost: $ 35i o 0 Permit Fee: $ So.00 Plans Submitted: YES X NO - Plans Reviewed: YES _ NO _ Business License# 519 Applicant License# 2 22_3 Business Information: Property Owner/Job Location Information: Sl�l,kl Cotte e Name: Mock r„ S�EPi }p,1 Name: . ? , • K — el Street: 6 MihliLI& 1Q_a Street: l2Xxh W i\ Q City/Town: Cf 0608- City/Town: N Or ikkor.A?Von MA Telephone: $ - 2 6 L - 3,105 Telephone: 413 - .5$,S- 214 O D Photo I.D.required/Copy of Photo I.D. attached: YES X NO Staff Initial J-1 /M-1-unrestricted license .1-2/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 X Institutional Other Square Footage: under 10,000 sq. ft. over 10,000 sq. ft. X Number of Stories: 3 - 1(N club I/ bre 3e fret'} Sheet metal work to be completed: New Work: Renovation: X IIVAC )( Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/ Vents Air Balancing Provide detailed description of work to be done: Pm 1ivAc- ,Skez} fretA1 au work a� +fie -,SM, kin Coneys esliv-60Ay lek - :RIJS 0 "4_etiliffy 4,Le acro 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, $100.00 Commercial INSURANCE COVERAGE: I have a current liahttity insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes.Di No❑ If you have checked Yes,Indicate the type of coverage by checking the appropriate box below: A liability insurance policy Ig Other type of indemnity A Bond E OWNER'S INSURANCE WAIVER: I am aware that the licensee rIres not have the Insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application weivesthis requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owners Agent By checking this box0,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation:YES NO�,- prngrece Incfrertinnc Date f nnsmrnts Final Incprrtipm pato Comments —..... Type of License: By -_ _ XMaster Title 0 Master-Restricted /' Otyi Town ❑Journeyperson Signature of Licensee Permit k ❑Joumeyperson-Restreted '' q x �; Fee$ License Number; 1 JX„tisi9,55 check at MC&uku macs gnuntpt Inspector Signature of Permit Approval 1\ The C'ommonweahh of Massachusetts • € Department of Industrial Accidents C OjJFce oflnvestigtUions I Congress Street, Suite 100 Boston, MA 02114-2017 \-.47,' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/(hganization/Iodividual): NorthEastern Sheet Metal Address:6 Niblick Rd, City/State/Zip: Enfield,CT., 06082 Phone #:860-265-3805 Arc you an employer? Check the appropriate box: Type of project(required): 1,El I am a employer with 44 4. ❑ I am a general contractor and I employees full and/or n have hired the sub-contractors 6. ❑ New construction p { pert-time). listed on the attached sheet. 7- �i Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have g. LI Demolition working for me in any capacity. employees and have workers 9H Building addition [No workers' comp, insurance comp. insurance.. required.] 5- f1 We are a corporation and its 10.[ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself, [No corkers comp. right of exemption per MGL 12 Roof repairs insurance required.] ' c. 152. $1(4),and we have no employees. [No workers' 13.n Other _ comp. insurance required.] 'Any applicant that checks Mx Sl mum also Ril out section below showing their orkms compensiMon reins informatins_ 'Idomennuers trim submit this alfduvit indicating they are doing all nork and then hire outside contractors must submit a nett aflidavit-idicating.such. ;Contractors that check this hos must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have cnoployea. If the sub-cmxraeaon haveemployees,they must provide heir It-criers cum.4aalicy number. lam an employer that is providing workers'compensation insurance for my emplmwes. Below is the policy andjoh,site information. Insurance Company Name:Arbella Indemnity Policy#or Self-ins. Lie. #:42200.5206107 Expiration Date:04/15/2017 Job Site Address: Smith College, Henshaw Complex, Bldg D., Round Hill Rd. City/state/Zip:Northampton, MA 01060 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGI.c. 152 can lead to the imposition of criminal penalties ofa fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the farm of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA fo -nsurance coverage verification. I do hereby certUi un rte sins and penalties of perjury that the information provided above is true and correct. 'matue: / 741/44 Date: 10/17/16 Phone#: 860-2 5-3805 ] Official use only. Do not write in this area,to be completed kr city or town official City or Town: Permit/License# Issuing Authority(circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: v.COMMONWEALTH OF MASSACHUSETTS BOARD OF. SHEET METAL WORKERS ISSUES THE FOLLOWING LICENSE AS A MASTER-UNRESTRICTED. 2 THOMAS J.MESSENGER p . 6 NIBLICK RD ENFIELD,CT 0608 -4456 44 2223 08/2812017 1810 I\ v.COMMONWEALTH OF MASSACHUSETTS BOARD OF SHEET METALWORKERS ISSUES THE FOLLOWING LICENSE AS A BUSINESS THOMAS J.MESSENGER NORTHEASTERN SHEET METAL CO INC DBA TJM SHEET METAL;MA 6 NIBLICK.RD ENFIELD,CT 06092 519 6412612018. 26469 t1 t .-- MASSACHUSETTS I,:ft _ DRIVERS t3CENSE 1 s ONE44S60331614 3 009 _. 2VII M 11JGER e88 PEASE RD ELQNGMEADOW,MA 010483111 xta»3xe.e it»» • /+4,1 NORTHZ3 OP ID: TF 4ORn CERTIFICATE OF LIABILITY INSURANCE OAi0/14/201VY" 10narzols 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 lama 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 Bouvier insurance NAME Tracy Finian 29 North Main Street iA<Nen,e.IL8S0 232-0491 FAX Doi.850-232-5637 West Hartford,CT 06107 =MEss:tfillian r@binsorance com Tina Gerard _. _. _.. INEUREA51 AFFORDING'COVERAGE NAIG/ INSURER A Arbella Protection Insurance INSURED CnySheet Metal INSURER R:Arbeila Indemnity Company, Inn nc, 6Niblick Road a+. ,C: _ - , - - Enfield,CT 06082 /WIRER 0: . _ INSURER E: - _ - - IN$URERf: 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. INSET .._. __ - _ ...._ _ libLSUBA,; POLICY NUMBER_ —Booe&ylFvF • ins rprvEvvy LAMSs_ . _. _. . .._ _ E TYPE OF INSURANCE ,. • • GENERAL ABILIIY EPLP O(:CUPRLNCE S 1,000,000 A X(sOMMERGwt GENERAL '4500058666 '04/15/2016 04(1612017 1 uS1 T9RE TE) - -- nFMI'ses @nuI"an s 250,000 �. JOLAIM$MADE % IO�uR MED EXP(Any a»mTs:ol $ _ 10.000 I PERSONAL a Auv METRE p 1,000,000 - GENERAL eGGREGATE s 2,000,000 I GENT AGGREGATE LINT APPLIES PER • PEO TS-C.oMPIIOR AGO s 2,004000 coucv' X ,PPO. Lnc .S __ _ I AUTOMOBILE UABILITY ccuelNl:.n slrvs,E OMIT 1,000,000 I¢P accident) s A iX_I ANY AUTO 1020019056 04/15/2016 04/15/2017 ROPILY INJURY(Per oersnm S SCHEDULED BODILYINJURY IPer Cdeno S ALL OWNED _ AUTOs _ NON-CONNED E(P4TY DAMAGE $ UIREO AUTOS __ AUTOS jFlh-C..0- T) X UMBRELLA LRB -. X .00CUR EACH OCCURRENCE 5 ,000,000 A 1 EXCESS LIAR_ CLAIMS-MADE 4600058667 04115/2016.04/1512017 Au,RCe4 E $ 5,000,000 DED ,X I RETENTIONS 10,000 I WORKERS COMPENSATION N. tFTW SEH. AND EMPLOYERS LIABILITY El TOR. CCI E. ER . B PROPRIFTORNAR DR,EXECUTIVE YIN 422005206101 04/1512016 04/15/2017 EA RRIDENT s_ 500.000 OFFICERVEMBER E>c UDED:+ xla. IMandeewy in Nm - : ELOIiASE-FA EMPLOYEES 500,000 i. eyes aesne u ., IOPERATIONS _ - DESCRIPTION m IPTIaON OF Ba anMelo. - EE.MESE-POU,LIMIT S 500,000 DESCRIPTION OE OPERA710MS I LOCATIONS I VEHICLES (Attach ACORD IDI,Additional Remsms Schedule,it more space is revuimdl evidence of Insurance for Sheet Metal Permit. Job: Smith College - Enabling Niesion, Henshaw-D CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL HE DELIVERED IN P ACCORDANCE WITH THE POLICY PROVISIONS. Building Department Puchalski Municipal Building AUTHORIZED REPRESENTATIVE 212 Main St. Northampton,MA ---I ,/Lkicii b©1988-2010 ACORD CORPORATION, All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD