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23B-046 (267) 30 LOCUST ST - PHARMACY SM-2017-0065 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON GIS it 9098 tg ;ti. Map: 38 _ 4 .. B ,� am SHEETMETAL PERMIT Permit: SHEETMETAL "` Category: SHEETMETAL Permit a __. sM-2017--0065 PERMISSION IS HEREBY GRANTED TO: Project# IS-2017-002464 Est cost: $8,200,00 Contractor: License: Expires: Fee Charged.l$50.00 MORAN SHEE'I'ME FAL Sheetrnetal- 1849 01/28/2016 Balance Due S.00 Owner: COOLEY DICKINSON HOSPI FAL INC #of Fixtures: ,.. Applicant: MORAN SHEET METAL DigSafe# AT: 30 LOCUST ST-PHARMACY UseGroup '.. ConstClass ISSUED ON: 20-Jun-2017 AMENDED ON: EXPIRES ON: TO PERFORM THE FOLLOWING WORK: DEMO DUCT, FAB&INSTALL DUCT, FURNISH& INSTALL ZONE DAMPER AND ROD'S THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fn Type: Receipt No: Date Paid: Check No: Amount Sheetmetal RW-2017-006867 19-1un-17 6097 $50.00 212 Main Street.Phone:(413)587-1240.Fax:(413)587-1272,F.mail:Ihashrouck@northamptooma.gov Gent stS:a 2017 Des Laurier Municipal Solutions,Inc. File#SM-2017-0065 APPLICANT/CONTACT PERSON MORAN SHEETMETAL ADDRESS/PHONE 139 EAST MEADOW ST (413)592-00310 PROPERTY LOCATION 30 LOCUST ST-PHARMACY MAP23B PARCEL 046 001 ZONE M(991/WP(21)/URBi1)/ THIS SECTION F O31 OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT yI� ,r Fee Paid -J! Building Permit Filled out �l Tec.Paid TypeofConstruction: DEMO DUCT.FAB&INSTALL DUCT,FURNISH&INSTALL ZONE DAMPER AND RGD'S New Construction Non Structural interior renovations Addition to Existing Accessory Structure Bui&Plans Included: Owner/Statement or License 1849 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 PermitVariance` 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 3 •• .m Street Commi Permit DPW Storm Water Management reyf 1.....IXr Signature of Buil ng Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain ail 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 40k Contact the Office of Planning&Development for more information. Commonwealth of Massachusetts City of Northampton \� Sheet Metal Permit paw/ 06/15/17 Pennit# SM—i7 — ‘'6.- /" Fj �/`'o stimated Job Cost: $ 8,200.00 Permit Fee: $ 50 l.,F/ (,uoq / Plans Submitted: YES NO Plans Reviewed: YES NO Business License# 638 Applicant License# 1849 Business Information: Property Owner/Job Location Information: Name: Moran Sheet Metal lna. Name: Cooley Dickinson Hospital- Pharmacy 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 Staff habil 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 V Other Square Footage: under 10,000 sq. ft. V over 10,000 sq. ft. Number of Stories: 1 -Ground Floor Sheet metal work to be completed: New Work:_,. Renovation: d HVAC V Metal Watershed Roofing Kitchen Exhaust System _ Metal Chimney/Vents Air Balancing__ Provide detailed description of work to be done: Demo Duct Fab and Install Duct Furnish and Install-Zone Damper and RGD's 496 046 INSURANCE COVERAGE: _/ I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes-10%o 0 If you have checked Yes,indicate the type of coverage by chocking the appropriate box below: A liability insurance policy pr Other type of Indemnity 0 Bond ❑ OWNERS INSURANCE WAIVER:I am aware that the licensee does riot 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 Owners Agent Ely checking this!mail;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 4 NO Progress Inspections Date Comments Final Inspection Date Comments Type of License: By Master Tine ❑Master-Restricted CayRovrtl ❑Joumeyperson Signature of Licensee Peimit# ❑Journeyperson-Restricted License Number: 1849 Fee S Check at www.mass.ggvtdpl Inspector Signature of Permit Approval COMMONWEALTH OF MASSeti44170.. 1A-7.4 SWEET WEFAL WORKERS ISSUES WW FOLLOWING L ICENSt AS WItErTER.UNRESTRICTFC PAUL R MORAN 14 REVERE RD SOUTIIWiCK MA Ifir177 9727 k ; 184N 41,2872012. CO MONW A TH OF MASSACHUSETTS DIVISION OF PROFESSIONAL LICENSURE BOARD OF SHEET METAL WORKERS ISSUES THE FOLLOWING LICENSE AS A I BUSINESS PAUL R MORAN (14 MORAN SHEET METAL INC 139 EAST MEADOW STREET CHICOPEE,MA 01013-1871 638 04128/2018 31002 c\‘‘ MOEN E NUMB EXPIRATION DATE SERIAL NUMMI 441,..NWelit.'SE L or7EN. S96$05641 a11e-2020 0116-1959 ''144c :4, ;NAN 0:RFF'FN- AC d CERTIFICATE OF LIABILITY INSURANCE 6 bA;M TYYYYI 017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the polloy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in Iiw of such endorsement(§). PRODUCER NAME: Linda Al s tele James J. Dowd and Sons Insurance Agency Inc. PHONE •PAX ""' 14 Bobal.a Road t_Aac Na Ent 411-91R-7(44 . - 019#921L.4.13-W02.0 - Holyoke MA 01040 ADDRESS: la1s t('de@dowd.cOln _ CUSTOMER MR 1a dr MORASHE-01 _ _ INSURERS)AFFORDING COVERAGE MAICF_ INSURED IN$YRER AGeneral Ca Spahr CompAny o,. WI Moran Sheet Metal, Inc. — INSURER°:Regent "' Insuance Company __24449 613 Meadow St reef — -- Agawam MA 01001 INSURER C: _ wSURER O; INSURER E, ......— _..—. SURER F: COVERAGES CERTIFICATE NUMBER:544072192 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 CONTRACTOR OTHER DOCUMENT WTH 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. MR - VADDL SIMI— . - POLICY EFF POLICY EXP - - Lip TYPE%WSURANCE ,Wy,. )WI POLICY NUMDER OMMIDONNPO tMWOdYYYf Lmt$ e GENEPALIJAeIDTY CCi1203094 9/18/2016 $/18/20t7 EACH OCCURRENCE $1,000,000 -DAMAGE TO RENTED'" X COMMERCIAL GENERAL LIABILITY PREMIE cmw2e) „$100 000 CAMS-MADE IX I OCCUR MED EXP(Any weperccn) 5 000 I ' PERSONAL 4ADV INJURY 81,000.00 a GENERAL AGGREC tE '$2.000,000 GEN'LAGGREGATE LIMIT APPLIES PER X I POUCY 128T HI LOC.. PRODUCTS.COMP/OP AGG $2,000,000 _ S A 111�AUTOMDBAISMISM/ cDA1203099 9/16/2016 9/1e/2019 COMBINED SINGLE LIMIT $1.000,000 IEA acade01) ANY AUTO 'KUpLY INJURY{Per gRSan} $ A0.0VVNE0 MHOS BODILY INJURY(Peracaaent) $ SCHEDULED AUTOS PROPERTY DAMAGE X HIREDAUTOS • . :(Pm-acute,* $ NONAWNED AUTOSi • $ E A Y I teMRELIAUAB X OCCUR CCU1203094 "9/1F/2016 9/18/2019 EACH OCCURRENCE 155,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE $5.000,000 EMT&.E _ 18 _. RETENTION $10,000 A WORKERS COMPENSATION I Q/c1303094 3115/2019 '9/16 2019 X ITORY STATU- OTH- AND EMPLOYERS166u M VI NI - ANY PROPRETORTMRTNER/EXECUTIVEEL.EACH ACCIDENT $1 000,1100 OFFIGERMEMBEN EXCLUDED? NIA (MenEtlOryln NH) E L. DISEASE EAEMPLOYE $1,000,000 HvaaPi WN sTNNOF O I oESCRIF(RERA1OIS beg* - E L'DISEASE.POLICY LIMIT I$1,000,000 I I DESCRIPTION OF OPERATIONS I LOCAPCNS I VEHICLES(Attach ACORD 101,Additional Remain SSMHMM,H more apace M nyuhet0 CERTIFICATE HOLDER CANCELLATION 30 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED City of Northampton IN ACCOORERDANCE WITHLON DATE THE POL�PROVISIONS.E WILL BE DELIVERED 212 Main Street #100 Northampton MA 01060 AUMORIZEO REPRESENTATNE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 23(2009/09) The ACORD name and logo are registered marks of ACORD