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24A-042 (10) 120 JACKSON ST - SCHOOL SM-2019-0011 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON b-i—sk:­ ;9135 ;Map: 124A Block1: 042 001 i(Lot: : SHEETMETAL PERMIT Permit:---]S—HE-,E-T--M--E--T*'A' Category* ISHEETMETAL lPermit SM-2019-0011 Project# 19-000442 PERMISSION IS HEREBY GRANTED TO IJS-20 Est.Cost: 1$24,600.00 Contractor: License: Expires: Fee Charged: JASON A MORAN Sheetmetal- 1953 11/28/2019 , $0.00 Balance Due:!$.00 lOwner: NORTHAMPTON CITY OF JACKSON STREET SCHOOL #of Fixtures:, !Applicant. JASON A MORAN DigSafe_#_ T. 120 JACKSON ST-SCHOOL jUseGroup LC0wt_ClU_S____L___ ISSUED ON: 06-Sep-2018 AMENDED ON. EXPIRES ON. TO PERFORM THE FOLLOWING WORK PROVIDE DUCTWORK FOR ERV SYSTEM 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: Sheetinetal REC-2019-000774 04-Sep-18 NA $0.00 212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck@)northamptonma.gov GeoTMS(9 2018 Des Lauriers Municipal Solutions,Inc. File#SM-2019-0011 APPLICANT/CONTACT PERSON JASON A MORAN ADDRESS/PHONE 78 TANNERY RD (413)569- PROPERTY LOCATION 120 JACKSON S -SCHOOL MAP 24A PARCEL 042 001 ZONE URB 00 / THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: PROVIDE DUCTWORK FOR ER YSTEM New Construction Non Structural interior renovations Addition to Existiniz Accessory Structure Buildiniz Plans Included: Owner/Statement or License 1953 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 Permit from Elm Street Commission Permit DPW Storm Water Management 42e-n, ` 9/5-/t 8 Signature of Building 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. i Commonwealth of Massachusetts A 2 8 j gEp - 4 2018 City Of Northampton Sheet Metal Permit DEPT OF BUILDING INSPECTIONS DEPT.OF BUIIHINft iCNSPE O Permit NORTHAMPTON,PAA 01060 NORTHAMPTON.NIA 1,70 1 Estimated Job Cost: $ C)q I Permit Fee: $ Plans Submitted: YES _ NO Plans Reviewed: YES NO I Business License# l Applicant License# I S� Business Information: Property Owner/Job Location Information: Name: A-Orki LLC Name: Street: PO B& Street: City/Town: �� �� City/Town: /1A Telephone: �� s �` dl%1 Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES_X NO Staff Initial J-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 Other Square Footage: under 10,000 sq. ft. ')6 over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: HVAC Y Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: ilk �JUIA Ar Sys 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, $100.00 Commercial _..: ._ . ,,. ` :�j• INSURANCE COVERAGE: �,( I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes g No❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy tv Other type of indemnity ElBond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee rinp-z not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waive this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box❑,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO PrnarPec incnPrtionc Date Date Comment-, Type of License: By ❑ Master Title ❑ Master-Restricted City/Town ❑Journeyperson Signature of Licensee Permit# Eli ourneyperson-Restricted License Number: Fee$ ❑ Check at www macs,finvidpi Inspector Signature of Permit Approval ill CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY(12/05/201 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(les) 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 CONTACT NAME: __ THE MASON AGENCY (Arc No,FXU!t 41.3-569-2307 _ (AIC,No1:413-569-2308 FARM FAMILY CASUALTY INSURANCE E-MAIL AooREs5:THEMASONAGENCY(MFARM-FAMILY.COM 504 COLLEGE HIGHWAY INSURMS)ARORDINOCOVBRA" NAIC10 SOUTHWICK, MA 01077 INSURER FARM FAMILY CASUALTY INSURANCE 1380.3 INSURED INSURER 8: MORDUCT LLC INSURER C: 78 TANNERY ROAD INSURER D: SOUTHWICK, MA 01077 INSURERS: INSUR R f 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 INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POUTW EXP LIMITS R POLICY NUMBER IYV A X COMMERCIAL GENERAL LIABILITY 2001 L7020 '11/22/2017111/22/2018 EACH OCCURRENCE $ 1.000 000 AMAGE 70 ENTEb--� CLAIMS MADE X OCCUR MISES1EE OCL---$ 100,00 MED EXP(Any one person $ 5,w0 PERSONAL&ADV INJURY $ 1,000,000 GATE LIMIT APPLIES PER GENERAL AGGREGATE $ _ 2,OOO 000 E POLICY .. PRO- 111 JECT LOC PRODUCTS•COMPIOPAGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED ` SCHEDULED - - ----------- - ---- AUTOS ,- AUTOS BODILY INJURY(Per sociderd) $ NON-OWNED— PROPERTY DAMAGE _ HIRED AUTOS AUTOS r cuOsntl -_ - UMBRELLA LIAB OCCUR EACH OCCURRENCE $ E%CESSLIAB CLAIMS-MADE AGGREGATE DEC) RETENTION$ $ WORKERS COMPENSATION PER OTH. AND EMPLOYERS'LIABILITY $TATUTE , ER ANV PROPRIETOR/PARTNERIEXECUTIVE YIN E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA - -- - + -- ---- (Mandatory In NH) I E L DISEASEEA EMPLOYEEi $ If yes describe under 1 DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CONTRACTOR �I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. COMMONWEALTH OF MASSACHUSETTS AUTHORIZE EPRESENTATIV ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/011 The ACORD name and loao are reaistered marks of ACORD MASSACHUSETTS DRIVER'S LICENSE OSHA 001073567 1210312016 1Nu2r Departmeet of Labor F p 820 0�v9� r 7 k-u{,a`nna!Safety end Health Administration 1111812021ST 1111811985 'OM Sr NONE NONE JASON MORAN JASON A has successfully completed a 1041our Occupational Safety and Health 78 TANNERY RD Tran,ng Course in SODTRtMCK,MA 01077-9791 Constnuction Safety&Health SE M HGT 8'-80" q p �r.tG�:.(1"-' � 6/2 L/n6 DD 12105r?016 R,,0111L1018 ! �J/1l� (Tii,ner) (D3l2) JI++ - l COMMONWEALLTH ; F MASSACHUSETTS OF CONNECTICUT • • ■ - � • D F , SHEET METAL WORKERS I LIMITED SHEET NIETALJOURNEYPERSON ISSUES THE FOLLOWING LICENSE MASTER-UNRESTRICTED JASON A MORAN JASON A MORAN a I 78 TANNERY RD z 78 TANNERY RD SOUTHWICK,NIA 01077-9791 SOUTHWICK, MA 01077-9791 LIC.f REG NO. EFFECTIVE EXPIRES SHM.0007443-SM2 06/18/2018 08/31/2019 1953 11/28/2019 356623 SIGNED19 SO ni t5tame 7/ This is to certify that Program EPA Approved f i Jason aD Drcembcr 28. 1993 ` successfully completed training in Confined Space Entry & Permit-Required CERTIFICATE NO. 0470680356600 ; Confined Space Hazard Awareness Moran Sheet Metal, Inc. NAME: JASON A. MORAN 29 CFR 1910.146 Issued:Dec. 14,2012 has been certified irs a SAFETY/ C UNIVERSAL PRIORITY Chip Darius,OHST,CET tec uileinn as required by 40CFR part 82 subpart C 1 800 809.0059•safetypriority.com -r ' USF TBS°xBfl r Jason Moran has passed the OSHA Compliant Forklift Safety Test and is Certified to Operate all powered industrial lift trucks 04-2021 This card MUST be carried Expiration Date whenever operating a forklift. i B 2 s>e,umero i:masoc R N L �aNe wu,sor.ze rr.v� warw.,wwuvu c \ 1-STREET wns NORrINMRTpN,AIAgSI,CHUSETT301p60 JACKSON STREET &CAFETERIA MEZZANINE&ROOF DUCTWORK PART PLAN �\ ELEMENTARY Eb,LE:,M•.TC SCHOOL \ CAFETERIA HVAC UPGRADES MECHANICAL u, DUCTWORK NEW F WORK PLAN I onwJ SY.JSS MIE:OSNS'SJ+e a«n rv:wr wrE:acn]wm,e srxE..,s ROTEo SHEFis�.E+ N M-100 SHEET 03 OF 07