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18D-026 (64) 55 DAMON RD - DUNKIN DONUTS SM-2019-0020 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON GIS 18933 Map: 181) Block: 026 SHEETMETAL PERMIT Lot: 001 Permit: SHEETMETAL Category: ISHEETMETAL Permit# SM-2019`0020 PERMISSION IS HEREBY GRANTED TO: Project# JS-201$-002423' Est.Cast: $49,550.00 Contractor: License: Expires: Pee Charged:$50.00 MANUEL SOARES Sheetmetal-5769 07/28/2020 Balance Due:$.00 Owner: SARDINHA EMANUEL #of Fixtures: Applicant: MANUEL SOARES IDigSafe# AT. 55 DAMON RD-DUNKIN DONUTS PseGroup ozlsstClass ISSUED ON. 15-Oct-2018 AMENDED ON. EXPIRES ON. TO PERFORM THE FOLLOWING WORK: INSTALL 3 ROOFTOP UNITS-SHEET METAL 1 EXHAUST FAN FOR SANDWICH STATION TYPE 2 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-2019-001323 15-Oct-18 14321 $50.00 212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbroucWnorthamptonma.gov GeoTMS®2018 Des Lauriers Municipal Solutions,Inc. RECEIVED OCT 1 2 2015 Commonwealth of Massachusetts City Of Northampton DEPT.OF BUILDING INSPECTIONS NORTHAMPTON,MA 01060 Date: — Sheet Metal Permit Permit# 5'41 ` �I � 1 Estimated Job Cost: $A/ N, �1 c�J Permit Fee: Plans Submitted: YES A-' NO Plans Reviewed: YES NO Business License# c� Applicant License# S"`a C 5 Business Information: Property Owner/Job Location Information: Name:4!Z4 "a-el Sl ,44FS� Name: Street: ��'/..�SB�C/ S/ Street:-5-7 J;170 A-1 City/Town: �i4-41�1/G/�C g� City/Town:O&e d0 i'/1�.OT0/1•� Telephone: y SFO Telephone: W13 a? V4--e9C'7-6 Photo I.D.required/Copy of Photo I.D.attached: YES —**- NO Staff Initial - /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 40'0' Retail t'o"" Industrial Educational Institutional Other Square Footage: under 10,000 sq.ft. c--"* over 10,000 sq.ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: HVAC Metal Watershed Roofing Kitchen Exhaust System-Z—r'Yope z Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: 1A,rS- Z-;4Gz-- .3 /2 CJ 4.,',(/7:r 57'T r?>p�•gC� ,� ,��6><'�ST �/��✓ X4'2 ,si4�,1��i1llr�/ ,s`T'�r/Q � 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,$100.00 Commercial l o f 12l i e L}t INSURANCE COVERAGE: I have a current llabWtit insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes93'NO❑ If you have checked Yes,Indicate the type of coverage by checking the appropriate box below: A liability Insurance policy 8"__ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee AaaamatJum the Insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application—a'—this requirement. Check One Only A-7 Owner 9' Agent ❑ Signature of Owner or Owner's Agent By checking this box13,1 hereby certify that all of the details and Information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and Installations performed under the permit Issued for this application will be In compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct Inspection required prior to insulation installation:YES NO J!CUM'ece laeg tions DaLp- commerite Finfll inc�r+inn Date CQU311mantc Type of License: By ❑Master Title ❑Master-Restricted City/Town ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted License Number: Fee$ ❑ Check at www mass n vidpi Inspector Signature of Permit Approval X� - s . rm W S . v tx TE ,R.- _ f 9 ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/ Y) A�O 10/12/22018018 F_ 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 have ADDITIONAL INSURED provisions or 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: Ana Aguier Oceanpoint Insurance Agency PHONE (401)847-5200 FAX (A/C. /C No): (401)848-5071 INC.No Ext): 500 West Main Rd ADDRESS: aaguiarri�oceanpointins.com INSURER(S)AFFORDING COVERAGE NAIC 0 Middletown RI 02842 INSURERA: Selective South Carolina 19259 INSURED INSURER B: Beacon Mutual FALCON ELECTRIC,INC.&MANUEL H.SOARES TRUSTEE INSURERC 125 SISSON ST INSURER D: INSURER E: PAWTUCKET RI 02860-4954 INSURER F: COVERAGES CERTIFICATE NUMBER: CL1881406471 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MWDD MMIDD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ®OCCUR PREMISES Ea occurrence $ 500,000 MED EXP(Any one person) $ 15,000 A S 2189460 10/28/2017 10/28/2018 PERSONAL&ADV INJURY $ 1,000,000 GENTAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 JECTPOLICY 0 PRO- F LOC PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Eaaccident $ ANY AUTO BODILY INJURY(Per person) $ OWNEDSCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED HNON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH. AND EMPLOYERS'LIABILITY STATUTE ER YIN N 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ B OFFICER/MEMBER EXCLUDED? N/A 69286 04/12/2018 04/12/2019 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of North Hampton ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main Street AUTHORIZED REPRESENTATIVE No.Hampton MA 01060 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD