31A-067 (47) I PARADISE - WILSON HOUSE SM-2019-0055
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS F: - -19451
Map: 31A
Block: 1067-- --- - SHEETMETAL PERMIT
],or:
Permit: SHEETMETAL
Category SHEETMETAL
'.Prank# SM-2019-0055 PERMISSION IS HEREBY GRANTED TO:
Project+r JS-2019-002076
Est. Cost: S24,66(D0 Contractor License: Expires:
Fee Charged:$50.00 NORTHEASTERN SHEET METAL Sheemletal-2223 0&12812019
Balance Due::S.00 Owner: SMITH COLLEGE OFFICE OF TREASURER
'p of Fixtures:' Applicant. NORTHEASTERN SHEET METAL CO INC
DigSafe d _ _ _ AT: 1 PARADISE-WILSON HOUSE
UseGroup
ConstClass
ISSUED ON: 22-May-2019 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK.
ALL HVAC SHEET METAL WORK FOR WILSON HOUSE
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
Fn Type: Reeelpt No: Dam Paid: Cbwk No: Amaum:
Shcounerel REC-2019-003690 21-May-19 34624 $50.00
212 Mein Street,Phoned,113)587-1240.Fox:(413)587-1272,Email liaaubwuek®nomhomptonmn.aae
GwTMS&2019 Dm Laurie.Municipal Solution&Inc.
File 8 SM.2019.0055
APPLICANT/CONTACT PERSON NORTHEASTERN SHEET METAL CO INC
ADDRESS/PHONE 6 NIBLICK RD (860)265-38050
PROPERTY LOCATION 1 PARADISE-WILSON HOUSE
MAP 31A PARCEL 067 001 ZONE EU(100)/URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
^ ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT /
FeePi
Building Permit Filled out
Fee Paid
Tweof Construction: ALL HVAC SHEET METAL WORK FOR WILSON HOUSE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 2223
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN RMATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER; §
Intermediate Project:^Site Plan AND/OR,_Special Permit with Site Plan
Major Project: Site Plan AND/OR_Special Permit with Site Plan
ZONING BOARD PERMIT REQUIRED UNDER:§
Findb%_ Special Permit Variance•
Received&Recorded at Registry of Deeds Proof Enclosed
_Other Permits Required:
_Curb Cut$om 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
Streets Commission Permit DPW Storm Water Management
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.
r Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact the Office of
Planning&Development for more information.
Commonwealth of Massachusetts
City Of Northampton
6
Date: 5/17/19 ermit#
Estimated Job Cost: $24,660 P it Fee: $50.00
MAY 2 1 2019
Plans Submitted: YES X NO PI R 'ewed: YES NO
Business License# 519 DEET OF Bu.lol a 1N n c o2223
RTH PTfiN�
Business Information: Property Owner/Job Location Information:
Name: NorthEastem Sheet Metal Name: Smith College - Wilson House
street: 6 Niblick Rd. Street: Kensington Rd.
city/To": Enfield, CT 06082 Cityrrowm: Northampton, MA
Telephone: 860-265-3805 Telephone: 413-584-2700
Photo I.D. required/Copy of Photo I.D. attached: YES X NO
staff telaa
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 X
Institutional— Other—
Square
ther_Square Footage: under 10,000 sq. ft. over 10,000 sq. f. X Number of Stories:
Sheet metal work to be completed: New Work: Renovation: X
HVAC X Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney/Vents Air Balancing
Provide detailed description of work to be done:
All HVAC sheet metal work for the Smith Collge - Wilson House
Access & Site Improvements renovation project per the
contract drawings.
Fees with Building Pend:$25.00 Residential,$50.00 Commercial.Fees for jobs without a Building Permit$6.00 per$1000
Minimum fees for jobs wi0rout Building Penni)$50.00 Residential,$100.00 Commercial
i '
INSURANCE COVERAGE:
I have a current 1tabUUy insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 yes a❑ No El
If you have checked Yea,indicate the type of coverage by checking the appropriate box below:
A liability Insurance policy M Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee dnna not have the insurance coverage required by Chapter 112 of the
Massachusetts General Laws,and that my signature on this permit application—i—this requirement.
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
By checking Nis boxes,I hereby certify Nat all of the details and information I have submitted(or entered)regarding this application are true and
accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be
In compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws.
Duct Inspection required prior to insulation Installation: YES NO
f)atc L:ommcnts
Final rngPnrr:nn
Dale (�nrnrnpntc
Type of License:
By ®Master
T a ❑Master-Restricted Thomasessenger - President
C'WT— 11Joumeyperson
Signature M Licensee
pe fte OJoume
yperson-Restricted License Number: Master-2223,easiness 519
Fee$ O Sheet Metal Business
Check at liggaii-madpa4gouldIal
Irgpach r Signature N Permit Approval
The Commonwealth of Massachusetts
Department ofindustrialAccidents
Office of Investigations
I Congress Street, Suite 100
Boston, HA 02114-2017
www massgov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Let:ibiv
Name (Business/Orgmization/Individuap: NOrthEBstem Sheet Metal
Address:6 Niblick Rd.
City/State/ZI :Enfield,CT., 06082 Phone N:860-265-3805
Are you an employer?Check the appropriate boa: Type of project(required):
LN 1 am a employer with 37 4. ❑ I am a general contractor and I
employees (full and/or part-time).' have hired the sub-contractors 6. M New construction
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet 7. ❑ Remodeling
ship and have no employees These subcontractors have S, ❑ Demolition
workingfor me in an capacity. employees and have workers'
y aP fY• 9. ❑Building addition
[No workers' comp. insurance comp. insurance.=
required.) 5. ❑ Weare a corporation and its 10.❑Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their 1 L❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.]t c. 152,§I(4),and we have no
employees. [No workers' 13.❑Other
comp. insurance required.]
•Any applicant that checks box MI must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
=Contractors that check this box must atteched an additional sheet showing the name of the suh-comract..and state whether or not those entities have
employees. If the sub conhactws have employees.they must provide their workcm'comp.policy number.
lam an employer that is providing workers'compensation insurance for my employees Below is the polity and job sire
information.
Insurance Company Name:Standard Fire Insurance Company(a subsidiary of Traveler's Insurance)
Policy#or Self-ins. Lic.#:UB7K104452 Expiration Date:0411512020
Job site Address: Smith College- Wilson House, Kensington Rd. City/State/Zip:Northampton, MA 01063
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 MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form 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 f9rAnsuTance coverage verification.
I do hereby certify and t ins and penalties ofperjury that the information provided above is true and correct.
5/16/19
Si store: raG Date:
Phone#: 860-265-6805
Official use anty. Do not write in this area,to be completed by city or town official.
City or Town: PermittLicense#
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
A R a CERTIFICATE OF LIABILITY INSURANCE snsrzols
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, E)(TEND 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: N the cerilficafe holder Is an ADDITIONAL INSURED,the WICYtles)must have ADDITIONAL INSURED provisions or be endorsed.
N SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,Certain Policies may require an endorsement. A sMlemeni on
this certlficaff does not confer flants to the certificate holder In lieu of such endon en a.
DNT
PRODUCER ASNEAUT
Vesenie Maggio
John M. Glover Agency PHONE X203-702-7924 203872<968
P.O. Box 700 -
NorwalkCT06652 EMAIL .Is aggioCohnmgkrver.com
MBURERa AFFdNataIe COVEMf2 MYCa
INSURER A:Standard Fire Insurance Company 19070
POURED NORTSHE-02 INSURER B:The Charter Oak Fire Insurance Com n 25615
Northeastern Sheet Metal Co.,Inc. INSURER C:Phoenix Insurance Compan 2SB23
6field CT 06082 UReldtlR Road
Enfield INSES o-Travelers Property Casually Company of 25674
INSURERS:
INfiURERF:
COVERAGES CERTIFICATE NUMBER:1894277631 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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.
INRL TYPE6NNURAXLE POLICY Numm PdICY EFf POLICYIDP LMNa
C X COMNERdALOOIeMLWIJTY C07KIJ6081 W1512019 V151020 EAGHOLdxMFNCE f1.000.000
dNNaarFLE ❑% OCCUR PREN E e $10.000
MEDE%P(Al.ou v $101000
PERSONAL&ADV INJURY f1,00Q000
GENLAGORCGiTELIMgITAPPLIES PER: GENERIJLAGGREWTE f2,000,000
POLICY❑% M6 O I P KXNJCTS-CDSPXIPMq f2.M.=
O EH f
B AIrr0lAoale WaallY N In"NONS40-19 1115IN19 4'1520fi E ) &1,00,000
X ANY AUTO BODILY NJURY(Per Perri) S
OANED SCHEUL
DED 600ILYINJURYIPererdWe S
AUTWONLY AUFOS _
MIRED N]NON]FD PROPERTY btUGE
X AUTCOONLY % AUTOS MY :Lft Ra e� .— S
S
0 x UMS AUAa x OCCUR N N CUPM10H62 0/152019 W15R020 EACHOCCURRENCE $5.00.000
•Iou, WB CWYSNLL'E Socia TF 55.0DO.000
1
DEC FTREETONITICAUJI S
A ANDDeRa WFPENEM1TIDX N UB]K10H52 W1YN19 N15R020 %
ANO CNROVERSWTNER YIN
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ANY PERSAIM ER EARTNER.£tECMVE EL.EACH ACCIOFM f50.00
Mmdws,IINN� CLUOED> MIA
E.L dSFISEEA EMPLOYE f50.000
11YeF OeMMINa
CESOiIPipN OF OPERPTI0NS 0ebe ELd8FA5E-PoUCY I.A.I f50.00
DE9WMNOFOPERAT SPLOMaMSIMICLE$IGCd1O1D,AtltlMmelMmerb SeMEUN.meybAbtlw6Nmon ePFnHnpWM)
The certificate holder is an add'Nonal insured under the general liability assumed under written Contract with the insured executed prior to a
loss.
Evidence of Insurance for Sheet Metal Permit
Job:SmOh College-Wilson House Access and Site Improvements
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Building Department ACCORDANCE WITH THE POLICY PROVISIONS.
Pulaski Muniapal Building
212 Main Street
Northampton MA 01060 AUT MMDREPe RJJESEHTATNE
0 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
v :COMMONWEALTH OF MASSACHUSETTS
BOARD OF
SHEET METAL WORKERS.
ISSUES THE FOLLOWING LICENSE
BUSINESS •Z
THOMAS J MESSENGER ` I�
NORTHEASTERN SHEET METAL COI
DBA TJM SHEET METAL-MA
6 NIBLICK RD
ENFIELD,CT 06082
619 0412612020 434290
SHEET METAL WORKERS I. J
ISSUES THE FOLLOWING LICESMASTER4INRSSTm*j;ITHOMAS J MEENGER6 NIBLICK RDENFIELD,CT 08082JiS62228 08128!2019
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