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39-041 (19) 15 AT W OO D DR - SUITE 303 SM-2020-0021 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON GIS#: 110417 Map: '39 Block: 041 Lot: oo 1 ,� : SHEETMETAL PERMIT �. Permit: SHEETMETAL Category: renovation Permit# SM-2020-0021 PERMISSION IS HEREBY GRANTED TO: Project# 'JS-2020-001223 Est.Cost: x$72,000.00 Contractor: License: Expires: Fee Charged:$50.00 M&E MECHANICAL CONTRACTSheetmetal-25311 01/28/2020 Balance Due:$.00 Owner: NORTHWOOD DEVELOPMENT LLC #of Fixtures:; 11y cant: M& E MECHANICAL CONTRACTORS INC DigSafe# f1 T: 15 AI WOOD DR-SUITE 303 UseGroup ConstClass ISSUED ON: 23-Dec-2019 AMENDED ON: EXPIRES ON: TO PERFORM THE FOLLOWING WORK.- FIT ORK:FIT OUT FOR SUITE 303 -CERT PA 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-2020-002100 20-Dec-19 7757 $50.00 212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck@northamptonma.gov GeoTMS®2019 Des Lauriers Municipal Solutions,Inc. Commonwealth of Massachusetts _ ( Ci Of Northampton OEC 2 0 ?p;q Sheet Metal Permit P ermit#D [ I NORT4A'Ar-1ON.MA01U6G Estimated Job Cost: $ 32-1000 _ Permit Fee: $_ Plans Submitted: YES NO�_ Plans Reviewed: YES NO Business License# 3�3 Applicant License# 253%1 Business Information: Property Owner/Job Location Information: Name: kkf. _n�C�� COra j Name: nS cc�S Street: -) A UCP SAme_4_ Street: J'S -Mk'x - "UAV*-- City/Town:��\"�ie� �AA (�LC)z� City/Town: PQr'+V\0r'kP+M, �AN Telephone: Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES '�__ NO ,� �� StaffInitial �" nrestricted 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. over 10,000 sq. ft. )(, Number of Stories: Sheet metal work to be completed: New Work: Renovation: HVAC)L__ Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: ins � New _uC,+ j SATILY+i on S)t sAenn 5-ox 1 y- 11 < 12— . -myn-m 1)tic* to IA40 UT4-.' ani bCyMX"sr poky 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, $100.00 Commercial F,NSURANCE COVERAGE: have a current ll''�insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes X No❑ If you have checked Yes, indica�t{e,the type of coverage by checking the appropriate box below: A liability insurance policy ISI Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does net have the insurance coverage required by Chapter 112 of the Massachusetts General Laws, and that my signature on this permit application waive this requirement. Check One Only _ Owner ❑ Agent Signature of Owner or Owner's Agent By checking this boxkl hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Prnarr�cc incn��tinnc Ratc Final inspoct*on Rate Type of License: Ely easter Title ❑ Master-Restricted City/Town ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted License Number: 26511 Fee$ ❑ Check at-_mass gnv_/T LAD, v ,/ao/,9 Inspector Signature of Permit Approval .eco® CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDDIYYYY) �' 10/02/2019 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 GUNTACT David R Jarry NA Neill&Neill Insurance Agency Inc PHONE 413-732-4137 FAX 413-731-6629 662 Riverdale Street ac,Nor West Springfield,MA 01089 E-MAIL dj@neillandneill.com AD RESS: INSURER(S)AFFORDING COVERAGE NAIC p INSURER A: SAFETY INSURANCE COMPANY 39454 INSURED M&E Mechanical Contractors 1 Allen Street INSURER 13: Safety Ind Ins CO 33618 Springfield,MA 01108 INSURER C: Technology Insurance Co 42376 INSURER D: INSURER E: INSURER 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 AD L SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE WVDPOLICY NUMBER MMIDD/YYYYI (MMIDDIYYYYI LIMITS A COMMERCIAL GENERAL LIABILITY BMA0009180 08/31/2019 8/31/2020 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE IV OCCUR DAMAGE1 OO,OOO PREMISES(Ea occurrence) $ _ MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- JECT [7 LOC 2,000,000 PRODUCTS•COMP/OP AGG $ OTHER: $ B AUTOMOBILE LIABILITY 1710518 04/21/2019 04/21/2020COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO Ea c,dent BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per a )dent $ $ A UMBRELLA LIAB OCCUR CM00006018 10/31/2019 10/31/2020 EACH OCCURRENCE $ 5,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 5,000,000 DED I I RETENTION 1 $ C WORKERS COMPENSATION WWC3374339 10/04/2019 10/04/2020PER o H- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNER/EXECUTIVEFI N I A E.L.EACH ACCIDENT $ 1,000,000 OFFICERWEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE.EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS bel I E.L.DISEASE-POLICY LIMIT 5 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Mike Edwards THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1 Allen Street ACCORDANCE WITH Tq9 POLICY PROVISIONS. Springfield,MA 01108 AUTHORIZED REPRESENT IVE a ©1988-2015 ACORD CORAQkATION. k1i ri is reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD ANE MECHANICAL CONTRACTORS INC. COMMONWEALTH OF • • , „ • MAS SACHtr?SETTS^ • BOAR SHEET METAL WORKERS ISSUES THE FOLLOWING LICENSE MASTER-UNRESTRICTED MICHAEL M EDWARDS 19 LONGVIEW DRIVE SUFFIELD, CT 06078 Z W U 25311 01/28/2021 j 636404. ��ACH tTSF'T TS DRIVER'S LICENSE . 9b!'W +r! NONE S45858092 Doe 0 01.089 sa M 43 Ds 2' CHAFE AWTHEW R 49 APRICOT HILL RD 3txce': SPRINGFIELO,A1A 010894481 noon-oe.00lsaee�.lyaoro +'V, 1 Allen Street • Springfield, MA01108 T: (413) 781-0014 • F. (413) 781-0016 www.mandemechanical.com MSE MECHANICAL CONTRACTORS INC. Sheet Metal Business License COMMONWEALTH OF MASSACHUSO ETTS BOARD OF SHEET METAL WORKERS ISSUES THE FOLLOWING LICENSE ` BUSINESS 'Luc MARK S EDWARDS MBE MECHANICAL CONTRACTORS INC 1 ALLEN STREET SPRINGFIELD, MA 01108 ' 323 04/07/2021 604622 • . 1 Allen Street .Springfield, MA 01108 T.(413)781.0014 • F: (413)781-0016