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38A-109 (6) I ` Commonwealth of Massachusetts M — _7� City Of Northampton °n M p =° � D —2 a t p Sheet Metal Permit Permit# ZCID o Es l ed Job Cost: $ 2 7of tn-o _ Permit Fee: $ (� o rIT i o �� Tks"Submitted: YES NO V" Plans Reviewed: YES NO ZL Business License#— Se Applicant License# C= 94 0 Business Information: Property Owner/Job Location Information: Name:1/V P InsTR/MC 7-C i7/y)eAJ SWYI e: '39- 111 L t f 6 t- ( /Zb , U Street:c2,5 f G(ry/ r A-) STgeei Street: �' 5 t/)L-L&7-z- !//L L 'bA� City/Town: kJC<r&Ar b City/Town: Telephone: �11-/3 Telephone: Photo I.D. required/ opy of Photo I.D. attached: YES NO Staff Initial J-1 4- 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 V Condo/Townhouses Other Commercial: Office Retail Industrial Educational Institutional Other / Square Footage: under 10,000 sq. ft. over 10,000 sq. ft. V Number of Stories: 3 Sheet metal work to be completed: New Work: / Renovation: HVAC V Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: w../ZAU' P /70 SR&T Mpr,,E �ICTL ..1i A(3U1ZP11V6 o2o - dc)31 0 $25.00 Residentiaj,� J' Fees for jobs without a Building Permit$6.00 per$1000 Minimum fees for jobs wit out Building Permit$50.00 Residential, $100.00 Commercial Z/y i s INSURANCE COVERAGE: I have a current liahilit insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes 15 No❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy & Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee rinPcz nor hay P the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waive this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box[],I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Prnarncc Tncn�rtinnc DW,P- CD1b1S encs Final Tncnnr•tion Wte Type of License: By ❑ Master Title ❑ Master-Restricted City/Town ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted License Number: Fee$ ❑ Check at •^�s..� ss gateirlpi Inspector Signature of Permit Approval i-� INDUTEC-03 LJUKI ,d►coRO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 10/01/2019 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(ies)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 cgllfer rights to the certificate holder in lieu of such endbrsement(s). PRODUCER C(jNTACT Mary Henderson NA E: People's United Insurance Agency,Inc. PHONE 413 735-6545 FAX 844 645-1330 One Monarch Place,10th Fir (AIC,No,Ext):( ) (A/c,No►:( ) Springfield,MA 01144 Ap^g41L .Mary.Henderson@peoples.com INSURERS AFFORDING COVERAGE NAIC p INSURER A:Arch Insurance Co. 11150 INSURED INSURER B:Continental Insurance Company 35289 Industrial Technical Services,Inc. INSURER C: 251 Union Street INSURER D: Westfield,MA 01085 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 TYPE OF INSURANCEADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000 CLAIMS-MADE X OCCUR ZAGLB9232501 10/01/2019 10/01/2020 DAMAGE TO RENTED 300,000 X X PREMISES rre MED EXP(Any oneperson) 10'000 PERSONAL&ADV INJURY 1'000'000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2'000'000 POLICY❑X PEST LOC PRODUCTS-COMP/OP AGG 2,000,000 OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 E id n X ANY AUTO X X ZACAT9260601 10/01/2019 10/01/2020 BODILY INJURY Perperson) OWNED SCHEDULED AUTOS ONLY AUTOS SSW BODILY INJURY Per accident X AUTOS ONLY X AUOTOS ONLQ PROPERTY AMAGE Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION$ A WORKERS COMPENSATION X I PER OTH- TATUTE ER AND EMPLOYERS'LIABILITY YX ZAWC19438301 10/01/2019 10/01/2020 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE � NIA E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 11000'000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT B Comm'I Excess Liab 6079476478 10/0112019 10101/2020 Each Inc/Aggregate 5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) General Liability: Blanket Additional Insured per CG2010 and CG2037;Waiver of Subrogation per CG2404;Primary&Non-contributory coverage. Auto Liability: Additional Insured Primary&Non Contributory perCA0116;Waiver of Subrogation per CA4044. Workers Compensation:Waiver of Subrogation per WC00 03 13. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Sample THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD I\IASSAGHUSETTS D RIVE NSE 0910412018 '1J 541870384 < >1011212023 10112/1351 CLASs. ':est 'NONE 21 "ti U EN NAI WAN _ 5 ROSEMARY OR WIlBRANAM,MA 01095.2527 7{ eres 1l ' wSEx M t R DD 09,V42018 78 Rev 012 017bNi6 i Fold,Then Detach Along All Perforations .COMMONWEALTH OF M� ACNt��ETT� SOARB QF SHEET METAL WORKERS ISSUES THE FOLLOWING LICENSE a MASTER-UNRESTRICTED a NAI W YUEN Lu 5 ROSEMARY DR WILBRAHAM,MA 01095-2527 J qa 2940 1028/2021 725763