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38A-109 (5) 35 VILLAGE HILL RD SM-2020-0036 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON GIS#: 11572 Map: 38A .; Block: 109 Lot: 00011 ' ` SHEETMETAL PERMIT Permit: SHEETMETAL Category: SHEETMETAL Permit# SM-2o20-0081 Project# JS-2018-000 815 PERMISSION IS HEREBY GRANTED TO: Est.Cost: $270,000.00 Contractor: License: Expires: Fee Charged:$75.00 INDUSTRIAL TECHNICAL SERVI Sheetmetal-2940 10/28/2021 Balance Due:$.00 Owner: HOSPITAL HILL DEVELOPMENT LLC C/O MASSDEVELOPMENT LLC #of Fixtures: Applicant: INDUSTRIAL TECHNICAL SERVICES DigSafe# AT: 35 VILLAGE HILL RD UseGroup ConstClass ISSUED ON: 14-Apr-2020 AMENDED ON: EXPIRES ON: TO PERFORM THE FOLLOWING WORK: HVAC 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-2020-002976 08-Apr-20 1182 $75.00 i i 212 Main Street,1'hone:(413)587-1240,Fav(413)587-1272,Email:lhasbrouck@northamptonma.gov GeoTMS®2020 Des Lauriers Municipal Solutions,Inc. _ Commonwealth of Massachusetts City Of Northampton 0 0 >- �, .Z _20Z Sheet Metal Permit _3 D D Permit Z. °O o Es>ma, ted Job Cost: $ 2.70, Permit Fee: $ 0 o Plans Submitted: YES NO ✓ Plans Reviewed: YES NO Business License#— SO�j Applicant License # o 9z 0 Business Information: Property Owner/Job Location Information: Name: //1,J P tis 7�C,(7/y/LAL 0gY1 Woe: 1/�L ZjI l /Z b , LL � Street:,-25 Uiv/ P A) Street: to G-L4C-z- )(1/t L City/Town: ji7) City/Town: AIO %yTe:>du a Telephone: 6/-/,3 Telephone: FA1AiL = /. 'YUr-iV %T S- Cor�T/zaL Cort Photo I.D. required 1-opy of Photo I.D. attached: YES \// NO staff Initial J-1M-1- 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: 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: `NS%c/}- LL. ��L. �Q�ML�.►"1 �tl�7H S'�/�T M�}T�L 14(,r �/z ��y BU�GD�N( O MIT # B p-Zv?o - D03� $25.00 Residential., Fees for jobs without a Building Permit$6.00 per$1000 Minimum fees for jobs without Building Permit$50.00 Residential, $100.00 Commercial Z'X/ 'S INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes u No❑ If you have checked Yes,indicate the type of coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee rinpc not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waive this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box❑,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO PrngrPQQ Tncnprtinnc .gate r'nrnmPntc Final Tuspectinn Dare com��nPntc Type of License: By ❑ Master Title ❑ Master-Restricted City/Town ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted License Number: Fee$ ❑ . r}7 W"— Check at wwwrr,a�cv _g.A /fl rni real 61 Inspector Signature of Permit Approval 4 g 12"j -� INDUTEC-03 LJUKIC ACORO` CERTIFICATE OF LIABILITY INSURANCE DATE 10101/20/9 Y) `.� 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 cp_lfer rights to the certificate holder in lieu of such endbrsement(s). PRODUCER N�E?'CT Mary Henderson People's United Insurance Agency,Inc. PHONE 413 735-6545 FAX 844 645-1330 One Monarch Place,10th Fir (A/C,No,Ext):( ) (AIC,No):(844) Springfield,MA 01144 ADDRE :Mary.Henderson@peoples.com INSURERS AFFORDING COVERAGE NAIC A 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 INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF (POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS AIDE X OCCUR ZAGLB9232501 10/01/2019 10/01/2020 DAMAGE TO RENTED 300,000 X X PREMIE E «en MED EXP(Any oneperson) 10'000 PERSONAL&ADV INJURY 1'000'000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2'000'000 POLICY❑X JJECT LOC PRODUCTS-COMP/OP AGG 2,000,000 OTHER: 000 A AUTOMOBILE LIABILITY EO accc dent SINGLE LIMIT $ 1�00O�— X ANY AUTO X X ZACAT9260601 10/01/2019 10/01/2020 gODILYINJURY Per erson $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ X HIRED X NON ED PROPER nt AMAGE $ AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION$ PER OTH- A WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATUTE ER YN X ZAWC19438301 10/01/2019 10/01/2020 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE NNIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT B Comm'I Excess Liab 6079476478 10/01/2019 10101/2020 Each Inc/Aggregate 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 1D1,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 0313. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Sample THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Pe a Zia" *76. ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MASSACHUSETTS DRIVER'S LICENSE 01�"" " 544870384 x`10/1212023 � 1011211951 `.CUSS ','REST Eli1 U 8 NONE YUEN r NAI WAN 5 ROSEMARY DR WILBRAHAM,MA 01095.2527 EYES DLIK 00� I � SEX M ii,HGr 5*-06" P` d" nOD OH/0�10ta flet/O7R1J26K Fold,Then Detach Along All Perforations .COMMONWEALTH OF MA CIACHt tETTS s - e6 BOARD OF SHEET METALWORKERS ISSUES THE FOLLOWING LICENSE Q MASTER-UNRESTRICTED 'L � rry NAI W YUENLu n 5 ROSEMARY DR WILBRAHAM,MA 01095-2527 J 2940 10128/2021 725763 Li 1m. �I