Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
31B-253 (24)
33 ELM ST COMMONWEALTH OF MASSACHUSETTS SM-2021-0063 Map:Block:Lot: 31B-253-001 CITY OF NORTHAMPTON Permit: Sheet Metal PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# SM-2021-0063 PERMISSIONIS HEREBY GRANTED TO: Project# HVAC Contractor: License: Est. Cost: 886000 KLEEBERG SHEET METAL INC Const.Class: Exp.Date: Use Group: Owner: SMITH COLLEGE XINH SPANGLER Lot Size (sq.ft.) Zoning: EU/URC Applicant: KLEEBERG SHEET METAL INC Applicant Address Phone: Insurance: 65 WESTOVER RD (413)589-1854 WC-0081102-02 LUDLOW, MA 01056 ISSUED ON:09/30/2021 TO PERFORM THE FOLLOWING WORK: DUCTWORK, FANS FOR ALUMNAE HOUSE RENO POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: 'f• • ).9 59Afa Fees Paid: $50.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner RECEIVED Commonwealth of Massachusetts SEP 2 9 2021 City Of Northampton Sheet Metal Permit Permit# 547 -a I . 00 03 DEPT.OF bill_ . rbIS NORTHA".O MA 010hU ,, Q Estimated Job Cost: $ 886,000 Permit Fee: $ 50 C i�3CJ Plans Submitted: YES x NO Plans Reviewed: YES NO Business License# 24 Applicant License# 2192 Business Information: Property Owner/Job Location Information: Name: Kleeberg Sheet Metal, Inc. Name: Smith College Street: 65 Westover Rd Street: 33 Elm Street City/Town: Ludlow, MA 01056 City/Town: Northampton, MA 01060 Telephone: 413-589-1854 Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES x NO Staff Initial J-1 -1-unrestricted lice 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 x Other Square Footage: under 10,000 sq. ft. over 10,000 sq. ft. x Number of Stories: 4 Sheet metal work to be completed: New Work: Renovation: x HVAC x Metal Watershed Roofing Kitchen Exhaust System x Metal Chimney/Vents Air Balancing x Provide detailed description of work to be done: Provide ductwork,fans and equipment for full Alumnae House remodel. 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,$100.00 Commercial INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes❑x No❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy E Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee rice not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waivesthis requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box®,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Progress Iucpectionc Date Cnmments Final Invert-inn Date ('nmments Type of License: By ® Master Title ❑ Master-Restricted Daniel Kleeberg City/Town ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted 2192 License Number: Fee$ ❑ Check at www mast gnvldpl (' 4)1\am_, 31/3 0 Inspector Signature of Permit Approval • .07121 I 1"1 ', — uy »-5nvK.i�a� h :Sty'. DANIEL J XLEEBERG f KLEEBERG SHEET METAL INC (SM) , ,$=ai«x 65 WESTOVER RD 'l`,•-� •s ... n ' c use i ' LUDLOW MA 01056 M..YI •D4titkJ s72490088{(; Rg L. • -- EWONGfiEADO ,{fA >. r , r i ,•,•/ /' i 0011423-20l Rev er-issp, J .. Fold,Then Detach Along All Perforations i ill+ ;LT •F ,- —RI DIVISION OF PROFESSIONAL LICENSURE SHEET METAL WOE:;' mugs.ilsfp FOLLOWNG uCeNSE , • J KLEESERiss WillEeRftcloogigts METAL!MC • 65 WritraVtelt ROAD.. LUDLOW.MA 01066 24 08110/2022 889324 ( I Fold,Then Detach Along All Perforations COMMONWEALTH OF MA. -, CHUSETTS DIVISION OF PROFESSIONAL LICENSURE BOARD OF SHEET METAL WORKERS ISSUES THE FOLLOWING LICENSE MASTER-UNRESTRICTED DANIEL J KLEEBERG KLEEBERG SHEET METAL INC a 65 WESTOVER RD LUDLOW, MA 01056-1298 z 2192 10/28/2021 725705 J ��..., KLEESHE-03 r MPROULX A�R� CERTIFICATE OF LIABILITY INSURANCE °��""�°°""`" 3/30/2021 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 WANED, subject to the teens 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 suc��hppeendorsement(s). PRODUCER NMEAC1 HUB International New EnglanPHONE d 1070 Suffield St (rue, Eat);(800)243-$134 1 rjrc.N.k(413)731-9539 Agawam,MA 01001 ss: ---- INSURERR3)AFFORDING COVERAGE NAIL s INSURER A:Republic-Franklin Insurance Company 12475 INSURED INSURER B:Graphic Arts Mutual Insurance Company 25984 Kleeberg Sheet Metal Inc. INSune c:Philadelphia Indemnity Insurance Company _18058 Kieeberg Mechanical Services LLC 65 Westover Rd INSURER D:Zurich American Insurance Company 16535 Ludlow,MA 01056 INSURE R E:Travelers Property Casualty Company of America 25674 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. Of INSURANCE NEED INVD POLICY NUMBER ryO uoMsuee potter yyI �1l orrr�YY1 �TS � TYPE A X COa11SRCiAL comm.maim,/ EACH OCCURRENCE_____- f 1,000,000 DAMAGE X OCCUR X X CPP4643304 4/112021 4/112022 D FT RE,s„oe) _s 100.000 MED EXP(Any one anion) $ 5'000 • PERSONAL a ADV INJURY $ 1,000,000 GENT AGGREGATEpLIWT APPIJES PER: GENERAL AGGREGATE $ 2,000,000 POucY X 1 JEC'r 1 1 LOC PRODUCTS-COMP/OP AGG 3 2,000,000 OTC $ COMBINED B AUTOMOBILE LIABILITY SINGLE Lail s 1,000,000 ANY AUTO X X 4640484 4/1/2021 4/1/2022 BODILY ai.RIRY(Per arson) s AUTOSOWNED ONLY X AUTO OS ED BODILY INJURY1Per aocidenu)-.,t X AH Ja ONI Y _X Ac ' ( r. M�"uGE s S C UMBRELLA LI _ABX OCCUR EACH OCCURRENCE I$ 5,000,000 X EXCESS UAS CLAIMS-MADE X X ,PHUB76152B 4/1/2021 4/1/2022 �� $ 5,000,000 DED 1 X RETENTION$ 10,000 $ D traumas AN O coovErisAnoLIA L n X I STATUTE 11 ANY pROPRIEroR/PARTN UVL CUTFVE TY Y/N X WC 00111102-03 3/1/2021 3/1/2022 E.I.-EACH ACCIDENT $ 1,000,000 (Mandal AE�YBER EXCLUDED? LNi Ni A 1,000,000 1IMMra�yya�er„rd�,r„�I, 1r R EA.D19EASE-EA Dow s DESCRIPTION OF�OPERATIONS below EL DISEASE-POLICY LIMIT ; 1��'� E Excess Umbrella ,ZUP31M2810021NF 4/1/2021 4/1/2022 5,000,000 j DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additk,nal Remarks Schedule,may be attaehad if mere apace is raquN.d) Re:Project Number:20-407-Amazon-DMH4,300 Dan Road,Canton MA 02021 Krusinski Construction Company"General Contractor",Stoneridge Inc.,"OwnerlLandiord",BL Companies"Architect",Amazon.com Services,Inc."Tenant, are named as Additional Insured In respect to General Liability as required per written contract or written agreement. Certificate holder is named as additional Insured as per Massachusetts laws and Business Auto Form II CA0001 and Massachusetts Amendatory form INAM9911 only. All policies are primary,non-contributory. Waiver of subrogation applies to all policies. 30 days written notice of cancellation except for non payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Krusinskl Construction Company ACCORDANCE WITH THE POLICY PROVISIONS. 2107 Swift Dr Oak Brook,IL 60523 AUTHORIZED REPRESENTATIVE � .�13 I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ;FARM ' ;=,y 1 Congress Street, Suite 100 '�- Boston,MA 02114-2017 n'wwmass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/orgauizatiot,nnaistiduat): Kleeber• Sheet Metal Address: 65 Westover Road City,'StateiZip: Ludlow, MA 01056 Phone#: (413) 547-8142 Are you au employer?Check the appropriate box: Type of project(required): 1.® I am a employer with 14 0 4. ❑ I am a general contractor and I 6. 0 New construction employees(full and/or part-time).* have hired the sub-contractors ..❑ T am a sole proprietor or partner- listed on the attached sheet. 7. []Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers 9. Building addition [No workers' comp.insurance comp. insurance.: required.] 5_ El We are a corporation and its 10.0 Electrical repairs or additions ] officers have exercised their 11.0Phunbiug repairs or additions 3.❑ I am a homeowner doing all wort: rep myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152.§1(4).and we have no employees. [No workers' 13.0 Other comp.insurance required.] 'Any applicant that checks box Fn must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all weak and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the utls.cartttactors and state whether or not those entities have employees. If the sub-contractors have employees.they mast provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information_ Insurance Company Name: Zurich American Insurance Company Policy#or Self-ins.Lic.#: WC 0 0 8110 2—0 2 Expiration Date 3/1/2022 Job Site Address: C'ityiState/Zip: 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 tine up to$1.500.00 ardor one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a tine 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 for insurance coverage verification. I do hereby cert1JJ'under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: (413) 589-1854 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# • 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#: