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32C-186 (3)
SM-2022-0012 398 PLEASANT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 32C-186-001 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-2022-0012 PERMISSION IS HEREBY GRANTED TO: Project# 2022 RENOVATION Contractor: License: NYZIO HEATING AND Est. Cost: 6500 AIRCONDITIONING Const.Class: Exp.Date: Use Group: Owner: J NIEDBALA, STEVEN Lot Size (sq.ft.) Zoning: GB Applicant: NYZIO HEATING AND AIRCONDITIONING Applicant Address Phone: Insurance: PO BOX 356 (413)534-3320 WCB76706 GRANBY, MA 01033 ISSUED ON:05/06/2022 TO PERFORM THE FOLLOWING WORK: HVAC 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: '0 • . 3.11 Fees Paid: S25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner omit Lp-I-Ci RECEIVED.) Commonwealth of Massachusetts ._�.____ _ I City Of Northampton j MAY - 6 2022 'Date: g j- 1..)--- Sheet Metal Permit Permit# S _`- -1-7dt '`{.QF QUlln NG �79PEGTION�i � v�=-31LAMICiiIrat3CtgOb_Cost: $ kg d C1 Permit F4M6' Plans Submitted: YES NO Plans Reviewed: YES NO e/ Business License# N OP Applicant License# a-7 II Business Information: Property Owner/Job Location Information: Name: 1' yzio A-e4iLA9 ghri ', -.6ed, Name: 9-e.J_zt, Ali, 3L1(1 Street: . O, .go,( 3S c Street: 2 ci 8 u v,,f I P v ,s.nv4 S 1 City/Town: C=''--, k j M 9 . 0 10 35:' City/Town: No ,/'p I.c. h Telephone: N/3- c?`i- ?3e c) Telephone: L I)3-- Zd S —6.26 6 Photo I.D. required/Copy of Photo I.D. attached: YES NO \� Staff Initial J-1 / -restricted 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 s . ft. V over 10,000 s . ft. Number of Stories: 9 g � q q Sheet metal work to be completed: New Work: Renovation: H VAC 1/ Metal Watershed Roofmg Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: Ff-4 I')1 c4k (k A ; (t. Si-i/) uci-wcrk -f t 1 ees with Building Permit: $25.00 esidential, $50.00 Commercial. Fees for jobs without a Building Permit$6.00 per$1000 rjobs without Building Permit$50.00 Residential, $100.00 Commercial INSURANCE COVERAGE: I have a current Jiahility insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes>'J No❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee dnpc not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waivPsthis requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box❑,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO progress Incpectionc Date Comments Final Inspection Date Comments Type of icense: By aster Title ❑ Master-Restricted City/Town ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted -� Fee$ License Number: Check at www mass dnv/dpl Inspector Signature of Permit Approval ACC DATE(MM/DD/YYYY) �.. CERTIFICATE OF LIABILITY INSURANCE 05/04/22 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 confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CON MC NAME: Jenny Murdza AX Metras Insurance Agency (A c No.EMI: 413-536-1491 (A ,No): 413-532-8522 2030 Memorial Drive E-MAIL Chicopee,MA 01020 ADDRESS: jmurdza@metrasinsurnance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: NGM Insurance Company INSURED INSURER B: Concord Group Insurance Nyzio Sheet Metal,LLC INSURER C: 56 Buckley Blvd. INSURER D Chicopee,MA 01020 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: TH;S 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 ADDLSUBN POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 TED CLAIMS-MADE X OCCUR PREMISES O(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 A MPT9289Q 01/21/22 01/21/23 PERSONAL A.ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- X POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNEDOSONLY AU X SCHEDTOSULED 20045371 02/05/22 02/05/23 BODILY INJURY(Per accident) $ AUT X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB _OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER A OFFICER/MEMBER ANY EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE Yv N/A WCB76706 06/11/21 06/11/22 E.L.EACH ACCIDENT $ 500,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Members are not included under the workers compensation coverage HVAC CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 210 Main Street Northampton,MA 01060 AUTHORIZED REPRESENTATIVE Jenny Murdza ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD