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31B-170
SM-2022-0023 HENSHAW AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31B-170-001 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-2022-0023 PERMISSION IS HEREBY GRANTED TO: Project# PARSONS HOUSE RENO Contractor: License: NORTHEASTERN SHEET METAL CO Est. Cost: 9000000 INC Const.Class: Exp.Date: Use Group: Owner: SMITH COLLEGE XINH SPANGLER Lot Size (sq.ft.) Zoning: EU/URC Applicant: NORTHEASTERN SHEET METAL CO INC Applicant Address Phone: Insurance: 88 PEASE RD LONGMEADOW, MA 01028 ISSUED ON: 11/21/2022 TO PERFORM THE FOLLOWING WORK: ALL HVAC SHEET METAL WORK 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: Fees Paid: $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner SM-2022-0023 0 HENSHAW AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31B-170-001 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-2022-0023 PERMISSION IS HEREBY GRANTED TO: Project# PARSONS HOUSE RENO Contractor: License: NORTHEASTERN SHEET METAL CO Est. Cost: 9000000 INC Const.Class: Exp.Date: Use Group: Owner: SMITH COLLEGE XINH SPANGLER Lot Size (sq.ft.) Zoning: EU/URC Applicant: NORTHEASTERN SHEET METAL CO INC Applicant Address Phone: Insurance: 88 PEASE RD LONGMEADOW, MA 01028 ISSUED ON: 11/21/2022 TO PERFORM THE FOLLOWING WORK: ALL HVAC SHEET METAL WORK 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: ;4A!s , 110,9. Fees Paid: $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner Commonwealth of Massachusetts City Of Northampton I Nov 4 2022 f Date: 10/27/22 Sheet Metal Permit Permit# - `CTIONS Estimated Job Cost: $69,800 Permit Fee: $50.00 CO*311 `C q Plans Submitted: YES X NO Plans Reviewed: YES NO Business License# 519 Applicant License# 2223 Business Information: Property Owner/Job Location Information: Name: NorthEastern Sheet Metal Name: Smith College - Parsons House Street: 6 Niblick Rd. Street: 24 Henshaw Ave. City/Town: Enfield, CT 06082 City/Town: Northampton, MA Telephone: 860-265-3805 Telephone: 413-584-2700 Photo I.D. required/Copy of Photo I.D. attached: YES X NO Staff Initial J-1 /M-1-unrestricted 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 X Institutional Other Square Footage: under 10,000 sq. ft. over 10,000 sq. ft. X Number of Stories: 5 Sheet metal work to be completed: New Work: Renovation: X HVAC X Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: All HVAC sheet metal work for the Smith Colige - Parsons House renovation project per the accompanying drawings. 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,$100.00 Commercial , INSURANCE COVERAGE: I have a current Jiahility insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes No❑ If you have checked Yes,indicate the type of coverage by checking the appropriate box below: A liability insurance policy ❑■ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee rfnag not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waivecthis requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box❑,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Progrt-ssInvections Date rnmmentq Final Incrertinri Date Comments Type of License: By ❑■ Master / `A "t Title ❑ Master Restricted Thom J. Messenger - President City/Town ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted Master-2223,Business 519 License Number: Fee$ Sheet Metal Business x Check at www macc tgnv/dpi ..)?,, , Va)/ ., ._. Inspector Signature of Permit Approval The Commonwealth of Massachusetts =o= Department of Industrial Accidents _'40 G Office of Investigations �,C :.�,�- -, 1 Congress Street, Suite 100_.. v Boston,MA 02114-2017 y www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): North Eastern Sheet Metal Address:6 Niblick Rd. City/State/Zip: Enfield, CT., 06082 _ Phone #:860-265-3805 Are you an employer? Check the appropriate box: Type of project(required): 1.❑■ I am a employer with 38 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. El Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions 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#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work 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 sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Utica National Insurance Company of Texas Policy#or Self-ins. Lic. #:5438940 Expiration Date:4/15/2023 Job Site Address: Smith College, Parsons House, 24 Henshaw Ave. City/State/Zip: Northampton, MA 01060 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 criminalipenalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine 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 -I insurance coverage verification. I do hereby certify un er t . pains and penalties of perjury that the information provided above is true and correct. gn to efritt.) Datc:10/27/22 signature: Phone#: 860-26 -3805 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#: ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 10/12/2022 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 CONTACT NAME: John M. Glover Agency PHONE Yesenia Maggio FAX P.O. Box 700 IA/C.No.Ext):203-702-7924 (ac,No):203-672-4968 Norwalk CT 06852 AnoRIEss: ymaqqio©johnmglover.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Republic-Franklin Insurance Company 12475 INSURED NORTSHE-02 INSURER B:Utica Mutual Insurance Company 25976 Northeastern Sheet Metal Co., Inc. 6 Niblick Road INSURER C:Utica National Insurance Company of Texas 43478 Enfield CT 06082 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:606805447 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY 5448253 4/15/2022 4/15/2023 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $100,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY JECOT- LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY 5437470 4/15/2022 4/15/2023 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) ,$ AUTOS ONLY AUTOS X HIRED x NON-OWNED PROPERTY DAMAGE �$ AUTOS ONLY AUTOS ONLY (Per accident) B X UMBRELLA LIAB X OCCUR 5448254 4/15/2022 4/15/2023 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTION$to nnn $ C WORKERS COMPENSATION N 5438940 4/15/2022 4/15/2023 X AND EMPLOYERS'LIABILITY STATUTE OTH- ER ANYPROPRIETOR/PARTNER/EXECUTIVE Y� N/A E.L.EACH ACCIDENT $1,000,000 OFFICERIMEMBEREXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A Equipment N N 5448253 4/15/2022 4/15/2023 Leased/Rented 200,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The certificate holder is an additional insured under the general liability assumed under written contract with the insured executed prior to a loss. Evidence of Insurance for Sheet Metal Permit. Job:Smith College-Parsons House Renovation 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. Building Department Puchalski Municipal Building 212 Main St. AUTHORIZED REPRESENTATIVE Northampton MA 01060 w7, 62. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD MASSACHUSETTS DRIVERS LICENSE NOT FOR FEDERAL ID . 1 166 M AIUER 04/04/2018 S60331614 08I2512023 08/25/1969 DM NONE NONE REST ENO . � MESSENGER w THOMAS J 88 PEASE RD EAST LONGMEADOW,MA 01028-3111 _ EYES BLU (� �Q+ /�// DO04092018 Rev 1I22)2016 08/251R7M COMMONWEALTH OF MASSACHUSETTS DIVISION OF PROFESSIONAL LICENSURE BOARD • SHEET METAL WORKERS ISSUES THE FOLLOWING LICENSE MASTER-UNRESTRICTED THOMAS J MESSENGER 6 NIBLICK RD ENFIELD,CT 06082-4456 N. 2223 08/2812023 76915 s�aIna-MEP ::Fs [._: >ir Tdcr+qr' �El COMMONWEALTH OF MASSACHUSETTS DIVISION OF OCCUPATIONAL LICENSURE BOARD OF SHEET METAL WORKERS ISSUES THE FOLLOWING LICENSE BUSINESS THOMAS J MESSENGER NORTHEASTERN SHEET METAL CO INC DIM TJM SHEET METAL-MA 6 NIBLICK RD s , ENFIELD,CT 06082 519 04/2612024 2 s:69 LACEN6E NUMBER EXPIRATION DATE SERIAL NUMBER NorthEastern Sheet Metal Co.,Inc. ! ,l 6 Niblick Road Enfield, CT 06082 Tel. (860)265-3805 Fax. (860)265-3815 To Whom It May Concern, Please mail the Sheet Metal Permit to: NorthEastern Sheet Metal Attn: Nick Fournier 6 Niblick Rd. Enfield, CT 06082 If you would like to send a copy of the permit electronically, please email the permit to: nfo urnier@nesmc o.com Thank you, Nick Fournier General Manager /�NorthEastenn r �\ Sheet Metal Co.,lnc i� /� 6 Niblick Rd. Enfield, CT 06082 Phone: (860) 265-3805 Fax: (860) 265-3815 Email: nfournier@nesmco.com