32C-001 SM-2023-0008
150 MAIN ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
32C-001-001 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-2023-0008 PERMISSION IS HEREBY GRANTED TO:
Project# 2023 TELLUS BAR RENO Contractor: License:
Est. Cost: 1500 ALL STATE HOOD & DUCT
Const.Class: Exp.Date:
Use Group: Owner: LLC THORNES MARKETPLACE
Lot Size (sq.ft.)
Zoning: CB Applicant: ALL STATE HOOD &DUCT
Applicant Address Phone: Insurance:
88 NOTRE DAME ST (413)568-4663 08WECAD9C9A
WESTFIELD, MA 01085
ISSUED ON: 02/14/2023
TO PERFORM THE FOLLOWING WORK:
VENT FOR PIZZA OVEN
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:
6
Fees Paid: $100.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
Commonwealth of Massachusetts
Sheet Metal Permit
Date: 2/( / 2 3 � ;_ r Permit# Sh'1_.A 3--
Y - L
Estimated Job Cost: $ (s O C� F E B 1 4 2023 Permit Fee: $ t�
Cc"- 3
Plans Submitted: YES NO I ---- Plans Reviewed: YES NO
TF14�,1 DI NG INSPFciIC!Nc,
Business License # 723 °'AiWiedi t License# 25236
Business Information: Property Owner/Job Location Information:
Name: Allstate Hood&Duct,Inc. Name:• r IG/l 4 S
Street: 88 Notre Dame St. Street: ( ) /''fir-r, r
City/Town: Westfield,MA 01085 City/Town:
Telephone: 413-568-4663 Telephone:
Photo I.D. required/Copy of Photo I.D. attached: YES ✓ 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
Institutional Other
Square Footage: under 10,000 sq. ft. over 10,000 sq. ft. Number of Stories:
Sheet metal work to be completed: New Work: Renovation:
HVAC Metal Watershed Roofing Kitchen Exhaust System V
Metal Chimney/ Vents Air Balancing
Provide detailed description of work to be done:
V/A� P;- U oL/€Ii
INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 YesVrNo❑
If you have checked Yes,indicate the type of coverage by checking the appropriate box below:
A liability insurance policy it Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
Check One Only
^� Owner ❑a/
Agent a
Signature of Owner or Owner's Agent
By checking this boil 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 Inspections
Date Comments
Final Inspection
Date Comments
Type of License:
By ' Master
Title ❑Master-Restricted
City/Town
❑Journeyperson Signature of Licensee
Permit#
❑Journeyperson-Restricted License Number: 25236
Fee$ ❑
r o Check at www.mass.qov/dpl
Pi/y a3
Inspector Signature of Permit Approval
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
•= 14- Boston,MA 02114-2017
< www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WiTH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Allstate Hood & Duct, Inc
Address: 88 Notre Dame St.
City/State/Zip: Westfield, MA 01085 Phone#: 413-568-4663
Are you an employer?Check the appropriate box: Type of project(required):
11 am a employer with 5 employees(full and/or part-time).* 7. ❑New construction
2.0 i am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3.❑1 am a homeowner doing all work myself.[No workers'comp.insurance required.]'
10 Building addition
4.0 lam a homeowner and will be hiring contractors to conduct all work on my property. I will
❑
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees. 12.❑Plumbing repairs or additions
5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet.
❑ 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance.:
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other Kitchen exhaust
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
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: The Hartford
Policy#or Self-ins.Lic.#: 08WECAD8C9A Ex piration Date: 10/06/22
Job Site Address: City/State/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 MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date:
Phone#:
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#:
MASSACHUSETTS DRIVER'S
LICENSE
a 12/0112021 44 S61705244
- } ,113EiR 3 DOB
12sr2026 12I29/1967
°\. ,r„ CFA55 12 REST 9'
NONE
' D' NONE NONE
27ODDWILLIAM
a 171 HILLSIDE RD
APT 1
WESTFIELD,MA01085-4106
G s sVEs BLU i /c
��r�W�/'" 500 12/82/2021 Rev 02122/ 29
1016 LI AJ!V7
COMMONWEALTH OF MASSACHUSETTS
DIVISION OF PROFESSIONAL LICENSURE
BOARD OF
SHEET METAL WORKERS
ISSUES THE FOLLOWING LICENSE Ituu:
wcc
MASTER-UNRESTRICTED
TODD W DUVAL
ALLSTATE HOOD&DUCT
88 NOTRE DAME ST z
WESTFIELD,MA 01085 �J
25236 12/28/2023 146042
LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER
COMMONWEALTH OF MASSACHUSETTS
DIVISION OF PROFESSIONAL LICENSURE
BOARD OF
SHEET METAL WORKERS
ISSUES THE FOLLOWING LICENSE
BUSINESS
TODD W DUVAL v,
ALLSTATE HOOD&DUCT, INC.
24 MAINLINE DR
WESTFIELD,MA 01085 ,J
723 01/0712024 146098
LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER