48-027 SM-2023-0020
66 RIDGE VIEW RD COMMONWEALTH OF M SSACHUSETTS
Map:Block:Lot:
48-027-001 CITY OF NORTHA PTON
Permit: Sheet Metal
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# SM-2023-0020 PERMISSION IS HEREBY GRANTED TO:
Project# 2022 new single family Contractor: License:
Est. Cost: 25000 PAUL TATRO
Const.Class: Exp.Date:
Use Group: Owner; S ARM.TRONG KIPP S & PATRICIA
Lot Size (sq.ft.)
Zoning: RR Applicant: DEE SE'VICES INC
Applicant Address Phone: Insurance:
999 RIVER RD (413)789-0800 A0198189006
AGAWAM, MA
ISSUED ON: 07/19/2023
TO PERFORM THE FOLLOWING WORK:
HVAC -DUCT WORK FOR GEOTHERMAL HEAT PUMPS
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 NO THAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: I
V • >2 . Ti„ .
I I ,
Fees Paid: $25.00
212 Main Street,Phone(413)587-1240,Fa : (413)587-1272
Office of the Building Commis 'oner
4 \/ j�� \�0 Commonwealth of Massachusetts
hi - 490a5. Sheet Metal Permit
4), `p 7/./20-
t1'I Permit# S -O?3- oii
4''1°F%r'ONs 25 000.00 i a /
gated J.. Cost: $ Permit Fee: $ 25.00 Ci *3
Plans Submitted: YES NO X Plans Reviewed: YES NO
Business License# 673 Applicant License# 6483
Business Information: Property Owner/Job Location Information:
Name: Dee Service, Inc. Name: Sovereign Builders
Street: 999 River Rd Street: 66 Ridge View Rd
City/Town: Northampton, Ma
City/Town: Agawam
Telephone: 413-789-0800 Telephone: 413-527-8001
Photo I.D. required/Copy of Photo I.D. attached: YES X NO
Staff Initial
J-1 f -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: I-2 family X Multi-family Condo/Townhouses Other
Commercial: Office Retail Industrial Educational
Institutional Other
Square Footage: under 10,000 sq. ft.X over 10,000 sq. ft. Number of Stories:
Sheet metal work to be completed: New Work: X Renovation:
HVAC X Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney/Vents Air Balancing
Provide detailed description of work to be done:
Install Complete Duct Distribution Systems to serve the New Geothermal Heat Pumps which
Serve Home Listed Above
INSURANCE COVERAGE:
I have a current liability 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 2 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 ❑ Agent ❑
Signature of Owner or Owner's Agent
By checking this boxE,1 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 X Master
Title
❑Master-Restricted
City/Town
❑Journeyperson
Signature of Licensee
Permit#
DJourneyperson-Restricted
Fee$ License Number: 6483
Check it www.mass.qov/dpl
Inspector Signature of Permit Approval
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:COMMONWEALTH OF MASSAVHUSEtrS
DIVISION OF OCCUPATIONAL LICENSURE
BOARD OF
SNEET`METAL WORKERS
Issugs Tog FOLLOWINGLICENSE W
MASTER-UNRESTRICTED �{
PAUL D TATRO
• 0 AUTUMN RIDGE RD
LUDLOW MA 01056-3258
6483 04/28/2024 239690
LICENSE NUMBER EXPIRATION DATE SERIAL NUMBED
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Lafayette City Center
2 Avenue de Lafayette, Boston,MA 02111-1750
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Dee Service, Inc.
Address: 999 River Rd
City/State/Zip: Agawam Ma 01001 Phone #: 413-789-0800
Are you an employer? Check the appropriate box: Type of project(required):
1.® I am a employer with 16 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. ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance.t 9. Building addition
❑
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.
tContractors 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: Middlesex Insurance Company
Policy#or Self-ins. Lic. #: A0198189006 Expiration Date: 10/01/2023
Job Site Address: 66 Ridge View Dr City/State/Zip: Northampton Ma
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
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 for insurance coverage verification.
I do hereby certi nder the enalties of perjug that the informati n provided above is true and correct.
Signature: Date: 7/3/2023
Phone#: 413-789-0800
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License #
Issuing Authority(check one):
l DBoard of Health 20 Building Department 31:City/Town Clerk 4.0 Electrical Inspector 59Plumbing
Inspector 6.0Other
Contact Person: Phone#: