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11C-059 (2) ACORD TA CERTIFICATE OF LIABILITY INSURANCE DATE (MU1DOA YY) 01/04/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AM) 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 tISURANCE 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 be endorsed. If SUBROGATION 1S 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: Webber &Grinnell Ins. Agency, Inc. ImAiicc.N (413)586 -0111 10 N (413)517 -0019 8 North King Street mss: Northampton, MA 01060 PRODUCER INSURER(S) AFFORDING COVERAGE NAIC I INSURED INSURER A: Peerless Insurance Hurley & David, Inc. INSURERS: Netherlands /Peerless 24171 90 Fisk Aveue ItsuRERc: A.I.M. Mutual Springfield, MA 01107 INSURER D: INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: Exp. 1/13 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 OTFER 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. LTR TYPE OF INSURANCE ADDL. SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS NMMIDDIYYYY) MMNOrYYYY} GENERAL LIABILITY CBP8235511 01101/2012 01/01/2013 EACN OCCURRENCE s 1,000,000 DA X COMMERCIAL GENERA,- Lustun ER AaGE To RIMED $ 100,000 I CLAIMS MADE X I OCCUR MED EDP (My one person) . 8 5,000 A PERSONAL ND A,DV INJURY 5 1,000,000 GENERAL AGGREGATE s 2,000,000 G EML AGGREGATE LIMIT APPLIES pen PRODUCTS - COMP/OP AGG S 2,000 , 000 � �t ^ I 1 1LOC AUTOMOBILE LIABILITY BA8230312 01/01/2012 01/01/2013 COMO NEDSINGLEL141IT (Ea amide,* s 1,000,000 ANY AUTO BODILY INJURY (Per person) S ALL OWNED AUTOS BODILY IUURY (Per accident) $ B X SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per aodder) X NON-OWNED AUTOS S $ X UMBRELLA LIAB X OCCUR CU823611201/01/2012 01/01/2013 EACH OCCURRENCE S 5,000 ,_00C EXCESS UAB CLAIMS -MADE AGGREGATE $ 5, 000, 000 A X RETENTION $ 10,000 $ — WORIORSCOMPENSATION WM78005601012009 01101(2012 01/01/2013 I TYORVTI^ I X J AND EMPLOYERS' UAEUTY ANY C o a� NIA EL EACH ACCIDENT $ 1,000,000 (Mandatory In NH) EL DISEASE - EA EMPLOYEE $ 1,000 ,000 It yyeess CRIPTION O desalbe OF OPERATIONS below der EL. DISEASE - POLICY Lair $ 1,000,000 DES DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Ware AUTHORIZEDREPRESENTATNE 1,11-"D Building Department Ware, MA 01082 Will Grinnell, CPCU /CINDY ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD « » . w r « : . £ � � � � ? 2 <y . y a\ y: . . w yy\ *� > < m.. - . \ < / y . / : : r . . w . - r..:wa m a ?2%« ... \\��'' r ... . .. x> . ... . .. . . w \ -0 . ( \y / ® COMMONWEALTH OF MASSACHUSETTS COMMONWEALTH OF MASSACHUSETTS • DIVISION OF PROFESSIONAL LICENSURE - BOARD OF DIVIS OF PROFESSIONAL LICENSURE - BOARD OF ., _ y ' !I e ' , SHEET METAL WORKERS S AS A BUSINESS AS A MASTER - UNRESTRICTED r SSUES THE ABOVE L!CE = lSF TO ISSUES THE ABOVE LICENSE TO: (;' WARD C WOODRUFF WARD C WOODRUFF , HURLEY AND DAVID INC 90 FISK AVE HURLEY AND DAVID IN 90 FISK AVE SPRINGFIELD MA 01107 -0000 SPRINGFIELD MA 01107 -1071 - 92 10/29/12 968469 804 06/28/13 3637 . LICENSE NO. EXPIRATION DATE . SERIAL NO. i NO ;,. { • EXPIRATION D AT k. A' # SERIAL NO `"f ,..y!' f->T ti �l Seyy t `ti+Mu I'.:e... 7.•. Yoi M° h" �:4: , t 1. 1r " ... 1 � \l/•. r' �f ..- .•n,. ,. ,s•, ..,,.•.,,r 1f ..'�i, ..:.. ,.s„ v •,}� I ' . I r, I' .:.s{�• %� •,""+'"r' ,�.5r,; _ ..,_.` :;x< > ' `t!: y „fit�.��: 1 _ l.. , r . v 7 r:. •• t.. r .1 , r,. . ! . r tef,•:,, l in tl is Mr f . r;. ,t +t {� x i r .:.. l r >r / r '•h t /G 4 r r , F t t \ e r r .. {' r'r t{i '�}+ •rA 1 •"' \r �. � ,, r r .,. 0V.,, ' v s.; . ;e ,,.: 411. ..•., c ••., .,, 41/..':;: ..,s , • ' 1" :' r ' .,.., z z ' r r .,. �\ // "`• r . �. CI STATE OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECTION V-.1_ 1 Be it known that V A WARD C T WOODRUFF � 230 SCANTIC RD -- i E WINDSOR CT 06088 ,.. \' W has been certified by th Departrrs of Consumer Protection as a '°"' _ . I HEATING PIPING & COOLING UNLIMITED CONTRACTOR til `,N, , -; ... ,-'1,,'-` 1 1,44,,,: i 1 License HI i 30 3024 -S1 ! :m f .q Effective: 09/01/2011 - -;ii 1 . Expiration: 08 /31/2012 ; _:-. ...._....,, 4,_ William M. Rubenstein, Commissioner : ,r te � •i ..,. ✓ i ,, y't v„„ � a . f ; . sf ...,;11 ..,;11;411,:p, t�tr Y ,t•' .�;��', ,G .. , 7 . :4!, •' v r,,,.,,, _,- 7 ✓, iJ• .;f � ? ' /� ; 'r tt • ' • h ^ , : .• / , �w '''':A •;til —" �, . ;- M: 4`k:1 b ��... \ "f r .\,` % iP r gi yt` :'--:;,,:,:}t"-'44;",,:. r .''d, t '• .. \.� -. 'ii .. - f L :9 v •1•`r'.: .0:4r-1:10Y0'.4,'10 . ' µyd j � .,. ¢d }e s""" ! : ti . .J f � �::.:_�7 1. y.° •. .. T , ,` Get. :.iT�"X �{ � !tie ` �j=� 4 " / �`i'+' Rai � { _ \-t_ \ � `�i�\ �� . - COMM(“<;',: .. r, , , ..s _ CH - : E r, ..,t6'.t ., ...... , MASSACHUSETTS } .0 . ' t k , t i:ENISUI`lE - BOARD OF: PLUMBERS AND GASFITTERS LICE(\' ;ED AS A MASTER GASFITTER PLUMBERS AND GASFITTERS "'� REGISTERED AS A GAS AS CORPORATION RATION { 1 1'1\RD C T WOODRUFF WARD CT WOODRUFF Ir_ HURLEY 8 DAVID INC M 3581 = 2 i0 SCAIITIC RD t = 90 FISK AVE 1 WA - tEHOUSE. POIN CT 06088 -9735 SPRINGFIELD MA 01107 - 1050``" 3581 05/01/14 154560 3 23 05/01/14 138894 ° n g < v l = .- ,,"- 1r-1" a( itt' ' SERIAL NO. ` 1 INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yesr No ❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy i g Other type of indemnity LI 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 boxlg, 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 V NO ProEress Inspections Date Comments Final Inspection Date Comments Type of License: By , J Master r - Title ( .. _ Y�IZ�w ❑ Master - Restricted City/Town DJourneyperson Signature of Licensee Permit # ❑Joumeyperson- Restricted g o License Number: < (' Fee $ ❑ Check at www.mass.gov /dpl Inspector Signature of Permit Approval i - ., 2012 Commonwealth of Massachusetts I 1 °E . RF A - .�,PEC;, Sheet Metal Permit NORTHAMF' 1 01p6p � � � Date: 0 ?(O i L- Permit #"5/ / Estimated Job Cost: $ 3 6 ./ 1 ) . 0 0 Permit itt t9 . (J D qv Plans Submitted: YES )( NO Plans Reviewed: YES NO Business License # c i 2 Applicant License # g Business Information: Property Owner / Job Location Information: Name: /-'� Gur"l�' t.e/ u4 i �hC Q,,, - Name: r(Ck S A, i", IA 4 -. °- c � Street: / Q : S k 4, 9 Street: s 0..,.nM, (d ✓r 5:4- irk, I , l r .--- City/Town: �� f f�j i /y'r, ()11 C') City/Town: 412. s / t Q i OS 3 ( Telephone: 1 -(' 3 - 7 3,4.. - S I I S Telephone: i f /3 - 53,x' - 7 6 <- <,,.,s r uc Photo I.D. required / Copy of Photo I.D. attached: YES X NO Staff Initial J-1 � .: N 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. x over 10,000 sq. ft. Number of Stories: I Sheet metal work to be completed: New Work: Renovation: .k HVAC X Metal Watershed Roofing Kitchen Exhaust System Metal Chimney / Vents Air Balancing Prvide detailed description of work to be done: /� 7 11 c-...y . rc^.rn /1�c�. Al%It � G ✓yvC - ic�:�✓1 G J ,-n Jici_Q+ i' t File # SM- 2013 -0003 APPLICANT /CONTACT PERSON HURLEY & DAVID INC ADDRESS /PHONE 90 Fisk Ave (413) 732 -3141 PROPERTY LOCATION FLORENCE ST - LEEDS SCHOOL MAP 11C PARCEL 059 001 ZONE URA(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid ;y Building Permit Filled out s >6 h 90 3 $5 Fee Paid G Typeof Construction: SHEETMETAL WORK FOR CLARKE SCHOOL RENO New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 92 3 sets of Plans / Plot Plan THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION PRESENTED: Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER : § Intermediate Project : Site Plan AND /OR Special Permit with Site Plan Major Project: Site Plan AND /OR Special Permit with Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management 7 ____ Signature o uilding Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact the Office of Planning & Development for more information. FLORENCE ST - LEEDS SCHOOL SM- 2013 -0003 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON !GIS #: 8775 �oa >� Map 11C ,i ■ Block: 059 �a� m L ot. ool ` ,'s ,► 4 a 1 SHEETMETAL PERMIT r Permit: SHEETMETAL ' Tf @C@NTElt Category: SHEETMETAL i — — Permit # SM- 2013 -0003 PERMISSION IS HEREBY GRANTED TO: Project # JS- 2013 - 000046 — Contractor: License: Est. Cost: $36,717.00 Expires: Fee Charged: $50.00 HURLEY & DAVID INC Sheetmetal - 92 10/29/2012 Balance Due J$.00 Owner: NORTHAMPTON CITY OF I# of Fixtures Applicant: HURLEY & DAVID INC DigSafe # I AT: FLORENCE ST - LEEDS SCHOOL UseGroup I ConstClass ISSUED ON: 20 -Jul -2012 AMENDED ON: EXPIRES ON: TO PERFORM THE FOLLOWING WORK: SHEETMETAL WORK FOR CLARKE SCHOOL RENO THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fixtures: Floor: Type: # of Fixtures Floor: Type: # of Fixtures Fee Type: Receipt No: Date Paid: Check No: Amount: Sheetmetal REC- 2013 - 000075 10- Jul -12 7903/7865 $50.00 212 Main Street, Phone:(413) 587 -1240, Fax:(413) 587 -1272, Emailahasbrouck @northamptonma.gov GeoTMS® 2012 Des Lauriers Municipal Solutions, Inc.