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17A-054 04/26/2013 01:38PM 5088454823 CONTROL POINT MECH. PAGE 02/02 ACL , CERTIFICATE OF LIABILITY INSURANCE DATEII@IM(DO/YYYY) 12/21/2012 PRODUCER (781)942-2225 FAX (781)942-2226 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Gil bert Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 137 Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Reading, MA 01867-3922 INSURERS AFFORDING COVERAGE NAIC# INSURED Control—Point Mechanical, Inc. INSURER A: ARBELLA MUTUAL INS. CO. 17000 165 Memorial Drive, Suite F INSURER B: Arbella Protection 41360 Shrewsbury, MA 01545 INSURER C: INSURER D: INSURER S: COVERAGES _ THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POuCY 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, I R TYPE OF INSURANCE POLICY NuMR!R DOUCY EFFECTIVE POLICY EXPIRATION pwre mlumrvvvr pA'�RNM�IVYY1 LIMITS GENERAL LIABILITY 8500050587 03/28/2012 03/28/2013 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED DgFMLSFS(Fa11raoral $ 100,000 ICLAIMS MADE f X 1 OCCUR MED EXP(Any one person) 5 5,000 A - PERSONAL S Apv INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 2 000 000 X POLICY JECT LOC ' r AUTOMOBILE LIABILrry 57864400004 03/28/2012 03/28/2013 COMBINED SINGLE LIMIT J ANY AUTO (EA accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY B X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS - BODILY INJURY $ X NON-OWNED AUTOS (Perecoident) PROPERTY DAMAGE $ (Per ecrddant) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC g OTHER THAN _ AUTO ONLY: AGO $ EXCESS/UMBRELLA LIABILITY 4600050591 03/28/2012 03/28/2013 EACH OCCURRENCE $ 3,000,000 OCCUR U CLAIMS MADE AGGREGATC $ 3,000 odd A $ idDEDUCTIBLE $ RETENTION $ 10,000 $ WORKERS COMPENSATION AND 9118520611 06/29/2012 06/29/2013 lTORSuMrrsf IA EMPLOYERS'LUIBILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE E L.EACH ACCIDENT $ 1,000,000 (WINGER/MEMBER EXCLUDED? EL DISEASE,EA EMPLOYEE $ 1,000,000 If yes Oe antler E.L,DISEASE-POLICY LIMIT $ 1,000,000 _ SPECIAL AL P ROUISIgN$petOw OTHER DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Evidence of Coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Evidence of Coverage AUTHORIZEDREPAESENTATIVE Mark Gilbert, CIC ACORD 25(2001/08) CACORD CORPORATION 1988 COMMONWEALTH OF MASSACHUSETTS DIVISION OF PROFES`SIONAI I IGE'NSURE-BOARD OF SHEET METAL WORKERS AS A MASTER-UNRESTRICTED ISSUES THE ABOVE LICENSE TD: DEREK S MORRISEY a 92 PINEDALE ST * SOUTHBRIDGE MA 01550-2342 4248 06/28/14 187958 LICENSE NO. EXPIRATION DATE SERIAL NO. s V .: :q .e 5x •4r„ 54��R, n Fi k1 ,..'171.5 I { t. E R� i.e souThassacc au of STREET V 5 0014t4iNhr A.li3Ni INSURANCE COVERAGE: I have a current!lability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes❑ No❑ If you have checked Xas,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 Liman not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application 1lfasthis requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box0,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 Pragrpec lgcrertinnq Late C'nmments ji in 91 I nepertinr, T1211. Comments Type of License: By Master Title 0 Master-Restricted // _ Cm`/Town ❑Joumeyperson ' LI Signature of Licensee I l� f Permit# ^ I ❑Joumeyperson-Restricted 248 License Number: "1 "i l� Fee$ ❑ Check at www-mass,g itipl inspector Signature of Permit Approval RECEIVED - 1 APR 26 2013 1 Commonwealth of Massachusetts City Of Northampton DEPT.OF BUILDING INSFLOTIONS NORTHAMPTON,MA 01060 1 Sheet Metal Permit Date: /24h3 Permit# m 13 5-3 coo d Estimated Job Cost: $ 13,OUO— Permit Fee: $ 19 ill 7, Plans Submitted: YES NO ( Plans Reviewed: YES NO Business License# 242. Applicant License# 4248 Business Information: Property Owner/Job Location Information: Name: _ice-,r c Ic_ o r r _ ;Y- Name: {I0 �a�t c$- ao LA)Artrox,-, Street: G c, PI r 42 c-Q.L St• (� Street: &.J' U'Rt4A9t. 'R d „ 9,--, U City/Town: co..) (}'. �,, d1 1 ,/"4� City/Town: N eir Art°M 1 Telephone: Q 2 8-, S'33 I Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES NO Staff Initial J-1 / 44111itt 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 sq. ft. ( over 10,000 sq. ft. Number of Stories: I Sheet metal work to be completed: New Work: Renovation: HVAC X Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: R p lacA duck ci•x),- or 3 sa\A. 0A. 4- 'lc sLuis - TO•Xv cre. 4 -Mc' (opag,kk cnA a, 2i -L-On fir- WbloA, 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 File#SM-2013-0053 APPLICANT/CONTACT PERSON DEREK MORRISEY ADDRESS/PHONE 92 PINEDALE ST (508) 887-5331 PROPERTY LOCATION 165 BRIDGE RD MAP 17A PARCEL 054 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid /q`fl 0 7 f lj � UI Tvpeof Construction: REPLACE DUCTWORK ON 3 SPLIT HEAT/AC SYS ' // New Construction �y 4 5 Non Structural interior renovations I/ Addition to Existing / I, ( - Cti Accessory Structure I �V l• 47(Lit.i � Building Plans Included: Owner/Statement or License 4248 3 sets of Plans/Plot Plan THE FOLL WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN 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 i' s Elm Street Commission Permit DPW Storm Water Management M1 d .. _ Ir.■t a P r' gie s---/-a Signature o Bui sing 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. 165 BRIDGE RD SM-2013-0053 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON 't t1AMP" GIS#: 8824 � oti Map: 17A Block: 054 SHEETMETAL PERMIT Lot: 001r�• Permit: SHEETMETAL r =R� 4RCEAT iisN Category: GAS _ Permit# SM-2013-0053 _ PERMISSION IS HEREBY GRANTED TO: Project# JS-2013-001583 Est.Cost: $13,000.00 Contractor: License: Expires: Fee Charged:$78.00 DEREK MORRISEY Sheetmetal-4248 06/28/2014 Balance Due:$.00 Owner: NORTHAMPTON CONGREGATION OF JEHOVAH'S WITNESS #of Fixtures: Applicant: DEREK MORRISEY DigSafe# AT: 165 BRIDGE RD UseGroup ConstClass ISSUED ON: 01-May-2013 AMENDED ON: EXPIRES ON: TO PERFORM THE FOLLOWING WORK: REPLACE DUCTWORK ON 3 SPLIT HEAT/AC SYS-line drawing required before final inspection THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fee Type: Receipt No: Date Paid: Check No: Amount: Sheetmetal REC-2013-005913 29-Apr-13 1941 $78.00 212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck@northamptonma.gov GeoTMS®2013 Des Lauriers Municipal Solutions,Inc.