32A-122 (3) A°IJ CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)
2!15120)3
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 ca l:Ideate holder Is an ADDITIONAL INSURED,the poficy(tasl must be endorsed. It SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may!squire an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endomement(s).
PRODUCER I'CONTACT
NAME
MEYER INSURANCE PHONE ��, t.4" 'Q3-5180 KAC
1 WC,NO)
186 Northampton St tss chadmever@charter.net
Easthampton.MA 01027 1,1VII ..-ER
CUSTOMER IQs
esugeR(el AFFORDING COVERAGE t NAIL/
INSURED All State Hood and Duct Inc l I INSURER A Farm Family Casualty
'INSURER B
24 Mainline Dr j INSURER C
Westfield_MA 01085-33lr1 ,INSURER D
INSURER E
IINSURER F I
COVERAGES CERTIFICATE NUMBER. 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 POUCIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLANS_
TYPE OF INSURANCE F W I POLICY NUMBER 11N• ''I Lifts D+ r I I LIMITS
GENERAL UAeIUTY Is
t EACH OCCURRENCE 1 s 1,000,000 I I
X I COMMERCIAL GENERAL LIABILITY I , I PREMISES(FakNacer►Onca) $ 50,000
CLAIMS'MADE l ,OCCUR I f MED EXP Any one person) S
I A i I (2007X0371 ` I PERSONAL a ACV INJURY S 1 030,000
1'2/1012013 12110/2014 GENERAL AGGREGATE S 2,000,000
(''Govt.AGGREGATE LIMIT APPLIES PER I PRODUCTS-COMP/OP AGG S2.00 •000
I I POLICY j 1 JECT ` l LOC
i t S
•AUTOMOBILE UABIIITY 4 I COMBINED SINGLE LIMIT I S
L. — I I (Ea accident)
ANY AUTO I I I fff_ BODILY INJURY(Per person! I
�
_ ALL OWNED AUTOS BODILY INJURY(Per acuderr)_S
SCHEDULED AUTOS I PROPERTY DAMAGE S I
I HIRED AUTOS I I 4 I Y(P(Per aCC+ O)
f l I S
NON-DINNED AUTOS
X I UMBRELLA LIAB I. OCCUR
EACH OCCURRENCE S 2,000,000
EXCESS LIRE CLAMS MADE 12001E1113 12110/2013 02110/20141_AGGREGATE S 2,000.000
I A .
I 1 DEDUCTIBLE 1 S
I I RETENTION S I I WC STATU. I (OTH-
I
WORKERS COMPENSATION
AND EMPLOYERS LIABILITY YIN TORY LIMITS I ER
A ,ANY moantETOR/PARTNERIEXECuTTIVE 1� I 2001 W b5 I± �03110t?013 taZ/)012014 E L EACH ACCIDENT S 500,000
OFFICERAIENSER EXCLUDED, y rI,rA 500,000
(eendnoq,n KM E L.DISEASE-EA EMPLOYEE E
I+yes demo nder 500,000
DES descrl N u Of OPERATIONS Detour ( El DISEASE-POLICY LIMIT S
III I I I
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 10I Addmonet Remarks Schea<de.If more space us,equated)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN I
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPR TAT�tE c I M ,ik..,,)
01 Q09 ACORD COR 71ON. All nghts reserved_
5(2009109) The ACORD name and logo are registered marks of ACORD
•
tom! Massachusetts -Department of Public Saiety
Board of Building Regulations and Standards
Construction Supervisor
License: CS-06 9654 ,! • ,
TODD W DUVAL,`
24 MAINLINE
WESTFIELD MR 01085
'1;
�` )� 11t�� cX'piration
Commissioner
12/29/2014
COMMONWEALTH OF- MASSACHHUSETTS
DIVISION OF PROFESSIONAL LICENSURE-BOARD OF
.AS EYP tR?ON-UN REST £TED
ISSUES THE ABOVE LICENSE TO
TODD W DUVAL r ,e
122 HILLSIDE RD
APT .1
``WEST€IELD MA 01085-4106
25011 12/28/13 141987
LICENSE NO. EXPIRATION DATE SERIAL NO.
INSURANCE COVERAGE: �/
I have a current liahility insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes 4!I No❑
If you have checked Yes,indicate the type of coverage by checking the appropriate box below:
A liability insurance policy Er Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee rinac not havp the insurance coverage required by Chapter 112 of the
Massachusetts General Laws, and that my signature on this permit application waivesthis requirement.
1 Check One Only r
e/ Owner ❑ Agent 'U��
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
Progrecs inspections
nate rnmmPnts
Final Incpertion
T)atP Comments,
Type of License:
By ❑ Master
Title ❑ Master-Restricted / Y
City/Town VJourneyperson
Signature of Licensee
Permit#
❑Journeyperson Restricted License Number: 56:;) //
Fee$ ❑
Check at www macc gnv/cipl
Inspector Signature of Permit Approval
f
Commonwealth of Massachusetts
' ' Lu! City Of Northampton
Electric. P u rr
coons
Nat i E ° Sheet Metal Permit Permit# 6g-/V-3y
Estimated Job Cost: $ (p( 062 Permit Fee: $,R) q 5 Co
7 f
Plans Submitted: YES J NO Plans Reviewed: YES NO
Business License# Applicant License#
Business Information: Property Owner//Job Location Information:
Name: ts-k,k 46 c+ DCI C Name: -2 1-er
Street:( / �(G '.� r4z fl Street: k.'45 (P-
City/Town: bJe.s /6-e(cl 4- f Q/0$5 City/Town: /w!`-f4uvn104.4 ./77
Telephone: '/( S 6 3 Telephone:
P oto I.D. required/Copy of Photo I.D. attached: YES ✓ NO
Staff Initial
J- 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 I/
Metal Chimney/Vents Air Balancing
Provide detailed description of work to be done:
pe, C,-�.��cf4 � �c�� s6 s ri/ �— 4) (a-.�
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-2014-0034
APPLICANT/CONTACT PERSON ALLSTATE HOOD&DUCT INC
ADDRESS/PHONE 24 MAINLINE DR (413)568-4663
PROPERTY LOCATION 65 KING ST-SUHER MEATS
MAP 32A PARCEL 122 001 ZONE CB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid 3 <j/ 450
Building Permit Filled out �/�7(p
Fee Paid
Typeof Construction: TYPE II COMMERCIAL HOOD SYSTEM
New Construction
Non Structural interior renovations
Addition to Existing_
Accessory Structure
Building Plans Included:
Owner/Statement or License 25011
3 sets of Plans/Plot Plan
THE FOL WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO 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
Pe i't fr.':.Elm eet Co 'ss� Permit DPW Storm Water Management
/ // / //fi ial Dat
Signature of Building Official
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.
65 KING ST - SUHER MEATS SM-2014-0034
COMMONWEALTH OF MASSACHUSETTS
1GIS#: 19942 HAMp,.-,
CITY OF NORTHAMPTON
Map: 132A ,;`
Block: 122 i , 1 �
=,• � SHEETMETAL PERMIT
Lot. 001
Permit: SHEETMETAL °��'��°�
ERCENTE-
[Category: SHEETMETAL
Permit# SM-2014-0034 _-1 PERMISSION IS HEREBY GRANTED TO:
Project# JS-2014-000932
Est. Cost: $6,000.00 Contractor: License: Expires:
ALLSTATE HOOD&DUCT INC Sheetmetal-25011
Fee Charged:$50.00 12/28/2013
,Balance Due:$.00 Owner: NORTHAMPTON CO-OPERATIVE BANK
#of Fixtures: (Applicant: ALLSTATE HOOD&DUCT INC
D1gSafe# AT: 65 KING ST-SUHER MEATS
UseGroup
ConstClass
ISSUED ON: 21-Nov-2013 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
TYPE II COMMERCIAL HOOD SYSTEM
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-2014-002293 21-Nov-13 3436 $50.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @northamptonma.gov
GeoTMS®2013 Des Lauriers Municipal Solutions,Inc.