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31D-102 (13) COMMONWEALrH OF MASSACHUSETTS cps �„ d s r:•`r >t t y�' t 3 ;$ �,'.�3 . ZA sN BOARD OF SHEET METAL WORKERS ISSUES THE FOLLOWING LICENSE AS A MASTER—UNRESTRICTED ` z THOMAS J MESSENGER ,O W 'Ctw» 6 NIBLICK ROAD 5. ENFIELD CT 06082-4456 2223 o8/28/15 179940 CONTROL# IMPORTANT If your license is lost, damaged or destroyed; is inaccurate;or needs to be corrected, visit our web site at mass.gov/dpl for instructions to ensure the proper mailing of your Renewal Application and any other correspondence. i This license is subject to Massachusetts General Laws and regulations. Your license is a privilege, and cannot be lent or assigned to any person or entity under penalty of law. Keen this license on your person or posted as required by law and/or COMMONWEALTH OF MASSACHUSETTS kTJ6-J Lug golj N- • • BOARD OF SHEET METAL 'WORKERS ISSUES THE FOLLOWING LICENSE AS A BUSINESS a � THOMAS J MESSENGER NORTHEASTERN SHEET METAL CO INC DBA TJM SHEET METAL - 'MA W 6 NIBLICK RD ENFIELD CT 06082-4456 519 04/26/16 197687 CONTROL # I IMPORTANT If your license is lost, damaged or destroyed; is inaccurate;or needs to be corrected,visit our web site at mass.gov/dpl for instructions to ensure the proper mailing of your Renewal Application and any other correspondence. This license is subject to Massachusetts General Laws and regulations. Your license is a privilege, and cannot be lent or assigned to any person or entity under penalty of law. Keep this license on your person or posted as required by law and/or regulations. i MASSACHUSETTS. r,f DRIVER'S - • LICENSE OLONGMEADOW,9a END 4d NUMBER NONE S60331614 3 DGB NE GER 2T8E MA 01028.3111 e 5 DD 09-30.2013 Rev 07-15-2009 I NORTH23 OP ID:AO „�+►►co/ZO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 05/13/2015 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 certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS 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: Y rac T Fillian Bouvier Insurance- O'Brien PHONE 29 North Main Street A/c,No Ext):86O-232-4491 Fa c,No): 860-232-6637 West Hartford,CT 06107 E-MAIL ADDRESS__tfillian@binsurance.com Tina Gerard INSURERS)AFFORDING COVERAGE __ _ ,NAIC# INSURER A:Arbella Protection Insurance INSURED North Eastern Sheet Metal INSURER 8:Ar_bella Indemnity Company, Inc. INSURER C: 6 Niblick Road -- - -- - Enfield,CT 06082 INSURER D: INSURER E: INSURER F: 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 POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN SR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY M DID1YYYY MMLDDfYYYY LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED A X COMMERCIAL GENERAL LIABILITY 8500058666 04/15/2015 04/15/2016 PREMISES(Ea occurrence $ - 250,00 _ CLAIMS-MADE �OCCUR MED_EXP(Any one person). $ 10,00 _PERSONAL&A_DV INJURY_ $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGO $ 2,000,00 POLICY X PRO LOC $ COMBINED SINGLE LIMIT 1,000,00 AUTOMOBILE LIABILITY Ea accident A X ANY AUTO 1020019056 04/15/2015 04115/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS - - -- ---- NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS LRER ACCIDENT)_ Is X UMBRELLA LIAB X OCCUR EACH OCCURRENCE _ $- 5,000,00 A EXCESS LIAB CLAIMS-MADE 4600058667 04/15/2015 04/15/2016 -AGGREGATE $ 5,000,00 DED X RETENTION$ 10,000 $WC STATU WORKERS COMPENSATION "TORY L L M"S O ER R AND EMPLOYERS'LIABILITY _ TORIMIT Y/N B ANY PROPRIETOR/PARTNER/EXECUTIVE 9122570414 04/15/2015 04/15/2016 E.L.EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? ❑ NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ _ 500,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Sheet Metal Permit. Job: Smith College — Stoddard Hall Renovation Project in Northampton, MA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of Northampton MA ACCORDANCE WITH THE POLICY PROVISIONS. 210 Main Street Northampton,MA 01060 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents w Office of Investigations I Congress Street, Suite 100 a� Boston, MA 02114-2017 V �.e www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): NorthEastern Sheet Metal Address:6 Niblick Rd. City/State/Zip: Enfield, CT., 06082 Phone #:860-265-3805 Are you an employer? Check the appropriate box: Type of project(required): 1.❑■ I am a employer with 39 4. ❑ I am a general contractor and 1 6. F-1 New construction employees (full and/or part-time).* have hired the sub-contractors 2.Fl 1 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 or me in an capacity. employees and have workers' g Y 9. E] Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 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.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box 41 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. :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:Arbella Indemnity Policy#or Self-ins. Lic. #:9122570414 Expiration Date:04/15/2016 Job Site Address: Smith College, Stoddard Hall, 23 Elm St. City/State/Zip: Northampton , MA 01063 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for' surance coverage verification. I do hereby certify and t ins and penalties of perjury that the information provided above is true and correct. 5/14/2015 Si nature: Act Date: Phone#: 860- -3805 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: INSURANCE COVERAGE: I have a current liabilitx insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 YesX No❑ If you have checked Yes,indicate the type of coverage by checking the appropriate box below: A liability insurance policy X Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee rinps not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waive this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box❑,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Brnarecc incnPrtinnc Daw cummentc Final inypeetion Tate CnmMontc Type of License: By Vmaster Title ❑ Master-Restricted City/Town ❑Journeyperson ('eSibcnk Signature of Licensee Permit# ❑Journeyperson-Restricted �1-sw-C 21 License Number: L3 gu.sirelS Sly Fee$ ceSr Check at— macs nnvlrinl Inspector Signature of Permit Approval mmonwealth of Massachusetts MAY 5 ` City Of Northampton Electric, �g&&G�CrIlOns t a t n, 01060 Sheet Metal Permit Permit Estimated Job Cost: $ Permit Fee: $ So gq3 Plans Submitted: YES NO Plans Reviewed: YES NO Business License# cS `� Applicant License# 2.2 Z-3 Business Information: Property Owner/Job Location Information: Name: NOC F—r.S 4fr11 Si,+ ftQ�4A I Name: SM�kk CeJl25}oba" tV,'` k Street: 6 M i b l"(1k 1U Street: 3 E Ion, s�r City/Town: Zia e T U 6 0 8 Z City/Town: jN v r A Telephone: 3 6 0- 26 S—3 80S Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES K NO Staff Initial J-1 (M-��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 Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: RUA C ad(a- ��� �o� �� SAMI��e�O S�o���� CO 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-2015-0041 APPLICANT/CONTACT PERSON NORTHEASTERN SHEET METAL CO INC ADDRESS/PHONE 6 NIBLICK RD (860)265-3805 () PROPERTY LOCATION 29 ELM ST- STODDARD HALL MAP 31 D PARCEL 102 001 ZONE EU(100)/URC(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 Typeof Construction: HVAC DUCTWORK New Construction Non Structural interior renovations Addition to Existing Accessoa Structure Buildiny Plans Included: Owner/Statement or License 2223 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 P=it from Un Street Commissio Permit DPW Storm Water Management Signa re of Building 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. 29 ELM ST - STODDARD HALL SM-2015-0041 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON GIS#: 9681 J Map: 31D Lot: - 01 � � SHEETMETAL PERMIT Lot: o01 Permit: SHEETMETAL _ Category: SHEETMETAL Permit# 5M 2015-0041 _ PERMISSION IS HEREBY GRANTED TO: Project# JS-2015-001714 _ __- Contractor. License: Est.Cost. _ _ Expires: Fee Charged:$50.00 NORTHEASTERN SHEET METAL Sheetmetal-2223 08/28/2015 Balance Due:$.00 - Owner: SMITH COLLEGE OFFICE OF TREASURER #of Fixtures ;Applicant: NORTHEASTERN SHEET METAL CO INC DigSafe# _ 'A T. 29 ELM ST-STODDARD HALL UseGroup ConstClass ISSUED ON: 18-May-2015 AMENDED ON. EXPIRES ON. TO PERFORM THE FOLL OWING WORK: HVAC DUCTWORK 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-2015-006197 15-May-15 29330 $50.00 212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @north amptonma.gov GeoTMS®2015 Des Lauriers Municipal Solutions,Inc.