11C-056 (2) File 1;SM-2016-0052
APPLICANT/CONTACT PERSON ALLSTATE HOOD&DUCT INC
ADDRESS/PHONE 24 MAINLINE DR (413)568-4663
PROPERTY LOCATION 410 NORTH MAIN ST
MAP )IC PARCEL 056 001 ZONE HB(34)/URA(l61/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid ego ld• 4 3 31 16i0
Building Permit Filled out
Fee Paid
Tyt,pf Construction: KITCHEN EXHAUST HOOD PER ATTACHED PLANS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 25236
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFTIAMATION 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: C
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
;VE1 i Street Commission Permit DPW Storm WatererManagement
Ass
Sig o ml mg *falai Dale
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.
Commonwealth of^vl[assachusetts
rn
N
�/7 ? Sheet Metal Permit
Gs
Permit 4 Sri 16a-
a f�
E. imated Job Cost: $_9J000 Permit Fee: $"r b
Plans Submitted: YES I NO Plans Reviewed: YES NO
Business License # 723 ypplleanl License# 25236
Business Information: Prooem Owner/Job Location Information: I�
Name: Allstate Hasa a Beet,Inc_ ‘!ante:• 1 / /tCJ on /(.{G/C. leml.
Street: 24 Mainline Drive.
Stres: Yc1i—Q,..k2S hAlen,iJ 7.
City/Pown: wesmela.NIA 01085 _ Ci tylT otcn. 700 CJo (� _
Telephone: 413 566-9663 - — I eIepde IC: /-C?5- Y(J j
Photo I.D. required /Copy of Photo 1.D. atta:hed: YES
Sul h iai
J-1 CIP nrestricted license
J-2/M-2-restricted to dwellings 3-stories or lets and commercial ap to 10.000 sq. $. : 2-,tories or less
Residential: 1-2 family Multi-family Condo /Townhouses Jther
Commercial: Office Retail Industrial Education,n
Institutional Other Nr
Square Footage: under 10,000 sq.ft._ _ o'er I O.DoO sq. Ft. Number of Stories:
Sheet metal work to be completed: Nev. Work: Renovation:
HVAC Metal Watershed Rooling I Itchen Exhaust System +dt•
Metal Chimney i Vents _ _ A it Balancing
Provide detailed description of work to be done:
KITCHEN EXFP UST HOOD PER ATTACHED PLANS
INSURANCE COVERAGE: '^`ts
I have a current liability insurance policy or its equivalent which meets'.he roquirements of ALGA-Ch.112 Yes syJrNo❑
If you have checked Yes indicate the type of coverage by c hocking the appropriate box ttalow:
A liability insurance policy Other type of indemnity [I, Bond 0
OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does sot have the insurance coverage required by Chapter 112 of the
' Massachusetts General Laws,and that my signature on this permit application waives this requirement
Check One Only
Owner 0 Agent
Signature
�off Owner or Owners Agent
By checking this hod hereby certify that all of the details and information I have subminec(or entered)regarding this application are true and
accurate to the post of my knowledge and that an sheet metal work and instailations performed under the permit issued losthis appticatian will he
in compliance with an pertinent provision of the Massachusetts Sodding Cede antl Chapter 112 of the General Laws.
Duct inspection required prior to insulation installation:YES.,,,,,, NO__
Progress lit sonsd 5
Date Comments
Final inspection
Date Crmrenejits
• Type of License.
By 1DMaster
The Master-Restricted fteslric:ed '.—/_ 2/
1
City/town_
'— QJeo@eYpaSon Signature of Licensee
Permit#
DJourneypersoMPest toted ti,ense Number: 26236
Fees ❑
""— Check at wvnw.mass.govld,Ql
Inspector Signature of Permit Approval
AC'oxd CERTIFICATE OF LIABILITY INSURANCE 2/24/2�k 016
Ih
p$CEIMFI4l£N ISSUED AS A NATTER OF INFORMATION ONLY ANO COWERS NO RIGHTS UPON THE GERIWGATE HOLORR.MRS
CERTIFICATE DOES.NOT AFFIRMATNEIY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. TNS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN TILE OWING INSUTFFIIS). AUTORREO
FCPRESENFATTVE OR PRODUCER,AND Tiff CERTIFICATE HOLDER.
I Imprint N Ile cerdlleele holder is an AM/MORAL MIMED.Be poNcy(iesf mum be endorsed If SUBROGATION S WANED,subteen to
me tones a'dbnndBwe of to poey,pwtan WARM*may egWre an erroeninmrt. AtM.uwot on the FerSRFsb does not con*r ryhM bore
IL >nMoabs bolder in Ted M sure mdoren/W.
PRODUCER LUNcrtn
A A B mSURrnCB GROUP, LLC Pxa>< (978)399-0025 3,0(239 Littleton Rd Suite 48 €.0 �' trt,Na:(9765349-0079 '.
•
Westford, M!. 01866 I seemWend4GabicsgrOaD.eam
wwrExm o.bme tOvEaMe sex.
_
outman A:Acadia insurance Coogaos
NEOFED Allstate }Rood and Duct Inc mHFLW5:
_
24 Main Line Drive IXOIBEAc, �... . '.
I Westfield, MA 01085 •INSURER 0 1
INSURER E. I
INSIRER 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_ NOTMATHSTANDNG ANY REO% N'MENt.TERM OR CONDITION CF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHCH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, TIE INSURANCE AFFORDED SY THE POLICIES DESCRBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDMONS OFSUCH POEMS.LPdTSSHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.YYpp
'LRh 'NPR OF 1PAta2 Y IAy� WM
vnD P0.1CY MA@Ea LSA. ae 441 ..... ...OARS
M i mx.AAma Neat usertY • EACH occutmencE s 1,000,000„!
MANN*.w WNW
1 ! I CLNMSM.LE L occuP aRMSESfEa I Ia 300,00
ADV 5175923 10/6/1510/6/1. AGp EXP(My one ,i s 10,000
A FEBSONNAApv saupY !a 1,000,0001
6ENt AGM/MATE LSAT UES PER: GENERAL AG$$REGATE s 2,000,0001
PODGY X aEcr 1_1 LOCPHOPucrs•coM„Oo m;G s 2,000,000 !
OTHER: •
COMBHHO SINGLE LMT
AUTOMOBILEDAalrrr (Ea+waE* IS 1,000,000 '..
ANYAUrow RAUHMer�) a5 I
A ALLOAUTONED s A EDULE°O'S I MAA 5181274 10/6/1510/6/19 emILrlruwv(Per aucNml 5
M'Wee)AUTOS x A 0 l I osxmt S
$
ORME" LI.s X I OCCUR ! EACH CCCURRFA£ s 2,000,000
A I utSS UAa .-1 ICDA 5190537 10/6/1510/6/16
IOWAMMSDE AGGREGATE S 2,000,000 .
CED RETiNLIONS t 5 1
ROWERS DUMPdSADON IX $iATuf EAH '
AND EMPLOYERS IMILRV rrx "—r"
oUP , Ina D1 ,E 1...I4.-III a INCA 5241894 7/10/162/10/17f,se"mossr is 500,0001
m.wuTaNIA I ELMusD•EAEwtoYE€s 500,000
ONI"a°
IDESCRPDDOFOPERATIONS caw I5 500,000 !
Et gsEASE-Tse'noun/.tile
TIS
. . ' l 1
I DESCRIPTION OE MERATICNR/LOCATORS 1 VEHICLES IACORD101.MMus!!Fetes Smakb.ney to anaowd mote5lv.2 a Renee
Certificate holder is listed as an additional insured as per written contract.
'Beating or Combined Keating and Air Conditioning systeMs or Equipment - dealers or distributors
j and installation servicing including duct system installation.
CERTIFICATE HOLDER CANCELLATION
Allstate Hood and Duet Inc SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CAROMED BEFORE
24 Main Line Drive 1 THE EXPIRATION DATE THEREOF, NOTICE WILL SE DELIVERED N I
ACCORDANCE VAINTHE WWIPPOvuSAINS.
Westfield, MA 01085
ALTO REPRESENT
REgSENIA itu
Please visit our web site at http://www.mass.gov/dpl/boards/SM
TODD W DUVAL
ALLSTATE HOOD&DUCT, INC. (SM)
122 HILLSIDE RD
APT#1
WESTFIELD,MA 01085-4106
n' Ea}`€zRrrt y. $'»' eE
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Fold,Then Detach Along All Perforations
s.COMMONW-M.7H OF
DIVISION OF PROFESSIONAL LICENSURE
.
SHEET METAL WORKERS ,:
ISSUES THE•FOLLOWING LICENSE ASA I
BUSINESS
TODD W DUVAL . ,. '.. S
'ALLSTATE HOOD 4 DUCT INC. a+l it
24 MAINLINE DR °
WESTFIELD,MA 0101@5' .--
723 - . 01107429119-= 13912 _ I_ �