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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 ... PP 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_ �