31B-281 (17) 86 MASONIC ST SM-2018-0050
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS#: 9585
Map: 316
,Bleck: 81 — —1 ' . SHEETMETAL PERMIT
Let 06 _
Permit: SHEETMETAL
Category. SHEETMETAL
°elmn slvt-2018-0060
'Project# PERMISSION IS HEREBY GRANTED TO:
15 2018-001860_—Contractor. License.cense:
Est:Cost $1,000.00 Expires:
Fee Charged:$ed 50.00 '"IARCTIC REFRIGERATION CO LL Sheetlnetal-7776 07/28/2018
F
ee Cha —
alance Due $.00 _ Owner: CORLISS RUGGIERO LLC
of FixhrreApplicant: ARCTIC REFRIGERATION CO LLC
�DS fe# _._iA T: 86 MASONIC ST
seGroup
ISSUED ON: 22-May-2018 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
MOVE SUPPLY REGISTERS IN THE FLOOR,RAN EXHAUST DUCT FOR 2 NEW BATHROOM EXHAUST FANS
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:
Sheetmmal REC-2018-005927 21-May-18 9891 $5000
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:Ibasbrouck,*nomhamptoama.gov
GroTMSJ 2018 Des Fauriers Municipal Solutions,Inc.
File 4 SM-2018-0050
APPLICANT/CONTACT PERSON ARCTIC REFRIGERATION CO LLC
ADDRESS/PHONE 20 OAK HILL RD (413)774-2283
PROPERTY LOCATION 86 MASONIC ST
MAP 3 1 B PARCEL 281 001 ZONE CB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT AP LICATIO ECKLIST
NCLOS REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildin2 Permit Filled out
Fee Paid
Tyj)eof Constructiom MOVE SUPPLY REGISTERS I FLOOR RAN EXHAUST DUCT FOR 2 NEW
BATHROOM EXHAUST FANS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure _
Building Plans Included:
Owner/Statement or License 7776
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO$MATION 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/ORSpecial Pernitwith 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
reit from Elm Street Commission Permit DPW Storm Water Management
a ue of But ding tial Da
Note: Issuance of a ming 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.
i iE(- i
— -' Commonwealth of Massachusetts
I W 21 2019 City Of Northampton
Sheet Metal Permit Permit#
Fc=T nF ui
'.JITHWJPTON.W01060
Estimated Job Cost: $� Permit Fee: $
Plans Submitted: YES--4 NO
- Plans Reviewed: YES NO
Business License# � Cy Applicant License #
Business Information: Property Owner/Job Location Information:
Name: _ fe, (- Name: N3►- h1Jlt yl
1
Street: Street:
rW M4—
City/Town: City/Town:
��
Telephone: -7 `fy� .__ Telephone:
Photo I.D. required/Copy of Photo I.D. attached: YES NO
smrr mre.r
J-1 1�- mrestricted 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: Officey Retail Industrial Educational
Institutional Other_
Square Footage: under 10,000 sq. ft. ver 10,000 sq. ft. _ Number of Stories:
Sheet metal work to be completed: New Work: — Renovation:
HVAC Ae(- Metal Watershed Roofing_ Kitchen Exhaust System
Metal Chimney/Vents Air Balancing
Provide detailed description of work to be done: __pp ,,(/�� //
44 n�.+ YxeiS�ftrr ira A e- Aif, : krr
Jkli
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,$100.00 Commercial
INSURANCE COVERAGE:
I have a curmntliabilily Insurance policy or Its equivalent which meets the requirements of M.G.L.Ch.112 Yes�No❑
If you have checked Yas, indicattethe type of coverage by checking the appropriate box below:
--I'm
A liability insurance policy xl Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER:I am aware that the licensee d-, not h-,the Insurance coverage required by Chapter 112 of the
Massachusetts General Laws, and that my signature on this permit application wabras this requirement.
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
By checking this box0,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and
accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be
in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws.
Duct inspection required prior to insulation installation: YES_NO
v�.o a 1..�oer•n
Date r,.m P„r�
c•..et tinweti....
Date C.rr,u'nt�
Type of License:
By ❑ Master
Title ❑ Maslar-Restricted
City/Town ❑Joumeyperson
Signature of Licensee
permit# ❑Joumeypereon-Restricted
License Number:
Fee$
Check at� on...n^vfdrd^^stdpi
Inspector signature of Permit Approval
Conso onwealth or Massachusetts
Division of Professional LicenNre a
Retri�Qptly>1rCMfracfor
RC-001666Ey Pores: 07/24/2019
JAMES FIRAUD
20 OAKHILL RE w
GREENFIELDD FiA 0130-t ,
Commissioner
as COMM NSF A T F Ail
g,IN 111
SHEET Mi;; WORKERS ..
j. {SSUES THE FOLLOWING LICENSE AS A
WASTER-UNRESTNGT'ED
ES
W RENAUD
10 K H"RG
GREEI,**.G.MA 01301.04". ,N
7776 6*29=18 ad `81
Y
A^�m DATE UuP.DIWYY)
�. CERTIFICATE OF LIABILITY INSURANCE 1511711e
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 INSURE ,the policy(les)must have ADDITIONAL INSURED provisions or 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: Jeanne DBneaUR,CISR
ALBERT B.ALLEN.INC. PNOHrt41
ria ES 3-773-SVS F xo 41YT133231
PO BOX 388 RDORE. info@albertallen.com
GREENFIELD,MA 01302-0388
INWREftIS AFFORDING COVERAGE NAICp
INSU0.ERA: Main StreSt America Assurance Co
INSURED INSURERS: National Grange
ARCTIC REFRIGERATION LLC INSURER C:
20 OAK HILL RD INSURER D:
GREENFIELD,MA 01301 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 NTH 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 OW MS.
N R TYPE OF INSURANCE
LTPoucy UP
0. D WV POLICY HUMBER "MID MMIDDRYVY LIMITS
X COMMEROMLGENERALLIABILITY EACH OCCURRENCE S 1,000,000
CIAIMS-MA°E ❑X OCCUR PREMISES Ee occurtenm S 50D,000
MED EXP Ano $ 10,000
A MPP8040D 0911411] 09114118 PERSONAL S ADV INJURY E 1,000,000
GEN'LAGGREG9TE LIMIT APPLIES PER'. GENE RALAGGREGATE $ 2,000,000
X POLICYD PRO DLOC PRODUCTS-CONFIDE AGG $ 2,000,000
JECT
OTHER $
AUTOMOBILE LIABILITY COM INE SINGLE IMIT $ 1,000,000
mi
ANV AViO BODILY INJURY(Pa Perim) S
A OWNEp F119 SCHEDULED MIPS04DD 01NH118 01101119 ROD LY N1URY/Pe1 accimm) $
AUTOS ONLY AUT05
HIRED PON.OVrNEp R0 ERW $
AUTOS ONLY AUTOS ONLY EPP, inn/
E
UMB0.ELIA LIAB OCCUR EACH OCCURRENCE $ 1,000,000
B Excass LIAB CLAIMS MADE CUP8040D 01101118 09114118 AGGREGATE $ 1,000,000
DEO RETENTION$ $
NORRERSCOMPENWHION PER OTH
AND EMPLOYERS'LIABILITY YIN STATUTE ER
B oFFICROPHEaOER E%CLUDEpxECUTME❑ NIA WCP8043D 0911411T 09114118 EL Egcn ACCIDENT $ 500,000
I M antlNo,in N") E.L.DISEASE-EA EMPLOYEE $ 500,000
Ny a be under.
AESL FIPTION OF OPERATIONS Cekw E L DISEASE.POLICY LIMN $ 500,000
DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES(ACORD 101,AEEIBanal Rema.SCM1eEub,may III aXacred it mare insi Is repaired)
Operations usual to heating and air conditioning repair and installation.
James Renaud is not covered under the Workers Compensation policy.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
City of Northampton,MA ACCORDANCE WITH THE POLICY PROVISIONS.
Building Department
212 Main St. AUTHORREDREPRESENTADVE
Northampton,MA D1060 Jeanne F.Deneault,CISR
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 26(2016103) The ADORE,name and logo are registered marks of ACORD