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18D-070 (2)
SM-2024-0004 971 BRIDGE RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 18D-070-001 CITY OF NORTHAMPTON Permit: Sheet Metal PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# SM-2024-0004 PERMISSION IS HEREBY GRANTED TO: Project# GOODWILL RENO 2023 Contractor: License: Est. Cost: 12500 JESSE FORTIER Const.Class: Exp.Date: Use Group: Owner: ELLENDAVE LLC Lot Size (sq.ft.) Zoning: HB/WP Applicant: ROCK VALLEY HVAC Applicant Address Phone: Insurance: 1 MAIN RD 4135357804 WESTHAMPTON, MA 01027 ISSUED ON: 01/19/2024 TO PERFORM THE FOLLOWING WORK: HVAC FOR RENO POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: '61144L I I ri Fees Paid: $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner RECEIVED Commonwealth of Massachusetts JAN 7 2024 City Of Northampton of suit DING INSPECTIONS Sheet Metal Permit "o aTN4rnPT 0'( 202 Permit# 5M" 7 Estimated Job Cost: $ 12,500.00 Permit Fee: $ V C4/ I '-v Plans Submitted: YES NO Plans Reviewed: YES NO Business License# 824 Applicant License# Business Information: Property Owner/Job Location Information: Name: Rock Valley HVAC Inc(Jesse Fortier) Name: Morgan Memorial Goodwill Street: 1 Main Road Street: 971 Bridge Road City/Town: Westhampton City/Town: Northampton Telephone: (413)535-7804 Telephone: (413)527-4060 Photo I.D. required/Copy of Photo I.D. attached: YES NO Staff Initial J-1 /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 V Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft. V over 10,000 sq. ft. Number of Stories: 1 Sheet metal work to be completed: New Work: V Renovation: .J HVAC .J Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: Extend existing spiral ductwork to condition new spaces. Re-locate thermostat for existing system. Complete branch ducting to new diffusers in ACT ceiling grid. 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,$100.00 Commercial INSURANCE COVERAGE: I have a current Jiahility insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes❑ No❑ If you have checked Yes,indicate the type of coverage by checking the appropriate box below: A liability insurance policy ® Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee rinac not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waivpsthis requirement. Check One Only Owner ® Agent ❑ Signature of Owner or Owner's Agent By checking this box®,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Progress Increetions Doti' Cororoc'nts final Incpeetinrt Date- Couimonts Type of License: By ® Master Title ❑ Master-Restricted City/Town ❑J ou rneyperso n Signature of Licensee Permit# ❑Journeyperson-Restricted License Number: SM2626 Fee$ ❑ i' Check at www matt gnv/dpt Inspector Signature of Permit Approval AMMO' CERTIFICATE OF LIABILITY INSURANCE °ATE(MMJD°"YYY' (12/05/2023 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 K.S.K.INSURANCE AGENCY,INC. jAIPHONE st)(413)527-7859 (r-mot(4131 527-8314 203 Northampton St. _ApD MA IRFss: dawnpepin( ksk-Insurance.com P.O.Box 597 INSURERS)AFFORDING COVERAGE NAIL# Easthampton MA 01027 INSURERA: SAFETY INSURANCE INSURED INSURER B:SAFETY INDEMNITY INS CO Rock Valley Heating and Air Conditioning Inc INSURER C: WESCO INSURANCE CO _ 1 Main Road INSURER D: Westhampton, MA 01027 INSURERE: 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. INSRXP ADDLSUBR PO_ `-- TYPE OF INSURANCE INSD mu POLICY NUMBER 1( IVDlYYI Y1 POLICY ) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 A -7 CLAIMS-MADE X DAMAGE TO RENTED OCCUR PRFMSER)Eaoccurrencr) $50,000 Y 8MA0024118 08/28/2023 08/28/2024 MED EXP Any one person) g 10,000 _� PERSONAL&ADV INJURY s 1,000,000 GLEN L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 _. — X I POLICY JEC�T 7LOC PRODUCTS-COMP/OP AGG $2r000,000 OTHER $ OOMBINED SINGLE LIMIT $1 MIL CSL AUTOMOBILE LIABILITY 1 B (Fmk scrioant) 1 ANY AUTO _ BODILY INJURY(Per person) $ {i !,ALL OWNED (SCHEDULED AUTOS _X AUTOS 6234640 08/10/2023 08/10/2024'BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED ,PROPERTY DAMAGE $ _ AUTOS $ UMBRELLA UAO , OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEp RETENTIONS WORKERS COMPENSATION ' ± . - PER i .OTH- AND EMPLOYERS'LIABIIrITY ,, :STATUTE ER _ I C ANY OFFICER'MEMR REJ(CLUDEDTECUTiVE NIA E.L.FACHACCIDENT �SOO,000 WWC3663037 08/12/2023 08/12/2024 (Mandatory in NH) ,EL.DISEASE-EA EMPLOYEE$S00,000 If YYes,describe under I DESCRIPTIONOrOPERATIONSbelow I E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached f(more space is required) HEATING AND AIR CONDITIONING INSTALLATION,MAINTANENCE REPAIR JOB: Goodwill Store and Donation Center,Northampton MA GC: CERTIFICATE HOLDER CANCELLATION Five Star Building Corp. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 123 Union Street Suite 200 ACCORDANCE WITH THE POLICY PROVISIONS. Holyoke MA 01040 Easthampton MA 01027 AUTHORIZED REPRESSEENTTAA IVE �tad " /„ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 4520 LOC#: 1 ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED K.S.K.Insurance Agency,Inc. !Rock Valley Heating and Air Conditioning Inc. POLICY NUMBER 1 Main Road Westhampton,MA 01027 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: BUSINESS OWNERS POLICY# BMA0024116 EFFECTIVE 08/28/2023-0812812024 ADDITIONAL INSURED---OWNERS,LESSEES or CONTRACTORS when required by written contract or agreement by endorsement SB 13 07 04 16 BLANKET WAIVER OF SUBROGATION when required by written contract or agreement by endorsement SB 13 07 04 16 PRIMARY and NON CONTRIBUTORY when required by written contract or agreement by endorsement SB 13 07 04 16 10 day notice of cancellation for non payment 30 day notice of cancellation for any other reason COMMERCIAL AUTO POLICY POLICY#6234640 EFFECTIVE 8/10/2023-08/10/2024 PRIMARY AND NON CONTRIBUTORY BLANKET ADDTIONAL INSURED when required by written contract by endorsement SCA 002 04 17 BLANKET WAIVER OF SUBROGAGTION when required by written contract by endorsement SCA 002 04 17 10 day notice of cancellation for non payment • f� ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD