The URL can be used to link to this page

31D-217 (4) SM-2024-0010 34 DEWEY CT COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31D-217-001 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-2024-0010 PERMISSION IS HEREBY GRANTED TO: Project# 2023 RENO Contractor: License: Est. Cost: 25000 ALL SEASONS HEATING AIR Const.Class: Exp.Date: Use Group: Owner: LLC DEWEY COURT PROPERTIES Lot Size (sq.ft.) Zoning: URC Applicant: ALL SEASONS HEATING AIR Applicant Address Phone: Insurance: 93 ELM ST (413)247-9842 WCT6529S HATFIELD, MA 01038 ISSUED ON: 02/09/2024 TO PERFORM THE FOLLOWING WORK: INSTALL DUCTED HVAC SYSTEM 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: Fees Paid: $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner /no t Commonwealth of Massachusetts w,) Slieetl ermit Date: ` I Ei 161 � 4 , Permit#51"-0N'/0 B Estimated Job Cost: $ a6,OOO. w T '9<O ,Pe?n �i it Fee: $ j �✓�1) (4, 4 Plans Submitted: YES NO ' '�'c P s iewed: YES NO FtIti •gsAFc 13uild,'r9 Pen Business License# =z -,?�C� I( °'�T p ica nt` icense# P- Business Information: Property Owner/Job Location Information: A 1 Seasons Name: N, � Air al mj;-l-ion,09 Name: The_ TUCk_c r- C i VD up Ll.C Street: ci, Elm ¶ Street: 34 (;lP,wej COUrrk City/Town: ICk+ e,Ic(, tilt\ OiO& City/Town: PJorth m cytnn Co) -4%a• a-I-1. g-ta Telephone:Cc' (r a-4• 'K%tea Telephone: 4 r i3. 3g . Photo I.D. required/Copy of Photo I.D. attached: YES NO Staff Initial J-1 /restricted 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: d Sheet metal work to be completed: New Work: v Renovation: HVAC ✓ Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: nsta1\cM;orl of c* cec$ \-1VAG ScJ 4elr-->. INSURANCE COVERAGE: I have a current liability 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,11 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not 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 ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this boxg,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 Inspections Date Comments Final Inspection Date Comments Type of License: By Master Title \:121 ❑ Master Restricted 2✓ City/Town ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted License Number: Fee$ ❑ Check at www.mass.gov/dpl (Uri/ Ins ector Signature of Permit Approval DATE(MM/DD/YYYY) ACORN® CERTIFICATE OF LIABILITY INSURANCE �,..--- 01/10/2024 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 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 Jennifer Ellinger NAME: Aquadro&Associates PHONE (413)586-7373 FAX (413)584-0859 (A/C,No,Ext): (A/C,No): 355 Bridge St.,P.O.Box 357 E-MAIL jenn@aquadroinsurance.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01061 INSURER A: Travelers Indemnity Co of CT 25682 INSURED INSURER B: National Grange Mutual Insurance Company 14788 All Seasons Heating&Air INSURER C: 93 Elm St INSURER D: INSURER E: Hatfield MA 01038 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2362210930 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. INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD- POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,DAMAGE T000 RENTED CLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) $ 300,000 MED EXP(Any one person) $ 5,000 A 6801G505644 07/10/2023 07/10/2024 PERSONAL a ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY n JPERCOT- n LOC PRODUCTS-COMP/OPAGG $ 2.000,000 OTHER: $ AUTOMOBILE LIABILITY -COMBINED SINGLE LIMIT $ 1,000,000 La accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED v SCHEDULED M1T6529S 07/10/2023 07/10/2024 BODILY INJURY(Per accident) $ AUTOS ONLY /� AUTOS X HIRED �/ NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) EPLUS $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN 1,000,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE Y NIA WCT6529S 07/10/2023 07/10/2024 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN DADMUN Design+Construction ACCORDANCE WITH THE POLICY PROVISIONS. 60 School St. AUTHORIZED REPRESENTATIVE s0,. Hatfield MA 01038 p I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents —741 Office of Investigations awill ^' Lafayette CityCenter - _ a fy 2 Avenue de Lafayette, Boston,MA 02111-1750 ��°`� www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): All Seasons Heating &Air Conditioning Address: 93 Elm Street City/State/Zip: Hatfield, MA 01038 Phone#:413.247.9842 Are you an employer?Check the appropriate box: Type of project(required): I.❑■ I am a employer with 8 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. 0 New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. D Demolition workingfor me in anycapacity. employees and have workers' p ry 9. ❑ Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I 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' 13.0 Other comp. insurance required.] *My applicant that checks box#1 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: National Grange Mutual Insurance Company Policy#or Self-ins. Lic. #: WCT6529S Expiration Date: 07/10/2024 Job Site Address: 34 Dewey Court City/State/Zip:Northampton MA 01060 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 insurance coverage verification. I do hereby certify u r e p ins and nalties of perjury that the information provided above is true and correct. Signature: Date: 01/18/2024 Phone#: 413.247.9842 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(check one): 10Board of Health 2❑Building Department 3.DCity/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone#: WORKERS COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY —INFORMATION PAGE INSURER: POLICY NO: WCT6529S NGM INSURANCE COMPANY 4601 TOUCHTON ROAD EAST SUITE 3400 RENEWAL OF: WCT6529S JACKSONVILLE, FL 32245-6000 NCCI Company No: 16322 Account No: CACT6529S ITEM 1. NAMED INSURED AND MAILING ADDRESS: AGENCY NAME AND ADDRESS: ALL SEASONS HEATING & AIR AQUADRO & ASSOCS INS AGCY INC (SEE NAMED INSURED ENDT) 93 ELM ST PO BOX 357 HATFIELD MA 01038-9715 NORTHAMPTON, MA 01061 AGENCY PHONE NO.: (413) 586-7373 AGENCY NO.: 201107 LEGAL ENTITY: CORPORATION OTHER WORKPLACES NOT SHOWN ABOVE: (See Workers Compensation Location Schedule) ITEM 2. POLICY PERIOD: From: 07-10-2023 To: 07-10-2024 Effective 12:01 A.M. Standard Time at the Insured's mailing address. ITEM 3. COVERAGE: A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers' Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident: $ 1, 000, 000 each accident Bodily Injury by Disease: $ 1, 000, 000 policy limit Bodily Injury by Disease: $ 1, 000, 000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: all states except: ND, OH, WA, WY and states designated in ITEM 3A of the information page. D. This Policy includes these Endorsements and Schedules: See Schedule of Forms and Endorsements. ITEM 4. PREMIUM: The premium for this Policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required on the Workers Compensation Classification Schedule is subject to verification and change by audit. Please see Classification Schedule. Total Estimated Minimum Premium: $ 351 Annual Premium: $ 10, 883 Audit Period: ANNUAL Date: 06-01-2023 Countersigned by WC 00 00 01 A Copyright 1987 National Council on Compensation Insurance INSURED COPY