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31D-148 (69)
SM-2024-0013 16/20 CENTER ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31D-148-001 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-2024-0013 PERMISSION IS HEREBY GRANTED TO: IRON HORSE RENOVATIONS Project# 2023 Contractor: License: NORTHEASTERN SHEET METAL CO Est. Cost: 600000 INC Const.Class: Exp.Date: Use Group: Owner: PARLOR ROOM Lot Size (sq.ft.) Zoning: CB Applicant: NORTHEASTERN SHEET METAL CO INC Applicant Address Phone: Insurance: 6 NIBLICK RD (860)265-3805 CPP5448253 ENFIELD, CT 06082 ISSUED ON: 03/22/2024 TO PERFORM THE FOLLOWING WORK: HVAC FOR RENOVATION 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: S50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner ,i 3(0 ` l�f� commonwealth of Massachusetts MAR 1 1 2024 City Of Northampton Date: 2/15/24�� ores Sheet Metal Permit Permit# I'� -)�'/3 n Estimated Job Cost: $54,400 Permit Fee: $50.00 , at CO:r- Plans Submitted: YES X NO Plans Reviewed: YES X NO Business License# 519 Applicant License # 2223 Business Information: Property Owner/Job Location Information: Name: NorthEastern Sheet Metal Name: Iron Horse Music Hall Street: 6 Niblick Rd. Street: 20 Center St City/Town: Enfield, CT 06082 City/Town: Northampton, MA 01060 Telephone: 860-265-3805 Telephone: 413-586-8686 Photo I.D. required/Copy of Photo I.D. attached: YES X 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 Industrial Educational Institutional Other X Eb his Square Footage: under 10,000 sq. ft. X over 10,000 sq. ft. Number of Stories: (basasement Sheet metal work to be completed: New Work: Renovation: X HVAC X Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: All HVAC sheet metal work for the Iron Horse Music Hall renovation project per the contract drawings. *Drawings were emailed to the building department* 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, $100.00 Commercial INSURANCE COVERAGE: I have a current liahility insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes ID No❑ If you have checked Yes,indicate the type of coverage by checking the appropriate box below: A liability insurance policy El Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee rinec not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waivPsthis requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box❑,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Progress inspections Date Comments Final incpectinn Date Comments Type of License: BY ❑ Master //JAW/ Title ❑ Master Restricted Thom s . Messenger - President City/Town ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted Master-2223,Business 519 License Number: Fee$ ❑ Sheet Metal Business x Check at www macs gnv/dpt 3-Z/-ZOzy Inspector Signature of Permit Approval The Commonwealth of Massachusetts Department of Industrial Accidents a I Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 ° www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): NorthEastern Sheet Metal Address:6 Niblick Rd. City/State/Zip: Enfield, CT., 06082 Phone#:860-265-3805 Are you an employer? Check the appropriate box: Type of project(required): 1.❑] I am a employer with 36 4. ❑ I am a general contractor and I 6. New construction employees (full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. ❑� Remodeling 2.El I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' P tY 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.❑ 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.❑ Other comp. insurance required.] *Any 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: Republic Franklin Insurance Co. Policy#or Self-ins. Lic. #:CPP5448253 Expiration Date:4/15/24 Job Site Address: Iron Horse Music Hall, 20 Center St. 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 r insurance coverage verification. I do hereby certify un er pains and penalties of perjury that the information provided above is true and correct. Si afore: //t4a, Date:2/15/24 Phone#: 860-2 -3805 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: NORTSHE-01 LPICCININNI ,a► oRO' CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY) 2/15/215/2024 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 Lisa Rogers NAMEAssuredPartners New England,Inc. PHONE FAX One Financial Plaza (A/C,No,Est):(603)399-6408 (,vc,No(603)399-6408 Hartford,CT 06103 E-MAIL Lisa.Rogers©AssuredPartners.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Republic Franklin Insurance Co. 12475 INSURED INSURER B:Utica Mutual Ins.Co. 25976 NorthEastern Sheet Metal Co.Inc. INSURER C:Utica National Ins.of Texas 43478 6 Niblick Rd. INSURER D: Enfield,CT 06082 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 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 ANSD WVD POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE POLICY NUMBER A X COMMERCIAL GENERAL LIABILITY (MM/DD/YYYYI (MMIDD/YYYYI 1,000,000 EACH OCCURRENCE $ CLAIMS-MADE X OCCUR CPP5448253 4/15/2023 4/15/2024 PREMISES EF;ENTErence) $ 100,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: A COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY (Ea accident) $ 1,000,000 X ANY AUTO 5437470 4/15/2023 4/15/2024 BODILY INJURY(Per person) $ OWNED SCHEDULED _ AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ AU' OS ONLY _D A N y��Ep UUTOS ONLY O (Perr acEclRdent)p AMAGE $ B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE CULP 5448254 4/15/2023 4/15/2024 AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 C WORKER AND EMPLO ERS'LIABILITYIN X STATUTE ERH ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 5438940 4/15/2023 4/15/2024 1,000,000 OFFICER/MEMBER EXCLUDED? Y N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space la required) Officer Excluded under Workers Compensation:Thomas Messenger Evidence of Insurance for Sheet Metal Permit. Job: Iron Horse Music Hall Renovation CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Building Department Puchalski Municipal Building 212 Main St AUTHORIZED REPRESENTATIVE Northampton,MA 01060 .i/Vie Maio ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD . �; -_- 9' •MMONWEALTH OF A A HtUSETTS DIVISION OF OCCUPATIONAL LICENSURE BOARD OF SHEET METAL WORKERS ISSUES THE FOLLOWING LICENSE BUSINESS 1 THOMASJMESSENGER NORTHEASTERN SHEET METAL CO INC- T W DBA TJM SHEET METAL-MA 6 NIBLICK RD ENFIELD,CT 06082 519 04/2612026 559802 LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER • DIVISIO% :)F I,r CUI`ATIONAL ENSUPI. `.t OF SHEET METAL WORKERS ISSUES THE FOLLOWING LICENSE MASTER-UNRESTRICTED 11 THOMAS J MESSENGER 6 NIBLICK RD ENFIELD,CT 06082-4456 NNN 2223 08/28/2025 '\�.. LICENSE NUMBER i EXPIRATION DATE SERIAL NUMBER MASSACHUSETTS DRIVER'S E NOT FOR FEDERAL ID ISS ,.I NUMBER 04/04/2018 860331614 REP 0(%I �., 08/2512023 08/25/1969 DM CLASS NONE NONE REST MESSENGER ENO 'a THOMAS J 88 PEASE RD EAST LONGMEADOW,MA 01028-3111 EYES BLU SEX M HGT 5'-10'' 7// [>U 040512016 Rev 01122/2016 'ir(�a�4/2,5/ 9