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2 NEW LIBERTY ST - BUILDING INSPECTION (2) } Commonwealth of Massachusetts Sheet Metal Permit / Date: — Permit# ell/,� Estimated Job Cost: $ Permit Fee: $ a Plans Submitted: YES _ NO_ Plans Reviewed: YES _ NO_ Business License# S�� Applicant License# Business Information: } �A Property Owner Job Location Information: Name:Ha n L !�h SY P r 1/I P,tall 16XI Name: Street: Street: �M City/Town: M u /� , City/Town:�CNA P /11 y't' u,Telephone: Telephone: -1 /2• ,5111 - /51 /r7 Ji►l� Utz ALLY\ Photo I.D. required/Copy of Photo I.D. attached: YES_ NO sr,f Inia.j 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-Z Retail_ Industrial_ Educational Institutional Other_ Square Footage: under 10,000 sq. ft, over 10,000 sq. ft. _ Number of Stories: _ Sheet metal work to be completed: New Work: Vq. Renovation: _ HVAC_ Metal Watershed Roofing_ Kitchen Exhaust System Metal Chimney/Vents_ Air Balancing Provide detailed description of work to be done: �7U,f 11 S I. I- ►-11 n db �� INSURANCE COVERAGE: I have a current(lability insurance policy or Its equivalent which meets the requirements of M.G.L.Ch. 112 Yes No❑ If you have checked Yes• Indicates 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 does not have the Insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my sign ure on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box ,1 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 ❑ Master-Restricted Cityfrown ❑Journeyperson Signature of Licensee Permit# ❑Joumeyperson-Restricted License Number: Fee$ Check at www.mass.aov/dDl Inspector Sign,ure of Permit Approval . AC40RI ® CERTIFICATE OF LIABILITY INSURANCE °o vzotz" 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(les)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 cartifcate holder In lieu of such andorsemen s. PRODUCER J.E.Schindler lnsAgy Inc CONTACT Nate Schindler One W211 Street PHONE (781)272-7505 F^x ,(781)721-7268 Sth Floor L nschindler@schindlerins.com Burlington MA 01803-0000 PRDDUCER Ne AFFORDING COv E INSURED INSURER A-Commerce Insurance Co. Hanlon Sheet Metal INSURFIR a.The Hartford Insurance Co. PO Box 560175 INSURER C West Medford MA 02156- INSURER D INSURER F INSURER I* COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 15 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 TYPE OF INSURANCE ADDL SUB POLICY EFF POLICY EXP LIMnb B GENERAL LIABILITY X 088BAF00544 12/31/2011 2/3l/2012 URREN E 1,000,000 DAMAGE TO RENTE COMMERGAL GENERRI AAII�,,LIABIL D frV 300,000 MAIMS-MADE OCCUR MED EXP LAjon S 10.000 PERSONALaADVINJURY 1,000.000 GENERAL AGGREGATE 2,000,000 LA TE UMIT APPLIES PER: PROOU P/OPA 2,000,000 X Po PRO- f A AUTOMOBILE LIABILITY X BDMPDL 12/31/2011 12/31/2012 COMBINED SINGLE UMm (E9acddanl) f 1.000,000 ANY AUTO BODILYIWURY(Par"=rs ) f ALL OWNED AUTOS BODILY INJURY(Per acddenl) $ SCHEDULED AUTOS PROPERTY DAMAGE XI HIREDAUTOS (Per amJtlant) f MON-OWW-DAUTOS f f S UMBRELLA OAS X JOCCUR X 08SBAF00544 12/31/2011 12/31/2012 969H OCCURRErICF S 5,000,000. X EXCESS IJA9 CLAIMS-MADE I AGGREGATE 51000,DD0 DEDUCTIBLE Rentention 10,000 RETENTION S f B WORKERS COMPENSATION 08WECLD2059 12131/2011 12/31/2012 wcSTATU- oTH- AND EMPLOYERS`LIABILITY ANYCERIMEMBEREXCLUER/FJ(ECUTNE� NIA EL EACH ACOOENT 1000,000 (NaI zlRIIAEM*0 EXCLUDEDT (MeMeleyMNH) E.L.DISEASE-EA EMPLOY 11000,000 If I)eunder EL DI POLICY LIM T I s 1,000,000 B Other X 08SBAF00544 12/31/2011 2/3l/2012 Contractor's Equip 115,000 installation 10,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,AddRlonal Remarks schedule,If mm spa=Is mwlmd) CERTIFICATE HOLDER CANCELLATION AI DOO921 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN For Office Use ACCORDANCE WITH THE POLICY PROVISIONS. ' AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD HANLON SHEET METAL CONTRACTORS, INC. 17 Prescott Street • P.O. Box 560175 West Medford, Massachusetts 02156-0175 (781) 391-8555 MQNWEALTM OF MASSACktU TaS . I . . ry AS AMASTER-UNREST R ICTED -_ ISSUES THE�A!36VE1-,ICENSE TO: J' t K'6UIN R 'FLANLON t lag:NLON -SHEET METAL 1 -'-P'R E S C'071ST' S T 0' TfDI .ORD MA 0 2 1 55-36 13 3359 08/28/12 918878 LICENSE NO. EXPIRATION DATE SERIAL NO. r -Ct1MMONWEALTH OF MASSACHUSETTS SHEET METAL WORKERS q=S A BUS1,NE,S.Sf = JSSUES TWABOVELIEENSE TO I0EW R; RANLOR HFtNiON `SHEET METAL INC 17 PR;ESC'OTT ST +EEJFbR4 MA 02155 0000 � . _-_ -25 05/21/14 197=75a .` Fold,Then Detach Along All Pedorations