29-547 25 PPWOULL BP- 2010 -0788
GIS #: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP- 2010 -0788
Project # JS- 2010 - 001175
Est. Cost: $13500.00
Fee: $81.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ALLAN JARVIS 094928
Lot Size(sq. ft.): 12937.32 Owner: BILLINGS STEPHANIE J & FRED KIM
Zoning: URA(100)//WSP Applicant: ALLAN JARVIS
AT. 25 INDIAN HILL
Applicant Address: Phone: Insurance:
2 JACKIELYN CIR (413) 262 -1065
GRANBYMA01033 ISSUED ON :311012010 0:00:00
TO PERFORM THE FOLLOWING WORK: RENOVATE BASEMENT
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:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 3/10/2010 0:00:00 $81.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
City of Northampton x_
Building Department
212 Main Street
;n Room 100
Northampton, MA 01060 ms
phone 413 -587 -1240 Fax 413 - 587 -1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1I -SITE INFORMATION
1.1 Property Address This section to be completed by office
Map Lot Unit
rr Zone
Overlay District
y
'•gIrmSt,,;Di- rict C13 Distr
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: ,
Name (Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
Name (P ' Current Mailing Address: rv�
Signa ie Telephone
SECTION 3 - MATED'CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed bv permit applicant
1. Building G� (a) Building Permit Fee
G
2. Electrical ` (b) Estimated Total Cost of
Construction from 6
3. Plumbing Bul Idling Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total= 0 +2+3 + 4 + 5) Check Number
This Section For Official se On!
Date
- Building 'Permit Number: Issued:
Signature: 0
Building Commissionerllnspectorof Buildings - Date
I
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: L—_' R L _j R
i
Rear 7 -i .
�._.._____� '�....� _._..._�
Building Height ,_...._.... °..
Bldg. Square Footage i 1 %
Open Space Footage _ %
(Lot area minus bldg & paved?
p arkin g)
# of Parking Spaces - -- - —
Fill:
volume & Location t•- - -- I
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO Q DONT KNOW 0 YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON KNOW _ 0 YES 0
IF YES: enter Book Page} and /or Document # _<
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained , Date Issued
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
_ - -- =K- - - D. Afe t ere dn IO osed czllaii 'es to or d itions o�si ns n3r - the property YES 0 NO 0
Y P P '; '; � inteed fo P P Y?
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
e '
r
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding [ED] Other [o]
Brief Description of Proposed ?
Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
tf NeFvu houg& and r 4ddtfloii> to Mistmg t ousilr><i comalet the:fol owing:
a. Use of building: One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank City Sewer Private well City water Supply
SECTION Ta - OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING ,PERMIT °
as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
as Owner /Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
"V' V
Print Name
J �Al r' '1/1 -- T/ " --
Signature of Owner /Agent Date
J t
' 4
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor Not Applicable ❑
Name of License Holder 411y y .z� f,; `� 9
License Number
Address Expi�t
/ Y C; e
Signature Telephone
i ,
S.,.Rea-intereii �Ixrme lrriprorhrnen#,Critracfor..
Not Applicable ❑
Company Name 72
r Registration Number
113 A?
Address / Expiration ate
✓ `tC� ..� / h v'G,4�' L' w Telephone 03 ,X 1
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... No...... ❑
�:�$ �m�.���rtex�x�m�tia►lil%+
- - _The-current-exemption for "homeowners ",was extended to include Owner - occupied Dwellings of one (1) or two(2) families
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor. CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner Person (s) who own a parcel of land on which he /she resides or intends to reside, on which there
is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm
structures. A person who constructs more than one home in a two -year period shall not be considered a homeowner
Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official that he /she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon
completion of the work for which this permit is issued.
Also be advised that with reference'to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned "homeowner' certifies and assumes responsibility for compliance with the State Building Code, City of
o ampton r mances; a e a ` - tts General -Laws- Annotated.
Homeowner Signature
v
The Commonwealth of Massachusetts
Department of Industrial Accidents -
Office of Investigations
600 Washington Street
Boston, MA 02111
V www.mass gov /dia
- Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumb.ers
Applicant Information Please Print Legibly
Name ( Business /Organiiation/Iadividual): /� /Lti ► y!,j'
Address: 2 Ix tt e z- , '
City /State/Zip: ~.— <�+.�. /'Zj 1�/�3 ' Phone. #:
Are you an employer?. Check the appropriate'box: Type of project (required):,
1.0 I am a employer with 4.. I am a general contractor and I
6. ❑New construction
employees (full and/or part- time).* have hired the sub- contractors
' listed on th
2,�-I am a sole proprietor or partner- e attached sheet 7. r Remodeling
ship" and have. no employees These sub - contractors have. 8. ❑ Demolition
working' for me in any capacity. employees and have workers'
9. El Building addition
[No workers' comp. insurance comp. insurance.
required.] 5. We are a corporation and its 10.0 Electrical repairs or additions
q ]
3.0 I am aliemeov+ner deing all woFk - -- -- - 9 v ', �_[] g rabiug repairs or additions
myself [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required] t P. 152, § 1(4), and we have no
employees. [No workers' 13.0 Other
comp. insurance required j.
*Any applicant -that checks box #1 must also fin out the section below showing their workers' compensation policy information.
t Homeowners who submit this affnda »t.mdicating they are doing all work and then hire outside contractors trust 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
�ormaz'ion.
Insurance Company Name:
Policy # or Self -ins. Lic. #: Expiration Date:
J Site A ddress: City /Stafe/Z.ip:
Attach a copy of the workers' compensation policy declaration page - (showing the policy number and expiration date).
Failure to secure coverage as required undeer Section 25A of MGL c. 152" can lead to the imposition of cim in4l 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 t9ie violator. lie advised that a copy of this statement maybe forwarded to the Office of
Investi:rations of the DIA for • urance coverage verification.
Ido herei_y certyfAund_er j eer ns andpenaLdes ofperjury that the information provi+ded_abovE islruenrrdcarrect___
Si ture: a te: f A?
Phone #: L ' �� tf --
Fer al use only. Do not write in this area, to be completed y city "or town officia
r Town: Permit/License #
g Authority (circle one):
rd of Health 2. Building Department 3. City/Town Clerk 4. Electrica Inspector 5. Plumbing Ins ector
t Person: Phone #:
J
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends to be, a one or two family
dwelling, attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two -year period shall not be considered a
home owner."
The building department for the City of Northampton wants person(s) who seek to use
the home owner exemption, to act as their own construction supervisor, to be aware that
by doing so you become responsible for compliance with state building codes and
1'e lati0ng The imp ion nroc r wire that the building department be calle to
inspect work at various stages, which include foundation /footings (before backfill),
sonotube holes (before pour), a rough building inspection (before work is
concealed), insulation inspection (if required) and a final building inspection The
building department requires these inspections before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occupancy
until the work can be inspected.
If the homeowner hires other trades to perform work (electrical, plumbing & gas) the
homeowner will be responsible to make sure that the trades hired secure their proper
-- - - - - - -- - ---- t&in- wnj.Lunction -t0- the- b »ildinQ n rmi _.issued,_and_that they get their required
inspections. Failure of the individual trades to secure. the permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
I, understand the above.
.(Home owner /resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Address of work
location
Allan Jarvis General Contractor
\ 2 Jackielyn Cir • Granby, MA 01033.413.262.1065 • aljarvis @charter.net
CONTRACT
This Agreement, made as of, February 2, 2010
Between the Contractor:
Allan Jarvis General Contractor MA CSL # 094928
2 Jackielyn Cir MA MC # 153197
Granby, MA 01033 CT HIC # 613298
And the Owner(s): Project Location:
Stephanie Billings Stephanie Billings
25 Indian Hill St 25 Indian Hill St
Florence, MA 01062 Florence, MA 01062
413- 413 -
For the project: BASEMENT
Contract Documents:
The contract documents consist of this agreement, contractor owned AutoCAD sketches if required, and all addenda
issued prior to execution of this agreement including any change orders or modifications issued and agreed to by both
parties. These contract documents represent the entire agreement of both parties and supersede any prior oral or
written agreement.
Ownership of Documents and Indemnity:
Drawings and specifications as instruments of service are and shall remain the property of Allan Jarvis General
Contractor, whether the project is constructed or not. Any reproduction, creation of derivative works based on these
documents, or use of these documents without proper compensation to Allan Jarvis General Contractor, and the
express written consent of Allan Jarvis General Contractor, is strictly prohibited.
Duties of the Contractor:
All work shall be in accordance to the provisions of the plans and specifications, and be in good working order.
All work shall be completed in a professional workman like manner, and shall comply with all applicable national,
state and local building codes and laws.
Contractor shall be available to communicate with owner regarding owner questions or concerns as needed.
Contractor shall leave work area clean and safe daily.
All work shall be performed by licensed individuals to perform their said work, as outlined by law.
Owner:
Owner agrees to remove items in work areas to assist in completing all work efficiently.
Owner shall be available to communicate with contractor regarding owner related decisions to maintain job progress.
Owner shall provide access to perform work as needed to not delay progress.
Owner shall communicate with subcontractors only through the contractor.
Owner will not assume any liability or responsibility, nor have controls over or charge of construction means, methods,
techniques, sequences, procedures, or for safety precautions and programs in connection with the project, since these
are solely the Contractor's responsibility.
Owner initial/ datel
CONTRACT Page 1 of 4 Contractor initial/ date:
?u Allan Jarvis General Contractor
2 Jackielyn Cir • Granby, MA 01033 - 413.262.1065 • aljanlis @charter.net
Scope of Work:
We hereby propose to supply the materials and perform the labor necessary for the completion of
Basement game /family room complete.
Contractor agrees to perform or have performed the following:
• Frame interior and exterior walls to com lete family/ ame area s ace.
• Frame ceiling and soffits as required for sheetrock finishing and concealing ducts.
• Install rough wiring for new area only. Includes all lighting, switching, outlets, heating, thermostat, fire
alarms, etc.
• Install fiberglass insulation at all exterior and `cold' walls and ceilings.
• Install duct registers to existing duct where possible to supplement heating if owner so desires.
• Install phone /cable /data each in one location only.
• Install sheetrock in family /game room and stairwell to complete. Includes walls and ceilings and soffits
hang, tape, sand. Includes installation of finish access panels for access to any plumbing shutoff valves
and/or electrical junction boxes as needed.
• Prime ceilings and walls.
• Install doors and hardware.
• Install finish electrical in family area complete. Includes finish lighting, switches, outlets and covers,
thermostats, fire alarm(s), electric baseboard heating elements in family area only.
• Install flooring.
• Install window and door casings and baseboard trim to finish.
• Install stair skirts (3) paint grade
• Install newel post, wall cap, railing, and open balusters. (stain grade oak rail, balance paint grade)
• Install carpet/pad on staircase.
•d remo!all onstruction debris.
The items listed above will be the only work completed. If there is any concerns or questions regarding scope of work
to be completed please don't hesitate to call to modify this contract.
Per owner request, price does not include:
• Finish painting of the walls trim or doors. (May be added to scope if owner desires)
• Any work at other basement areas other than new space.
Specifications:
Specifications are subject to permit approval. Any required changes to obtain permit will be handled as change orders
andlor general provisions.
All materials will be of standard mid -grade building products or as specified below.
• Wall framing will consist of 2 x 4 pressure treated sole plates, and kiln dried top plates and studs.
• Ceiling and soffit framing may consist of both wood and metal framing.
• Insulation will be fiberglass R13 in 2 x 4 walls, R19 in 2 x 6 walls, R25 or 30 in ceilings depending on
framing size.
• All wiring and wire sizing will be determined by load and code. 12/2- 20 amp circuits for outlets, 14/2- 15
amp circuits for lighting.
Owner initial/ date:
CONTRACT Page 2 of 4 Contractor initial/ date:
r Allan Jarvis General Contractor
2 Jackielyn Cir • Granby, MA 01033.413.262.1065 • aljarvis @charter.net
• Foam or rubber pipe insulation.
• Recessed lighting by Commercial Electric, Halo, or Jams. (maximum 12 cans with standard covers)
• Electric baseboard heating with isolated circuits, wall mounted thermostat controlled.
• '/z " gypsum wall board on walls, ceilings, and soffits.
• 6 panel masonite prehung doors (2 door maximum)
• kwickset or schlage door hardware.
• 2 '' /2' colonial door /window casings- paint grade pine
•
3 colonial base molding- paint grade pine
• Newel post, wall cap, railing, and open balusters. (stain grade oak rail, balance paint grade)
• Laminated wood flooring (owner existing provided)
• Carpet on staircase.
• Shelving will be design built to suit using mdf or cabinet grade ply with edge banding
Please inform contractor of any specific brand, type, color or any other special material desires needed as this contract
can be modified to suit.
Allowances:
Allowances are allowed budget expenses toward owner selected items for purposes of supplying a total cost for a
project before items are actually selected. These allowances are based on items as discussed during project
consultations. Under - budget expenses can be added to increase other line items budgets or to receive a credit overall.
An increase of overall budget expenses will increase project costs total.
Allowanced items included in project are as follows:
• Carpeting $175.00
Change Orders:
A Change Order is any change to the original plans and/or specifications or scope of work. All change orders need to
be agreed upon in writing beforehand, including cost, payment terms, additional time considerations, approximate
dates when the work will begin and be completed, a legal description of the location where the work will be done and
signed by both parties. Original scope of work willprogress until written change orders are signed and returned.
Additional time needed to complete change orders shall betaken into consideration in the project completion date.
Finish Schedule:
A Finish Schedule is a detailed list of all owner selected ( allowanced or `owner selected' included) finish items. The
schedule should contain wall and trim paint color selections and all manufacturer /model information including
specifications (not directions!) for installation of each owner selected product. The purpose of this schedule is to
ensure all sub - surfaces have been modified or prepared properly to accept selected finishes and to ensure efficient
construction progress. If applicable, a completed Finish Schedule shall be submitted to the Contractor by it's due date.
The due date is one week prior to the longest `owner selected' material delivery lead time in your project. Any delay
or changes in finish schedule may cause removal of installed materials at an additional cost and/or delay the projected
completion date. Contractor requires 24 hrs to review finish schedule after receipt.
General Provisions:
If conditions are encountered at the construction site which are subsurface or otherwise concealed physical conditions
or unknown physical conditions of an unusual nature, which differ naturally from those ordinarily found to exist and
generally recognized as inherent in construction activities, the Owner will promptly investigate such c itions and, if
Owner initial/ date: Z q 1 t
CONTRACT Page 3 of 4 Contractor initial/ date: t � —
C/�
Allan Jarvis General Contractor
`F 2 Jackielyn Cir • Granby, MA 01033 - 413.262.1065 • aijarvis @charter.net
they differ materially and cause an increase or decrease in the Contractor's cost of, andlor time required for,
performance of any part of the work, will negotiate with the Contractor an equitable adjustment in the contract sum,
contract time or both.
Hazardous Materials, Waste and Asbestos:
Both parties agree that dealing with hazardous materials, waste or asbestos requires specialized training, processes,
precautions and licenses. Therefore, unless the scope of this agreement includes the specific handling, disturbance,
removal or transportation of hazardous materials, waste or asbestos, upon discovery of such hazardous materials the
Contractor shall notify the Owner immediately and allow the Owner to contract with a properly licensed and quaked
hazardous material contractor. Any such work shall be treated as a Change Order resulting in additional costs and
time considerations.
Total of Contract:
Including all materials and labor to complete. �( .
The cost for remodeling the project as specified in this contract shall beset at the sum of ' $J 4 x E
ITM ousa seven hun red and fifty oars.) 4'13 9
This price is subjecho U additions and d du t o p suant�to authorized change orders and allowances and valid for 30
days.
Payment terms: 11 4/c6
$500 with signed contract, '7 A 511
`r .�aterial d it (minimum 1 week prior to start), $4710. rough electrical
completed, $2375. DITwith sheetrock primed, balance upon completion.
�2 Z33.33 Q
Time to compl
Estimated time to complete, weather permitting- 4 weeks
Contractor hours are between 8 a.m. — 5 Am. (7 p.m. overtime) Monday- Friday. Subcontractor coordinated projects
are subject to subcontractor scheduling and hours of operation.
Guarantee:
All materials will be installed according to manufacturer specifications ensuring all material manufacturers
guarantees and warrantees remain valid. All owners manuals and other pertinent literature, including any accessories
will be turned over to owner upon completion. All contractor and subcontractor workmanship to be of professional
quality in nature and guaranteed for a period of one year from completion. If any installed systems fail to function as
designed, call immediately for service. I cannot guarantee additional damages cause from continAe use of a faulty
system or misuse or neglect.
f
Contingencies or extra work
Respectfully submitted
The above prices, specifications and conditions are satisfactory and are accepted. You are authorized to do the work as specified.
Payments will be made as outlined above.
C' [
Owner/ Representative Signature: Date: D
Contractor/ Representative Signature: Date:'
Owner initial/ date:
CONTRACT Page 4 of 4 Contractor initial/ date:
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DATE M
ACORD OF LIABILITY INSURANCE 219 1 2 010 r
PRODUCER (413 )214 -7474 FAX: (413 )2147447 THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION
Fole Insu =ante Group ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1' p HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
37 Elm Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
West Sp ringfield MA 01089 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A' Travelers P rU ex tZ
Al Jarvis INSURER 13
2 Jacklyn Circle INSURER C
4NSURER D.
Granby MA 01033 INSURER E
OVIERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN IziSIED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTIMTWSTANUM ANY
REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VIRTH 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-
AGGREQA LIMITS SHOWN MAY 14AVE AM R EDUCED
INSR ADDL POLICY EFFECTI)YE POLICY EXPIRATION
IPLqRn TYPE OF INSURANCE POLICY NUMBER DATE DA UMC[S
GENERAL LI ASILITY EACH OCCURREN $ 1,000 ' 000
DAMAGETO RENTED
�{ CuMiMER(:iAL f�tNER AL L1AB4Li IY PREMIS E oc rrence $ 50,
A CLAIPASIdADE MOCCUR I6804399N206 4/28/2004 4128/2010 MEDEXP Any onep --son) $ 10,000
PER,50 &A VINJURY $ 1,000,000
GENLkALAGGREGAiE $ 2,000,000
GFN'L AGGREGATE LIMAT APPI IFS PEP _ $ 2,000,000
X. Y PRO- C - - -_ -
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO (EaacGdent) $
AL- OWNED AUTOS DODILY INJURY $
SCHEDULED AUTOS (Per per;or.)
HIRED AUTOS BODILY INJURY
14014, OWNED AUTOS (Per accident) $
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ NY AUTO
ANY THAN EA A(:C $
AUTO ONLY AGO $
EXCESSIIAABRB.LA LIABILITY E OCC uR RF N , :A7 $
OCCUR F-1 CLATNIG MADE AGGREGATE £
b
f7ED1JCT161_E � $
i
RETERTION
WORKERS COMPENSATIONAND T ORY TU 0TH - FR
MH I L OVERS'LIANLITY
ANY P ROPRIETORFPARiTIE1'2ri ECUTtVE E L EACH ACCIDENT $
OFFICERRvitMSER EXCLUDED? F.. t.. 1 AS - 'A tMPL OYFt $
R yft deSf betj
SPECIAL P 0 I i J` - � E. .DISEASE - PO ICY LIMIT I s
OTHER
-- - - --- -- - --- - -- .. - -- - - - . --- -
..._.. - - -- - --
DES�CAIPT" OF 9PERAT30N61LOCAT�ESIE XClY646NSADDEDB�F PROWCWNC
CERTIFICATE HOLDER CANCELLATION
5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Northampton EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAY
Building Inspector 10 DAYS WRITSEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
212 Main Street FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
Nor thamp ton, MA 01060
INSURER. ITS AGENTS OR UPMSENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2001/08) ACORD CORPORATION 19=
INS025(oim) om P69e 1 612