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22B-113 (6)
157 SPRING ST-FLORENCE FIELDS BP-2017-1511 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:22B- 113 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2017-1511 Project# JS-2017-002525 Est.Cost: $44000.00 Fee:$0.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: BRIAN DIAS 075914 Lot Size(sq.ft.): 1061121.60 Owner: CITY OF NORTHAMPTON Zoning: Applicant: CITY OF NORTHAMPTON AT: 157 SPRING ST - FLORENCE FIELDS Applicant Address: Phone: Insurance: Office of Planning& Sustainability (413) 587-1262 0 WC NO RTHAM PTO N MA01060 ISSUED ON:6/27/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:REMOVE AND REPLACE EXISTING STANDING SEAM ROOFING ON TWO PARK PAVILION STRUCTURES***PER CONTRACT SPECIFICATIONS** 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 6/27/2017 0:00:00 $0.00 212 Main Street.Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck--Building Commissioner File#BP-2017-151 I APPLICANT/CONTACT PERSON CITY OF NORTHAMPTON ADDRESS/PHONE Office of Planning&Sustainability NORTHAMPTON (413)587-1262 0 PROPERTY LOCATION 157 SPRING ST-FLORENCE FIELDS MAP 22B PARCEL 113 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY:, PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid puiiding Permit Filled out _ Fee Paid /� _ TvpeofConytmction: REMOVE AND REPT C9 EXISTING STANDING SEAM RO FING ON TWO PARK PAVILION STRUCTURES ,7 New Construction P Non Structural interior renovations ,pAC' I1 Lt' 6 Addition to Existing ^� 1 'lC.�0 _ Accessory Structure `I ' Cl Building Plans Included: I n ('r f�a- Owner/Statement or License 075914 W.' 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER* Intermediate Project: Site Plan AND/OR _ Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding_ Special Permit Variance* _Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability _ Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission _Permit DPW Storm Water Management De�molition I' ay t-} 40I4 ZC-. Si_ of Building • teiel Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. Version) 7 Commercial building Permit May 15,2000 Department use only City of Northampton Status of Permit Building Department Curb Cut/Driveway Permit 212 Main Street Sewer±Septic Avaaability_ Room 100 WaterANell Availability Northampton, MA 01060 Two Sets of StnicwralPlans phone 413-587-1240 Fax 413-587-12 PIOUSite Plans other Speciy [ APPLICATION TO CONSTRUCT,REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY OWELL.ING SECTION I -SITE INFORMATIONI This section to be completed by office 1,1 Property Address: 156 Spring St Florence,MA < Map a a(� Lot 11 / — ,nit i 157 Sfin47 J Zone Overlay District - Elm Elm St District Gd OisV:ct SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 1.1 Owner of Record: City of Northampton 210 Main St Northampton,MA 010x0 Name(Print) Cermet Mailing Addres=_ 413-537-4900 Signature _ _ Telephone 2,2A tthoiz•d ••ent Ti VlnaTl- armue� ' Name vie 4-311 (Pt tA I � bdr Gtgnaturet( •_ C I /a Tee hi SECTIO • •NSTR CTION COSTS Item Estimated Cost(Dollars)to oe Official Use Only _..._! . completed bypynmt angle-mar 1. Building $44,000 (a)Budding Permit Fee 2. Electrical - - -- (b)Estimated Total Cost of Construction from 3. Plumbing Budding Permit Pee 4. Mechanical(HVAC) - - 5.Fire Protection �� ,4 9- Total r(1 +2 +3 4+5) _n_a_.y�• Check Number F E 0 This Section For Official Use Only Bulking Permit Number Date Issued Signature: 9u ding f mmisa onertInopeccnr r nt816inp5 Dale - .._... .._ _ @ersioaL7 Conarmrcial Building Pcnnit May IS.:000 SECTION 4 CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations 0 Existing Wall Signs 0 Demolition❑ Repairs 0 Additions 0 Accessory Building 0 Exterior Alteration 0 Existing Ground Sign 0 New Signs 0 Rootingriii Change of Use❑ Other 0 Brief Description _. . - - -. -8 Of Proposed Work: Remove and replace existina standing seam roofing on two park pavilion structures_ SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE'::GROUP(Check as applicable) 1 CONSTRUCTION TYPE A Ass¢mdly ❑ A-i 0 A-2 0 A3 0 1A ❑ A-4 0 A-5 0 IS 0 8 Business 0 _ 2A ❑ E Educational 0 28 ❑ F Factory 0 F-1 ❑ F2 0 20 0 H H:gh Hazard ❑ 3A ❑ I Institutional ❑ 1-1 ❑ 2 L0 I-3 0 �,�a8 0 M Mercanntn 0 �.� 9 _ 0 R Residential 0 R-1 ❑ R-2 0 R-3 ❑ SA 0 S sWrage 0 s-f 0 8-2 0 se 0 U Utility ❑ Specify, M Mixed Use 0 SPecity: S Sp,.;ial Use ❑ t Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group. : Proposed Use Group _ Existing Hazard Index 780 CMR 34) Proposed Hazard Index 760 CMR 34): _.. SECTION 6 BUILDING HEIGHT AND AREA BUIL DING AREA EXISTING PROPOSED NFW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) ... _ 1n is - ... 4th ._. Total Area(sf Total Proposed New Construction(sf) Total Height(N) Total Height II 7 Water Supply(MGL c. 40,§54) LI Flood Zone Information: Tt Sewage Disposal System: Public pPnYatp ❑ Zone Outside Flood tune( Municipal On site dip osal ,ysten ❑ Version] 7 Commercial Building Permit May IS.2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning Thinngcniumn Dearbentt in Ly i Wuil�ng DgimLacm Lot Size Monaca.. Setbacks dram Side Rear Building I Might Bldg Square Peerage. - Open Sean, Foot ldg&p (1.or nrenarkin ) minnshidp&paved purr�int) of Parking Spaces_ arrived LA,adore A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW O YES 0 IF YES, date issued' IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW 0 YES O IF YES: enter Book Page and/or Document g B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O IF YES, describe size, type and location: L Will the construction activity disturb(clearing,grading,excavation,or filling)overt acre or is it part of a common plan that will d6rub over 1 acre' YES (3 NO IF YES,then a Northampton Storm Water Management Permit from the DPW fs required Vcrsionl 7 Commercial Building Permit May 15.2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: Morgan Studios .._ _.. _. Not Applicable 0 . . Name(Registrant) _ Sherburne Falls,MA Address R iao-ation Number 413-E245127 Expiation Dale Siynawru Telephone 9.2 Registered Professional Engineer(s): I Name Area of Responsibility '-- –"� Number Address Registration Signature Telephone Expiration Date Name Area of Responsibility Address _ H gstration Number Signature Telephone Expiration Dale Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date -- - — Name --- Area of Responsibility Address Registration Number Signature _ Telephone Expiration Date 9.3 General Contractor Meadows Construction Comapny LLC Not Applicable Company Name: Brian Dias Responsible In Charge of Construction 4 New Pasture Road Newburyport,MA Address n/'� d foa–ma 1 ' 918815-7149 Signature Telephone Version) 7 Commercial But)ding fermi t May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes O No 0 _ l SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Davd Pomerantz I, _ as Owner of the subject property Mea s Construction Company ILC I n. rani authorize to y alt, 1: matters relative to work authorized by this riding permit applicatio iiL ► Wilco.I1_ Si nail alia Date iiSna •Is 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 rrd� Signed und�the ----enc les of pI ry. luau%, — Point 6G-I t 1 Di a$$ 6/26/2017 Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor. Not Applicable ❑ l Name of License Homer Urian Dias _ 075914 License Number 111 Pelham Road Hudson,NH 03051 9/28/2018 Address Expiration Date 978 815.7149 Sgnalvre TdeOhmie SECTION 13-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 affidavitwill result n the denial of the issuance of the building permit_ Signed Affidavit Attached Yes 0 No 0 City ot Northampton 212 Main Street, Northampton,MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c ill, S 150A. Address of the work: 156 Spring Rd Florence,MA The debris will be transported by: Meadows Disposal The debris will be received by: Machoche 2nd Street Chelsea,MA Building permit number: Name of Permit Applicant Meadows Co nstmchen Company u C 6/26/2017 Date Signature of Permit Applicant 'a` The Commonwealth of Massachusetts �. Department of Industrial Accidents i__y=��/ ` at - --rl Office of Investigations 1= - I Congress Street, Suite 100 7.�,,o a..` r' Boston, MA 02114-2017 �C=f own:mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name fus nessiOB nt,n/Individualy Meadows Construction Company LLC Address: 4 New Pasture Road City/State/Zip: Newburypod, MA 01950 Phone rf: 97&465-4735 Arc you an employer? Check the appropriate box: 'type of project(required): I 1-41 T am a employer with 40 4. ❑ I am a general contractor and 1 employees (full and/or part-time).* have hired the sub-contractors 6. ❑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 R. 1J Demolition working forme in anycapacity. employees and have worked — p } 9. Building addition [No workers' comp. insurance wrap_ insurance.] — required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions officers have exercised their I1 Plumbing repairs or additions 3.Li I am a homeowner doing all work -❑ P' myself. [No workers' comp. right of exemption per MGL 12❑ Roof repairs insurance required.)1 e. 152,§I(4).and we have no employees. [No workers' 13. Other comp.insurance required.] *Any applicant hat checks box I most also fill out the section Mbar shiming their work compensation policy informm ion. I HODICOWIICIS who submit tdda alildadil indicating they arc do rp all wok and then hire Cd contra:tom must stannic anew anitwit indicatingsuck 1Cmlac rs that check this box must attached additional sheetshowing then t .- Of and stale whether not those entities hae employesif thesub-ournoors have employees then-west provide their workers'comppolicy number_ l am an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site information. Insurance Company Name: Travelers Property Casualty Company of America Policy#or Sell-ins, He. #: UB68226814-16 Expiration Date: 9/12/2017 Job Site Address 156 Spring St _ City/State/Zip: Florence, MA 01062 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 e. 132 can lead to the imposition cif criminal penalties of a tine 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 5250.00 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 vete Bead on. I do hereby certify under the� pains , ,enalties of perjury that the it formation p raided above is true and correct SignaNre __y_...f+! _ / �'i{"—"t Dale_ --Cv/?/' 7 phone / 7Y--nc- 7/ (4 [ Official use only. Do not write in this area, to be completed by city or tmvn official. City or Town: Permit/License# Issuing Authority (circle one): I. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees, Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written" An employer is defined as"an individual, partnership,association,corporation or other legal entity,or any two or more of die foregoing engaged in a joint enterprise, and including the legal representatives ofa deceased employer:, or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner ofa dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer" MGA chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply subcontractor(s) name(s), address(es) and phone number(s)along with their certi ticate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage_ Also be sure to sign and date the affidavit. The affidavit should he returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' co npensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly_ The Department has provided a space at the bottom of the affidavit for you to till out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Deparunent's address,telephone and fax number_ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. 4 617-727-4900 ext 7406 or 1-877-MASSAFE Fax #617-727-7749 Revised 7-2013 www,mass.gov/dia f.--T---.1 e FrIF lits:cnCERTIFICATE OF LIABILITY INSURANCE ITIOTTAIN FIGATE IS ISSUED ASA MATTER OF INFORMATION ONI-Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE DER.HOLTHIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POI.icing IIF1 OW. THIS CERTIFICAIE 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/ios)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement.A statement on Ibis ter-Plicate does notcanter rights to Me certificate holder in lieu or such endorsement(s). PRODUCER CONTACT NAME: STARK WEA➢frR Se SHEI>LEY PHONE FAX PO BOX 549 MM.No,EBY INC.Nap - PROVIDENCE,RI U2901 ADDRESS pHryX luso ER(S)AFFORDING COVERAGE INSURER A: TRAV&t}YS PROBER1 Y CASUull COMPANY OF AMERICA INSURED MEADOWS CONS rRUCCION CO LLC INSURER INSURER C INSURER D. 4 NEW PASTURE ROAD INSURER Et NEWBTIRYPORT,MA 01950 INSURER COVERAGES CERTFICATE NUMBER: REVISION NUMBER: EMS IS To CERTIFY THAT TIM POLICES OF INURANGEUSLED BELOW RAVE BEER ISSUED TO.TEE INSURED NAMED ABOVE FOR TIM Prm BY FFM0D FUNKIER NOLVERNSTANumr. ANy REM:ERFURT,TEMA LLF:CONDITION OF APXY CONTRACT OR DIRER OGROmENTWMI RESPECT TO WRICEE REX ELM:WHALE slAY BF GsLIFUOR RAY 15 IMAIV IRE IRSGRANcE AFFoRDER Bs THE POLMIES DESCRIBED HEREIN es FERNECT 10 AU_THE TERMS,EXEC/SIMI:ARO carmirsiRS or FMG/IPOLCIES,!AMR SNOW.;MAY RAVE PEER REDUCED By RAM CLAMS. mu NM SUB Pal ICY Ea pan FVE LIE TYPE OE uuuuu¢E POLICY UMBER DLYSMA)C rymomvrrmmE LIMOS GENERAL DAP/till/ ACH OCCURRENCE Ii 1 COMMERCIALAD MASH OCCUR C GEi R- S MS MA 6ES r' MP/Anyone',Damp -S. PERSONAL 6 ADV INJURY :S GENL AGGREGATE OMIT APPLIES PER GENERAL AGGREGATE F POLICY L iPROJF,CIi LOC 'RODUCTS-COW+IUP AUG I$ AUTOMOBILE OReAY COMBINED SINGS E f ANYAUTO iimhi Ra anal L MANED EUTOS BODILY INJURY $ SCHEDULE AUTOS ("Cpevon BODILY INJURY ERRED AUTOS Per accident) 4 NON-OWNED AUTOS PROPERTY DAMAGE 2 amdenll UMBRELLA LIARROC..L r C C CU RBSE 3 /MESS ESS I IARAGGREGATE DEDUCTIBLE IS PETEMION $ I$ A WORKER'S COMPENSATIONAND y 11 X HNI EMPLOYER'S LIABILITY Uaa9Z268MR BgIIJ2C 6 0911212°17 Y ..: off 1D Y�tN'I - cLooma nlvs Ll " E I.rJCH Ao]IGENT i$ !HOC 000,DOD MaJI y h.NH) EL.DISEASE-EA EI.A'LOYEE_jl IcaOuoo DESCRIPTION OF OPERATIONS Wa+ -_DISEASE-POLICY M s '000,0!0 DESCRIPTION OF OPERATIONSILOCATIONSNEHIOLESRTESTRICTIONPSPECIAL ITEMS !Additional insured City of Northampton,MA 210 Main Street Northampton,MA 1 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBE PLR IMES BE CANCELLED Inglewood Development Corp IF EXPIRATION DATE 1BERENROBOT WILL PE DELIVERED IN A.c 123 Dwight Road _ACCORDANCE WITH THE POLICY Pnu Longmeadow,MA 01106 AUTHORISED REPRESENT E A ACORO 25(201 D/O$) The ACORO nrme and logo ere!Roistered marks of ACORD 1988-20IO ACORO CORPORATION_ FII rights reserved. Client#:102269 MEADOCUN ACORD- CERTIFICATE OF LIABILITY INSURANCE DPiEIMMThDNWl 912612016 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:Ilthe certificate tholder is,cntaiADDITIONAL INSURED,the ensemutA be endoed certificate oes not IVED,confer to the terms and conditions of the endor certain policies may regime an endorsement A statement on this certific[e does not confer rights to the certificate holder in lieu of such endorsement(sl. PRODUCERT Liz Basile sk Starkweather S Shepley(WW) plosk 1.A., ., "'- -- e�78i 320-9660 i 96; ]6t 320A901 Insurance Corp.of MA EARL --- A„,„,„, LBasile@starshep.com PO Box 549 Providence,RI 02901 0549Associated !N t I FORDING RAGE Cu _-_-_ s ER Ass ciat dlnd Ins(RT) 133]55 DREGINs Burlington I Co(NT) T Meadows Construction Co LLC pA Plymouth Rock Assurance Co 114731 4 New Pasture Road Newburyport,MA 01950 SURE -- - -{ RIs kE 1 COVERAGES CERTIFICATE NUMBER: 'INSURERF REVISION NUMBER: THIS IS 10 CERTIFY THAT THE POLICIES OF INSURANCE LISSSEID el LOW I'PVE BEEN ISSUED TO THE INSURER NAMED ABOVE FOR THE POLICY PERIOD INDICATED_ NOTWIIHSTANDING ANY REQUIREMENT, TERM OR CONOII ION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT 10 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. I IMITS SI-OVM MAY HAVE BEEN REDUCED BY PATO CLAIMS. T`RR INSURANCEMI R POLICY ----. Y EFF � r 5_ -. _.. I OPYY .11y Ylr Lour_ -_ ... A © - ENE ♦ u^" AES1041617 19112/201609/1212017 eco [AICD S1000000 ® AOE %OCCUR BVPDDd6,000 PREMISES(Fa re a) 5100000 EnEAPt RIS PERSONAE&ADVINJURY $1,000,000 ceNs AGGREGATE I MIT APPI IFS PER. GLNEPAL AGGREGATE s29O0000-11 pal ICY � Lx]PE+ hoc PRODUCTS OPA6D $2,000.000 J MITER _ i C ADTOMOBLE LIABILITY PRC00001004903 19112/2016 09/12120171 FEUUE NGIELun y1,000,000 1 Amy To I SWAP INJURY a.»,.1 S (_AWES IC_ X SCOWLED MADILLINJURY( E mI10ds 1 HIRED AUTO I% UTOs ° I PERmAjd„ AG $ -� B e I X� a I HEF0003936 19/12/2016 09112/2017 E C a ECB s5,000,000 % ESs hull AS L MS uAnE AGGREGATE $5,000,000 I - LNT NS AND EMPLOYERS'[LABIUM d lel Nf NEft � NI LEE H s W - MSE A A - L EACH II yes,durnbe under 'P V $ ..-•.... IMO VELE 05E DESCRIPTION OE OPERA/IONS MEP ! EL DISErah POLICYOPT IS DESCRIPTION OF OPERATIONS I LOCATORS IVEmaES mann mi,Addl:bno!Rm,:ks Smedale,may be truth d if space is mVoYoB Additional insured City of Northampton,NIA 210 Main Street Northampton,MA CERTIFICATE HOLDER CANCEL/-ATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Inglewood Development HE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ! p Corpp ACCORDANCE WITH THE POLICY PROVISIONS. • 123 Dwight Road • Longmeadow,MA 01106 AUTHORIZED RR� EN EPRESrAIVF - • • I U 1T"_°---- ci 1988"2014 ACORD CORPORATION.All rlyhts reserved. ACORO 25(2014401) 1 of I The ACORD name and loan a re registered marks of ACORO #SRA24461MA5134A9 PATI • r'%Jt' +/ GIT/;/tf+7/ veree 71/2 to 0/111-747 ire CArl/16/17 Office ot Consumer Affaiis and Business R'agulation 10 Palk Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration_ 157479 Type: Private Corporation Expiration_ 10/42017 Tri 270240 MEADOWS CONSTRUCTION CO. MICHAEL MEADOWS --- - - --- -- 166 MIDDLE RD. --- BYFIELD, MA 01922 Update Address and return card.Mark reason for change. s" •or.0 Address C] Renewal 1R1Employment ;'I Lor Card r7 ,Y //L7' /L,...,rl,,,di, - oniCe Of ConsumerAlFurs&a usinesS Regalauoa License or registration valid for fn dividul use only EL- «iROME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: .157479 Typo: Office of Consumer Affairs and Business Regulation Expiration' 101412017 nis fare C rporatlon 10 Park Plaza Suite 5170 Boston,MA 02116 MEADOWS CONS I RUCTION CO. MICHAEL MEADOWS 166 ASCU(FE BD fi/EI LD.OAA 01E52 - - ��/ _-..-.. u.aai rclarr a"6"E°.E`Oature ®, .lbusettsartmentliSa Hoardossecof BuildingDReyepulatlonsoi anPubtl Standardc fetys License'. CS-075914 • Construction Supervisor BRIAN M DIAS 111 PELHAM ROAD •HUDSON NH 03051 �I Expiration Corn 0912812016