Loading...
29-251 (16) 61 OVERLOOK DR BP-2018-1294 GIS k: COMMONWEALTH OF MASSACHUSETTS Mao:Block:29-251 CITY OF NORTHAMPTON Lot-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeorv: Deck BUILDING PERMIT Permit# BP-2018-1294 Protect# JS-2018-002304 Est Cost: $6500.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use croup: Homeowner as Contractor_ Lot Size(sq.ft.): 18120.96 Owner. CLOVER REGAN Zoning: Applicant. CLOVER REGAN AT. 61 OVERLOOK DR Applicant Address: Phone., Insurance: 61 OVERLOOK DR (617) 519-0647 O FLORENCEMA01062 ISSUED ON:61712018 0.00:00 TO PERFORM THE FOLLOWING WORK ADD 12X18 DECK 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 Sienature: FeeTyoe: Date Paid: Amount: Building 6/7t2018 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File N BP-2018-1294 APPLICANT/CONTACT PERSON CLO',ER REGAN ADDRESS/PHONE 61 OVERLOOK DR FLORENCE (617)519-06470 PROPERTY LOCATION 61 OVERLOOb DR MAP 29 PARCEL 251 001 ZONE THISSI ;CION FCROFFICIALUaE ONLY: PER4ITAPP_LTCA'rtO1 CHECKLIST OSEE REQUIRED DATE ZONING FORM FILLED OUT _ Fee Paid Build PPermit Filledout Fee Paid T eof Construction: ADD 12X18 DECK New Construction Non Structural interior renovations Addition[o Existing Accessory Structure Building Plans Included' Owner/Statement or License 3 sets of Plans/Plot Plan THE POLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF RMATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIREYUNDER:§ Intermediate Project: SitePlan 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 - 'C: Wariancc- 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 molition Delay e of m I rcial Dat, L New: Is o 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. R Department use only ---- City of Northampton status of Permit: .y: Building Department Ourtr Outlbrveway Permit � , X. ly, 212 Main Street SawB/Septic Availability Room 100 WalerlWell Availability Northampton, MA 01060 Two Sets of Structural Plans �' phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Q Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING -(2C1 SECTION 1 -SITE INFORMATION QP./ This section to be completed by office iA Property Address OU !/ / J J �✓- 'A p Map T' Lot �.� Unit Zone Overlay District r/r('n P/ / ''I r� L Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: / ^^ / / 0 A Name Pr' Current Mailing Addraasy/ Telephone VV !a Signal 2.2 Authorized Anent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permitapplicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) J OtI Check Number This Section For Official Use Only Date Building Permit Numb Issued: Si9natur . Bui din /missionerllnspect//or of B/ui/ldings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) A 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: R:. C'._ R: Rear Building Height Bldg.Square Footage Open Space Footage sot area minus bldg&Payed _.... rkm l §of'Parking Spaces -- Fills (Intomc&Locadon) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained O , Date Issued: C. Do any signs exist on the property? YES Q 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: 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 O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aoulicable) New House ❑ Addition ❑ Replacement Wintlows AIteration(s) ❑ Roofing ❑ gr Doors [� Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks )id Siding[01 Other[d) Brief Description of Proposed //�� .�� i Work: f.Z K�� 0, k 4./ F.. �{/1',.✓ 1-7f— -0/. nd Alteration of existing bedroom_Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Be.If New house and or addition to existing housing, complete the following: a. Use of building :One Fari 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? I. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? If. Type of construction 1. 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 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 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 Data I, Q 7- ✓1 C 1(_l� 'V/ .as Owner/Authorized Agent herem,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. Print Name ro� ► ► $ Sgnature OwnerlAgent Da e SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone 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...... ❑ City of Northampton Sl •'"'" Massachusetts sss `F DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building �p Northampton, MA 01060 s tyq `^cit AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.C.L. Chapter 142A requires that the"reconstruction,alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any preexisting owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC, that entity must be registered Type of Work: Est. Cost: Address of Work: Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): _Job under S 1,000.00 Owner obtaining own permit(explain): Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: 1 hereby apply for a building permit as the agent of the owner Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice�,pl/�tJ]�reby apply for a building permit c owner of t e above property: fIXQ Date — Owner N4me and Signature ^y I City of Northampton Q�_, MassachusettsDEPARTMENT OF BUILDING INSPECTIONS 212 Main Street a Municipal Building ; Northampton, MA 01060 Massachusetts Residential Building Code Section 11085.1.2 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. Section 110.R5.1.31 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR 110.R5, provided that if a homeowner engages a persons) for hire to do such work,then such homeowner shall act as supervisor. 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. City of Northampton Massachusetts - c< a 111 `s Northampton, M 01060 vr�J�� DEPARTMENT OF BUILDING INSPECTIONS Ma2 }}} .�' 212 in Street eMunicipal Building Debris 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 111, S 150A. The debris frr/ojjm construction work being performed at: (Please print house number and street name) Is to be disposed of at: (Ple,arse print napAe and location of facility) ��— Or will be disposed of in a dumpster onsite rented or leased from: (Company/Name and Address) (Z 6 f d Signature of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. The Commonwealth oeMassachusetts Department ojlndustrial Accidents I s I Congress Suite 100 Boston,MAA 02 02114-2017 www.mass.gov/die R others' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING.AUTHORITY. Applicant Information Please Print Legibly Name (BusinesslOrgarma6on/Individual): Address: City/State/Zip: Phone #: Are you an employer?Check the appropriate tax: Type of project(required): I-❑I am a employer with cmpl oyeea(Poll andlor partaime) 7. ❑New construction Irl lam a sole pmpnator or partnership and have no employees working forearn 8. Remodeling any rapacity.[I4o condor, comp.iamrance required.] 3�❑/I am a hmncoweardang all work mysc6[Noworkcrs'comp.mourenurcquircd.l' 9- ❑Demolition 4.T slaa homwwncr and will be hiring contractors to conduct all work on my pmpeary_ Iw,If ]0❑ Buildiltgeddi0on ,-are that all contractors either have workers comperavafion insurance or are sole Il.❑Electrical repairs or additions pmpec o,with ao employees 12.❑Plumbing repass or additions iThese general mutmaorand 11crlist chlredt to sub-crkers rrslL ted on[M1e attached sheer 13.0ROofrepairs These sub commuters have employees and have workers'comp_insurantt: 6 We am Is common-andItsoffemshavecxemised their right ofeAtandem.per MGL c. 14.❑Other 14,kl(4),and we have an employees.[No wmlou'comp.insurance..Guimdl *Any applicant that checks box#I must also fill out the section below showing their workers'comp derdcon policy iofonnadon. 'homeownerswho submit this arum,k indicating they are doing all work and their hire outside contractors must submit a new affidavit indicating such :Comracmrs that check this box must attached an additional sheer showing creature of the sob-contractors and state whether or not those entities have employees_ units sob-eoduch rs have employees,they must provide their workers comp.policy number. Ian,an employer that is providing workers'compensation insurance for my,employees. Below is the policy and job site information. Insurance Company Name- Policy Is or Self-ins.Lit.#. Expiration Date: Job Site Address: City/SUmcZlp: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 151$25A is a criminal violation punishable by a fine up to 51,500.00 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.A Copy fthis statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. /do hereby certi�f;pamlder the pains andpenaffies ofperjury,that the information provided above is true and correct. S'vmaturC7 Ies,—_ ( Off � —7 Dale t'I(e g Phone': L e l— p S1- o\/—o '1(( 1 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#: 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 the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a 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." MGL 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 comrmonwealth 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 sub-contractor(s)name(s),address(es)and phone number(s)along with their ccoificate(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 be resumed 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' compensation 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 fill out in the event the Office oflnvestigations has to contact you regarding the applicant. Please be sure to fill in the perait/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 proofthat a valid affidavit is on file for future permits or licenses. A new affidavit must be it tied 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia 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 the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However,the owner of 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 bean employer." MCL 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 pal itical 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 workerscompensation affidavit completely,by checking the boxes that apply to your simation and,if necessary,supply your insurance company's name,address and phone number along with a certificate 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 be 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' compensation 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 sore that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill 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). 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street Boston, MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 www.mass.gov/dia Fonn Revised 02-2I-15 • 12" tubes 48" deep for main beam footings • 8" tubes 48" deep for stair footings • Deck surface is about 24" above ground level • Triple 2" x 12" main beam • 2" x 10" joists and 16" on center • Joists are on hangers • Stair stringers are 16" on center • 5/4 x 6" decking and stair treads • Deck surface and stair treads are screwed into place • All lumber is pressure treated xh%. h �t T stn f Lcy�''��yxi S � s t,n' '.im�`3r�3jtr1 yP.. a v A4 t ✓t�F� r � c A 1 ti v� CERTIFICATE OF LIABILITY INSURANCE 052M2016 THIS CERTWATE M M AS A MATTETI OF INFORMATION ONLY AND COWERS ND REMS UPON THE CERIICATE HOLDER.TMS CERTIFICATE 0061 MOT AFRRMATAMLY OR NEGATIVELY ANEW EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICES BELOW. THE CERTIFICATE O INSURANCE DOES NOT COWWITI E A CONTRACT BETTSEBI THE ISWM DIfURER(SI, AUTNOIiVIED REPRFSENTATNE OR PRODUCER,AND THE CERTIFICATE MOLDER. bPORTA N Wa o OMN ImldN N an ADDITIONAL INSURED.tlN palkY(lr)mad M eMmaed R SUBROGAIM IS WANED,SWjad M IDltnr Add cond0or of NN pot4,cwWn po41r may mpube an IMomanalN. A ataerlNm on this mWNafe dor not DONan Adds totlr r1tIn IMbr M Nn of auah a. .a.a1As1 =A7 CWaam YMeale, REGINA JASAK INDEPENDENT INSURANCE INC NNIE 41 b1"M IAA EMIL can P O BOJ(563 Aaer110t%VaN.E aeras LUDLOW MA 01056 amwa,,A: AIMMUTUALINSCO 337M 'duan 0100H., HANDY 14UBSV nsulan c: -- 0111001.: 47 E CENTER STREET IMrEAE: LEEDS MA 01053 F: COVERAGM CERTIFICATE NUMBER: 274214 REVISION NUMBER: ANIS IS TO CERTIFY THAT THE POLICIES OF INSINANCE LISTED BELOW NAYS BEEN ISSUED TO TIE INSIAED NNAEO ABOVE FOR THE POIJCY PERIOD INDICATED. NDINEMSTANDNO ANY�OUPBENT,TEAM OR COMpipN OF ANY CONMACT OR OTTER DOCm.ENT VAfI l RESPECT lD VM4CH TMS CERTIFICATE WY BE ISSUED OR MAY KnNN,T1E INSURANCE AFFOROm BY Ti*;MMES DESCRMEU IEREN IS SUwI TO ALL T1E TEMIS, IXCLUSIWISANDCONDTNNSOF SUCH MUOES.UMTS SmAAN MAY HAVE BEEN REDUCED BY PND CU THE OFamMll� .R ATE ® La08 W m01aLLOnNKWW1Y FISH CLc1A..}KE i �CWYSWDE �IXL'W b f YE.E%P WOOYPYVI:) f WA FFtsW+ffaw nuum i tfxtulOEC.tAEum/.FRIBVER IEHEIMLna3RFf.LIF 3 Nltr❑MM. �LOc PBOOIG*4-COYnCP AGC f 0Hn i YImY.a\elM>m � 9xaEU f AHTAur. eoaLv iwtwv pwpsunl s wrm o sauD WA ecaLr IWVH/lPevYeU f MR®AIROS AMOSW YJ_ f amP0LA1Pa �.Iq FAaIOCCWIFNCE i DIl911InN cwl6awE WA nccrdr>I.re i o® s tfaaNlaema9aaw01 X 6T0TVlE ER IndllDraRWW11 ulwumxaTwR.wArEwoosurna ♦/a EL.III f tOD,000 A arDmNENemEJpunm+ O LVA n ANA:100]D15]262017A /18/142017 01/112010 pYq.rwyYma EL a6FASE-FA EYRM f 100.000 OE�Pna16CPEPAAp16 m. EL asFwsE-x0lcv umr f Ob WA rAlOI1Y09010a/IDIaIaMElaaC6IAcam1H.AOmY�IA_bbAa:w.�)noYaaaa —n—Yee Vbllfsa'Cna pa naton tax wE W pdd In Masaadvaota noo nes only.PmnanA In ErdanfanMaA M 200306 B.no"wbaliOn a liven m pry WYm for 1,e eea In er plo,.n Notes rer Nan Mafsadweta HON Ireacd Hans.N Ues And NPfe enplumes amide of Maenad mdln. Tots caNNrale of Ialaare Brows ON POLY at fa¢on ne dale fail Van WO /Cam wr RMmd(NMr Ina aaP,o dde n Em otlove Palq Pm WaRa On, Seonta st lmEcegorirelaamo). TDeeYIN MNa maeioml. IN nviwed miy byameNllg tlN MoMdCOYoago-Covetapa VelMrNon Semdl lod ot wwxaNse90`/naaNMarsm^Daaatd^RneN91Uo1al. CERTIFICATE MOLDER CANCELLATION 91101IID ANYK 1111 ABWEOIIEGF. POUCNBBEC DELIVERED BEFORE THE E[PNI111ON DATE THERE6, NDTIfE 1YLL BE pELNM1ED N TOWN OF NORTHAMPTON ACCO"OA"DE "T�°O1" ' LOCATION610V 001I(DR AelN1ln�.a9maBIMl1YE FLORENCE MA 01062 "CPCU,V PM11dnt-ReeidWMo"-VICRE" 01988,2014ACORD CORPORATION. AN"UMs retemed. ACORD 25(2&MM) The ACORD roma and logo am regletwed manias 0 ACORD +cod CERTIFICATE OF LIABILITY INSURANCE r I 131(30/2D1B TUS CFRTFICILTE6Di&1ED AS A MILT OF NFORMATION ONLY AND CONFERS N0IRWIT3 UPONTHE CERNFICATE HOLDER.TIRE CEATi1CATE DOES NOT A RMATNELY CR NEGATIVELY MEND,EXTEND ORALTER THE L:OYERAEiEA RDED BY THE POLKIES BELOW. THM CERTFT W OF INBURANCE DOES NOT CONSTITTRE A CONTRACT BENYEEN THE MSUNG WSURER(SJ AUIFWIltI�)D REPIESEMATNE OR PRODUCER.AND THE CERTFT WHOLDER. a Gb an D,RM pdiry(W)mlW ba erldosad. ,wlHadb Down arnicand fim a o1RM PalicY.urMin PaNOIW maF naLllm an erMpamlNnL A aWllwR an Rfia dr3Blab dWb not COnbFHpnb b Ble IaHU1km NoldsP b Nsu of auGr endorasnMM(a). PMwoar nrarE: Chmnina VJllBaler Regina Jasak Independent Insurance Inc Boll (413)3155TT5 Iwc,wt (855)2I3A332 P O Bar 513 wvMNsa: xuc• Ludl. MA 01056 ImNNB^ Claxad GmLpCL IXBNRERa: Clluixd Cmp(:L Pal3Bladistl HANDYHUBBY am ntc: 47 E CENTER ST marmarD LEEDS MA 01053 m.F: COVEMOES CERTIFIWLTE NUMBER: REIRBNHI NUMBER: THI515 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW IWVE BEEN ISSUED TO THE INSURED NNIED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTNIg MYREWIREMEM.TERMORWNDITONOFNIYCONFRACTOROTHERDOCUMENTWITHRESPECTTOWHICHTHIS CER RI MIMYMISSUEOORMAYMRTNN.THEWSURANCEAFFOMMBYTHEPOLICIESDESCWBEOHEREWIBS ECTTOALLTHE71R EXLLLISIONSNIDCOHp11IX150FSACHP IES.LIMBSSHOYMFMYHIVEBEERH WCEDBYPAIDCWMS. ME6MMIRAMLE Fa11:Y N111lFR PoIILY EFF MIILYEA L�5 m pEMTIAL LPrIaTiY FAW OOGIRRENEE i 1000000 COMMERL44 rrHaw LMavrr rnFillsESlF+aa.em) f 50000 GAmswaE ®°ccuR uE°F}➢Ilny aw pweonl $ 5090 20021000 916Y2017 9162010 PEReONKAMVIIHORY f 10011000 ❑I f 2000000 f£HL MAREGOTE LIWTARLIES PER: f 2999990 ❑ ig11CY ❑ JECT Fill- i AIROYOaIELI.LWrr/ (F+,mesq f ❑ yn•.VfIO auury lPV Tarnl f Li �0.Sm ❑ RVI E° aOpLV INJURVIW wOfMI s IMIEOAUTW NON-0 . f aM.nl ❑ ❑ NP0.S i 11WEllALMB ❑ CCCUfl EACH CLLIIRxENLE i ❑ QOmW ❑1. wGfl¢GATE f ❑ . JLJ 1. f f COi69A11O11 WLSTMLL ❑ OM 6KOYM18'LMRnY FRCNLnTORPOMNFl4DZlYI1VE Sl....ENT f FN£RA£MEER FXQUOE% N/A FMR f N4 hwNe OFCPEPAlgX3EeLH EL.PEFAh£ POLICY LWT f oFalauTmxarLacwTOxalvraxlaAs Mainwcon°1n.maulwrMswdxa Mrwnme N.a+�al 61 Ovsbok Or FI°rerca AU 01062 CEHTIFTCATE HOLDER CANCELLATNNI SIIOIMDAMY OFTIE ABOYE OESLNMEU POl1L688E WNCElL{D BRFdiE TONTI OF NORTHAMPTON THE EIWUTpN MlE TNFAEOF.NOTICE Wll BE DEINFA®N NORTHAMPTON MA 01060 ACCORDANCE WITH THE IH]L1CY PROW9gNS wNlwl@nRESREmrtATF/E CHRISTINAWHEELER ACOND 25(20110/05) ®1983-2010 ACORD CORPORATON. AU fiWft mwvad. TM ACORD name and Ngo am"island nual s of ACORD