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38 AC©e CERTIFICATE OF LIABILITY INSURANCE FDATE(MM001YYYY) 1/15/2018 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 certificate holder in lieu of such endorsemert s . PRODUCER NSE. Cynthia Henderson, CISR Webber 6 Grinnell j PHONE (413)586-0111 Fax UkC.No.E�111: (AIC,No);f413)sa6-1602 B North King Street IF-MAIL ADDRESS: enerand9 chderson@webbrinnell.com INSURER(S)AFFORDING COVERAGE NAIC M Northampton MA 01060 INSURERA:Sel6etive Ins Co of S Carolina I INSURED INSURERB:SeleCtive Ins Co of Southeast 39926 'SQL Home Improvement Contractors Inc. -INBURERC 24 Chestnut Street INSURER INSURER E Hatfield MA 01038 INSURER COVERAGES CERTIFICATE NUMBER-.Master Exp 2019 REVISION NUMBER: I THIS IS TO CERTIFY THAT THF POE ICIFS 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 ?'HE POLICIES DESCRIBED 'HEREIN IS SUBJFCT TO At.:. THF TERMS, EXCI USIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BFEN REDUCED BY PAID CLAIMS }INSq TYPE OF INSURANCE ADOL SUBR_ POLICY N McER POLICY EYF� POLICY E7tF' LIMITS R COMMERCIAL GENERAL LIABILITY OCCURRENCE $ 1,000,000 1 A C-AIMS VAD(. X OCCUR 1ANAGE 10 RENTED E 100,000 - PRI MISFS(Ea aceur �;e�, 82204065 1/112018 1/1/2019 Mi 7r'XP;Any CIM oorxar,; 10,000 Pl RSONA:.a AoV INJURY 3 1,000,000 G; N, A(:Gfif GA,t IMIT APPLIES PER CFNf RAI AGGRFC,AT ,$ 3,000,000 PR{y. 111401A,CTS"COMPIOP AG(i 5 3,000,000X ,000,000X �O,IGy II 1.O% j OTHER a AUTOMOBILE LIABILITY CO aaaAder6J T MIT- 6 1,000,000 - + A MY AJ 70 HODII Y INAJRY(Per pwsv: $ Al I-t)ARJE Ii X SCHEDUFF; AU`OS AUTOS A9:00328 11112018 1/1/2019 40'x.`';NJ4F2Y,vt X NON•OV"/NK) OMS N.:Rt:i)AUTOS $ AUTOS �RiJtl AA(3P. a cvr-su+ao+no�rmi U=a :a E 100,000 X UMBRELLA LIAR X ACr EXCESS UAS 3Cr URRENC5 S 1,000,000 AGGR�,SA7E S 1,000,OGO f A C:.nt+xJs trLaoE OFi) X; RI-TENTION$ 10 000 52204065 1/112018 1/1/2019 S WORKERS COMPENSATION AND EMPLOYERS'LIABILITY TH YIN X SrAI;1TL X FR .ANY PROS-RF'0RIPARTNFR/F y U?-w,. t.ti"H ACCtllEh'. 4 500,000 B �FF!CGRMAEMBfR eXCLJQ�. y !NIA i - (Mandatory in NM) WC9024456 2 123,124':8 2/2312019 LEASE E'A EMPcOYLf, J 500,000 I!yesaesc-;be crow U RIP I,ONOF QFtRA IIQNSb8,ow L ;'sISEASE-POLICY!IMi7 .i 500 000 i DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(ACORD 101,Additionat Remarks Schedule,may be mac"d ff more space is required) The Workers Compensation policy does not include coverage for Paul Schmidt, Kendrick Dempsey and Douglas Schmidt. I CLEAResult, Eversource and National Grid, NSTAR, Boston Gas Co. , Colonial Gas Co. , Essex Gas Co. , and iWestern NA Eelectric are named as Additional Insured per written contract with respects to General Liability for work performed and per the terms and conditions of the policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CLEAResult THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Contractor Services' ACCORDANCE WITH THE POLICY PROVISIONS. j 50 Washington Street, Ste 300 1 Westborough, MA 01581 AUTHORIZED REPRESENTATIVE ' ) ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(nY41 ) The Conrmruntrxealth r�f'.Vfassachttsetts Department of'Industrial Accidents Office of ins=estigutions � - 600 Washington Street Boston. VA 02111 wwwv.mass.gov1dia Workem' Compensation insurance Affidavit: Builders/( o)ntractors/Electricians/Plumbers Alliglicant Information Please Print LSWbly ' ane al t>sinr••t 4eant;atioll lrtdiXidualr: SDL Home Improvement Contractors Inc Address: 24 Chestnut Street _t"itl " tate dip. Hatfield, MA 01038 1'ilcitt� - ; 413-247 5739 _ -__..___ Are you an employer?Check the appropriate Mix: Type of project(required} 4_ 71 1 ,int general Contractor and 1 !.[ 1 ani it entpkrgrr with $ ti. A;cu ctmstructiOtl entplo%ceN(/till an6or part-ttme).� itavc"hiredthe,uh cc�ntr��cttrrs '. I ant a sole proprietor or partner-1#tcsx stth cc�ntr��ctc�r;hatit 8. (-1 Dernolition ein let.ees and hai e t4 C+rker4 working for me in any capacitN�. p �). � Budding addition i 10 workers comp. insurance Ct rttp srtsttr.nt c_ scyttsrctL( 5 4 ti�'c tate,t txtrloralitm and it,, 10.E f Electrical repairs oradditions ? [� 1 <ain it honte(trener doing;all work t&icer have ev:rciaed thcru" 11 Plumbing repairs or additions � right „f r 1161 e\ernption per� tttesei,1. ('�a tvnrkers� rump. ls,❑ Roofrepairs tnsura'rce required.] ' c P� 10),and vee hatiw no empltl+,ees_I\i)worker% 13.[8()#her Insulation 't7rt1l�. trtstJrarl4't reytttred.� \v\ :spphk:4m than dvt .K!,k",=_! Must uts,I tilt Out the sttcttMr t,00V. its,Data dxac w,,t'ker, owpcosumm polto mit 4nratwn i<nrteet+tk rR s41ar suhim%this atiidavit ntdiratiny they atc d6+:nr aril wwlt and then tatty ot,tsul, ontracior,"last+uhnkil a tic"uthdavn nrdt:attnv ueh E ootttr„ctotrs th:u chs:.k tht+N?.-"lust atadwd are additional select au,µttsr tate nanx;At the o,h-c,,illraLaur.and stateµheethcr or ns,t ttwse entitic,ha-,c rmpimce� It i1w uh-",ntravtor,iravc cmpio%ec<,true}roust provide thor „,,rkrrs pomp p,l,c, nuirrher I um an employer that Is provkling wwrkerc'"Ampen.sorion insurance,for MP'emp gees. Brfow is tilte pv/ia-rrndjod site information. Insurance C ornpan} 'Same: Selective Insurance Co Policti :.or Self ins. Lic. " WC902-4''-�4--'56I)ate 02/2312019 ' l:kpiratiort � 2:�f "�"�' Eity Stats,zi J y� Job Site. Address _. .__,.�_.___�..._.�._._. . S ' ` l' 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 255 of NA61,c 15”can lead to the imposition of criminal penalties of a fine up it,Is 1,500,00 and-or one-year imprisonment.as.,see it as 6%11 penalties in the Foran of STOP WORK ORDFR and a uric oto up to S2.;0.(X)a 1'1y against the violator_ Be adv ised that is copti t+F this statement colt)°he tiro-arded to the Office of Investigations of the DIA Jbi-insurance cortege verificat ion I do hereby cert' ndrr t pains acrd penalties(if perjury that the information provided abot,y is acre and correct. ' inaiiire: _._ Date. ( l C)fJicial use ontt,. Do not write in this area,to he completed hr c•ip-or town official. City or`town: Permit/License# Issuing Authority(circle orae): 1. Board of Health 2. Building Department 3.City/Town Clerk 4, Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: � r Permit Authorization mass save Form Site ID: 3449148 Customer: ANNA TAYLOR f� i, � , owner of the property located at: (Owner's Name,printed) 132 W Farms Rd Northampton, MA 01062 (Property Street Address) (city) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a buliding permit to perform insulation and/or weatherization work on my property. Owner's Signature: Date: C, FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Name: CLEAResuit Phone: 800-480-7472 Email: Far Office Use only Rev.102015 City of Northampton Massachusetts DEPARTMENT 04' 80-ILDXNG' T.VSP-VC'r10,VS 212 MA,,,n ..".1 nq ILA I A 0 Home Improvement (.ontractor l.avk Suppletrient it) Permit Xpplication tiv Off k"'o of Consunicr Affairs and i*;,"%�� vBR %c)41,1wes the reg �)stratton ol contracr,,,>ran j j(qjs(lieu! MIC k I i 0141 fanl I 0hoines, fln Or pe!'fz,)1711111t.; W(TP on such hornes, a con I , I I M ien t Contr Ctor [-I I( o"I &, ; J i,�1 r e improven a . M.G.1- Chapter 142A requires that the !enov,,wion, repair, modernization, convef'Nlor) improvement, removal, demolition, or construction.ofar, addition is ary pre-existing owner-occupied building containing at h..,-,,qst one but not more then four dwelling una � , ,tri c!,,.i iwt-, a adjacent to such residence or building" he done bY rep-istered contractors. Xote:"the homeowner has contracted with u corporation sir fl-( that entity muv/be repvtered. k IS! 000 1);ate ,,,)! flaiiiii Apphcatitn. ' 'hereb,, certifv that, R--nstratiori is not rLquired for the Work excluded hy law f explaii-i Job tinder'i1.000100 Owner obtaining own pern-I'll 1 exll)1,tilt, Other(specify-): OWNERS OBTA1NI,*S'G T HEIR OWN, PERM 11 (,o,N,rRA(.-i'oR,s OR SUB(ONTRAk,"FORS FOR APPIJ( ABLE HOME IMPROV EINIENTWORK ARE OI ELIGIBLE FOR AND DO NOT HAVE AC(11 ESS"TO FHE ARBITRATION PROGRAM OR GU'ARA-*N7TY FLAND UNDER M.G,L.Chapter 142A.SUCH OWNERS ALSOAssumt,',-rHF RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT. SFY NEXT PA(,-iF FOR MORE INFORMATION. Slaned undef the penalties of'pequiN 'ai"q)i'v 4or buil dill" 1. as tilt', ,I e ri o,0 roc, V it D, Contractor NITT,t' K, -T7w—.HIS'Revistration N OR: peraw �i� tic owner-A'the above propert.�,- " otwvhstantfiiig the above notice. I herebyaPpP, Im C)kn, i? i, City of Northampton Massachusetts DEPARTWIVT ")F 3V7LDIN6 ZNSPECTIONS 21.2 Ma yam—;-i oa] 13,"-11'j 1 nq Debris Disposal Affidavit accordance of the provisions of MGL (; 401 S54 acKnowledge that as a condition of the building --rmit 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 ("1 111 S 150A, hdebris from construction work beinq perforr-neo .............*- ---- - - (Pleasp ,7)nnt Douse ni-irriber and street name; is to be dispose}d of at Please t7rint name---e—nd-l'o—ca-tio-r"i, 6i"fa,ci'litky, Or will be disposed of in a dumpster onsite: rentew =")f 'ease(,, from, _C '----"'�--&m-"'pan-y N—am-e-a—ndAddre-' Andress; ignatur> of e It pelican or towner Date p- if, for any reason, the debris will not be disposed of, as =ndwated, the Applicant or Owner shall notify the, ' Building Department as to the location where the debris w I j be d!soosed SECTION$-CONSTRUCTION SERVICES .............. 8.1 Licensed Construction Su icor: 1 Not Applicable Name of Ligense Holder. Number, Ira P, d .......... 9. Not Applicable 0 ............... ............... Rn Comoanv Name egistratiorrbe Expation ate/Z77L .... ......... ....................... ........... ir M�4 Olb-��e .................... ........... SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G,L.c, 152,§25C(6)) ................... Gompensaton Insurance affidavit fnust s;J1bI-r,!tted mtr tnis appficabor Faikj!e to provide this affidewir,will res„l� -ial It he�den, he issuance ofihe D a it, V19 parr ?tit Affidav0l Attached Yes. N c ............ .................. .............. SECTION S•DE CRIPTi N OF P OSED WORM icheckall aDolic } Now Nouse Addition Replacement Windows Alterations} � � Roofing _..__ Or Doors Accessory BldgDemolition New Signs (decks =J Siding[p, -,"-"Othe►,;Cg r;. . 3'—f Desc'npto. �f Proposes C A ,r v _C 1 i m ,.. .,s Narrative , , y r e- yes f No cJr rY,existing txedr;�,�,°� �� � ?��, A pip .�?,-�. <-, :U # e:',e f t,.a viel < '" ?i 1✓' Ne a,�,js Attached Rol; - ;meet New hlo r" )f bu:Adinn One amily 4.e,ea+Aerate attacner �' CIS 5e Srloar'fc;otage of new CC.'nStruC;tiL7rr mber of st ries'% Method<)F 'Ov:Chf,7sT;..vc-F-; Number of react),,,.._...._......._ (',amphanc l4 aS,".£ .;u S ''car .,.,r„ lar. fc"rr 1$dG lf'Ct ,,�.,._...,..., .,........�.....__._,..__....., Type of constructho , 5tr Ca.J `�Ji her, '00 ft, of wets fs? �,..< _...._ � rv.T, ( y 1t,, a _"Y ._ rpf :nF baS2!n£?r?t C r cellar flo below fi=nished oranr, b id!r p --orfom%,tti;th uildiny and lonmig reclirk `Or's 'res _. _No Sewer SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of me suriecf operty ,x er.;a ,F ac", .Jt =.V C38:,21f, in all matters relative to work aut orizeC' mi .s bu iidin j oer nll arJnllcat.Cn. '. Signature of Owner tN as OwneriAuthon ee Agent hereby declare that the statements and information ,; me r)regi nq a olv,atior° -ire true and accurate to the best of my xnowledge <cr unser the pa=r's and penalties of perjury. , ., ._. N, _....._....__ „g of e of/:awn.r nd + Section) 4. ZONING Aa information Must ae wompieted. permit Can Bp denied Due To Incomplete Information Existing W... w Prapc>s Required by Zoning This colunui to leo filled in by Building Department j -it Lot Size Front � f Setbacks Front , I 1 I s Sider S l W f 3 Re—ar } Building Height I i Bldg.Square Footage t Open Space Footage i (Lot area minus brag paved � f of Parking Spates # .-- .._ ...,-•...,... .__..... _ _-r_._.._-------------- till. rI I A. Has a Special Permit/Variance/Finding ver been issued for/on the site? NO C) DON7 KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW � YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water,or wetlands? No DON7 KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained t-11\ Obtained � Date Issued: C. Do any suns exist on the property? YESar IF YES, describe size, type and location. D. Are there any proposed changes to or additions of suns intended for the property? YES NO '' IF YES, describe size, type and location: Will the construction activity disturb(a �nng. grading.ex tion,ran fining)Quer 1 acre car is it part of a common plan that ivill disturb over 1 acre? YES g!i , NO IF YES,then a Northampton Storm Weer Management'Permit from the DPW is required RECEfv City of Northampton Building Dep met 212 Iain S reet NOV _ r; 20 Vroom 1 Northampton IV t > 1 OF BUILDING INSP phone 413-X87-124fl x 4,3 fiHOJ,0 _0t MA .. ..._.. ._. ....... ........._.._..__.'-----........._.__........__-...,,......:....-_,.,_,_........ ......_._..._.,.,, .....,,._..,,_,.__,_. ...., ,�C � ��� '>�✓ /h, 111 APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION ' q �� ..._......._.... _.._...... P ro This"ction to be� o Y office r Address —� map � Lot of 0 Unit f Elrr St.District ....__..._...._._..._ _... ce Diwict SECTION 2-PRCPERTY OWNERSHIPJAUTHORIZED AGENT ..._.._......_._.._.__ ___._._-_._.._....__._.__........__.._.___ __..___ 2.'l Owner of Record, "vlc>2 ter- r>ent Mailing ari<lress :'i.�tUre 2.2 thori ed AS+iLt Le- va ne "P elepnone ' f t til rJ tdressi< z�" �tufe SECTION 3-ESTIMAT 7 CONSTRUCTION COSTS j Estimated Cost(Doliars .% of Official Use Only cam Ieteo by permit applLcant >3�..iltY:ng U ;a?Building Permit Fee lectr3ccai b estimated Total Cost of _._..__..._. Building Permit from(S} mb� , ee ... _....._ .... . ._.._______ ' _._._ g bac ra,zca1 FyVA(; c Protectior, till * 1 3 4 + o. _ liheCx NllmI3Ll This Section For Of ficial Use Only Bukiirng Permit Number Date _.______..._...__......_ Issued Signature. Building COMMISSioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED EITHER HOMEOWNER OR CONTRACTOR) 132 WEST FARMS RD BP-2019-0559 GIS#: COMMONWEALTH OF MASSACHUSETTS Man:Block: 35 -018 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit# BP-2019-0559 Project# JS-2019-007910 Est. Cost: $4000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PAUL SCHMIDT 103635 Lot Size(sq-ft.): 23348.16 Owner: TAYLQR ANNA L Zoning: Applicant: PAUL SCHMIDT AT. 132 WEST FARMS RD Applicant Address: Phone: Insurance: 24 CHESTNUT ST (413) 247-5739 WC HATFIELDMA01038 ISSUED ON.111712018 0:00:00 .TO PERFORM THE FOLLOWING WORK 600 SQ FT, 6" LAYER, R-23 ADDED TO ATTIC FLOOR OPEN BLOW CELLULOSE 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: Firepeagrtrgent Fireplace/Chimney: Rough: 241 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: FeeTgpe: Date Paid: Amount: Building 11/7/2018 0:00:00 $65.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner