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42-011 959 WESTHAMPTON RD BP-2019-0772 GIs#: COMMONWEALTH OF MASSACHUSETTS MV.-Block:42-011 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category: ROOFING/REPLACE WINDOWS BUILDING PERMIT Permit# BP-2019-0772 Project# JS-2019-001272 Est.Cost: $11720.00 Fee: $78.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JOSEPH KENNEDY 055440 Lot Size(sq.ft.): 32016.60 Owner: BRONNER DAWN&J CEMBURA JR MAIL TO:JOSEPH J CEMBURA JR Zoning: Applicant: JOSEPH KENNEDY AT. 959 WESTHAMPTON RD Applicant Address: Phone: Insurance: 38 HARKNESS AVE (413) 525-1735 O Workers Compensation EAST LONGMEADOWMA01028 ISSUED ON:1/7/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE SECTION OF ROOFING, PORCH REPAIR, WINDOWS 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: FeeTyne: Date Paid: Amount: Building 1/7/2019 0:00:00 $78.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2019-0772 APPLICANT/CONTACT PERSON JOSEPH KENNEDY ADDRESS/PHONE 38 HARKNESS AVE EAST LONGMEADOW (413)525-1735 Q PROPERTY LOCATION 959 WESTHAMPTON RD MAP 42 PARCEL 011 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building,Permit Filled out Fee Paid Typeof Construction: REPLACE SECTION OF ROOFING, PORCH REPAIR WINDOWS New Construction Non Structural interior renovations Addition to Existing, Accessory Structure Building,Plans Included: Owner/Statement or License 055440 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 Demolition Delay //�7 1-jr7_ )q Signature of Building Official 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. Department use only City of Northampton Status of Permit: Building Department Curb CutlDriveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413- n APPLICATION TO CONSTRUCT,ALTER, REPAIR RENOVATE OR DEMOLISH A NE R TWO FAMILY DWELLING JAN 4 2U18 SECTION 1 -SITE INFORMATION r 1.1 Property Address: DEPT.OF BUILDING It n t be completed by office + t ) I l - NORTHAMPTON. 01060 �—1 W��'T I alb {�-I 0CA T O Map Lot Unit 1� I Zone Overlay District d I--evlrk ( "`c, d 062 Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: f n � ' ,, <�)l 0 t'ew"o �k Ct Name(Prim Current Mailing Address: ZCL Telephone Signat e 2.2 AuthorizedAnent: d S Nam (Print) Current Mailing Address: C� ( o 7-73 r� Si ature V Telephone SECTION 3.ESTIM D CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building D (a)Building Permit Fee 2. Electrical 6 r , p (b)Estimated Total Cost of Construction from 6 3. Plumbing \ r Building Permit Fee /l 4. Mechanical HVAC v 5.Fire Protection ) 6. Total=0 +2+3+4+5) Check Number 0 This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) 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 Depanment Lot Size ,R _ Frontage Setbacks Front Side ;[: R: L: R: a Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW Of YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW YES Q IF YES: enter Book Page, and/or Document # B. Does the site contain a brook, body of water or wetlands? NO © DONT KNOW '(�— YES O 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 O NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES © NO W 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 © NO P- IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding[p] Other[a Brief Description Proped Work: I Alteration of existing bedroom Yes No Adding new bedroom Yes -,e- N o Attached Narrative Renovating unfinished basement Yes _�No Plans Attached Roll -Sheet 6a.1f New house and or addition to existing housing, complete the following: 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 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, J d J C� U as Owner of the subject property I hereby authorize -S-0 s to act on my behalf,in all matters re tive to work authorized K this building permit application. - q- 19 ­ A 6UA C-0, J r Signatu o wner V Date —70 I, 0 �t' r� u Lt�q(-� , as Owner/Authorized Agent hereby d clareOth, ts and inforrnfition on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed undo the p ink and pe alties of perjury. fN Print Name Signature of O r/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable (❑//, Name of License Holder License Number LLW i X,,-p L-4 5-1LV? l,4<f1" 0 (od `7_ Addre Expiration Date Sign re Telephone 9. Realstered Home Improvement Contractor: Not Applicable ❑ G U( S' C0 Cit S- r-V-C4() L4, Comaanv Name I Registration Number L Address ' Expiration Date Oo a 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 r 7 sic Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 4. 212 Main Street • Municipal Building Northampton, MA 01060 ssyJyi�° 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.G.L. Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing 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: N_P_ W �C� O LUa ,t �,Ou Est. Cost: L 0 Address of Work: G 5-9 �' (°�� Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): `Job under$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: I hereby apply for a building permit as the agent of the owner: r -Z-npP 1 _ ft) Date �� Contractor,Name � 1 \Q� HIC Registration No. Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton Massachusetts Vl; DEPARTMENT OF BUILDING INSPECTIONS �'• '�° 212 Main Street • Municipal Building Northampton, MA 01060 rs ,_- iso Massachusetts Residential Building Code Section 110.R5.1.2 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.R5.1.3.1 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 person(s) 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. The Commonwealth of Massachusetts Department of Industrial Accidents > 1 Congress Street,Suite 100 d Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant InformationPlease Print Le ibl Name (Business/Organization/Individual): C t S CCU LIS ,-o Address: 4�—&45-r G ��u "a eJ City/State/Zip: VV O l ) D_-g' Phone#: S 5'-'— '�7' Are you an employer?Check the appropriate box: Type of project(required): 1la-I am a employer with _employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.[J I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Q Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I LE]Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. oof repairs These sub-contractors have employees and have workers'comp.insurance.t p 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. � \\ •� �^ — Insurance Company Name: 32f �wL Policy#or Self-ins.Lic.#: WC 000d-��Z Expiration Date: �j 0 Job Site Address: l `P t'` City/State/Zip: Tlo�-tkg 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. 152, §25A is a criminal violation punishable by 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 the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce tify un er the p s n perjury that the information provided above is true and correct. Signature: c Date: Phone#: Oficial 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#: City of Northampton j/JJ/J///� - ' '• Massachusetts 1 y hi .G DEPARTMENT OF BUILDING INSPECTIONS ` 212 blain Street a Municipal Building Northampton, MA 01060 sstryY•.• j��a 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 from construction work being performed at: 9(5-q4LO-Q��� I?d (Please print house number and stree name) Is to be disposed of at: S W a A-P (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: U �- �' Uj q d--e �- �U (Company Name and Address) r-�2 9::S) Si ature 8f Per Applican r 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. ,acoRo® CERTIFICATE OF LIABILITY INSURANCE DATE( 06/2288//22018018 Y) THIbiCERTIPI ATE 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 have ADDITIONAL INSURED provisions or 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 endorsement(s). PRODUCER -CONTACT Marion Lentes NAME: Berkshire Insurance Group,Inc. PHiCONN 4 -1200 -5300( )Ext FAX, 138 Longmeadow St. ADORIEss: mlentes@berkshireinsurancegroup.com INSURER(S)AFFORDING COVERAGE NAIC# Longmeadow MA 01106 INSURERA: Star Insurance Company 18023 INSURED INSURER B: Charista Construction Services,Inc. INSURER C: 38 Harkness Avenue INSURER D: INSURER E: East Longmeadow MA 01028 INSURER F: COVERAGES CERTIFICATE NUMBER: CL1862854112 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL POLICY EFF LTR TYPE OF INSURANCE IND WVp POLICYNUMBER MM/DD/YVYY MMIDDl11YY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE RENTED CLAIMS-MADE 1-1 OCCUR PREMISES Ea occurrence $ MED EXP(Any oneperson) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Es accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ LIEXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? NIA WC0002537 06/08/2018 06/08/2019 (Mandatory in NH) E.L.DISEASE.EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Charista Construction Services,Inc. ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 1 IY DATE(MMIDDYYY) Acoizo CERTIFICATE OF LIABILITY INSURANCE 05/31/2018 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(ies)must have ADDITIONAL INSURED provisions or 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 endorsement(s). PRODUCER CONTAT Joseph Leahy,Jr. NAME: Leahy&Brown Insurance+Realty,Inc. PHONE (413)xt (413)788-8393 FAX No): (413)788-6492 535 Allen Street,Suite 1 ADDRESS: ileahy@leahyandbrown.com INSURER(S)AFFORDING COVERAGE NAIL# Springfield MA 01118-2009INSURER A: ATLANTIC CASUALTY 21792 INSURED INSURERS: ARBELLA PROTECTION Charista Construction Services INSURER C: 38 Harkness Avenue INSURER D INSURER E: East Longmeadow MA 01028 INSURER F: COVERAGES CERTIFICATE NUMBER: Master Certificate(2018) REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY 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 TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDIL SUORI POLICY EFF —POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDNYYY MM/DOIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE RENTED N CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ 50,000 MED EXP(Any one person) $ 10,000 A AC12294869PC 04/01/2018 04/01/2019 PERSONAL BADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE s 2,000,000 JECT LOC 2,000,000POLICY ❑PRD PRODUCTS-COMPIOPAGG $ OTHER: S AUTOMOBILE UABILJTY COMBINED SINGLE LIMIT $ a accident ANY AUTO BODILY INJURY(Per person) s 250,000 B OWNED XSCHEDULED 1020072227 05/03/2018 05/03/2019 BODILY INJURY(Per accident) $ 500,000 AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ 100,000 AUTOS ONLY AUTOS ONLY Per accident s UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION I PER OTH- AND EMPLOYERS'LIABILITY YIN SER UTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN VERA MONTENEZ ACCORDANCE WITH THE POLICY PROVISIONS. 15 MANSFIELD STREET AUTHORIZED REPRESENTATIVE SPRINGFIELD MA 01108 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constnjlott6ii'§dporvisor CS-055440 Upires: 07/22/2020 JOSEPH A KENNE 41 1S FOREST S`G PO BOX 1356 BONDSVILLE Mk'01009. / OLSN'iid0 Commissioner �/"'" Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: Corporation 1982 CHARISTA CONSTRUCTION SERVICES,INC. Registration: PO BOX 706/38 HARKNESS AVE Expiration: 055/09/2/09/2 020 E.LONGMEADOW,MA 01028 Update Address and Return Card. SCA 1 c: 20M-05/17_ c'4"farrtmnntug{ !�o�r>���_- Office of Consumer ./irs&Business egu/tion HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: R2gistration Expiration Office of Consumer Affairs and Business Regulation 171982 05/09/2020 One Ashburton Place-Suite 1301 CHARISTA CONSTRUCTION SERVICES,INC. ston,M 02108 JOSEPH KENNEDY � � PO BOX 706/38 HARKNESS AVE E.LONGMEADOW,MA 01028 Undersecretary Ot WIthO gnat