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22B-069 (3) 83 SPRING ST BP-2019-0924 GIS 4: COMMONWEALTH OF MASSACHUSETTS Map.Block:22B-069 CITY OF NORTHAMPTON Lot: .001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category:renovation BUILDING PERMIT Permit# BP-2019-0924 Project JS-2019-000536 Est.cost: $18000.00 Fee:$331,5 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JARROD GOSS 112968 Lot Size(so.ft.): 8015.04 Owner: HANOUSH BUYS HOUSES LLC Zoning: URA(100)/WSP(100)/WP(t0o)/Applicant: JARROD GOSS AT. 83 SPRING ST Applicant Address: Phone: Insurance: 12 GLENWOOD DR WESTFIELDMA01085 ISSUED ON:3/5/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.ROOFINGANDSIDING 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 4 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 signal FeeTvpe: Date Paid: Amount: Building 3/5/2019 0:00:00 $331.50 212 Main Street,Phone(413)587-1240,Fax: (413)587-1292 Louis Hasbrouck-Building Commissioner File# BP-2019-0924 APPLICANT/CONTACT PERSON JARROD GOSS ADDRESS/PHONE 12 GLENWOOD DR WESTFIELD PROPERTY LOCATION 83 SPRING ST MAP 22B PARCEL 069 001 ZONE URA(100)/WSP(100VWP(I00V THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid TvoeofConstructiom ROOFING AND SIDING New Construction No. Structural interior renovations Addition to Existing. Accessory Structure Building Plans Included: Owner/Statement or License 112968 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON I MRMATION PRESENTED: V 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 Si ureof 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. File 0 BP-2019-0924 APPLICANT/CONTACT PERSON JARROD GOSS ADDRESS/PHONE 12 GLENWOOD DR WESTFIELD PROPERTY LOCATION 83 SPRING ST MAP 22B PARCEL 069001 ZONE URA(100)/WSP(100)/WP(100)/ THIS SECTION FOR OEFICIAL USE ONLY: PERMIT APP ATION NECKLIST SED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Tof Construction: NEWROOF SID1N F G RENO2 LL AND 2 14ALI BATHS O KITCHEN-NO STRUCTURAL CHANGES-FIXTURE SWAP New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Ownerl Statement or License 112968 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 a 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 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. FI-1 — - City of Northam on --- Pe Department use only Building DepartrIent CurbC yPermit ,J -- 212 Main Stre t FEB 2 6 d poo wilapilitt. Room 100 Water A ilabift Northampton, MA of Plans phone 413-587-124 ax 13-68T/sr '' i $Ia APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office tg.g$ s�•� �t Map apl/ 'a e> Lot Unit Zone Owrlay District Elm St.District Ce District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Denied of Record: 1 (' /V�gAWallw G DNI Lq pc.rKw.k S� MIS c) Name(Pho}t- Current Mailing Address // //fes (yn\ tis-aro>� Telephone &gnature 2 2 Authorized Agent Name(Pant) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permitapplicant 1. Building (/1 pod (a) Building Permit Fee 2. Electrical oeo (b)Estimated Total Cost of Construction from fi 3. Plumbing S ppr) Building Permit Fee 3 31 SD 4. Mechanical(HVAC) �A1 5. Fire Protection V & Total=(1 +2t 3+4+5) (7 Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissionedirispector of Buildings Date m rbi en I i @ '5Mad, cervi. 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 in be fi11M in by d L Building Dcpamnent Lot Size Frontage ..._._.. Setbacks Front Side L R:_. L... R:..... .. Rear -- - Building Height Bldg.Square Footage % -- Open Space Footage % ... — (Lot arca minus bldg&paved arkin _......... _. aofParking Spaces -- (volume&Lorzdonl A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW � YES O IF YES, date issued:.. IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT,KNOW„ a/ YES O IF YES: enter Book Page and/or Document k B. Does the site contain a brook, body of water or wetlands? NO `-Y DONT 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 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 IF YES, describe size, type and location: E. Wil 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 F IF YES,then a Northampton Shona Water Management Pewit from the DPW is required. SECTION 5.DESCRIPTION OF PROPOSED WORK(check all applicable) � 6vae New House ❑ Addition ❑ Replacement Windows Alterations) Roofing Or Doo s Accessory Bldg. ❑ Demolition ❑ New Signs ID Decks [ Siding[ ) Other[a rt7 BriefDescript of Proposed (('� Work, Alteration of existing bedroom_Yes_�No Adding new bedroom Yes No Attached Narrative Renovafing unfinished basement _Yes No Plans Attached Roll -Sheet Be.If New house and or addition to existing houi complete the folloill a. Use of building '. OneFarmli 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? R Type of construction Is construction within 100 ft.of wetlands?_Yes No. Is construction within 100 yr. floodplain_Yes_No I. 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 To-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, �LlAA/ (S/�L/i i/i• , as Owner of the subject property hereby authorize J C�O55 ! ga C?Y✓c�( ( �fr�pyesS V) to act on beh in all matters relative to work authorized by this building er application. Z $ at a of owner Date I, Ac' t as Owner/Authorized Agdot hereby declare at the statements and information on the foregoing application are true and accurate,to the best of my knowledge d belief. Signed under the pains and penalties of perjury. Print ok1ature of OwnerlAgent Cate SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder .I DLi 6,0 SS CS^ I t ag(rk License Number la GIrrV.�niy1 we (./Inj�1' tirl Y�nu nt` SS ii / ]9 Address// Expirationon Date Dale L.1/ i VIA Oar- 80a1 Si ture Telephone 9.Reaistered Home Imoroyement Contractor: Not Applicable ❑ T "5S (OnS 'r "A on _i793o1 Company Name Registration Number la �.,Irn,..u:l Dc'Qf Wrix$4.4 o'C' I/ I) / )Ofq Address Expiration Date Telephone Lit 4J4 icDi SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(e)) 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 Massachusetts s DEPARTMENT OF BUILDING INSPECTIONS 2 212 Nein street a Municipal Building Northavgton, as 01060 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 redstered contractors. Note:!f the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work:-" I tip_Est. Cost: I,Dnd Address of Work: Date of Permit Application: L /9 I hereby certify that: Registration is not required for the following reasord 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: Tc�as ao q 'j,rro3 �a c'i-� 119303ao q 'j,rro3 �ac,� 119303 Date Contractor Name H C Registration No. OR: 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 �- p c DEPART NT OF BUILDING INSPECTIONS 2 :; 212 Mean C[ a Myn 010 Building'M NorMl3mpton, IA 01060 Massachusetts Residential Building Code Section I IO.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 I I O.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 s - Massachusetts ` f DEPARTMENT OF BUILDING INBPZCTIONa 7 z 212 Main 6teeet &Municipal Building C` Northampton, M 01060 J 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: �13 -SS5' �Y.v (Please print house number and st -tname) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: A55Dc,n4ec') �� ) �rv, �CecVets (Company Name and ddress) Feb d5 aco Sin re of PermitApplicant or Owner Date Sid 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. ,yam The Commonwealth of Massachusetts UW Department of lndusirial Accidents I Congress Street,Suite 700 Boston,MA 02114-1077 lowminess.gov/dia Rockers'Compensation Insurance Affidavit'Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Filings Print Legibly Name(Business/OrganM —�—rzaroadivideah: , ta,.ri 64AAr,� .ev Address: )d (yl Pst..r�.\ Dc, City/State/Zip: WcsaS,el� Nis oicsS Phone#: 413 42( goat, Are you an employer?Check the appropriate baa: Type of project(required): 141 am a employer with—�cmployecs an[]and/or Pam—m)r 7. ❑New constmetion 2 I am a sole proprietor or partnership and have no employees working for me in ❑ R. roJ Remodeling my cupeciry [No workers comp_insurance aquvedd 6 3,�l am a homeowner doing all work myself(No workers comp Insurance required] 9. Demolition 4.❑1 am a homeowner sad will be Ruing contractors to conduct all work on my properly. 1 will 10❑ Building addition ensure that all contractors rima have workers'compensation insumme or are sole Il.❑Electrical repairs or additions Mormons s with as employees. 12.E]Plumbing repairs or additions 5 1 on,a general contractor and I have hired me sub-contractors listed on the mtuched sheer 13.,�/(Roof repairs Mesa sub-con[racton have empluree and have workers'comp.insmm�re; QSI P 1 other 4 IIM 6.❑\Nearea),=it wehon and eoncruicershsvNoworsedthomp,i munity prion per MGL c. T- 152,q 1(4),=it we have no employee.[No workers'coiup insurance requacd.] •Any applicsut that checks Mx p1..at also hill out me section below showing thea workers'compansatum policy mmusation. 'lhomeowners who submit this affidavit indicating they are doing all work and men him outside contractors most submit a new affidavit indicating smth. :Cameros,that check this has anal amched an additional sheet showing me name of me subcontractors and sate whether or not those entities have employees. If the sub-contractors have employees,they most provide thea workers comppolicy number. I am an employer that is providing workers'compensadon insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage w required under MGL a 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 certify under the pains and penalties ofperjury that the informadon provided above is nue and correct Signature' Dat Phone#: Official use only. Do not write in this area,to be completed by city or town officiaa 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, §25Q7)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 subcontractors)mame(s),address(es)and phone number(s)along with their certificate(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 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 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 of Investigations has to contact you regarding the applicant. Please be sure to fill in the permitAicense number which will be used as a reference number. In addition,an applicant that must submit multiple permitilicense 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 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 Department's address,telephone and has number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 02-23-15 www.mass.gov/dia Worker's Compensation and Employer's Liability Policy t �/ NorGUARD Insurance Company- A Stock Co. rBerkshire Hathaway Policy Number 3AWC930372 ,1 ; of 3AWC929871 'G UARD COmpan es InsuranceRene NICCI No. [25644] Policy information Page '[1]Named Insured and Mailing Address Agency Jarrod Goss PEOPLE'S UNITED INSURANCE AGENCY, INC. DBA/TA Goss Construction One Monarch Place 12 Glenwood Dr 10th Floor Westfield, MA 01085-1919 Springfield, MA 01103 Agency Code: VFPOME12 Federal Employer's ID 45-3493308 Insured is Individual Additional Names of Insured (1,12) Goss Construction [2] Policy Period From September 16, 2018 to September 16, 2019 12:01 AM, standard time at the insureds mailing address. [31 Coverage A. Workers' Compensation Insurance - Part One of this policy applies to the Workers' Compensation Law of the following states: Massachusetts B. Employer's Liability Insurance - Part Two of this policy applies to work in each of the states listed in item [3]A. The limits of our liability under Part Two are: Bodily Injury by Accident - each accident $500,000 Bodily Injury by Disease -each employee $500,000 Bodily Injury by Disease - policy limit $500,000 C. Other States Insurance - Part Three of this policy applies to all states, except any state listed in item [3]A. and the states of North Dakota, Ohio, Washington, and Wyoming. D. This policy includes these endorsements and schedules: See Extension of Information Page - Schedule of Forms [41 Premium The Premium Basis and, therefore, the premium will be determined by our Manual of Rules, classifications, Rates, and Rating Plans. All required information is subject to verification and change by audit. (Continued on another page) ( Total Estimated Policy Premium $ 11,454 I I Total Surcharges/Assessments $ 424.00 Total Estimated Cost t 11979.00 I Page - 1- Information Page , MGA :JAWC930372 WC 000001A D.W :09/14/2018 MANDTE Issuing Office:P.O. Box A-M, 16 S. River Street,Wilkes-Barre, PA 19703-0020 •www.guard.com CITY OF NOR'T'HAMPTON P' OFFICE OF THE TREASURER 212 Main Street, Room 305 Northampton, MA 01060 Telephone:(413)587-1296 Fax: (413)587-1289 Kristine A. Bissell Kristen J. Yezierski Treasurer Assistant Treasurer October 15,2018 Jericho Commercial Construction LLC 874 State St. Springfield,MA 01109 To whom it may concern, Your check, number 1291, in the amount of$390.00 payable to The City of Northampton,was not honored by your bank. Your check was returned due to non sufficient funds. The City of Northampton's Building Inspectors Office has been notified of your unpaid status. Any check that is returned by the bank to the City of Northampton as unpaid is subject to a fee of $25.00 per check You may make your payment of$415.00 by cash in Person or by cashier's check or money order, payable to the City of Northanwton at the following address: Treasurer City of Northampton 212 Main Street,Room 305 Northampton, MA 01060 Sincerely, Kristen erski E� O PY ;0-2018 cit PboplesBank \t 0C1 Notice Date: 1 Account Number: 1053731113 CITY OF NORTHAMPTON DEPOSITORY ACCOUNT Current Balance: 18, 996, 701 .E 212 MAIN ST STE 305 NORTHAMPTON MA 01060-3112 RETURNED CHECK CHARGE NOTICE The enclosed check(s) that were deposited to your Inst' l Interest Analysis account have been returned. Please deduct the amounts listed below from your account balance. If you have any questions concerning this notice, please call us at (413) 538-9500. 1 x061000146x NSF 10/10/2018 4901370368 "a 0 This is a LEGAL COPY of m .ols000wA• NSF yow Ned.You ran use it Os alrslnma thesamewayyouwoulE TO Tu nnw use the onghal Dred. p RETURN REASON - A NOT SUFFICIENT t` n ":.M weu. �"^�`°• "'••"°'u 'M' E1.111 rnmE1.11111 RM111 ,A FUNDS .•� M1 x.T iWtICIERi ,,,fff ,,IIee ^- —�ywErn•e n Q .• i a ynn� M1 n A N wo.nv ax.0 wAe ♦RRwmR too 1F91e 4E:2i 1a71601R: 64670009", 1000003900[11 `w? 4x: 21L67L601.4 698700095411' 1. 291 .''00000390000, 1_.1 aan w it—v nvcnun. Hnlvokn.Mn nIMO 413.538.9500 bankatoeoolesxom Cft of Louis Hasbrouck<Ihasbrouok@northamptonma.gov> 83-85 Spring Street 1 message Louts Hasbrouck<Ihasbrouck@northamptonma.gov> Sun,Sep 16,2018 at 2:21 PM To:Jenchogreg@gmag.com Cc. Daniel Wasiuk<dwasluk( nonan ptonma.gov> Greg, I've received are perk application for 83-85 Spring Street. As I said when we met at the house,the permit fee is doubled because work started without a permit.and there is a$50 fee to remove the stop work order.The peril fee,based on the estimated cost of work is$390.Doubled,plus the$50 fee;total$830.You paid$390; balance due,$440. The description of work does not include mold remediation.Based on the water damage to the building,you need to remove sheetrock and test for mold.As much sheetmck as necessary must be replaced to ensure remediation and safe indoor air quality.Certification that mold has been alfectively remedlated is required before the walls are closed up.Additionally,the building must be Inspected by the Northampton Health Inspector before the wags are closed. An electrician must certify that the building wing has not been damaged by water. The water leaks in the basement must be addressed,including waterproofing,sump pumps,ventilation and dehumidification. Please send a check for the balance of the permit fee($440),and also provide a detailed room by room list of the work to be performed. Louis Hasbrouck Building Commissioner City Of Northampton Town of Williamsburg (413)587-1240 office (413)587-1272 fax 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 employee 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 mora 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 compiiance 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 your insurance company's time,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 a partners,are nor 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 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 of Investigations has to contact you regarding the applicant. Please be sure to fill in the pemdo'licerrse number which will be used w 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 Corrvnonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street Boston, MAO2114-2017 Tel. #617-7274900 ext 7406 or 1-877-MASSAFE Fax#617-727-7749 www.mass.gov/dia Fmm Rcviud 02-2315 Information and Instructions Massaehusens General Laws chapter 152 requires all employees to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the smite 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,parnership,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 shaft 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 imauranee 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 subtontractor(s)name(s),address(m)and phone number(s)along with their certificate(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 tarty 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 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 of Investigations has to contact you regarding the applicant. Please be sure to fill in the permitAicense 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Depannicnt'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 The Commonwealth ofMassaehusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gowdia Vw.rkers*Compensation Insurance Affidavit:BuilderdContrector✓Electrician&Tiumben. TO BE FILED WITH THE PERMITTING AUTHORITY. ApplicamInforisnation Please Print 1 Name(Business/(kgwirationtindivivltW): Address: City/State/Zip: - V Phone#: —7 Are You an amplhyer'Chdk fere appmpriete loos: Type of project(required): I.Q lamaemployawiW cmploYem(fWl avNmpm-torsi' 7. ❑New construction 2 •sole PsoPietampumwshipad hawm®ploYas whakivg formew 8. f modeling a°y c+PcM.(No wohm'comp.ivswamc aquncd.] rL�l 3.F11 an a homcoweerdoing all wok mywl[[Nowohen'cnem,memvmerequited]r 9. Demolition 10❑Building addition 4.❑I�mahommwuer and wi enter liav conhacmomcovdi.as.h mye'.k (wall emwe mat dfcmhw;tasesha loam wovhm'compenaatim ivatuaaewere salt il.❑Electrical repairs or additions wYp°eiors with m employes. l2.❑P umbing repairs or additions 5�Iemegemal mhhacmr and l lwvc hive the mbcmuamn field on We snacked shat ]3.ORoof repairs Thew rah<nnextars here employ.end have wodsn'comp.IY9mBM .: 6.❑We meamaponnon axlas.f have cxacised their naht ofexcmplon pa MGL,. 14.[�Gthtt 152.$1(4),axi we haw no ml,W,ees.[No woken'cow.ioswame ayuive.] 'AYYappli rlchecka box al mustahh fill ow the safim below ebowing Weir moderns'compmwtloe policy ivfovmdon. 'Horn newhosubmit Wia affdays i se atheyad sheet aVwhdc ad Wrn hheoutside meuacmumensubmitlinew nlrt ieedeVeiegsuch. 'K'mheeNrs Wer chatthu boa smnaawhd air edivowl shat showag tis more oEthe subchvnacmn'and awe whither or not Waamaoea have employ.. Iftbe aubcoehamnhave cmpbYas.they amus Provide they waken'comp.Policy mmbc. Jose an employer that is providing workers'compensation insurance for my employees. Below is dse policy andjob sire infannabon. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Dare: Job Site Address: city/State/zip:- Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required order MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well m 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 me*under the pains and penalties of perjury then the information provided above is nue and correct Simulate Date, Phon # Of Nal nae only. Do not ry*e in this area,to be completed by city or town official City or Town: Permit/Liceene# 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 Maaeachuaatts 'Fc 1fPaR11TN4 08 BUILDING TNSPBOTIONS m z 212 Wilding NasNuQ<on, Ew 01060 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 property licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from ccooconstruction work being performed at: n�A ` ,' ,t (Please pont house humber nd street name) Is to be disposed of at: c S t ( ease print n me an i location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company �l Name and -Address) LA Signature of Permit Ap cant 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. City of Northampton Massachusetts i ISPARTIIDVT 08 BDZZDSH6 SNSPECSSOBS � 212 I n Zt t • Wn c p" Building n NnrfA ton, M 01060 Massachusetts Residential Building Code Section I I O R5.1.2 Homeowner: Person(s) who own a parcel of land on which helshe 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 faun structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Section 110.85.1.3.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR 110.85, 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. City of Northampton Massachusetts S. t6PARor HVrnarB 212 an a G • biei0 tmildnq artb� o , M 01OfiO . 1 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.Prim to perforating work on such homes,a contractor must be registered as a Horne Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction, alteration,renovation,repair,modernization, conversion, improvement, removal,demolition,or construction of an addNon to any prerexistihg owner-0ccupied building containing at least one but not more than lour dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homevi,mer has contracted with a corporados or LLC,that entlly man be registered Type of Work: lL (Aak, `� t,Est. ,C1ost: R(eb r�,I_ Address of Work: '9,0) �f W.r2 7G . ,V ONM/yl t AA. Date of Per Application: '7t/) 'r�ITi � I hereby certify that: Registration is not required for the following reason(s): _Wmk excluded by law(explain): _Job under$1,000.00 _Owner obtaining own permit(explain): _Building not owneroccupied _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 RESPONSIBH.ITES 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 buildingt t as the agent of the owner: Little Contractor Namd HIC Registration No. OR: Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature SECTION B-CONSTRUCTION SERVICES B.1 LI neednstru m rvl r: Not Appli �ca�ble 13 Name of License Holder. 0 aP4 13 Lkntsa Number T— Atldreb Expiration Date Signature Telephone ,.. _ ...., _, rn:. ,. Not APPficable ❑ <� rr; ono CaMrnn[z ia� �i9Ns�r �I;h U.E /77 y5a Company Name Registrabon Number �d s� 010 Address ilol90 Expiration Dae — Telephone SECTION 10-WORKERS'COSIPENSATION INSURANCE AFFIDAVIT(M.O.t_o.152.12 6)) Workers Compensa0on 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....... pr No...... ❑ SECTION i DESCRIPTION OF PROPOSED WORK(check ae macksbMl New House ❑ Addition ❑ Replacement WyrBows Albration(s) ❑ Roofing Or Doors L(! Accessory Bldg. ❑ Demolition ❑ New Signs [O) Decks [I-3 Sidingl Oth [I7f Brief Desc' tion f Proposed Work: Alteration of toasting bedroom_Yes_4L No Adding new bedroomYes No Attached Narrative Renovating unfinished basement — es No Plans Attached Roll -Sheet sajf Now hot," a. Use of building: One Family Tv/ia1 Family Other b. Numberofroomsin each familyurvt of Number of Bathrooms_ 2 c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stones? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Com lien s. Masscheck Energy Compliance form attached? h. Typeofconstruction j i. Is mn bucbon w thin 100 R 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 regutations? Yea No. 1. Septic Tank_ City Sevesr_I,-,' Private well_ City water Supply�� SECTION Ts-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, U as Owner of the sugecl Property hereby a orae L..I to act on beha0, in=1five fo work allthchized by this b ilding permit applicatio . Signal of Date I. as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name Signature of OvmerlAgent Date Section 4. ZONING All Information Mast Be templeted. Permit Can LidDue Ta Incomplete Wpmdnon Existing Propos Whuirild by Mfig Itis mhmombe filled mby 1 mr Lot Size FrontageSetbacks Front Front Side U: R:'= L:=R:_ Building Height `— Bldg. Square Footage — % Open Space Footage Open Space tilde ge #of Puking Spaces -- '--" Fill: volume a Loratiav A Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW er YES O IF YES, date issued:. IF YES: Was the permit recorded at the/Registry of Deeds? NO O DONT KNOW V 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 0 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 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 IF YES, describe size, type and location: E. Will th construction activay disturb(dealing,grading,excalilifion,or filling)over 1 acre or Is It part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Stan Water Management Permit from the DPW is required. City of No ann n 321 ala2L"NNiT Is nt n r i {l DEPT.of A 0 060 - ax 413587-1272 APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION 1.1 ProaentrAddnss: p.t [ This models to he compisisd by allies V•W` (U w ). Zone ONnslr EisrSLowla Daotwlat SECTION 2-PROPERTY OWNERSHIPIAUTHORQED AGENT 2,1 Owner of Record�:�S� Name(Pnn Cum Halling Address: Telephone U1 Signal 2.2 Authorized Acent Na a(Pn Cummt Mailing Addmss Signatu Telephone SECTION 3-ES71MAT ED CONSTRUCTION COSTS hem Estimated Cost(Dollars)to be Official Use Only completed vewmitapolicant 1. Building Lfqk (a)Building Permit Fee 2. Electricalt/ (b)Estimated Total Cwt of l, CoreWction from 8 3. Plumbing Building Pe 4. Mechanical(HVAC) �E F d °D 390 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number This Sectlon For Official Uee Only Date Building Permit Number. Issued: Signature: Bidding CommWianarllnapeo«of Buildings Date ,der icho�1".I� @ 5Yv0Li1 ca �� EMAIL ADDRESS(REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) c`��,�1// File#BP-2019-0329 n L _ /C f,� u NO�b' ' APPLICANT/CONTACT PERSON JERICHO COMMERCIAL.CONSTRUCTION LLC ADDRESS/PHONE 11 PEARL ST SPRINGFIELD PROPERTY LOCATION 83 SPRING ST Q p�E MAP22BPARCEL069 001 ZONE URA(100)/WSP(100)/WP(I00)/ i 67p,dv THIS 0� TS SECTION FOR OFFICIAL USE ONLY: `Y U J PERMIT APPLICATION CHECKLIST � � ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT//s a. / Fee Paid Building Permit Filled ou Fee Paid Tvneof Construction: REPLACE FRONT DOORS WINDOWS SIDING AND ROOF New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included, Owner/Statement or License 022613 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 Variances 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 Relay Signature of Building Official Date Note: Issm ance 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 piddle works and other applicable permit granting audwides. r Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of planning&Development for more information. Client#: 109788 GOSCO ACORD.,, CERTIFICATE OF LIABILITY INSURANCE 2/26/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANO CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,WEND 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:Nlhscani0cate hnider is an ADDfDONAI MSUR£0,In Fol,C ies)moat have ADDITIONAL INSURED provisbns or ba endorsetl, If SUBROGATION IS WAIVED•subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this carti0este does not confer any rights to the certificate NVMy to lard of such eTd RR menNsU VKQPUGEa XA E" MaryA.Henderson People's United Ins.Agency MAx `nt 413 781.6871 — cam One Monarch Piece,fifth Floor PO Box 4980I1sB Mary.Nondarso@peopies�com — _ — Spdngfieid MA 01144 IxsaaEMsI AFFonplxc wvER.cE xucN — --- ------ --�--- ixsuxsa A:M_orcha+NC MMWat lnwrance Co 23329 INSURED IwsIHER B_NOFGuard lnsunmee 131470 Jarrod Goss dye Cwss Construction 12 Glenwood Drive AsNRER r Westfield, MA 01085 �6URER 0: ---_-- --_ i-- W$4MERE _ ___ _ INSUflER F'. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT tH£ POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO'rHE INSURED NAMEDABOVE FORE POLtCYPERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDIT{ONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REO ROD BY PAID CLAVAS _. —..---_ —_--.. _ .-- __ iADUus119R —. LTR TYPE nFIX6UWNCE6RLm9 pOLIGV NUMBER MMNfJ N DOV �__ LIMPS '� �— ___ _ A XCOMMERCIAI.q£NERAL UABIurY BOP1098713 3117/201803/1712020EACHOccURRENCE si0D0000 — .�. teams-MAPF LX.00CUR Me�FiI�RE�YE_"T�o uyL�$Soo 000_ _ X Blankettp9rprlor,__,,,__ reR$aNALBAoa iNaRr s1�0000J _ Ex IAng e�,m 615000 wrdten contract ____ 00 "'— fiEN'LA(3CiREGA_ELIMITAP-1 PLIR; G@,NERALAgGREGATE_�6200�000 _ —1 _ „—POI,h:Y X Y£T I LOC anueR. — � ( PRowCrs.rc+mrar+GG s2.90Q000 OAM—OB"—ILE—LIABILITY——__— - D3/__6OI,—E 1 -00 — D6A MCA1002562 3117(201917/221aDDSNGLELMll A. 54TO� ONI s X1SCHEDULED W URY OUWSONLY AUTOS BODILY INJURY Pa,of tl t X NIBSpIXINDNOWNED A.,O$ONY — IkCl.IlR ( PR(pERtt pANAGE S rt __— _-- --- —_ -- — a �iraneluwae �ocara 1 rF Ce o.=wRREe 6 —..-- IEXGE88LIAR CIAMIMAOE AGGREGATE __ �g OEP �RkjENTIONS 6 B wo FIMPLOoMpeareArrox JAWC930372 911 Axo EupLOYERa•LIABILITY rin 6120180916201gX2ZC L—I SFRµ — -- ANY PROPRIE B0RIPARTNERTXEDUTNEr E 4 EACH ACCIDENT IKFCERIMEMBER ENCAUOEU9 —NNI- $500000 M, E L.DISEASE.EA EMPCC1 EE'$5000000 — vve.,ne:u QN IFO ---.--- OLCRipnoNGFpPEFAr10 eHw— CL.bc.Ase.Roucr dun x500000 Proof of II Osman AT1gN5/IorALONa l YEK.Uhl TACORD tat,Amal-1 RNYmRS SOFWOM,MY Ca affiFM1aO anon aww M fqulndl Proof of Insurance CERTIFICATE HOLDER CANCELLATION Matt Bierda SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 6E CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 83-85 Spring Street ACCORDANCE WITH THE POLICY PROVISIONS, Northampton,MA 01062 AUTHORTI REPRESENTATIVE ACORD 2S(2016103 ©190&2015 ACORD CORPORATION.All rights ..ad, MS75(2 121/10541 i Bof 1 The ACORD name and hog.are registered marks of ACORD MADCT